FY 2017 RWHAP Part B Supplemental HIV/AIDS Bureau Division of State HIV/AIDS Programs (DSHAP) FY 2017 RWHAP Part B Supplemental Notice of Funding Opportunity (NOFO) HRSA-17-038 Technical Assistance Webinar April 5, 2017

HAB DSHAP Mission To provide leadership and support to States/Territories for developing and ensuring access to quality HIV prevention, health care, and support services. 2

Agenda Welcome Katherine Patterson RWHAP Announcements Michael Goldrosen Questions and Answers Opening Remarks RWHAP Part B Supplemental NOFO Kim Brown Kim Brown and Michael Goldrosen Closing Remarks 2

Objectives To discuss the FY 2017 Ryan White HIV/AIDS Program (RWHAP) States/Territories Part B Supplemental NOFO. Provide pre-application Technical Assistance (TA) to RWHAP Part B recipients. Answer Questions related to the NOFO. 2

Presenter Michael Goldrosen Director Division of State HIV/AIDS Programs 2

Announcement and Updates Announcements & Updates 2

Announcements 2016 RSR Save the Date: 2019 Ryan White Services Report Data Collection Webcast on Tuesday, May 2, 2017: 1:00 – 3:00 p.m. EST CY 2016 ADAP Data Report (ADR) is due June 5, 2017 by 6 pm EST FY2017 Partial Awards Integrated Plans ASRV RWHAP Part B Base/ADAP Base (X07) Thank you for completing your RSR on time. There will be a webcast on May 2, from 1-3 pm ET to present information and changes that are being proposed to be implemented on the Ryan White Services Report (RSR) data collection for 2019 to provide an opportunity for stakeholders to learn about the process and ask questions. More information will be provided soon, including a link to the webcast. ADR is due June 5, 2017 by 6:00 pm EST. The FY 2017 grant budget period began on April 1, 2017. Partial awards have been made for the RWHAP Part B formula grants to States and Territories (X07). You were notified by letter about partial awards being issued.   We are currently operating under a continuing resolution until April 28th. We will have more details on the full awards timeline when the Ryan White HIV/AIDS Program has a final FY 2017 appropriation. HRSA HAB’s Division of State HIV/AIDS Programs, Division of Metropolitan HIV/AIDS Programs, and the Centers for Disease Control and Prevention Division of HIV/AIDS Prevention conducted joint reviews of the Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statements of Need, in March 2017. CDC and HRSA are in the process of finalizing the joint review summaries and planning a phased joint feedback process to all jurisdictions. The plans are intended to be living documents so while we will want to know about updates there won’t be any requirements to rewrite the plans. As you know, we plan to conduct an in person Administrative Reverse Site Visit this year to provide additional training on our administrative, program, fiscal, ADAP, and QM requirements. We are currently looking at late summer 2017 for this meeting and will share additional details once available. As a reminder the key audience will be new staff or staff that need a refresher on aspects of the program. I wanted to provide an update on upcoming changes we hope to implement with RWHAP Part B Based/ADAP Base (X07) NOFO process. As I announced on our X07 Webinar last fall we have been working diligently with a number of our colleagues in HRSA to convert the X07 grant award into a 5 year project period. The goal is to align the project period with the Integrated Plans. The current one year project period would be converted to a 5 year project period, with the current year counting as year one of the project period. In converting to a 5 year project period, for years 2-5 (FY 2018-2022) recipients would submit via EHB a streamlined non-competing continuation submission. The submission would request information needed to run funding formula and key updates to information submitted in the previous year, if any. As soon as this is finalized we will provide an official announcement and further details Another improvement we are hoping to make is an updated FFR Addendum, which would make the process for reporting rebates clearer We will share more information available once we are able to launch this. 2

Question and Answer Session

HRSA-17-038 Technical Assistance Webinar Opening Remarks Michael Goldrosen Director Division of State HIV/AIDS Programs 2

HRSA-17-038 Technical Assistance Webinar Kim Brown Public Health Analyst Division of State HIV/AIDS Programs Today we will be discussing the Part B Supplemental Grant Program’s Notice of Funding Opportunity . As we go through the slide set, I will reference the specific sections of the NOFO and highlight the relevant content. 2

Purpose Solicits applications for the Ryan White HIV/AIDS Program Part B Supplemental Grant Program. Supplements the HIV care and treatment services provided by the States/Territories. Determined by the applicant’s ability to demonstrate the need in the State/Territory based on an objective and quantified basis. The purpose of Ryan White HIV/AIDS Part B Supplemental funding is to supplement HIV care and treatment services provided by the State or Territory and is awarded based upon the applicant’s ability to demonstrate additional need, which we will discuss later. 2

