Alaska Dept. of Health: RHTP Advisory Council (July 1, 2026)

Hi, good morning. I would like to welcome everyone to the Alaska Rural Health Transformation Advisory Council, and I would like to call the meeting to order. Thank you for joining us, and I would like to thank everyone on the Advisory Council for your willingness to serve in this important role. Just as a level setting and reminder, the council brings together a broad range of experience, perspectives, and community voices, and your participation is essential to shaping the future of this project. As a reminder, the purpose of the Advisory Council is to provide structured, informed, and directional recommendations to the Commissioner regarding the design, oversight, and continuous improvement of the Rural Health Transformation Program.

The Department of Health recognizes that Alaska's rural health system is highly interconnected and that Advisory Council members may be applicants to the RHTP or have professional affiliations with organizations that are applicants, partners, or stakeholders. These relationships do not preclude service on the Advisory Council, but they do require awareness and transparency as we conduct our work. Members are expected to disclose status as an applicant or relevant professional affiliations to the Department in a timely manner. Members are expected to disclose possible direct personal benefit to themselves and/or family members to the Department as well in a timely manner. And we will review potential conflicts on an ongoing basis.

Before we begin, a few reminders about how we operate. Our meetings typically follow kind of an informal Robert's Rules of Order. When the Steering Committee needs to take action, we will use a simple majority vote among voting members. And because we are meeting virtually, all votes will be conducted by roll call. So we will begin this morning with a roll call, and we will start with the elected officials serving on the committee.

So start with Senator Giesel.

Oh, you have no sound. I'm sorry, Senator. Let me see if someone on our team can connect with communications and see if there's anything on our end we can do to support that. But we see you. Mark you as here.

Representative Mena? Here.

Jarrod Cosen. Here. Mary Wilson. Here. Nils Andreassen.

Here.

Jen Moreau stepping in for Monique Martin. Good morning. Here. Thanks. And Terry O'Connor stepping in for Nancy Merriman.

Here. Okay. All members are present and we have a quorum to conduct business.

Okay, thank you, Senator Giesel.

I would start with approval of the agenda. The agenda was provided in advance. It has also been publicly noticed, and if there are no objections, we will consider approving the agenda.

Nils? To approve the agenda, do you need a motion or—. I don't know. No objection from me. Thank you.

Seeing no objections, the agenda is approved. Next, we will move on to approval of the minutes. The minutes from our last meeting were distributed ahead of time. Does anyone have any corrections or changes to the minutes?

Okay, if there are no further corrections or changes, the minutes will be approved. Any objections?

Hearing no objections, the minutes are approved. So next we will move on to department updates, and I just again want to start by thanking everyone for your help over the past few months. We continue to try to move as fast as we can. I know we are not alone in that. Everyone who is touching this process is also moving very fast and taking on a lot of work.

So I just want to start by saying thank you. I would like to pass off— I would like to invite Betsy Wood to come and to share her screen and walk through a presentation to highlight some of the updates with the project. These updates are outlined in the agenda, and we have a slideshow just to kind of help orient everyone and provide some information. Again, we can pause at different times to talk through any items on the slideshow and discuss those in more detail with the advisory committee. So with that, Betsy, are you able to share your screen?

Yeah, well, Allison's sharing and you should be able to see the slide deck now. So let me know if you cannot.

I am not able to.

Are others able to? I'm able to see it. Yeah, I'm seeing it. Okay, it must be me. Yeah, I think it may be your view setting.

Okay. Well, thank you very much. I'm Betsy Wood. I'm the director for the Office of Health Savings here at the Department of Health. And we're really excited to share kind of an update on where we are in the process.

A little quick recap of where we've come. Allison, you can go to the next slide if you don't mind. We wanted to very briefly just kind of remind everyone of the work that we've collectively accomplished over the last last 6 months, I think we've really been able to accomplish a substantial amount of foundational work to launch this program. We've engaged partners across the state to inform our strategic and high-impact RHCP investments. We hosted our statewide kickoff convening that brought together providers, community partners, and leaders from across the state to frame up the shared goals of this program.

We've launched our request for, request for letters of interest, request for proposals, which I think, as we all know, resulted in the nearly 1,800 letters of interest. We've developed and delivered our RHDP learning series, which has engaged hundreds of stakeholders through 11 webinars to date. And as many of you know and have been able to participate in some of them, we've initiated our regional planning meetings across the state, which we'll talk a little bit more about later on. This morning to help each region identify gaps, opportunities, and transformation priorities. The legislature passed HB 195 and HB 110, which advanced 5 of the 6 interstate licensure compacts, as well as the pharmacist scope of practice policies identified in Alaska's RHTP application.

And we really want to thank all of you for the support and stakeholder engagement that helped move that work forward. And finally, we have opened the implementation application period and are currently in final review of the additional information required to execute the planning subawards. So really, we just, you know, I think that we're, we're going to spend most of this time focused on the work ahead, but I do think it's helpful for us to remember what we've, what we've built so far and how we've really laid a foundation for what we feel is going to be a strong program going forward.

Next slide, please.

So slide 3 is meant to briefly reorient everybody to where we are in the year 1 funding cycle. As a reminder, we released the letter of interest or LOI outcomes in late May, and those projects or proposals that advanced to the full implementation application process were able to provide those full applications through a window from June 1st through June 22nd. So now we've moved into the review and evaluation phase of this process, and over the next several weeks, these applications will move through administrative review, project evaluation, and portfolio review, and we'll cover each of these components in a little more detail a little bit later on in the presentation, but those are the stages that the applications will walk through before the final funding recommendations are developed. We're anticipating that that review and evaluation process, you know, we've, we've been in the thick of it since the application period closed. Our team and the team at ACF have really been applying a lot of time and energy into reviewing the thoughtful applications that we received, we expect that we'll be able to move through that stage through late July.

Um, at that point, we'll work with CMS to complete any federal review that may be required under the cooperative agreement, and then DOH and ACF will work together to finalize and execute the award agreements with those implementation awards expected to begin in, in August of this year.

Chen, go ahead. I see you have a question. Thank you very much. I just wanted to ask the question of whether or not the department is soliciting or receiving feedback on the letter of interest and then RFP process. And I asked the question just, you know, in terms of thinking about efficiencies.

For the department, for the Alaska Community Foundation, and, you know, for all the organizations, including the smaller organizations that, you know, needed to navigate this process. Thank you. Jen, I think that's a great question, and I know later on in the deck today we have some opportunities to have, you know, a collective conversation about reflections on the process. But I think at a high level, and so I say that to say we're very interested in hearing, especially from this group, but really from anyone, feedback, what works, what didn't, suggestions for next time, refinements. I would say in general, you know, this process has moved really fast for everybody at every level, and we've worked to set up frameworks that we believe are helpful to kind of intake the information that we need to help us sift through it, to help organizations provide the right amount of information at the right time.

And I think we've seen opportunities for refinement as we move forward, and we're very interested in feedback from, from our partners and especially from those who have gone through the process. I think that there's always, you know, you build something and say, okay, here's how it's going to work and how people are going to provide information. And then in practice, when that actually happens, I think you learn so many lessons from, from the people who use the process and then the people who evaluate the information coming in. And that's certainly an area that we're interested in kind of refining as we move forward and adjusting this process so that it works a little better for everybody as we go. And I think we're planning to kind of have more of a discussion about that when we get to observation and insights.

I think there are definitely some things that we've seen, and then we want to hear from committee members or council members on kind of your perspective as well. But it will kind of be the beginning of the conversation. And, you know, I think we want to engage more broadly, probably over the next few weeks as we think about round 2, kind of what are some of those observations and how should we be thinking about that.

Okay, thank you, Alison. Can we go to the next slide, please?

So I think the key takeaway on slide 4 is that as, you know, we've completed the application period, we know that we advanced 403 proposals into that application process. And we anticipated that we wouldn't receive 403 full applications. And so we've received 365. This is, you know, some organizations may have self-selected and said, you know, if they had multiples that move forward, maybe they decided to focus their efforts in any given area. I think this is common to see, you know, a little bit of folks who were invited or selected to advance recognizing that maybe this isn't the right time or not completing that application, but we did want to share that, you know, starting with our initial nearly 1,800 letters of interest, you know, moving down to what's the body of applications that the department is currently reviewing, we are looking at 365 proposals that have been submitted, one for every day of the year.

And Allison, can you please go to the next slide?

We are going to talk, you know, a little bit more up next about how, how we're evaluating those applications. But I do think that we should spend a few minutes walking through at a high level how the department approached that LOI review process and how, how we landed, you know, on the applications that move around the letters of interest that move forward. The Commissioner's advancement decisions were informed by multiple inputs that included ACF's initial organization of the letters of interest, department subject matter expertise, and broader program— programmatic considerations, including portfolio balance, available funding, and strategic priorities. But throughout that entire review process, the central questions really were, would this project meaningfully advance rural health transformation, and was it ready to move to implementation? So as we thought about those questions, The department considered factors like alignment with the 6 RHTP initiatives, the project's potential impact on the rural health system, implementation readiness, and whether RHTP funding was the appropriate fit for the idea, partnership and coordination needs, and any significant external dependencies.

And we also looked at how would this project fit within the overall statewide portfolio. So our goal was not to identify just good projects, but also to advance a balanced portfolio of investments that taken together would have a great impact on strengthening Alaska's rural health system. So that was, you know, the approach that we took with that LOI review stage. And DC Ricci, would you add anything here thinking about how we move through those decisions at the LOI stage? And I think one thing I would add is that there were, you know, some projects where we saw some trends or we saw some similarities, right?

