HIV/AIDS Bureau Division of State HIV/AIDS Programs (DSHAP) Ryan White Part B Technical Assistance Webinar FY 2013 Ryan White Part B Supplemental Funding Opportunity Announcement (FOA) and the FY 2013 ADAP Emergency Relief Funding (ERF) FOA June 26, 2013

2 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.

3 Agenda Opening Remarks/ AnnouncementsHeather Hauck Question and Answer Part B Supplemental FOAHarold Phillips Questions and Answer ADAP ERF FOAHeather Hauck Questions and Answer Closing RemarksHeather Hauck

4 Presenters Harold Phillips Deputy Director, Division of State HIV/AIDS Programs Heather Hauck Director, Division of State HIV/AIDS Programs

5 Objectives To discuss the FY 2013 Ryan White States/Territories Part B Supplemental FOA and ADAP ERF FOA Provide pre-application Technical Assistance (TA) to Part B grantees Part B Supplemental X08 FOA due - July 15 th FY 2013 ADAP ERF X09 FOA due – July 19 th

6 Announcements Heather Hauck, Director Division of State HIV/AIDS Programs HIV/AIDS Bureau

7 Questions

Ryan White States/Territories Part B Supplemental FOA New - Limited Competition Announcement Number: HRSA Harold Phillips, MRP Deputy Director, Division of State HIV/AIDS Programs HIV/AIDS Bureau Health Resources and Services Administration Department of Health and Human Services

9 Purpose of RW Part B Supplemental Solicits applications for the Ryan White HIV/AIDS Program Part B Supplemental program. Supplement the services otherwise provided by the State. Determined by the applicant’s ability to demonstrate the need in the State based on an objective and quantified basis.

10 Summary of Funding Approximately $15,433,994 is expected to be available for 2013 Part B Supplemental funding, of which up to approximately $4,534,654 will be used for priority funding. Ryan White States/Territories Part B Supplemental

11 Ryan White States/Territories Part B Supplemental The State/Territory must demonstrate the severity of the HIV/AIDS epidemic in the State/Territory by using: 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 should explain why supplemental funding for health services is needed to provide necessary services for people living with HIV and AIDS in the State/Territory.

12 RW Part B Supplemental Demonstrated Need Factors in assessing demonstrated need: The unmet need for HIV-related services as determined by section 2617(b) of the PHS Act; An increasing need for HIV/AIDS-related services, including relative rates of increase in the number of living cases of HIV/AIDS; The relative rates of increase in the number of living cases of HIV/AIDS within new or emerging subpopulations;

13 RW Part B Supplemental Demonstrated Need The current prevalence of HIV/AIDS; 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;

14 RW Part B Supplemental Demonstrated Need The prevalence of homelessness; 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

15 RW Part B Supplemental Demonstrated Need Impact of a decline in the amount received in formula funding on services available to all individuals with HIV/AIDS identified and eligible under the title. Applicants should document the use of multiple data sets, such as HIV/AIDS epidemiologic data, co- morbidity data, poverty and insurance status data, current utilization data and assessments of emerging populations with special needs.

16 New to this Year’s Application 2013 Part B Supplemental FOA does not request Epidemiology Data, as the information was provided in the Ryan White HIV/AIDS Program Part B (HRSA ) FOA Part B Supplemental FOA does not request Unmet Need data, as the information was provided in the Ryan White HIV/AIDS Program Part B (HRSA ) FOA.