Purpose Authorized by the Ryan White HIV/AIDS Program legislation, Section 2620 of the Public Health Service (PHS) Act. Funds are subject to the Core Medical Services requirement per Section 2620(e) and Section 2612(b)(1) of the PHS Act. The RWHAP Part B Supplemental Program is authorized by the Ryan White HIV/AIDS Program legislation, Section 2620 of the PHS Act. The Part B Supplemental funding is an extension of activities under the X07 grant. Therefore, it is also subject to the 75/25 Core Medical Services requirement. After allocating amounts for administration, planning/evaluation and clinical quality management, 75% of the remaining funds must be used for Core Medical Services. 2

Summary of Funding Approximately $218 million is available for FY 2016 Part B Supplemental funding, of which up to approximately $5.5 million will be used for priority funding. Applicants may apply for a ceiling amount of up to $35 million. The project and budget period is one (1) year, September 30, 2017 through September 29, 2018. Page i of the NOFO provides the summary of funding. Approximately $218,000,000 is expected to be available for FY 2017 Part B Supplemental funding, of which up to approximately $5,500,000 will be used for priority funding. Applicants may request up to $35,000,000 in supplemental funding. However, if an applicant requests more than the ceiling amount of $35,000,000, the application will NOT be considered for funding as stated on page 7 of the NOFO . The project and budget period is one (1) year, beginning September 30, 2017 through September 29, 2018. 2

Summary of Funding 45 CFR 75 uniform administrative requirements, cost principles, and audit requirements for HHS awards: Effective December 26, 2014 Supersedes and streamlines previous OMB Circulars HHS implementation of 2 CFR 200 Under summary of funding, effective December 26, 2014, all administrative and audit requirements and the cost principles that govern Federal monies associated with this award are subject to the Uniform Guidance 2 CFR 200 as codified by HHS at 45 CFR 75, which supersede the previous administrative and audit requirements and cost principles that govern Federal monies. 2

Priority Funding Provision Section 2620(c) of the PHS Act: The amount of Supplemental Funds disbursed to States/Territories under RWHAP Part B to address the decline or disruption of services related to the decline in the amount of formula funding. Such a decline in funding compares the amount received in fiscal year 2016 to the amount received in fiscal year 2006 and a State’s assertion that such decline has had an impact on services available to eligible PLWH in the state. Page 5 of the NOFO discusses the Priority Funding Provision recipients who are eligible for priority funding should include an assertion for priority funding in ATTACHMENT 5: Applicant Assertion Statement. 2

RWHAP Part B Supplemental The State/Territory must demonstrate the severity of the HIV/AIDS epidemic in the State/Territory: Applicants must explain why supplemental funding is necessary to provide HIV care and treatment services for PLWH in the State/Territory Applicants must use quantifiable data on HIV epidemiology, co-morbidities, cost of care, the service needs of emerging populations, unmet need for core medical services, and unique service delivery challenges. Applicants must describe how supplemental funding will support viral suppression and achieve positive client level health outcomes. As mentioned earlier, applicants must demonstrate the need for supplemental funding. Applicants must provide quantifiable data, discuss the service needs for people living HIV, and describe how supplemental funding will support viral load suppression and positive health outcomes. 2

Demonstrated Need The State/Territory must demonstrate the severity of the HIV/AIDS epidemic in the State/Territory by using: The current prevalence of HIV/AIDS; The unmet need for HIV-related services as determined by section 2617(b) of the PHS Act; An increasing need for HIV/AIDS services, including relative rates of increase in the number of living cases of HIV/AIDS; Increases in the number of living cases of HIV/AIDS within new or emerging subpopulations; Pages 1-2 of the NOFO discuss factors for demonstrating need and listed on the next few slides. 2

Demonstrated Need (cont.) Relevant factors related to the cost and complexity of delivering health care to individuals with HIV/AIDS in the eligible area; The impact of co-morbid factors, including co- occurring conditions including high rates of sexually transmitted infections (STIs), Hepatitis, Tuberculosis, substance use, severe mental illness, and other co- morbid factors; The prevalence of homelessness; 2

Demonstrated Need (cont.) The prevalence of individuals who were released from Federal, state or local prisons during the preceding three years and had HIV/AIDS on the date of their release; Relevant factors that limit access to health care including geographic variation, adequacy of health insurance coverage and language barriers; and Impact of a decline in the amount of RWHAP Part B funding received on services available to all individuals with HIV/AIDS identified and eligible for RWHAP services. 2

Demonstrated Need (cont.) Applicants must provide a narrative and data to support the service categories chosen to respond to the demonstrated need(s) and the request for funds. 2

