Department of Health and Human Services Health Resources and Services Administration

1. Women, Infants, Children, and Youth (Part D WICY) Overview:Program Introduction and RequirementsTechnical Assistance Conference CallSeptember 6, 2012 Department of Health and Human Services Health Resources and Services Administration HIV/AIDS Bureau Division of Community HIV/AIDS Programs Director: Dr. Margarita Figueroa-Gonzalez

2. Agenda Overview of HRSA, HAB, and Part D WICY Program Division of Grants Management Operations CCR and SAMS Part D Legislative and Program Requirements Minority AIDS Initiative (MAI) Designated Service Area Condition of Award (COA) Monitoring Subcontractors Program Income Salary Limitations Reporting Requirements 2012 Ryan White All-Grantees Meeting Q &A 2

3. Health Resources and Services AdministrationORGANIZATION CHART Office of Special Health Affairs Director Dr. Terry Adirim Office of Legislation Director Leslie Atkinson OFFICE OF THE ADMINISTRATOR Administrator Mary K. Wakefield, Ph.D., R.N. Deputy Administrator Marcia K. Brand, Ph.D. Senior Advisor Tina Cheatham Chief Public Health Officer CAPT Linde-Feucht Office of Equal Opportunity, Civil Rights, and Diversity Management Director M. June Horner Office of Communications Director Martin Kramer Office of Planning, Analysis and Evaluation Director Rebecca Slifkin, PhD Office of Operations Chief Operating Officer Thomas Morford Office of Rural Health Policy Associate Administrator Tom Morris Office of Federal Assistance Management Associate Administrator Mike Nelson Office of Regional Operations Associate Administrator Lee Wilson Bureau of Primary Health Care Associate Administrator James Macrae Healthcare Systems Bureau Associate Administrator Joyce Somsak Maternal and Child Health Bureau Associate Administrator Michael Lu HIV/AIDS Bureau Associate Administrator Deborah Parham Hopson Bureau of Clinician Recruitment and Service Associate Administrator Rebecca Spitzgo Bureau of Health Professions Associate Administrator Janet Heinrich

4. Acronyms AGM All Grantees Meeting CCR Central Contractor Registry COA Conditions of Award CQM Clinical Quality Management DCHAP Division of Community HIV/AIDS Programs DGMO Division of Grants Management Operations EHB Electronic Handbooks FFR Federal Financial Report FOA Funding Opportunity Announcement GMS Grants Management Specialist HAB HIV/AIDS Bureau MAI Minority AIDS Initiative NOA Notice of (Grant) Award PO Project Officer SAM System for Award Management 4

5. HIV/AIDS Bureau (HAB) 101 • HAB – HIV/AIDS Bureau – Five Divisions • Division of Metropolitan HIV/AIDS Programs (Part A) • Division of States and Territories ( Part B) • Division of Community HIV/AIDS Programs • --Part C – Early Intervention Services • --Part D – Women, Infants Children and Youth • --Part F – Dental • Division of Training and Capacity Development • Division of Policy and Data

6. The Ryan White HIV/AIDS Treatment Extension Act is a legislative program. • Public Health Law 111-87 under Title XXVI. • Enacted into law in 1990, • Reauthorized 1996, 2000, 2006,and 2009; • Up for Reauthorization in 2013.

7. Part D WICY Program Overview --The purpose of Part D funding is to provide family-centered primary medical care to women, infant, children, and youth (WICY) living with HIV/AIDS when payments for such services are unavailable from other pay sources. --Theentire Ryan White HIV/AIDS Program Part D was re-competed in 2012 to respond to the changing HIV epidemiology and the National HIV/AIDS Strategy with the goal of providing comprehensive health care services for the WICY populations in areas of greatest need for services.  

8. Ryan White HIV/AIDS New Part D Awards • 114 selected through an Objective Review Committee (ORC) process • 37 are new Part D grantees; 7 are new DCHAP grantees • 76 are funded under both Ryan White Parts C and D • 63 Academic medical centers or Hospitals • 20 Community based organizations • 17 Departments of Health • 14 Federally Qualified Health Centers

9. Division of Grants Management Operations • Provides clarification on grants regulations and financial aspects of the project • Reviews and make recommendations on continued Federal support • Monitors compliance with grant requirements and cost principles • Monitors receipt of all required reports and follows-up as necessary to obtain delinquent reports • Issues Notice of Grant Awards (NoA) • Only the HRSA grants office has legal authority to change, approve or deny expenditures, changes in project scope, or any other action which requires prior approval from HRSA.

