PKG00260185-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

HIV AIDS Bureau (HAB) Division of State HIV/AIDS Programs (DSHAP)

Ryan White HIV/AIDS Program Part B

States/Territories Supplemental Grant Program

Funding Opportunity Number: HRSA-20-065 Funding Opportunity Type(s): New, Limited Competition

Assistance Listings (CFDA) Number: 93.917

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2020

Application Due Date: May 18, 2020

Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

HRSA will not approve deadline extensions for lack of registration.

Registration in all systems, including SAM.gov and Grants.gov, may take up to 1 month to complete.

Issuance Date: March 17, 2020

Susan Robilotto, D.O.

Director, Division of State HIV/AIDS Programs Telephone: (301) 443-6554 Fax: (301) 594-5224 Email: SRobilotto@hrsa.gov

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

mailto:SRobilotto@hrsa.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2020 Ryan White HIV/AIDS Program (RWHAP) Part B State/Territories Supplemental Grant Program. The purpose of this program is to supplement the HIV care and treatment services provided by the states/territories through the HIV Care Grant Program - RWHAP Part B States/Territories Formula and AIDS Drug Assistance Program (ADAP) Formula and ADAP Supplemental Awards (Notice of Funding Opportunity HRSA-17-036). The amount of funding awarded will be determined by the applicant’s ability to demonstrate the need for supplemental funding to provide comprehensive HIV care and treatment services for people with HIV in the state/territory.

Funding Opportunity Title: Ryan White HIV/AIDS Program Part B

States/Territories Supplemental Grant Program

Funding Opportunity Number: HRSA-20-065 Due Date for Applications: May 18, 2020

Anticipated Total Annual Available FY 2020 Funding:

Estimate up to: $60,000,000 Approximately $5,000,000 will be used for priority funding*

Estimated Number and Type of Award(s): Up to 30 grants Estimated Award Amount: Up to $10,000,000 per year subject to the availability of appropriated funds.

Cost Sharing/Match Required: No Period of Performance: September 30, 2020 through

September 29, 2021 (one (1) year)

Eligible Applicants: All 50 States, the District of Columbia, and eight (8) Territories except American Samoa, Marshall Islands, Nevada, Montana, and Oregon

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

* Estimated annual available funding level based on current projections.

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide, available online at https://hab.hrsa.gov/fundingopportunities/default.aspx?id=813e8c16-5644-4d92-88a1-b28377e32a0d

HRSA-20-065 ii http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf, except where instructed in this NOFO to do otherwise.

Technical Assistance

HRSA has scheduled the following technical assistance:

Webinar

Day and Date: Wednesday, April 1, 2020 Time: 2:30-4:00 PM EST Call-In Number: 1- 888-603-9750 Participant Code: 5602370 Weblink: https://hrsa.connectsolutions.com/part_b_supplemental/ http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa.connectsolutions.com/part_b_supplemental/

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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/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. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER AND

SYSTEM FOR AWARD MANAGEMENT

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

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Ryan White HIV/AIDS Program (RWHAP) States/Territories Part B Supplemental Grant Program.

The purpose of this program is to supplement formula-based funding provided through the HIV Care Grant Program – RWHAP Part B States/Territories Formula and AIDS Drug Assistance Program (ADAP) Formula and ADAP Supplemental Awards (Notice of Funding Opportunity (NOFO) HRSA-17-036).

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

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

Eligible RWHAP Part B states/territories that are focus areas, or have counties that are focus areas, for the Ending the HIV Epidemic: A Plan for America should consider the demonstrated need criteria below in the context of potential Ending the HIV Epidemic activities and may consider utilizing RWHAP Part B supplemental funding for these purposes.

As required in 42 U.S.C. § 300ff-29a(b) (section 2620(b) of the PHS Act), states/territories must demonstrate severity of need for RWHAP Part B supplemental funding using quantifiable data in the following areas:

1) The current prevalence of HIV/AIDS;

2) The unmet need for HIV-related services as determined by 42 U.S.C. §

300ff-27(b) (section 2617(b) of the PHS Act);

3) An increasing need for HIV/AIDS-related services based on increases in the number of living cases of HIV/AIDS;

4) Increases in the number of living cases of HIV/AIDS within new or emerging subpopulations;

5) Factors related to the cost and complexity of delivering health care to people with HIV in the eligible area;