We saw an identified need, and that need is an important need that we will need to work out and build, right? Sometimes we saw that through different types of training for specific types of behavioral health workers or a desire from, you know, different organizations that were kind of uncoordinated across the state to do something similar. And some of those were not moved forward for consideration of implementation, partially due to the kind of the system need to bring them together and maybe talk about how we can coordinate those efforts, right, in preparation for a future funding round. Some of that had to do with where the department was. Some of these things may need more department support to stand up and build out, and we may not be in a position where we are able to do that in a way that makes sense with moving forward and funding this at this round through Rural Health Transformation Programs.

And when we're looking at, you know, all of these 1,800 letters of interest, it is a great way to see kind of where people are at as a starting point. We can identify key themes. Again, where we're seeing that, that that, that need that is being identified across different communities or across different sectors. And one of the things that I think we want to do as a department after we finish making decisions on the awards, and we're already thinking about it, is where we saw some of those really, where we saw some of those coordinated or consistent needs or ideas that we think will bring a lot of value but need to be coordinated, need to be lifted up and shaped by the state and with other entities participating participating. We want to think, we want to build those out, basically looking at year 2, which is coming up pretty soon, and then thinking about year 3 in the future.

There's other things we saw where there may be a better fit than RHTP for funding those projects. There may be resources that the department has available through technical assistance or other grants that may be a good fit as well. So those were also taken into consideration when we looked at kind of the slate of letters of interest to move forward. I think one of the reasons this is important is because we're think— we're trying to think about RHDP as like that, how do you move the system forward? And the system kind of is sensitive to not just what does the entity want to do, but are there other elements that need to happen for that entity to be successful and for the impact to that system to be successful?

And so those are some of the considerations that we took into advance.

And I Senator Giesel, I am seeing your question in the chat and I want to make sure that we respond to that. So there's not, you know, we don't have a really good database in the state right now that exists to look at where preexisting services are or where services are coming online. That is a gap that we identified, that is a need that we identified from the state, and that's actually something that we built into our milestones with the rural health transfer, not transportation, first time I've done that in a few months, Rural Health Transformation Program, right? Our application. So we are building out right now a gap analysis that will look at different providers and services, not just in behavioral health, although that was probably the initial focus, but across the state.

And we will use that to help guide and shape, you know, how we think about funding expansion or advancement of services in the future. So we don't, we don't have perfect information right now. I kind of go back to sequencing, like, you know, in a perfect world, I think we would have sequenced this whole thing a little bit differently, but we are kind of moving forward as fast as we can with what we have. Betsy, do you want to add anything to that? And then we'll go to Jen's question.

No, I, well, I will say no, and then I'm going to add something to it. So, you know, I think that when we, when we look at where are gaps in communities and where are ideas and places to fill in, I really think that as we move through the provider gap analysis, that's going to provide us with additional tools and additional resources. But I also think that As we, as we move through our community and regional planning efforts, I think this is an area too where we're seeing a lot of really, really powerful collaboration come out of those efforts where organizations and community leaders and partners are coming together. And we're really seeing some collaborative conversations where people say, we see these needs, we're working on this bit, we need these, we have these needs, we're working on this bit, and seeing how they can fit together without too much overlap. So I think that's another another tool that as we move through those, those efforts and see some of the reports coming out of those that will be reflected back to communities and provided publicly as well, I think that will help kind of shape and guide some of these, you know, funding decisions as we move forward.

And Senator Gissel, to the second part of your comment, you know, we agree, we see this as a large need. And actually, behavioral health was kind of the area that that triggered this need. And we started, we, this was part of a, a contract that we had established with GuideHouse, uh, performing a gap analysis for behavioral health providers. I think that contract just got finalized in the spring, but we had started this concept pre-RHTP. We're, um, working with them right now quickly to try to build out that database.

And again, we are starting and focusing on behavioral health, so we should have that Relatively soon, Betsy. I'm not sure what the timeline is, but that is a priority that's already underway. Betsy, do you know what the timeline is for the gap analysis right now? I think it's like a late summer, early fall. I don't have the exact date.

Of this year? Yes, this year. Yeah. And ideally that will be— I believe that will be available online. So it's not just available to the department, but it will be available statewide.

And I kind of— the demos I've seen are— have some really helpful kind of graphic interface that I think will be interesting.

Jen. Thank you. And I really appreciate Senator Giesel's question and comment, and I appreciate this discussion. And likely this discussion will kind of come up again during the regional planning part of the agenda. But I just thought this was an opportunity to say thank you to the department for your partnership matrix.

I think the partnership matrix is going to be an effective tool to understand how services will fit in and mesh with regional needs as defined by the region itself. There was a deep dive from Tribal Health Organizations into kind of the distribution of the applications that were moved forward, and we noticed that some, probably falling into the statewide category, get to check the box on a lot of regions., but may not have actually worked with those regions. In some cases, some of those, the proposers were actually unknown to the regional organizations. So wanna just kind of call out the usefulness of the partnership matrix. I think that fits in with this whole gap analysis conversation.

And, you know, it is definitely something to pay attention to. So thank you very much. Appreciate it. And thank you, Jen, for calling that out. I think You know, and I won't steal too much thunder from Allison, who will be talking through some of the application elements.

But, you know, we saw as we looked through the letters of interest that getting initial information about partnerships is really helpful. But we identified some areas where we, we thought that maybe the partnerships that were described were perhaps slightly more aspirational than they were grounded in foundational relationships. And I think that's where the partnership matrix partnerships that we developed. And really kudos to the Alaska Community Foundation for helping us kind of put together a framework where we really could evaluate the strength of those partnerships and kind of see how— identify a way to kind of elaborate more on what partnerships existed and to what degree they had already been established. I think we thought that was going to be a really important component as we evaluated the applications.

And I also want to touch on, you know, the statewide reach and the regional reach and all of that. You know, I think when we were asking questions through the letter of interest process, some of the questions looked at where does this— or, you know, asked organizations to self-identify where do you work today and also where do you anticipate this project impacting. And then, you know, we also had to kind of take a look at that and evaluate, does that seem reasonable? And so we've asked questions in the applications as well, you know, about where would the project be implemented to try to get at it a little bit more. Because I think it is— we want to, we want to be careful not to just assess a project's regional impact or kind of geographic impact based off of where is that organization physically located today.

But we also want to be careful about ensuring that if a project says, hey, we're statewide, um, you know, understanding how realistic is that, or what does that look like, and what kind of partnerships have been established to really build out that broader reach. So thank you for highlighting that. I'm glad it was helpful.

Any other questions on this slide?

Hey, Alison, I think we can go to slide 6.

This, this slide, we don't have to spend too much time here. This is meant to provide a quick snapshot of the portfolio that advanced from the letter of interest stage. So again, 431 projects advanced, 403 of those were for implementation, 28 were for planning, and that represents 224 unique organizations. We saw a range of project sizes. The largest share of the projects requested or identified that they would be requesting between $250,000 and $1 million, but we did advance projects across the full spectrum of funding levels.

And I think those of you who have gone through the application process know that applicants were asked to refine their, their funding need and provide the actual amount that they, that they are requesting. So we do see more detailed, uh, budget asks in, in the applications. Uh, we also included some information around the primary organization type. This is a self-reported field from the letters of interest. So we did ask organizations to say, okay, what— out of all these organization types, you could fit into multiple boxes, but which one is your primary organization?

Um, you can see that healthcare providers represented about a third of the advancing projects. This is followed by community-based organizations and tribal organizations, and there's, of course, additional participation from EMS agencies, local governments, educational institutions, and other partners.

And Allison, can we go to slide 7, please? This is a little bit of an eye chart, but we wanted to include some information that highlights some of the common areas that emerged from across the advancing proposals. So collectively, these projects that, that we advanced into the letter of interest stage and that we're seeing the applications from, we see them as advancing all 6 of the RHCP initiatives through complementary investments. We saw a lot of proposals focused on expanding access to clinical, clinical care, particularly behavioral health. Primary care, EMS, and home and community-based services.

We saw a strong emphasis on strengthening the healthcare workforce, improving provider financial sustainability, and modernizing health information technology and data infrastructure. Telehealth and remote monitoring remain major priorities alongside investments in care coordination, patient navigation, and connecting people to the right level of care at the right time. Time. We received a number of proposals focused on maternal and early childhood health, as well as tribal-led models that integrate tribal healing and culturally grounded approaches to care. While each proposal addresses local needs, again, the portfolio as a whole advances the broader vision that the state has collectively built for a more accessible, sustainable, and connected rural health system.

And with that, I think I'll pass it over to Allison Miller, one of our RHTP program coordinators, and she can talk through the implementation application components. Thanks so much, Betsy. Yeah, happy to talk a bit more about what the application looked like. For those of you who submitted LOIs, a lot of this information will look familiar, and I want to emphasize that our goal in asking for some of the same information was not to create redundancy or more work for people. We realized, and we heard a lot of feedback from submitting organizations, that they wanted more room to elaborate on their project and to give more specific information.

And details about what they were going to do. We also recognized a lot of places where we could have asked better questions, and so we refined a lot, especially in terms of asking for more distinction around where our organizations were located, but also where they were serving and who their target populations were. We also asked for a lot of new information that focused a lot on how organizations intended to accomplish their planned proposals, who was going to do it, anticipated risks and mitigation strategies, their partnerships. We talked about the partnership matrix a little bit, and I think we're all cognizant that this project will create a lot of new relationships, and we're excited about that. But what we're really looking for is just some kind of evidence that everyone who is involved has had at least one conversation, is on the same page about what they're going to do and how they're going to do it.