Important Notes 75% Core Medical Services Requirement on Service Expenditures At the end of the grant year, after accounting for recipient administration, P & E, and CQM, no less than 75% of the service dollars remaining must be spent on core medical services. Core Medical Services Waiver HAB PCN 13-07 Uniform Standard for Waiver of Core Medical Services Requirement for Recipients Under Parts A, B, and C. Pages 2-3 of the NOFO include “Important Notes” applicants should be aware of. •The X08 Supplemental Grant funding is subject to the 75% core medical services requirement. Recipients not meeting the 75 percent core medical services expenditure requirement will be subject to the financial penalty associated with this requirement. If a recipient anticipates less than 75 percent expenditures in core medical services, the recipient may submit a core medical services waiver in accordance with the guidance provided in the NOFO. At the end of the grant year, after accounting for recipient administration, P & E, and QM, no less than 75% of the service dollars remaining must be spent on core medical services 2

Background National Goals to End the HIV Epidemic Reduce new HIV infections; Increase access to care and optimize health outcomes for people living with HIV; Reduce HIV-related health disparities and health inequities; and Achieve a more coordinated national response to the HIV epidemic. The Background Section on pages 2-5 of the NOFO includes information that will assist applicants in understanding and completing this year’s grant application: National Goals to End the HIV Epidemic .To the extent possible, program activities should strive to support the four primary goals:   Reduce new HIV infections; Increase access to care and optimizing health outcomes for people living with HIV; Reduce HIV-related health disparities and health inequities; and Achieve a more coordinated national response to the HIV epidemic. 2

Background (cont.) To achieve these goals, recipients should take action to align their organization’s efforts, within the parameters of the RWHAP statute and program guidance, around the following areas of critical focus: Widespread testing and linkage to care, enabling people living with HIV to access treatment early; Broad support for people living with HIV to remain engaged in comprehensive care, including support for treatment adherence; and Universal viral suppression among people living with HIV. National Goals to End the HIV Epidemic To achieve these goals, recipients should take action to align their organization’s efforts, within the parameters of the RWHAP statute and program guidance, around the following areas of critical focus: Widespread testing and linkage to care, enabling people living with HIV to access treatment early; Broad support for people living with HIV to remain engaged in comprehensive care, including support for treatment adherence; and Universal viral suppression among people living with HIV. 2

Background (cont.) HIV Care Continuum Clinical Quality Management RWHAP recipients are to utilize RWHAP Part B funds to achieve better outcomes in the jurisdiction’s HIV continuum of care Clinical Quality Management Clinical Quality Management PCN 15-02 Integrated Data Sharing and Utilization Integrated HIV data sharing and utilization approaches HIV Care Continuum Recipients are encouraged to work with their stakeholders to improve health outcomes along their HIV Care Continuum by identifying people infected with HIV, linking them to HIV primary care, accomplishing lifelong retention in HIV medical care, and ultimately HIV viral load suppression. RWHAP Recipients are to utilize RWHAP Part B funds to achieve better outcomes in the jurisdiction’s HIV continuum of care Clinical Quality Management   Recipients must assess the extent to which HIV health services provided to clients under the grant are consistent with the most recent PHS guidelines, (otherwise known as the HHS Guidelines) for the treatment of HIV disease and related opportunistic infections; and Develop strategies for ensuring that such services are consistent with the guidelines for improvement in the access to, and quality of HIV services. Please see Clinical Quality Management Policy Clarification Notice 15-02 (PCN) for information regarding the statutory requirements of a CQM program. Integrated Data Sharing and Utilization Coordinate and collaborate with Prevention stakeholders through integrated data sharing and utilization approaches to further the goals of the NHAS and improving outcomes on the HIV Care Continuum. 2

Caps on Expenses RWHAP Part B recipient administrative costs may not exceed 10% of the total Part B Supplemental award. Planning and Evaluation costs may not exceed 10% of the total Part B Supplemental award. Collectively, Recipient Administration, and Planning and Evaluation may not exceed 15% of the total Part B Supplemental award. RWHAP Part B Clinical Quality Management costs may not exceed 5% of the total Part B grant award or $3 million (whichever is the lesser amount) of the Part B Supplemental award. Like the X07 grant, the X08 grant is subject to cap on expenses. Please refer to PCN #15-01 for guidance on the 10% Admin Cost Cap when developing the X08 budgets. Recipients should use their best estimates in preparing budgets for the application. When submitting your revised budget for approval, after Part B Supplemental funds have been awarded, you must adhere to these costs caps. Note: Cost sharing/Matching is not required for this program. 2

Attachments Recipients should clearly label all attachments. Attachment numbers 1, 2 and 3 only have to be resubmitted if there have been changes since the submission of the HRSA-17-036 (X07) award of if Part B Supplemental funds will be used to support personnel. Attachment 4: Remember to include your cost and complexities co-morbidities as Table 4. Attachment 5: For those eligible for Priority funding, remember to include a statement for this attachment. If you are applying for a Core Medical Services Waiver, please include it as Attachment 6. 2

