HRSA-25-054 (HAB) RWHAP Part A ERGP final 7.1.2024.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2025

HIV/AIDS Bureau

Division of Metropolitan HIV/AIDS Programs

Ryan White HIV/AIDS Program Part A HIV Emergency Relief Grant Program

Funding Opportunity Number: HRSA-25-054 Funding Opportunity Type(s): Competing Continuation

Assistance Listing Number: 93.914

Application Due Date: October 1, 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: July 3, 2024

Chrissy Abrahms Woodland Director, Division of Metropolitan HIV/AIDS Programs Telephone: (301) 443-1373

FAX: (301) 443-5271

Email: CAbrahmswoodland@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 USC §§ 300ff-11 to -20 and 300ff-121 (sections 2601-2610 and 2693 of the Public Health Service (PHS) Act).

HRSA-25-054 RWHAP Part A 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 Part A HIV Emergency Relief Grant Program

Funding Opportunity Number: HRSA-25-054

Assistance Listing Number: 93.914

Due Date for Applications: October 1, 2024

Purpose: This notice announces the opportunity to apply for funding under the Ryan White HIV/AIDS Program (RWHAP) Part A HIV Emergency Relief Grant Program. The purpose of this program is to provide direct financial assistance to an eligible metropolitan area (EMA) or a transitional grant area (TGA) that has been severely affected by the HIV epidemic. Grant funds assist eligible jurisdictions to develop or enhance access to a comprehensive, high quality, community-based care for people with HIV through the provision of grant funds. The goal is to provide optimal HIV care and treatment for people with HIV and improve their medical outcomes.

RWHAP Part A recipients must use these funds to provide comprehensive primary health care and support services throughout the entire designated geographic service area. Your application must address the entire service area, as defined in Appendix B.

Program Objective(s):

RWHAP Part A EMAs and TGAs must use grant funds to support, further develop, and/or expand systems of care to meet the needs of people with HIV within the EMA/TGA and strengthen strategies to reach disproportionately impacted subpopulations.

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Eligible Applicants: RWHAP Part A recipients that are classified as an EMA or as a TGA and continue to meet the eligibility criteria as defined in the statute are eligible to apply for these funds.

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

Anticipated FY 2025 Total Available Funding:

$654,000,000 of which approximately $10,300,000 will be used for priority funding, and $52,000,000 will be available for Minority AIDS Initiative (MAI) funding.

(Note: Estimated annual available funding level based on current projections.)

Estimated Number and Type of Award(s):

Up to 52: competing continuation grants.

Estimated Award Amount: Varies, see Appendix B, subject to the availability of appropriated funds

Cost Sharing or Matching Required:

No

Period of Performance: March 1, 2025, through February 29, 2028 (3 years)

Agency Contacts: Business, administrative, or fiscal issues:

Olusola Dada Grants Management Specialist Division of Grants Management Operations, Office of Federal Assistance Management Email: ODada@hrsa.gov

Program issues or technical assistance:

Chrissy Abrahms Woodland Director, Division of Metropolitan HIV/AIDS Programs HIV/AIDS Bureau Email: CAbrahmswoodland@hrsa.gov mailto:ODada@hrsa.gov

HRSA-25-054 RWHAP Part A iii

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 technical assistance (TA) webinar to assist potential applicants in preparing applications that address the requirements of this notice of funding opportunity. Participation is optional.:

Day and Date: Thursday, July 18, 2024 Time: 2 p.m. – 4 p.m. ET Weblink: https://hrsa-gov.zoomgov.com/meeting/register/vJIsc-yopj4pG8D6XLCWgnjRaxHHko58xoc

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

Call-In Number: 833-568-8864 Meeting ID: 161 450 8531 Passcode: 47707377

We will record the webinar. The recorded webinar will be available on the TargetHIV website.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://hrsa-gov.zoomgov.com/meeting/register/vJIsc-yopj4pG8D6XLCWgnjRaxHHko58xoc https://hrsa-gov.zoomgov.com/meeting/register/vJIsc-yopj4pG8D6XLCWgnjRaxHHko58xoc https://targethiv.org/hrsa-25-054

HRSA-25-054RWHAP Part A 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 C: PAGE LIMIT WORKSHEET

HRSA-25-054 RWHAP Part A 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) Part A HIV Emergency Relief Grant Program. The purpose of this program is to provide direct financial assistance to an eligible metropolitan area (EMA) or transitional grant area (TGA) that has been severely affected by the HIV epidemic. Grant funds assist eligible jurisdictions to develop or enhance access to comprehensive, high quality, community-based care for people with HIV through the provision of grant funds. The goal is to provide optimal HIV care and treatment for people with HIV and improve their medical outcomes.

