Rural Graduate Medical Education Program Development.doc

State of Missouri Office of Administration, Division of Purchasing

Request for Proposal (RFP) for

Rural Graduate Medical Education Program Development

PROPOSAL DUE NO LATER THAN: November 17, 2026 AT 2:00 PM CENTRAL TIME

Proposal response must be submitted electronically through MissouriBUYS, powered by MOVERS, at https://missouribuys.mo.gov.

E-mailed, mailed, courier, or hand-delivered proposal responses will not be accepted.

RFP CONTACT INFORMATION:

BUYER: Ariel Bradford

PHONE NO.: (573) 751-2497

EMAIL: Ariel.Bradford@oa.mo.gov

See “RFP Questions” in Section 1 for appropriate communications during the procurement process.

DELIVER SUPPLIES/SERVICES FREE ON BOARD (FOB) DESTINATION TO THE FOLLOWING ADDRESS:

Department of Health and Senior Services

912 Wildwood Drive

Jefferson City, MO 65109

ATTENTION:

1. After reviewing the Request for Proposal (RFP), the vendor must complete and return Exhibit A, Proposal Signature Page and all other necessary exhibits.

2. Due to lead times for obtaining the information needed to complete the various Business Compliance Exhibits herein as explained in the RFP’s Vendor Response Exhibits, vendors are encouraged to IMMEDIATELY begin securing these verifications.

3. The vendor must be registered in MissouriBUYS, powered by MOVERS in a “Prospective” or “Spend Authorized” registration status to submit a proposal. The vendor must achieve “Approved” registration status in MissouriBUYS (WebProcure/Proactis) and “Spend Authorized” registration status in MissouriBUYS, powered by MOVERS to be considered for a contract award. Reference Section 5.

RFP Organization:

RFP Sections:

RFP Vendor Response Exhibits (Return these exhibits with the proposal):

BUSINESS COMPLIANCE EXHIBITS

Attachments (Separate Documents) (Do not return these documents with response)

Separate Documents: The vendor is advised that the separate documents to this document referenced above provide additional requirements, information, and/or instruction. The separate documents must be downloaded from the Division of Purchasing’s MissouriBUYS, powered by MOVERS, website at: https://missouribuys.mo.gov/. The separate documents are downloadable from the same web page where the solicitation document is downloadable. It shall be the sole responsibility of the vendor to obtain each of the separate documents. The vendor shall not be relieved of any responsibility for performance under the subsequent contract due to the failure of the vendor to obtain a copy of the separate documents.

1. INTRODUCTION AND BACKGROUND INFORMATION SECTION

1.1 Introduction:

1.1.1 Purpose: This document constitutes a request for competitive, sealed proposals for the provision of Rural Graduate Medical Education Program Development as set forth herein for the Department of Health and Senior Services (hereinafter referred to as “state agency”).

1.1.2 The purpose of this solicitation is for the development of (1) a new rural graduate medical education (GME) program; or (2) an expansion of a current Missouri-based rural GME program to a new rural location. This opportunity is limited to development or expansion of rural GME programs in General Surgery, Obstetrics and Gynecology, or Psychiatry that are accredited by the Accreditation Council for Graduate Medical Education (ACGME).

1.1.3 Minimum Experience Qualifications: There are minimum experience qualifications in the RFP (See Section 2.2, Minimum Experience Requirements in Section 2: Scope of Work).

1.1.4 Titles: Titles of paragraphs used herein are for the purpose of facilitating reference only and shall not be construed to infer a contractual construction of language.

1.2 Background and Historical Usage Information:

1.2.1 Missouri lacks an adequate supply of physicians in most areas of the state. In addition to overall shortages, there is a maldistribution of providers, with rural and other underserved communities experiencing the greatest shortages. According to the National Center for Health Workforce Analysis (NCHWA), this shortage will only grow especially in non-metro areas without significant intervention.

1.2.2 In addition, Missouri does not currently have enough residency slots to train Missouri medical school graduates. Missouri requires additional residency slots to strengthen the health care workforce and increase access to health care services, especially for rural populations. In 2026, there were 1,110 medical graduates, with only 849 first-year residency positions available. With this deficit of residency positions, approximately 261 Missouri medical school graduates have no other recourse but to leave the state to complete their residency training.

1.2.3 About one-third of Missouri’s population, or 2.05 million individuals, live in rural communities. People living in rural communities have higher rates of chronic conditions, mental health and substance use disorders, preventable hospitalizations, and lack of access to timely care compared to their urban counterparts. Eighty percent (80%) of areas designated as a primary care health professional shortage area (HPSA) are in rural or partially rural areas. Retaining and recruiting physicians remain critical issues for rural communities. One evidence-based strategy is medical residency training in rural communities. A recent study found that rural exposure during family medicine residency training is associated with a five to six-fold increase in choosing rural practice. A second study found that rural training is more strongly associated with rural practice than having a rural background. Despite the demonstrated successes of rural training, research finds persistently limited opportunities for residents to train in rural communities. Ninety-one percent (91%) of residents nationwide reported no rural training, and only four percent (4%) of residents participated in a program that provided more than half of their training in a rural setting.

