DSHAP Final Review_HAB-HRSA-24-065-(X08)-RWHAP-Part B Final-Modified.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2024

HIV/AIDS Bureau

Division of State HIV/AIDS Programs (DSHAP)

Ryan White HIV/AIDS Program Part B States/Territories Supplemental Grant Program

Funding Opportunity Number: HRSA-24-065

Funding Opportunity Type(s): New, Limited Competition

Assistance Listing Number: 93.917

Application Due Date: April 30, 2024 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

We will not approve deadline extensions for lack of registration.

Registration in all systems may take up to 1 month to complete.

Issuance Date: February 27, 2024

Modified on March 4, 2024 to update the Technical Assistance information.

Susan Robilotto, D.O.

Director, Division of State HIV/AIDS Programs HIV/AIDS Bureau Call: 301-443-6554 Email: SRobilotto@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. § 300ff-29a (Title XXVI, § 2620 of the Public Health Service Act).

mailto:SRobilotto@hrsa.gov@hrsa.gov

HRSA-24-065 DSHAP RWHAP Part B i

508 COMPLIANCE DISCLAIMER

Persons using assistive technology may not be able to fully access information in this file. For assistance, email or call one of the HRSA staff listed in Section VII Agency Contacts.

SUMMARY

Funding Opportunity Title: Ryan White HIV/AIDS Program (RWHAP) Part B States/Territories Supplemental Grant Program

Funding Opportunity Number: HRSA-24-065

Assistance Listing Number: 93.917

Due Date for Applications: April 30, 2024

Purpose: The purpose of this funding is to supplement formula- based funding provided through the HIV Care Grant Program – the RWHAP Part B States/Territories Formula and AIDS Drug Assistance Program (ADAP) Formula and ADAP Supplemental Awards Notice of Funding Opportunity (HRSA-22-033).

Program Objective(s): States/territories must demonstrate that RWHAP Part B Supplemental funding is necessary to provide comprehensive HIV care and treatment services for people with HIV in the state/territory.

Eligible Applicants: Current recipients funded under (HRSA-22-033) Division of State HIV/AIDS Programs (DSHAP) (which include all 50 States the District of Columbia, and eight territories) except the Republic of the Marshall Islands and the Commonwealth of the Northern Mariana Islands.

Per statute, Native American tribal governments and tribal organizations are not eligible.

See Section III.1 of this notice of funding opportunity (NOFO) for complete eligibility information.

https://www.grants.gov/web/grants/view-opportunity.html?oppId=333257 https://www.grants.gov/web/grants/view-opportunity.html?oppId=333257

HRSA-24-065 DSHAP RWHAP Part B ii

Anticipated FY 2024 Total Available Funding:

$48,000,000. Approximately $6,000,000 will be used for priority funding.

We’re issuing this notice to ensure that, should funds become available for this purpose, we can process applications and award funds appropriately. You should note that we may cancel this program notice before award if funds are not appropriated.

Estimated Number and Type of Award(s):

Up to 30: limited competition, new grants

Estimated Award Amount: Up to $9,000,000 per award, subject to the availability of appropriated funds

Cost Sharing or Matching Required:

No

Period of Performance: September 30, 2024, through September 29, 2025 (1 year)

Agency Contacts: Business, administrative, or fiscal issues:

Marie Mehaffey Grants Management Specialist Division of Grants Management Operations Office of Federal Assistance Management Email: MMehaffey@hrsa.gov

Program issues or technical assistance:

Kibibi Matthews-Brown Senior Program Advisor, Division of State HIV/AIDS Programs HIV/AIDS Bureau Email: KMatthews-Brown@hrsa.gov

Application Guide

You (the applicant organization / agency) are responsible for reading and complying with the instructions included in this NOFO and in HRSA Application Guide (Application Guide). Visit HRSA’s How to Prepare Your Application page for more information.

Technical Assistance

We have scheduled the following webinar:

Topic: HRSA-24-065 (X08) Recipient TA Webinar mailto:MMehaffey@hrsa.gov mailto:KMatthews-Brown@hrsa.gov http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application

HRSA-24-065 DSHAP RWHAP Part B iii

Wednesday, March 20, 2024 2 p.m. ET Weblink: https://hrsa-gov.zoomgov.com/j/1601889736?pwd=ZS94a2hLSWt4Zm0rOFFVTStiRjg4dz09

Attendees without computer access or computer audio can use the following dial-in information:

Call-In Number: 1-833-568-8864 Meeting ID: 160 188 9736 Passcode: 70151273

We will record the webinar and will post to TargetHIV when available.

https://hrsa-gov.zoomgov.com/j/1601889736?pwd=ZS94a2hLSWt4Zm0rOFFVTStiRjg4dz09 https://hrsa-gov.zoomgov.com/j/1601889736?pwd=ZS94a2hLSWt4Zm0rOFFVTStiRjg4dz09 https://targethiv.org/

HRSA-24-065 DSHAP RWHAP Part B iv

Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING OR MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

3. UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: PAGE LIMIT WORKSHEET

HRSA-24-065 DSHAP RWHAP Part B 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Ryan White HIV/AIDS Program (RWHAP) States/Territories Part B Supplemental Grant Program, which includes the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, the Republic of Palau, and the Federated States of Micronesia. The purpose of this program is to supplement formula-based funding provided through the HIV Care Grant Program – RWHAP Part B States/Territories Formula and AIDS Drug Assistance Program (ADAP) Formula and ADAP Supplemental Awards Notice of Funding Opportunity (HRSA-22-033).

