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Women, Infants, Children, and Youth

(Part D WICY) Overview:

Program Introduction and Requirements

Technical Assistance Conference Call

September 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

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

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 Rural Health Policy

Associate Administrator

Tom Morris

Office of Regional Operations


Lee Wilson

Office of Operations

Chief Operating Officer

Thomas Morford

Office of Federal Assistance

Management


Mike Nelson

Healthcare Systems Bureau


Joyce Somsak

HIV/AIDS Bureau


Deborah Parham Hopson

Bureau of Clinician

Recruitment and Service


Rebecca Spitzgo

Bureau of Primary

Health Care


James Macrae

Maternal and Child Health

Bureau


Michael Lu

Bureau of Health

Professions


Janet Heinrich

Office of Legislation

Director

Leslie Atkinson

Office of Communications

Director

Martin Kramer

Office of Special Health

Affairs

Director

Dr. Terry Adirim

Office of Equal Opportunity, Civil

Rights, and Diversity Management

Director

M. June Horner

Office of Planning, Analysis and

Evaluation

Director

Rebecca Slifkin, PhD

Health Resources and Services Administration

ORGANIZATION CHART

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

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

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.

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.

--The entire 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.

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

• 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.

Division of Grants Management

Operations

• 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

Understanding Your Notice of

Award (NOA)

• 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.

NOA Information

• 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

Non-Compliance and

Termination

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: [email protected]

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.

Payment Management

System

http://www.dpm.psc.gov/

All post award administration is done through EHBs

HRSA EHBs can be accessed going to the URL: https://grants.hrsa.gov/webexternal/login.asp To 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: [email protected] 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.

The HRSA Electronic

Handbooks (EHB)

https://grants.hrsa.gov/webexternal/login.aspmailto:[email protected]:877-464-4772tel:877-464-4772tel:877-464-4772tel:877-464-4772tel:877-464-4772

• 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.

The HRSA Electronic

Handbooks (EHB) (2)

• 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).

The HRSA Electronic

Handbooks (EHB) (3)

• 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.

The HRSA Electronic

Handbooks (EHB) (4)

THRSA Electronic Handbooks (EHB)

Privilege Capabilities

View Prior Approval

Requests

Access the read-only version of any prior approval requests started by

others

Access read-only submitted versions of past prior approval requests

Edit Prior Approval

Requests

Enter and save the data in the electronic forms

View the reviewer change requests and comments

Submit Prior Approval

Requests Submit the request once the data has been entered

• 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.

Post Award Procedures

Navigate to Prior Approval

Requests

New/Existing link

Prior Approval Requests – List Page

Search button

Click the

Search button

to search for

previously

completed PA

Requests

Any pending prior approval requests will appear in the

New/Existing Prior Approval Requests list page

Prior Approval Requests

– Begin New Request

Click GO to

Begin New Request


– Select Type of Request

The Instructions link provides

additional information about each type

of request


– Select Type of Request (2)

Select Type

Click

Continue

Prior Approval Request

– Created Confirmation

Click

Continue

Tracking

Number

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).

Part D WICY

Coordinated HIV Services

& Access to Research

Key Requirements

27

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

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.

Ryan White Programs:

Payer of Last Resort

30

• 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.

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/

http://nationalqualitycenter.org/

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

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.

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

Part D Budget Categories

1. Medical Services

2. Clinical Quality Management (CQM) (reasonable %)

3. Support Services

4. Administrative Costs, including Indirect Costs (10%)

• Refer to pages 15-21 of FOA HRSA-

12-073 for budget instructions.

35

Part D Line-Item Budget

Line Item Annual Salary

Program FTEs

Program Salary Subtotal

Medical Services CQM

Support Services Administrative

Program TOTAL

Personnel, Name & Position Salary FTE

Subtotal

Fringe benefit rate

Total Personnel

Travel

Total Travel

Supplies

Total Supplies

Contractual

Total Contractual

Other

Total Other

Total Direct Costs

Indirect Costs

GRAND TOTAL

% budgeted by cost category % 10.0% cap

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.

• This is a new HRSA requirement resulting from the Appropriations Act for 2012, that salaries 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.

Salary Limitation

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

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 .

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

http://hab.hrsa.gov/manageyourgrant/pinspals/eligible1002.html

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

Staffing Plan

Name

Education

Title

FTE

Funding Source

Experience

Nurse Jones

FNP

Nurse Practitioner

1.0

1.0 Part D

2 years FNP, 8 years

RN in hospital setting,

less than 2 months HIV

experience

Nurse Thomas

RN

Clinic Nurse Mgr

1.0

0.2 Part A

0.8 Part D

2 years RN with less than

1 month HIV experience

Ms. Kona

Assoc Degree

Admin. Assistant

1.0

1.0 Part A

4 years working in HIV

clinic scheduling appts,

making referrals, medical

data entry

Mr. Lewis

MSW

Medical Case Mgr

1.0

1.0 Part B

3 years providing HIV

medical case

management

Ms. Johnson

RD

Contracted

Registered

Dietician

0.2

0.3 Part D

0.3 Part C

0.2 hospital

0.2 WIC program

2 years HIV nutritional

Counseling and 20 years

nutritional counseling

experience

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.

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.