We also asked for a handful of attachments. This included a work plan with milestones, a detailed budget and a budget narrative, the partnership matrix and documentation, and then some standard certifications that are consistent with all DOH grants.

I want to talk a little bit about what the review process is going to look like. Right now we're in the middle of our subject matter expert internal review. Concurrent with that, ACF is also completing an administrative review where we're checking to make sure that All of the applications are complete, everything is where it's supposed to be, there's nothing that is really unallowable or that stands out as not being appropriate. The project-level evaluation is really focused on each individual project, and for this, our source of truth is the project evaluation framework that is posted online on our website. That is intended to be both an internal resource and sort of a standard for us to make sure that we're staying consistent in our review.

Review, but also a tool—. Excuse me—. A tool for applicants. They had access to it during the application preparation process so that they could see what, what we were going to focus on during the review process. And then following that individual project-level evaluation, the department leadership will complete a portfolio-level review, which is where we're sort of checking for that, that broader, more sort of puzzle aspect to the applications, making sure that all of the projects fit together, that there is even distribution across the state, that we're meeting the biggest needs and serving all populations as much as we can.

And that will be completed by DC REACHI and Commissioner Hedberg, with Commissioner Hedberg making all of the final decisions.

I want to spend a few more minutes talking about the rubric-based review. This is the same as the project evaluation framework that I mentioned a minute ago. And we've tried to be as specific as possible about what this is going to look like, both for our reviewers and for our applicants, to ensure that everyone has clarity and transparency into the process. So applications are being evaluated across 8 different categories that are listed here on the bottom left of the screen, and within each of those categories, each application is rated on a scale of 1 to 5. In order to be eligible for funding, And to move on to the portfolio analysis phase, each application has to score a 3 or higher in every single category.

And so we're trying hard to ensure that there's clear delineations of what a good project, what a strong project looks like, and what a weaker project that maybe, maybe needs a little bit more work looks like. The portfolio analysis process is following a similar pattern. There's 5 different areas where we're evaluating. To ensure that we are funding things that are serving Alaskans equitably and transparently. And then final stage, the commissioner will make final decisions, as we discussed previously, based on the feedback from the subject matter experts and notes from the portfolio analysis phase.

All right, Betsy, I'll hand it back to you for this one. Can we pause for a second and see if there's any questions?

Again, at the end of this, we can also have a discussion, see if anything else comes up.

Okay. Emily, I don't know if something changed with your sound, but you do sound a little far away. It could just be me though. Can you hear me now? There you go.

Okay. Does anyone have questions? Okay. At the end of this, we can have more of a discussion too if anything comes up. Okay, thank you.

Thank you. Okay, Alison, I'm happy to talk through timelines. So the next 2 slides will be a bit of a refresher on the funding timelines for this. I recognize that there are a lot of different ways to slice a year, so you can see that at the top of, at the top of this graphic here. That this is meant to illustrate how the state's allocation and the performance period for this funding cycle line up against the federal fiscal year, the state fiscal year, calendar year, and the RHTP budget periods.

None of those are quite aligned, so it does mean that you have to track across multiple multiple metrics if you were trying to kind of think of where does this funding fit within it. So really there are 3 different timeframes that I think are helpful for us all to keep in mind as we think about how does this funding roll out. So first are the state's federal budget periods under the CMS cooperative agreement that determines when does the state receive funding. So you can see our first budget period, our allocation Um, is from really December 29th, 2025 through October 30th, 2026. That's the first budget period, and that's when the state receives that money.

Um, this is also when the state needs to obligate those funds by the end of the budget period. Second is the federal expenditure window, and those windows establish the deadline by which those federal funds must ultimately be spent. And states are given an 11-month expenditure window. So through the end of the federal fiscal year following, you know, that, that first budget period. So we have through September 30th of 2027 to finish expending those Budget Period 1 funds.

The next element to keep in mind is what are the performance periods when we're thinking about our subrecipients who are receiving awards under these funds? Those performance periods are the timeframes during which awarded organizations are expected to carry out their project activities. And you'll see that the performance period ends before the expenditure window closes. That timing is intentional. It provides time for the annual reporting, the financial reconciliation, closeout activities, and where appropriate, consideration of any extensions before the federal expenditure deadline.

So we wanted to provide a visual representation of how these timelines fit together for this first funding cycle to try to help us all kind of get it in our heads and make sense of it.

Jen, go ahead. Thank you so much, and I really appreciate you digging into this timeline. I thought maybe I could share some technical feedback that we got from tribal health organizations. This may be something you want to take up in like a virtual office hour, but just, you know, on the heels of this, I thought I'd share. There's both a question and a comment.

The comment was that if this tribal health organization is required to follow federal procurement guidelines, that organization would need to post the RFP, go through the process, And while that process would be ideal from a compliance standpoint, that would risk spending 60 to 90 days to get a federally compliant RFP done, contracted, and started, which would then create another compliance concern about not being able to complete the project. So putting that comment out there for any response you might have, can take it up later in a virtual office hour. But I think, you know, very interested in any flexibilities. Given the compressed timeline? And then one more question to add, and again, this is very technical, but I think it fits into what you were just discussing.

So usually federal funding has a 25% or 10% flexibility between line items, but these budgets, these RHTP budgets, are split by initiative and allowable cost buckets. So what will the variability be between federal cost categories, and how will the initiative and cost categories impact within a project. So again, we could take those up in another setting, but just want to add those comments, that comment and question to this part of the conversation. Thank you. Sure, and thank you, Jen.

I think both of those are elements that we've seen from other organizations, and so I think I can provide maybe a high-level response, but I think it's— I want to plug, you know, both our RHTP email address and then also the Alaska Community Foundation's email address, that those are both really great resources for applicants applicants, and then as we move into award for awardees to reach out to say, hey, I've got a technical question for how to actually implement my project. And maybe somebody who has access to the chat can put those in the chat. The Alaska Community Foundation and the, the DOH kind of RHCP program team email boxes are great places for people to ask. First, on the procurement requirements, I will say that in general, You know, we understand that there is a lot of tension between federal requirements for these types of grants and cooperative agreements and the tight implementation timelines. I think we're feeling that tension at every level.

We see it, you know, our federal partners are working under these, these same kind of timelines and within the same constraints. At the state level, we see that. We're seeing that for our subawardees, and I think that that's a common tension across states. So we want to work with organizations so that we can understand, you know, their specific circumstances. We're happy to work with our CMS program team and say, look, our subawardee is interested in doing this type of project.

Let's—. This is how they plan to go about it. Um, can you, you know, provide us with some guidance and some advice to make sure that, that what they're doing fits within the program requirements? So I always recommend if someone has like specific question about their own project to reach out and we can, you know, work with them. I do think that kind of that general guidance though, as we learn things that, you know, through specific questions that may be helpful for other organizations to understand too.

We're trying to update the resources on our website, looking at what's the best way to do this. Is it office hours? Is it, you know, updating our written guidance, things like that. So certainly we want to get that information out to our partners. As we have it.

So on the procurement one, I would say, you know, please encourage that organization to reach out to us and we can kind of work with them to understand how they're planning to approach their project and then try to understand what flexibilities may be there. For the—. Is it fair to say that kind of the guidance from CMS has not been completely clear on that requirement? And that is one of the reasons that we want to reach out to them when you have a specific project that could be impacted by that. Yeah, I think, you know, as we ask CMS questions, and fair enough to them, I think as we ask them questions, when we ask questions in generalities, then they provide the best information back they have.

And they typically say, you know, go look at the, you know, go look at the CFR, go look at the federal rules for this type of a project. But if we bring to them a specific example, they're really good about saying, let's help you understand what would work or what wouldn't work here. I think it's, you know, for all of us, I think it's fair to say it's easier to look at a certain instance rather than a kind of general overall view. And they are, I think our partners at CMS really do want to get information out, not just to Alaska, but to all states to say, here's how this program is going to work. And they're balancing, again, you know, building up a new program that fits within the federal requirements that apply to these types of programs.

In rapid succession. So I think the more questions that we can ask, the more program refinements they can build in on their side too. So we really do appreciate any kind of specific examples.

Nils, go ahead. Yeah, I just, I mean, I've been through enough of these processes that I'm used to Alaskans saying we need something different. Right? And I think we should be clear along the way that compliance is compliance. And yes, we can go through lots of iterations of communication with CMS and federal partners about, can we do this and can we do that?

And it will add to the overall timeline for delaying a potential project. So I think there's a couple things and we can all probably work on how to do procurement better, faster, and still be compliant. And I'm looking forward to the department's resources on that or whatever else is able to come out. The other thing I'm going to— I think to think about is if you can't be compliant within that timeline, it probably impacts your, like, determination around project feasibility, right? Like, that will be then a department consideration for if we can't get through a procurement with enough time, then this project doesn't end up feasible within this time.

And so people will have to think about de-scoping, reworking, and other ways to actually be compliant with those federal guidelines. But it's great to hear that CMS is responsive, right? Like, and federal agencies are great at like, we want this to be successful, right? Like, they don't roll out these programs not to be successful. But just kind of build all those factors into your considerations if if half of your project period is trying to get to the flexibility you need to implement the project, then that's probably part of the problem that you're— it's just going to compound the problem that you're having.