17 The “Justification for Ryan White Part B Supplemental Funding” which appeared in last year’s Part B Supplemental FOA has been removed from this application and those Review Criteria points have been redistributed among the remaining sections. New to this Year’s Application

18 Part B Supplemental funding may be used to support the strategy, plan and data collection as it relates to how the State/Territory will identify individuals living with HIV/AIDS who are unaware of their status (EIIHA). Additional Information

19 For States/Territories with current or potential shortfalls in ADAP resources, HAB strongly encourages grantees to prioritize Part B Supplemental funds to augment ADAP program resources when the following exist: ADAP Waiting Lists Capped Enrollment Reductions in ADAP formulary Reduction in Percentage of FPL Eligibility Other ADAP Program Restrictions within the jurisdiction Additional Information

20 Priority Funding Provision $4,534,654 will be used for priority funding Section 2620(c) of the PHS Act: The Amount of Supplemental Funds Disbursed to States under RW Part B to Address Service Decline or Disruption of Services Due to Reductions in Formula Grant Amounts Such a decline in funding compares the amount received in fiscal year 2013 to the amount received in fiscal year 2006, and a State’s assertion that such decline has had an impact on services available

21 Scoring of Applications Objective Review Committee (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 and the grantee’s number of living HIV/AIDS cases.

22 Caps on Expenses Part B grantee administrative costs may not exceed 10% of the total Part B grant award including the Part B Supplemental. Planning and Evaluation costs may not exceed 10% of the total Part B grant award. Collectively, Grantee Administration, and Planning and Evaluation may not exceed 15% of the total Part B award. Part B Clinical Quality Management costs may not exceed 5% of the total Part B grant award or $3,000,000 (whichever is the lesser amount).

23 Who Can Apply? 53 States/Territories are eligible to apply. Any State or Territory that had more than 5 percent of their FY 2011 formula funds cancelled under sections 2618(a)(1) or 2618(a)(2)(F)(i), offset under section 2622 (e), or covered by any waivers under section 2622(c) for fiscal year 2011 are not eligible Therefore the following States/Territories are not eligible to apply to this FOA this year – American Samoa, Guam, Marshall Islands, Mariana Islands, Palau, Rhode Island

24 Application and Submission Applicants are required to apply electronically through Grants.gov The Central Contractor Registration (CCR) transitioned to the System for Award Management (SAM) July 30, (To learn more about SAM, please visit SAM Quick Guide for Grantees ( e_Grants_Registrations-v1.6.pdf), an entity’s registration will become active after 3-5 days. Check for active registration well before the application deadline.

25 Application and Submission All applicants are responsible for reading the instructions included in HRSA’s Electronic Submission User Guide, available online at Applicants are also responsible for reading the Grants.gov Applicant User Guide, available online at

26 Application and Submission Applicants must submit proposals according to the instructions in the Guide and in this FOA in conjunction with Application Form SF-424. The forms contain additional general information and instructions for applications, proposal narratives, and budgets. The forms and instructions may be obtained by: 1) Downloading from or 2) Contacting the HRSA Digital Services Operation (DSO) at:

27 Application Format Requirements The total size of all uploaded files may not exceed the equivalent of 40 pages when printed by HRSA. The total file size may not exceed 10 MB. The 40- page limit includes the abstract, project and budget narratives, attachments, and letters of commitment and support. Standard forms are NOT included in the page limit. Applications must be submitted prior to the deadline to be considered under this announcement. See pages 7-8 for table of contents and order of documents and attachments.

28 Agency Contacts Program issues and/or technical assistance regarding this funding announcement may be obtained by contacting: Heather Hauck, Tel: Fax: , Business, administrative, or fiscal issues related to this funding opportunity announcement by contacting: Karen Mayo Telephone: (301) Fax: (301)

29 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 withGrants.gov Contact Center Telephone: iPortal:

30 Questions

Ryan White PART B AIDS Drug Assistance Program (ADAP) Emergency Relief Awards New & Competing Continuation Grants Announcement Number: HRSA Heather Hauck, MSW, LICSW Director, Division of State HIV/AIDS Programs HIV/AIDS Bureau Health Resources and Services Administration Department of Health and Human Services

32 Objectives Assist eligible applicants in preparing FY 2013 ADAP ERF application Explain Limited New and Competing Continuation ADAP Emergency Relief Funds

33 Overview of FY 2013 ADAP ERF Eligible Competing Continuation applicants are current FY 2012 ADAP ERF grantees. There are two awards available within this single FOA: Limited New Competition and Competing Continuation Limited New Competitive applicants are states that have instituted new waitlists since the date of issuance of the last ADAP ERF FOA on May 2, 2012 to April 30, 2013, and States that have implemented a waiting list as of January 1, 2013.

