Department of Health and Human Services Health Resources and Services Administration

1. FY 2014 Ryan White Part AHIV Emergency Relief Grant ProgramTechnical Assistance CallSeptember 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

2. 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 Agenda 1

3. 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

4. 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

5. 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-for-monitoring-hhs-funded-hiv-services.html. 4

6. 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

7. Due and Award Dates • Application Due Date October 9, 2013 by 11:59 PM EST • Award Date March 1, 2014 6

8. Changes in FY 2014

9. 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

10. 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

11. 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

12. 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

13. Changes in FY 2014 Early Identification of Individuals with HIV/AIDS (EIIHA) • 1- Legislation • 2- Background • 3- EIIHA in FY2013 11

14. 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

15. Changes in FY 2014 EIIHA Standard Terms • EIIHA • Unaware • Identification • Informing • Referral • Linkage 13

16. Changes in FY 2014 EIIHA Components • Strategy • Plan • Identify, Inform, Refer & Link • Reflects subgroups in EIIHA Matrix 3. Data 14

17. 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 15

18. 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 16

19. 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

20. 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

21. 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 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. 19

22. 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

23. 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 self-report having previously tested HIV positive and has not been reported to jurisdiction’s surveillance department as being HIV positive. 21

24. 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 previouslydiagnosed 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

25. 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 HIV-positive test results received CD4 and VL testing. 23

26. Changes in FY 2014 PreviouslyDiagnosed 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

27. Changes in FY 2014 Summary • FOA for Parts A and B Streamlined • Duties will be the same for Planning Council and grantee • 2 Parts – Plan Background Summary and Progress Report • No Data Matrix – Detailed Narrative Responses • Historical Perspective 25

28. Changes in FY 2014 Cost Categories – Part A • 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

29. Changes in FY 2014 Cost Categories - Salary Limitations Requirement (Appropriations Act 2013) ` Grantee subcontracts with nephrologist for half day clinic at $100/hr. Does this subcontract comply with salary limitations? 27

30. 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) A 28

31. 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! 29

32. Changes in FY 2014 Cost Categories - Administration Costs (Grantee) 30

33. Changes in FY 2014 Cost Categories – Quality Management Costs (Grantee) 31

34. 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) 32

35. Reporting Requirements 33

36. Question & Answer Period

37. 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