10. Understanding Your Notice of Award (NOA) • Your NOA consist of the following sections: • Face Page with Grant Number & Award Amount, Institutional Information, etc. • Program/Grant Specific Conditions • Program/Grant Specific Terms • Standard Terms • Reporting Requirements • HRSA Contacts (GMS & PO) • Attachment Pages

11. NOA Information • Program/Grant Conditions of Award --Always require a response by a specific date – failure to respond in a satisfactory manner may result in adverse action --HRSA will remove the condition, once it is met, by issuing a new NoA • Program/Grant Terms --Generally informational and advisory by nature (e.g., uses and limitations of funds and post award administration), but may require a response to HRSA --A new NoA is not usually issued for Reporting Requirements --Always require a response by a specific date – failure to respond may result in adverse action --Does not require the issuance of a new NoA to remove or acknowledge receipt All Terms and Conditions remain in effect unless explicitly removed.

12. Non-Compliance and Termination • If an organization fails to comply with the terms, conditions or reporting requirements of the grant award, HRSA may take one or more of the following actions: • Temporarily withhold cash payments pending correction of the deficiency (drawdown restriction) • Disallow all or part of the cost of the activity or action that is non-compliant • Wholly or partly suspend or terminate the current award • Withhold further awards for the project or program • Take other remedies that might be legally available

13. Payment Management System Payments for grants awarded by HRSA are made through the Division of Payment Management. P. O. Box 6021 Rockville, MD 20852 (877) 614-5533 E-Mail: PMSSupport@psc.gov http://www.dpm.psc.gov (Click on contacts) The ONE-DHHS Help Desk for PMS Support is now available Monday – Friday from 7 a.m. to 9 p.m. EST (except Federal Holidays) Federal Financial Reports (FFR) are due to PMS on a quarterly basis, and are separate from the FFR requirements for HRSA.

14. The HRSA Electronic Handbooks (EHB) All post award administration is done through EHBs HRSA EHBs can be accessed going to the URL: https://grants.hrsa.gov/webexternal/login.aspTo register, click on the ‘create account’ link. If you have a registered account but do not have the permission to access the given Grant Portfolio then login to HRSA EHBs and click on the ‘Add Portfolio’ link on the side menu. Follow the instructions on the Add Portfolio page to gain access to the Grant Portfolio If you need assistance regarding registering with HRSA EHBs, gaining access to the Grant Portfolio, or other EHBs issues, please contact the HRSA Contact Center by email: CallCenter@HRSA.Gov or by phone: 877-464-4772. The HRSA Contact Center is available 9:00 a.m. to 5:30 p.m. Eastern Time, Monday through Friday.

15. The HRSA Electronic Handbooks (EHB) (2) • The Project Director or other user with “Administer Grant Users” privileges in the Grant Handbook will manage user privileges for Prior Approval Requests. • Grantee users with privileges to Edit or Submit Prior Approval requests in the Grant Handbook will login to the EHBs and begin the request. • In some cases, templates for the required documents will be available for download in the EHBs. • Grantee will complete required fields in the web-forms and upload completed required documents as attachments in the EHBs.

16. The HRSA Electronic Handbooks (EHB) (3) • Once all required fields have been completed and validated and all documents have been uploaded into the EHBs, the grantee will submit the request to HRSA. • HRSA Program and Grants Office personnel will review the request and approve, disapprove, or request more information. • Grantee user(s) will receive an electronic notification of HRSA’s decision. • If returned for changes, make the appropriate changes and re-submit the request. • Once the request is approved, HRSA will complete the process and deliver any related documentation, such as a revised Notice of Grant Award (NOA).

17. The HRSA Electronic Handbooks (EHB) (4) • By default, the Project Director and Financial Reporting Administrator will have privileges to view, edit, or submit prior approval requests. • All other users must be given privileges by the Project Director or other user with the ability to Administer Grant Users privileges in the Grant Handbook.

