Ryan White HIV/AIDS Program Part A HIV Emergency Relief Grant Program FY 2017 Funding Opportunity Announcement (FOA) Technical Assistance Call September 16, 2016 Division of Metropolitan HIV/AIDS Programs HIV/AIDS Bureau (HAB) Health Resources and Services Administration (HRSA)

Presenters Steven Young, Director Gary Cook, Deputy Director Chrissy Abrahms Woodland, Senior Policy Advisor Amelia Khalil, Project Officer Sera Morgan, Project Officer Monique Richards, Project Officer 2

Agenda Welcome Purpose of Webinar Program Information Application Due Date and Project Period Highlights of FY 2017 Funding Opportunity Announcement (FOA) Section Overviews 3

Purpose The purpose of this webinar is to provide: Technical Assistance Answers to questions received from all Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs) as they relate to the HRSA

Program Information Approximate funding for FY 2017 – $618,322,901 Available to 52 recipients Information on RWHAP and the Affordable Care Act, along with Policy Clarification Notices, can be found at Information on the National HIV/AIDS Strategy: Updated to 2020 (NHAS 2020) is located at hiv_aids_strategy_update_2020.pdf hiv_aids_strategy_update_2020.pdf 5

Due Date and Project Period Application Due Date October 18, 2016 by 11:59 PM EST Project Period March 1, 2017 – February 28,

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FY 17 FOA Overview 8 Needs Assessment Epidemiologic Overview HIV Care Continuum Demonstrated Need EIIHA Unmet Need Service Gaps Minority AIDS Initiative LPAP Methodology Impact of Funding Planning and Resource Allocation Coordination of Services and Funding Streams Work Plan Service Category Plan Table and Narrative HIV Care Continuum Work Plan Resolution of Challenges Evaluation Clinical Quality Management & Grant Administration MOE

9 Highlights FY2017 FOA

Aligned with the Integrated HIV Prevention and Care Plan Epidemiologic Overview HIV Care Continuum Coordination of Services and Funding Streams EIIHA Revised MAI Revised Resolution of Challenges Revised 10

Highlights FY2017 FOA 11 Epidemiologic Overview People at Highest Risk EIIHA PLWH Communities MAIUnmet Need

Section Overview: Needs Assessment 12 Epidemiologic Overview HIV Care Continuum Demonstrated Need EIIHA Unmet Need Service Gaps Minority AIDS Initiative Special Populations Local AIDS Pharmaceutical Assistance (LPAP)

Epidemiologic Overview Based on the Integrated Guidance for Developing Epidemiologic Profiles: HIV Prevention and RWHAP Planning Section should describe: Geographic region covered by the EMA or TGA Socio-demographic characteristics of PLWH, Newly Diagnosed and Person at Higher Risk Demographic data Socioeconomic data 13

Epidemiologic Overview Cont. Describes burden of HIV infection in the population living with HIV: Number of PLWH Rates/Trends Populations most affected Geographic concentrations Describes indicators of risk for HIV infection: Behavioral surveillance data HIV surveillance data RWHAP data 14

Epidemiologic Overview Resources Integrated HIV Epidemiologic Profiles for HIV Prevention and Care Planning Training profiles-hiv-prevention-and-care-planning-training profiles-hiv-prevention-and-care-planning-training Integrated Guidance for Developing Epidemiologic Profiles: HIV Prevention and Ryan White HIV/AIDS Programs Planning, July ogic_profiles.pdf ogic_profiles.pdf Epidemiologic Overview and HIV Care Continuum components of Section One of the Integrated HIV Prevention and Care Plan, including the SCSN Guidance, June pdf 5.pdf 15

HIV Care Continuum Section should include: Disparities along the HIV Care Continuum Planning, prioritizing, targeting, and monitoring available resources Improving engagement and outcomes at each stage Evaluation Dissemination 16

Early Identification of Individuals with HIV/AIDS (EIIHA) The EIIHA Section has been streamlined. Applicants have to respond to the EIIHA FY 2017 Plan only EIIHA Data Section removed 17