6) The impact of co-morbid factors, including co-occurring conditions inclusive of high rates of sexually transmitted infections (STIs), hepatitis, tuberculosis, substance use and mental health disorders, and other co-morbid factors;

7) The prevalence of homelessness;

8) The prevalence of individuals who were released from federal, state, or local https://hab.hrsa.gov/fundingopportunities/default.aspx?id=813e8c16-5644-4d92-88a1-b28377e32a0d 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://www.hrsa.gov/ending-hiv-epidemic

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prisons during the preceding three (3) years, and had HIV/AIDS on the date of their release;

9) Relevant factors that limit access to health care including geographic variation, adequacy of health insurance coverage, and language barriers;

and/or

10) Impact of a decline in the amount of RWHAP Part B funding received on services available to all individuals with HIV/AIDS identified and eligible for RWHAP services.

Pursuant to 42 U.S.C. § 300ff-29a(c) (section 2620(c) of the PHS Act), the Secretary prioritizes funds to states/territories to address the reduction or disruption of services related to a decline in the amount of formula funding. Such a decline in funding is determined by comparing the amount of formula funding received in the current fiscal year (FY) to the amount received in FY 2006.

For states/territories with current or potential shortfalls in ADAP resources, HRSA strongly encourages those applicants to prioritize utilization of RWHAP Part B supplemental funds to augment ADAP resources when the following conditions exist:

1) Anticipated ADAP waiting lists,

2) Capped enrollment,

3) Reductions in ADAP formulary,

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

5) Other ADAP restrictions within the state/territory.

2. Background

Ending the HIV Epidemic: A Plan for America

In February 2019, the Administration announced a new initiative, Ending the HIV Epidemic: A Plan for America. This ten-year initiative beginning FY 2020 seeks to achieve the important goal of reducing new HIV infections in the United States to less than 3,000 per year by 2030. The first phase of the initiative will focus on 48 counties, Washington, D.C., San Juan, PR, and 7 states that have a substantial rural HIV burden.

By focusing on these jurisdictions in the first phase of the initiative, the U.S. Department of Health and Human Services (HHS) plans to reduce new HIV infections by 75 percent within five years. Across the United States, the initiative will promote and implement the four Pillars to substantially reduce HIV transmissions – Diagnose, Treat, Prevent, and Respond. The initiative is a collaborative effort among key HHS agencies, primarily HRSA, the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the Indian Health Service (IHS), and the Substance Abuse and Mental Health Services Administration (SAMHSA).

National HIV/AIDS Strategy: Updated to 2020

The National HIV/AIDS Strategy for the United States: Updated to 2020 (NHAS 2020) is a 5-year plan that details principles, priorities, and actions to guide the national response to the HIV epidemic. The RWHAP promotes robust advances and https://www.hhs.gov/blog/2019/02/05/ending-the-hiv-epidemic-a-plan-for-america.html https://www.hhs.gov/blog/2019/02/05/ending-the-hiv-epidemic-a-plan-for-america.html

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innovations in HIV health care using the National HIV/AIDS Strategy to end the epidemic as its framework. Therefore, to the extent possible, activities funded by RWHAP focus on addressing these four goals:

1) Reduce new HIV infections;

2) Increase access to care and improve health outcomes for people with HIV;

3) Reduce HIV-related health disparities and health inequities; and

4) Achieve a more coordinated national response.

To achieve these shared goals, recipients should align their organization’s efforts, within the parameters of the RWHAP statute and program guidance, to ensure that people with HIV are linked to and retained in care, and have timely access to HIV treatment and the supports needed (e.g., mental health and substance use disorders services) to achieve HIV viral suppression.

HIV Care Continuum

Diagnosing and linking people with HIV to HIV primary care, and ensuring people with HIV achieve viral suppression are important public health steps toward ending the HIV epidemic in the United States. The HIV care continuum has five main “steps” or stages that includes: HIV diagnosis, linkage to care, retention in care, antiretroviral use, and viral suppression. The HIV care continuum provides a framework that depicts the series of stages a person with HIV engages in from initial diagnosis through their successful treatment with HIV medication. It also demonstrates the proportion of individuals living with HIV who are engaged at each stage. The HIV care continuum allows recipients and planning groups to measure progress and to direct HIV resources most effectively.

RWHAP recipients are encouraged to assess the outcomes of their programs along this continuum of care. Recipients should work with their community and public health partners to improve outcomes across the HIV care continuum. HRSA encourages recipients to use the performance measures developed for the RWHAP at their local level to assess the efficacy of their programs and to analyze and improve the gaps along the HIV care continuum.

