FOA_Content_of_HRSA-26-012.pdf

Notice of Funding Opportunity

Application due Monday, November 3, 2025

HIV/AIDS Bureau Division of State HIV/AIDS Programs

AIDS Drug Assistance Program (ADAP) Emergency Relief Funds

(ERF)

Opportunity number: HRSA-26-012

Contents

Step 1: Review the Opportunity 5

Basic information 6

Eligibility 7

Program description 9

Award information 11

Step 2: Get Ready to Apply 15

Get registered 16

Find the application package 16

Application writing help 16

Step 3: Build Your Application 18

Application checklist 19

Application contents and format 20

Step 4: Understand Review, Selection, and Award Application review 31

Selection process 36

Award notices 37

Step 5: Submit Your Application 38

Application submission and deadlines 39

Step 6: Learn What Happens After Award 40

Post-award requirements and administration 41

Reporting 42

Contacts and Support 43

Before you begin 4

Contents 2

Appendices 46

Contents 3

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registrations are active and up-to-date.

SAM.gov registration (this can take several weeks)

You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days)

You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by the application due date

Applications are due by 11:59 p.m. Eastern Time on Monday, November 3, 2025.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 4 https://sam.gov/ https://grants.gov/

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 6

Eligibility 7

Program description 9

Award information 11

Basic information Health Resources and Services Administration (HRSA)

HIV/AIDS Bureau

Division of State HIV/AIDS Programs

Have questions?

Go to Contacts and Support.

Key facts

Opportunity name: AIDS Drug Assistance Program (ADAP) Emergency Relief Funds (ERF)

Opportunity number:

HRSA-26-012

Announcement version:

New

Federal assistance listing:

93.917

Key dates

NOFO issue date: October 2, 2025

Informational webinar:

October 15, 2025

Application deadline:

November 3, 2025

Expected award date is by:

April 1, 2026

Expected start date: April 1, 2026

See other submissions for other time frames that may apply to this NOFO.

Summary The purpose of the AIDS Drug Assistance Program (ADAP) Emergency Relief Funds (ERF) is to provide funding to states/territories to prevent, reduce, or eliminate ADAP waiting lists or to address shortfalls in ADAP funding for medications and/or the purchase of health care coverage. Recipients will use these funds along with the Ryan White HIV/ AIDS Program (RWHAP) Part B ADAP base award.

Funding details Application Types: Competing continuation, New

Expected total available funding in FY 2026: $75,000,000

Expected number and type of awards: Up to 25 grants

Funding range per award: $100,000 to $10,000,000

• If you have a current ADAP waiting list, you may apply for up to $10,000,000. If you do not have a waiting list, you may apply for up to $7,000,000. The minimum award amount is $100,000.

We plan to fund awards in one 12-month budget period from April 1, 2026, to March 31, 2027.

The program and awards depend on the appropriation of funds and are subject to change based on the availability and amount of appropriations.

Step 1: Review the Opportunity 6

Eligibility Who can apply You can only apply if you are a state/territory that receives RWHAP Part B funding and needs additional funding to:

• Reduce or eliminate an existing ADAP waiting list.

• Actively prevent an ADAP waiting list.

• Address a reduction in available resources to fund ADAP.

• Address a current or projected increase in treatment needs to end the HIV epidemic in the U.S.

• Address other increases in the number of clients in the program due to new diagnosis, re-engagement in care, loss of income, and/or loss of health care coverage.

Types of eligible organizations These types of domestic* organizations may apply:

• State governments, including the District of Columbia, domestic territories, and freely associated states.

* “Domestic” means the 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

Tribes and tribal organizations are not eligible for this funding. Individuals are not eligible for this funding.

Completeness and responsiveness criteria We will review your application to make sure it meets these basic requirements to move forward in the competition.

We will not consider an application that:

• Is from an organization that does not meet all eligibility criteria.

• Requests funding above the award ceiling shown in the funding range.

• Is submitted after the deadline.

Step 1: Review the Opportunity 7

Application limits You may not submit more than one application. If you submit more than one application, we will only accept the last on-time submission.

Cost sharing This program has no cost-sharing requirement. If you choose to share in the costs of the project, we will not consider it during merit review. We will hold you accountable for any funds you add, including through reporting

Post-award requirements

Before you apply, make sure you understand the requirements that come with an award.

See Step 6: Learn What Happens After Award for information on regulations that apply, reporting, and more.

Step 1: Review the Opportunity 8

Program description Purpose This notice announces the opportunity to apply for funding under the Ryan White HIV/ AIDS Program (RWHAP) Part B AIDS Drug Assistance Program (ADAP) Emergency Relief Funds (ERF).

ADAP ERF awards are intended for states/territories that need additional resources to prevent, reduce, or eliminate ADAP waiting lists or to address shortfalls in ADAP funding for medications or health care coverage. HRSA will base ADAP ERF awards upon your ability to successfully demonstrate the need for additional funding.

