PKG00262151-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

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-21-055

Funding Opportunity Type(s): Competing Continuation Assistance Listings (CFDA) Number: 93.914

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2021

Application Due Date: October 7, 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: June 11, 2020

Chrissy Abrahms Woodland Director, Division of Metropolitan HIV/AIDS Programs Telephone: (301) 443-1373 Fax: (301) 443-5271 Email: CAbrahms@hrsa.gov

Authority: 42 USC 300ff-11 – 300ff-20, and 300ff-121, Public Health Service Act, Sections 2601-2610, and 2693.

mailto:CAbrahms@hrsa.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2021 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. This competition is open only to Part A jurisdictions to provide RWHAP services in the geographic service areas described in Appendix B. Eligible jurisdictions may apply for an amount up to the defined funding ceiling listed in Appendix B, which represents a level five percent above the final FY 2020 award.

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

HIV Emergency Relief Grant Program Funding Opportunity Number: HRSA-21-055 Due Date for Applications: October 7, 2020 Anticipated Total Annual Available FY 2021 Funding:

$620,000,000, of which approximately $10,800,000 will be used for priority funding, and $53,000,000 will be available for Minority AIDS Initiative funding.*

Estimated Number and Type of Award(s): Up to 52 grants Estimated Award Amount: Varies, see Appendix B Cost Sharing/Match Required: No Period of Performance: March 1, 2021, through February 28, 2022 (one year) 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.

*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 http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf, except where instructed in this NOFO to do otherwise.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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Technical Assistance

All interested applicants are encouraged to participate in a technical assistance (TA) webinar for this funding opportunity. The purpose of this webinar is to assist potential applicants in preparing applications that address the requirements of this funding notice. Participation in the pre-application TA webinar is optional.

HRSA has scheduled the following technical assistance:

Webinar

Day and Date: Thursday, July 30, 2020 Time: 2 p.m. to 4 p.m. ET Call-In Number: 888-399-8606 Participant Code: 3671978 Weblink: https://hrsa.connectsolutions.com/rwhap_part_a_2020_ta/ Playback Number: The recorded webinar will be available on the TargetHIV website.

https://hrsa.connectsolutions.com/rwhap_part_a_2020_ta/ https://targethiv.org/

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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 TRANSITION

TO THE UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A

APPENDIX B

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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) 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 continuum of high quality, community-based care for people with HIV who are low-income through the provision of formula, supplemental, and Minority AIDS Initiative (MAI) funds.

RWHAP Part A recipients must provide comprehensive primary health care and support services throughout the entire designated geographic service area. The goal is to provide optimal HIV care and treatment for people with HIV who are low-income, uninsured, and underserved, to improve their health outcomes. 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 medical 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. Funded service categories should facilitate improvements at specific stages of the HIV care continuum.

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, who are low-income, 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. A comprehensive application should reflect on how you have used those data to develop and expand the system of care in EMA/TGA jurisdictions. 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.

Important Notes:

• Budget: You must submit a detailed budget narrative/justification as part of the application. You may apply for no more than the published ceiling amount in Appendix B. Please note that your application budget that is approved or subsequently amended during the award process will be your approved budget for the FY 2021 period of performance.

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• Unmet Need: HAB has integrated the Unmet Need requirement in this NOFO into the Demonstrated Need section. No not submit separate and new estimates for unmet need with this application. Please review carefully when preparing this section of your application.

• Annual Progress Report: As part of your annual progress report, you will provide a narrative describing the impact of MAI-specific interventions on improving viral suppression and other HIV-related health outcomes for the MAI subpopulations identified in the Demonstrated Needs section.

The following information will assist you in understanding and completing your FY 2021 application:

• Policy Clarification Notices: Information on the RWHAP and HAB Policy Clarification Notices (PCNs) are available online at http://hab.hrsa.gov/manageyourgrant/policiesletters.html. Please note that the following PCNs have been updated:

o PCN 16-02 Ryan White HIV/AIDS Program Services: Eligible Individuals and Allowable Uses of Funds - updated as of 10/22/2018 o PCN 15-02 Clinical Quality Management - updated as of 11/30/2018 o PCN 13-02 Clarifications on Ryan White Program Client Eligibility

Determinations and Recertifications Requirements – updated as of May 1, 2019.