34 Overview FY 2013 Part B ADAP ERF ADAP Wait List o A waiting list is a strategy used when adequate funding is not available to provide medications to all eligible persons requesting enrollment in the state ADAP after implementing all other feasible cost- effectiveness strategies (e.g., lowering federal poverty level [FPL], reducing formulary, capping costs, etc.)

35 Summary of ADAP ERF Funding In FY 2013, it is anticipated that $10 million will be available in ADAP ERF limited new competition funds to fund up to10 grantees with a ceiling of $3 million. $65 million in competing continuation grants is available to fund approximately 25 grantees with a ceiling amount of their total FY 2012 ADAP ERF award. Any FY 2013 appropriated ADAP ERF funds not awarded under the Limited New Competition section of the FOA will be made available as needed to existing ADAP ERF grantees as continuation grants.

36 ADAP ERF Award Information The Amount of Each Award Will Be Based On: The applicant’s ability to demonstrate need for funding to prevent, eliminate or reduce waiting list and/or implement “cost-cutting” measures and/or “cost saving” measures and The success of the applicant’s past efforts to improve the cost-effectiveness of ADAP operations consistent with HRSA recommendations and policies and to maximize available resources.

37 Use of ADAP ERF Funds ADAP Wait List Cost Containment Measures Cost-cutting measures Cost-saving measures

38 Use of ADAP ERF Funds States with existing waiting lists as of January 1, 2013 must use all ADAP ERF Limited New Competing funds to address the waiting list. States without a waiting list reported to HRSA as of January 1, 2013 must use all ADAP ERF limited New Competing funds to address “cost-cutting” measures and/or support implementation of “cost saving” measures during the project period to prevent a waiting list.

39 Cost -Saving Measures Any measure taken to improve the cost- effectiveness of ADAP operations, which are required to achieve, improve and/or maximize HRSA recommended cost-saving strategies that all States should be working to achieve and/or maximize regardless of financial status. States may request emergency ADAP emergency relief funding to implement “cost-saving measures”

40 Cost -Cutting Measures ADAP ERF funding may be requested to address/reverse (completely or partially) “cost- cutting” measures. Restrict/reduce enrollment (e.g. reduction of financial eligibility below 300 percent of the Federal Poverty Level (FPL), capped enrollment) Reduce benefits (e.g. formulary reductions with respect to antiretroviral and medications to treat opportunistic infections or complications of HIV) Instituted out of necessity due to insufficient resources and/or to avoid starting a waiting list.

41 Limited New Competing Applicants Limited New Competing applicants are states that have instituted new waitlists since the date of issuance of the last ADAP ERF FOA on May 2, 2012 to April 30, 2013, and States that have implemented a waiting list as of January 1, States with an ADAP waiting list reported to HRSA as of January 1, 2013 must use all funding awarded under this announcement to remove clients from the waiting list.

42 States that did not report a waiting list to HRSA as of January 1, 2013, must use funding awarded under this announcement to address “cost-cutting” measures (e.g. reduction in ADAP eligibility below 300% FPL and/or the formulary with respect to antiretrovirals and drugs to treat opportunistic infections or HIV/AIDS complications) and/or support the implementation of “cost-saving” measures during the project period to prevent a waiting list. Limited New Competing Applicants

43 Limited New Competing Applicants The amount of each award will be based on Applicant’s ability to demonstrate need for funding to address a waiting list and/or “cost-cutting” measures and/or “cost-saving” measure Success of the applicant’s past efforts to improve the cost-effectiveness of ADAP operations consistent with HRSA recommendations Policies to maximize available resources. Determination will be made by Objective Review Committee (ORC)

44 Limited New Competing Applicants Funding will be based on the applicant’s responses to addressing the waiting lists as follows: The ORC scores will be used to establish the rank order for the awarding of funds. All applicants that request new limited competitive ADAP ERF funds to address waiting lists and are recommended for an award by the ORC will receive awards based on their ORC scores. Applicants that request funds for “cost-cutting” measures and/or “cost saving” measures will receive awards based on their ORC scores.