States/territories use RWHAP Part B Supplemental Grant Program funding in conjunction with RWHAP Part B HIV Care Grant Program funding to develop and/or enhance access to a comprehensive continuum of high-quality care and treatment services for low-income people with HIV. To obtain funding, states/territories must demonstrate that RWHAP Part B supplemental funding is necessary to provide comprehensive HIV care and treatment services for people with HIV in the state/territory. Proposed activities should include the provision of core medical and/or support services, as defined in HRSA HAB Policy Clarification Notice (PCN) 16-02:

RWHAP Services: Eligible Individuals and Allowable Uses of Funds, and other activities to ensure responsiveness to unmet needs. States/territories must describe how proposed activities will address unmet needs and improve client-level health outcomes across the HIV care continuum, including viral suppression.

Eligible RWHAP Part B states/territories that are focus areas, or have counties that are focus areas, for the Ending the HIV Epidemic in the U.S. (EHE) initiative should consider if there is a demonstrated need for RWHAP Part B supplemental funding due to the EHE initiative efforts using criteria below.

As required in section 2620(b) of the Public Health Service (PHS) Act, states/territories must demonstrate the severity of the need for RWHAP Part B supplemental funding using quantifiable data in one or more of the following areas:

1. The unmet need for such services, as determined under section 2617(b) of the PHS Act.

2. An increasing need for HIV/AIDS-related services, including relative rates of increase in the number of cases of HIV/AIDS.

3. The relative rates of increase in the number of cases of HIV/AIDS within new or emerging subpopulations.

4. The current prevalence of HIV/AIDS.

https://www.grants.gov/search-results-detail/333257 https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/service-category-pcn-16-02-final.pdf

HRSA-24-065 DSHAP RWHAP Part B 2

5. Relevant factors related to the cost and complexity of delivering health care to individuals with HIV/AIDS in the eligible area.

6. The impact of co-morbid factors, including co-occurring conditions, determined relevant by the Secretary.

7. The prevalence of homelessness.

8. The prevalence of individuals who were released from federal, state, or local prisons during the preceding three (3) years and had HIV/AIDS on the date of their release.

9. The relevant factors that limit access to health care, including geographic variation, adequacy of health insurance coverage, and language barriers.

10. The impact of a decline in the amount of RWHAP Part B funding received on services available to all individuals with HIV/AIDS identified and eligible under this title.

Pursuant to section 2620(c) of the PHS Act, the Secretary prioritizes funds to states/territories to address the reduction or disruption of services related to a decline in the amount of formula funding. Such a decline in funding is determined by comparing the amount of formula funding received in the current fiscal year (FY) to the amount received in FY 2006.

If you are a state/territory with current or potential shortfalls in ADAP resources, we strongly encourage you to prioritize use of RWHAP Part B supplemental funds to augment ADAP resources when the following conditions exist:

1. Existing or anticipated ADAP waiting list,

2. Capped enrollment,

3. Reductions in ADAP formulary,

4. Reduction in the percentage of federal poverty level (FPL) eligibility requirement, and/or

5. Other ADAP restrictions within the state/territory.

2. Background

The RWHAP Part B States/Territories Supplemental Grant Program is authorized by 42 U.S.C. § 300ff-29a (Title XXVI, § 2620 of the Public Health Service Act).

The Ryan White HIV/AIDS Program

The HRSA Ryan White HIV/AIDS Program (RWHAP) provides a comprehensive system of HIV primary medical care, essential support services, and medications for low-income people with HIV. The program funds grants to states, cities, counties, and local community-based organizations to provide care and treatment services to people with HIV to improve health outcomes and reduce HIV transmission among priority populations.

https://ryanwhite.hrsa.gov/

HRSA-24-065 DSHAP RWHAP Part B 3

The RWHAP has five statutorily defined Parts (Parts A, B, C, D, and F) that provide funding for core medical, support services, and medications; technical assistance (TA);

clinical training; and the development of innovative interventions and strategies for HIV care and treatment to respond to emerging needs of RWHAP clients.

An important framework in the RWHAP is the HIV care continuum, which is comprised of the series of stages a person with HIV engages in from initial diagnosis through their successful treatment with HIV medication to achieve viral suppression. Supporting people with HIV to reach viral suppression not only increases their own quality of life and lifespan, it also prevents sexual transmission to an HIV-negative partner.

