Official Links
| What Information is Supplied | Web Address |
|---|---|
| MO RHTP website for program updates | mydss.mo.gov/mhd/rural-health |
| CMS RHTP website | CMS RHTP Program Overview |
| MO DSS bid proposals website | MO DSS Bid Proposals |
| Official Hub boundary map | Hub Boundary Press Release |
| Hub Anchor application | Hub Anchor Application Press Release |
| Webinar slides and recordings | |
| Program email | DSS.RHTP@dss.mo.gov |
Frequently Asked Questions
This document supplements the official ToRCH Care FAQ and reflects common questions raised during the May and June 2026 roadshows across Missouri. Information in this document expands upon, but does not replace, the ToRCH Care FAQ and application materials.
Hub Operations and Governance
- Can an organization participate in multiple Hubs?
Yes. Organizations that operate clinics, services, referral networks, or programs across multiple Hub geographies may participate in multiple Hubs, engage with multiple Leadership Boards, and contribute to implementation activities in multiple regions.
Participation should align with the organization’s service footprint and the needs of local communities. The intent of the Hub structure is to strengthen coordination, not restrict organizations to a single geography.
- Can an organization apply to serve as the Hub Anchor for more than one Hub?
Yes. Organizations may apply to serve as the Hub Anchor for multiple Hubs; however, a separate application must be submitted for each Hub. Applicants should demonstrate sufficient staffing capacity, governance structures, stakeholder relationships, and operational readiness to support each Hub independently.
- Can multiple organizations jointly serve as a Hub Anchor?
Although it is not the preferred model, the RHTO understands that under certain circumstances, some Hubs may determine that a co-Anchor structure could be beneficial for their local circumstances and operational needs. Organizations proposing a co-Anchor model will need to clearly describe the rationale for jointly serving as a Hub Anchor, how coordination will occur between participating entities (such as governance arrangements, operational responsibilities, decision-making processes, and accountability mechanisms), and any prior history of collaboration or partnership.
In instances where a co-Anchor application is being considered for approval, the RHTO may conduct additional engagement with the applicant organizations to better understand the proposed structure and assess readiness prior to making a final decision.
- Do organizations need to serve on the Leadership Board in order to participate in ToRCH Care?
No. Organizations may participate as Hub partners, referral partners, program implementers, community collaborators, or funding recipients without serving on the Leadership Board.
Leadership Boards represent one component of Hub governance, but participation in the broader Hub ecosystem is not limited to Board membership.
- Does every county within a Hub need representation on the Leadership Board?
Leadership Boards should reflect the diversity of organizations and stakeholders within the Hub. While representation from every county is not currently a formal requirement, applicants are strongly encouraged to ensure that the perspectives and needs of all counties within the Hub are meaningfully represented.
The specific composition of each Leadership Board may vary based on local needs, available partners, and governance considerations. However, applicants should be prepared to demonstrate how they will engage stakeholders across the Hub geography and ensure that decision-making reflects the interests of the entire Hub.
- Will there be opportunities for Hubs and Leadership Boards to learn from one another?
Yes. One of the intended functions of the Regional Coordinating Network (RCN) structure is to facilitate cross-Hub learning, operational support, and the sharing of promising practices. The State also anticipates future opportunities for statewide collaboration, peer learning, and dissemination of successful implementation strategies.
- Does a Leadership Board need to be established before submitting a Hub Anchor application?
No. Leadership Boards do not need to be fully established at the time an application is submitted.
Applicants should demonstrate a plan for establishing governance structures, engaging stakeholders, and forming a Leadership Board; however, final board membership and governance structures may continue to develop during implementation and onboarding activities.
- Can Hub Anchors apply for Horizon funding opportunities?
Yes. Organizations serving as Hub Anchors remain eligible to pursue Horizon funding opportunities and are not restricted from applying solely because they serve as a Hub Anchor. Eligibility requirements for individual funding opportunities will continue to apply.
- How will ToRCH Care governance relate to existing ToRCH Pilot governance structures?
Existing ToRCH pilot Hub Anchors will need to reapply to serve as Hub Anchors under the new model. Local ToRCH Care initiatives will be guided by the selected Hub Anchors and Leadership Boards and may resemble current ToRCH pilot governance structures. The State intends to build on successful existing partnerships and governance models; therefore, during the foundation phase, the RHTO will collaborate with current ToRCH pilot governance entities and provide additional guidance as needed.
- Will Hub Leadership Boards issue local Requests for Proposals (RFPs)?
