Rural Health Outreach Grant Application
A hospital’s relationship with its community is an integral part of its ability to
serve residents and improve their access to healthcare. MultiPlan’s Rural Health
Outreach Grant seeks to help rural hospitals develop creative community
outreach programs that encourage new services or reach new populations.
Recipients of our Rural Health Outreach Grant will each receive up to $7,500 to
implement outreach programs in their communities.
MultiPlan 2017 Rural Health Outreach Grant
Program Information
Key program dates
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Deadline for applications: May 19, 2017
Grant recipients announced: June 2017
Eligibility requirements
Applying hospitals must meet the following requirements to be eligible for a MultiPlan Rural Health Outreach Grant:
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The facility must be considered an inpatient hospital.
The facility must provide acute care.
The applicant must be located in a rural area as defined by the US Census Bureau.
The applicant must be a participating provider in at least one of the following MultiPlan networks:
MultiPlan, PHCS, HealthEOS, Beech Street, Texas True Choice, IHP, AMN, HMN or RAN.
A facility may submit only one program for consideration.
The grant award may be used to replicate an outreach program conducted at another hospital or
establish a new community outreach program.
The community outreach program must be access-oriented; it must enhance its community’s access to
quality healthcare.
The applicant must demonstrate how it will assess and monitor the progress of the proposed
community outreach program.
The applicant must show that, through the proposed outreach program, a new population will be served
or a new service will be offered to an existing population, for example, through health screenings.
A community or hospital match (either cash or in-kind) is encouraged and preferred, although it is not
required.
Submission instructions
Completed applications may be sent to MultiPlan via mail, e-mail or fax. Applications must be received by 5:00 p.m. ET
on May 19, 2017.
E-mail
[email protected]
Please include “Rural Grant
Application” in the Subject field.
Fax
781-895-3455
Attn: Rural Grant
Mail
MultiPlan, Inc
Attention: Rural Grant
16 Crosby Drive
Bedford, MA 01730
Questions?
For more information about MultiPlan’s Rural Health Outreach Grant, please contact us at [email protected].
MultiPlan 2017 Rural Health Outreach Grant
MultiPlan Rural Health Outreach Grant Application
Part I: General Information
Name of hospital:
Mailing address:
City:
State:
Zip:
TIN:
Name of Chief Executive Officer:
Has this hospital received a previous Rural Outreach Grant from MultiPlan?
Yes
No
If yes, what year?
Contact person regarding this grant —
Name:
Title:
Telephone:
Department:
Fax:
E-mail:
Public relations contact —
Name:
Telephone:
E-mail:
Part II: Program Information
Program Name:
Program Description – Please include program budget, project scope, program sustainability and partners, if
applicable. You may attach the program description to the application. Please include a copy of the hospital’s W-9
form with the application.
MultiPlan 2017 Rural Health Outreach Grant