Attachment A (Corrected) - Rural Partner Application~1.pdf

Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

Please review the Request for Applications to learn more about the program and procurement prior to completing this Application for the Massachusetts Rural Health Transformation Program.

This is a corrected version of the application form.

Sections 1-4: Required for all applications.

Section 5: Please check the red box for activities you are interested in applying to participate. You may only apply for areas that your organization is eligible. Please leave areas you are not eligible for and/or not applying to blank.

For the best functionality when completing the application, applicants should download the application PDF and open it using the desktop version of Adobe Acrobat Reader, rather than completing the form in a web browser or web-based PDF viewer. Browser-based viewers may not fully support all form fields, formatting, saving, or other interactive features included in the application.

Adobe Acrobat Reader is available to download at no cost from Adobe. Applicants are encouraged to save a copy of the application to their computer before entering information and to confirm that all responses and attachments have been saved properly before submission.

Attachment A (Corrected) – Rural Partner Application Rural Health Transformation Program Rural Partner Application For eligible rural-located facilities, providers, municipalities, and community organizations seeking RHTP technical assistance, planning support, program participation, and direct funding

Application Instructions sbryant Line

Page 1Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

1. Organizational Information

Organization Name:

Organization Type:

If “Other,” please specify:

Organization Address:

If your organization has multiple locations, list the sites you plan to include in this application's activities:

What rural regions do you provide service to? (Select all that apply. See list of towns included in each rural region below — from Attachment A.)

West Franklin Ashfield, Buckland, Charlemont, Colrain, Conway, Hawley, Heath, Monroe, Rowe, Shelburne

Southern Berkshires Alford, Egremont, Great Barrington, Lee, Lenox, Monterey, Mount Washington, New Marlborough, Otis, Sandisfield, Sheffield, Stockbridge, Tyringham, West Stockbridge

Southeastern Mass Berkley, Dighton, Freetown, Halifax, Marion, Mattapoisett, Plympton, Rehoboth, Rochester, West Bridgewater

Quaboag Valley Belchertown, Brimfield, Brookfield, East Brookfield, Holland, Monson, North Brookfield, Palmer, Wales, Ware, Warren, West Brookfield

Northern Berkshires Adams, Cheshire, Clarksburg, Florida, New Ashford, North Adams, Savoy, Williamstown

North Quabbin Athol, Erving, New Salem, Orange, Petersham, Phillipston, Royalston, Warwick, Wendell

Rural Health Transformation Program Rural Partner Application For eligible rural-located facilities, providers, municipalities, and community organizations seeking RHTP technical assistance, planning support, program participation, and direct funding

Please review application instructions on the previous page before completing.

Page 2Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

North Central Ashburnham, Ashby, Boylston, Clinton, Hubbardston, Lancaster, Princeton, Sterling, Templeton, Townsend, Westminster, Winchendon

Nantucket Nantucket

Lower/Outer Cape Brewster, Chatham, Eastham, Orleans, Provincetown, Truro, Wellfleet

Hilltowns Blandford, Chester, Chesterfield, Cummington, Goshen, Granville, Huntington, Middlefield, Montgomery, Plainfield, Russell, Southampton, Southwick, Tolland, Westhampton, Williamsburg, Worthington

Essex Boxford, Essex, Newbury, Rowley, West Newbury

East Quabbin Barre, Hardwick, New Braintree, Oakham, Paxton, Rutland

East Franklin Bernardston, Deerfield, Gill, Greenfield, Leverett, Leyden, Montague, Northfield, Shutesbury, Sunderland, Whately

Dukes County Aquinnah, Chilmark, Edgartown, Gosnold, Oak Bluffs, Tisbury, West Tisbury

Central Pioneer Valley Granby, Hadley, Hampden, Hatfield, Pelham

Central Berkshires Becket, Dalton, Hancock, Hinsdale, Lanesborough, Peru, Richmond, Washington, Windsor

Blackstone Valley Charlton, Douglas, Mendon, Sturbridge, Sutton, Upton

495 Corridor Ayer, Berlin, Bolton, Boxborough, Carlisle, Dover, Dunstable, Harvard, Lincoln, Sherborn, Shirley, Stow

Briefly describe your organization and the services you currently provide. (150 words max)

How long has your organization been providing these services in the rural regions selected?