The HIV care continuum framework allows recipients and planning groups to measure progress and to direct HIV resources most effectively. RWHAP recipients are required to assess the outcomes of their programs and should work with their community and public health partners to improve outcomes across the HIV care continuum. We encourage recipients to use the performance measures developed for the RWHAP at their local level to assess the efficacy of their programs and to analyze and improve the gaps along the HIV care continuum.

Strategic Frameworks and National Objectives

National objectives and strategic frameworks like Healthy People 2030, the National HIV/AIDS Strategy (NHAS) (2022–2025); the Sexually Transmitted Infections National Strategic Plan for the United States (2021–2025); and the Viral Hepatitis National Strategic Plan for the United States: A Roadmap to Elimination (2021–2025) are crucial to addressing key public health challenges facing low-income people with HIV. These strategies detail the principles, priorities, and actions to guide the national public health response and provide a blueprint for collective action across the Federal Government and other sectors. The RWHAP supports the implementation of these strategies and recipients should align their organization’s efforts, within the parameters of the RWHAP statute and program guidance, with these strategies to the extent possible.

Expanding the Effort: Ending the HIV Epidemic in the United States

As demonstrated by recent data from the 2022 Ryan White HIV/AIDS Program Services Report (RSR), the RWHAP has made tremendous progress toward ending the HIV epidemic in the United States. From 2017 to 2022, HIV viral suppression among RWHAP patients who have had one or more medical visits during the calendar year and at least one viral load with a result of <200 copies/mL reported, has increased from 85.9 percent to 89.6 percent. Additionally, racial and ethnic, age-based, and regional disparities reflected in viral suppression rates have significantly decreased.[1]

[1] Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2022. https://ryanwhite.hrsa.gov/data/reports. Published December 2023. Accessed January 11, 2024.

http://ryanwhite.hrsa.gov/deliverhivaidscare/habperformmeasures.html https://health.gov/healthypeople https://www.hiv.gov/federal-response/national-hiv-aids-strategy/national-hiv-aids-strategy-2022-2025 https://www.hiv.gov/federal-response/national-hiv-aids-strategy/national-hiv-aids-strategy-2022-2025 https://www.hhs.gov/programs/topic-sites/sexually-transmitted-infections/plan-overview/index.html https://www.hhs.gov/programs/topic-sites/sexually-transmitted-infections/plan-overview/index.html https://www.hhs.gov/hepatitis/viral-hepatitis-national-strategic-plan/national-viral-hepatitis-action-plan-overview/index.html https://www.hhs.gov/hepatitis/viral-hepatitis-national-strategic-plan/national-viral-hepatitis-action-plan-overview/index.html https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/data/rwhap-annual-client-level-data-report-2022.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/data/rwhap-annual-client-level-data-report-2022.pdf https://ryanwhite.hrsa.gov/data/reports

HRSA-24-065 DSHAP RWHAP Part B 4

In February 2019, the Ending the HIV Epidemic in the U.S (EHE) initiative was launched to further expand federal efforts to reduce HIV infections. For the RWHAP, the EHE initiative expands the program’s ability to meet the needs of clients, specifically focusing on linking people with HIV who are either newly diagnosed, diagnosed but currently not in care, or are diagnosed and in care but not yet virally suppressed, to the essential HIV care, treatment, and support services needed to help them reach viral suppression.

Using Data Effectively: Integrated Data Sharing and Use

HRSA and the Centers for Disease Control and Prevention’s (CDC) Division of HIV Prevention support integrated data sharing, analysis, and utilization for the purposes of program planning, conducting needs assessments, determining unmet need estimates, reporting, quality improvement, enhancing the HIV care continuum, and public health action. We strongly encourage RWHAP recipients to:

• Follow the principles and standards in the Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Programs: Standards to Facilitate Sharing and Use of Surveillance Data for Public Health Action

• Establish data sharing agreements between surveillance and HIV programs to ensure clarity about the process and purpose of the data sharing and utilization.

Integrated data sharing, analysis, and utilization of HIV data by state and territorial health departments can help further progress toward reaching the NHAS goals and improve outcomes on the HIV care continuum.

We strongly encourage complete CD4, viral load (VL), and HIV nucleotide sequence reporting to the state and territorial health departments’ HIV surveillance systems to benefit fully from secure integrated data sharing, analysis, and utilization. State health departments may use CD4, VL, and nucleotide sequence data to identify cases, stage of HIV disease at diagnosis, and monitor disease progression. These data can also be used to evaluate HIV testing and prevention efforts, determine entry into and retention in HIV care, measure viral suppression, monitor prevalence of antiretroviral drug resistance, detect transmission clusters and understand transmission patterns, and assess unmet health care needs. Analyses at the national level to monitor progress toward ending the HIV epidemic in the United States can only occur if all HIV-related CD4, VL, and HIV nucleotide sequence test results are reported by all jurisdictions. CDC requires the reporting to the National HIV Surveillance System (NHSS) all HIV-related CD4 results (counts and percentages), all VL results (undetectable and specific values), and HIV nucleotide sequences.