1.2.4 Retention of Missouri physicians is optimized when physicians do both medical school and residency training in the State of Missouri. For residents who completed their training in Missouri between 2015 and 2024, the in-state retention of those physicians was 50.2%. https://www.aamc.org/data-reports/students-residents/data/report-residents/2025/table-c6-physician-retention-state-residency-training-state.

1.2.5 Rural GME training may incur financial, human resource and organizational capacity constraints, such as a lack of sustainable financing, faculty support, and sufficient patient volume to meet accreditation requirements. This opportunity is designed to provide resource funding and facilitate urban/academic partnerships to bolster sustainable GME training in rural communities that champion the training of home-grown physicians.

1.2.6 In order to meet the specific healthcare needs of Missourians, state GME funding intentionally incorporates training locations and curricular components to enhance desired skills and practice preferences of the physician workforce.

a. Supporting the expansion of GME training in rural facilities will directly increase the number of health care providers who choose to stay in Missouri and practice in rural areas.

b. Curriculum:

1) Addiction training in GME ensures multiple specialties of physicians are equipped to screen, diagnose, manage, or swiftly provide a treatment referral for patients with addiction disorders, including but not limited to opioid use disorder and tobacco addiction which contribute to some of the most frequent causes of death of Missourians.

2) Extended nutrition education in GME will equip physicians with the practical skills to treat diet-related conditions, intercept the leading causes of death, and improve patient health. It addresses the historically low number of hours doctors get in clinical nutrition, empowering MO GME trainees to deliver targeted lifestyle counseling. Physician-delivered nutrition-focused counseling can significantly improve health outcomes for conditions like type 2 diabetes, obesity, hypertension, and cardiovascular disease.

3) For psychiatry GME programs, ensuring education on the diagnosis and management of individuals with intellectual and developmental disabilities (I/DD) is essential. Providing unfragmented, efficient, and compassionate care to Missourians who have both a mental health disorder and I/DD requires psychiatrists with this training.

1.2.7 The Department of Health and Senior Services funds a separate Missouri Graduate Medical Education Technical Assistance Center (GME TAC) to support Missouri Graduate Medical Education Program contractors. The GME TAC will work with contractors to share resources and provide technical assistance to develop and plan for the sustainability of their programs. The Department of Health and Senior Services requires all Missouri Graduate Medical Education Program contractors to work with the GME TAC during the contract performance period.

1.3 Current and/or Previous Contract Information:

1.3.1 No current or previous contract exists for the services being obtained via this RFP.

1.4 RFP Questions:

1.4.1 Buyer is Single Point of Contact for Solicitation: Vendors and their agents (including subcontractors, employees, consultants, or anyone else acting on their behalf) must direct all of their questions or comments regarding the RFP, the evaluation, etc., to the buyer indicated on the first page of this RFP. It is preferred that questions be emailed to the buyer.

a. Except as noted herein, vendors and their agents are instructed not to contact any other state employee regarding any of these matters during the solicitation and evaluation process. Inappropriate contacts are grounds for suspension and/or exclusion from specific procurements. Vendors can be sanctioned for unauthorized contact with any evaluator under 1 Code of State Regulation (CSR) 40-1.060(8)(G) and (H) available at http://www.sos.mo.gov/adrules/csr/csr.asp.

b. Service-Disabled Veteran Enterprise and Honorably Discharged Veteran Enterprise certifications or subcontract questions should be directed to the Office of Equal Opportunity (OEO) at http://oeo.mo.gov.

1.4.2 Vendor is Responsible for Asking Questions About the RFP: It is the vendor’s responsibility to ask questions, request changes or clarifications, or otherwise advise the Division of Purchasing if the vendor believes that any language, specifications, or requirements are: (1) ambiguous, (2) contradictory or arbitrary, (3) violate any state or federal law or regulation, (4) restrict or limit the requirements to a single source, or (5) restrict or limit the vendor’s ability to submit a proposal.

1.4.3 Vendor Question Deadline: Every attempt shall be made to ensure that the vendor receives an adequate and prompt response. However, in order to maintain a fair and equitable procurement process, all vendors will be advised, via the issuance of an amendment to the RFP, of any relevant or pertinent information related to the procurement. All questions and issues should be submitted no later than ten (10) calendar days prior to the proposal closing date and time of the proposals. If not received prior to ten (10) calendar days before the proposal closing date and time, the Division of Purchasing may not be able to fully research and consider the respective questions or issues.

