FY 2014 Ryan White Part A

HIV Emergency Relief Grant ProgramTechnical Assistance Call

September 6, 2013Department of Health and Human Services

Health Resources and Services AdministrationHIV/AIDS Bureau

Division of Metropolitan HIV/AIDS ProgramSpeakers:Gary Cook

Mark PepplerLCDR Keisha Johnson

Karen IngvoldstadSonya Hunt-Gray

Agenda

• 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.

4

http://blog.aids.gov/2012/08/secretary-sebelius-approves-indicators-for-monitoring-hhs-funded-hiv-services.html.

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 2014FOA Template and SF-424 Guide

Application Guidance — 2 Components• Program specific instructions

--Part A Funding Opportunity AnnouncementHRSA-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

Early Identification of Individuals with HIV/AIDS (EIIHA)

• 1- Legislation

• 2- Background

• 3- EIIHA in FY2013

Changes in FY 2014

11

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”

Changes in FY 2014

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EIIHA Standard Terms

1. EIIHA2. Unaware 3. Identification4. Informing5. Referral6. Linkage

Changes in FY 2014

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EIIHA Components

1. Strategy2. Plan

a) Identify, Inform, Refer & Linkb) Reflects subgroups in EIIHA Matrix

3. Data

Changes in FY 2014

14

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

Changes in FY 2014

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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

Changes in FY 2014

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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

Changes in FY 2014

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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.

Changes in FY 2014

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Newly and Previously Diagnosed Positive HIV Test Events

Referral to partner services•This calculated indicator determines whether a client with a confirmed HIV-positive test result was given a referral to partner services.

Interviewed for partner services•This calculated indictor determines whether a client with a confirmed HIV-positive 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.

Changes in FY 2014

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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.

Changes in FY 2014

20

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 self-report having previously tested HIV positive and has not been reported to jurisdiction’s surveillance department as being HIV positive.

Changes in FY 2014

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Number of newly diagnosed positive test events with client linked to HIV medical careLinkage 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 careLinkage 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.

Changes in FY 2014

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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 HIV-positive test results received CD4 and VL testing.

Changes in FY 2014

23

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.

Changes in FY 2014

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Summary

1. FOA for Parts A and B Streamlined2. Duties will be the same for Planning Council and

grantee3. 2 Parts – Plan Background Summary and Progress

Report4. No Data Matrix – Detailed Narrative Responses5. Historical Perspective

Changes in FY 2014

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Changes in FY 2014

Cost Categories – Part A

1.Core Medical Services 75%2.Support Services 25%3.Clinical Quality Management (CQM) 5% 4.Administrative Costs 10%

Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87,October 30,2009), §

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Changes in FY 2014

Cost Categories - Salary Limitations Requirement (Appropriations Act 2013)

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`Grantee subcontracts with nephrologist for half day clinic at $100/hr. Does this subcontract comply with salary limitations?

Salary Limitations Requirement(Continuing Appropriations Act

2013)

NOGrantee may reimburse

for nephrologist services at a rate of $86.39/hour

or below with Ryan White funds (HHS)

Changes in FY 2014

28

Changes in FY 2014

Cost Categories – Salary Limitation Example•Individual’s full time salary: $350,000

• A

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

Please provide an individual’s actual base salary if it exceeds the cap!

50% of time will be devoted to project

Direct salary: $175,000Fringe (25% of salary):

$43,750

Total: $218,750

50% of time will be devoted to project

Direct salary: $89,850Fringe (25% of salary):

$22,462

Total: $112,312 29

Changes in FY 2014

Cost Categories - Administration Costs (Grantee)

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• 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

Changes in FY 2014

Cost Categories – Quality Management Costs (Grantee)

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• Clinical Quality Management coordination

• Training of subcontractors

• Continuous Quality Improvement activities

• Grantee CQM staff training/technical assistance

• Data collection for clinical quality management

Changes in FY 2014Cost 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

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FY 2012 Requirements Contents Submission Due to EHB

Requirement Type

Final FY 2012 MAI Annual Report

Final FY 2012 MAI Annual Report for period 3/1/2012 to 2/28/2013

January 31, 2014 Reporting Requirement

Question & Answer Period

Program Contacts

HAB/DMHAP Contact Steven R. Young, MSPHDirector, Division of Metropolitan HIV/AIDS Programs5600 Fishers Lane, Room 7A-55Rockville, Maryland 20857Email: Syoung@hrsa.govTelephone: (301) 443-6745Fax: (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