RWHAP Part A recipients must use these funds to provide comprehensive primary health care and support services throughout the entire designated geographic service area. Your application must address the entire service area, as defined in Appendix B.

Comprehensive HIV care consists of core medical services and support services that enable people with HIV to access and remain in HIV primary medical care to improve their health outcomes. Based on an annual assessment of the services and gaps in the HIV care continuum within a jurisdiction, HIV Planning Councils/Planning Bodies (PCs/PBs) and RWHAP recipients identify specific service categories to fund. Activities in each funded service category should lead to improvements in HIV care continuum outcomes.

RWHAP Part A EMAs and TGAs must use grant funds to support, further develop, and/or expand systems of care to meet the needs of people with HIV within the EMA/TGA and strengthen strategies to reach disproportionately impacted subpopulations. The Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) requires EMAs/TGAs to collect and analyze data to identify needs, set priorities, make allocations, and validate the use of RWHAP funding. Your application should describe how you have used data to develop and enhance the system of care in your jurisdiction. HRSA encourages innovation and collaboration with other agencies and organizations to maximize impact on health outcomes and effectively meet the needs of people with HIV within the EMA/TGA.

For more details, see Program Requirements and Expectations.

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2. Background

The Ryan White HIV/AIDS Program Part A HIV Emergency Relief Grant Program is authorized by 42 USC §§ 300ff-11 to -20 and 300ff-121 (sections 2601–2610 and 2693 of the PHS Act).

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 better health results, and lower HIV spread in priority groups.

The HIV care continuum is key to the program. It shows the journey of someone with HIV from diagnosis to effective treatment, leading to viral suppression. Achieving viral suppression boosts the patient's quality of life and prevents HIV spread.

This continuum also helps programs and planners measure progress and use resources effectively. We encourage you to assess your outcomes and work with your community and public health partners to improve. To assess your program, learn more at HRSA’s Performance Measure Portfolio.

Strategic Frameworks and National Objectives

To address health challenges faced by low-income people with HIV, using national objectives and strategic frameworks is crucial. These frameworks include:

Healthy People 2030

National HIV/AIDS Strategy (NHAS) (2022–2025)

Sexually Transmitted Infections National Strategic Plan for the United States (2021– 2025)

Viral Hepatitis National Strategic Plan for the United States: A Roadmap to Elimination (2021–2025)

These strategies offer guidance on the main principles, priorities, and steps for our national health response. They serve as a blueprint for collective action.

Expanding the Effort

There have been significant accomplishments:

• From 2017 to 2021, HIV viral suppression among Ryan White program patients improved from 85.9% to 89.7%. For more, see the 2021 Ryan White Services Report (RSR).

• Racial, ethnic, age-based, and regional disparities in viral suppression rates have significantly reduced. For more, see the Annual Client-Level Data Report 2021.

https://ryanwhite.hrsa.gov/about/parts-and-initiatives https://www.hiv.gov/federal-response/policies-issues/hiv-aids-care-continuum/ https://ryanwhite.hrsa.gov/grants/performance-measure-portfolio https://ryanwhite.hrsa.gov/grants/performance-measure-portfolio https://health.gov/healthypeople 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-2021.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/data/rwhap-annual-client-level-data-report-2021.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/data/rwhap-annual-client-level-data-report-2021.pdf

HRSA-25-054 RWHAP Part A 3

• 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

HRSA and CDC promote integrated data sharing and use for program planning, quality improvement, and public health action.

We encourage you to:

• Follow the Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Programs.

• Create data-sharing agreements between surveillance and HIV programs.

• Progress towards NHAS goals through integrated data sharing, analysis, and use of HIV data by health departments.

• Complete CD4, viral load, and HIV nucleotide sequence reporting to the state and territorial health departments’ HIV surveillance systems. CDC mandates the reporting of all such data to the National HIV Surveillance System (NHSS).