So those are just some thoughts. Thank you. I appreciate them, and I think it is a really good point that I think compliance is compliance at the end of the day, and there are some components of this program that are— that just are the components of the program, right? And we look at the timelines and we look at some of the limitations and some of the pieces. And, you know, while our— again, our CMS team, I cannot say enough wonderful things about them being responsive to us, answering our questions, making sure that we understand or that they understand what we're trying to do and how does that fit within the CMS requirements.

You know, flexibilities only go so far as they are allowed to have flexibility. Abilities in certain spaces. But again, that, you know, I think, I think you're right. Everybody is approaching this program from wanting to drive success from the position of wanting to drive success. And we've seen that across the board.

I think too, it goes into a little bit of sequencing for projects, right? Like there were some good LOIs that we were not ready for this round, but those are things we want to build out so that we can be ready to be really successful with those next round, right? Same thing with some— I'm sure this will happen with some of the applications as well, right? It, it, there's an element of sequencing and timing that we need to take into consideration because we need to make sure that we're able to expend these funds within that window for future years. But we need to think about this as, you know, a kind of a multi-year, that multi-year perspective.

Any other comments or questions on the slide? The one thing that I do want to address is the second part of Jen's question, which was asking about the 10%. And so I would say what we've seen What we've heard from CMS is that, or the, like, adjustability between budget categories, right? And so I think that, you know, we see, we're asking for applicants to provide us information on their budget within kind of two different dimensions, or three different dimensions, I guess, right? First is based off of the initiative.

We have asked organizations to really kind of funnel their project or align their project to one primary initiative. We are, you know, we know that a lot of this work, there's cross-pollination, I guess, between initiatives that you may be doing one thing that could be supportive of multiple initiatives. But we are asking organizations to, as best they can, pick one initiative. I think we offered the opportunity for organizations where it really, they're like, no, it's really two, to provide that. Their budget at least under two different initiative components.

But I would say, um, I would strongly counsel organizations to look at funneling to one initiative because we do know that we need to report up, um, how are we advancing projects, how are we advancing work, how are we expending funds by initiative. And you can say, you know, I have this, um, this workforce initiative where we're building out maternity, the maternity workforce, and that very much so could be under workforce or it could be under Healthy Beginnings. You know, I think that we would want you to really just pick one and say, look, it's primarily a workforce initiative. Yes, it's going to strengthen your Healthy Beginnings thing, but this is where this lives. And we'll work with organizations too that advance through this process to make sure that, you know, we kind of understand and that we're all on the same page about which initiative are they primarily driving towards.

Then when we look at the CMS cost categories, those federal cost categories of personnel, fringe, travel, equipment, contractual, other kind of those standard cost categories that you see across a lot of other federal programs, within those cost categories, that's where CMS has communicated to the state that we can adjust between those cost categories and, you know, make spending adjustments of up to 10% without the need for a budget amendment. If our, um, if our budget needs to shift more than 10% in any direction between those cost categories, then, then we do need to amend our budget with CMS and kind of say, here's, here's the new look at that. Those program requirements are meant to flow down through the subawards and subrecipients. So if you have a subawardee who says, okay, here's how much I thought I was going to spend on personnel and contractual and travel, but then their amount kind of shifts and it stays under 10% between those categories. That's allowable and that aligns with the requirements that the state has to align with to our federal partners.

Jen, you also asked about the use of fund categories, which is the alphabet soup, the A through K or J or how, however far out the alphabet goes. Those are programmatic categories, the way that I've been thinking about them. Those are from a program perspective how these funds are allowed to be used. And so when we report, when we ask for our subawardees to say, I'm spending, you know, X number of dollars on fostering collaboration, or I am spending X number of dollars on behavioral health, and that's what I'm planning for. We know that we are going to need to report up to CMS across the program.

Here's how many— here's, here's how the funds are looking under behavioral health. Alaska spent X number of million dollars on behavioral health. I, to my knowledge today, there is not the same requirement for looking at, you know, the 10% variance between those cost categories if it shifts. You know, I think that as people are awarded, if they're finding significant shifts, if they say, hey, look, I proposed my project entirely was going to be under behavioral health, but really I think it should be fostering collaboration. If they want to get that granular, I would say work with ACF, work with us so that we can understand those shifts.

But those are really programmatic categories as opposed to kind of the help me understand from a budget perspective categories, which are those federal cost categories. I hope that was helpful. I realize it's— it is a technical down in the weeds question, and we will try to put more information out to answer some of those in a written format. Well, I just want to compliment you on managing all the details of the question and providing all those details. So thank you very much, Betsy.

I really appreciate your answer on that. Yeah, problem. It gets some insight too into the level of complexity that Betsy has had to build out for this program. Everything has to be viewed at multiple angles and balanced.

Any other questions on this slide?

Okay, next slide. This slide, I don't think we need to spend a significant amount of time here. This focuses on what do these timelines mean for awardees and how do these performance periods kind of stack up. So for this first funding cycle, we expect that our implementation awards could begin as soon as August 1st. I want to caveat this to say we expect these, these implementation awards to begin in August, right?

I think that as we move through this timeline, like I mentioned before, the ACF team, the team, we are all working incredibly hard putting in incredibly long hours around the clock to move through a thoughtful application review and to make decisions. And then when we make decisions, there are some elements of timing that end up being out of our control. There's an element of back and forth with CMS for certain types of projects. There's, you know, review cycles. We are truly working as hard as we can to move applications that advance into execution of grant agreements as timely as possible.

But I would say, you know, when we say August 1st is the start date, that's probably the earliest start date we could potentially see. But I would anticipate that those, those subawards would, would be executed in August depending on, you know, what degree of question or back and forth or refinement we need to have. So just want to share that. But we, you know, anticipate that the implementation awards will begin again later this summer. And for the first performance period, organizations should plan to complete their project activities and expend their awarded funds by June 30th, 2027.

They would have an annual report due about a month later, and that also provides the state enough time to wrap up our reporting requirements and fund drawdown requirements. Under the federal timeline to, to finish our activities by September 30th, 2027. And then you can see in the table that there would be a similar cadence that would repeat for each subsequent performance period. And our intent is to provide consistent annual implementation cycles throughout the 5-year Rural Health Transformation Program. As we look ahead to future years, we anticipate that there may be performance periods or different funding opportunities that open, um, on a fall cycle.

I would say that in general, our intent and our approach is to build out for every funding opportunity 12-month performance periods for consistency, and so that people can plan as they say, okay, I'm, I'm planning a project, I am interested in RHTP funding for it, um, to ensure that everybody's kind of looking at the same you know, cadence that we'd like people to be thinking in 12-month performance periods.

Any questions on this slide?

Okay. Okay. So again, you know, as we mentioned at the start, there's been a considerable amount of work that has brought us to this stage, and it really does feel like we're in the thick of it and that we're still in the program buildup. But we already have identified that there are a lot of lessons learned, and we have some observations from the process that we intend to kind of roll in. I think we're very interested in this group's feedback and your observations and reflections, and we kind of want to talk a little bit about, you know, what's coming next too.

But, you know, I'll just share that, you know, one of the first observations is really that the scale of interest in this program and organizations that are ready to engage— we knew that this was going to be a transformative and incredibly impactful opportunity for the state, and the interest that we saw and the engagement that we saw far exceeded our expectations and really does reflect the substantial statewide demand. And we see So much active engagement, and we are really excited to continue this through the program. We have learned that the readiness grants as originally envisioned didn't align with kind of program requirements and program expectations. And, you know, as all of our funded activities really have to demonstrate that clear and direct connection to the RHCP initiatives and allowable uses of funds and goals, we shifted our approach there. You know, I think that this aligns a little bit with some of the conversations we've been having, that we are looking for ways to build out support.

We're not looking for ways, we are discussing and building ways to, to roll out support and technical assistance for subrecipients. We're looking at how can we support our subgrantees in understanding what are the federal kind of program and budget requirements around this, what are some of the programmatic requirements, what are some practices that may be rolled in. And I think that's an area that we can expect to see a lot of growth over the next year is how can we support the state or the statewide organizations and community organizations and regional organizations that are going to be engaging in this program in providing some technical assistance.

You know, I think that we have seen a really wide range of themes and strategies, but we've really seen them line up nicely with with the initiatives that we built out, which is good because I think we built those initiatives based on a lot of community and partner feedback. We knew that this was going to need to be a, a statewide collective project. We approached it that way from the beginning, and I've been really heartened to see that some of the most exciting and innovative ideas that have bubbled up through this process really do align with, with those initiatives. And so it feels, you know, like we kind of created, you know, some good, a good roadmap from the outset, and we're excited to see where we go. I would also share that the letter of interest process was incredibly valuable, especially for this first year.

I think it provided a really strong kind of baseline understanding of where the organization's at today, where are we at as a state, but I think we see opportunities for refinement. And to provide a little more, you know, direction and guidance in those future funding opportunities in future rounds. We've heard from organizations that they appreciate a simplified structure, but I do think any way we can simplify this process for organizations is something that we're interested in building. And we know that it's a lot of work to provide information to the state and to apply. And, and we're looking to, you know, build in refinements where we can to kind of streamline that process because, you know, we can always improve.

