Admin Cost Form Email Solicitation - Script Annual

Attachment 10d: Email Solicitation Script, Annual

Dear ,
As the independent evaluator for the Medicaid Incentives for the Prevention of Chronic Disease
(MIPCD), RTI International is legislatively mandated to report on the costs incurred as part of
the administration of the MIPCD program. To collect this data, we created the attached
Administrative Costs Form for State staff to complete. We ask that State staff review the
instruction and complete the form by XXX.
Completing the form includes filling out the one-page form on costs for your XX program year
(Year X, 9/13/20XX to 9/12/20XX). We expect form completion to take no more than 8 hours to
complete this form. Completing the form is voluntary. We do not expect any risks to you for
completing this form. If you find completing any of the fields in the form makes you
uncomfortable, you may skip them. If you decide not to participate, it will not impact your
MIPCD grant in any way. After completing this form, we will ask you to provide annual cost
updates over the next two years.
There is no direct benefit to you for being part of this study except the satisfaction of helping us
learn more about the administrative costs of the MICPD programs.
Results of the Administrative Costs Form will be used to assess the following:
 How has the State been spending its administrative funds, and how does this compare
with the projected spending in its proposal?
 Have administrative expenditures changed in the different phases of the initiative?
 How do administrative costs vary by major structural differences, such as the type of
program, target group/health condition, type and amount of incentive, and scope of the
program (statewide vs. limited)?
 What are the costs of the incentives that are paid by the program?
 Were there additional financial costs of the program that were not covered by the
program?
If you have any questions about the study or the cost data that is requested in the form, please
contact XXX.
Thank you for your time and consideration.
Sincerely,