• Use HRSA’s interactive RWHAP Compass Dashboard to visualize reach, impact, and outcomes of the Ryan White program and to inform planning and decision making. The dashboard gives you a look at national, state, and metro area data and displays client demographics, services, outcomes, and viral suppression. It also includes data about clients using the AIDS Drug Assistance Program (ADAP).

• Develop data-sharing strategies with others to reduce administrative burden.

• Use electronic data sources to verify client eligibility when you can. See Policy Clarification Notice 21-02, Determining Client Eligibility & Payor of Last Resort in the Ryan White HIV/AIDS Program.

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 https://data.hrsa.gov/topics/hiv-aids/compass-dashboard 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

HRSA-25-054 RWHAP Part A 4

Program Resources and Innovative Models

HRSA offers multiple projects and resources to help you. A full list of resources is available on TargetHIV. We urge you to learn about them and use them in your project.

For some examples, see Helpful Websites.

Helpful Websites

Consider using these in Helpful Websites section of Contacts and Support.

Examples include:

• Access, Care, and Engagement Technical Assistance Center (ACE TA)

• Best Practices Compilation

• Center for Innovation and Engagement (CIE)

• Center for Quality Improvement and Innovation (CQII)

• Dissemination of Evidence-Informed Interventions (DEII)

• Using Evidence-Informed Interventions to Improve Health Outcomes among People Living with HIV (E2i)

• Ending Stigma through Collaboration and Lifting All to Empowerment (ESCALATE)

• Engage Leadership through Employment, Validation, and Advancing Transformation and Equity for persons with HIV (ELEVATE)

• Integrating HIV Innovative Practices (IHIP)

• AIDS Education Training Center Program – National Coordinating Resource Center

II. Award Information

1. Type of Application and Award

Application type: Competing Continuation.

We will fund you via a grant.

We will decide the amount of a recipient’s funding using a formula to calculate RWHAP Part A formula and MAI funding, and a separate calculation using normalized competitive application scores for determining discretionary awards for supplemental funding, including priority funding, as described in the Summary of Funding section below.

https://targethiv.org/help/ta-directory https://targethiv.org/ace https://targethiv.org/bestpractices https://targethiv.org/CIE https://targethiv.org/cqii https://targethiv.org/deii https://targethiv.org/deii https://targethiv.org/e2i https://targethiv.org/e2i https://targethiv.org/escalate https://targethiv.org/elevate https://targethiv.org/elevate https://targethiv.org/ihip https://targethiv.org/ta-org/aetc-ncrc https://targethiv.org/ta-org/aetc-ncrc

HRSA-25-054 RWHAP Part A 5

2. Summary of Funding

We estimate $654,000,000 will be available to fund 52 RWHAP Part A recipients.

Approximately $10,300,000 will be used for priority funding, and $52,000,000 will be available for MAI funding.

Notes:

• This program includes priority funding, as authorized by section 2603(b)(2)(C) of the PHS Act. Section 2603(b)(2)(C) of the PHS Act directs the Secretary to provide funds to eligible areas to address the decline or disruption of services related to the decline in the amount of formula funding. HRSA sets aside a portion of the RWHAP Part A supplemental funding to award priority funds in conformance with this statutory requirement. Applicants eligible for Part A supplemental funding that received more than a 20 percent reduction in their current RWHAP Part A formula award when compared to their FY 2006 formula award are eligible for priority funding. If determined eligible for priority funding, HRSA will calculate the additional amount to be awarded, and that amount will be included in the final award.

• You may apply for no more than the published ceiling amount in Appendix B. HRSA established ceiling amounts based on current funding with a five percent increase to accommodate fluctuations in formula and supplemental funding. The actual amount available will not be determined until the enactment of the final FY 2025 federal appropriation. If the RWHAP Part A award calculation results in an amount less than the budget submitted with your application, your budget will be proportionally reduced across all budget categories to reflect the actual award amount. If your award calculation results in an amount greater than the budget submitted with the application, you may be required to submit a revised SF-424A, budget narrative, and service category plan table. Establishing realistic ceiling amounts ensures that there will be an approved project budget in place at the beginning of each budget period.

• The Ryan White HIV/AIDS Program Part A HIV Emergency Relief Grant Program is an annually funded program with a three-year period of performance. The period of performance is March 1, 2025, to February 29, 2028 (three years).