1.4.4 State’s Response to Vendor Questions: Upon the Division of Purchasing’s consideration of questions and issues, if the Division of Purchasing determines that changes are necessary, the resulting changes will be included in a subsequently issued RFP amendment(s); absence of such response indicates that the questions and issues were considered but deemed unnecessary for an RFP amendment. All vendors will be advised of any change to the RFP’s language, specifications, or requirements by a formal amendment to the RFP. There will be no posted written records of the questions/communications (i.e., formal question/answer document).

1.4.5 RFP is State’s Only Official Position: The only official position of the State of Missouri shall be that which is contained in the RFP and any amendments thereto.

1.5 Amendments:

1.5.1 If the Division of Purchasing determines that changes to the RFP are necessary, the resulting changes will be included in a subsequently issued RFP amendment(s) prior to the proposal closing date and time.

1.6 Pre-Proposal Teleconference:

1.6.1 Pre-proposal Teleconference Date and Time: A pre-proposal teleconference regarding this RFP will be held on November 3, 2026, at 9:00 a.m., Central Time. Vendors are encouraged to participate in the pre-proposal teleconference as it will be used as the forum for questions, communications, and discussions regarding the RFP. The vendor should become familiar with the RFP and develop all questions prior to the pre-proposal teleconference in order to ask questions and otherwise participate in the public communications regarding the RFP.

a. Pre-Proposal Teleconference Agenda: The vendor should have a copy of the RFP for the pre-proposal teleconference since it will be used as the agenda for the pre-proposal teleconference.

b. Communication Prior to the Teleconference: The vendor is encouraged to review the RFP prior to the pre-proposal teleconference and may submit written communications and/or questions regarding the RFP, which reference the RFP paragraph numbers, to the buyer identified on page one. Such prior communication will provide the State of Missouri with insight into areas of the RFP which may be brought up for discussion during the conference and which may require clarification.

c. Communication During the Teleconference: During the pre-proposal teleconference, it shall be the sole responsibility of the vendor to orally address all issues previously presented to the buyer by the vendor, including any questions regarding the RFP or areas of the RFP requiring clarification.

d. Amendment to the RFP: Any modifications needed to the RFP as a result of discussions from the pre-proposal teleconference will be accomplished as an amendment to the RFP. Neither formal minutes of the pre-proposal teleconference nor written records of the questions/communications will be maintained.

1.6.2 Pre-Proposal Teleconference Special Accommodations: Vendors are strongly encouraged to advise the Division of Purchasing within five (5) state business days of the scheduled pre-proposal teleconference of any special accommodations needed for people with health conditions or impairments who will be participating in the pre-proposal teleconference so that these accommodations can be made.

1.6.3 Pre-Proposal Teleconference Dial-In Information: The vendor should contact the buyer from the Division of Purchasing as indicated on the first page of this RFP to obtain dial-in instructions. The vendor will be provided with a telephone number to dial and/or webinar information to access, in order to listen and participate in the pre-proposal teleconference. The vendor shall refrain from contacting anyone other than the buyer to obtain the dial-in information.

1.7 Glossary of Terms and Acronyms:

1.7.1 Whenever the following terms and acronyms appear in the RFP document or any amendment thereto, the definitions or meanings described below shall apply.

1.7.2 General Glossary, Acronyms, and Abbreviations:

a. Agency and/or State Agency means the statutory unit of state government in the State of Missouri for which the equipment, supplies, and/or services are being purchased by the Division of Purchasing (Purchasing). The agency is also responsible for payment, unless otherwise specified herein.

b. Amendment means a written, official modification to a solicitation or contract.

c. Attachment applies to all documents which are included with an RFP to incorporate any informational data or requirements related to the performance requirements and/or specifications.

d. Buyer means the procurement staff member of Purchasing.

e. Code of State Regulation (CSR) contains the current administrative rules of executive agencies of Missouri government. The regulations are arranged by agency rather than by subject.

f. Contract means a legal and binding agreement between two or more competent parties, for a consideration for the procurement of equipment, supplies, and/or services.

g. Contractor means a supplier, offeror, person, or organization who is a successful vendor as a result of an RFP and who enters into a contract.

h. Exhibit applies to forms which are included with an RFP for the vendor to complete and submit with their proposal prior to the specified closing date and time.

i. May means that a certain feature, component, or action is permissible, but not required.

j. Must means that a certain feature, component, or action is a mandatory condition.

k. Party refers to either the State of Missouri or the contractor as an entity that may enter into a contract pursuant to the terms herein.

l. Pricing Page(s) applies to the form(s) on which the vendor must state the price(s) applicable for the equipment, supplies, and/or services required in the RFP. The pricing pages must be completed and submitted by the vendor with the proposal prior to the specified proposal closing date and time.

m. Proposal Closing Date and Time and similar expressions mean the exact deadline required by the RFP for the receipt of sealed proposals.

n. Purchase Order means the authorized document issued by the state agency to the contractor indicating descriptions, quantities, and agreed prices for products and/or services.