At the time of this NOFO publication, there are no ADAP waiting lists. States/territories that establish a waiting list after this NOFO is published must report the waiting list to HRSA immediately and use funding awarded under this NOFO to remove clients from the waiting list.

HRSA anticipates increases in clients who need ADAP services due to reductions in program income or rebates, loss of health care coverage among people with HIV, and increased case finding. States/territories may use ERF funds to address current or projected increases in treatment needs aligned with ending the HIV epidemic in the U.S. or other increases in the number of clients in their ADAP.

Background ADAPs ensure access to medication to treat HIV for eligible clients by directly purchasing medication and covering the costs of health care coverage premiums, deductibles, co-payments, and co-insurance. The state/territory determines client eligibility and ADAPs are expected to confirm client eligibility on a timely basis.

Eligibility criteria include documented diagnosis of HIV, financial eligibility, and residence eligibility.

The Ryan White HIV/AIDS Program

The HRSA Ryan White HIV/AIDS Program has five statutory funding parts that provide a comprehensive system of medical care, support, and medications for low-income people with HIV. The goal is to improve health outcomes and to prevent HIV transmission.

The HIV care continuum is a key strategy to meet the goals of the program. It shows the journey of someone with HIV from diagnosis to effective treatment, leading to viral

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 9 https://ryanwhite.hrsa.gov/about/parts-and-initiatives suppression. Achieving viral suppression boosts the individual’s quality of life and prevents HIV transmission.

This continuum also helps programs and planners measure progress and use resources effectively. We require you to assess your outcomes and work with your community and public health partners to improve outcomes across the HIV care continuum. To assess your program, review HRSA’s Performance Measure Portfolio.

Expanding the effort

There have been significant accomplishments:

• From 2010 to 2023, HIV viral suppression among RWHAP clients improved from 87.1% to 90.6%. For more, see the 2023 Ryan White Services Report (RSR).

• In 2020, the Ending the HIV Epidemic in the U.S. (EHE) initiative launched to further expand federal efforts to reduce HIV transmission. 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.

Program requirements and expectations The steady growth in the number of eligible clients combined with rising costs of complex HIV treatments can result in states/territories experiencing greater demand for ADAP services than available resources can cover. As a last resort, a state/territory may implement an ADAP waiting list when available funding cannot provide medications to all eligible people requesting enrollment in their ADAP and after they have used all other feasible cost-containment strategies.

HRSA HAB defines a waiting list as a register of individuals who have applied for and been deemed eligible for a state’s/territory’s ADAP, but whom the state cannot immediately serve due to insufficient resources. If an ADAP is proposing to implement a waiting list, the ADAP must be able to clearly demonstrate to HRSA HAB the need for the list before they establish one.

An ADAP must have written policies and procedures for managing a waiting list that include:

• Fair and equitable criteria.

• Compliance with relevant state/territory laws and regulations.

• A means for public input and communication to the public.

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 10 https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview/ending-epidemic-timeline

• Methods for monitoring the waiting list to make sure that policies and procedures are consistently followed across the state/territory.

• A revisions and appeals process.

An ADAP must assess each applicant for ADAP eligibility before putting them on the waiting list. The ADAP must confirm eligibility according to a pre-established schedule outlined in a waiting list policy and procedure. An ADAP must prioritize individuals by predetermined criteria and bring clients into the program as soon as funding becomes available. Clients on waiting lists should be given information about:

• Why a waiting list is necessary.

• Waiting list criteria.

• The estimated length of time they might remain on the waiting list.

• Options for getting their medications in the meantime, including:

◦ Recommendations or requirements for clients to work with a case manager.

◦ Patient Assistance Programs (PAPs) applications and help applying.

◦ Other available options, such as the RWHAP Part A Local Pharmacy Assistance Program (LPAP).

◦ Continuous assistance applying and re-applying for other programs, as needed.

We strongly discourage the use of a waiting list to contain costs, unless absolutely necessary. If you establish a waiting list, the DSHAP project officer will monitor the RWHAP Part B grant more closely, and you will need to report waiting list data to us.Statutory authority

Statutory authority:

42 U.S.C. §§ 243(c) and 300ff-26 (§§ 311(c) and 2616 of the Public Health Service Act)

Award information Funding policies and limitations Changes in HHS regulations As of October 1, 2025, HHS will adopt 2 CFR 200, with some modifications included in 2 CFR 300. These regulations replace those in 45 CFR 75.

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 11 https://www.ecfr.gov/current/title-2/part-200

Policies

• We will only make awards if this program receives funding. If Congress appropriates funds for this purpose, we will move forward with the review and award process.

• Award amounts are subject to demonstrated need and the availability of funds.

Total cost includes both direct and indirect costs per year.