Selecting EIIHA Populations 18 UNAWARE People at Highest Risk Epidemiologic Profile EIIHA Purpose: 1) Increase the number of individuals who are aware of their HIV status 2) Increase the number of HIV positive individuals who are in medical care 3) Increase the number of HIV negative individuals referred to services that contribute to keeping them HIV negative. 3 Key Populations Test (+)HIV Refer to Treatment and Care Service Retention & VL Suppression (-)HIV Refer to Prevention service Re-test

EIIHA Scoring FY2017 EIIHA section will be scored the same as in past FOAs EIIHA FY 2017 Plan = 33 points total 19

Unmet Need Framework Unmet Need is defined as the need for HIV primary medical care among individuals who know their HIV status but are not receiving such care Compute two Unmet Need estimates for 2017 using CY2015 data: 1.Current Unmet Need Framework upload/resources/UnmetNeedPracticalGuide.pdf 2. HIV Care Continuum Framework 20

HIV Care Continuum Framework Unmet Need = (Diagnosed) - (Retained in Care) 21 Diagnosed, the known/reported cases of HIV infection, regardless of AIDS (stage 3 HIV infection) status Retained in Care, the number of diagnosed individuals who had two or more documented medical visits, viral load or CD4 tests performed at least three months apart in the calendar year The Unmet Need estimate is then calculated by subtracting the number of Retained in Care from the number of Diagnosed Unmet Need Estimate

Service Gaps Service gaps are defined as all service needs not currently being met for all PLWH except the need for primary medical care. Based on gaps identified along the HIV care continuum, describe: Service gaps within the jurisdiction Method used to prioritize the service gaps How these service gaps will be addressed with FY 2017 Part A funding 22

Selecting MAI Populations 23 3 Key Minority Populations AWARE People of Color Living with HIV Epidemiologic Profile Population-Tailored Treatment and Care Service Retention & Viral Suppression MAI Purpose: Improve “HIV- related health outcomes to reduce existing racial and ethnic health disparities.”

Minority AIDS Initiative Identify minority populations living with HIV and the specific sub-groups For each MAI population identified: 1.Describe the planning process for determining the needs of the MAI populations identified in the Epidemiologic Overview 2.Describe specific culturally appropriate, population-tailored interventions and community partnerships utilized to increase bars on the HIV care continuum. Explain how these unique activities differ from other RWHAP Part A services 3.Describe the impact of these specific interventions and how it will be evaluated and disseminated to stakeholders Impact of MAI funded programs and/or activities on improving the HIV health outcomes among minority populations 24

MAI HIV Care Continuum 25

Special Populations and Complexity of Providing Care Emerging Communities – New/emerging populations not reported on in last year’s application where significant changes were noted in service delivery Under-represented populations in the RWHAP funded system of HIV primary medical care Co-morbid conditions (i.e., substance abuse, STIs, Hepatitis C, etc.) (Attachment 5) Narrative description of the impact of co-morbidities and the cost and complexity of care in the EMA/TGA Compare rates between PLWH and general population 26

Local Pharmaceutical Assistance Program (LPAP) This section must be completed if an LPAP is funded LPAP section is not scored Purpose of this section is to describe, in detail, the need for an LPAP An LPAP may not be used to provide short-term or emergency medication assistance Describe the specifics on how other resources (e.g. ADAP, patient assistance programs, other RWHAP funded service categories) are unable to meet the needs of the jurisdiction Include a description of how the LPAP is to be implemented 27

Section Overview: Methodology 28

Impact of Funding Impact & Response to Reduction in RWHAP Part A formula funding Impact: Specific services that were eliminated/reduced and by how much Response: Cost containment measures, planning council priority changes, policy changes 29

Impact of Changing Health Care Landscape 30 PLWH Uninsured and Living in Poverty Impact of Health Insurance Expansion Outreach & Enrollment Marketplace Options