According to recent data from the 2018 Ryan White Services Report (RSR), the RWHAP has made tremendous progress toward ending the HIV epidemic in the United States. From 2014 to 2018, HIV viral suppression among RWHAP patients who have had one or more medical visits during the calendar year and at least one viral load with a result of <200 copies/mL reported, has increased from 69.5 percent to 87.1 percent;

additionally, racial/ethnic, age-based, and regional disparities have decreased.1 These improved outcomes mean more people with HIV in the United States will live near normal lifespans and have a reduced risk of transmitting HIV to others.2 Scientific advances have shown antiretroviral therapy (ART) preserves the health of people with

1 Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2018. http://hab.hrsa.gov/data/data-reports. Published December 2019. Accessed December 2, 2019.

2 National Institute of Allergy and Infectious Diseases (NIAID). Preventing Sexual Transmission of HIV with Anti-HIV Drugs. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US).

2000- [cited 2016 Mar 29]. Available from: https://clinicaltrials.gov/ NCT00074581 NLM Identifier:

NCT00074581.

http://hab.hrsa.gov/deliverhivaidscare/habperformmeasures.html https://hab.hrsa.gov/sites/default/files/hab/data/datareports/RWHAP-annual-client-level-data-report-2018.pdf http://hab.hrsa.gov/data/data-reports https://clinicaltrials.gov/

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HIV and prevents sexual HIV transmission. This means that people who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner. Such findings underscore the importance of supporting effective interventions for linking people with HIV into care, retaining them in care, and helping them adhere to their ART.

Integrated Data Sharing and Use HRSA and CDC’s Division of HIV/AIDS Prevention support integrated data sharing, analysis, and utilization for the purposes of program planning, needs assessments, unmet need estimates, reporting, quality improvement, the development of your HIV care continuum, and public health action. HRSA strongly encourages RWHAP Part B recipients to:

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

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

Integrated HIV data sharing, analysis, and utilization approaches by state and territorial health departments can help further progress toward reaching the NHAS 2020 goals and improve outcomes on the HIV care continuum.

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

Minority HIV/AIDS Fund from the HHS Secretary’s Office (MHAF), HAB Technical Assistance, and Special Projects of National Significance (SPNS) Program Through the MHAF and through HAB technical assistance cooperative agreements, HRSA has a number of projects that may be useful for RWHAP recipients to consider.

Some select examples are:

• Building Futures: Youth Living with HIV at https://targethiv.org/library/hrsa-hab-building-futures-supporting-youth-living-hiv http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf https://targethiv.org/library/hrsa-hab-building-futures-supporting-youth-living-hiv https://targethiv.org/library/hrsa-hab-building-futures-supporting-youth-living-hiv

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• The Center for Engaging Black MSM Across the Care Continuum (CEBACC) at https://targethiv.org/cebacc

• E2i: Using Evidence-Informed Interventions to Improve Health Outcomes among People Living with HIV at https://targethiv.org/e2i

• Using Community Health Workers to Improve Linkage and Retention in Care at https://targethiv.org/chw

Below are additional examples for specific populations, co-morbidities, and program areas: https://targethiv.org/help/ta-directory

Through its SPNS Program, HRSA’s HAB funds demonstration project initiatives focused on the development of effective interventions to respond quickly to emerging needs of people with HIV receiving assistance under the RWHAP. Through these demonstration projects, SPNS evaluates the design, implementation, utilization, cost, and health related outcomes of innovative treatment models, while promoting dissemination, replication, and uptake of successful interventions. SPNS findings have demonstrated promising new approaches to linking and retaining into care underserved and marginalized people with HIV. All RWHAP recipients are encouraged to review and integrate a variety of SPNS evidence-informed tools within their HIV system of care in accordance with the allowable service categories defined in PCN 16-02 Ryan White HIV/AIDS Program Services: Eligible Individuals and Allowable Uses of Funds as resources permit. SPNS-related tools may be found at the following locations:

• Integrating HIV Innovative Practices (IHIP) (https://targethiv.org/ihip)

Resources on the IHIP website include easy-to-use training manuals, curricula, case studies, pocket guides, monographs, and handbooks, as well as informational handouts and infographics about SPNS generally. IHIP also hosts technical assistance (TA) training webinars designed to provide a more interactive experience with experts, and a TA help desk exists for you to submit additional questions and share your own lessons learned.