Work Plan Summary

Sample

46

Access to Care Objective FY 2012

Objective (# only)

FY 2013

Objective (# only)

FY 2014

Objective (# only)

1. # to be Counseled and Tested funded by Part D

2. # positive results anticipated

3. # New HIV infected patients to be enrolled in

primary HIV medical care

Comprehensive, Coordinated Primary HIV Medical

Care (funded by Part D)

FY 2012

Objective (# only)

FY 2013

Objective (# only)

FY 2014

Objective (# only)

1. Total # of WICY to be provided with Primary

HIV medical care services

2. # of women (25 years and older) to be provided

with primary HIV care

3. # of youth (13 to 24 years) to be provided with

HIV medical care

4. # of HIV-infected infants and children to be

provided with HIV medical care

5. # of HIV exposed infants (0 to 2 years) to be

followed under surveillance

6. # of pregnant women with HIV to be provided

with prenatal services

7. # of youth who will be transitioned into adult

medical care

Work Plan Summary

Sample (cont.)

47

Comprehensive, Coordinated Primary HIV Medical

Care (funded by Part D)

FY 2012

Objective (# only)

FY 2013

Objective (# only)

FY 2014

Objective (# only)

8. Total # of patients (specify which target

populations) to be provided with treatment

adherence services

9. # of specialty referrals

Other Medical and Support Services (funded by

Part D)

# to be provided with mental health screening,

assessment, and/or treatment (specify target

populations)

Screening: Screening: Screening:

Treatment: Treatment: Treatment:

# to be provided with substance abuse screening

and/or treatment (specify target populations)

Screening: Screening: Screening:

Treatment: Treatment: Treatment:

# to be provided with oral health care (specify

target populations)

# to be provided medical nutrition screening

(specify target populations)

# to be provided medical nutrition therapy (specify

target populations)

# to be provided support services (specify each

support service and target population)

Work Plan Summary

Sample (cont.)

Clinical Quality Management Program FY 2012

Objective (# only)

FY 2013

Objective (# only)

FY 2014

Objective (# only)

Provide measures your organization has selected

for Clinical Quality Improvement projects.

Insert additional lines as needed.

For the HAB performance measures, see

http://hab.hrsa.gov/special/qualitycare.htm

example: Viral Load suppression

example: Frequency of Medical Visits

example: Gaps in Care

example: % of eligible women receiving annual

Pap smears

example: % of Adolescents transitioned into and

retained in adult medical care

example: % of pregnant women with HIV

receiving ARV

48

Work Plan Summary

Sample (cont.)

Consumer Involvement FY 2012

Objective

FY 2013

Objective

FY 2014

Objective

# consumers involved in planning,

implementation, and evaluation of the Part D

program

# of consumer meetings

49

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.

Part D – Data Reporting

Requirements

• Allocations Report – due 60 days after initial NOA,

submitted AFTER budget revisions are approved

• Expenditures Report – due 90 days after end of Budget

Period, aligns with the FFR

• Federal Financial Report (FFR, SF425) – due 90 days

after end of Budget Period, includes Program Income

• Ryan White Services Report (RSR) – client level report

due at the end of March annually

• Non-competing Progress Report (NCC) – available in

EHB 4-5 months before next Budget Period

Ryan White Services

Report (RSR)

• Future technical assistance sessions will

address RSR reporting and provide more

specific training.

• HAB’s TA Providers will work with your

project officer to help you get ready for RSR

• You can find additional information on

line at

• HRSA/HAB website

• TARGET website

http://hab.hrsa.gov/manageyourgrant/clientleveldata.htmlhttp://www.careacttarget.org/category/topics/ryan-white-services-report-rsr

Part D – Grant Monitoring and the

Role of the Project Officer

• Monitors grantee implementation of Part D

funded HIV medical care system and fiscal

management of federal funds:

• Through monthly monitoring calls

• Review of submitted reports

• Diagnostic Compliance Site Visits

• Technical Assistance requests

HRSA.gov -- http://www.hrsa.gov

HAB websites • http://hab.hrsa.gov/manageyourgrant/granteebasics.html

• http://careacttarget.org/

HRSA Contact Center (EHB Help)

Phone: 877-Go4-HRSA/877-464-4772; 301-998-7373 (9:00 AM to 5:30 PM ET M-F)

Email: [email protected]

Payment Management System (PMS)

http://www.dpm.psc.gov/Default.aspx

Grants.gov

Phone: 1-800-518-4726

http://www.grants.gov/CustomerSupport

Useful Resources

http://www.hrsa.gov/http://www.hrsa.gov/http://www.hrsa.gov/http://hab.hrsa.gov/manageyourgrant/granteebasics.htmlhttp://careacttarget.org/mailto:[email protected]://www.dpm.psc.gov/Default.aspxhttp://www.grants.gov/CustomerSupporthttp://www.grants.gov/CustomerSupporthttp://www.grants.gov/CustomerSupport

Part D Technical Assistance

Webinars

• Future Technical Assistance

activities:

• webinars are planned at least

quarterly; next one is scheduled for

early October

• Pertinent workshops at All Grantees

Meeting

• A Orientation session on Thursday

November 29, 2012 PM

Conference Website: www.ryanwhite2012.com

Abstract Deadline: 9/14/12, midnight EST

Registration Deadline: 9/24/12, midnight EST

All grantees must register.

Maximum registrants allowed per grantee: Three

--Program director, data/CQM staff, and medical

provider

Ryan White ALL Grantees Meeting – November 27 – 29, 2012

Washington, D.C.

Ryan White AGM Registration

http://www.ryanwhite2012.com/

Thank You!

Part D Women, Infants, Children,

and Youth (Part D WICY)

Questions?

57

CONTACTS

Your Grants

Management

Specialist

Or

Adejumoke Oladele

Part D Lead

301-443-2441

[email protected]

Your HAB/DCHAP

Project Officer

Or

Anna Huang, M.D.

Chief Medical Officer

301-443-3995

[email protected]
mailto:[email protected]:[email protected]

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