I want to share one thing about dashboards and then DC REACH, I may ask for some of your reflections as well. You know, as we've shared out the information around what letters of interest did we receive, we know that we anticipate anticipate sharing information on our website about which projects advance. And we've heard a lot of people, ourselves included, say, "We're really interested in looking at this and being able to sift and sort and identify what projects are advancing, what areas do they cover, where are they located, all of that." And so, do wanna share, you know, we're working with one of our partners at Guidehouse to put together some dashboards that we can share on our website that will provide the public and this group the opportunity to look in more detail at the projects that are advancing and understand what types of projects are they, where are they located. And I think that we can continue to refine those dashboards as we move through the, through the project. But I did just want to flag that for this group that we're— we hear that, that you and the public are very interested in where are these funds going, how are they being used, and then being able to kind of track and view that progress as they go.

And we're building out those resources and we should see those soon. DC Ricci, is there anything that you would add to this slide? I would just say in terms of dashboards and being able to kind of easily manipulate the information that's being put out there, especially because there's a large volume of it, we've committed to this advisory council in the past and the legislature, and we've done so publicly that we really do want to make sure the information is usable., in a way that's easy to access. And so, Betsy, I'm not sure what the timeline is for guideline— for Guidehouse to get that dashboard up. I mean, our, our goal is to have it ready when we award, when we make award notifications, so people will be able to use it at that point.

Is that still accurate? Yeah, that's the goal. You know, I think that when we— similarly to when we announced, outcomes from the letter of interest process, you know, we put some information on our website. We would like the information that we can put onto our website when we announce the outcomes of the full application process to include some sort of a dashboard component. I will say, um, I imagine what you'll see when we, when we first put that online will be the starting point, and that we expect that that will be built out and refined and will grow and get better.

And, and we'll be, um, you know, we'll be able to adjust it based off of feedback. But we do want to provide, um, information in a way that's searchable and usable, and you can kind of take that data and translate it into information and conclusions a little bit faster. You know, we just— we're building— every element of the program is growing at the same time. So I do think that as we move through this, we'll be able to see adjustments and refinements rather than having to build everything at once. And I'm excited for that.

So, Allison, I think maybe we can stop screen sharing just so that we can see everyone's faces on our box of squares, if that's okay. And I kind of open it up to the Advisory Committee for any— or Council for any questions or thoughts, discussions, or feedback as well on the process. Again, I think we will continue this. I would like to come back at the end of the award process and have a more in-depth discussion about some of these, some of our observations, but it's always helpful to start that now.

Representative Mina. Oh, sorry, I saw your hand first. No, perfect. Thank you, and thank you for the presentation and just for the amount of work that the Department of Health and the Community Foundation has really put into this process for year 1 and now going into year 2. Just 2 questions.

The first, on the dashboard, is GuideHouse designing it, or is it the Department of Health designing it and GuideHouse House is giving that consultation. And my second question is, um, I really appreciate the key themes among the advancing proposals. I'm curious about key themes among proposals that were rejected, which were the majority. And I don't know if it's because they were more readiness grants, more ambiguous, but what learning lessons could be provided for those other organizations organizations, especially since the department doesn't have the capacity, or ACF doesn't have the capacity to provide that individual feedback.

Betsy, do you want to talk about the dashboard? Yep, I can start with the dashboard. I would say that's, you know, we're working together with GuideHouse to say, here are some of the elements of really, I would say, the foundation of what you'll see are elements of what the information that organizations provided to say, you know, okay, here, this is my organization, this is where the project is intended to reach, This is what I intend to do, and we're working together with them to say, how can we best reflect this information in a way for the advancing projects that the public and the interested parties can look at? What are we— what types of projects are moving forward? How are we, you know, supporting different areas?

So I would say it's very much co-designed, and you'll see that kind of built and on the website. And I think that, you know, we're also interested in working with this group and with other organizations to say, okay, here's a starting point. What other information would be helpful to see? How does this sit with you? Does this, you know, kind of track and make sense for the type of information you were hoping to get from that?

Related to the second question about feedback for organizations, Betsy, do you want to kind of talk about where we're at, what our thoughts are. Yeah, you know, I think that, um, what one of the things that, you know, I would echo some of the comments that you made earlier, DC Ricci, around, um, you know, the majority— you're right, Representative Mina— that the majority of the letters of interest were not advanced. And I wouldn't say that that is, um, really a reflection of, of volume. I think that's one of the main reflections that we see, that we, you know, have as we've discussed with this group before, when we look at the midpoint of the asks, the volume, the dollar amount of the asks from that first letter of interest process, that totaled about $2.5 billion in first-year asks. And we know that we have the $270 million available for this first year.

So we couldn't advance everything. And when we think of how, how we tried to make those decisions, you know, we really tracked back to the initiatives. We tracked back to readiness. We tracked back to what do we see as being able to kind of advance in this first year, thinking about some of those elements of are there externalities, you know, is the department, you know, is the state ready for this? Do we need to bring partners together in some areas to make sure that we are collaborating?

We tried to as best we could, identify areas where groups may need to work together to kind of create a cohesive plan for a certain type of work before we're ready to move into funding. So we're trying to be as thoughtful as we can there. And I think that the, you know, what we've seen is an opportunity for us to communicate out to organizations some of that feedback of, okay, it wasn't this in You know, you didn't advance in the first round, what are you looking for? I think we see that through future funding opportunities that we'd like to provide more information on the front side and say, you know, here's a funding opportunity for Healthy Beginnings. We are looking for these types of projects and provide a little bit more of that guidance in the funding opportunity up at the beginning, and hopefully we can, you know, provide that feedback to organizations so that they can say, okay, here's what the department's looking for.

Here's where I fit. I see this. So that's, that's kind of the approach that we've taken. Um, I would add, and then TC, Richie, what would you add? Yeah, I would add, um, you know, right now we're, we're, we're just, we're trying to be like laser focused on getting the planning grants out the door.

And ACF is doing an incredible job of supporting us with that and getting the application scored. And out the door. But there is a kind of a list of follow-up that I think we have. I have a mental list and I've written it down, right, where there, where we need to go back to some of those LOI kind of groups or themes where again, we needed to build out that coordination on a statewide basis. Like maybe everybody wants to do a certain type of training.

Well, what are the standards for that training before we did, before we move forward with funding those, right? So that we make sure that we are coordinated in that. So there's a series of actions that I think we've kind of bookmarked and we're going to move forward with. But because of the timeline and the federal reporting, I know we're going to talk about that under new business. We have to be like, we have to prioritize right now getting through the applications and getting that out and awarded.

So I would anticipate some more time in like August and September where we're coming together and reaching out maybe to specific groups of organizations that have similar alignment. And doing some workshops or kind of bringing everybody together to say, we need to clarify this. And then when we move into round 2, I think we anticipate a lot more direct, like some more directed initiatives that, that will make sure if we're funding things, we're doing it consistently, right? So we don't end up with people engaging in or or building out a series of different items that are connected but haven't been strategically, like, are using different standards or are trying to achieve kind of different goals in a way that ends up being conflicted. Like, I think that's one of the challenges we have in our healthcare system now is that we are all pretty highly fragmented.

Like, Alaska values independence, right? How many of our, how many times have we heard physicians or others say like they moved up here to move away from some of the like heavy managed care that was happening down south. And there's benefits to that, but it also means that we are not as coordinated as you could be when you're under a larger system, and it means that there's additional fragmentation. And so one of the challenges that I think we really have with RHTP, and we saw it in the LOIs, we're seeing a little bit in the applications, right? And we're going to try to shape it more in round 2, is how can we preserve that independence that I think is really valuable to all of us and our system supports, but make sure that there's consistency in like standards or goals or approaches or some of those things that right now, at least in our Medicaid program, I see creating a lot of barriers or challenges for items as they come online or as we try to pay for them.

So when I think about like Round 2 coordination, that's, that's kind of what I'm thinking about. How do we pull these groups of ideas together and make sure that before we, before we consider funding them in round 2, that we're aligned on kind of those core components that we need for it to be effective. If I can just briefly follow up, I just have a comment, a question. I know other folks have, are in the queue. Just going back to the dashboard, I actually appreciated the Department of Transportation and Public Facilities and the their public dashboard that they had for the STIP because you had a geographically map based on projects.

You could click on individual projects, see like specific funding awards and what they're used for. And I just think if you're looking at all of these different awards to subrecipients, that could be a good model to refer off to. And second, back to these different, um, the interests that, that were rejected and having that follow-up later in October. I don't know if there's any consideration to potentially make some of those follow-ups or themes public or having an earlier notification, just because it seems like it's a lot of work for the department to also do these follow-ups that were really just catalyzed by the RHTP process to help coordinate these different groups together that I understand will also funnel into those Year 2 awards. Perhaps some of these different organizations can independently start to communicate together so they don't have to wait for an email from the department in the fall.

So just a suggestion. Thank you. Thank you, Representative Mena. And I think I know, like, the Trust and others, we've said we, we need to do this coordination and support. We can't do it.

We don't have capacity at the state, so we're going to need you to kind of help facilitate that or to coordinate. And so we're going to be— we actively need help doing some of this stuff or coordinating entities so they can do it independently. Appreciate that.

Jared, I see your hand up next in my box of squares. Yeah, thank you. I just wanted to appreciate the fact that you guys are acknowledging that we're also kind of going through a lessons learned and that things are going to different the next time as we develop, as we see this first round through and embark on the next round. And I think that's really important because we're all doing this for the first time. But I also want to compliment you and your team on how much work you guys are producing.