Eligible applicants will submit a competitive application in the first year (FY 2025), and non-competing continuation (NCC) progress reports for years two and three (FY 2026 and FY 2027, respectively). The normalized score from the objective review of the demonstration of additional need provided in the competitive application during the first year of the three-year period of performance will be utilized to calculate the discretionary supplemental award in the second and third years.

• An annual SF-424A and Budget will need to be submitted in each year of the period of performance (i.e., in FY 2025 you will only include an SF-424A and Budget covering the FY 2025 budget period, same for FY 2026, and FY 2027).

HRSA-25-054 RWHAP Part A 6

Furthermore, assurances will be required with the competitive application and the NCC progress reports.

• This program notice is subject to the appropriation of funds and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds in a timely manner.

• HRSA will send the Notice of Award (NOA) to the CEO or to the delegated administrative agency responsible for dispersing RWHAP Part A funds.

• The HHS Secretary (Secretary) may reduce the amount of grant funds under the RWHAP Part A to an EMA/TGA for a fiscal year (FY) if, with respect to such grants for the second preceding FY, the EMA/TGA fails to prepare audits in accordance with the procedures of Section 7502 of Title 31, United States Code. See Section 2682(a) of the PHS Act.

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

• If you have 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 that a governmental department or agency unit that receives more than $35 million in direct federal funding must negotiate an indirect cost rate.

III. Eligibility Information

1. Eligible Applicants

RWHAP Part A recipients that are classified as an EMA or as a TGA and continue to meet the status as an eligible area as defined in the statute are eligible to apply for these funds. Eligibility for RWHAP Part A grants is based in part on the number of confirmed AIDS cases within a statutorily specified “metropolitan area.” The Secretary uses the Office of Management and Budget’s (OMB) census-based definitions of a Metropolitan Statistical Area (MSA) in determining the geographic boundaries of a RWHAP metropolitan area. HHS utilizes the OMB geographic boundaries that were in effect when a jurisdiction was initially funded under RWHAP Part A. For all newly eligible areas, the boundaries are based on current OMB MSA boundary definitions.

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

HRSA-25-054 RWHAP Part A 7

EMA Status:

EMAs must have more than 2,000 cases of AIDS reported and confirmed during the most recent five calendar years, and have a population of at least 50,000. For three consecutive years, the recipients must not have fallen below the required incidence levels already specified and required prevalence level of 3,000 living cases of AIDS.

TGA Status:

TGAs must have at least 1,000, but fewer than 2,000 cases of AIDS reported and confirmed during the most recent five calendar years for which such data are available and have a population of at least 50,000. For three consecutive years, recipients must not have fallen below both the required incidence levels already specified and required prevalence level of 1,500 or more living cases of AIDS. For a TGA with five percent or less of the total amount from grants awarded to the area under Part A unobligated, as of the end of the most recent FY, the required prevalence is at least 1,400 (and fewer than 1,500) living cases of AIDS.

This competition is open to eligible Part A jurisdictions to provide comprehensive primary health care and support services for people with HIV in their service areas as listed in Appendix B. The supplemental portion of the award is open to all eligible Part A jurisdictions that did not have an unobligated balance of greater than five percent in a previous fiscal year, which will be determined annually and communicated to applicable recipients.

Native American tribal governments and tribal organizations are not eligible.

2. Cost Sharing or Matching

Cost sharing or matching is not required for this program.

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

Maintenance of Effort

You must agree to maintain non-federal funding for award activities. This must be at least at the same spending level for the fiscal year prior to the fiscal year for which you receive the award, as Section 2605(a)(1)(B) of the PHS Act requires.

Federal funds should add to, not replace, existing non-federal spending for such activities. Complete the Maintenance of Effort (MOE) information and submit as Attachment 3.

https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/about-program/legislation-title-xxvi.pdf

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We will enforce statutory MOE requirements through all available mechanisms.

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 for additional guidance.

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

Select “Subscribe” and enter your email address for HRSA-25-054 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 are 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 is 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 80 pages when we print them. We will not review any pages that exceed the page limit.

Using the pages within the page limit, HRSA 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

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

• Indirect Cost Rate Agreement

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

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-25-054 RWHAP Part A 9

If you use an OMB-approved form that is not in the HRSA-25-054 workspace application package, it may count toward the page limit.

Applications must be complete and validated by Grants.gov under HRSA-25-054 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 action as described in 45 CFR § 75.371. This includes suspending or debarring you.2

• If you cannot certify this, you must include an explanation in Attachment 14:

Other Relevant Documents.