18. THRSA Electronic Handbooks (EHB)

19. Post Award Procedures • A prior approval request is a request initiated by the grantee to change grant-related information. • In the past, these requests were submitted on paper or via email. Grantees will now be required to submit Requests through EHB. • Prior Approval Requests include: • Project Director Change • Carry over of Unobligated Balances • Extension of Project Period (with or without funds) • Re-Budgeting • Administrative Supplements • Other Changes (Grantee Name, Deviation from Terms, etc.) • All prior approval requests must be submitted by an Authorized Official (AO), or contain a letter counter-signed by an AO.

20. Navigate to Prior Approval Requests New/Existing link

21. Prior Approval Requests – List Page Any pending prior approval requests will appear in the New/Existing Prior Approval Requests list page Search button Click the Search button to search for previously completed PA Requests

22. Prior Approval Requests – Begin New Request Click GO to Begin New Request

23. Prior Approval Requests – Select Type of Request The Instructions link provides additional information about each type of request

24. Prior Approval Requests – Select Type of Request (2) Select Type Click Continue

25. Prior Approval Request – Created Confirmation Tracking Number Click Continue

26. CCR and SAM • Central Contractor Registration (CCR) transitioned to the System for Award Management (SAM) at the end of July 2012. • SAM will reduce the burden on those seeking to do business with the government. Vendors will be able to log into one system to manage their entity information in one record, with one expiration date, through one streamlined business process. • SAM information must be updated at least every 12 months to remain active (for both grantees and sub-recipients).

27. Part D WICYCoordinated HIV Services & Access to Research Key Requirements 27

28. Part D Program Requirements • Provision of comprehensive, coordinated HIV outpatient/ ambulatory medical care, including behavioral health, nutrition, and oral health services. • Specialty care, including HIV specialty care, • obstetrics/gynecology, neurology, hepatology. • Support Services which help WICY clients access • primary HIV medical care and are linked to measurable • health outcomes. • Funded Part D services should be increase access to HIV primary medical care for each and every WICY population

29. Part D – Clinical Care • Part D grantees are expected to provide to comprehensive and high quality HIV and primary medical care, as well as Core Medical Services and Support Services that are clearly linked to the health care outcomes for persons living with HIV/AIDS (PLWHA). • Funding should be prioritized for HIV medical care, then Core Medical Services.

30. Ryan White Programs: Payer of Last Resort • Grantee and contracted providers must participate and be able to bill for all Medicaid covered services. • Grant funds must not be used for any service for which payment has been or can reasonably expected to be made under any state compensation program, under an insurance policy, under any Federal or state health benefits program, except Indian Health Service, or on a pre-paid basis. 30

31. Part D – Clinical Quality Management (CQM) • CQM is a Legislative Requirement! • The purpose of CQM is to ensure that federally funded services adhere to established HIV clinical practice standards and HHS guidelines. • HAB is encouraging Part D grantees to participate in the In+Care Campaign to improve patient retention in HIV care and strengthen CQM programs. • HAB has a cooperative agreement with the New York AIDS Institute to support the National Quality Center which provides CQM technical assistance. • http://nationalqualitycenter.org/

32. Minority AIDS Initiative • Goal: To help reduce the disproportionate impact of HIV/AIDS and address disparities by: • Increasing the number of persons from racial and ethnic minority populations receiving HIV care, and • Increasing the number of persons from racial and ethnic minority populations who stay in care. • MAI funds awarded are noted under the grant specific terms section of the Notice of Award (NoA) which establishes the final funding for the budget period. • Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87,October 30,2009), §2693 32

33. Designated Service Areas • Listed as a Grant Specific Term • DCHAP designated the Service Area in the decision of the funding level for awards based upon the HIV epidemic, the gaps in services, and the proposed project. • Grantees are expected to focus Part D services on WICY populations within the service area first and ensure that all HIV medical and core medical services are available.