It's all— it's still, in my mind, an impossible task, and yet you guys are still here and you're still doing it. Which is so impressive. My question is— and you don't have to go into a long answer— I just wanted to ask, is there any other support that would be helpful for you guys, especially as we kind of go through lessons learned and go forward into the next round? Any resources that would benefit you or Alex's— your team— ways that we can help you do your job? Because you guys are doing a great job..

But I know it's an impossible pace to keep up, so I want to make sure you guys are supported.

I might start, Betsy, and then pass it off. Jared, thank you for that acknowledgement. It is much appreciated. We look forward to getting through year 1 intensely.

I think to Representative Mena's point on what we were saying, there's so much from the LOIs that we can come together and build off of and create the structure that we need for many of those kind of shared concepts to be successful. The department doesn't have the capacity to do that for everything that could occur in that list. We're going to have to like pick and choose. We're just not going to be able to do it. And we're not going to be able to start digging into it realistically until August, right?

Because we got to get the money out. So if any organizations want to come together and they see each other in that list and they want to start having those discussions, we would greatly appreciate that. And if you want to let us know that it's happening and we can provide, you know, some sort of resources or can connect you with you know, the Trust— sorry, Mary, to put you on the spot— or Nils, you know, Jared, you do this. I mean, everyone on the council, right? You guys, you know how to support these types of things.

I would say, please, if you see something that you can help in and that you know is going to be important for the system as we prepare for round 2, don't wait for us to take the lead on it. Step in, let us know, hey, we want to work on this, and we will give you a very grateful thank you.

I would just say I heard Jared volunteer to babysit my children, which is great. So that would be very helpful if you want to come and do that. That is true. That is true for the record. So they're wonderful.

I will drop them off. But beyond that, I think that I would just echo what TC Ricci said, that, you know, as we think about what did we see what do we see in the LOIs and what do we see in the full applications and what do we see as advancing in year 1? I think we see a lot of building blocks that are building towards these initiatives, and I want us to be collectively thinking about these initiatives as cohesive kind of projects where we started somewhere and that we would like to be able to say at the end of this project, at the end of, you know, the 5 years and all, you know, the 7 years with expenditure windows and all of that. That we've really kind of built some systemic transformation across these 6 areas. And so I think that that planning and that work between the state, between organizations, organizations working together, that collaboration and that partnership and that, you know, interest in trying new things and in working differently than we have and in working together and in saying, okay guys, really look at this, how do we, where do we all fit and how would we move together collectively rather than kind of each of us moving our own bit forward.

That collaboration on the front side would be really helpful because it makes it a lot easier for us as we move through this process to say all of our partners, all of our organizations, they've decided and, and kind of provided input into how are we moving this initiative forward. And, and it kind of gives us that opportunity to continue to grow that where we see, you know, the regional planning and what are we talking about at the regional planning level. And, you know, even like the gap analysis that we talked about earlier, how do all these pieces kind of weave together something that's going to be a cohesive project? And so doing that work on the front side is so helpful. And, you know, like DC Ricci said, our team is incredible.

Like, we have hired fantastic people to come in and to move this forward. And we also can't be everywhere all at the same time. And so some of this strategic, thoughtful planning, we really, you know, get started. That would be great. You know, continue to build on what we've done.

That would be really helpful.

Terri?

Yeah, thank you. I guess I've got a comment and then a question. First, the comment, just want to appreciate the volume and complexity of the work that your team is doing right now to get all this done. And I think with that in mind, I saw a comment, I think in maybe the last meeting, of just wanting to express the priority of like, you know, it seems like from where I sit, it's really, I would just really want to emphasize that I think the priority, I would really love the priority to be on you know, focusing on the efficient and timely distribution of funds. And there are lots of good ideas out there about other things that could be done to support this process.

But like, if we can, if you guys can focus on that and we can maybe support you in other ways, because knowing that you can't do everything all at once and, and it seems like the priority is getting those funds out in a timely way to Alaska organizations. So, and then my question is, there is, I think, a lot of interest in understanding geographic distribution, not just in terms of the service areas, but also in terms of who are leading the projects. And it seemed like there was a lot of, a lot of entities that are urban-based and understanding that a lot of entities that serve statewide populations are based in our urban areas, including my own. But could you speak to kind of how rural representation and geographic reach into rural areas are being factored into funding decisions and also maybe how those might be represented on dashboards.

Sure, I can start with kind of thinking about the, you know, that I hear you on wanting to ensure timely distribution of funds in the process with that. And I would say you see a lot of folks from the Alaska Community Foundation here. And our teams are working together very closely to ensure that we establish processes so that when we make funding decisions, that we can move through that very quickly and that we can support organizations. And Alex, I don't know if there's anything that you would want to share on that front. But, you know, I'd invite you to, and I would just say it's certainly a focus of our collective team.

Yeah, I think with each round, Each step, actually, it feels like a round, but each step we're kind of finding out what we could have done better and how we could have actually made people more prepared. Is that the part that you were asking me about? Yeah, and just, you know, I think that Terry had shared that there's a desire to have kind of the DOH team and the ACF team ensure that we're really focusing on once we make funding decisions that we move through this process as, uh, in a streamlined manner where we're really supporting, um, subrecipients and kind of timely distribution of funds. And I think that's such a strength that ACF brings to the table, and we're, we're very glad to kind of partner on that with you. Yeah, and we really are tracking it, you know.

So there's a lot of things that we would like to do in the application process in terms of technical assistance that we can offer that we really didn't have capacity for because we were building it at the same time. And that's just the challenge with this compressed timeline, but we have lots of ideas about things that we could do. Even the partnership matrix was sort of creating a way to sort of help applicants fill it out so they got the answers that we needed, you know, and, you know, kind of try to figure out how to make it easier, you know, whether there are more templates and more guidance. But I think there will be a lot more the next, next time around. Thank you.

And then I would also just mention too, with, you know, looking at the geographic representation and how are the rural areas represented in what we see funding and how we advance projects. And I would say, again, looking to that portfolio review element of the decision-making process, that that's a really critical component of that. You know, I think you heard Allison speak earlier about how we move through the rubric review, and we're looking at each project individually.. And then once we move from that kind of project review, then when we look at the portfolio, that balance from a geographic perspective as to not just where our organization's headquartered, but where is the project reach going to actually occur, those are two really critical components of those— of the ultimate decision-making process. I would balance that with kind of the concerns that Jen mentioned earlier about entities saying that they are doing statewide work or regional work.

You know, I would say as a reviewer, again, too, in looking at the evaluation, if an entity is saying that they're doing regional work and then they don't have or list, have in their partnership matrix or demonstrate that they have, you know, an established relationship with the main entity in the region providing health services, I, you know, I think it would be difficult to, but it would be difficult to view them as having a substantial impact in that area, right? So I think we tried to design a multiple process to take care of that. Uh, Mary, would you mind? I'm sorry, Alex. Um, also because you had— they're all of the reviewers, you know, really are from these communities and from across the state and have so much knowledge, um, the feasibility You know, it really makes a difference, you know, when we were, when we were really reviewing it, you see who are you working with, you know, what is your experience here and all of that sort of comes out and it, it shows if there aren't enough connections to the community or to the work.

And that really affects the scoring, I think, of any of the applications just on that feasibility piece.

Thank you, Alex. Well made point. Mary. Yeah, hi. I just had, I think, 3 sort of categories of comments.

First of all, in building on what's been talked about already, the— we've been helping at the Trust with Alex and her team on the application review, and I just want to give a shout out to that. It's really, as everybody on this call knows, it's extremely complex. It's not perfect, but the iterations as it's going forward is steadily improving, and Big thank you for that. The other thing I think is working really well from my perspective are the, the convenings. I've been able to go to a couple of those.

I was telling Emily I was in Cordova last few days for that one, and these are really important ways of getting the community to be in to sort of air what they are thinking about. It's also a way for the state to figure out where do we lean in and have things that have to— we have to do together. As a partner and a stakeholder, and then where do— where communities, can they do things on their own? For example, when you think about, you know, affordability, sustainability, and, you know, how do you make sure that the— whatever we have going forward is— are the— are going to have the most transformative impact in 5 years? And There's a lot of waste, as we all know, in our healthcare delivery systems, our behavioral health systems, all of that.

And a lot of that waste, not all of it, but a lot of it sits in medical record stuff. So there's a lot of wasted time trying to get information that's necessary to the right people at the right time that the patient can benefit from or the community can benefit from. So that's a partnership between a local area and this, you know, some other entities and stakeholders. That's a big way of driving value-based care that we can all lean in together on, that as we go through the process in the rural— someplace like Cordova is very interested in being able to share that information. They can't do it by themselves, but they can do a lot.

Then the big other part of waste in the system is human beings spending 20 or 30 minutes doing technical stuff in a chart or in a record or in a billing process or a coding process that a bot or something could do, AI could do. And so that's the other big area where then those— because in the rural communities, as you all know, people, they don't have enough people to do the work in general. And if people are doing the wrong work because they have to, and those same people could be doing work that actually impacted outcomes, that would be a great shift. And so that's another sort of shared partnership that's been coming up in those sessions, and I think it's really interesting to pay attention to. And then the third thing from our— and that's just one example, there's a million other things that come up— from the trust perspective, we are looking at where can we fill in the gaps that came up earlier, and we talked to the team together of other foundations that have money.

Gretchen and I'll be talking with the team again in August. So after all the stuff is settled at the beginning of August, or whenever that date is, getting a coordinated look at the gaps and where we can help fill those in is a priority for all of us in, in the world that I'm in. And then we're giving technical assistance to anyone. Even right now, we're giving technical assistance to some of the finalists in trying to get in their application, and we're open for business for that at a very high rate. The team, the staff is working really, really hard on that.

