2024 Fund for Health Care Delivery Projects Using Waivers- Application Form

Screening Application for Funded Waiver Projects

OneCare has allocated $100,000 to fund up to five delivery system projects intended to impact the key areas of quality focus and goals.
Minimum funding request: $10,000.

DEADLINE EXTENDED: Applications due March 28, 2024 by 5:00 pm

PLEASE DO NOT SUBMIT PROTECTED HEALTH INFORMATION (PHI)

The information you present will be used to screen the request for meeting the key criteria and waiver requirements. For projects that move forward, you will be asked for more detailed information.

Waivers Project Fund

First name(Required)

First name of person filling out this report

Last name(Required)

Last name of person filling out this report

Email(Required)

In case we need to contact you

Name all of the parties involved in this project(Required)

Legal Business Name of your Organization/Organizations(Required)

Are all organizations involved in this project contracted with OneCare?(Required)

Yes

If no, please explain further.(Required)

How much funding is being requested?(Required)

Minimum funding request: $10,000.

Briefly describe the project you would like to implement with funding from OneCare. Include information about: the design of the project; what role each participant will have; the expected implementation timeline; and the goals of the arrangement (include impact on identified quality measures, Population Health Model goals or identified focus areas).(Required)

Does any part of the project include patients receiving services or items at no cost or at reduced cost?(Required)

Yes

If yes, please explain.(Required)

Summarize how the funding will be used:(Required)

Summarize if there are additional funds being contributed by other parties working on the project and how much funding they will contribute:(Required)

Will you agree to provide regular reporting to OneCare about the implementation and outcomes of the project, including the impact on patients and health care providers, and to maintain documentation about the project?(Required)

Yes

We want to share about the success of our network. We may reach out to learn more about the implementation and outcomes of the project to share with our stakeholders, the public, and for regulatory requests. If you are selected, will you agree to allow OneCare to share the story and impact of your project?(Required)

Yes

2024 Fund for Health Care Delivery Projects Using Waivers- Application Form

Screening Application for Funded Waiver Projects

Waivers Project Fund

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