• HAB will base the amount of your award on your showing the need for funding to:

◦ Reduce or eliminate an existing ADAP waiting list.

◦ Actively prevent implementing an ADAP waiting list.

◦ Address a reduction in available resources to fund ADAP.

◦ Address a current or projected increase in treatment needs aligned with ending the HIV epidemic in the U.S.

◦ Address other increases in the number of clients in the program due to new diagnosis, re-engagement in care, loss of income, and/or loss of health care coverage.

• HRSA will base funding decisions on review by an external merit review panel (MRP) review and scoring of the criteria listed in the merit review section of this notice.

• HRSA places significant importance on eliminating waiting lists, so:

◦ We will use the MRP scores to establish the rank order for awarding funds.

◦ If sufficient funding is available, we will make awards to all applicants that request funds to address an existing waiting list, as long as the MRP recommends them for an award based on their MRP score. See the funding preference section.

◦ After we provide funds to address existing waiting lists, we will award funds to remaining applicants that the MRP recommends for an award based on their MRP scores.

ADAPs are required to secure the best price available for all products on their ADAP formularies to achieve maximum results with these funds. As covered entities, ADAPs are eligible to participate in the 340B Drug Pricing Program under Section 340B of the PHS Act. Rebates and program income generated from these funds must be applied to the RWHAP Part B program, with priority given to ADAP (see Policy Clarification Notices 15-03 and 15-04 for more information).

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 12 https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/pcn-15-03-program-income.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/pcn-15-04-pharmaceutical-rebates.pdf

General limitations

• For guidance on some types of costs we do not allow or restrict, see Project

Budget Information in Section 3.1.4 of the Application Guide. You can also see 2 CFR Part 200 Subpart E - General Provisions for Selected Items of Cost ..

• You cannot earn profit from the federal award. See 2 CFR 200.400(g)..

• Congress’s current appropriations act includes a salary limitation, which applies to this program. As of January 2025, the salary rate limitation is $225,700. This limitation may be updated. You may pay salaries at a rate higher than Executive Level II if the amount beyond the salary rate limit is paid with non-HHS funds not associated with the HHS awarded project.

Program-specific statutory or regulatory limitations As outlined under applicable statute, regulation, or policy, you cannot use funds under this notice for the following purposes:

• Any costs unallowable under the ADAP service category (as defined in PCN 16-02:

RWHAP Services Eligible Individuals and Allowable Uses of Funds).

• Payment for any item or service to the extent that payment has been made (or reasonably can be expected to be made), with respect to that item or service, under any state compensation program, insurance policy, federal or state benefits program, or any entity that provides health services on a prepaid basis (except for a program administered by or providing the services of the Indian Health Service).

• Planning and evaluation activities as defined by the RWHAP Part B.

• Cash payments to intended recipients of RWHAP services.

• Clinical quality management.

• International travel.

• Construction. (Minor alterations and renovations to an existing facility to make it more suitable for the purposes of the award program are allowable with prior HRSA approval.)

• Syringe Services Programs (SSPs). Some aspects of SSPs are allowable with HRSA’s prior approval and in compliance with HHS and HRSA policy.

• Development of materials designed to directly promote or encourage intravenous drug use or sexual activity, whether homosexual or heterosexual.

• Pre-exposure prophylaxis (PrEP) medications and related medical services or post-exposure prophylaxis (PEP), as the person using PrEP or PEP is not diagnosed with HIV and therefore is not eligible for RWHAP-funded medication.

See Manage Your Grant for other information on costs and financial management.

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 13 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13 https://www.ecfr.gov/current/title-2/part-200/subject-group-ECFRed1f39f9b3d4e72 https://www.ecfr.gov/current/title-2/part-200/subject-group-ECFRed1f39f9b3d4e72 https://www.ecfr.gov/current/title-2/part-200#p-200.400(g) https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/service-category-pcn-16-02-final.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/service-category-pcn-16-02-final.pdf https://www.hrsa.gov/grants/manage-your-grant

Indirect costs Indirect costs are costs you charge across more than one project that cannot be easily separated by project. For example, this could include utilities for a building that supports multiple projects.

To charge indirect costs you can select one of two methods:

Method 1 – Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency at the time of award.

Method 2 – De minimis rate. Per 2 CFR 200.414(f), if you have never received a negotiated indirect cost rate, you may elect to charge a de minimis rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct costs.

This rate is up to 15% of modified total direct costs (MTDC). See 2 CFR 200.1 for the definition of MTDC. You can use this rate indefinitely for all your federal awards or until you choose to receive a negotiated rate.

Consider your indirect costs when developing your budget.

Program income and rebates Program income is money earned as a result of your award-supported project activities. You must use any program income you generate from awarded funds for allowable project-related activities. Find more about program income at 2 CFR 200.307.

Rebates generated because of awarded funds must be used for the statutorily permitted purposes under the RWHAP Part B with a priority for ADAP.