• Allowable Services and Service Category Definitions: Core medical services are listed in Section 2604(c)(3) of the Public Health Service (PHS) Act. Support services allowed under RWHAP Part A are limited to services that are needed for people with HIV to achieve their medical outcomes, as defined by RWHAP. The service definitions effective for awards issued on or after October 1, 2016, are listed in PCN 16-02 Ryan White HIV/AIDS Program Services: Eligible Individuals and Allowable Uses of Funds.

• Core Medical Services Waiver: RWHAP Part A funds are subject to Section 2604(c) of the PHS Act, which requires that not less than 75 percent of the funds remaining after reserving funds for administration and Clinical Quality Management (CQM) be used to provide core medical services. You may seek a waiver of the core medical services requirement. You may submit a waiver request prior to submission of the grant application, with this application, or up to four months after the budget period start date. Submission should be in accordance with PCN 13-07 Uniform Standard for Waiver of Core Medical Services Requirement for Grantees Under Parts A, B, and C. You can find sample letters to fulfill the requirements of the Core Medical Services Waiver at https://hab.hrsa.gov/sites/default/files/hab/Global/samplereqwaiverletters.pdf.

In addition, your RWHAP Part A core medical services waiver request must include funds awarded under MAI. HAB will not consider a waiver request that does not include MAI funds. If you submit the core medical services waiver request and allocation table with the application, both http://hab.hrsa.gov/manageyourgrant/policiesletters.html 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/Global/CQM-PCN-15-02.pdf https://hab.hrsa.gov/sites/default/files/hab/Global/pcn1302clienteligibility.pdf https://hab.hrsa.gov/sites/default/files/hab/Global/pcn1302clienteligibility.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/Global/13-07waiver.pdf https://hab.hrsa.gov/sites/default/files/hab/Global/13-07waiver.pdf https://hab.hrsa.gov/sites/default/files/hab/Global/samplereqwaiverletters.pdf

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should be included as Attachment 9. The waiver request counts toward the 100-page limit.

• Agreements and Compliance Assurances: The agreements and assurances, found in Appendix A of this NOFO, require the signature of the chief elected official (CEO), or the CEO’s designee. Include this document as Attachment 2.

2. Background

This program is authorized by 42 USC 300ff-11 – 300ff-20, and 300ff-121, Public Health Service Act, Sections 2601-2610, and 2693. Fifty-two (52) eligible metropolitan jurisdictions receive Part A formula, supplemental, and MAI funding through this program.

The Ryan White HIV/AIDS Program (RWHAP) funds direct health care and support services for over one-half of one million people diagnosed with HIV in the United States.

RWHAP funds are awarded to cities, states, and local community-based organizations to deliver efficient and effective HIV care, treatment, and support services for low-income people with HIV. Since the program’s inception in 1990, RWHAP has developed a comprehensive system of safety net providers who deliver high-quality, innovative HIV health care.

The RWHAP has five statutorily defined Parts (Parts A through D and Part F) that provide funding for core medical and support services, technical assistance, clinical training, and the development of innovative models of care to meet the needs of different communities and populations affected by HIV.

The Strategic Framework

The RWHAP supports the implementation of the National HIV/AIDS Strategy for the United States: Updated 2020 (NHAS 2020). This strategy is a 5-year plan that details principles, priorities, and actions to guide the national response to the HIV epidemic.

The plan also provides a blueprint for collective action across the federal government and other sectors to help achieve the strategy’s vision.

To ensure that RWHAP aligns with the National HIV/AIDS Strategy, to the extent possible, activities funded by the program focus on addressing the plan’s 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 support services needed (e.g., mental health and substance use disorders services) to achieve HIV viral suppression. The RWHAP also provides technical assistance and training initiatives and promotes the effective use of data to enhance recipients’ capacity

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to implement programs that support the strategy’s objectives.