HRSA’s RWHAP Compass Dashboard is an interactive data tool to allow users to visualize the reach, impact, and outcomes of the RWHAP and supports data utilization to understand outcomes and inform planning and decision making. The dashboard provides a look at national-, state-, and metro area-level data and allows users to https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview/ending-epidemic-timeline http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf https://data.hrsa.gov/topics/hiv-aids/compass-dashboard

HRSA-24-065 DSHAP RWHAP Part B 5 explore RWHAP client characteristics and outcomes, including age, housing status, transmission category, and viral suppression. The RWHAP Compass Dashboard also visualizes information about RWHAP services received and the characteristics of those clients accessing the AIDS Drug Assistance Program (ADAP).

In addition, RWHAP recipients and subrecipients are encouraged to develop data sharing strategies with other RWHAP recipients and relevant entities to reduce administrative burden across programs. As outlined in Policy Clarification Notice 21-02, Determining Client Eligibility & Payor of Last Resort in the Ryan White HIV/AIDS Program, recipients and subrecipients should use electronic data sources (for example, Medicaid enrollment, state tax filings, enrollment and eligibility information collected from health care marketplaces) to collect and verify client eligibility information, such as income and health care coverage (that includes income limitations), when possible.

RWHAP recipients and subrecipients should first use available data sources to confirm client eligibility before requesting additional information from the client.

Program Resources and Innovative Models

HRSA has several projects and resources that may assist RWHAP recipients with program implementation. These include a variety of HRSA HIV/AIDS Bureau (HAB) projects focused on specific TA, evaluation, demonstration, and intervention activities. A full list is available on TargetHIV. Recipients should be familiar with these resources and are encouraged to use them as needed to support their program implementation.

II. Award Information

1. Type of Application and Award

Application type(s): New, Limited Competition

We will fund you via a grant.

2. Summary of Funding

We estimate $48,000,000 will be available to fund 30 recipients. You may apply for a ceiling amount of up to $9,000,000 (reflecting direct and indirect costs).

The period of performance is September 30, 2024, through September 29, 2025 (1 year).

This program notice depends on the appropriation of funds. If funds are appropriated for this purpose, we will proceed with the application and award process.

The amount of each award will be based on the total amount of funding available and your ability to demonstrate the need for additional funding due to the severity of the HIV epidemic in the state/territory, unmet need for core https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/pcn-21-02-determining-eligibility-polr.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/pcn-21-02-determining-eligibility-polr.pdf https://targethiv.org/help/ta-directory

HRSA-24-065 DSHAP RWHAP Part B 6 medical services, and/or unique service delivery challenges. Funding will be based on the external Merit Review Panel (MRP) review and scoring of the criteria published in Section V.1 of this notice. The applications will be evaluated as follows:

a. The MRP will score applications and establish the rank order for awarding funds.

b. We will fund applicants based upon funding availability up to the requested amount for allowable services under this NOFO (see Section VIII. Other Information for further details), as long as the amount requested falls under the amount allowable detailed previously in this NOFO.

c. If determined eligible for priority funding, we will calculate the amount to be included in the final award. (See Section V.2 Review and Selection Process, Priority Funding for further details.)

45 CFR part 75 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards applies to all HRSA awards.

If you’ve never received a negotiated indirect cost rate, you may elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC)*. You may use this for the life of the award. If you choose this method, you must use it for all federal awards until you choose to negotiate for a rate. You may apply to do so at any time. See Section 4.1.v. Budget Narrative in the Application Guide.

*Note: One exception is a governmental department or agency unit that receives more than $35 million in direct federal funding.

III. Eligibility Information

1. Eligible Applicants

Under Sections 2620 and 2689(11) of the PHS Act, all “States” – defined as all 50 States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, the Republic of Palau, the Federated States of Micronesia, and the Republic of the Marshall Islands – are eligible for RWHAP Part B supplemental funding, unless any such state/territory had an unobligated balance of more than five percent of a prior year’s formula funds which include the Republic of the Marshall Islands and Commonwealth of the Northern Mariana Islands. Per statute, Tribes and tribal organizations are not eligible.

2. Cost Sharing or Matching

Cost sharing or matching is not required for this program.

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75

HRSA-24-065 DSHAP RWHAP Part B 7

3. Other

We may not consider an application for funding if it contains any of the following non-responsive criteria:

• Exceeds the funding ceiling amount

• Fails to satisfy the deadline requirements referenced in Section IV.4

Multiple Applications

We will only review your last validated application before the Grants.gov due date.

IV. Application and Submission Information

1. Address to Request Application Package

We require you to apply online through Grants.gov. Use the SF-424 workspace application package associated with this notice of funding opportunity (NOFO). Follow these directions: How to Apply for Grants. If you choose to submit using an alternative online method, see Applicant System-to-System.

Note: Grants.gov calls the NOFO “Instructions.”

Select “Subscribe” and enter your email address for HRSA-24-065 to receive emails about changes, clarifications, or instances where we republish the NOFO. You will also be notified by email of documents we place in the RELATED DOCUMENTS tab that may affect the NOFO and your application. You’re responsible for reviewing all information that relates to this NOFO.