Per 2 CFR 200.305(b)(5), to the extent available, you must disburse funds available from program income and rebates before requesting grant funds. Please see HAB PCNs 15-03: Clarifications Regarding the Ryan White HIV/AIDS Program and Program Income and 15-04: Utilization and Reporting of Pharmaceutical Rebates for more information.

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 14 https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC)) https://www.ecfr.gov/current/title-2/section-200.307 https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/pcn-15-03-program-income.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/pcn-15-04-pharmaceutical-rebates.pdf

Step 2:

Get Ready to Apply

In this step

Get registered 16

Find the application package 16

Application writing help 16

Get registered SAM.gov You must have an active account with SAM.gov to apply. This includes having a Unique Entity Identifier (UEI). SAM.gov registration can take several weeks. Begin that process today.

To register, go to SAM.gov Entity Registration and select Get Started. From the same page, you can also select the Entity Registration Checklist to find out what you’ll need to register.

When you register or update your SAM.gov registration, you must agree to the financial assistance general certifications and representations. You must agree to those for grants specifically, as opposed to contracts, because the two sets of agreements are different. You will have to maintain your registration throughout the life of any award.

Grants.gov You must also have an active account with Grants.gov. You can see step-by-step instructions at the Grants.gov Quick Start Guide for Applicants.

Find the application package The application package has all the forms you need to apply. You can find it online. Go to Grants Search at Grants.gov and search for opportunity number HRSA-26-012.

After you select the opportunity, we recommend that you click the Subscribe button to get updates.

Application writing help Visit HHS Tips for Preparing Grant Proposals.

Visit HRSA’s How to Prepare Your Application page for more guidance.

See Apply for a Grant for other help and resources.

Join the webinar For more information about this opportunity, join the webinar on Wednesday, October 15, 2025 at 2 PM ET.

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 16 https://sam.gov/content/entity-registration https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application/assurances-non-construction-programs https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application/assurances-non-construction-programs https://grants.gov/applicants/applicant-registration http://www.grants.gov/quick-start-guide/applicants https://www.grants.gov/search-grants https://www.hhs.gov/grants-contracts/grants/get-ready-for-grants-management/tips-for-preparing-grant-proposals/index.html https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://www.hrsa.gov/grants/apply-for-a-grant

Join on: Microsoft Teams

If you are not able to join through your computer, you can call in:

• Phone number: 240-800-7959

• Meeting ID: 264 408 003#

Have questions? Go to Contacts and Support.

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 17 https://teams.microsoft.com/l/meetup-join/19%3ameeting_MzczZTBkYTktZmY5MS00NTgyLTkzYjQtZWRiMzhlMGU4ZTNj%40thread.v2/0?context=%7b%22Tid%22%3a%2214b77578-9773-42d5-8507-251ca2dc2b06%22%2c%22Oid%22%3a%22d6bb9832-2d2b-472d-a334-74e4f4c59950%22%7d

Step 3:

Build Your Application

In this step

Application checklist 19

Application contents and format 20

Application checklist Make sure that you have everything you need to apply:

Narratives

Component Included in page limit*?

Project narrative

Use the Project Narrative Attachment form.

Yes

Budget narrative

Use the Budget Narrative Attachment form.

Yes

Attachments

Insert each in the Attachments Form in this order.

Component Included in page limit*?

1. Work plan

Yes

2. Agreement Compliance Assurances

Yes

3. ADAP Organizational Chart

Yes

4. ADAP Funding Utilization Summary for FY

Yes

Other required forms

Upload using each required form in Grants.gov.

Component Included in page limit*?

Application for Federal Assistance

(SF-424)

No

Step 3: Build Your Application 19

Budget Information for Non-Construction Programs

(SF-424A)

No

Project Abstract Summary Form

No

Disclosure of Lobbying Activities (SF-LLL), optional

No

Project/Performance Site Location(s)

No

Grants.gov Lobbying Form

No

Key Contacts

No

*Only what you attach in these forms counts toward the page limit. The forms themselves do not count.

Application contents and format Applications include 5 main components. This section includes guidance on each.

Application page limit: 40 pages.

Submit your information in English and express whole number budget figures using U.S. dollars.

Required format You must format your narratives and attachments using our required formats for fonts, size, color, format, and margins. See the formatting guidelines in Section 3.2 of the Application Guide.

Project narrative In this section, you will describe all aspects of your project.

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 3: Build Your Application 20 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=24

Use the section headers and the order listed.

Introduction See merit review criterion 1: Need

Briefly describe the purpose of your project.

Need See merit review criterion 1: Need

The purpose of this section is to show that you need additional resources to meet the projected ADAP client service needs for FY 2026. Provide the following information to show that you are eligible for this award and explain the structure, functions, and operational processes of the ADAP and its clients.