34. Conditions of Award (COA) • What are Conditions of Award? • Where are they noted on the NOA? • Examples of Conditions of Award; • Line-item Budget, budget narrative, SF242A • Work Plan Summary • Staffing Plan • Organizational Chart

35. Part D Budget Categories Medical Services Clinical Quality Management (CQM) (reasonable %) Support Services Administrative Costs, including Indirect Costs (10%) Refer to pages 15-21 of FOA HRSA-12-073 for budget instructions. 35

36. Part D Line-Item Budget

37. Administrative Cost & Indirect Costs • Administrative Costs are those costs not associated with service provision directly to clients. By law, no more than 10 percent of the federal Part D budget can be allocated to administrative costs. Staff activities that are administrative in nature should be allocated to administrative costs. • Indirect costs must be no more than the federally approved indirect cost agreement, is for the grantee of record (not for any subcontractors), and is counted toward the 10% limit for administrative expenses. • Each subcontractor budget much adhere to the 10% administrative cap.

38. Salary Limitation • This is a new HRSA requirement resulting from the Appropriations Act for 2012, thatsalaries charged to grants are capped at $179,700 annually. • This amount reflects an individual’s base salary, exclusive of fringe benefits and income earned outside of the applicant organization. • The limitation also applies to subcontracts. Refer to pages 18-20 of the FOA.

39. Salary Limitation • Individual’s actual base full time salary: $350,000 • 50% of time will be devoted to project • Direct salary $175,000 • Fringe (25% of salary) $43,750 • Total $218,750 Amount that may be claimed on the application budget due to the legislative salary limitation: • Individual’s base full time salary adjusted to Executive Level II: $179,700 • 50% of time will be devoted to the project • Direct salary $89,850 • Fringe (25% of salary) $22,462.50 • Total amount $112,312.50

40. Monitoring Subcontractors • Subcontractors providing Part D funded services must adhere to the same requirements as the grantee. All legislative and program requirements that apply to grantees also apply to subrecipients of their awards. The grantee is accountable for the subrecipient’s performance of the project, program, or activity, the appropriate expenditure of funds under the award; and the other obligations of the Part D award. Grantees are required to annually monitor all subcontractors. • Grantee should provide itemized budget allocations and specific work plan objectives for each subcontractor .

41. Part D Funds cannot be used for: Inpatient services Nursing home care Syringe services programs Supplementation of payments by Medicaid, Medicare or other insurance programs Clinical research Cash payments to clients Purchase or improvement of real estate/property Entertainment costs Activities related to influencing Federal/ state/ local legislation, appropriations, regulation, and administrative action. (Services must be consistent with HAB Policy Notice 10-02. http://hab.hrsa.gov/manageyourgrant/pinspals/eligible1002.html ) 41

42. Staffing Plan • Include the following information for all staff in your HIV program including key staff not funded by the grant. • Education, training, HIV experience and expertise • Language fluency and cultural competence • Provide all funding sources and the respective FTE for each staff member • Specifically identify • Program Coordinator • Staff managing and overseeing grant activities • Staff monitoring activities of contractors • Medical Director and all medical providers • Lead for quality management activities

43. Staffing Plan

44. Organizational Chart • The Organizational Chart should clearly show the placement of the Part D program within the larger organization (HIV specific or otherwise), how your program is divided into departments, the professional staff positions that administer those departments, and the reporting relationships of the Part D funded staff within the organization. • Subcontractors should also be included in the chart demonstrating the linkage to the grantee staff who are monitoring performance.

45. Work Plan Summary • The Work Plan Summary should include all • four major areas: Access to Care, Comprehensive Primary HIV Care, Clinical Quality Management, and Consumer Involvement. • The Work Plan should only include services • supported with Part D funds only. • Objectives should be measurable and • relevant to your Part D program. • Work Plan should include individual objectives for all sub-contractors.

46. Work Plan SummarySample 46

47. Work Plan Summary Sample (cont.) 47

48. Work Plan SummarySample (cont.) 48

49. Work Plan Summary Sample (cont.) 49

50. Part D – Program Income • Grantees are expected to track all Program Income from reimbursable HIV-related health care services provided under Part D funding. • Any program income generated should be used to further the objectives of the HIV program. • Grantees will report Program Income annually on the Federal Financial Report.