Page Limit: ½ page

Points: Pass/Fail (0 points allocated)

Briefly describe your organization, including the type of organization,
mission/purpose, geographic area(s) served, types of programs provided, and target population served.

Page Limit: ½ page

Points: 10/100 points allocated

Briefly describe the needs your organization will address, based on the selected priority area(s), including any research and data to support the need.

• Leveraging community input: Additional points will be allocated if the organization utilizes a community input process, such as: local community needs assessments; non-profit hospital needs assessments; Kids Count; DataSource; or any other community needs input process available within your local community. 

NOTE TO APPLICANT: THIS SECTION HAS TWO COMPONENTS. 
Page Limit: 2 pages

Points: 40 points allocated

1. Provide a detailed explanation of the intended use of the funds, including but not limited to:
   • Staffing, programs, technology and/or systems that will be impacted by the investment
     • Workforce — If investing in the workforce, how will the funds impact the strengthening of the Provider/medical workforce?
   • Geographic area(s) to be served 
   • Target audience(s) that will ultimately benefit from the advancements made as a result of the investment
   • How the investment will impact the cultural and diverse needs of the impacted target audience(s)
   • Collaboration with other providers, community-based organizations, or organizations in the geographic area(s) being served, to maximize the collective impact of the investment
   • Anticipated implementation timeline 
2. A priority of Nevada Medicaid is collaborative funding from Managed Care Organizations (MCOs).
   1. Has another MCO committed funding to this project in 2025? 
   2. If so
      • How much funding has been committed? 
      • Which MCO has committed funding? 
      • When will your organization receive the funds? 

Page Limit: 2 pages

Points: 40 points allocated

Note: Awardees are required to submit a final report, due January 31, 2027. Use the following guidelines as a template to complete this section. 

The goals, actual outcomes, and metrics must be provided in the year-end report.

1. Goal statement for use of the investment
2. Expected Outcomes
   • Identify the expected outcome(s) by providing the following details: 
     • Provide the specific outcome that will be achieved as a result of the investment 
       • Establish the baseline for this outcome
       • Define the metric(s) that will be collected to track progress toward this outcome
       • Provide the expected increase/decrease (by number and/or percentage) to reach the target(s) provided for this outcome (proposed performance target)
3. Measuring Success
   • Define how the success of the expected outcome will be tracked. 

Example: The goal of this investment is to increase access to care for the residents of Elko County by more accurately scheduling and managing appointments. 
The investment will be used to purchase software that enhances our current billing system, which includes a more robust scheduling platform. Our expected outcome is that we will increase the number of appointments scheduled and confirmed weekly.

• Baseline: Our practice currently schedules an average of 12 appointments per day. We do not currently have an automated confirmation process to remind and confirm patient appointments. 
• Metrics: We will track the number of appointments scheduled per week over a 12-month period, as well as the number of patients that confirm appointments using the automated system. o Expected change: 
  • 10% increase in the number of weekly appointments scheduled 
  • 25% increase in the number of appointments confirmed via the automated system 

 4. Previous Funding and Reporting (only for previously funded   organizations)If you have previously received funding from SilverSummit Healthplan between 2022 - 2025, did your organization submit the required reporting, based on the details of your agreement? 

If your organization was required to submit reporting and your organization did not, please provide a brief statement of why reporting was not submitted.

Page Limit: 1 page narrative, plus the Budget Template

Points: 10/100 points allocated

• Complete the Budget Template.
• Describe and justify all line items in the completed Budget Template.
  
  

Pro Tip: 

• Do not request funding in excess of the stated funding range. Requests in excess of the stated funding range will not be considered.

FREQUENTLY ASKED QUESTIONS

Application attachments: Are additional attachments required beyond the details listed on the web site – the narrative responses listed, and the budget template? No, there aren’t additional attachments required. Our goal is to streamline the process so that the Evaluation Committee can conduct a complete analysis based on the requested application requirements. Submitting attachments that cause the application to fall outside of the requested page number count can cause the application to fail the technical requirements review.

Budget Template’s “Other Funding Sources”: Are other funding sources required? No, additional funding sources are not required, however the Committee is interested in additional resources that will be allocated to the initiative beyond the funds being requested. The committee is interested in understanding long-term sustainability.

Budget: If awarded, can the organization use funding differently than what was outlined in the proposal? The funds should be spent based on what is indicated in the proposal, unless approval is given. Awardees will be required to submit a report to provide metrics, outcomes, and updates. 

Payments: Are payments paid through reimbursement? No, a lump-sum payment is provided once the awards have been made. 

Reporting: Are investment recipients required to submit reports if funding is awarded? Yes, failure to submit reports by the required deadlines can impact future funding. Year-end reports must include the results of the goals and outcomes provided in the application.