No. Procurement and contracting activities are expected to occur through the RCN and the RHTO rather than individual Hub Leadership Boards.
Leadership Boards are intended to focus on identifying local priorities, reviewing community needs, supporting implementation activities, raising proposed programs to the RCN for approval, and providing governance oversight rather than managing procurement processes.
- What is the expected decision-making pathway?
Most decisions will be made at the Leadership Board level. Hub Anchors help coordinate the Hub stakeholders and convene the Leadership Board to make local recommendations, while the RHTO and CMS provide technical assistance in final decisions. Protocols are in place for elevating clinical, operational, or technical issues to the RCN or RHTO.
Regional Coordinating Networks (RCNs)
- When will RCN boundaries be announced?
RCN boundaries are expected to be released alongside additional operational guidance materials. Current planning assumptions continue to include approximately seven RCNs statewide. These RCN boundaries are intended to provide organizational structure and technical support rather than create barriers to collaboration between regions.
- Will implementation be standardized across different RCN boundaries?
Most elements are expected to be standardized across Missouri where possible, including governance expectations, reporting requirements, core infrastructure, spending deadlines, and implementation support. At the same time, Hubs will likely have flexibility to determine local priorities, implementation plans (within the year), and vendor selections based on regional needs and project types. The intent is to balance a consistent statewide framework with the flexibility needed to address local circumstances, though specific requirements will be finalized as the model evolves.
Staffing and Workforce
- How were RHTP Navigator allocations determined?
Navigator allocations were initially developed using Medicaid population data because it represents one of the most complete statewide datasets currently available. As implementation progresses and the Digital Backbone expands data visibility, additional population and community factors may inform future planning and resource allocation decisions.
- Can Hubs choose to employ fewer Navigators than initially allocated?
Lessons learned from the ToRCH pilot demonstrated that dedicated staffing is critical to successful implementation; therefore hiring fewer Navigators is not recommended. Communities should carefully consider local workload, service demands, and coordination responsibilities when evaluating staffing decisions.
- Must Program Coordinators or RHTP Navigators be Community Health Workers?
Not necessarily. Although individuals with Community Health Worker experience may be well-suited for these roles, candidates from a variety of professional backgrounds may also be successful. These roles do require full-time, complete dedication to RHTP activities.
Experience in community engagement, care coordination, patient navigation, public health, healthcare delivery, or related fields may be beneficial. The primary consideration is that staff possess the skills, experience, and capacity needed to fulfill the responsibilities of the position and support ToRCH Care implementation activities.
- Will Program Coordinator and RHTP Navigator job descriptions be released?
Yes. Formal job descriptions and operational guidance materials were released alongside this FAQ document. Please refer to the RHTP website for additional information.
- Can salary levels for Program Coordinators and RHTP Navigators be adjusted?
The compensation assumptions included in program materials represent planning estimates. Organizations may choose to offer compensation above those levels; however, any additional costs would need to be supported by the Hub Anchor, Hub Partner, or through available Hub funding and comply with applicable program requirements.
Cross-Hub & Cross-State Coordination
- What happens when patients receive services outside their assigned Hub?
Patients may continue receiving care from providers they currently use regardless of Hub boundaries. The Hub model is intended to strengthen coordination and improve outcomes, not alter existing care relationships or restrict access to services. Providers and Hubs are expected to coordinate when referral patterns, service areas, or patient populations extend across Hub boundaries.
- How will ToRCH Care address communities located near state borders?
The State recognizes that many Missouri communities routinely receive services from providers in neighboring states and that many providers serve residents from both Missouri and surrounding states. Currently, ToRCH Care is intended to support services delivered to eligible Missouri residents and providers participating within the Missouri RHTP framework. RHTP funding cannot be used to support services incurred in other states, and activities funded through ToRCH Care will need to align with applicable program and funding requirements.
- Can RHTP funds support workforce training initiatives for students who may not currently live or work in rural Missouri?
Workforce development and training initiatives are tailored to improve rural healthcare within Missouri. The RHTO will align with CMS requirements and guidance for workforce training and initiatives, which can be found here.
- Can Missouri RHTP funds support provider-owned sites in other states?
No. Dedicated Missouri RHTP funds should generally be used for eligible Missouri-based activities and sites. Cross-border care coordination questions, such as use of CIE for out-of-state patients, may need additional review.
Funding and Financial Operations
- Will funding operate through a reimbursement process?