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

Program Requirements and Expectations

• Policy Clarification Notices: Information on the RWHAP and HAB

Policy Clarification Notices (PCNs) are available online at https://ryanwhite.hrsa.gov/grants/policy-notices.

• Program Letters: Information on the RWHAP and HAB Program Letters are available online at https://ryanwhite.hrsa.gov/grants/program-letters.

The following program letters have been updated recently:

o Ryan White HIV/AIDS Program Planning Council and Planning Body

Requirements and Expectations Letter o RWHAP Parts A and B Annual Site Visit Exemption o Supporting Community Engagement in the Ryan White HIV/AIDS

Program

Program-Specific Instructions In addition to application requirements and instructions in Section 4 of the SF 424 Application Guide (including the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract), also follow these program specific instructions:

1 See def initions at eCFR :: 2 CFR 180.995 -- Principal. and eCFR :: 2 CFR 376.995 -- Principal (HHS supplement to government-wide def inition 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://ryanwhite.hrsa.gov/grants/policy-notices https://ryanwhite.hrsa.gov/grants/program-letters https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/fy23-rw-council-body-requirements.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/fy23-rw-council-body-requirements.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/fy2023-rw-part-a-part-b-recipients.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/hab-community-engagment-program-letter.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/hab-community-engagment-program-letter.pdf 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-25-054 RWHAP Part A 10

i. Project Abstract

Use the Standard OMB-approved Project Abstract Summary Form that you will 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.

• A general overview of the HIV epidemic in the EMA/TGA, including epidemiologic, demographic, and geographic information. You may present this information as a table.

• A description of the comprehensive system of care in the entire EMA/TGA, including the available core medical and support services funded by RWHAP Part A and by other sources, where services are located, and how clients access those services, including services for disproportionately impacted subpopulation(s) supported by MAI funds.

• The overall viral suppression rate for the EMA/TGA. Use HIV surveillance data on TargetHIV.

NARRATIVE GUIDANCE

The following table provides a crosswalk between the narrative sections and where each section falls within the review criteria. Make sure you address all information requested in each narrative section. We may consider other forms or attachments you reference in a narrative section during the merit review.

Narrative Section Review Criteria

Introduction Criterion 1: NEED

Organizational Information Criterion 5: RESOURCES/CAPABILITIES

Needs Assessment Criterion 1: NEED

Approach Criterion 2: RESPONSE

Work Plan Criterion 2: RESPONSE and Criterion 4: IMPACT

Resolution of Challenges Criterion 2: RESPONSE

Evaluation and Technical Support Capacity

Criterion 3: EVALUATIVE MEASURES and

Criterion 5: RESOURCES/CAPABILITIES

Budget Narrative Criterion 6: SUPPORT REQUESTED

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ii. Project Narrative

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

Provide the requested information in the following order, using the narrative section headers. This ensures reviewers can understand your proposed project.

INTRODUCTION – Corresponds to Section V’s Review Criterion(a) #1 (Need) This section must briefly describe how the EMA/TGA will utilize RWHAP Part A grant funds, as defined in Appendix B, to support a comprehensive continuum of high-quality care and treatment for people with HIV in the RWHAP Part A service area.

ORGANIZATIONAL INFORMATION -- Corresponds to Section V’s Review Criterion(a) #5 (Resources/Capabilities)

A. Grant Administration The purpose of this section is to demonstrate the extent to which the CEO or designee in the EMA/TGA has met the legislative requirements to disburse funds quickly, closely monitor their use, and ensure the RWHAP is the payor of last resort.

RWHAP stresses the importance of timely obligation of RWHAP funds. Timely obligation of RWHAP funds ensures that services can be provided as rapidly as possible and decreases the possibility that unobligated funds will remain at the end of the budget period.

Unobligated Balance (UOB) Penalties

Please refer to Section 2603(c) of the PHS Act regarding the RWHAP Part A formula and supplemental unobligated balance (UOB) requirement, as well as Policy Notice 12-02 Part A and Part B Unobligated Balances and Carryover.

Formula Funds If the recipient reports unobligated formula funds of five percent or less, HRSA does not impose penalties, although a future year award may be subject to an offset.

