FY 2014
Ryan White Part A
HIV Emergency Relief Grant Program
Technical Assistance Call
September 6, 2013
Department of Health and Human Services
Health Resources and Services Administration
HIV/AIDS Bureau
Division of Metropolitan HIV/AIDS Program
Speakers:
Gary Cook
Mark Peppler
LCDR Keisha Johnson
Karen Ingvoldstad
Sonya Hunt-Gray
Agenda
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Welcome
Program Information
Purpose of the Call
Context
Application Due Date and Award Date
Changes in FY 14 FOA
Reporting Requirements
Question & Answer Period
Program Contact Information
1
Purpose of the Call
• To provide technical assistance, general information
and responsive answers to all eligible metropolitan
areas relative to HRSA-14-034, HIV Care Program
Part A - HIV Emergency Relief Grant Program, which
provides direct financial assistance to an Eligible
Metropolitan Area (EMA) or a Transitional Grant Area
(TGA) that has been severely affected by the HIV
epidemic.
2
Program Information
• FY 2014 – 24 EMAs and 28 TGAs
• OMB Census and MSAs
• TGAs and Planning Councils
• Hold Harmless in 2014
• Core Medical Services Waiver Policy
3
Context – Continuum of HIV Care
• On July 15, 2013, the Executive Order on the HIV
Care Continuum Initiative was released (please refer
to page 18 of the FOA for the link).
• The ultimate goal of the Continuum of HIV Care or
Care Treatment Cascade is to achieve viral load
suppression.
http://blog.aids.gov/2012/08/secretary-sebelius-approves-indicators-formonitoring-hhs-funded-hiv-services.html.
4
Context – Affordable Care Act
• As part of the Affordable Care Act (ACA), several
significant changes have been made in the health
insurance market that expand options for health care
coverage.
• Outreach efforts are needed to ensure that families and
communities understand these new health care
coverage options and to provide eligible individuals
assistance to secure and retain coverage during
transition an beyond.
• Ryan White grantees are strongly encouraged to
support ACA-related outreach and enrollment activities
to ensure that clients fully benefit from the new health
care coverage opportunities.
http://hab.hrsa.gov/affordablecareact/outreachenrollment.html
5
Due and Award Dates
• Application Due Date
October 9, 2013 by 11:59 PM EST
• Award Date
March 1, 2014
6
Changes in FY 2014
Changes in FY 2014
FOA Template and SF-424 Guide
Application Guidance — 2 Components
• Program specific instructions
--Part A Funding Opportunity Announcement
HRSA-14-034 (FOA)
• SF 424 Application Guide (“Application Guide”)
--link found throughout FOA, starting on page
i – Executive Summary
7
Changes in FY 2014
Needs Assessment Updates
• Section 1)C.(2)(a) First and fourth bullets at top of
page 11, ACA components – Medicaid expansion and
health insurance marketplaces – are identified as
possible funding sources
• Section 1)A.(3) FY 2013 should be FY 2014 priorities
8
Changes in FY 2014
Work Plan Updates
• Section 1) A. Continuum of Care for FY 2014, on page
17 requests information on “integrated HIV
prevention/care planning”, “how coverage and receipt of
services may change due to implementation of the ACA”,
and outreach and enrollment of clients in new health
coverage options”.
• Section 1) C. (2) page 18 references “Medicaid
expansion and ACA marketplaces” as possible funding
sources for prioritized core medical services.
• Section 1) C. (8) page 19 requests applicant to describe
how goals/objectives relate to the NHAS
9
Changes in FY 2014
Clinical Quality Management Updates
• Please note that the CQM section has been updated
with more emphasis on:
• CQM program implementation and evaluation
• Performance measure data and use
• Client level data collection
10
Changes in FY 2014
Early Identification of Individuals with
HIV/AIDS (EIIHA)
• 1- Legislation
• 2- Background
• 3- EIIHA in FY2013
11
Changes in FY 2014
EIIHA - Part A Legislation
 Part A Grant
 “…shall determine size and demographics of the
estimated population of individuals with HIV/AIDS who
are unaware of their HIV status ”
 “determine the needs of… individuals with HIV/AIDS who
do not know their HIV status”
 “ develop a comprehensive plan…that includes – “
 “a strategy, coordinated as appropriate with other
community strategies and efforts , including discrete
goals, a timetable, and appropriate funding, for
identifying individuals with HIV/AIDS who do not
know their HIV status, making such individuals aware
of such status, and enabling such individuals to use
the health and support services”
12
Changes in FY 2014
EIIHA Standard Terms
1.
2.
3.
4.
5.
6.