Planning and Resource Allocation 31

Community Input Process Describe the structure of the community input process, including: Priority setting and resource allocation processes How planning is linked to improving health outcomes along the HIV care continuum Letter of Assurance/Concurrence 32

Coordination of Services and Funding Streams Financial and Human Resources Inventory should include: Public and private funding sources for HIV prevention, care, and treatment services in the jurisdiction (Appendix A) Dollar amount and the percentage of the total available funds in fiscal year (FY) 2016 for each funding source Provider agencies Services delivered Components of HIV prevention programming and/or the HIV care continuum stage(s) that is (are) impacted 33

34 SAMPLE Attachment 7

Section Overview: Work Plan 35

Section Overview: Work Plan Service Category Plan Table Service Category Plan Narrative Core Medical Services Waiver (if applicable) HIV Care Continuum Work Plan 36

Service Category Plan Table Two separate tables- Attachment 8 1. Part A 2. MAI including Target Populations Include every funded service category Actual amount of Unduplicated Clients (UDC) Served and the funding expended per service category in FY15 Allocated amount of funding and the anticipated number of Unduplicated Clients (UDC) that will be served per service category in FY16 Anticipated amount of funding and the anticipated number of Unduplicated Clients (UDC) to be served per service category in FY17 37

38 PART A Service Category Priority Number 2015 Actual2016 Allocated2017 Anticipated Funding Amount UDC Served Service Unit Definition Service Units Funding Amount UDC Serve d Service Unit Definition Service Units Funding Amount UDC Served Service Unit Definition Service Units Example: Outpatient Ambulatory Medical Care $2,400, unit = 1 visit 5000$2,000, unit = 1 visit 4500$1,200, unit = 1 visit 3800 Example: Medical Case Management $1,200, unit = 1 visit 20,000 $1,500, unit = 1 visit 25,000$2,000, unit = 1 visit 30,000 Service Category Plan Table SAMPLE Attachment 8

39 SAMPLE Attachment 8 Service Category Plan Table MAI Service Category Priority Number 2015 Actual2016 Allocated2017 Anticipated MAI Only Funding Amount UDC Served Service Unit Definition Service Units Funding Amount UDC Served Service Unit Definition Service Units Funding Amount UDC Served Service Unit Definition Service Units Target populations Example: Outpatient Ambulatory Medical Care $500, unit = 1 visit 600 $400, unit = 1 visit 500$350, unit = 1 visit 400 Hispanic Women Child- bearing Age Example: Medical Case Management $200, unit = 1 visit 1200$ unit = 1 visit 1500$ unit = 1 visit 2000 Hispanic Women Child- bearing Age

Service Category Plan Narrative Narrative : Identify any prioritized core medical services that will not be funded with FY 2017 RWHAP funds and how these services will be delivered in the EMA/TGA; How activities described in the Plan will promote parity of HIV services throughout the EMA/TGA How planned activities assure that services delivered by providers are culturally and linguistically appropriate 40

Service Category Plan Narrative Cont. Describe factors that contributed to changes in funding within service categories; How the EMA/TGA will ensure that resource allocations provide services for WICY How any changes to service categories are linked to needs assessments 41

Core Medical Services Waiver (if applicable) Applicants may submit a CMS Waiver at three points during the year. In advance of a recipient’s annual grant application In the Application (Attachment 9) After the grant application has been submitted up to 4 months into the grant year Note: If a CMS waiver is submitted with the application, then an Allocation Table consistent with the waiver request must be submitted as part of Attachment 9. 42

CORE MEDICAL SERVICES WAIVER CORE MEDICAL SERVICES WAIVER REQUEST SubmissionService Category Plan TableAllocation Table Before ApplicationMatch Waiver RequestNot Applicable With Application Match Waiver Request Or 75/25 Compliant Match Waiver Request After ApplicationNot Applicable Match Waiver Request 43 Instructions for CMS Waivers can be found at:

