Packaging a Competitive Application: Appendices and Extras That Matter
The final step in the Rural Health Transformation (RHT) application process, before you click “submit”, is to ensure your supporting materials — data tables, letters, and policy crosswalks — tell the same story of readiness, alignment, and impact that runs through your narrative.
This final post in the RHT Application Roadmap series explains how to package your materials to leave CMS reviewers with no doubts about your state’s credibility and capacity to deliver.
Step 1: Treat Appendices as Evidence, Not Attachments
CMS reviewers often start with the appendices to verify claims in the main narrative. That means every table, letter, or document should reinforce a key point of your plan.
Ask yourself:
Does each appendix strengthen the case for need, equity, or readiness?
Can reviewers easily locate the data that supports our narrative?
Are all attachments consistently and properly labeled, dated, and referenced in the text?
When every piece connects to your story, your application feels cohesive. Organization ensures cohesion ensuring applications are orderly and not cluttered.
Step 2: Include a Clear Table of Contents
Start your appendices section with a short, well-formatted table of contents. Reviewers will use this to navigate hundreds of pages of materials quickly.
Example format:
Rural Demographic and Health Indicators Table
Workforce Analysis Summary
Stakeholder Engagement Documentation
Letters of Support
Policy Crosswalks and Alignment Tables
Risk Register (Summary)
Evaluation and CQI Framework Overview
A clean layout signals professionalism and organization — qualities CMS reviewers appreciate under time pressure.
Step 3: Strengthen Your Data Tables
Your demographic and health indicator tables should tell a concise story: who lives in your rural areas, what challenges they face, and how transformation will help.
Include:
Population totals and rural percentages by county or region
Key health outcomes (chronic disease, maternal health, behavioral health access)
Provider and facility counts (hospitals, FQHCs, LTSS providers)
Broadband access, transportation availability, and workforce vacancy rates
Pro tip: Use visuals — charts, maps, and infographics — to make complex data digestible. Reviewers retain visuals better than raw numbers.
Step 4: Curate Letters of Support Strategically
Quality matters more than quantity. CMS reviewers will skim letters that repeat generic statements — but they will notice letters that demonstrate real partnerships.
Aim for a balanced collection that includes:
State and local health agencies
Hospitals, clinics, and provider networks
Tribal and Indigenous organizations
LTSS and home- and community-based providers
Academic and workforce partners
Advocacy and consumer organizations
Each letter should clearly state:
The organization’s role in implementation
Specific commitments (e.g., staff training, data sharing, technical support)
How the partnership advances sustainability and equity goals
Organize letters alphabetically or by sector with a summary list upfront.
Step 5: Build a Policy and Program Crosswalk
CMS reviewers look for alignment across programs. Include a policy crosswalk table showing how your RHT plan connects to:
Medicaid Section 1115 or 1915 waivers
State health innovation plans
Workforce development initiatives
Behavioral health or broadband expansion programs
Hospital stabilization or value-based payment reforms
This demonstrates that your proposal leverages existing infrastructure — and that RHT funding will accelerate, not duplicate, progress.
Step 6: Attach Your Risk Register and Evaluation Summary
A concise Risk Register summary and Evaluation Framework overview can reinforce two key messages:
The state understands its vulnerabilities.
The state has systems in place to measure success and adapt over time.
Keep these summaries to one or two pages each — high-level, visual, and easy to scan.
Step 7: Double-Check Formatting and Accessibility
Small presentation issues can hurt credibility. Before submission:
Verify all attachments are legible and use consistent formatting.
Ensure PDFs are accessible (screen-reader friendly, searchable text).
Label each file clearly (e.g., “Appendix_4_StakeholderEngagement.pdf”).
Cross-reference appendix titles exactly as they appear in the narrative.
Attention to detail communicates competence — and makes it easier for CMS reviewers to score your application accurately.
Step 8: Package for Impact
When everything is organized, cohesive, and clearly labeled, your appendices do more than support your application — they amplify its strength.
The best RHT submissions will:
Demonstrate data integrity and transparency.
Showcase authentic collaboration through stakeholder materials.
Align seamlessly with CMS’s priorities on equity, sustainability, and workforce development.
The Bottom Line
The appendices are where your application stops being a proposal and starts being proof. They transform claims into evidence, partnerships into commitments, and strategy into credibility.
When CMS reviewers open your attachments, they should see a state that is organized, capable, and ready to lead rural transformation at scale.
Call to Action
State RHT Teams: Begin assembling your appendix materials now — don’t wait until narrative writing is complete.
Partners and Providers: Submit letters of support early, and make them specific.
Data and Communications Teams: Ensure every chart, map, and table is accurate, accessible, and branded consistently.
Your appendices tell the final chapter of your state’s transformation story. Make it one that CMS — and your communities — will remember.