And we're looking at ourselves at AI internally. What can— what is my staff doing that we could free up them to do more strategic work if we were looking at that? We'll share those learnings as well.

Be great. And again, it makes me think about resources, like, you know, what— once we get through this prioritization for getting the funds out, right? How do we think about resources for next round? For the next round that maybe we— it's all about communication, right? How do we make sure people are aware that you are providing that support or some of the other organizations that are coming together?

Jen.

Thank you. And I am aware of the time and I will try and make this brief, but I want to go back a little bit because Terry's comments— I appreciate Terry's comments about regional distribution and then Alex's comments about partnership matrix, and then I couldn't resist but raise my hand. I just wanted to kind of dig in a little bit on that because it seems as though— so just an observation, kind of not in the weeds on that, on the application process— but it seems as though perhaps the partnership matrix wasn't necessarily triggered in certain statewide initiatives. So maybe that hasn't been used by organizations that have proposals that may in fact touch regions, but they weren't somehow triggered to fill that out. So I just kind of want to call that out and say that there are other ways that organizations, so like using the organization that I work for, Alaska Native Tribal Health Court Consortium, you know, we have data around like the zip codes of the patients that we serve.

So just kind of want to call out, you know, robust data sets that might help identify regional distribution. Also, I just wanted to mention, I'm hearing the provider gap analysis referenced. That's come up a couple times during this conversation. Just want to put a pin in that. Would be very interested in learning more about that.

I'm tracking that that has a milestone of, I think, quarter 2 in this calendar year. So, you know, like very interested in what that provider gap analysis looks like. And just a reminder that, you know, the answers you get will be based on the questions that are asked. So, you know, it's going to be— there's pretty diverse services that, you know, may or may not be picked up depending on how a survey is framed. And then just because I heard, and thank you, Mary, for your comments, I heard the comment about value-based care.

I did have a note that I wanted to bring that up. I know that value-based care is on the agenda for the regional planning meetings and very exciting, so many opportunities. But just in terms of like scaling up, I think it's going to become important to start talking about the, you know, provisions and protections for Alaska Native people and American Indian people. Who represent about 35% of the Medicaid population. And those provisions and protections allow that population to opt in, not have to opt out, but to actually assertively have to opt in to any managed care organization.

And so in terms of scaling up, I think that's got to be a big part of the conversation so that folks understand that. Thank you.

Thank you, Jen. I would add in terms of The gap analysis, your point is well made.

I think one thing that we found at the regional meetings, one of the areas that we're really focusing on asking is like, here's the data that we have from the department, and I will tell you that data is not always complete. There's many— there's— and, but the question to the community in the region, does this reflect your experience? Right? Because you can have data, but that data doesn't always reflect the experience of what people, how people can access care in their community. And so I think the gap analysis provides us, excuse me, with important information that we need from a systems perspective, but it is, it is and will always be imperfect information because it will never perfectly represent what people are experiencing or what community needs are.

So we need that combination of both. Growth. And in terms of value-based care, we had initially calendared internally a value-based care workgroup or workshop to start to have some of those discussions for entities that we know are going to be important contributors to that. We had actually looked at that for this month, but I go back to our priority right now is making sure that year 1 funding gets out the door. And so we are having to make decisions about looking, you know, looking at that at later dates because we're not, we're just not going to be able to support it in July.

So we do need to spend more time having that conversation and all of the unique needs of Alaska and kind of the nuances between how we do something differently that we have not been able to do before, right? Because we have a really different environment. We need to start having those discussions now so we can be thoughtful about our investments with our HDP and future years.

Niels? Yeah, Jared earlier was like, what more can we do? And I do think, kind of recognize that your priority, DOH and ACF's priority right now is getting dollars out the door, right? Getting these projects moving. So you're probably not spending that, you don't have the time right now and shouldn't be looking back at who didn't get funded.

Jared, I think it would be a fun exercise, and I keep thinking I'll have the time for it, to look back at all the applications or letters of interest that came in and do kind of a combing through of who's out there, what were the interests, and like that might be something that, you know, a small group of us, and I would volunteer to be part of, could go through and just kind of get our take on what else was out there and how do we kind of leapfrog, like get ahead of the next round to be able to provide the department and ACF some insights, you know, just from our perspectives. But I think that would be at least fun and maybe interesting and hopefully helpful. I just find it pretty interesting that I've now been volunteered to babysit children and comb databases here. So this meeting is not going the way I had planned, but no, I agree with you. I agree with you, Nils, and you and I have partnered on a lot of things, and I think that's a great idea, and we certainly would be happy to work, certainly with your team, Nils.

We work on a lot of projects. Good point, and count us in. Is there an opportunity to have Betsy's Kids do the database analysis? Like, could we—. This is why we work very well together, is we creatively think, you know, to solve problems.

So yeah, perfect. They're very low-key and they're very well-behaved. So, how about—.

Thank you. We would say yes, please, thank you. You know, I'm sure we can find time to at least share some of what we've seen at a high level. I need to kind of put my thoughts down in a cohesive way on paper and maybe that can provide a good starting point.

Okay. Any other observations or insights? I know we're running short on time. There's a— I think we might just jump. I might give Alison a moment to talk very quickly about regional planning upcoming and then move from that into unfinished and new business.

So, okay, hearing none and seeing no hands, Alison, do you want to talk about regional planning meetings very quickly, let's do lightning round. Yeah, happy to. We wrapped up our 6th regional planning meeting yesterday in Cordova, and as I'm sure many of you know, these are part of our milestones. We have intentions to do them, uh, first round in year 1 and then a second round in year 3. And part of this is what DC Ricci mentioned a moment ago about making sure that we are incorporating both the data we have but also feedback from communities about whether that data accurately reflects what they're seeing in their communities.

But secondarily, we're also interested in connecting people who live and work in those communities and getting them started on thinking about how they could work together. Even in some of the smaller communities, it's been really surprising to see people who say things like, oh, you're working on a transportation program for older people to ensure that they get to their medical appointments, we are too. And seeing kind of the, the wires start to spark about maybe we could do this together instead of trying to build the same thing in two separate places. We are also developing reports after every single meeting that encapsulates what we've heard, and we are using those as a source of feedback and kind of a guide for ourselves as we move through the process. But also we are sharing that back with community communities to use as a resource moving forward so that they can continue the work on their own.

And I'll just share quickly, it was really— it's been really inspiring to be at these. And there was a conversation in Cordova yesterday that has been sort of bouncing around in my head. This gentleman who helps run the EMS program there, and he has this cool idea for an exchange program that would allow people from Cordova to train elsewhere and get skills in areas where maybe the EMS call volume is a lot higher and a lot more intense, while also allowing people who live and work in other areas to come spend some time in Cordova and have a little bit of a burnout recovery period in a place that has maybe one call a day and that are generally less low acuity. And Cordova struggles with a lot of workforce challenges in terms of recruiting people and housing shortages and all manner of things that I probably don't have to explain to you guys, and it was It was really cool watching him realize that this was a thing that he could potentially get started under RHDP and then continue sustainably elsewhere, when for him this had until this point been just a pipe dream or just something that he sort of played with in his spare time, and that he didn't maybe necessarily have to live with this really intense workforce, workforce shortage for the rest of his career in Cordova. We have 3 more planning 3 more regional planning meetings coming up in the near future, and this is an incomplete list.

I expect that there will be at least 2 more this year, one in Juneau and one in the North Slope that we are still working on pinning down dates for. Possibilities will also continue into next year, so we're not done, but the progress we've seen so far has been really exciting and encouraging.

Okay, thank you, Allison. You can stop sharing.

Just cognizant of time, are there any other thoughts or comments on department updates?

Okay, seeing none, the next item on the agenda is unfinished business. Is there any unfinished business that we want to discuss before we move on to new business items?

To new business items. So again, we've got a couple of items on here. One is upcoming reports, one is milestones, and one is the stakeholder committee. So Betsy, do you want to talk about the upcoming federal reports? Yes, and I think this is really just kind of a— this and the milestones can both be a brief update.

I think we just wanted to share with the group a kind of a reminder that our program team has our first annual report due to CMS by the end of August. That, that report will cover the time period from December 29th when we received the notice of award through the end of July. So we'll be reporting on our activities for that time period and providing that to CMS at the end of August. The non-compete continuing application will be due around the same time. So that's again where the state puts together kind of a refresh of our initial application, and we tell CMS, okay, here's what, you know, if there have been any adjustments, you know, to a project, to the project plan, and also looking ahead at, you know, how do we anticipate that year 2 award being spent.

I will say what I think what we said to this group before, but I will reiterate that CMS CMS has communicated in no uncertain terms that they are not looking for states to make major adjustments to their initiatives, that these kind of continue— non-compete continuing applications are meant to really align with, with the initial application, with the initiatives that we built out. That said, we have asked CMS as we look at the milestones— I think this goes into the next component— the milestones that we built into our application evaluation, we have identified that maybe we were really ambitious in what we thought we were going to be able to accomplish by a certain stage in our program. And most of our milestones have us completing activities, you know, by 2028, which is, you know, midway through the program. And I think as we have seen how CMS CMS is looking at those milestones as being reflective of kind of progress across the length of the program. We have said this feels a little front-loaded if we were meant to accomplish most of the activities that we identified in our application by the midpoint.