• Replication Resources from the SPNS Systems Linkages and Access to Care (https://targethiv.org/library/replication-resources-spns-systems-linkages-and-access-care) There are intervention manuals for patient navigation, care coordination, state bridge counselors, data to care, and other interventions developed for use at the state and regional levels to address specific HIV care continuum outcomes among hard-to-reach people with HIV.

• Dissemination of Evidence Informed Interventions (https://targethiv.org/library/dissemination-evidence-informed-interventions) The Dissemination of Evidence-Informed Interventions initiative runs from 2015- 2020 and disseminates four adapted linkage and retention interventions from prior SPNS and the MHAF initiatives to improve health outcomes along the HIV care continuum. The end goal of the initiative is to produce four evidence-informed care and treatment interventions (CATIs) that are replicable, cost-effective, capable of producing optimal HIV care continuum outcomes, and easily adaptable to the changing health care environment. Manuals are currently available at the link provided and will be updated on an ongoing basis.

https://targethiv.org/cebacc https://targethiv.org/e2i https://targethiv.org/chw https://targethiv.org/help/ta-directory 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://targethiv.org/ihip https://targethiv.org/library/replication-resources-spns-systems-linkages-and-access-care https://targethiv.org/library/replication-resources-spns-systems-linkages-and-access-care https://targethiv.org/library/dissemination-evidence-informed-interventions

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II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New, Limited Competition

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA expects approximately $60,000,000 to be available to fund up to 30 recipients.

Approximately $5,000,000 will be used for priority funding. You may apply for a ceiling amount of up to $10,000,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. The period of performance is September 30, 2020 through September 29, 2021 (one (1) year).

The amount of each award will be based on your ability to demonstrate the severity of the HIV epidemic in the state/territory, using quantifiable data on epidemiology, co-morbidities, cost of care, the service needs of emerging populations, unmet need for core medical services, and unique service delivery challenges. An external Objective Review Committee (ORC) will make this determination. Funding will be based on the external ORC review and scoring of the criteria published in Section V.1 of this announcement. The applications will be evaluated as follows:

• The ORC will score applications and establish the rank order for awarding funds.

• All applicants that request RWHAP Part B supplemental funding to develop and/or enhance access to a comprehensive continuum of high quality care and treatment services for low-income individuals and families living with HIV, and are recommended for an award by the ORC, will receive awards based on their ORC scores.

• HRSA will fund applicants with the highest scores at the full amount requested as long as the amount requested is for allowable services under this NOFO (see Section VIII. Other Information for further details), the amount requested falls within the maximum amount available, and there are still funds available to distribute.

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

All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements at 45 CFR part 75.

Please see HRSA HAB PCN 15-01: Treatment of Costs under the 10% Administrative Cap for Ryan White HIV/AIDS Program Parts A, B, C, and D, for information regarding the statutory 10 percent limitation on administrative costs.

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://hab.hrsa.gov/sites/default/files/hab/Global/pcn1501.pdf

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III. Eligibility Information

1. Eligible Applicants

Under 42 U.S.C. §§ 300ff-29a and 300ff-88(11) (sections 2620 and 2689(11) of the PHS Act), a “State” – defined as all 50 States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, the Republic of Palau, the Federated States of Micronesia, and the Republic of the Marshall Islands – is eligible for RWHAP Part B supplemental funding. However, any state/territory that had an unobligated balance of more than five percent of their FY 2018 formula funds is not eligible to apply for the FY 2020 RWHAP State/Territories Part B Supplemental Grant Program.

Based on the criteria listed above, the following entities are not eligible to apply to this

NOFO:

• American Samoa

• Marshall Islands

• Montana

• Nevada

• Oregon

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA will consider any application that exceeds the ceiling amount non-responsive and will not consider it for funding under this notice.

HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV.4 non-responsive and will not consider it for funding under this notice.

If for any reason (including submitting to the wrong funding opportunity number or making corrections/updates) an application is submitted more than once prior to the application due date, HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, prior to the Grants.gov application due date as the final and only acceptable application.

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IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through Grants.gov using the SF-424 workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

The NOFO is also known as “Instructions” on Grants.gov. You must provide your email address when reviewing or preparing the workspace application package in order to receive notifications including modifications and/or republications of the NOFO on Grants.gov before its closing date. You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. Responding to an earlier version of a modified notice may result in a less competitive or ineligible application. Please note you are ultimately responsible for reviewing the For Applicants page for all information relevant to desired opportunities.

