Rural Health Transformation Funding Now Available: Click here for more information!

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Missouri Emergency Medical Services Association

RHT Pillar 2: MIH-CP System Expansion & Care Delivery Transformation

Green oval graphic showing MIH-CP System Expansion and Care Transformation with icons for Mobile Health Teams, Care Coordination, and Telehealth and Specialty Care.

MIH-CP Vision:

To build a fully integrated, statewide MIH-CP system that:

  • Serves as the front door to care in rural communities
  • Reduces unnecessary emergency department utilization
  • Improves chronic disease and behavioral health outcomes
  • Connects patients to the right level of care across the continuum

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IMPORTANT NOTICES:

  • Anticipated Notices of Award. [Updated September 22, 2026.]

    The review and scoring of MIH-CP System Expansion & Care Delivery Transformation applications is underway. To conduct a fair review and to ensure equitable distribution, this review will take some time. MEMSA cannot guarantee a specific award date but is targeting between October 1 and October 12, 2026. Notice of Awards is also contingent upon the release of the Rural Health Transformation Program funds to MEMSA. Monitor this webpage for t updates.

  • The MIH-CP Period 1 Application Cycle is now closed. [Updated September 9, 2026.]
    No newly submitted applications will be accepted for this funding cycle.

Rolling Application Review and Funding Availability

MIH-CP Program applications are accepted and reviewed on a rolling basis, subject to the availability of funds within each applicable budget period. Eligible applications are considered for funding as they are received and evaluated in accordance with the requirements and selection criteria outlined in the request for applications.

When enough eligible and fundable applications has been received to fully obligate the funds allocated for budget a period, no additional applications will be considered for awards from that budget period. The number of applications to obligate Period 1 funds has been received.

Applications received after the applicable budget period has been fully allocated will be carried forward to Budget Period 2 for review and funding consideration, subject to continued program eligibility, availability of funds, and any applicable program requirements.

Applicants are encouraged to submit fully completed applications as early as feasible. As a reminder, submission of an application does not guarantee funding.

The Missouri EMS Association reserves the right to establish and announce application cutoff dates based on the availability of funds and the volume of eligible, fundable applications received.

Who Can Apply:

You must be a rural EMS agency in Missouri that is collaborating with one or more healthcare partners to start up or expand a Mobile Integrated Care-Community Paramedicine (MIH-CP) program or Regional MIH Network. You must agree to integrate your MIH-CP program within ToRCH Care Hubs and Regional Coordinating Networks (RCNs).

Priority criteria for participation:

  • Located in rural RHT-designated areas
  • Serving multi-county rural regions, desired but not required
  • Demonstrated capacity to collect and report program data, both clinical and non-clinical
  • Active stakeholder engagement, health care provider and community referral networks, and care coordination infrastructure
  • Commitment to exploring healthcare reimbursement opportunities
  • Commitment to participate in HealthCall, the MIH-CP charting platform

Review the eligibility information in the “How To Apply” section below.

Key Funding Details:

You will use funding to start up or expand a rural MIH-CP program. You must use funding to implement services through the MIH-CP care delivery model to address the following:

Care Delivery

  • Reduce emergency department utilization
  • Reduce hospital readmissions
  • Improve chronic disease outcomes
  • Expand access to care

System Performance

  • Increase care coordination
  • Improve patient navigation
  • Improve integration across providers

Financial Impact

  • Lower total cost of care
  • Reduce unnecessary transports
  • Create more efficient resource utilization

We expect to award an estimated $4.150 million to at least 10 MIH Regional Networks in rural and/or RHTP Hub counties with a minimum annual award of $250,000 and a maximum annual award of $500,000 per request. Funding will be awarded upon application for MIH-CP start-up or expansion of Regional MIH Networks. Agencies will submit a request with a plan for the use of the funds. Individual programs will be approved up to $250,000 for start up. The maximum award for a regional system will be $500,000. There could be more awards based on the number of applications submitted and applicant readiness. Funding shall be awarded only to entities in Missouri-designated RHT counties.

In addition to individual program awards, we will leverage $1.1 million to provide the charting and data collection platform “HealthCall” to every rural program in Missouri (existing, start up and expansion).  This will ensure detailed data is being collected in a uniformed manner with HEDIS clinical quality metrics being tracked and trended in the background.  This will truly elevate our community in the direction of being true Mobile Healthcare Clinicians.

HealthCall: The HealthCall Care Delivery platform enables local providers to close service gaps, empower communities, and create sustainable, person-centered systems capable of meeting rural health challenges. Applicants will be required to utilize the HealthCall platform or use a platform that can readily interface with HealthCall, for immediate data collection and reporting.

