Rural Health Transformation Program – Public Comment

Introduction Information

Please note, this comment form is not being used as an application to fund specific, individual projects. Please do not include any sensitive, proprietary, confidential, or health related information. All information submitted through this portal will be considered public information.

Missouri is planning its application for the Rural Health Transformation Program authorized by the “One Big Beautiful Bill” Act (OBBBA).  Stakeholders may use the form below to provide suggestions regarding priorities, strategies, and specific opportunities. To help us collect the most impactful information, we are sharing the basic principles that we intend to follow in creating our application, with the caveat that guidance from the Centers for Medicare & Medicaid Services is still under development. At this time, the amount of federal funding Missouri might receive if its application is approved is unknown.

 

Basic Principles

  • Because achieving population health likely requires a mix of clinical providers as well as some non-traditional providers, we propose investing in the capacity of a range of provider types who practice in rural areas. 
  • Strategic partnerships with health-related organizations with a direct connection to population health or innovative IT solutions to advance clinical care will also be considered for investment funding.
  • Because we want to ensure maximum impact on rural population health, we will prioritize investing dollars in those entities that are willing to partner with each other at the local community level, to break down silos and jointly work toward meaningful incentivized goals. 
  • Because local partnerships and alignment take intentional, focused effort, we propose to fund community-level hubs to coordinate funded activities.
  • Because the funds are not permanent, our design will explicitly promote rural provider readiness to participate in current or new value-based models in Medicaid, Medicare and with commercial payers, providing a path to sustainability.

Guidelines for Comments

  1. Deadline: Comments will be accepted from August 25 to September 30, 2025.
  2. Multiple submissions: Stakeholders may submit more than one comment, but please refrain from having multiple individuals from the same organization submitting the same comment.
  3. Sustainability: Missouri encourages comments for the use of funds for projects or initiatives that are one-time costs or projects that clearly identify how it will be sustained without additional state or federal funding when this funding ends.
  4. Transformative: Missouri encourages comments focusing on innovation of health care that include value-based care arrangements and alternative payment models.
  5. Defining rural: Based on OBBRA language, the definition will be similar to Federal Office of Rural Health Policy grant eligibility, which includes counties outside Metropolitan Statistical Areas, outlying counties that belong to MSAs, and certain rural-designated Census tracts within Metropolitan counties.
  6. New Projects or Initiatives: Funded initiatives may not be used to supplant funds for projects or initiatives that have already been budgeted by an organization for which state or federal appropriations are already available.
  7. Federal and State Compliance: No funding shall be used by the State for an expenditure that is attributable to an intergovernmental transfer, certified public expenditure, or any other expenditure to finance the non-Federal share of expenditures required under any provision of law including under the State plan established under this title, the State plan established under XIX, or under a waiver of such plans.
  8. Align with Missouri Statutes and Regulations: Funds should not be used in lieu of options, where other sources of federal funds may be available (e.g., Medicaid, healthcare marketplace exchanges, block grants, etc.), or for optional benefits or coverage under existing programs for additional populations for which Missouri law has not granted authority to provide these benefits or coverages to these populations.
  9. Efficiency: Projects should have a clear, direct, and immediate impact on the health of Missourians.

Response Format and Content Guidance

Complete All Questions: A comment form cannot be submitted unless all questions have a response.

Attachments are accepted and optional: At the end of the comment form, supplemental information will be accepted by uploading a file that is limited to 5 pages in a PDF format.

It is strongly encouraged for concepts with detailed information that will be submitted as an attachment to use the format below:

Overview

  • Provide a high-level summary of the idea.
  • Clearly identify with which of the nine (9) OBBBA required activities the idea aligns.
  • Describe the anticipated impact on Missourians residing in rural communities, including health outcomes or improvements to health care access and/or quality
  • Identify how the concept could be sustained after OBBBA funding expires.

Demographic and Contact Information

1. Please provide the following information.

OBBBA Funding Concept

OBBBA Funding Concept Continued

OBBBA Funding Concept Continued

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    Your Rural Health Transformation Program – Public Comment has been submitted.

    The application ID for this submission is {formuniqueid}.