2. Content and Form of Application Submission

Section 4 of HRSA’s SF-424 Application Guide provides instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

See Section 8.5 of the Application Guide for the Application Completeness Checklist.

Application Page Limit The total size of all uploaded files included in the page limit may not exceed the equivalent of 50 pages when printed by HRSA. The page limit includes the abstract, project narrative, and budget narrative, as required in the Application Guide and this NOFO. Attachments do not count in the page limit. Standard OMB-approved forms that are included in the workspace application package do not count in the page limit.

Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. We strongly urge you to take appropriate measures to ensure your application does not exceed the specified page limit.

Applications must be complete, within the specified page limit, and validated by Grants.gov under the correct funding opportunity number prior to the deadline to be considered under this notice.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You, on behalf of the applicant organization certify, by submission of your proposal, that neither you nor your principals are presently debarred, suspended, https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html

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proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. 3321).

3) Where you are unable to attest to the statements in this certification, an explanation shall be included in Attachment 8 – 15: Other Relevant Documents.

See Section 4.1 viii of HRSA’s SF-424 Application Guide for additional information on all certifications.

Program-Specific Instructions In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 Application Guide (including the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract), include the following:

i. Project Abstract See Section 4.1.ix of HRSA’s SF-424 Application Guide.

In addition to the information addressing the elements for the project abstract in the SF-424 Application Guide, provide a brief paragraph addressing the information below, not to exceed one page:

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

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

c. Describe the severity of the HIV epidemic in the state/territory, using quantifiable data on epidemiology, co-morbidities, cost of care, the service needs of emerging populations, unmet need for core medical services (as defined by HRSA HAB PCN 16-02), and unique service delivery challenges.

ii. Project Narrative This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, and well organized so that reviewers can understand the proposed project.

Successful applications will contain the information below. Please use the following section headers for the narrative:

INTRODUCTION -- Corresponds to Section V’s Review Criterion 1

Briefly describe how the state/territory will utilize RWHAP Part B supplemental funding in support of a comprehensive system of high-quality care and treatment for people with HIV. Describe the current prevalence of HIV/AIDS in the state/territory, and provide corresponding data tables or figures as Attachment 6.

You may submit an updated version of tables or figures included in Section I.A.

Epidemiological Overview of the Integrated HIV Prevention and Care http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf https://www.cdc.gov/hiv/pdf/funding/announcements/ps12-1201/cdc-hiv-integrated-hiv-prevention-care-plan-guidance.pdf

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Plan/Statewide Coordinated Statement of Need, CY 2017-2021 (FY 2016 Integrated Plan) or provide other comparable documentation to meet this requirement. Describe how the comprehensive system of care and treatment will improve outcomes across the HIV care continuum.

NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criteria 1 and 6

The RWHAP legislation, Section 2620(b) of the PHS Act, requires RWHAP Part B supplemental funding applicants to demonstrate need in certain categories.

Respond ONLY to the needs assessment sections below that are relevant to your request for RWHAP Part B supplemental funding. The needs assessment narrative and data must support the service categories (as described in HRSA HAB PCN 16-02) chosen to respond to the demonstrated need, the implementation plan, and the request for funds.

1) Unmet Need for HIV-Related Services

Unmet Need is defined as the number of people with HIV in a state/territory who are aware of their HIV status but for which there is no evidence of at least one of the following three components of HIV primary medical care during a specified 12-month time frame: (1) VL test result, (2) CD4 test result, or (3) provision of ART.

If you are applying for RWHAP Part B supplemental funding due to Unmet Need in the state/territory, then please indicate that you are applying for funds to address Unmet Need in this section and provide the Unmet Need Framework and corresponding narrative from your application in response to NOFO # HRSA-17- 036 as Attachment 7. If you have updated your Unmet Need Framework and corresponding narrative since the submission of your application in response to NOFO # HRSA-17-036, then submit the updated framework and corresponding narrative as Attachment 7.

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

2) Assessment of New or Emerging Populations with Special Needs

The RWHAP legislation requires the state/territory to determine the needs of emerging populations who may have limited access to existing HIV care and services. These needs and service gaps should be incorporated into the FY 2020 implementation plan narrative of this application and align with the previously submitted FY 2016 Integrated Plan. The applicant can use RWHAP Part B supplemental funding to address identified needs.