2. Content and Form of Application Submission

Application Format Requirements Submit your information as the Application Guide and this program-specific NOFO state. Do so in English and budget figures expressed in U.S. dollars. There’s an Application Completeness Checklist in the Application Guide to help you.

Application Page Limit The total number of pages that count toward the page limit shall be no more than 60 pages when we print them. We will not review any pages that exceed the page limit.

Using the pages within the page limit, we will determine eligibility using Section III.

Eligibility Information of the NOFO.

These items do not count toward the page limit:

• Standard OMB-approved forms you find in the NOFO’s workspace application package https://www.grants.gov/ https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants https://www.grants.gov/system-to-system/applicant-system-to-system/

HRSA-24-065 DSHAP RWHAP Part B 8

• Abstract (standard form (SF) "Project Abstract Summary”)

• Indirect Cost Rate Agreement

• Proof of non-profit status (if it applies)

If there are other items that do not count toward the page limit, we’ll make this clear in Section IV.2.v Attachments.

If you use an OMB-approved form that is not in the HRSA-24-065 workspace application package, it may count toward the page limit.

Applications must be complete and validated by Grants.gov under HRSA-24-065 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals1 (for example, program director, principal investigator) can participate in receiving award funds to carry out a proposed project. That is, no federal department or agency has debarred, suspended, proposed for debarment, claimed you ineligible, or you have voluntarily excluded yourself from participating.

• If you fail to make mandatory disclosures, we may take an action like those in 45 CFR § 75.371. This includes suspending or debarring you.2

• If you cannot certify this, you must include an explanation in Attachments 8-15:

Other Relevant Documents.

(See Section 4.1 viii “Certifications” of the Application Guide)

Program-Specific Instructions Include application requirements and instructions from Section 4 of the Application Guide (budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract). Also include the following:

i. Project Abstract

Use the Standard Office of Management and Budget (OMB)-approved Project Abstract Summary Form that you’ll find in the workspace application package. Do not upload the abstract as an attachment or it may count toward the page limit. For information you must include in the Project Abstract Summary Form, see Section 4.1.ix of the Application Guide.

1 See definitions at eCFR :: 2 CFR 180.995 -- Principal. and eCFR :: 2 CFR 376.995 -- Principal (HHS supplement to government-wide definition at 2 CFR 180.995).

2 See also 2 CFR parts 180 and 376, 31 U.S.C. § 3354, and 45 CFR § 75.113.

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180/subpart-I/section-180.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376 https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title31-chapter33&edition=prelim https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-B/section-75.113

HRSA-24-065 DSHAP RWHAP Part B 9

Provide a summary of the application in the Project Summary box of the Project Abstract Summary Form using 4,000 characters or less. The following information should be included:

• Address

• Project Director Name

• Contact Phone Numbers (Voice, Fax)

• Email Address

• Website Address, if applicable

• List all grants program funds requested in the application, if applicable

• If requesting a funding preference, priority, or special consideration as outlined in

Section V. 2. indicate here.

Additionally in this same section, provide a brief paragraph addressing the information below:

a. Why RWHAP Part B supplemental funding is necessary to ensure a comprehensive system of HIV care and treatment for people with HIV in your state/territory;

b. How this supplemental funding will improve viral suppression and achieve positive client-level health outcomes across the HIV care continuum; and

c. Describe the severity of the HIV epidemic in the state/territory, using quantifiable data on:

1. Epidemiology

2. Co-morbidities

3. Cost of care

4. Service needs of emerging populations

5. Unmet need for core medical services (as defined by HRSA HAB Policy

Clarification Notice 16-02 Ryan White HIV/AIDS Program Services:

Eligible Individuals and Allowable Use of Funds) and unique service delivery challenges

NARRATIVE GUIDANCE

The following table provides a crosswalk between the narrative language and where each section falls within the review criteria. Make sure you’ve addressed everything. We may consider any forms or attachments you reference in a narrative section during the merit review.

Narrative Section Review Criteria

Introduction Criterion 1: Need

HRSA-24-065 DSHAP RWHAP Part B 10

Narrative Section Review Criteria

Organizational Information Criterion 5: Resources/Capabilities

Need Criterion 1: Need

Criterion 6: Support Requested

Approach Criterion 2: Response

Work Plan Criterion 2: Response

Criterion 4: Impact

Criterion 5: Resources/Capabilities

Criterion 6: Support Requested

Resolution of Challenges Criterion 2: Response

Evaluation and Technical Support Capacity

Criterion 3: Evaluative Measure

Criterion 5: Resources/Capabilities

Budget Narrative Criterion 6: Support Requested

ii. Project Narrative

This section must describe all aspects of the proposed project. Make it brief and clear.

Provide the following information in the following order. Please use the section headers.

This ensures reviewers can understand your proposed project.