  • HealthCall Overview Video (link coming soon)

How To Apply:

Applications are accepted on a rolling basis and are reviewed monthly by the MEMSA review committee. Funding recommendations are based on application completeness, project readiness, alignment with program priorities, and the availability of funds.

Applicants should anticipate receiving a Notice of Award (or funding decision) within approximately 30 days following the monthly review in which their application is considered. Applicants may be contacted during the review process to provide additional information or clarification if needed.

Completed applications and supporting documents should be consolidated into one email and MUST be emailed to: rhtp@memsa.org. This is the official application submission portal. The application may be obtained from the MEMSA Website. A complete application includes:

MIH-CP NEW SITES

Application Resources:

Application Components:

MIH-CP EXPANSION SITES

Application Resources:

Application Components:

Resources For Your Application:

Readiness Assessment

Applicants are required to complete a readiness assessment as part of the application process. This assessment will be scored as part of the application and will impact your overall score and funding decisions. The readiness assessment will provide reviewers with information about your readiness to start up or expand your MIH-CP program or Regional MIH Network. The components of the assessment include information on the following:

  • Service Area & Community Overview
  • Service Area Map
  • Stakeholder/Partner Engagement
  • EMS System Utilization, including baseline data
  • Payer Mix Analysis
  • Integrations and Partnerships
  • Equipment and Procurement

Importance of Standardized Data and Uniform Data Collection:

  • Importance of Standardized Data and Uniform Data Collection Video (link coming soon)

This video is a resource for understanding the importance of collecting uniform data to demonstrate progress toward addressing the goals of the Rural Health Transformation program. Paralign enables health plans to activate community-based emergency services teams like fire departments and EMS agencies to reach their highest-cost, hard-to-reach members with EMS-led preventive care. Participation in payment or network agreements may be available or required as specified in the RFA and award agreement, subject to applicable legal, contractual, payer, and compliance requirements.

  • Paralign Overview Video (link coming soon)

Participation with Paralign is optional unless otherwise specified in the RFA or award agreement. Organizations choosing to participate will be required to enter into a separate agreement with Paralign.

Scoring Rubric:

Additional Resources:

Additional resources related to Coordination Center Planning, Referral Management, Time Tracking, Life Safety Services, Dispatch Integration, and other MIH-CP program implementation topics may be added as they become available.

Frequently Asked Questions (FAQs)

Read this along with the RHT EMS Workforce Development and Sustainability Request for Application (RFA).

MIH-CP Services

EMS and fire agencies are eligible to deliver MIH-CP services under this program when meeting the criteria outlined in the Request for Application.

 

MIH-CP services are to be provided by a Community Paramedic with the support of other individuals, including but not limited to a care team of referral partners, healthcare providers, EMTs, A-EMTs, data coordinators, community health workers, and others.

The activities to be undertaken by MIH-CP start-up programs or expansion sites, including Regional MIH Networks, are as follows:

  • Identify and secure necessary agreements (MEMSA contract, partner Memorandums of Agreement, Business Associate Agreements, data sharing agreements, HealthCall platform utilization agreement, etc.).
  • Participate with the Paralign Clinically Integrated Network for payment of some MIH-CP services.
  • Identify target populations to be served during start-up through full implementation or for MIH expansion.
  • Meet data collection and reporting requirements for RHT program.
  • Stay informed of MIH-CP resources and best practices.
  • Acquire necessary equipment and supplies for start-up or expansion.
  • Participate in training, education, and network opportunities for MIH personnel, including sharing of best practices.
  • Develop processes for ensuring and documenting that individuals have access to resources to address non-clinical needs.
  • Determine data capture processes and ensure appropriate system users are trained in appropriately capturing and documenting services delivered under the MIH framework.
  • Establish baseline data to be monitored (utilization, clinical metrics, etc.) based on standard evaluation metrics.
  • Capture and monitor data for the standard evaluation metrics.
  • Monitor the percentage of MIH visits that include a provider telehealth visit.

Coordinate with MEMSA and RHT subject matter experts for program evaluation and cost savings.

A clinically integrated network (CIN) is a group of healthcare providers that work together to deliver efficient and affordable coordinated care to patients. Clinically integrated networks (CINs) serve an important role in achieving the “triple aim” of healthcare: a better patient experience, improved population health, and lower healthcare costs. Because of their commitment to communication and care coordination, CINs also help to improve documentation, quality performance, and provider accountability. With an increasing number of value-based contracts, these things help to ensure the providers maintain excellent care quality and risk no decrease in payor reimbursements.

Population health refers to a collection of health outcomes for any given group of individuals. While a specific definition for this term has yet to be universally decided upon, some healthcare institutions view population health as an interdisciplinary strategy that encourages non-traditional, communal relationships to bridge the gap between healthcare practice and policy and make change at a local level.