State/territory’s ADAP profile

ADAP funding and utilization summary for FY 2024

In table format, please list:

• All the following sources of funding for ADAP (1 through 12),

• The amount received.

• The amount expended.

• The amount of unspent funds and unobligated balances during the FY 2024 period of performance (April 1, 2024 through March 31, 2025)

• The estimated number of unduplicated clients served with each funding source.

If you did not receive funding from one or more of the categories listed below, please list the source and enter zero. Please include the table as Attachment 4. A sample table format is provided in Appendix B.

The funding sources are:

1. ADAP base

2. ADAP supplemental

3. RWHAP Part B Base Contribution to ADAP

4. RWHAP Part B Supplemental Contribution to ADAP

5. ADAP ERF Award

6. RWHAP Part A Contribution to ADAP

7. State funds

8. Pharmaceutical rebates

9. Carryover

Step 3: Build Your Application 21

10. Program income

11. Other sources (describe)

12. Total ADAP funding

Cost-cutting measures for FY 2024 and FY 2025

Please identify which, if any, of the following cost-cutting measures you were using or began using in FY 2024 and FY 2025 for your ADAP:

• Enrollment cap—specify the maximum number of enrollees.

• Capped number of prescriptions per month—specify the cap.

• Capped expenditure—specify the amount and timeframe.

• Drug-specific enrollment caps for antiretroviral medication—specify the cap.

• Reduction in formulary—specify the reduction.

• Decrease in financial eligibility criteria—specify the decrease.

• Other—please specify.

Cost-Saving Measures for FY 2024 and FY 2025

Please identify which, if any, of the following cost-saving measures you were using or began using in FY 2024 and FY 2025 for your ADAP:

• Expansion of health care coverage assistance—specify the services you currently offer.

• Enrolling eligible clients in health care coverage—specify how many were enrolled and how they were enrolled.

• Enrolling eligible clients into Medicaid.

• Improved client eligibility confirmation processes—specify improvements.

• Decrease in administrative expenditures—specify decreases.

• Other—please specify.

Factors affecting state/territory ADAP capacity to meet need Provide a detailed description of any key factors affecting the ADAP’s need for additional resources for the approved purposes. Describe:

• Why the ADAP cannot meet the need with existing resources.

• Any anticipated funding shortfalls for ADAP.

• The cost-cutting measures you would take if your ADAP was not awarded additional funding.

If you reported any unspent funds or unobligated balances in the ADAP Funding Summary for FY 2024, please explain why you need emergency funds, given these other available resources.

Step 3: Build Your Application 22

Examples of factors that could create need for additional resources include, but are not limited to:

• Trends or changes in the HIV disease prevalence over the past two calendar years (January 1, 2023, through December 31, 2024) have affected the ADAP.

• Increases in clients engaged in care.

• Changes to the state/territory’s service delivery system may increase client need or administrative burden as a result of the changing health care landscape.

• Changes in client population or demographics over the last two calendar years, including:

◦ More eligible clients.

◦ Higher percentage of eligible clients below 100% of the FPL.

◦ High unemployment rates.

◦ Increased co-morbidities, such as substance use disorder.

◦ Increased number of out-of-care clients seeking treatment.

• Increased program costs, including the cost of ADAP medications or cost to ADAP for health care coverage premiums, deductibles, or cost sharing.

• Decreased or level funding from state or RWHAP resources for ADAP and/or HIV services.

• Decreased program income or pharmaceutical rebates.

You should include data sources when discussing trends and changes (including environmental changes) that have resulted in this need.

Approach See merit review criterion 2: Response

ADAP average annual client costs and forecasting Calculate the projected average cost per client for medication assistance and/or health care coverage for the FY 2026 ADAP ERF period of performance (April 1, 2026, to March 31, 2027). Important note: You only need to provide average costs for clients for the types of assistance you are requesting funding for.

Determine the average cost per client through your own calculations, or through the formula in Appendix A. Whichever method you use, provide the step-by-step calculations you used to find the average cost per client. Use this calculation to develop the proposed budget for the ADAP ERF funds. Show how you multiplied the average cost per client by the projected number of clients to be served to determine the budget request for medication assistance and/or health care coverage assistance.

Step 3: Build Your Application 23

ADAP average annual client costs

• If you are requesting funding for medication costs, please provide current projected annual average medication cost per client and all calculations used to determine the cost.

• If you are requesting funding for health care coverage, please provide current projected annual average health care coverage assistance cost per client and all calculations used to determine the cost.

Forecasting

• If you have an existing ADAP waiting list, provide the current number of people on the list.

• Describe the projected impact of ADAP ERF and any other projected resources in addressing any of these:

◦ Your projected/potential ADAP waiting list.

◦ Your current waiting list.

◦ Your other increases in the number of clients in the program.