Introduction—Corresponds to Section V’s Review Criterion #1 NEED

• Briefly describe how the state/territory will utilize RWHAP Part B supplemental funding in support of a comprehensive system of high-quality care and treatment for people with HIV.

• Describe the current prevalence of HIV/AIDS in the state/territory and provide corresponding data tables or figures as in Attachment 6.

You may provide your HIV/AIDS Epidemiological Overview of the

Integrated HIV Prevention and Care Plan/Statewide Coordinated Statement of Need, CY 2022-2026 (FY2022 Integrated Plan) or another comparable documentation to meet this requirement.

• Describe how the comprehensive system of care and treatment will improve outcomes across the HIV care continuum.

HRSA-24-065 DSHAP RWHAP Part B 11

Organizational Information -- Corresponds to Section V’s Review Criterion(a) #5

RESOURCES/CAPABILITIES

• Briefly describe, regardless of if using RWHAP Part B supplemental funding for staffing:

How the state/territory will ensure proper oversight, management, and administration of FY 2024 RWHAP Part B supplemental funding, including a brief overview of the capabilities of your organization, and the quality and availability of facilities and personnel.

• If you propose to use FY 2024 RWHAP Part B supplemental funding for staffing, then provide:

A staffing plan and job descriptions for key personnel as Attachment 1.

Biographical sketches of key personnel as Attachment 2, and

A project organizational chart as Attachment 3

Need-- Corresponds to Section V’s Review Criterion(a) #1 NEED and #6

SUPPORT REQUESTED

• The RWHAP statute, Section 2620(b) of the PHS Act, requires RWHAP Part B supplemental funding applicants to demonstrate need in one or more of the categories listed. You only need to respond to the need sections below that are relevant to your request for RWHAP Part B supplemental funding.

• The needs assessment narrative and data must support the service category(ies) (as described in HRSA HAB Policy Clarification Notice16-02 Ryan White HIV/AIDS Program Services: Eligible Individuals and Allowable Use of Funds) chosen to respond to the demonstrated need and the request for funds.

1) Need for HIV-Related Services

• If you are applying for RWHAP Part B supplemental funding due to a need for HIV-related services in the state/territory which may include:

Addressing unmet need, https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/clarification-services-veterans.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/clarification-services-veterans.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/clarification-services-veterans.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/clarification-services-veterans.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/clarification-services-veterans.pdf

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An increased need due to an increase in relative rates or prevalence in HIV cases, or The decline in the amount of funding received for HIV services.

• Please provide a narrative describing all relevant factors that will be addressed, and how requested funds will be used to address each factor.

• If you are applying for RWHAP Part B supplemental funding to augment ADAP services in the state/territory, please provide a narrative identifying which of the following conditions exist, and its impact on developing and/or enhancing access to a comprehensive continuum of high-quality care and treatment services for people with HIV.

How requested funds will be used to address this condition/s:

a) Existing or anticipated ADAP waiting list,

b) Capped enrollment,

c) Reductions in ADAP formulary,

d) Reduction in the percentage of FPL eligibility requirement, and/or

e) Other ADAP restrictions within the state/jurisdiction.

• If you are applying for RWHAP Part B supplemental funding due to unmet need in the state/territory, indicate that in this section and provide the Unmet Need Framework and corresponding narrative from your application in response to NOFO # HRSA-22-033 as Attachment 7.

If you have updated your Unmet Need Framework and corresponding narrative since the submission of your application in response to NOFO # HRSA-22-033, then submit the updated framework and corresponding narrative as Attachment 7.

• If you are NOT applying for RWHAP Part B supplemental funding due to need for HIV-related services in the state/territory, then please indicate that requested funds are to address a different demonstrated need as listed in Section 2620(b) of the PHS Act (see Section I.1. of this NOFO) and do not provide a narrative addressing need for HIV-related services.

2) Assessment of New or Emerging Populations with Special Needs https://www.hrsa.gov/grants/find-funding/HRSA-22-033 https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/about-program/legislation-title-xxvi.pdf

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• The RWHAP statute requires the state/territory to determine the needs of new or emerging populations who may have limited access to existing HIV care and services.

• These needs and service gaps should be addressed in the FY 2024 work plan narrative of this application. You can use RWHAP Part B supplemental funding to address identified needs.

• If you are applying for RWHAP Part B supplemental funding due to new or emerging populations in the state/territory, identify no more than six new or emerging populations to be served. Provide a narrative that addresses each of the following elements:

Unique challenges that each population presents to the service delivery system and how funds will be used to overcome those challenges;

Service gaps for each population and how funds will be used to address service gaps;

Estimated cost of care associated with delivering services to each of these populations and how funds will be used to cover those costs; and

Current HIV viral suppression rates for each population and how funds will be used to increase such viral suppression rates.

• If you are NOT applying for RWHAP Part B supplemental funding due to new or emerging populations in the state/territory, then please indicate that requested funds are to address a different demonstrated need as listed in Section 2620(b) of the PHS Act (see Section I.1. of this NOFO) and do not provide a narrative addressing new or emerging populations.