To learn more about rural clinically integrated networks, visit the Rural Health Information Hub.

In Missouri, the ToRCH model depends on strong partnerships among three main entities within the rural community : the hospital, primary care and behavioral health clinics, and community-based organizations (CBOs) offering social services. These partners utilize the Community Information Exchange (CIE) software from Unite Us, a secure digital tool that streamlines care coordination by sharing resources, making referrals, and ensuring the completion of the referral process. This system aims to bridge the gap between individuals and the services intended to assist them. Click here to learn more about ToRCH.

Transformation of Rural Community Health Care – Missouri program using federal funding to integrate social and clinical care and improve rural health outcomes expanding onthe success of the ToRCH pilot. The pilot program included six rural Missouri hospitals to transform rural healthcare.

In the ToRCH model, a Hub Anchor is the lead organization responsible for convening and coordinating the Local Community Hub in its service area, directing services in the interest of patients and the community. Rather than “owning” all services, the Anchor utilizes their existing services and organizes hospitals, clinics, EMS, pharmacies, LPHAs, behavioral health providers, and community-based organizations (CBOs) into a cohesive local network that can plan together, share information, and act on community health priorities.

To learn more about the ToRCH Hub Anchor, review the Rural Health Transformation Program Hub Anchor Application.

This HUB map shows the counties in each hub and identifies which counties are considered rural under the RHT definition.

To build the central foundation of ToRCH Care, seven Regional Coordinating Networks (RCNs) will connect and provide technical assistance and oversight to groupings of Hubs across the state. Both the RCNs and Hubs will be overseen by the statewide Rural Health Transformation Office (RHTO). Together, the RCNs and Hubs will form an integrated operating model that enables coordinated and improved care across providers with the ability to track outcomes and impact, ensuring that every rural Missourian can reach the right care without barriers. The RCN functions as the regional backbone, while Anchors operate as the local engine. Regional Coordinating Networks

  • Provide TA (technical assistance) to Hubs
  • Coordinate procurement and contracting for Hub programs
  • Review and escalate Hub performance reporting to the state
  • Ensure data quality and timely submissions of Hub performance dashboards
  • Coordinate Hub learnings across regions
  • Ensure non-duplication of Hub programming
  • Liaise cross-Hub community partnership opportunities
  • Clinical lead responsibility

Yes, MIH-CP programs or Regional MIH Networks seeking RHT funding must agree to utilize the HealthCall platform for data collection and reporting. An exception may be considered if the MIH-CP program or Regional MIH Network is using a platform that can readily interface with HealthCall for immediate data collection and reporting.

Health Information Exchange allows healthcare professionals and patients to appropriately access and securely share medical information electronically. Benefits of Health Information Exchange include the ability to:

  • Support transitions of care and referrals through sharing patient data electronically.
  • Implement clinical information reconciliation for medication, medication allergies, and current problems lists.
  • Inform care coordination in order to improve patient outcomes.
  • Generate care management alerts to prevent hospital readmissions.
  • Facilitate public health reporting.

At the present time, you will not be required to connect to a Health Information Exchange. However, the long-term goal is for MIH-CP programs and Regional MIH Networks to be connected to an HIE to maximize the benefits outlined above.

For more information on Health Information Exchange and who participates in Health Information Exchange in Missouri.

MIH-CP programs and Regional MIH Networks will measure success through standardized data collection. Data collected will include, but it not limited to:

  • Number of MIH patient encounters
  • Reduction in repeat 911 calls
  • Reduction in avoidable emergency department visits
  • Hospital readmission reductions
  • Number of patients receiving follow-up care
  • Number of community outreach participants
  • Patient satisfaction surveys
  • Transportation assistance utilization
  • Healthcare partner collaboration metrics
  • Program data will be reviewed quarterly and shared with funding partners.

Reporting mechanisms are under development More information on reporting processes will be shared as processes are developed and finalized.

Yes. Both programs may apply for funding for their respective MIH programs, provided there is no duplication of funding, activities, or costs between the two applications. Each applicant must clearly define its proposed service area, scope of work, and budget, and funds may not be used to support the same activities or expenses across both programs.

Allowable Uses of Funds

Funding will focus on MIH-CP programs with the greatest readiness and will be distributed by MEMSA through contracted agreements. Funds may be used for personnel, equipment (including an MIH vehicle), equipment to fully equip the MIH vehicle for service delivery, supplies (medical and non-medical supplies), technology, and administrative costs. Program funding should reduce barriers to care. Examples of eligible use of funds include:

  • Hiring or contracting with qualified MIH-CP personnel
  • Developing promotion and recruitment materials.
  • Purchasing supplies and wraparound supports that address clinical and non-clinical needs.
  • Purchasing supplies/equipment needed to conduct MIH-CP services.