High-level work plan See merit review criteria 2: Response and 4: Impact

Work plan Provide a workplan, uploaded as Attachment 1, that lists each planned ADAP ERF service—for example, purchase of ADAP medications, purchase of health care coverage premiums, or payment of medication co-payments, deductibles, or co-insurance. Only costs allowed under the ADAP service category (as defined in PCN 16-02 RWHAP Services Eligible Individuals and Allowables Uses of Funds) can be funded through ADAP ERF. If you have any unallowable costs in your proposed budget, we will deduct them before award.

HRSA encourages you to use a table format with the following sections:

• Planned Expenditures Summary listing the amount budgeted by service category and recipient administrative costs.

• Planned Expenditures by Service Category with columns for Planned Service, Service Unit Description, Number of Service Units, Number of Clients, and amount budgeted for each service.

• Service Unit Description with the definition of the unit of service for the planned service category.

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 3: Build Your Application 24

Work plan narrative Provide a narrative that describes the following for each planned service and recipient administrative cost identified in the work plan:

• How you will ensure that you will spend funds allocated for each service/activity within the 12-month period of performance.

• If you have an existing ADAP waiting list, how the services/activities will reduce the number of people on the waiting list.

• If you do not have an existing waiting list, how the services/activities will prevent an ADAP waiting list in FY 2026, address a reduction in available resources to fund ADAP, or address a current or projected increase in treatment needs or in the number of clients in the program.

Anticipated impact of ADAP ERF Briefly describe the anticipated impact of the proposed ADAP ERF-funded planned service(s).

• Describe how you’ll monitor progress toward meeting the goals and objectives of the proposed project.

• Describe how these activities will support the continued function of the ADAP.

• Describe the anticipated outcomes resulting from ADAP ERF supported activities.

Monitoring Briefly describe your methods to monitor and assess the effectiveness of the activities proposed on the ADAP ERF work plan. Describe how the ADAP will measure and monitor progress on outcomes and address problems identified through monitoring.

Important note: We expect you to use your current RWHAP Part B clinical quality management program when implementing services funded through the ADAP ERF award.

Resolving challenges See merit review criterion 2: Response

State/territory actions to address ADAP challenges Please describe for each of the following sections how the program has addressed the specific challenges and barriers facing the ADAP through cost-cutting and/or cost-saving strategies in FY 2024 and FY 2025. Support each section with data showing how these strategies benefit the ADAP.

Program efficiencies:

Step 3: Build Your Application 25

Please describe any challenges regarding program efficiencies and how your program has addressed challenges, including by using ADAP ERF funding or improving operations to reduce costs and improve efficiency. Support your decision with data showing how the improved operational efficiencies will benefit ADAP.

Ability to enroll clients in other payor sources

Please describe any challenges enrolling clients in other payor sources, and how your program has addressed challenges by improving systems to increase enrollment in Medicare Part D, Medicaid, and other health care coverage options. Be sure to support your decision with data showing how improved enrollment in other payor sources will benefit your ADAP.

Reallocation of ADAP resources

Please describe any challenges or limits with ADAP resources, and whether or how you have reallocated funds to address ADAP challenges. Be sure to indicate whether this reallocation is a one-time augmentation to the program or an expected long-term, sustainable reallocation of funds.

Generation and collection of rebates and program income

Please describe any challenges generating or collecting rebates and program income.

Include how your ADAP has modified its processes or monitoring of processes to ensure that you purchase drugs at the best possible cost and/or that you fully collect rebates or program income and apply them back to the RWHAP Part B program, with priority given to ADAP.

Sustainability See merit review criterion 4: Impact

We expect you to sustain key project elements that improve practices and outcomes for the target population. Propose a plan for project sustainability after the period of federal funding ends.

• Highlight key elements of your projects. Examples include training methods or strategies that have been effective in improving practices.

• Describe the actions you’ll take to obtain future sources of funding.

• Determine the timing to become self-sufficient.

• Discuss challenges that you’ll likely encounter in sustaining the program. Include how you will resolve these challenges.

Organizational information See merit review criterion 5: Resources and capabilities

Step 3: Build Your Application 26

ADAP oversight and administration Provide a brief narrative that describes the organizational structure and resources that help the ADAP maintain compliance with legislative requirements and program expectations, including those of ADAP ERF funding. Include an organizational chart for the ADAP as Attachment 3.

Compliance with reporting requirements Describe how you will meet reporting requirements by tracking and reporting ADAP ERF specific expenditures and client utilization.

Budget and budget narrative See merit review criterion 6: Support requested

Your budget should follow the instructions in Section 3.1.4 Project Budget Information

– Non-Construction Programs (SF-424A) of the Application Guide and the instructions listed in this section. Your budget should show a well-organized plan.

HHS now uses the definitions for equipment and supply in 2 CFR 200.1. The new definitions change the threshold for equipment to the lesser of the recipient’s capitalization level or $10,000 and the threshold for supplies to below that amount.

