Rhode Island’s
Rural Health Transformation Program is a five-year initiative designed to strengthen access to high-quality, sustainable, and community-driven health care for the state’s rural and island communities. Initiative 11, Supporting Hospitals and Primary Care in Value-Based Payment Transition, seeks to accelerate provider participation in advanced alternative payment models (APMs), through three
time-limited, complementary components: incentive payments, targeted technical assistance, and provider transformation funds. This application is solely for the APM Incentive Payment Program.
Applications are due at 5PM ET on November 2, 2026.
Under the primary care and hospital APM models, participating providers must satisfy requirements in two areas:
- APM participation/commitment, and
- cost and quality reporting/performance
APM participation/commitment
The APM commitments vary by provider entity type.
Primary care practices may qualify by continuing an existing arrangement or committing to execute, in 2028, at least one of the following:
- a commercial or Medicare Advantage Primary Care Capitation contract, or
- a Total Cost of Care (ACO or AE) contract with downside risk.
Hospitals may qualify through:
- current participation in a qualifying ACO/AE contract with Downside Risk in any line of business;
- a written commitment to seriously explore participation in a qualifying ACO/AE contract with downside risk in any line of business in 2028;
- a written commitment to seriously explore participation in a Hospital Global Budget contract with Medicare and at least one Medicaid managed care organization during the first year of AHEAD implementation, in alignment with Medicaid’s phase-in schedule.
Cost and quality reporting/performance
The cost and quality commitments also vary by provider entity type:
Primary care practices may qualify by:
- self-reporting the 2026 OHIC Primary Care Aligned Measure Core Set measures that do not require payer claims for the practice to report, and
- self-reporting participation in one commercial Accountable Care Organization (ACO), Medicare ACO, Medicare Advantage full-risk, or Medicaid AE contract. The contract can be shared savings, shared risk or full risk.
Hospitals may qualify by:
Eligibility for the APM Incentive Payment Program
The APM Incentive Payment program is open to all rural acute care hospitals and primary care practices located within the state of Rhode Island that commit to satisfying applicable program requirements.
Rhode Island uses a functional, access-based methodology to identify rural and rural-serving providers. Providers who meet the following criteria qualify as a rural health provider for the purpose of this application:
- Statutorily Defined Rural Health Facility. The provider meets the federal definition of a rural health facility under 42 U.S.C. § 1397ee(h)(3)(D). This includes Rural Health Clinics, Federally Qualified Health Centers, certain federally designated health centers, and hospitals that hold or satisfy an applicable federal rural-hospital designation or classification.
- Rural Geographic Location. The provider is physically located in one of Rhode Island’s 18 designated rural municipalities or within Narragansett Indian Tribe territory.
- Rural Patient Population Threshold. At least 18 percent of the provider’s patients reside in rural ZIP codes.
- State-Designated Catchment or Regional Access Responsibility. The provider has a formal state designation, contract, or regional responsibility that covers rural communities.
- Essential Statewide or Unique Access Provider. The provider offers a sole-source or specialty service routinely accessed by rural residents because the service is not available locally.
Program eligibility is determined at the practice level for primary care and at the individual hospital level for hospitals. Incentive funding is allocated for each eligible primary care practice site and each eligible hospital. Parent organizations – i.e., health systems, IPAs, ACOs and other provider aggregators - may submit applications on behalf of owned and affiliated practices and hospitals. Parent organizations may only receive payment on behalf of eligible practices or hospitals that they own.
What to Expect in This Application
A hospital, primary care practice, health system, or other authorized provider organization may submit an application. A single application may include one or multiple hospitals or primary care practice sites.
To complete the application, the submitting organization must:
- provide its name and application contact information;
- download and complete the Provider Application Workbook, entering one record for each hospital or primary care practice site seeking incentive funding;
- identify the qualifying APM participation or commitment applicable to each provider;
- upload the completed workbook, and
- review the application certifications and submit the application through an authorized representative.
This application applies only to Year 1 of the program. Providers will reapply annually, and requirements for future program years will be communicated separately. The application does not collect required reporting data; participating providers will submit that information separately according to the applicable program-year reporting schedule.
OHIC will review each provider included in the application separately for eligibility. OHIC may contact the submitting organization to request clarification, corrected information, or supporting documentation. Providers approved for participation will be required to execute a performance agreement before receiving incentive payments.
For additional information about program eligibility, participation requirements, payment timing, and the application review process, please refer to the
APM Incentive Payment Program FAQs.