EIIHA
Unaware
Identification
Informing
Referral
Linkage
13
Changes in FY 2014
EIIHA Components
1. Strategy
2. Plan
a) Identify, Inform, Refer & Link
b) Reflects subgroups in EIIHA Matrix
3. Data
14
Changes in FY 2014
EIIHA in FY2013
FOAs for Parts A and B are streamlined
2 Parts to EIIHA- FY 2014 FOA Requirements and
Progress Report (same as in past)
• FY 2014 FOA EIIHA Information
• Overall Assessment of EIIHA Plan and Approach
• Allow grantees to reflect on their EIIHA approach since
its inception
• Summarize how the EIIHA Plan was developed and
implemented
• Target Group selection
• Data collection, analysis usage
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•
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Changes in FY 2014
EIIHA in FY2013
• FY 2014 FOA EIIHA Information (cont)
Data collection, analysis usage
Major outcomes and Challenges
EIIHA Plan connection to National HIV/AIDS Strategy
Report on Testing Data will be requested from 3 populations
(Jan 1, 2013-June 30, 2013 or most recent six month period)
• Previous Data Matrix has been removed
• EIIHA Section will be scored same as in past FOAs- 33
points
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16
Changes in FY 2014
Definitions
Source Document:
HIV Testing at CDC-Funded Sites,
United States, Puerto Rico, and the
U.S. Virgin Islands, 2010
http://www.cdc.gov/hiv/pdf/testing_cdc_sites_2010.pdf
17
Changes in FY 2014
Newly and Previously Diagnosed Positive HIV Test
Events
HIV testing event
• An HIV testing event is a sequence of one or more HIV tests
conducted with the client to determine his or her HIV status.
During a single testing event, a client may be tested once
(e.g., one rapid test or one conventional test) or multiple times
(e.g., one rapid test followed by one conventional test to
confirm a preliminary HIV-positive test result).
HIV medical care
• HIV medical care includes medical services for HIV infection
including evaluation of immune system function and
screening, treatment and prevention of opportunistic
infections.
18
Changes in FY 2014
Newly and Previously Diagnosed Positive HIV Test
Events
Referral to partner services
• This calculated indicator determines whether a client with a confirmed HIVpositive test result was given a referral to partner services.
Interviewed for partner services
• This calculated indictor determines whether a client with a confirmed HIVpositive test result was interviewed for Partner Services within 30 days of
receiving their confirmed positive test result. In order for a client to be
counted as interviewed for Partner Services, the client must both be referred
to Partner Services and interviewed within 30 days of positive test result.
19
Changes in FY 2014
Newly and Previously Diagnosed Positive HIV Test
Events
Referral to prevention services
• This indicator determines whether a client with
confirmed HIV-positive test results was given a
referral to HIV prevention services.
20
Changes in FY 2014
Newly Diagnosed Positive HIV Test Events
Confirmed HIV-positive result
• A testing event with a positive test result for a conventional HIV test
(positive EIA test confirmed by supplemental testing, e.g., Western Blot)
or a nucleic acid amplification test (NAAT).
Newly identified confirmed HIV-positive result
• A confirmed HIV-positive test result associated with a client who does not
self-report having previously tested HIV positive and has not been
reported to jurisdiction’s surveillance department as being HIV positive.
Newly identified HIV-positive result
• An HIV-positive test result associated with a client who does not selfreport having previously tested HIV positive and has not been reported to
jurisdiction’s surveillance department as being HIV positive.
21
Changes in FY 2014
Number of newly diagnosed positive test events with client linked
to HIV medical care
Linkage to HIV medical care
• This calculated indictor determines whether a client with an HIV-positive
test result was linked to HIV medical care within 90 days of initial positive
test. In order for a client to be linked to care, the client must both be
referred to HIV medical care and attend the first medical care appointment.
Number of previously diagnosed positive test events with client
re-engaged in HIV medical care
Linkage to HIV medical care
• This calculated indictor determines whether a client was linked to HIV
medical care within 90 days of the re-diagnosis. In order for a client to be
linked to care, the client must both be referred to HIV medical care and
attend the first medical care appointment.
22
Changes in FY 2014
Number of previously diagnosed confirmed positive test events
linked to and accessed CD4 cell count and viral load testing
and
Total number of newly diagnosed confirmed positive test events
who received CD4 cell count and viral load testing
CD4/VL
• This variable indicates whether a client with confirmed HIVpositive test results received CD4 and VL testing.
23
Changes in FY 2014
Previously Diagnosed Positive HIV Test Events
Previously identified HIV-positive result
• HIV-positive test result associated with a client who
self-reports having previously tested HIV positive or
has been reported to jurisdiction’s surveillance
department as being HIV positive.
24
Changes in FY 2014
Summary
1. FOA for Parts A and B Streamlined
2. Duties will be the same for Planning Council and
grantee
3. 2 Parts – Plan Background Summary and Progress
Report
4. No Data Matrix – Detailed Narrative Responses
5. Historical Perspective
25
Changes in FY 2014
Cost Categories – Part A
1.
2.
3.
4.