2. Rural Region

Briefly describe the rural region(s) your organization is located in/provides service to, including population characteristics, demographics, and any unique conditions that shape access to healthcare and/or service delivery in the area. (100 words max)

Page 3Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

What do you see as the three greatest assets in the region? (150 words max)

What do you see as the three greatest needs in the region? (150 words max)

3. Organizational Approach and Current Scope of Community Engagement

Describe your organization’s current approach to engaging rural residents, patients, families, community-based organizations, municipalities, and/or other local partners. (150 words max)

What formal or informal structures does your organization currently use for community engagement?

(150 words max)

4. Readiness and Existing Partnerships

What experience or resources does your organization currently have to support the various selected activities? (150 words max)

What additional capacity or expertise will be needed to support your participation in these activities?

(150 words max)

Page 4Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

What current partnerships do you have related to these activities that you would want to include?

Please note if the partnerships are specific to an activity area. Include a partner validation form (RFA Attachment B) for each named partner. (150 words max)

5. Activities

Activity descriptions and eligibility are located in Section 10 of the RFA. Please indicate which activity areas you are applying for by checking the box next to the corresponding activity. In order to be considered, you must answer all questions associated with each activity area.

INITIATIVE ONE – POPULATION HEALTH

1.1 Chronic Disease Management Networks

Describe your organization’s current role, infrastructure, and resources to prevent, identify, treat, manage, or support individuals with chronic disease. (500 words max)

Which chronic conditions does your organization most frequently encounter or support? Please identify any areas of focus, such as diabetes, hypertension, heart disease, COPD, cancer, obesity, or other chronic conditions. (100 words max)

Page 5Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

Why is your organization interested in participating in the development of a regional Chronic Disease Management Network? (100 words max)

How do you plan to partner with other rural-serving organizations in your area to support a successful Chronic Disease Management Network? (250 words max)

1.2 Rural MA Connect

Describe how your organization currently refers rural residents to healthcare, social service, or community-based resources. What challenges do you experience with referrals, communication, follow-up, or knowing whether services were received? (150 words max)

What functions or capabilities would be most important for your organization in a shared Rural MA Connect platform? Examples may include electronic referrals, closed-loop referral tracking, community resource directories, data sharing, care coordination, EHR integration, reporting, or other workflow supports. (150 words max)

Page 6Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

1.3 Massachusetts Youth Care: Closer to Home (MY Care)

Describe your organization’s current role in serving youth and young adults with unmet or complex behavioral health, developmental, medical, or co-occurring needs. Include the populations and geographic areas you serve and your role in identifying, referring, admitting, placing, treating, coordinating, transitioning, or discharging youth and young adults. (150 words max)

Identify up to three significant barriers or service gaps affecting youth and young adults with complex needs in the rural communities you serve. Describe how these barriers affect timely access to appropriate care closer to home. (150 words max)

Describe how your organization currently receives, makes, and manages referrals or placement requests for youth and young adults. How do you determine service availability, eligibility, clinical fit, and capacity, and where do delays, repeated steps, incomplete information, unsuccessful referrals, or communication gaps occur? (150 words max)

Does your organization operate one or more programs located in an eligible rural community that provide out-of-home or residential care to youth or young adults?

Yes No

For each applicable program or site, please provide the following. If your organization operates more than 3 applicable programs or sites, please include an attachment with the additional sites in your submission.

Program / Site 1

Program and site name Physical location

Type of out-of-home or residential service Age range served

Page 7Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

Population and needs served

Relevant license, certification, or state agency relationship Licensed or approved capacity

Current staffed or operational capacity Approximate number of youth and young adults served annually

Primary referral sources

Program / Site 2

Program and site name Physical location

Type of out-of-home or residential service Age range served

Population and needs served

Relevant license, certification, or state agency relationship Licensed or approved capacity

Current staffed or operational capacity Approximate number of youth and young adults served annually

Primary referral sources

Program / Site 3

Program and site name Physical location

Type of out-of-home or residential service Age range served

Population and needs served

Relevant license, certification, or state agency relationship Licensed or approved capacity

Page 8Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

Current staffed or operational capacity Approximate number of youth and young adults served annually