If you are applying for RWHAP Part B supplemental funding due to new or emerging populations in the state/territory, identify no more than six (6) new or emerging populations to be served. Provide a narrative that addresses each of the following elements:

https://www.cdc.gov/hiv/pdf/funding/announcements/ps12-1201/cdc-hiv-integrated-hiv-prevention-care-plan-guidance.pdf https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf

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

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

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

d. Viral suppression rates for each population and how funds will be used to increase viral suppression rates.

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

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

If you are applying for RWHAP Part B supplemental funding due to the impact of co-morbidities in the state/territory, please provide quantitative evidence in a table format on the impact of co-morbidities on the cost and complexity of providing HIV care and treatment, including the data sources. You must submit the table as Attachment 4. Please provide the following information in the table:

a. Rates of sexually transmitted infections (STIs), hepatitis, tuberculosis, substance use, mental health disorders, and other co-morbid factors;

b. Estimated number of persons who are homeless;

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

d. The number and percent of persons without insurance coverage (including those without Medicaid); and

e. The number and percentage of people with HIV living at or below 138 percent and 400 percent of the 2020 (FPL) (see https://aspe.hhs.gov/poverty-guidelines). Also, include the percentage of FPL used to determine RWHAP eligibility in the state/territory.

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

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

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

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4) Access to Health Care

If you are applying for RWHAP Part B supplemental funding due to factors that limit access to health care in the state/territory, including, but not limited to, geographic variation, deficiencies of health insurance coverage, or language barriers, please provide a narrative describing each factor that will be addressed, how each factor impacts access to care, and how requested funds will be used to address each factor.

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

5) Augment ADAP Resources

If you are applying for RWHAP Part B supplemental funding to augment ADAP services in the state/territory, please provide a narrative identifying which of the following conditions exists, their impact on developing and/or enhancing access to a comprehensive continuum of high quality care and treatment services for people with HIV, and how requested funds will be used to address this impact:

a. Anticipated ADAP waiting lists,

b. Capped enrollment,

c. Reductions in ADAP formulary,

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

e. Other ADAP restrictions within the state/jurisdiction.

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

METHODOLOGY -- Corresponds to Section V’s Review Criterion 2

Propose methods to address demonstrated needs outlined in the Needs Assessment section, and program requirements and expectations outlined in Section I of this NOFO. Describe the tools, strategies, and approaches that you will use to ensure effective and efficient implementation of the proposed program.

These may include but not be limited to clear communication, staff training, outreach to people with HIV, new service models, and on-going or new collaborations.

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

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

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

c. Ensure timely and ongoing training of program staff, contractors, and/or service providers;

d. Sustain activities beyond the federal funding period. Recipients are expected to sustain key elements of proposed projects. These may include but not be limited to strategies or services and interventions which have been effective in improving program operations and improving health outcomes for the target population;

e. Provide opportunities for involvement of clients, patients, families, and communities living with and affected by HIV/AIDS, as appropriate; and

f. Disseminate project data, reports, and other relevant information to key target audiences.

WORK PLAN -- Corresponds to Section V’s Review Criteria 2, 4, 5, and 6

FY 2020 Implementation Plan Narrative

The Implementation Plan Narrative should be commensurate with your request for RWHAP Part B supplemental funding, address demonstrated needs identified in the Needs Assessment section, and correspond with the approach proposed in the Methodology and Evaluation sections.

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

Describe the core medical and support services that will be provided to address the demonstrated needs described in the Needs Assessment section. A service category may be related to more than one stage on the HIV care continuum. For example, proposed activities falling under the Outpatient/Ambulatory Health Service category may have a positive impact on diagnosis, linkage to care, retention in care, antiretroviral therapy (ART) prescription, and viral suppression.

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

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

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

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

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

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

https://hab.hrsa.gov/sites/default/files/hab/Global/hivcarecontinuumcrosswalk.pdf

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

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

Include goals and objectives that are tied to stages of the HIV care continuum and the core medical and support services to be provided. Objectives should be specific, measureable, achievable, realistic, and time-framed (SMART). Activities proposed in the implementation plan should align with their corresponding objectives, and identify the specific outcomes to be achieved during the project period. You may present these goals and objectives in tabular or outline format for clarity. If approved for funding, you will be required to submit an Implementation Plan Table with the Program Terms Report post-award.

RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion

Discuss any challenges you anticipate encountering in the planning and implementation of the proposed project. Be sure to discuss anticipated challenges regarding each demonstrated need for which you are requesting funding, as described in the Needs Assessment section. Describe the specific activities or strategies you will use to mitigate or resolve anticipated challenges for each demonstrated need. The methodology and implementation plan narrative sections should reflect the proposed activities or strategies, as appropriate.

EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to Section V’s Review Criteria 3 and 5

Describe how you will evaluate your proposed program, assess whether proposed SMART objectives have been achieved, and ensure continuous quality improvement. The evaluation plan should align with the methodology and implementation plan narrative proposed in this application.

Describe the specific goals, objectives, benchmarks, and/or outcomes you will use for program evaluation and continuous quality improvement. Describe the staff (e.g., position, knowledge, skills, experience), systems (e.g., software, tools), procedures (e.g., actions, responsible parties, timelines), and other resources that will support your evaluation. Identify what data you will collect and how you will analyze and use the collected data for continuous quality improvement. Describe what control mechanisms you will use to ensure accurate and timely data collection, analysis, reporting, and use. Describe how you will share evaluation results internally with program staff and externally with key stakeholders to improve program implementation and outcomes.

ORGANIZATIONAL INFORMATION -- Corresponds to Section V’s Review

Criterion 5

Briefly describe how the state/territory will ensure proper oversight, management, and administration of FY 2020 RWHAP Part B supplemental funding; including a

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brief overview of the capabilities of the applicant organization, and the quality and availability of facilities and personnel.

If you propose to use FY 2020 RWHAP Part B supplemental funding for staffing, then provide a Staffing Plan and Job Descriptions for Key Personnel as Attachment 1, Biographical Sketches of Key Personnel as Attachment 2, and a Project Organizational Chart as Attachment 3.

NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, this table provides a crosswalk between the narrative language and where each section falls within the review criteria. Any attachments referenced in a narrative section may be considered during the objective review.

Narrative Section Review Criteria Introduction (1) Need

Needs Assessment (1) Need and (6) Support Requested

Methodology (2) Response

Work Plan (2) Response,(4) Impact,(5) Resources/ Capabilities, and (6) Support Requested

Resolution of Challenges (2) Response

Evaluation and Technical Support Capacity

(3) Evaluative Measures and

(5) Resources/Capabilities

Organizational Information (5) Resources/Capabilities

Budget and Budget Narrative

(6) Support Requested – the budget section should include sufficient justification to allow reviewers to determine the reasonableness of the support requested.

iii. Budget

See Section 4.1.iv of HRSA’s SF-424 Application Guide. Please note: the directions offered in the SF-424 Application Guide may differ from those offered by Grants.gov.

Follow the instructions included in the Application Guide and the additional budget instructions provided below. A budget that follows the Application Guide will ensure that, if HRSA selects the application for funding, you will have a well-organized plan and by carefully following the approved plan can avoid audit issues during the implementation phase.

Reminder: The Total Project or Program Costs are the total allowable costs (inclusive of direct and indirect costs) incurred by the recipient to carry out a HRSA-supported project or activity. Total project or program costs include costs charged to the award and costs borne by the recipient to satisfy a matching or cost-sharing requirement, as applicable.

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

Project Line-Item Budget

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

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

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

3) Consortia and Emerging Communities – This column must include all funds allocated to consortia and emerging communities; and

4) Direct Services – This column must include all funds allocated to the following award activities: State direct services, home and community-based care, and health insurance continuation.

Important Notes:

You must adhere to the following budget requirements:

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

• Core Medical Services Requirement: RWHAP Part B supplemental funding is subject to Section 2612(b)(1) of the PHS Act, which requires that not less than 75 percent of the portion of the grant award remaining after reserving amounts for administration, planning and evaluation, and clinical quality management be used to provide core medical services that are needed in the state/territory for people with HIV who are identified and eligible under the RWHAP. The core medical and support service category definitions effective for awards can be found in HRSA HAB PCN-16-02: Ryan White HIV/AIDS Program Services:

Eligible Individuals and Allowable Uses of Funds.

Applicants seeking a waiver of the core medical services requirement must submit a waiver request either with this application, or up to four (4) months after the budget period start date. Include a core medical services waiver request as Attachment 5, if it is submitted with the application. Contact your Project Officer regarding submission procedures if submitting your request separate from this application.