o. Reasonable, Necessary or Proper as used herein shall be interpreted solely by the State of Missouri.

p. Request for Proposal (RFP) means the solicitation document issued by Purchasing to potential vendors for the purchase of equipment, supplies, and/or services as described in the document. The definition includes the following sections: Introduction and Background Information; Scope of Work; Terms and Conditions (“terms and conditions” and “Terms and Conditions” are used interchangeably throughout the RFP); General Contractual Requirements; and Vendor Submission, Evaluation, and Award Information; and the RFP Vendor Response Exhibits, Attachments, and Amendments of the RFP.

q. RSMo (Revised Statutes of Missouri) refers to the body of laws enacted by the Legislature which govern the operations of all agencies of the State of Missouri. Chapter 34 of the statutes is the primary chapter governing the operations of Purchasing.

r. Shall has the same meaning as the word must.

s. Should means that a certain feature, component and/or action is desirable but not mandatory.

t. State collectively referring to the state government and/or the agencies thereof.

u. Supplier has the same meaning as the word, vendor.

v. Vendor means the supplier, offeror, person, or organization that responds to an RFP by submitting a proposal with prices to provide the equipment, supplies, and/or services as required in the RFP document.

1.7.3 Technical Glossary:

a. Curriculum – for the purpose of this contract, planned training for graduate medical education trainees that meets the requirements as outlined in the contract.

b. Graduate Medical Education (GME) is the required training physicians must complete after graduating from medical school to be eligible for full licensure and board certification. This training can include medical residencies, which can last three to seven (3 to 7) years, depending on the specialty, as well as post-residency fellowship.

c. Graduate Medical Education Consortium (GMEC) – an association between two or more organizations (e.g., academic medical centers, rural hospitals, rural community-based ambulatory patient care centers, universities, and/or medical schools) to form an entity that serves as the intuitional sponsor and operator of an accredited GME program. The relationship between the consortium members must be legally binding, and the agreement establishing the relationship must describe the roles and responsibilities of each entity.

d. Health Professional Shortage Area (HPSA) – a geographic area, population group or health care facility that the Health Resources and Services Administration (HRSA) designates as having a shortage of health professionals.

e. Letters of Agreement - refers to an official written agreement between two parties.

f. Medically Underserved Area (MUA) and Population (MUP) – geographic areas and populations lacking access to primary care services as designated by HRSA.

g. Missouri Graduate Medical Technical Assistance Center (GME TAC) – the state agency contractor funded to provide technical assistance (TA), tools and resources to MO GME programs and organizations interested in starting a GME program, including Missouri Graduate Medical Education Program award recipients. The GME TAC will assist programs in efforts to sustain, expand, and develop new GME programs, thereby expanding the physician workforce in rural and other underserved areas.

h. Residency Program – a GME program accredited by ACGME to provide a structured educational experience designed to conform to the ACGME Foundational and Advanced Specialty Requirements of a particular specialty.

i. Resident – a physician in an ACGME-accredited GME residency program. Residents are employees of the residency program or sponsoring institution (paid a salary and benefits) who work in a training-rich environment with faculty supervision, educational enrichment activities, and clinical exposures.

j. Rotation – a structured educational experience in GME that involves a specific length of time spent training in a designated clinical area. This provides trainees with the opportunity to broaden their knowledge, skills, and experience, while also tailoring their education to specific interests and/or curricular needs.

k. Rural Hub County is a Missouri county participating in Missouri’s Rural Health Transformation Program’s TORCH Care model, which includes all counties except Boone, Cass, Clay, Cole, Greene, Jackson, Jefferson, Platte, St. Charles, St. Louis, and St. Louis City.

l. Sponsoring Institution – the organization that assumes the financial and academic responsibility for a GME program; the sponsoring institution's primary purpose is to provide educational programs and/or health care services.

1.8 Accuracy of Background Information:

1.8.1 Although an attempt has been made to provide accurate and up-to-date information, the State of Missouri does not warrant or represent that the background information provided herein reflects all relationships or existing conditions related to this RFP.

****END OF INTRODUCTION AND BACKGROUND INFORMATION SECTION****

2. SCOPE OF WORK SECTION

2.1 General Requirements:

2.1.1 The contractor shall provide a Rural Graduate Medical Education (GME) Program for the Department of Health and Senior Services (hereinafter referred to as state agency) in accordance with the provisions and requirements stated herein and to the sole satisfaction of the state agency.

2.1.2 The contractor shall develop or expand a rural GME program that is accredited by Accreditation Council for Graduate Medical Education (ACGME) by the final expiration date of the contract. The rural GME program shall be sustainable long-term through viable and stable funding mechanisms, such as Medicare, Medicaid, and other public or private funding sources.