Important Note The Objective Review Committee will be provided with the following attachments previously submitted from the RWHAP Part B NOFO (HRSA-17-036) application, or the Jurisdiction’s Integrated Plan: HRSA 17 -036 ATT 1: Project Organizational Chart HRSA 17-036 ATT 2: Staffing Plan & Job Descriptions for Key Personnel HRSA 17-036 ATT 3: Biographical Sketches of Key Personnel HRSA 17-036 ATT 6: Unmet Need Framework Table and Narrative Integrated Plan Section 1.A: HIV/AIDS Epidemiological Data and Narrative The Objective Review Committee will be provided the following attachments from your earlier submission of HRSA-17-036 (X07) application Project Organizational Chart, Staffing Plan & Job Descriptions for Key Personnel, Biographical Sketches of Key Personnel and, Unmet Need Framework Table and Narrative (Attachments 1, 2, 3 and 6 respectively). Your HIV/AIDS Epidemiological Data and Narrative will be provided to the ORC from your Integrated Plan submission. 2

Funding Restrictions Section 2681(c) of the PHS Act requires that, “as a condition of receipt of funds, a State shall provide assurances to the Secretary that health support services funded under this title will be integrated with other such services, that programs will be coordinated with other available programs (including Medicaid), and that the continuity of care and prevention services of individuals with HIV/AIDS is enhanced.” Therefore, the expectation is that these funds must be used to supplement other Federal grant or State funds. This award is subject to the funding restrictions as described in the SF-424 Application Guide and p. 34-41 of the NOFO. Please Note: X08 funding must be used to supplement other federal grant and/or state funds. 2

Scoring of Application The review criteria provided in the NOFO are the basis upon which the Objective Review Committee (ORC) will evaluate the application. ORC scores will be used to establish the rank order for the awarding of funds. Once the applications have been ranked by the ORC, award amounts are determined on a formula based on the ORC score. Please see section 5.3 of the HRSA SF-424 Application Guide 2

Who Can Apply? 59 States/Territories are eligible to apply. However any State or Territory that had more than 5% of their FY 2014 formula funds cancelled under Section 2622(e) for FY 2014, are not eligible to apply for the FY 2016 Part B Supplemental Funding. Therefore the following States/Territories are not eligible to apply to this NOFO this year Ohio, Massachusetts, Marshall Islands, American Samoa Due to the UOB penalties under Part B X07 award there are some states who cannot apply under this announcement. 2

Application and Submission Application Deadline: May 15th at 11:59 PM Eastern Time. HRSA requires applicants for this NOFO to apply electronically through Grants.gov. Section 4 of HRSA’s SF-424 Application Guide provides instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and project abstract. You must submit the information outlined in the Application Guide in addition to the program specific information below. Applicants must download the SF424 application package associated with this funding opportunity following the directions provided. Application Deadline: May 15th at 11:59 PM Eastern Time. HRSA requires applicants for this NOFO to apply electronically through Grants.gov. Section 4 of HRSA’s SF-424 Application Guide provides instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and project abstract. You must submit the information outlined in the Application Guide in addition to the program specific information below. All applicants are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide. 2

Application Format Requirements The total size of all uploaded files may not exceed the equivalent of 40 pages when printed by HRSA. The 40-page limit includes the abstract, project and budget narratives, attachments, and letters of commitment and support. Standard OMB-approved forms are NOT included in the page limit. Applications must be submitted and validated by Grants.gov prior to the deadline to be considered under this announcement. See pages 38-44 of HRSA’s SF-424 Application Guide for table of contents and order of documents and attachments HRSA strongly urges applicants to print their application to ensure it does not exceed the 40-page limit. 2

Agency Contacts Program issues and/or technical assistance regarding this NOFO may be obtained by contacting: Michael Goldrosen Telephone: (301) 945-9779 Fax: (301) 443-8143 E-mail: MGoldrosen@hrsa.gov Business, administrative, or fiscal issues related to this NOFO may be obtained by contacting: India Smith Telephone: (301) 443-2096 Fax: (301) 594-4073 E-mail: ISmith@hrsa.gov 2

Agency Contacts Applicants may need assistance when working online to submit their application forms electronically. Applicants should always obtain a case number when calling for support. For assistance with Grants.gov, Contact Center Telephone: 1-800-518-4726 or E-mail: support@grants.gov Self-Service Knowledge Base : https://grants-portal.psc.gov/Welcome.aspx?pt=Grants 2

Question and Answer Session 2

Thank You 2

Contact Information Kim Brown Public Health Analyst, Division of State HIV/AIDS Programs (DSHAP) HIV/AIDS Bureau (HAB) Health Resources and Services Administration (HRSA) Email: KBrown2@hrsa.gov Phone: 301-443-1434 Web: hab.hrsa.gov Twitter: twitter.com/HRSAgov Facebook: facebook.com/HHS.HRSA