2017 HIV Care Continuum Work Plan The HIV care continuum work plan depicts how RWHAP service categories will be used to improve indicators along the HIV care continuum (Attachment 10) The work plan is comprised of: Stages of the HIV care continuum Baseline indicators for each stage Desired target outcome to be achieved during the current fiscal year RWHAP-funded service categories to help support achieving the desired outcome 44

45 SAMPLE

Section Overview: Resolution of Challenges 46

Updated Resolution of Challenges Describe the approaches that will be used to resolve the challenges and barriers identified throughout this application in the larger context of implementing your Part A Program (e.g., implementing the Affordable Care Act, community engagement) Discuss challenges that have been encountered in integrating the HIV care continuum into planning and implementing the Part A program, and approaches that will be used to resolve such challenges. Insert a Table with the following headers: Challenges, Resolutions, Outcomes and Current Status for implementing both the RWHAP Part A Program overall and the HIV care continuum. 47

Resolution of Challenges Table 48 SAMPLE

Section Overview: Evaluation and Technical Support Capacity 49

Clinical Quality Management CQM section has three components: 1.CQM Infrastructure 2.CQM Program Performance Measures 3.CQM Program Quality Improvement 50

Data for Program Reporting Name and describe the information/data system(s) within the EMA/TGA used for data collection and reporting operations. Describe the grant recipient’s current client level data collection capabilities included in the Ryan White Service Report (RSR). Include the percentage of subrecipients that were able to report CY 2015 client level data. Describe efforts to increase data completeness and validity. 51

Section Overview: Organizational Information 52

Section Overview: Organizational Information Program Organization Grant Recipient Accountability Program Oversight Fiscal Oversight Administrative Assessment Third Party Reimbursement Maintenance of Effort (MOE) Budget and Budget Justification Narrative 53

Organizational Information: Grant Administration Program Organization Applicants should describe: How funds are administered in the jurisdiction Organizational Chart (Attachment 11) Grant Recipient Accountability Applicants should describe processes for : Program Oversight Fiscal Oversight 54

Organizational Information: Grant Administration Administrative Assessment Applicants should describe efficiency of the administrative mechanism to rapidly allocate funds Third Party Reimbursement Applicants should screen for proof of insurance status and financial eligibility Maintenance of Effort Applicants should identify the MOE budget elements and the amount of expenditures related to HIV/AIDS core medical and support services for the applicant’s two most recently completed fiscal years prior to the application deadline 55

Organizational Information: Budget Instructions for completing the budget are found in HRSA’s SF-424 Application Guide. guide.pdf guide.pdf Please note: the directions offered in the SF-424 Application Guide differ from those offered by Grants.gov. Follow the instructions included the Application Guide and, if applicable, the additional budget instructions provided in the FOA. 56

Organizational Information: Salary Limitations 57 Cost Categories - Salary Limitations Requirement (Appropriations Act 2013) Salaries charged to HHS grants may not exceed $185,100 annually Individual’s base salary, exclusive of fringe benefits and outside income earned Applies to subcontracts Consolidated Appropriations Act, 2015 (Public Law ), signed into law on December 16, 2014, restricted the amount of direct salary to Executive Level II of the Federal Executive pay scale. NOT-OD

Review Criteria 58

Review Criteria 59

Review Criteria Cont. 60

Errata Page 14 – EIIHA Plan, 1)c)2), substitute “accessing” for “assessing …to address barriers to accessing testing and treatment Page 21- Under 2) a) (3), should it be changed from 2015 FPL to 2016 FPL Page 32 – Program Oversight, a)3), substitute “2017” for “2016” at end in terms of the number planned for the FY 2017 period of performance Page 33- Numbering of a subsection E. Maintenance of Effort” should be B. Maintenance of Effort 61

Questions & Answers 62

Contact Information Steven R. Young Director, DMHAP HIV/AIDS Bureau (HAB) Health Resources and Services Administration (HRSA) Phone: Please continue to submit all questions to your Project Officer. The questions will be combined with others and answers, and posted and circulated to all eligible areas. Technical Assistance Website: