(A) A complete application for MIH Program Approval shall, at a minimum:

1. (1) Identify and validate one or more gaps in service delivery using data and a corresponding community health needs assessment;

2. (2) Describe how the proposed MIH Program would address identified gaps in service delivery and provide improvements in quality, access, and cost effectiveness, an increase in patient satisfaction, improvement in patients' quality of life, and an increase in interventions that promote health equity, including cultural and linguistic competencies, through one or more of the following:

   1. (a) A decrease in avoidable emergency department visits or hospital readmissions;
   2. (b) A decrease in total medical expenditures;
   3. (c) A decrease in cost to patient;
   4. (d) A decrease in time to appropriate patient care in an appropriate health care setting;
   5. (e) An increase in access to medical or follow-up care under the direction of the patient's Primary Care Provider; or
   6. (f) Improvement in clinical care coordination, including, but not limited to the patient's adherence to medication and other therapies previously prescribed by the patient's Primary Care Provider.
3. (3) Pursuant to M.G.L. c. 111O, § 2(b)(iii), describe any proposed partnerships with existing health care entities; identify all partnerships, contracts, agreements, and affiliation agreements between the applicant and other health care entities; and propose a plan for coordination and use of existing personnel and resources without duplication of services;
4. (4) For proposed programs with a primary focus on MassHealth beneficiaries with behavioral health needs, identify partnership or coordination with an ESP;
5. (5) Demonstrate, through such information as financial and legal viability, sustainability and compliance history, sufficient capacity to develop and operate the proposed MIH Program in accordance with 105 CMR 173.000;
6. (6) Designate a medical director who shall be responsible for meeting the requirements of all clinical aspects of the proposed MIH Program, including, but not limited to, 105 CMR 173.100(A)(9);
7. (7) Provide a complete description of the proposed operational plan for medical control and medical direction including, but not limited to, lines of authority and responsibility, development and review of clinical protocols, training and assessment of skills, communication systems, and continuous quality assurance and improvement; and
8. (8) Provide a complete description of the proposed coordination and interaction with applicable 911 EMS systems in accordance with the provisions of 105 CMR 173.100.