The total project or program costs are all allowable (direct and indirect) costs used for the HRSA award 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 maintenance of effort, if applicable).

The budget narrative supports the information you provide in Standard Form 424-A.

See other required forms. It includes an itemized breakdown and a clear justification of the costs you request. The merit review committee reviews both.

As you develop your budget, consider:

• If the costs are reasonable and consistent with your project’s purpose and activities.

• The restrictions on spending funds. See funding policies and limitations.

ADAP ERF applicants must also consider the following:

• Caps on expenses: Administrative costs for ADAP ERF funding recipients may not exceed 10% of the total grant award. For further guidance , see PCN 15-01:

Treatment of Costs under the 10% Administrative Cap for Ryan White HIV/AIDS Program Part A, B, C, and D.

• Staffing: Due to the emergent nature of this award, if you need any additional personnel to administer this award, their salaries must fit within the

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 3: Build Your Application 27 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Equipment) https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200#p-200.1(Supply) https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/pcn-15-01.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/pcn-15-01.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/pcn-15-01.pdf administrative cost cap. Usual and ordinary expenses for salaries associated with RWHAP awards must be allocated to the RWHAP Part B award and therefore cannot be allocated to this award.

• Payor of last resort: Charges that are billable to third-party payors are unallowable. Third-party payors include Medicaid, Children’s Health Insurance Programs (CHIP), Medicare (including Medicare Part D), basic health plans, and private insurance, including those purchased through the Health Insurance Marketplace. The RWHAP is the payor of last resort, and recipients must vigorously pursue alternate sources of payments. HRSA expects recipients to determine eligibility for all clients and to confirm eligibility on a timely basis (please see HAB PCN 21-02: Determining Client Eligibility & Payor of Last Resort in the Ryan White HIV/AIDS Program). Recipients are required to use effective strategies to coordinate with third-party payers that are ultimately responsible for covering the cost of services provided to eligible or covered people.

To create your budget narrative, see detailed instructions in Section 3.1.5 of the Application Guide.

Attachments See Section 3.2.6 of the Application Guide.

Place your attachments in this order in the Attachments Form. See application checklist to determine if they count toward the page limit.

Attachment 1: Work plan Attach the project’s work plan. Make sure it includes everything required in the work plan section of the project narrative.

Attachment 2: Agreement and compliance assurances Please complete and include Appendix D: Agreements and compliance assurances.

Attachment 3: ADAP organizational chart Provide a one-page diagram that shows the project’s organizational structure.

Attachment 4: ADAP funding and utilization summary for FY 2024 In table format, please provide all information requested in the Need section of the project narrative. A sample table format is provided in Appendix B.

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 3: Build Your Application 28 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://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/pcn-21-02-determining-eligibility-polr.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=18 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=25

Other required forms You will need to complete some other forms. Upload the following forms at Grants.gov.

You can find them in the NOFO application package or review them and any available instructions at Grants.gov Forms.

Component Included in page limit*?

Application for Federal Assistance

(SF-424)

No

Budget Information for Non-Construction Programs

(SF-424A)

No

Project Abstract Summary Form

No

Disclosure of Lobbying Activities (SF-LLL), optional

No

Project/Performance Site Location(s)

No

Grants.gov Lobbying Form

No

Key Contacts

No

Form instructions Follow the instructions for Application for Federal Assistance in section 3.1 of the Application Guide and any additional instructions provided here.

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 3: Build Your Application 29 https://grants.gov/forms/forms-repository/sf-424-family

Project abstract summary form instructions. Complete the information in the Project Abstract Summary form. Include a short description of your proposed project. Include the needs you plan to address, the proposed services, and the population groups you plan to serve. In addition, provide brief up-to-date information, in this order:

• Brief description of the state ADAP and key environmental factors impacting the program.

• Description of the need for additional resources to:

• Prevent, reduce, or eliminate an ADAP waiting list.

• Address a reduction in available resources to fund ADAP.

• Address a current or projected increase in treatment needs aligned with ending the HIV epidemic in the U.S.

• Address other increases in the number of clients in the program due to new diagnosis, re-engagement in care, loss of income, and/or loss of health care coverage.

• Description of how you plan to use the ADAP ERF, if awarded.

For more information, see Section 3.1.2 of the Application Guide.

Important: public information

When filling out your SF-424 form, pay attention to Box 15: Descriptive Title of Applicant’s Project.

We share what you put there with USAspending. This is where the public goes to learn how the federal government spends their money.

Instead of just a title, insert a short description of your project and what it will do.

See instructions and examples.

1. Review 2. Get Ready 3. Build 4. Understand 5. Submit 6. Award Contacts

Step 3: Build Your Application 30 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13 https://www.usaspending.gov/ https://www.hhs.gov/sites/default/files/hhs-writing-award-descriptions.pdf

Step 4:

Understand Review, Selection, and Award Application review

In this step

Selection process 36

Award notices 37

Initial review We will review your application to make sure that it meets eligibility criteria, including the completeness and responsiveness criteria. If your application does not meet these criteria, it will not be funded.