Note: UOB Penalties (applies to each year in the three-year period of performance) If the UOB of a formula award exceeds five percent, two penalties are imposed:

• The future year award is reduced by the amount of the UOB, less the amount of approved carryover; and

• The grant recipient is not eligible for a future year supplemental award.

Note: The amount of formula UOB not approved for carryover is subject to an offset.

https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/hab-part-uob-policy.pdf

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Supplemental Funds

Under the RWHAP legislation, unobligated supplemental funds cannot be carried over, but are subject to an offset. If a grant recipient has a UOB of supplemental funds, the recipient remains eligible for a future year RWHAP Part A award, including supplemental funds.

MAI Funds The UOB requirement does not apply to MAI funds.

1) Program Organization

a) Describe how RWHAP Part A funds are administered within the EMA/TGA with reference to the staff positions, including program and fiscal staff, described in the budget narrative and the program organizational chart included as Attachment 1. The narrative should describe the local agency responsible for the grant and identify the entity responsible for administering the RWHAP Part A, including the department, unit, staffing levels (full-time equivalent staff [FTE], including any vacancies), fiscal agents, PC/PB staff, and in-kind support staff. Submit a staffing plan (including vacant positions, job descriptions, and biographical sketches for key personnel) as Attachment 2.

Note: We expect the staff person responsible for management of the RWHAP Part A grant (i.e., the Project Director or Program Coordinator) have at least 0.5 FTE allocated to the Part A program (this can be a combination of budgeted grant funds and/or other sources) to ensure sufficient oversight and monitoring of all grant activities conducted by recipients and subrecipients.

b) If you administer the RWHAP Part A funds through a fiscal agent, describe the staffing, fiscal agent scope of work or services to be provided, and how you will monitor the performance of the work or services provided.

2) Grant Recipient Accountability The Uniform Administrative Requirements, Cost Principles, and Audit Requirement for HHS Awards (45 CFR part 75) - Subrecipient Monitoring and Management (45 CFR § 75.351 and 352) and Part A National Monitoring Standards, which requires recipients to monitor the activities of subrecipients to ensure funding is used for authorized purposes, in compliance with federal statutes, regulations, and the terms and conditions of the subaward, as well as to ensure that performance goals are achieved. To meet the monitoring requirements, RWHAP Part A recipients must conduct annual subrecipient site visits.

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/2023-rwhap-nms-part-a.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/2023-rwhap-nms-part-a.pdf

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a) Monitoring – Provide a narrative that describes your planned subrecipient monitoring process for the FY 2025 – FY 2027 period of performance.

Note: see the RWHAP Parts A and B Annual Site Visit Exemption for guidance on requesting an exemption from this requirement.

b) Payor of Last Resort – Describe how your program complies with the requirements stated in PCN 21-02 Determining Client Eligibility and Payor of Last Resort in the Ryan White HIV/AIDS Program and PCN 15-03 Clarifications Regarding the Ryan White HIV/AIDS Program and Program Income.

Note: The RWHAP is the payor of last resort, and you must vigorously pursue alternate sources of payments. Recipients and subrecipients are required to use effective strategies to coordinate between RWHAP Part A and third-party payors who are ultimately responsible for covering the cost of services provided to eligible or covered persons. Subrecipients providing Medicaid eligible services must be Medicaid certified.

c) Fiscal Oversight – Provide a narrative that describes the process used to coordinate fiscal activities, to include ensuring adequate reporting, reconciling, and tracking program expenditures by funding stream, and the process for timely invoice payments to subrecipients.

B. Maintenance of Effort (MOE) RWHAP Part A funds are not intended to be the sole source of support for HIV care and treatment services in the EMA/TGA. The recipient must agree to maintain non-federal funding for award activities at a level that is not less than expenditures for such activities maintained by the entity for the fiscal year preceding the fiscal year for which the entity receives the award, as required by Section 2605(a)(1)(B) of the PHS Act.

Core medical services and support services are defined in Section 2604(c)(3) and 2604(d) of the PHS Act and in PCN 16-02 Ryan White HIV/AIDS Program Services:

Eligible Individuals & Allowable Uses of Funds. RWHAP Part A recipients must document that they meet the MOE requirement annually.