Primary referral sources

Describe your organization’s readiness and commitment to participate in Year One MY Care planning and implementation. Include your ability to designate organizational and operational leads, participate in regional planning and workflow design, engage frontline staff, complete training, and support data and technology readiness activities. (150 words max)

What funding, technical assistance, equipment, or specialized consulting support would be most valuable to your organization in Year One? (select all that apply from below)

Staff participation and coordination

Workflow and process redesign

Regional network planning

Data and technology readiness

Equipment

Training and workforce development

Data-sharing or governance support

Legal or agreement development

Referral and transition coordination

Capacity development

Other locally identified implementation need

Describe how those supports would strengthen access, provider capacity, referrals, placement, transitions, or regional coordination for youth and young adults. (150 words max)

Page 9Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

1.5 Expand Remote Patient Monitoring (RPM) Programs

Describe any existing clinical, care management, telehealth, or home-based infrastructure that could support implementation of an RPM program. Please include an estimate of the patient population served by any current infrastructure. (100 words max)

What unmet needs or gaps in care within your rural patient population do you believe RPM could help address? (100 words max)

What existing clinical or community partnerships could support patient identification, enrollment, education, monitoring, or follow-up for an RPM program? Describe how your organization could coordinate RPM with other rural providers or programs. (150 words max)

1.6 Home Visiting

Describe your organization’s current experience providing home-based, community-based, or care coordination services to rural residents. (100 words max)

What population(s), chronic condition(s), and health or social needs would your organization propose to address through a rural home visiting program? (100 words max)

Page 10Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

Provide an overview of your proposed program that includes your agency catchment area (i.e., all the cities and towns that you plan to serve), and how the proposed program will connect to your agency’s mission. (200 words max)

Describe your organization’s current capacity and readiness to implement or expand rural home visiting services. Indicate whether your organization is proposing to establish new home visiting services or expand existing services, and briefly describe the staffing structure (i.e., home visitors, supervisors, coordinators, etc.), partnerships, referral relationships, infrastructure, and other resources that would support implementation. Identify any gaps in capacity as well as any training, technical assistance, or other support needed to successfully implement or expand services. (150 words max)

1.7 Hospital at Home

Please check the box above to confirm your participation. Optional: Please include anything you would like us to know about your interest or ability to participate here. (100 words max)

1.8 Create New Incentives and Payment Programs

Please check the box above to confirm your participation. Optional: Please include anything you would like us to know about your interest or ability to participate here. (100 words max)

Page 11Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

INITIATIVE TWO: INNOVATION IN RURAL CARE

2.1 Mobile Health Units / Mobile Health Infrastructure

Briefly describe the mobile health project or concept your organization is proposing. Please include the population(s) to be served, the services to be provided, and whether the project involves a mobile unit, portable equipment, telehealth-enabled infrastructure, rotating community sites, or another mobile care model. (150 words max)

What is your organization’s current level of readiness to implement this project? Please describe whether the project is implementation-ready or requires additional planning. Note any existing staffing, partnerships, equipment, infrastructure, workflows, or approvals already in place. (150 words max)

Does your organization currently have a business and sustainability plan for the proposed rural mobile health model? If yes, please briefly describe the plan, including reimbursement strategies, operating costs, revenue sources, and key partnerships. If not, please confirm your willingness to participate in business and sustainability planning with technical assistance providers as a condition of receiving funding. (150 words max)

2.2 Specialty Care Networks

What specialty care access gaps are most significant for the rural population(s) you serve? Please describe the specialty areas of greatest need and any challenges related to waiting times, travel distance, local availability, referral completion, or continuity of care. (150 words max)

Page 12Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

What types of specialty partnerships or service models would be most useful to your organization?

Examples may include eConsults, Project ECHO, direct-to-patient telehealth, provider-to-provider consultation, rotating specialty clinics, diagnostic support, or coordinated pathways to in-person specialty care. (150 words max)

Describe your organization’s interest and readiness in participating in an Integrated Specialty Care Network. Please include any existing specialty relationships, referral workflows, telehealth or eConsult capabilities, diagnostic infrastructure, staffing, or other resources that could support implementation.