2.1.3 The contractor shall develop or expand a rural GME program to train physicians from one of the following specialties to practice in and meet the clinical needs of Missourians, especially rural and underserved populations.

a. General Surgery;

b. Obstetrician/Gynecology (OB/GYN); or

c. Psychiatry.

2.1.4 The contractor shall develop or expand a rural GME program with a minimum of thirty percent (30%) of total clinical training (e.g., in a hospital, clinic, outpatient facility, etc.) physically located in a rural health transformation program (RHTP) hub county as outlined in Attachment 1.

2.1.5 The contractor shall develop or expand a rural GME program that includes nutrition training for a cumulative amount of training time equal to a minimum of 80 hours (two (2) weeks equivalent) during a multi-year rural GME program.

a. The contractor’s training may be integrated into existing rotations, a separate rotation, or provided as an adjunctive training opportunity, so long as the minimum training time requirement is fulfilled.

2.1.6 The contractor shall develop or expand a rural GME program that includes addiction training for a cumulative amount of training time equal to a minimum of 80 hours (two (2) weeks equivalent) for OB/GYN or general surgery rural GME programs, and training time equivalent to a minimum of 320 hours (eight (8) weeks equivalent) for psychiatry rural GME programs.

2.1.7 If the contractor develops or expands a psychiatry rural GME program, the contractor shall include training in the treatment of individuals with intellectual and developmental disabilities for a cumulative amount of training time equal to a minimum of 160 hours (four (4) weeks equivalent) during a multi-year rural GME program.

2.1.8 If the contractor has not completed a feasibility assessment to determine the need and feasibility of developing or expanding a rural GME program for the physician specialty area where the program will be located, the contractor may use contract funding to do so.

2.1.9 The contractor shall provide rural GME program trainees with exposure to and information about career opportunities within Missouri at varied settings, including and beyond the facility hosting the contractor’s rural GME program. The contractor shall provide current post-GME career options already presented to current rural GME program trainees that include varied practice settings for underserved and rural populations within the State of Missouri

2.1.10 The contractor shall allow adequate administrative time for the program leadership team to implement the program including participation in an annual, in-person multi-day GME meeting and other meetings (in-person or virtual) and/or training, as required by the state agency.

2.1.11 The contractor shall evaluate the activities outlined in the approved work plan and report the progress to the state agency.

2.1.12 Contractor’s Obligation: Unless otherwise specified herein, the contractor shall furnish all material, labor, facilities, equipment, and supplies necessary to perform the services required herein.

2.2 Minimum Experience Requirements:

2.2.1 The contractor’s service must meet or exceed the following minimum experience requirements at the time of proposal submission and for the duration of the contract:

a. The contractor shall have a minimum of three (3) years of experience operating as one of the following organization types:

1) Missouri hospital facility licensed as a hospital under Chapter 19 CSR 30-20. 100;

2) Missouri public or independent medical institution that awards a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree; or

3) An ambulatory patient care center which includes:

i. A federally qualified health center, as defined by §1905(1)(2)(B), Social Security Act (42 U.S.C. §1395x(ff)(3)(B)).

ii. A community mental health center, as defined by §1861(ff)(3)(B), Social Security Act (42 U.S.C. §1395x(ff)(3)(B)).

iii. A rural health clinic, as defined by §1861(aa)(2), Social Security Act (42 U.S.C. §1395x(aa)(2)); and

iv. A teaching health center, as defined by 42 U.S.C. §2931-1(f)(3)(A).

b. The contractor may be a GME consortium partnership or consortium between two (2) or more of the organization types listed in 2.2.1 a. 1) – 3) above to form an entity that serves as the institutional sponsor and operator of an accredited rural GME program.

1) The contractor must achieve ACGME institutional accreditation before applying for ACGME accreditation for the developed rural GME program.

c. The contractor must have either completed an assessment within the last two (2) years to determine the need and feasibility of developing or expanding the proposed rural GME program for the physician specialty area where the program will be located, or provide a plan to complete an assessment within the first contract period. The assessment must provide, at a minimum, the information stated below for the location of the rural GME program:

1) Patient population.

2) Include demographic characteristics, health outcomes, barriers to access and care, and any other unmet needs.

i. Note the presence of Medically Underserved Population (MUP).

3) Physician workforce.

4) Include data demonstrating the need for physicians in the proposed specialty in the rural GME program target area.

i. Note the presence of Health Professional Shortage Areas (HPSA).

5) Healthcare system.

6) Include a description of the health care delivery system.

7) Note rural GME programs (existing or in development) in the specialty area that serves the same target area(s) where the proposed rural GME program will be located, as well as any rural GME program collaborations.

8) Note the region’s assets and deficits that may affect the success and sustainability of a rural GME program.

9) Primary rural GME program facility(ies).