You must submit the following information as Attachment 3:

1) A table that identifies the baseline aggregate for actual non-federal EMA/TGA political subdivision expenditures for HIV-related core medical and support services during your most recently completed FY prior to the application deadline, and an estimate for your current FY.

https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/fy2023-rw-part-a-part-b-recipients.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://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-15-03-program-income.pdf 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-15-03-program-income.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/about-program/legislation-title-xxvi.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/about-program/legislation-title-xxvi.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/about-program/legislation-title-xxvi.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/about-program/legislation-title-xxvi.pdf https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf

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2) A description of the process, methodology, and elements used to determine the amount of expenditures in the MOE calculations.

NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion(a) #1

(Need) The purpose of this section is to demonstrate the severity of the HIV epidemic in the EMA/TGA.

A. Demonstrated Need The Demonstrated Need section includes Epidemiologic Overview, Unmet Need, HIV care continuum, Early Identification of Individuals with HIV/AIDS (EIIHA).

RWHAP Part A recipients should conduct a comprehensive needs assessment to determine service needs in the jurisdiction. Based on the comprehensive needs assessment, recipients must set priorities and allocate resources to meet these needs as directed by the planning council (PC) or recommended by the planning body (PB).

HAB will direct supplemental funds to eligible areas where epidemiologic data demonstrate that HIV infection prevalence rates are increasing, where there is documented demonstrated need and service gaps, and where there is a demonstrated disproportionate impact on people we have not yet successfully maintained in care.

1) Epidemiologic Overview An epidemiologic overview provides a description of the demonstrated need for HIV care in the population of an area in terms of the socio-demographic characteristics of persons newly diagnosed with HIV, people with HIV, and persons at higher risk for HIV. Understanding the populations affected by HIV provides the basis for setting priorities, identifying appropriate interventions and services, allocating funding to HIV care services, implementing appropriate service standards, and evaluating programs and policies.

The epidemiologic overview should focus on the most recent year for which data are available. When presenting trends, HRSA recommends a minimum of three years of data. Please cite data sources. Submit the HIV/AIDS Demographics Table, including socioeconomic data, as Attachment 4.

a) Provide a summary of the HIV epidemic in your EMA/TGA jurisdiction, not to exceed one page.

b) Provide a brief description of the socio-demographic characteristics of

(1) persons newly diagnosed, (2) people with HIV, and (3) persons at

HRSA-25-054 RWHAP Part A 15 higher risk for HIV in the EMA/TGA jurisdiction. This description should not exceed two pages.

Include the following, as available:

i. Demographic data (e.g., race, age, sex, transmission category, current gender identity) and

ii. Socioeconomic data (e.g., percentage of federal poverty level

(FPL), income, education, health insurance status, language barriers).

c) Provide the incidence and prevalence estimates for each of the following conditions co-occurring with HIV in the EMA/TGA in a table format (submit as Attachment 5) and document the data sources used. Include estimates for the most recent three years of data available. If data are not available, provide a justification. The table must include:

i. Hepatitis C virus

ii. Sexually transmitted infection rates, including syphilis, gonorrhea, and chlamydia

iii. Mental illness

iv. Substance use disorder

v. Homeless/unstably housed

vi. Justice involved

Note: You may include additional conditions unique to your jurisdiction, as applicable.

d) Provide an overall description of health care coverage options available to all people with HIV in the jurisdiction, not to exceed one page.

2) Unmet Need

Unmet need is defined as the number of individuals with HIV in a jurisdiction who are aware of their HIV/AIDS status and are not in care.

RWHAP legislation indicates that RWHAP Part A recipients need to address unmet need by identifying, determining the needs, and facilitating interventions for individuals with unmet need.

The Unmet Need Framework broadly characterizes unmet need by including three components: (1) late diagnosed, (2) unmet need, and (3) in care, but not virally suppressed. In reporting estimates across each component of the unmet need framework, recipients must submit estimates using jurisdictional HIV surveillance data (i.e., required method).

Additionally, recipients may also include estimates using RWHAP data

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(i.e., enhanced method). Submit Unmet Need Framework estimates as Attachment 6 in your application, and clearly identify the method utilized for the unmet need framework. Detailed information, training materials, and reporting tools of the unmet need framework are located on TargetHIV.

Based on the Unmet Need Framework estimates provided in Attachment 6, provide responses to the following:

a) Describe the need(s) of the estimated number of people in your jurisdiction that are 1) late-diagnosed, 2) have unmet need, and 3) are in care but not virally suppressed.