(150 words max)

2.3 Telehealth Expansion

Please check the box above to confirm your participation. Optional: Please include anything you would like us to know about your interest or ability to participate here. (100 words max)

2.4 Rural Digital Health Sandbox

Please indicate if your organization would be interested in serving as a partner for a pilot of an emerging digital health technology through the Rural Digital Health Sandbox Program.

Yes No

What categories of digital health technologies would your organization be interested in testing? (Select all that apply)

Remote patient monitoring solutions

Patient engagement tools

Wearable technologies

Care navigation platforms

Administrative health care solutions

AI solutions

Other

Page 13Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

2.5 Rural SHINE-HT

Please indicate if your organization would like to attend an information session to learn more about the Rural SHINE-HT Program.

Yes No

AI Call Center

Ambient Scribing

Scheduling Solutions

Patient Intake Tools

Prior Authorization and Insurance Verification

Translation and Interpretation Services

Other

INITIATIVE THREE: TRAINING HEALTHCARE FOR RETENTION, INNOVATION, AND EXCELLENCE (THRIVE)

3.1 Launch a Rural Talent Recruitment Campaign

What talent recruitment strategies does your organization currently use, if any? Examples may include job fairs, sign on bonuses, local ad campaigns, or partnerships with local staffing organizations, municipalities, employers, schools, or nonprofits. (150 words max)

What types of recruitment campaign assistance or local partnership models do you believe would be most effective in helping your organization recruit rural healthcare workers? (150 words max)

3.2 Expand State-Wide Rural Training Networks and Pipeline Programs

What health professions or training topics do you feel are most needed for your facility or area? (100 words max) the

Please select which use cases your organization would be interested in addressing through SHINE-HT Program. (Select all that apply)

Page 14Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

3.3 Create Rural Nurse Practitioner (NP) Residency Programs

Please check the box above to confirm your participation. Optional: Please include anything you would like us to know about your interest or ability to participate here. (100 words max)

3.4 Support Pathways to Permanent Housing for Clinical and Support Staff

Describe how housing availability or affordability affects your organization’s ability to recruit and retain clinical and support staff. Please include the types of positions most affected and any examples of housing-related recruitment or retention challenges. (150 words max)

What housing support does your organization currently offer, if any? Examples may include temporary housing, relocation assistance, rental support, down payment assistance, housing navigation, or partnerships with local housing organizations, municipalities, employers, or nonprofits. (150 words max)

What types of housing assistance or local partnership models do you believe would be most effective in helping your organization recruit and retain rural healthcare workers? (150 words max)

3.5 Launch Incentive Programs for Field Placements and Supervising Clinicians

Describe any experience you have training healthcare professionals in your facility. What have been the biggest barriers? (100 words max)

Page 15Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

3.6 Facilitate Recruitment and Retention Plans

What are your organization’s most significant workforce recruitment and retention challenges? Please identify the occupations or positions most affected and describe any persistent vacancies, turnover, or other workforce pressures. (150 words max)

What are the primary reasons employees leave your organization, and what strategies do you believe could improve long-term retention? (100 words max)

If selected, what organizational leadership and staff would be engaged in developing and implementing the recruitment and retention plan? (100 words max)

INITIATIVE FOUR: HEALTHY RURAL COMMUNITIES

4.1 Community Chronic Disease Prevention & 4.2 CBO Networks

Describe your organization’s experience convening or coordinating community partners across the rural region you propose to serve. Please identify key organizations or sectors you would expect to engage in a regional CBO and chronic disease prevention network. (150 words max)

Describe your organization’s capacity and readiness to serve as a regional backbone organization.

Please include relevant staffing, partnerships, grant or program management experience, community engagement capacity, and any technical assistance you would need. (150 words max)

Page 16Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

How would you engage rural residents and community partners in identifying priorities and selecting prevention activities for the region? (100 words max)

4.3 Coordinate with Local Public Health Shared Service Arrangements

Please check the box above to confirm your participation. Optional: Please include anything you would like us to know about your interest or ability to participate here. (100 words max)

4.4 Population-Specific Programs

Which priority population and rural community or communities do you propose to serve, and what health or prevention needs would the proposed program address? (150 words max)

Describe your organization’s current experience and relationship with the population you propose to serve. Please include any existing programs, partnerships, or community engagement activities. (150 words max)

What evidence-based, evidence-informed, or community-informed program or approach would you propose to implement or expand? If a specific model has not yet been selected, describe the type of intervention you believe would best meet local needs. (150 words max)

Page 17Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

How will members of the priority population be engaged in program design, implementation, and ongoing improvement? (100 words max)

INITIATIVE SIX: ENHANCING TECHNOLOGY INTEROPERABILITY AND CONNECTIVITY

6.1 Rural HIE Program

Is your organization interested in attending a listening session to learn more about the Rural HIE Program?