10) Note the specific assets and resources that the facility(ies) hosting the rural GME program can provide, including the administrative, clinical, faculty, infrastructure, physical space, patient, and procedural capacity needed to support the rural GME program.

d. The contractor shall have a minimum of five (5) years of experience providing care services to medically underserved areas and/or populations located in rural hub communities.

e. The contractor shall have a minimum of five (5) years of experience providing services for patients who receive Medicaid benefits.

f. The contractor shall be hosting, working towards hosting, or desire to host clinical rotations for medical students from medical schools based in Missouri.

1) If the contractor is not currently engaged in medical student education, the contractor shall work towards hosting/teaching students from at least one (1) of the seven (7) Missouri-based medical schools in some capacity.

2) If the contractor already hosts clinical rotations for medical students, the contractor shall:

i. Prioritize medical students enrolled in Missouri-based medical schools, instead of medical schools from outside of Missouri, and

ii. Provide the percentage of medical students’ education that is being done for students from Missouri-based medical schools.

g. The contractor shall have a minimum of three (3) years of experience successfully engaging partners, communities, and populations in strategies to improve health care services and access to those services.

h. The contractor shall have a minimum of five (5) years of experience in budget management and administration with the capacity to establish financial procedures and track, monitor, and report expenditures.

i. The contractor shall have or be working towards a commercial nicotine-free campus policy prohibiting the use of all tobacco products, including e-cigarettes, in any indoor facilities and anywhere on grounds in outdoor spaces under the contractor’s control.

1) If the contractor has no policy, the contractor must indicate the contractor’s plan to work towards adopting a policy during the contract period. An example policy toolkit, Dimensions: Tobacco-Free Policy Toolkit, can be found at: https://www.bhwellness.org/resources/toolkits/Tobacco-Free%20Policy%20Toolkit-web%20v.2.pdf.

2.3 Team Qualifications:

2.3.1 The contractor shall include the following team members/personnel to administer and perform the contract requirements:

a. Leadership Team: The contractor’s leadership team shall, at minimum, consist of a rural GME program director. The contractor may designate an assistant rural GME program director to assist the rural GME program director in the administrative and clinical oversight of the educational program.

1) The rural GME program director must have three (3) years of documented experience working as part of an interdisciplinary, interprofessional team to create an educational environment that promotes high-quality care, patient safety, and GME trainee well-being, and working with diverse populations.

2) If applicable, the assistant rural GME program director should have two (2) years of experience working as part of an interdisciplinary, interprofessional team to create an educational environment that promotes high-quality care, patient safety, and GME trainee well-being, and working with diverse populations.

3) The contractor’s rural GME program director and if applicable, assistant rural GME program director, must meet all ACGME requirements for the rural GME program director and assistant rural GME program director role, respectively, including current certification in the specialty for which they are the rural GME program director and assistant rural GME program director. The contractor’s rural GME program director and assistant rural GME program director shall have authority and accountability for the overall medical rural GME program, including compliance with all applicable program ACGME accreditation requirements.

4) By no later than five (5) business days after receipt of the state agency’s authorization to proceed with services, the contractor shall provide the state agency with the rural GME program director/contact person’s contact information including name, telephone number, physical address, and electronic mail (e-mail) address.

b. Working Team: The contractor’s working team shall consist of a rural GME program coordinator, faculty, and other qualified staff, subcontractors, or consultants, as needed.

1) The rural GME program coordinator shall have a minimum of three (3) years of experience in each of the following:

i. Establishing rural GME programs or managing the planning, implementation, monitoring, and reporting of state or federal program funding requirements, or the contractor may subcontract with an entity with experience guiding the contractor through the program development or expansion process. In lieu of sub-contracting, if the rural GME program coordinator has limited experience establishing a rural GME program, the state agency shall require monthly meetings to discuss progress with the state funded GME TAC or appointed contract.

ii. Engaging partners, communities, and populations in strategies to improve health care services and access to those services.

2) The contractor shall designate a rural GME program coordinator who shall serve as the liaison and primary contact between the contractor and the state agency. The contractor shall allow adequate administrative time to the rural GME program coordinator to successfully implement the program and attend Missouri GME Conferences. The contractor shall provide the state agency with the name, address, email address, and telephone number of the rural GME program coordinator no later than thirty (30) business days after the contract award is fully executed.

i. The rural GME program coordinator shall assume responsibility and liability for services performed under the contract.

ii. The rural GME program coordinator shall manage the planning, implementation, monitoring, and reporting of the contract requirements and serve as a liaison and facilitator between the learners, faculty, other staff members, and the ACGME.

3) The contractor shall identify key faculty who will support the program providing details regarding experience they have collectively in teaching other learners (i.e., medical students, Nurse Practitioner (NP) students, Physician Assistant (PA) students, etc.) The contractor’s faculty should have a minimum of three (3) years of experience in teaching.

4) The contractor shall notify the state agency via email within forty-eight (48) hours or two (2) business days of any changes in staffing for the working team under this contract.