3) Impact of Co-Morbidities and Other Factors on the Cost and Complexity of Providing Care

• If you are applying for RWHAP Part B supplemental funding due to the impact of co-morbidities in the state/territory, please provide:

Quantitative evidence in a table format on the impact of co-morbidities on the cost and complexity of providing HIV care and treatment, including the data sources.

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You only must include information in the table for co-morbidities you plan to use RWHAP Part B supplemental funding to address. You must submit the table as Attachment 4.

• Please provide the following information in the table:

Rates of sexually transmitted infections (STIs), including syphilis, hepatitis, tuberculosis, substance use, and mental health disorders.

Estimated number of people who are homeless.

Estimated number of people with HIV who were released from federal, state, or local prisons during the preceding 3 years.

The number and percent of people without insurance coverage

(including those without Medicaid).

The number and percent of people with HIV living at or below

138 percent and 400 percent of the 2024 FPL (see https://aspe.hhs.gov/poverty-guidelines). Also, include the percentage of FPL used to determine RWHAP eligibility in the state/territory.

• Include a narrative explanation of the data provided in the table using the available program and surveillance data sources.

• If you are NOT applying for RWHAP Part B supplemental funding due to the impact of co-morbidities in the state/territory, then please indicate that requested funds are to address a different demonstrated need as listed in Section 2620(b) of the PHS Act (see Section I.1. of this NOFO) and do not provide a narrative addressing the impact of co-morbidities.

4) Access to Health Care

• If you are applying for RWHAP Part B supplemental funding due to factors that limit access to health care in the state/territory, including, but not limited to:

Geographic variation, Deficiencies of health insurance coverage, or Language barriers

• Please provide a narrative describing each factor that will be addressed.

https://aspe.hhs.gov/poverty-guidelines

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• How each factor impacts access to care, and how requested funds will be used to address each factor.

• If you are NOT applying for RWHAP Part B supplemental funding due to factors that limit access to health care in the state/territory, then please indicate that requested funds are to address a different demonstrated need as listed in Section 2620(b) of the PHS Act (see Section I. 1. of this NOFO) and do not provide a narrative addressing factors that limit access to health care.

This section will help reviewers understand whom you will serve with the proposed project.

Approach -- Corresponds to Section V’s Review Criterion(a) #2 RESPONSE

Describe how your state/territory will implement the following actions to address demonstrated needs indicated above:

• Use programmatic and fiscal forecasting tools to increase your ability to meet projected program service needs for the period of performance;

• Develop new, maintain existing, streamline, and/or diversify service delivery models, service contracts, strategic partnerships, and/or collaborations;

• Sustain activities beyond the federal funding period. Recipients are expected to sustain key elements of proposed projects. These may include but not be limited to strategies or services and interventions which have been effective in improving program operations and improving health outcomes for the population of focus, including activities that have been previously funded through Ryan White HIV/AIDS Program Part B States/Territories Supplemental Grant Program; and

• Provide opportunities for involvement of clients, families, and communities with and affected by HIV, as appropriate.

Work Plan -- Corresponds to Section V’s Review Criterion(a) #2 RESPONSE, #4

IMPACT, #5 RESOURCES/CAPABILITIES, and #6 SUPPORT REQUESTED

• The Work Plan Narrative should be commensurate with your request for RWHAP Part B supplemental funding, address demonstrated needs identified in the Need section and correspond with the approach proposed in the Approach and Evaluation sections.

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• Describe how funded services 1) will be implemented to promote access to high- quality HIV care, 2) will address any significant health disparities in your state/territory, and 3) will maximize positive health outcomes along the HIV care continuum.

• Describe the core medical and support services that will be provided to address the demonstrated needs described in the Need section.

• Funded services should show impact along the HIV care continuum. A core medical or support service category may be related to more than one stage on the HIV care continuum. (For example, proposed activities falling under the Outpatient/Ambulatory Health Service category may have a positive impact on diagnosis, linkage to care, retention in care, antiretroviral therapy (ART) prescription, and viral suppression.)

Please see the HIV Care Continuum Crosswalk developed by us to assist with identifying funded services that impact each stage of the HIV care continuum.

• Describe implementation of each of the following through current or planned activities:

Addressing gaps, barriers, and significant health disparities across the HIV care continuum that may exist among people with HIV;

Addressing unmet need and reducing the number of persons out of care;

Addressing the needs of new or emerging populations who may have limited access to existing HIV care and services;

Improving engagement of people with HIV and health outcomes at each stage of the HIV care continuum;

Engaging people with HIV and other internal and external stakeholders in planning programmatic activities;

Utilizing the HIV care continuum in planning, prioritizing, targeting, and monitoring available resources in response to needs of people with HIV; and

Ensuring geographic parity for all activities supported by RWHAP Part B supplemental funding.

• Include goals and objectives that are tied to stages of the HIV care continuum and the core medical and support services to be provided.