And CMS has said that we can— they're willing to work with states to make adjustments on some of the timing of that. So, I think that you'll see that as something that my team has already started to work work through that we've started to look at, okay, what is, you know, recognizing the kind of the body of the milestones that we have, where would we want to make adjustments on the timing, what's going to make the most sense from the implementation perspective with our partners, with ourselves. Some of those milestones that you see in the application are, you know, kind of gates for the state to walk through, but some of them are dependent on our partner organizations that would ultimately be funded through that too. So, So I just flag that to say we expect to see some adjustments within that milestone space to be more reflective of progress spread across the life of the program rather than us saying we're going to get it all done by 2028. I would also add to, I think, again, everyone's working quickly, including CMS, and there's a difference between funding being awarded, right, and funding being available or released to states..

I think some states just had their budgets approved sometime in the last 60 days, maybe. So CMS is looking at everybody's milestones because if your budget hasn't been released until, you know, May and you had milestones that you were put into your application to complete in that time period, I think they're letting everybody kind of step back and take a look at those and align them with a combination of kind of when their budget has been available, like how fast the feds have been able to move, and then what's realistic for states. So I don't know that— there's not an— it's not— it won't be removing things from the milestones, and there has to be justification for the changes, right? So it is not a do-over by any means. But I think there is just a reflection from CMS that both, I think, states and CMS were not necessarily— will not be successful with these milestones because we are acting on incomplete information at the time they were submitted.

And so they're letting everyone adjust based on that.

Jen, I see your hand up. Yeah, thank you. I appreciate this conversation. And speaking of milestones, I want to thank the state for listening to tribal health organizations across the state who talked about the importance of water and sanitation. And so just in the context of the milestone, I know that launching off-grid sanitation projects had a milestone of quarter 4 in calendar year 2026, but it appears as though— and that's the LOIs, is a large body of material to read— but it appears as though no water projects are moved forward.

So I'm hoping that that is part of your discussion with CMS is to extend the milestone on off-grid sanitation projects. Thank you. Thanks, Jen. That is, that is kind of one of the items we're tracking on the milestone. I think too it's important for us to have some more context around the construction, the federal requirements, and things like that in order for some of those projects to be successful and for us to be confident when we're awarding funding, especially on the timeframes that I know are required to do construction in Alaska.

And so all of those are really important reasons for us to kind of get some clarity from CMS and then think about what's realistic from a milestone perspective for those types of projects.

Is there anything that you would add, or do we have any other questions from the council?

Okay. I, I would add, I think it's going to be important for us, again, maybe this is more of a fall project than an August discussion, but I, I do think that it, an overview of the milestones once those have been updated is going to be warranted. Kind of with the advisory committee because as we move out of the, you know, get the money out the door stage because of the tight timeframe we're on in year 2 and we move more into like the strategic component of what— how is CMS— what are some of the components CMS will be using to evaluate our progress? We haven't talked a lot about milestones, but milestones are one of those elements that CMS will be using to evaluate our progress. So I think it's going to be important for us to be aware of and align on those, but again, we have an opportunity to update those.

One of the other elements that we know CMS, of course, is looking at is our— it's the policy commitments that were made as part of the application. And so I just wanted to highlight that. I think we're in a strong position, particularly with some of the legislation that has moved forward, and I'm optimistic about that in our first report. I think I would share kind of anecdotally Well, I have been at a few national conferences over the past 3 weeks and had a chance to— and RHCP has been on the discussion. So there's a Medicaid Director Conference I was at, and it is fascinating to listen to other states and their perspectives about kind of their position with RHCP.

And what's one of the things that I think has been interesting about this is because CMS did set it up as a, as a, you know, a relatively like ongoing competitive grant. There is a lot of positioning I think that you see between states and to a certain degree everybody's looking at each other and saying, oh, I heard this state is doing really well. Ooh, what if we're behind? You know, and there's, there's moments where I've heard about other states that people are saying, well, they've got it all done. They've got it all out.

I'm like, really? How? We are moving so fast and so hard, and then I will, you know, that state will come to me and say, "You guys, how have you figured it out? It sounds like you're moving really fast too." So from what I can tell, and again, also in kind of having a chance to talk a little bit with CMS, I think we are in the top tier of states in terms of how we are moving and the timeline and the schedule we are on. I don't know that any state is leaps and bounds above others.

I would say that kind of, I would think about it as like banding or tiering. There are some states that have not hired staff. There are some states that have not put out any contracts. And we have, you know, a report to CMS at the end of August, and we have to have money expended in October. So there are some states that I would say are kind of in that tier that is towards the end of the timeline.

But I think Alaska, when I see where we're positioned compared to others, I think we're in the top end of that tier. This year. So, and again, I, I really appreciate everyone that has participated in the council and has helped us along the way, because when I talk with other states as well, I don't see other states that are having the same collaborative relationship that's productive with all of the different entities that are participating in the program. And so those are just a few observations from what I've seen.

Run your own race, Emily. No, the— run your own race. We've got priorities in front of us, and it might be useful for this council to look at what other states are doing, kind of build that into like a September, October, or whatever. Like, I think that would be at least interesting. The other— sorry, it just seemed like we were closing out, and I just wanted to thank— there were almost 100 people online at one point during this call, and so Clearly, there's a lot of interest.

A lot of Alaskans are paying attention to what this group is doing and decisions made by, by the state in support of this program. I saw the commissioner's op-ed as well for RHTP, and I just want to thank everybody who has been online and monitoring this discussion. It's, it's of consequence, right? And I think the Commissioner's op-ed spoke to that. Thank you.

Thank you, Nils. Appreciate that. One other item under new business that I wanted to touch on was the stakeholder committee. You know, I think in the past we had talked about standing up a stakeholder committee. I think with some of the legislation that's passed recently, we are kind of figuring out what comes next in terms of that.

And also, we again, we have kind of run into a little bit of a bandwidth issue with the division, with the department, and we are again focusing on the applications. So I did not want anyone to think that we had forgotten about that. I think it's something that we should revisit probably in August or September and get a sense of how to move forward with that. You know, does, does the way it was initially contemplated continue to make sense? And so I would ask kind of the advisory council to consider that as well.

And maybe we can have a discussion on that in the next month or so.

I just have a quick comment. Thank you. I just have a quick comment on that stakeholder committee, just tying in what Nils and Jared were saying about looking at those rejected proposals. I also think that the stakeholder committee, if you convene one, I know we have to figure out the people first, could also sub in to help address some of these other follow-ups from the initial process.

Thank you. That's a great idea. That's a great idea.

Any other questions or comments under new business?

Okay. With 7 minutes left, I would move into closing items. Um, Betsy, do you have anything in terms of next steps that you'd like to add or what people should be aware of? I think I would just, you know, share, like, like I've, like we've said throughout the, the course of this conversation today, that our teams are, you know, from the ACF side, from the DOH side, we're really, um, applying all of our resources and then some to move through the application review process in a thoughtful way, but also an expeditious way that we hear that there is a desire for us to move. I think that there's, you know, this, this program has a lot of like, let's move fast.

And also we have to, you know, take the time that it takes. And we're, we're really trying to be thoughtful about this process. And we understand that, that people are really ready to go. I would also share that, you know, when we look, we hear You know, kind of going off of what you said earlier, DeeCee Ritchie, about how other states are approaching it. You know, I've talked to a lot of other states and I think no two states are doing this the same way.

And I think that's beautiful that, you know, there's a lot of flexibility in the way that states can implement this program. But I think one of the strengths of Alaska's approach is that we really are taking a community-driven approach to this, that we know that our community partners are the fabric of our rural health system and that we really have been trying to build a program that provides entry points for a lot of different organizations and the ability for us all to work together in really collaborative and new and different ways. And I think we're seeing that. And I have heard other states say, oh, wow, you really are like in it and engaging everybody in your state. And we kind of say, of course we are.

I mean, how else would we be able to do it? So I just really appreciate the partnership of this group and all of the organizations across the state that are, that are contributing to the program. But really, I think that what you'll see is as we approach the end of this month, we anticipate turning around responses and decisions on the applications. We anticipate working with organizations where we need to, to either ask questions or to, you know,, you know, if there's review processes with our federal partners. So, do you kind of want to put everybody, you know, on notice, like, don't abandon your email box for the month of July because it happens to be sunny, that if you hear us, if you receive outreach from the ACF team, from the DOH team, that we would ask that organizations really do be prepared to try to get us any additional information timely if we request it.

Because that will help us move faster through the process and get it so that people can kind of get started and move forward with their projects.

Thank you, Betsy.

I would recommend that we think about the committee coming back, or the council coming back and meeting again in August, maybe mid-August. I would suggest that we work on calendaring that offline. Versus during the meeting. But I think kind of those are my final thoughts on next steps. I would just open this up to the council members for any additional comments, thoughts, or considerations.

Okay. Well, with that, again, I would just say a big thank you to all of you. I cannot tell you how much it means. To be able to say, you know, we need to bring people together, we need to do this work, we don't have the time, and then Nils and Jarad, to have you guys stand up and say, let's do that, that's huge. Thank you so much for that.

Thank you for everyone who spent time on this. Big thank you to Alex McKay and the ACF team. They have just been an incredible partner through this process, and it's really inspiring to see everybody coming together. So thank you again. I hope everyone can get out and enjoy the sunshine.

It was like beating down on my office. And I would ask if there's any objections before we adjourn.

Okay, seeing none, we are adjourned. I hope everyone has a happy Fourth. Bye.