2.3.2 The contractor shall understand and agree that the state agency reserves the right to request any of the contractor’s personnel assigned to provide the services be removed without just cause. The contractor shall understand and agree that the state agency will allow the contractor a reasonable time to find a replacement. The state agency shall approve all replacement personnel. The state agency reserves the right to require background checks and non-disclosure agreements (NDA) of selected contractor personnel, at the contractor’s expense.

2.4 Rural GME Program Development or Expansion Requirements:

2.4.1 The contractor shall have the organizational capacity and program governance to meet ACGME sponsoring institution and program accreditation requirements, including acquiring access to electronic health records, library services, learning management systems, etc.

2.4.2 The contractor shall develop and implement a faculty recruitment and development plan, including recruiting specialty faculty to meet ACGME requirements for the proposed specialty.

2.4.3 The contractor shall submit an ACGME program application or complement increase by the end of the first contract renewal period.

a. The contractor shall submit to the state agency, the appropriate ACGME documentation confirming application completion or complement increase request and submission by the end of the first (1st) contract renewal period.

b. Once received, but no later than the end of the second (2nd) contract renewal period, the contractor shall submit evidence to the state agency of their ACGME program accreditation or complement increase approval.

2.4.4 The contractor shall develop and submit to the state agency an impact analysis with detailed estimates of the impact of the developed rural GME program and a justification for how each estimate was determined. The impact analysis shall include:

a. The type and length of the rural GME program.

b. The anticipated rural GME program trainee complement annually for the first five (5) years of the rural GME program, if known.

c. The estimated number of rural GME program trainees who will complete the rural GME program annually, if different from 2.4.4 b.

d. The estimated number of rural GME program trainees practicing in Missouri one (1) year and five (5) years after program completion.

e. The estimated percentage of training time occurring in a rural hub county.

2.4.5 The contractor shall develop a rural GME program trainee matriculation plan and submit it to the state agency for review and approval by the end of the second (2nd) contract renewal period. The contractor’s matriculation plan shall include how to:

a. Recruit and support a cohort of high-quality rural GME program trainees, including outreach to medical students graduating from medical schools, colleges, high schools, or other upbringing or current familial/social rural, and disadvantage backgrounds with ties to Missouri.

b. Promote practice in rural and other underserved Missouri communities.

c. Collect and submit collective applicant and rural GME program trainee demographics to the state agency to assist in workforce development planning and future outreach efforts.

2.5 Program Sustainability Requirements:

2.5.1 The contractor shall develop and submit to the state agency for review and approval by the end of the first (1st) contract renewal period, a sustainability plan that includes funding stream(s) to sustain rural GME program training once the program is established. The contractor’s sustainability plan shall include:

a. The projected five (5) year annualized, ongoing training program costs.

b. The annual ongoing training cost per rural GME program trainee.

c. Confirmed five (5) year plan for obtaining sustainment funds.

d. The contractor’s long-term commitment to the program and the contractor’s ability to support ongoing program costs following start-up.

2.6 Graduate Tracking Requirements:

2.6.1 The contractor shall develop a graduate tracking plan to track and report on resident career outcomes post-rural GME program for a period of at least five (5) years to determine retention in rural and other underserved communities in Missouri.

a. The contractor may develop a new tracking tool or leverage an existing graduate tracking system to track and publicly report aggregate data (e.g., on the program website) on program graduates’ career outcomes and retention in rural and underserved areas. At a minimum, the graduate tracking plan shall collect the following program graduate outcomes:

1) National Provider Identifier (NPI) and physician license number;

2) Current status of in practice or in training (e.g., fellowship);

3) Medical specialty/sub-specialty (of current practice or current fellowship training);

4) Current location(s) (of current practice or current fellowship training), including:

i. Whether or not in Missouri;

ii. Whether or not in rural area, as defined by Federal Office of Rural Health Policy (FORHP); and

iii. Whether or not providing services in a HPSA, MUA, or MUP.

5) Employment status (i.e., part-time, or full-time).

b. The contractor may add additional tracking measures, including:

1) Information on rural GME program trainees, organized by postgraduate year of training, including:

i. Age, gender, race, and ethnicity;

ii. Rural training location(s) intent to be employed in rural area, intent to stay in general practice vs. pursuing additional specialty training;

iii. Step 3 Board Exam pass/fail results;

iv. What state they graduated from for medical school, college, and high school, specifically highlighting the Missouri schools that were graduated from; and

v. Application signaling a geographic preference for “West, North, Central” and/or setting preference for “rural.”

2.6.2 The contractor shall submit their tracking plan to the state agency by the end of the second (2nd) contract renewal period.

2.7 Performance Requirements:

2.7.1 The contractor shall work with the state-funded GME TAC on their GME development or expansion program strategies and activities.