Yes No

Which HIE or interoperability use cases would you like to see supported through this program? (Free text answer)

6.4: Provide Cybersecurity Supports to Rural Providers

Is your organization interested in any of the following services offered by this program?

Cybersecurity Assessments – Evaluating a program against cybersecurity and HIPAA compliance

Virtual CISO (vCISO) and Training – Support for cybersecurity compliance enablement

Managed Detection and Response (MDR) – 24/7 monitoring of computers, servers, and laptops

Extended Detection and Response (XDR) – Advanced logging and reporting

Application Control and Zero Trust – Application Whitelisting and Access Control

Email Security – Tools to mitigate business email compromises

If your organization is interested in the services above, please indicate when you would be interested in starting services:

Please provide an estimate of the number of devices in your environment:

Computers Phones Laptops

Servers Virtual Computers Internet of Things (IOT) devices

Other feedback about your environment:

Page 18Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

INITIATIVE SEVEN: FACILITY MODERNIZATION AND RE-USE

7.1 Fund Critical Capital Updates for Rural Hospitals

Describe the proposed capital improvement project, including the facility location, space or infrastructure to be improved, and the primary work or equipment proposed. (200 words max)

What clinical, operational, safety, accessibility, or community need will this project address? Please describe how the need was identified. (150 words max)

What is the current readiness of the project? Please identify any completed assessments, designs, cost estimates, permits, approvals, or other planning activities and any additional support needed before implementation. (150 words max)

Provide the estimated total project cost and amount of RHTP funding requested (up to $2.5 million per facility).

Identify major cost categories and any other funding sources that will support the project.

Estimated total project cost RHTP funding requested (up to $2.5M)

Major cost categories and other funding sources:

Page 19Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

Activity 7.2 Fund Critical Capital Updates for Rural Primary Care Sites

Describe the proposed capital or equipment project and the rural primary care site(s) that would benefit.

(200 words max)

What current facility, infrastructure, equipment, or service limitation does the project address, and how does that limitation affect rural patients or staff? (150 words max)

What new or improved services, capacity, or efficiencies would be made possible through this investment? (150 words max)

Describe the project’s current readiness and any additional design, engineering, feasibility, permitting, or technical assistance needed. (150 words max)

Provide the estimated total project cost and amount of RHTP funding requested (up to $1.5 million per facility).

Identify major cost categories and any other funding sources that will support the project.

Estimated total project cost RHTP funding requested (up to $1.5M)

Page 20Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

Activity 7.3 Fund Critical Capital Updates for Rural Nursing Facilities

Describe the proposed facility improvement and the specific area, system, or resident-care need that will be addressed. (200 words max)

Why is this investment important to maintain safe, high-quality nursing facility services in the rural community you serve? (150 words max)

Describe the current condition of the affected infrastructure and any immediate safety, accessibility, infection-control, or operational concerns. (150 words max)

How will the project support the medium- and long-term operational or financial sustainability of the facility? (150 words max)

Provide the estimated total project cost and amount of RHTP funding requested (up to $1 million per facility).

Identify major cost categories and any other funding sources that will support the project.

Estimated total project cost RHTP funding requested (up to $1M)

Page 21Attachment A (Corrected) – Rural Partner Application: Massachusetts Rural Health Transformation Program — Rural Partner Application

Activity 7.4 Rural Nursing Facility Units for Behavioral Health & Substance Use Disorder Services

Is your facility interested in developing a behavioral health unit? Describe the need and outcomes you would like to see. (150 words max)

Is your facility interested in increasing capacity and infrastructure to care for residents with substance use disorder(s)? Describe the need and outcomes you would like to see. (150 words max)