3) HIV Care Continuum

The HIV care continuum is a public health model that outlines the steps or stages that people with HIV go through from diagnosis to achieving and maintaining viral suppression. For the purposes of this NOFO, you will use a diagnosis-based HIV care continuum. A diagnosis-based HIV care continuum depicts each step as a percentage of the number of people with diagnosed HIV.

The CDC data set provided on TargetHIV must be used to complete the HIV care continuum from FY 2025 – 2027. Detailed information, training materials, and reporting tools for the HIV care continuum are also located on TargetHIV.

a) Using the CDC definition for a diagnosis-based HIV care continuum, and the numerators and denominator descriptions above, provide a graphic depiction (i.e., bar chart) of the HIV care continuum for the jurisdiction. TargetHIV contains the data for each step of the care continuum for each eligible RWHAP Part A jurisdiction.

B) Early Identification of Individuals with HIV/AIDS (EIIHA)

The purpose of this section is to provide information associated with ensuring that individuals who are unaware of their HIV status are identified, informed of their status, referred to supportive services, and linked to medical care if HIV test is positive. The goals of the EIIHA plan are to present a strategy for:

(1) identifying individuals with HIV who do not know their HIV status.

(2) making such individuals aware of their status and enabling them to use the health and support services; and

(3) reducing barriers to routine testing and disparities in access and services among affected subpopulations and historically underserved communities. See Section 2603(b)(2)(A) of the PHS Act.

https://targethiv.org/library/topics/estimating-unmet-need-hiv-primary-medical-care https://targethiv.org/hrsa-25-054 https://targethiv.org/hrsa-25-054

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1) Describe the planned EMA/TGA EIIHA activities for the three-year period of performance. Include the following information:

a) A brief description of the overall EIIHA strategy for your jurisdiction, including any adjustments to the strategy based on lessons learned from the prior period of performance.

b) Provide a description (can be in table format) of 1) activities, 2) anticipated outcomes, and 3) primary collaborators (e.g., other programs and agencies, including HIV prevention and surveillance programs) for each of the four EIIHA components listed below:

i. Identification of individuals unaware of their HIV status;

ii. Informing individuals that tested positive of their HIV diagnosis;

iii. Referral to care of newly diagnosed individuals; and,

iv. Linkage to care of newly diagnosed individuals.

Note: The EIIHA activities will remain the same for the three-year period of performance. Outcomes will be reported in FY 2026 and FY 2027 Reporting Requirements.

C) Subpopulations of Focus

Subpopulations of focus are specific groups of people with HIV within RWHAP Part A jurisdictions that are disproportionately affected by HIV because of specific needs.

A data driven process should be used to identify subpopulations of focus disproportionally affected by HIV. This should include an analysis of the jurisdictional needs assessment, outcomes in the HIV care continuum, data from the unmet need framework, epidemiological data (i.e., incidence of new HIV infections and trends, prevalence of HIV), and potential impact of other major public health threats (e.g., opioid epidemic, COVID-19, monkeypox, etc.).

The PC/PB should determine the needs of subpopulations, with particular attention to identifying disparities in access and services among the affected subpopulations and historically underserved communities. See Section 2602(b)(4) of the PHS Act for a description of the PC/PB’s duties.

1) Identify three subpopulations with disparities in health outcomes in your jurisdiction (e.g., subpopulations with disparities in viral suppression, receipt of care, retention in care, late diagnosis, HIV incidence, etc.), and briefly describe the specific needs for each subpopulation.

2) Briefly describe how the activities for each required EIIHA component (identification of individuals unaware of HIV status; informing newly

HRSA-25-054 RWHAP Part A 18 diagnosed individuals of HIV status; referral to care of newly diagnosed individuals; and linkage to care of newly diagnosed individuals) align with the needs of the identified subpopulations of focus for the jurisdiction. Indicate which EIIHA activities are not applicable.

Note: The subpopulations of focus will remain the same for the three-year period of performance. Updates will be reported in FY 2026 and FY 2027 Reporting Requirements.

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)

A. Planning Responsibilities The purpose of this section is to document the existence of a functioning planning process in the EMA/TGA that is consistent with RWHAP and HRSA program requirements. Section 2602(b)(1)-(4) of the PHS Act delineates the responsibilities of the PC/PB, and further clarification is provided in Ryan White HIV/AIDS Program Planning Council and Planning Body Requirements and Expectations Letter.

A planning process is imperative for effective local and state decision making to develop systems of…