We will not review any pages that exceed the page limit.

Merit review A panel reviews all applications that pass the initial review. The members use these criteria.

Criterion Total number of points = 100

1. Need 50 points

2. Response 25 points

3. Impact 10 points

4. Resources and capabilities 5 points

5. Support requested 10 points

Criterion 1: Need 50 points

See the project narrative Introduction and Need sections.

The panel will review your application for how well it:

• Demonstrates the need for additional resources to prevent, reduce, or eliminate a waiting list, to address a reduction in available resources to fund ADAP, or to address a current or projected increase in treatment needs aligned with ending the HIV epidemic in the U.S. or other increases in the number of clients in the program due to new diagnosis, re-engagement in care, loss of income, and/or loss of health care coverage.

Introduction (5 points)

• Describes a feasible plan for how the state/territory will use RWHAP ADAP ERF to prevent, reduce, or eliminate a waiting list, address a reduction in available resources to fund ADAP, or address a current or projected increase in treatment needs or the number of clients in the program.

Step 4: Understand Review, Selection, and Award Application review 32

State/territory’s ADAP profile (20 points)

• Provides a strong, complete, and clear ADAP profile.

• Provides a strong, clear demonstration of need for additional resources by presenting data, including the complete use of available resources, the implementation of cost-cutting and/or cost-saving measures, and/or an increase in clients utilizing the ADAP.

Factors affecting the state/territory ADAP capacity to meet need (25 points)

• Provides a strong, clear narrative (and supporting data) describing the demonstrated need for additional resources to prevent, reduce, or eliminate a waiting list, address a reduction in available resources to fund ADAP, or address a current or projected increase in treatment needs or the number of clients in the program. (10 points)

• Provides a strong, clear description of why the ADAP cannot meet the need with existing resources (especially if you report any unobligated or unspent funds), any anticipated funding shortfalls for ADAP, and the cost-cutting measures you would need to implement if you do not receive additional funding. (15 points)

Criterion 2: Response 25 points

See the project narrative Approach, High-level work plan, and Resolving challenges sections.

ADAP average annual client costs and forecasting (5 points) The panel will review your application for the extent to which it provides clear, complete, and compelling descriptions of the following:

• A step-by-step methodology for calculating average cost per client for medication assistance and/or health care coverage assistance, depending on the type of assistance requested.

• Accurate calculations of annual client costs, reflected in your plan and budget.

• The impact of the requested funding on preventing, reducing, or eliminating a waiting list or addressing a current or projected increase in treatment needs or in the number of clients in the program.

Note: If the calculations are incorrect, we will note the error along with its impact on your average client cost calculations and budget request.

Step 4: Understand Review, Selection, and Award Application review 33

Work plan and work plan narrative (10 points) The panel will review your application for the extent to which it provides strong and feasible descriptions of:

• The proposed services and projected expenditures to address the problem and align with the project objectives

• Evidence that funds allocated for each service/activity will be spent within the 12-month period of performance.

• For applicants with an ADAP waiting list, proposed services/activities to reduce the number of persons on the waiting list:

◦ Proposed services/activities to improve ADAP operations and maximize ADAP resources.

◦ Proposed services/activities to prevent a waiting list in FY 2026.

State/territory actions to address ADAP challenges (10 points) The panel will review your application for the extent to which it provides:

• A strong, clear description of the challenges facing the ADAP in the following areas:

◦ Program efficiencies.

◦ The ability to enroll clients in other payor sources.

◦ Reallocation of ADAP resources.

◦ Generation or collection of rebates and program income.

• A strong, clear description of the cost-cutting or cost-saving strategies you have taken in response to these challenges and the extent to which they could achieve program objectives.

• Data demonstrating how these strategies benefit the ADAP.

Criterion 3: Impact 10 points

See the project narrative High-level work plan and Sustainability sections.

The panel will review your application for the extent to which the application provides strong and feasible descriptions of:

• The methods in place to monitor and assess the effectiveness of the activities proposed on the ADAP ERF work plan.

• How the applicant will monitor progress toward meeting the proposed goals and objectives.

Step 4: Understand Review, Selection, and Award Application review 34

• How the proposed activities support the continued function of the ADAP.

• The anticipated outcomes of the ADAP ERF.

Criterion 4: Resources and capabilities 5 points

See the project narrative Organizational information and Performance reporting and evaluation sections.

The panel will review your application to determine the extent to which it provides a strong and complete description of your ability to implement the ADAP ERF, as evidenced by:

• The organizational structure and resources that administer the ADAP to maintain compliance with legislative requirements and program expectations, including those of ADAP ERF funding.

• The organizational chart for the ADAP in…