Yes. Program funding is expected to operate through established approval and reimbursement processes. Once approvals are obtained, the State intends to distribute funds as efficiently as possible while maintaining compliance with federal requirements.
- If an organization receives funding above applicable audit thresholds, will additional audit requirements apply?
Yes. Organizations remain subject to existing audit and financial compliance requirements associated with federal funding. Applicable requirements will depend on funding amounts and organizational circumstances.
- Are successful Hubs likely to receive additional funding opportunities in the future?
Future funding opportunities are still being developed. However, successful implementation strategies, strong outcomes, and demonstrated leadership may position organizations and Hubs to play larger roles in future program activities, peer learning initiatives, and statewide transformation efforts.
- Can discretionary Hub funding be used for patient incentive programs?
Potentially. While patient incentive programs were not originally envisioned as a primary use of discretionary funding, Hubs may propose innovative approaches that align with local priorities, program goals, and applicable funding requirements.
Discretionary funding is intended to provide flexibility for communities to address local needs, and proposed uses will be evaluated based on program objectives, community benefit, and compliance considerations.
- How should Hubs decide whether to pursue funding through statewide initiatives versus discretionary Hub funding?
Discretionary Hub funding is intended to support priorities identified at the local level and address community-specific needs.
When local priorities align with broader statewide initiatives, Hubs may choose to leverage statewide funding opportunities and program pillars while using discretionary resources to address unmet needs or implementation gaps. Hubs should evaluate whether a particular need is best addressed through local flexibility, statewide resources, or a combination of both approaches. The RCN can assist with determining the best approach.
- Can a provider’s clinics outside the home hub receive the same funded tools or services?
Hub funding should stay within the Hub. Exceptions could be considered if approved by applicable RHTP governance processes. Funding should not be duplicative of another Hub’s funding, and consistent with RHTP scope and available funding.
Data, Reporting, and Digital Backbone
- Will providers be required to replace existing EHRs or referral platforms?
No. The goal of the Digital Backbone initiative is to expand interoperability and connectivity across the statewide health ecosystem, not to require providers to replace systems that are already working well. For organizations that do not currently have an EHR or comparable clinical documentation system, the initiative is designed to provide foundational support to enable participation in secure data sharing. For providers that already have an EHR or referral platform in place, the focus is on enhancing interoperability, such as improving standards-based connectivity and data exchange, rather than disrupting existing workflows. Whenever possible, current systems will be connected and integrated into the broader statewide infrastructure, with targeted support directed only to areas where additional capability or modernization is needed.
- If an organization already uses a social care referral platform, can it continue using that platform?
The State’s goal is to enable interoperability and information exchange across participating organizations. Existing platforms may continue to be used if they can support required integration, data exchange, and reporting capabilities.
- Will the Digital Backbone support interface development, connectivity, and interoperability costs?
The State recognizes that interoperability requires more than software licenses and often involves interface development, connectivity, integration services, implementation support, and technical infrastructure. Specific funding approaches continue to be evaluated as Digital Backbone planning progresses.
- How will data governance decisions be made?
Data governance standards are being developed through dedicated governance and interoperability workgroups involving technical experts and stakeholders. The goal is to balance privacy, security, compliance, operational practicality, and meaningful information exchange across healthcare and community-based organizations.
Program Evolution and Future Planning
- Will Hub structures, funding priorities, and implementation approaches evolve over time?
Yes. ToRCH Care is designed to learn and adapt throughout implementation. Information gathered through Hub applications, stakeholder engagement, performance reporting, and implementation experience will help inform future funding opportunities, operational improvements, and program priorities. The State expects continuous refinement as lessons are learned and community needs evolve.
- How will Missouri’s performance be evaluated under the Rural Health Transformation Program?
Missouri’s agreement with CMS includes a broad set of implementation and outcome measures spanning access, quality, sustainability, and health outcomes. The 11 key success metrics that the For year 1, the RHTO has chosen to focus on 11 key success metrics.
Program evaluation will assess both implementation progress and long-term impact throughout the five-year program period. In addition to established performance measures, baseline data collection and metric development activities remain underway for several measures that are still being finalized.
As the program matures, evaluation efforts will focus on both successful implementation of ToRCH Care infrastructure and measurable improvements in health outcomes for rural Missourians. Please refer to the MO Project Narrative for the agreed-upon performance metrics.
The Rural Health Transformation Program information provided by the Missouri Department of Social Services is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $216,276,817.66, with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CMS/HHS, or the U.S. Government.