• Objectives should be specific, measurable, achievable, realistic, and time-framed (SMART).

https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/hiv-care-continu-um-cross-walk.pdf

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• Activities proposed in the work plan should align with their corresponding objectives and identify the specific outcomes to be achieved during the period of performance. Please present these goals and objectives in table or outline format for clarity.

Resolution of Challenges -- Corresponds to Section V’s Review Criterion(a) #2

RESPONSE

• Discuss any challenges you anticipate encountering in planning and implementing the proposed project. Be sure to discuss anticipated challenges regarding each demonstrated need for which you are requesting funding, as described in the Need section.

• Describe the specific activities or strategies you will use to identify risks and mitigate or resolve anticipated challenges for each demonstrated need. The approach and work plan narrative sections should reflect the proposed activities or strategies, as appropriate.

Evaluation and Technical Support Capacity -- Corresponds to Section V’s Review Criterion(a) #3 EVALUATIVE MEASURES and #5 RESOURCES/CAPABILITIES

• Describe how you will evaluate your proposed program, assess whether proposed SMART objectives have been achieved, and ensure continuous quality improvement.

• The evaluation plan should align with the methodology and work plan narrative proposed in this application.

• Describe the specific goals, objectives, benchmarks, and/or outcomes you will use for program evaluation and continuous quality improvement. Describe the staff (e.g., position, knowledge, skills, experience), systems (e.g., software, tools), procedures (e.g., actions, responsible parties, timelines), and other resources that will support your evaluation.

• Identify what data you will collect and how you will analyze and use the collected data for continuous quality improvement.

• Describe what control mechanisms you will use to ensure accurate and timely data collection, analysis, reporting, and use.

• Describe how you will share evaluation results internally with program staff and externally with key stakeholders to improve program implementation and outcomes.

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iii. Budget

The Application Guide directions may differ from those on Grants.gov.

Follow the instructions in Section 4.1.iv Budget of the Application Guide and any specific instructions listed in this section. Your budget should show a well-organized plan.

Reminder: The total project or program costs are all allowable (direct and indirect) costs used for the HRSA activity or project. This includes costs charged to the award and non-federal funds used to satisfy a matching or cost-sharing requirement (which may include MOE, if applicable).

Program Income

You must use any program income you generate from awarded funds for approved project-related activities. Use program income under the addition alternative (45 CFR § 75.307(e)(2)). Find post-award requirements for program income at 45 CFR § 75.307.

Specific Instructions

RWHAP States/Territories Part B Supplemental Grant Program requires the following:

Project Line-Item Budget

You must submit a separate line-item budget using Section B Object Class Categories of the SF-424A. The program budget categories for the line-item budget include:

• Administration – This column must include all funds allocated to the following award activities: recipient administration, planning and evaluation, and clinical quality management;

• ADAP – This column must include all funds allocated to ADAP activities;

• Consortia – This column must include all funds allocated to consortia; and

• Direct Services – This column must include all funds allocated to the following award activities: State direct services, home and community-based care, and health insurance premium and cost sharing assistance.

Important Notes:

1. Use of Funds: RWHAP Part B supplemental funding can be used for the same activities under the RWHAP Part B HIV Care Program or another RWHAP Part, only if these funds are additive to these activities and not duplicative of those funds. Please see Section IV.6 and Section VIII.1. of this NOFO for additional information on the use of funds.

2. Core Medical Services Requirement: RWHAP Part B https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307

HRSA-24-065 DSHAP RWHAP Part B 19 supplemental funding is subject to Section 2612(b)(1) of the PHS Act, which requires that no less than 75 percent of the portion of the grant award remaining after reserving amounts for administration, planning and evaluation, and clinical quality management be used to provide core medical services that are needed in the state/territory for people with HIV who are identified and eligible under the RWHAP. The core medical and support service category definition effective for awards can be found in HRSA HAB Policy Clarification Notice (PCN) 16-02: RWHAP Services: Eligible Individuals and Allowable Use of Funds.

If you are seeking a waiver of the core medical services requirement, you must submit a waiver request either in advance of the grant application, with this grant application, or up to four (4) months into the grant award budget period. Include a core medical services waiver request as Attachment 5 if it is submitted with the grant application. Contact your project officer regarding submission procedures if submitting your request separate from this application.

Submission must be in accordance with HRSA HAB Policy Notice (PN) 21-01 Waiver of the RWHAP Core Medical Services Expenditures Requirement.

3. Caps on Expenses: Recipient administrative costs may not exceed 10 percent of the total RWHAP Part B States/Territories Supplemental Grant Program award. Planning and evaluation costs may not exceed 10 percent of the total grant award. Collectively, recipient administration and planning and evaluation may not exceed 15 percent of the total award.

If a RWHAP Part B grant recipient has contracted with an entity to provide statewide or regional RWHAP management and fiscal oversight (i.e., the entity has entered into a vendor or procurement relationship with the recipient and is acting on behalf of the recipient), the cost of that contract, exclusive of subawards to providers, would count toward the recipient’s 10 percent administrative cap.

Recipients may allocate…