45 Limited New Competing Applicants Eligibility Information The following States and Territories are NOT eligible to apply for funding under the Limited New Competition: AL, AK, AZ, CA, CO, FL, GA, ID, IL, IA, KY, LA, MT, NE, NJ, NC, ND, PR, SD, TN, UT, VI, VA, WA, and WI.

46 ADAP ERF Competing Continuation This FOA also contains instructions for FY 2013 ADAP ERF Competing Continuation applications for the grantees that received FY 2012 ADAP ERF, to the extent that additional funds are needed and justified. Applicants for Competing Continuation awards must document how FY 2012 ADAP ERF dollars have been used to reduce their waiting list and/or address “cost-cutting” measures and/or implement “cost-saving” measures. This includes the number of clients removed from the State’s ADAP waiting list and/or otherwise impacted by the implementation of cost containment measures implemented after September 20, 2012.

47 ADAP ERF Competing Continuation A total of $65 million is available for FY 2013 Competing Continuation awards. Applicants are advised that the awards will be capped at the applicant’s total FY 2012 ADAP ERF award amount. A Competing Continuation award is not guaranteed, but rather will be determined by the applicant’s documentation and justification of the need for continuation funds, with priority given to addressing waiting lists.

48 ADAP ERF Competing Continuation Competing continuation awards are intended to : Prevent, reduce and/ or eliminate ADAP waiting lists Address “cost-cutting” measures initiated after September 30, 2012 Complete the implementation of “cost saving” measures initiated after September 30, 2012.

49 Grants are intended to provide support to Ryan White Part B grantees that received FY 2012 ERF Grantee provide justification for additional funding $65 Million is available for FY 2013 competing continuation awards Funds will be awarded on a needs-based formula ADAP ERF Competing Continuation

50 ADAP ERF Competing Continuation Will be capped at the applicant’s FY 2012 ADAP ERF award amount; Applicants are to calculate and request funds for a 12 month budget period Funds are not guaranteed, and determined by the applicant’s documentation and justification of the need for continuation funds for the 6-month project and budget period (September 30, 2012 – March 31, 2014).

51 ADAP ERF Competing Continuation Only the following 25 Part B grantees that received FY 2012 ADAP ERF awards are eligible to apply for FY 2013 Competing Continuation ADAP ERF awards: AL, AK, AZ, CA, CO, FL, GA, ID IL, IA, KY, LA, MT, NE, NJ, NC, ND, PR, SD, TN, UT, VI, VA, WA, and WI.

52 Scoring of Competing Continuation Applications Funding will be based on the Objective Review Committee’s (ORC) review and scoring of applicant’s responses to the criteria published in this announcement with priority given to addressing waiting lists as follows: The ORC scores will be used to establish the rank order for the awarding of funds. All applicants that request competing continuation ADAP ERF funds to prevent, eliminate or reduce waiting lists and are recommended for an award by the ORC will receive awards first based on their ORC scores. Once those funds are distributed, then applicants that request funds for cost-containment (“cost-cutting” measures and/or “cost saving” measures) will receive awards.

53 Scoring of Competing Continuation Applications Applicants with the highest scores will be funded at the full amount requested as long as the amount requested is for allowable services under this FOA, and recommended by the ORC, falls within the minimum and maximum amount available, and there are still funds available to distribute. The FOA also identifies reports and other forms of documentation that will be required from all applicants for funds under this announcement. Applicants are advised that all FY 2013 ADAP ERF awards will be for a 6-month project and budget period (September 30, 2013 to March 31, 2014). All applicants must submit their application electronically through Grants.gov. Applicants may utilize information previously submitted in their FY 2013 Part B application (HRSA ) where applicable.

54 FY 2013 ADAP ERF The Sample format for the ADAP Profile can be found at

55 Questions