Rural Healthcare Access Modernization Program (RAMP)

This is a $104.4 million Tennessee Department of Health grant program funded via TennCare Savings provided by the General Assembly, designed to strengthen health through targeted capital projects in hospitals and primary care practices.

The grant period ends on June 30, 2031.

The maximum individual grantee amount is $40,000,000. The following awards are available for capital investment projects: one $40,000,000 award, one $20,000,000 award, two $10,000,000 awards, two $5,000,000,000 awards, and four awards up to $2,500,000. The following awards are available for primary care practices in rural areas but are capped at $500,000 per applicant: eight $500,000 awards and one $427,500 award.

Eligible entities include governmental entities, non-profits, for-profits, and Tennessee state agencies serving rural populations from any of Tennessee’s 95 counties.

Applicants from all 95 counties in Tennessee will be considered.

You can submit invoices no more than once per month through the online portal system. This means you cannot submit weekly or bi-weekly invoices - the maximum frequency is monthly. 

You must submit invoices within 30 days after the end of the calendar month in which the costs were incurred. Example: For May services, you must invoice by June 30.

Late invoices will NOT be paid unless you provide special written justification that the state approves at its sole discretion.

All invoices must be submitted through the TDH Grant Management Portal only.

No paper or email invoices are accepted. The portal includes pre-populated fields for all required information and upload capability for supporting documentation.

All payments are made via ACH (electronic deposit) only. You must complete the Authorization Agreement for Automatic Deposit form before any payments can be made.

No. This is a reimbursement-only grant. You must incur and pay for costs first, then invoice for reimbursement.

Upload supporting documents through the portal for each budget line item with expenses.

Examples include:

• Personnel: Timesheets, payroll records, employee contracts
• Professional Fees: Consultant contracts, invoices, proof of payment
• Supplies: Purchase orders, receipts, vendor invoices
• Travel: Receipts, mileage logs, conference registration (per state travel regulations)
• Equipment >$10K: Prior TDH approval letter, purchase orders, receipts

Yes. All procurement must be competitive where practical. You must document the competitive process and provide written justification if competitive bidding isn't practical.

Yes, but the total of equipment purchased cannot exceed 20% of the total individual grant amount and is limited to Information and Technology (IT) and equipment upgrades included in the scope of the capital investment “brick and mortar” project to extend health care services. You must obtain prior written approval from TDH before purchasing any equipment costing $10,000 or more.

You take legal title, but the state maintains a security interest until the grant ends. Upon grant completion, all equipment and motor vehicles become your property.

No. You cannot collect any fees from recipients of services provided under this grant.

Absolutely not. No grant funds can be paid directly or indirectly to any Tennessee state employee.

Yes, you can move up to 20% of any line item to other categories, provided you make equal offsetting reductions. An amendment will be required if the total amount of the budget changes or if money is moved from one Fiscal Year to another.

Yes, but you must submit a copy of your indirect cost rate approved by your cognizant federal or state agency. Once you elect direct or indirect treatment for a cost, you must apply it consistently throughout the grant. This information was submitted with your application.

Any changes require prior approval from your cognizant agency. If your rate is provisional and becomes final later, you may owe money back or receive additional payment. This information was submitted with your application.

Absolutely not. Any lobbying of federal, state, or local officials is strictly prohibited.

You must submit:

• Quarterly progress reports (due 30 days after each quarter)
• Quarterly disbursement reconciliation reports
• Annual fiscal reports (due 3 months after your fiscal year end)
• Final fiscal report (due 45 days after grant end)

Quarterly reports must include updated Work and Evaluation Plans, progress updates, and photographs using the online template TDH provides.

You must maintain all grant records for 5 years minimum from the date of final payment, following GASB/FASB accounting standards.

If you expend $ $1,000,000 in a single fiscal year, you’re subject to audit requirements.

You must complete Information for Audit Purposes (IAP) and End of Fiscal Year (EOFY) forms through the Edison Supplier Portal.

Yes. TDH, the Tennessee Comptroller, or their representatives can audit your records at any reasonable time with reasonable notice.

Only with prior written approval from TDH. Approved subcontracts must include key contract provisions about conflicts of interest, lobbying, nondiscrimination, and records.

No changes should be made to the project. The original submission of the project idea was what was evaluated by the State and cannot be deviated from, as funds were awarded for the project submitted. If there is an emergent issue with your project, please contact TDH within 30 Days.

Yes. The state can terminate for convenience (30-day notice) or for cause (immediate for contract violations). You'll be paid for satisfactory work completed.

The state can terminate the grant with written notice. You'll be compensated for satisfactory work completed to the termination date.

You must attend a mandatory training within 90 days of contract execution covering invoicing and reimbursement procedures.

TDH may conduct site visits and virtual check-ins as requested. You must allow and participate in these monitoring activities.

Questions about RAMP may be directed to Competitive.Health@tn.gov.

You must notify TDH within 30 days of any significant issues that could prevent completion of project goals.

Yes. All state data must be housed in the continental United States, with access limited to US-based resources only. No state data can be transmitted outside the US.

Travel reimbursement follows Tennessee's Comprehensive Travel Regulations and must be within your approved grant budget.

Yes, conference and meeting expenses are allowable if they're reasonable, necessary, and within your approved budget.

You must comply with 2 C.F.R. §§ 200.317-200.327 for procurement under federal awards.

As an independent contractor, you must carry adequate public liability and appropriate insurance and pay all applicable taxes.

You must maintain perpetual inventory for all equipment purchased with grant funds, including detailed tracking and annual physical inventories. Remember: Upon grant termination, all equipment becomes your property.

Yes, depreciation of equipment, buildings, and other depreciable assets can be charged according to your established accounting methods.