HRSA-17-030 Program: Technical Assistance for FY 2017 Funding

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

2. 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

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

4. 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-17-030

5. 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 http://hab.hrsa.gov/healthcarelandscape/index.html • Information on the National HIV/AIDS Strategy: Updated to 2020 (NHAS 2020) is located at https://www.whitehouse.gov/sites/default/files/docs/national hiv_aids_strategy_update_2020.pdf

6. Due Date and Project Period • Application Due Date • October 18, 2016 by 11:59 PM EST • Project Period • March 1, 2017 – February 28, 2018

8. FY 17 FOA Overview Evaluation • Clinical Quality Management & Grant Administration • MOE

9. Highlights FY2017 FOA

10. Highlights FY 2017 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

11. Highlights FY2017 FOA

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

13. 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

14. 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

15. Epidemiologic Overview Resources • Integrated HIV Epidemiologic Profiles for HIV Prevention and Care Planning Training https://careacttarget.org/library/integrated-hiv-epidemiologic-profiles-hiv-prevention-and-care-planning-training • Integrated Guidance for Developing Epidemiologic Profiles: HIV Prevention and Ryan White HIV/AIDS Programs Planning, July 2014 http://www.cdc.gov/hiv/pdf/guidelines_developing_epidemiologic_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 2015 http://hab.hrsa.gov/manageyourgrant/hivpreventionplan062015.pdf

16. 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

17. 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

18. Selecting EIIHA Populations 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

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

20. 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: • Current Unmet Need Framework https://careacttarget.org/sites/default/files/file-upload/resources/UnmetNeedPracticalGuide.pdf • HIV Care Continuum Framework

21. HIV Care Continuum Framework Unmet Need = (Diagnosed) - (Retained in Care) Unmet Need Estimate • 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

22. 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

23. Selecting MAI Populations AWARE People of Color Living with HIV Epidemiologic Profile • MAI Purpose: • Improve “HIV-related health outcomes to reduce existing racial and ethnic health disparities.” 3 Key Minority Populations

24. Minority AIDS Initiative • Identify minority populations living with HIV and the specific sub-groups • For each MAI population identified: • Describe the planning process for determining the needs of the MAI populations identified in the Epidemiologic Overview • 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 • 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

25. MAI HIV Care Continuum

26. 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

27. 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

28. Section Overview: Methodology

29. 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

30. Impact of Changing Health Care Landscape

31. Planning and Resource Allocation

32. 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

33. 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

34. SAMPLE Attachment 7

35. Section Overview: Work Plan

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

37. 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

38. SAMPLE Attachment 8 Service Category Plan Table

39. SAMPLE Attachment 8 Service Category Plan Table

40. 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

41. 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

42. 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.

43. CORE MEDICAL SERVICES WAIVER Instructions for CMS Waivers can be found at: http://hab.hrsa.gov/healthcarelandscape/13-07waiver.pdf

44. 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

45. SAMPLE

46. Section Overview: Resolution of Challenges

47. 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.

48. Resolution of Challenges Table SAMPLE

49. Section Overview: Evaluation and Technical Support Capacity

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