When the Centers for Medicare and Medicaid Services (CMS) announced its Rural Health Transformation Program (RHTP), a $50 billion, five-year federal investment to improve rural health care, it marked a pivotal shift in how states will be rewarded for removing barriers to care ( Centers for Medicare & Medicaid Services [CMS], 2024 ).

The program’s Notice of Funding Opportunity (NOFO) opened on Sept. 15 and will close on Nov. 5, 2025, with awards announced by December 31. Part of each state’s technical score will depend on its scope-of-practice environment, specifically whether it allows nurse practitioners (NPs) to practice independently with full practice authority (FPA).

This metric recognizes what decades of research have proven: nurse practitioners provide high-quality, cost-effec

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