The Missouri EMS Association has a relationship with Savvik Buying Group and is exploring bulk purchasing options to maximize RHT funding. More details will be shared as information becomes available.

Yes, if it will support MIH-CP program implementation or expansion. Examples include:

  • Connectivity to StarLink
  • Computers/tablets
  • Patient monitoring devices

Yes. You may include recruitment or retention incentives for key personnel hired to perform MIH-CP duties. Incentives must be reasonable based upon annual salary.

Budget Requirements

Funding will be awarded upon application for MIH-CP start-up or expansion of Regional MIH Networks. Agencies will submit a request with a plan for the use of the funds.  Individual programs will be approved up to $250,000 for start-up. The maximum award for a regional system will be $500,000. There could be more awards based on the number of applications submitted and applicant readiness. Funding shall be awarded only to entities in Missouri-designated RHT counties.

When the budget template is finalized, someone needs to include instructions for completion for each budget category.

Examples include but are not limited to:

  • MIH Vehicle
  • Vehicle Upfitting (Radios, Emergency Response Package, Inverter)
  • ALS QRV Equipment (Cardiac Monitor, Ventilator, Lucas Device)
  • MIH-CP Specific Equipment

Yes. As long as the request is reasonable and the supplies are used for individuals enrolled in your program, as outlined in your application.

Other

You are encouraged to seek counsel from your CPA about whether any funding awarded from RHT will have an impact on your threshold for triggering a single audit. You are encouraged to explore further education on audit requirements, particularly if funding will trigger a single audit. You may also need to consider the costs of a single audit when applying for RHT funding. Audit expenses may be included in the budget as an Administrative expense.

Budget Presentation

REQUIREMENT: Use this budget template to develop a complete and accurate funding request for your Mobile Integrated Healthcare–Community Paramedicine (MIH-CP) project. You MUST select whether you are applying as a New Site or an Expansion Site, then complete all budget categories based on your program’s needs.

Applicants are required to submit a budget for a three-year project period to demonstrate anticipated project costs. Initial awards will provide funding for Year 1 only. Funding for subsequent years (Years 2 and 3) is subject to the availability of federal and state appropriations, satisfactory performance, and continued programmatic need. Additional continuation funding for up to two more years (Years 4 and 5) may also be available under the same conditions, for a maximum project period of five years.

Key guidance includes:

  • Prorate personnel costs based on when staff will begin MIH project activities. Contracted personnel should be included under the Contract budget category.
  • Include an overall fringe benefit estimate (detailed calculations should be retained for audit purposes).
  • Funding may support the purchase of one MIH vehicle (e.g., SUV or van—not an ambulance) and essential equipment. Price quotes will be required before purchase.
  • Budget for non-clinical supplies to address barriers to care whenever possible. Leveraged or partner-provided resources may be reflected as in-kind contributions.
  • Contract expenses should generally be limited to MIH Network partner contracts, although other MIH-related contracts may be considered.
  • Travel costs must directly support MIH implementation, including training, stakeholder meetings, and participation in regional or statewide MIH activities.
  • The Other category may include additional MIH-specific implementation expenses or in-kind contributions.
  • While no fixed funding cap has been established, applicants should use the template as the primary guide for anticipated expenses. Additional justified costs may be considered.
  • Identify all leveraged or in-kind resources that support the project.

Replace all placeholder values (e.g., “XXXXX”) with actual figures, FTEs, percentages, and verify that all formulas and totals in the spreadsheet calculate correctly before submission.

Find Technical Assistance / Contact Us

If you have a question about the following or the RHTP funding for MIH-CP, please send your inquiry to the attention of Chris White, Program Lead, MIH-CP System Expansion & Care Delivery Transformation Pillar, at rhtp@memsa.org. Please use this address, as it is the official portal for RHTP inquiries.

Disclaimer

This webpage is intended as a summary only. The applicable Request for Application, award agreement, federal and state requirements, and any MEMSA-issued written guidance control in the event of any inconsistency. MEMSA reserves the right to modify, clarify, suspend, or cancel funding opportunities, requirements, award amounts, timelines, or allowable uses as required by law, funding availability, program requirements, or administrative need.

MEMSA may reject applications that are incomplete, nonresponsive, inaccurate, late, or inconsistent with program requirements. MEMSA may request clarifications, negotiate budgets, impose conditions, reduce requested amounts, or decline to fund any application. Applicants and awardees must comply with applicable conflict-of-interest, nondiscrimination, procurement, privacy, reporting, and record-retention requirements.

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