2.7.2 The contractor shall develop an evaluation plan that is aligned with project goals and includes outcomes and appropriate measures for assessment of the goals, meets ACGME accreditation requirements and promotes continuous quality improvement. The contractor’s evaluation plan shall be submitted to the state agency by the end of the original contract period.

a. The evaluation plan shall include qualitative and quantitative progress toward the identified goals, a timeline, and metrics, along with descriptions of the inputs (e.g., key personnel, collaborators, and other resources), key processes, and meaningful expected outcomes of the funded activities, including improved health outcomes for Missourians.

b. The state funded GME TAC may conduct an evaluation to assess the statewide effectiveness of the MO GME Program across all contractors. Rural GME Program contractors shall participate in such evaluation.

2.8 Work Plan Requirements:

2.8.1 Within thirty (30) calendar days after the state agency’s notification to proceed with services, the contractor shall meet virtually or in-person at a location mutually agreed upon between the contractor and the state agency, with the state agency and other designees identified by the state agency. The state agency and its designees shall meet with the contractor to review the contractor’s work plan submitted with the initial proposal and make changes as deemed necessary to accomplish and fulfill the needs of the state agency.

2.8.2 The contractor’s work plan shall include, but not be limited to, a step-by-step plan of action to complete program development or expansion, as shown in Attachment 2, Sample Work Plan Template.

a. In addition, the work plan must itemize specific tasks that will be completed prior to each quarterly progress report, personnel who will perform each task, anticipated work hours each person will provide in completing each task, and a detailed timeline for completion of the specified tasks.

2.8.3 Within ten (10) calendar days after the work plan meeting, the contractor shall revise the work plan submitted in the contractor’s awarded proposal pursuant to the requirements of the state agency as specified during the work plan meeting, and shall finalize and submit the work plan to the state agency for review and approval.

a. Work Plan Approval: The contractor shall understand and agree that the state agency will have complete and total approval authority of the contractor’s work plan and will have the right to request the contractor to modify and/or provide additional elaboration to the work plan to accomplish the objectives and goals of the state agency.

2.8.4 Implementation of Work Plan: Within 150 calendar days after the state agency’s notification to proceed with services, the contractor must have obtained the state agency’s approval of the work plan and must be fully operational which shall include completion of all necessary function, action, set-up, providing required personnel, etc. necessary for full implementation of all required services pursuant to the requirements herein and the approved work plan.

2.8.5 The contractor shall submit an updated work plan that includes specific objectives, activities, deadlines, and responsible parties to meet the contract deliverables and project goals to the state agency within ninety (90) calendar days after the end of the original contract period and any subsequent renewal periods for the state agency’s approval.

2.8.6 Modifications to Work Plan: As work progresses in accordance with the work plan, modifications to the approved work plan shall be permitted due to changes in state agency needs or for other reasons approved by the state agency.

a. State Agency Requested Changes: If, after implementation of services, the state agency determines that modifications to the approved work plan are necessary or desired, the state agency will document the requested changes to the contractor in writing with any new instructions. Based on the written instructions provided by the state agency, the contractor must revise the work plan according to the requirements for the work plan specified herein, including any resulting changes in the assignment of percentage of completion factors tied to the contractor’s payment.

b. Contractor Requested Changes: If, after implementation of services, the contractor determines that modifications to the approved work plan are necessary, the contractor must submit a written request to the state agency for changes. The written request must include the reason for the modification and must detail the contractor’s proposed changes to the work plan. The contractor shall understand and agree that the state agency will review the written request from the contractor and will send written notice of approval or disapproval of the request to the contractor.

c. The contractor shall understand and agree that the state agency will have final approval of all individual components of the work plans revised as specified herein and reserves the right to require modifications, deletions, and/or additional elaboration to the work plan as the state agency deems necessary. The contractor shall understand and agree that the decision by the state agency shall be final and without recourse.

d. The contractor shall not proceed with implementation of services related to the modifications until final written approval of the state agency is obtained.

2.9 Reporting and Recordkeeping Requirements:

2.9.1 Publicity: Any publicity release mentioning contract activities shall reference the contract number and the state agency. Any publications, including audiovisual items produced with contract funds, shall give credit to the contract and the state agency. The contractor shall obtain approval from the state agency prior to the release of such publicity or publications.

2.9.2 The contractor shall meet at least quarterly, and as needed, with the state agency to report on implementation progress and contract deliverables.

a. The state agency will coordinate the quarterly meetings at a time that is mutually agreeable to both the contractor and state agency.

b. The meetings may be conducted in person, by phone, or virtually.

2.9.3 The contractor shall submit progress reports quarterly by the 15th of the month for the activities conducted in the quarter prior, including activity updates and work plan progress.

2.9.4 The contractor shall submit an annual performance report to the state agency within thirty (30) calendar days after the end of the contract period. The report shall include:

a. Summary of progress to date on developing or expanding the proposed rural GME program as well as any additional successes (e.g., identified through evaluation results or lessons learned) achieved in…