Core Medical Services 75%
Support Services 25%
Clinical Quality Management (CQM) 5%
Administrative Costs 10%
Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public
Law 111-87,October 30,2009), §
26
Changes in FY 2014
Cost Categories - Salary Limitations Requirement (Appropriations Act 2013)
Salaries charged to
Individual’s base
HHS grants may not
salary, exclusive of
Applies to
exceed $179,700
fringe benefits and
subcontracts
annually
outside income earned
`
Grantee subcontracts with nephrologist for half day
clinic at $100/hr. Does this subcontract comply with
salary limitations?
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Changes in FY 2014
Salary Limitations Requirement
(Continuing Appropriations Act 2013)
NO
Grantee may reimburse for
nephrologist services at a
rate of $86.39/hour or below
with Ryan White funds (HHS)
28
Changes in FY 2014
Cost Categories – Salary Limitation Example
•Individual’s full time salary: $350,000
50% of time will be devoted to project
Direct salary:
• A
$175,000
Fringe (25% of salary):
$43,750
Total:
$218,750
Amount that may be claimed on the Federal grant
•Individual’s base full time salary adjusted to Executive Level II:
$179,700 or ~ $86.39/hour
50% of time will be devoted to project
Direct salary:
$89,850
Fringe (25% of salary):
$22,462
Total:
$112,312
Please provide an individual’s actual base salary if it exceeds the cap!
29
Changes in FY 2014
Cost Categories - Administration Costs (Grantee)
• Indirect costs (with approved
Federally negotiated indirect rate)
• Planning Council Support and
related activities
• Operation and maintenance
expenses
• National Monitoring Standards
implementation costs
• Rent, utilities, and facility costs
• Costs associated with contract
award procedures
• Personnel Costs
• Computer hardware and software
• Payroll/accounting services
• Telecommunications, postage,
office supplies
• Audits
• Program evaluation, development,
strategic planning
• Office equipment lease
• Copying and printing
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Changes in FY 2014
Cost Categories – Quality Management Costs (Grantee)
• Clinical Quality Management
coordination
• Training of subcontractors
• Continuous Quality Improvement • Grantee CQM staff
activities
training/technical assistance
• Data collection for clinical quality
management
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Changes in FY 2014
Cost Categories – Administrative Costs (Subcontractor)
• Section 2604 (h)(4) SUBCONTRACTOR ADMINISTRATIVE
ACTIVITIES- For the purposes of this subsection, subcontractor
administrative activities include—
• (A) usual and recognized overhead activities, including
established indirect rates for agencies;
• (B) management oversight of specific programs funded under this
title; and
• (C)other types of program support such as quality assurance,
quality control, and related activities.
• Section 2604(h)(2) Sub-recipient administrative costs are limited to
10% of HIV-related service dollars (in the aggregate)
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Reporting Requirements
FY 2012 Requirements
Contents
Final FY 2012 MAI Annual
Report
Final FY 2012 MAI Annual Report
for period 3/1/2012 to 2/28/2013
FY 2013 Requirements
Contents
FY 2013 Program Term
Report
REVISED: SF 424A, Budget Narrative,
Reporting Requirement
Implementation Plan, CLC, CRC, & FY 2013
Part A & MAI Planned Allocation Table
(Send Planning Council Co Chairs signed
letter endorsing the allocations and program
priorities)
Final FY 2013 MAI Annual Plan for the use of August 20, 2013
Reporting Requirement
the Part A MAI funds for period 3/1/2013 to
2/28/2014
UOB Estimates and Estimated Carryover
December 31, 2013 Reporting Requirement
Final FY 2013 MAI Annual
Plan
Unobligated Balances (UOB)
Ryan White Services Data
Report (RSR)
Federal Financial Report, FFR
(SF 425)
FY 2013 Part A & MAI Final
Expenditure Table
Final FY 2013 Part A Annual
Progress Report
MAI Annual Report
Submission
Due to EHB
January 31, 2014
Requirement Type
Submission
Due to EHB
September 20,
2013
Requirement Type
Ryan White Services Data Report (RSR)
March 31, 2014
Reporting Requirement
FY 2013 Final FFR and Carry Over
July 30, 2014
Condition
FY 2013 Part A & MAI Final Expenditure Table
June 30, 2014
Reporting Requirement
Final FY 2013 Part A Annual Progress Report & July 30, 2014
Expenditure for WICY (see NOA for additional
details)
FY 2013 MAI Annual Report
January 31, 2015
Reporting Requirement
Reporting Requirement
Reporting Requirement
33
Question & Answer Period
Program Contacts
HAB/DMHAP Contact
Steven R. Young, MSPH
Director, Division of Metropolitan HIV/AIDS Programs
5600 Fishers Lane, Room 7A-55
Rockville, Maryland 20857
Email: Syoung@hrsa.gov
Telephone: (301) 443-6745
Fax: (301) 443-8143
Please continue to submit specific questions through your assigned
Project Officer. These will be combined with others with answers posted
and circulated to all eligible areas.
Technical Assistance Website: http://www.careacttarget.org