HIV Care Continuum

Diagnosing and linking people with HIV to 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 stages that include: 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 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 81.4 percent to 87.1 percent.

Additionally, racial/ethnic, age-based, and regional disparities reflected in viral suppression rates 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 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.

Using Data Effectively: 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, conducting needs assessments, determining unmet need estimates, reporting, quality improvement, 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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enhancing the HIV care continuum, and public health action. HRSA strongly encourages RWHAP Part A recipients to:

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

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

Integrated data sharing, analysis, and utilization of HIV data by state and territorial health departments can help further progress toward reaching the NHAS 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 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.

Expanding the Effort: Ending the HIV Epidemic: A Plan for America

In February 2019 the Administration launched the Ending the HIV Epidemic: A Plan for America (EHE) initiative to further expand federal efforts to reduce HIV infections. This 10-year initiative which began in FY 2020 seeks to achieve the important goal of reducing new HIV infections in the United States to fewer than 3,000 per year by 2030.

The first phase of the initiative is focused 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. The initiative promotes and implements 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).

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://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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Program Resources and Innovative Models

Through the Minority HIV/AIDS Fund from the HHS Secretary’s Office (MHAF) and HAB technical assistance (TA) cooperative agreements, HRSA has a number of projects that may be useful for RWHAP recipients to assist with program implementation. Some select examples are:

• Building Futures: Youth Living with HIV at https://targethiv.org/library/hrsa-hab-building-futures-supporting-youth-living-hiv

• 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

Through HAB’s Special Projects of National Significance (SPNS) Program, HRSA funds demonstration projects focused on the development of effective interventions to respond quickly to emerging needs of people with HIV that receive assistance under the RWHAP. Through these demonstration projects, SPNS evaluates the design, implementation, utilization, cost, and health-related outcomes of innovative treatment models. Evaluating these models enables HRSA to identify successful interventions that can be replicated and disseminated nationally. SPNS findings have demonstrated promising new approaches for linking and retaining into care underserved and marginalized people with HIV. As resources permit RWHAP recipients are encouraged to review and integrate 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. 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 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) https://targethiv.org/library/hrsa-hab-building-futures-supporting-youth-living-hiv https://targethiv.org/library/hrsa-hab-building-futures-supporting-youth-living-hiv https://targethiv.org/cebacc https://targethiv.org/e2i https://targethiv.org/chw 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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The Dissemination of Evidence-Informed Interventions initiative runs from 2015- 2020 and disseminates four adapted linkage and retention interventions from prior SPNS and 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 healthcare environment. Manuals are currently available at the link provided and will be updated on an ongoing basis.

Social determinants of health (SDOH) include factors like socioeconomic status, neighborhood and physical environment, social support networks, community violence, and intimate partner violence. SDOH affects a wide range of health, functioning, and quality-of-life outcomes and risks. Addressing SDOH, such as intimate partner violence, is a HRSA objective to improve the health and well-being of individuals and the communities in which they reside.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: Competing Continuation.

HRSA will provide funding in the form of a grant.

The amount of funding awarded to each RWHAP recipient will be determined according to a formula that includes MAI funds and discretionary awards for supplemental funding as described in the Summary of Funding section below.

2. Summary of Funding

HRSA estimates approximately $620,000,000 to be available annually to fund 52 RWHAP Part A recipients. Approximately $10,800,000 will be used for priority funding, and $53,000,000 will be available for MAI funding. 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 2021 appropriation. 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. The period of performance is March 1, 2021, through February 28, 2022 (one year).

The RWHAP Part A provides non-discretionary formula grants that include MAI funds and discretionary supplemental awards. These funds assist eligible areas in developing or enhancing access to a comprehensive continuum of high quality, community-based care for people with HIV who are low-income within the EMA/TGA and strengthening strategies to reach minority populations. HRSA awards two-thirds of the funds available for EMAs and TGAs according to a formula based on the number of living cases of

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HIV/AIDS in the EMAs and TGAs. HRSA awards MAI funding based on the number of people with HIV and AIDS who are minorities in a jurisdiction. HRSA awards the remaining funds as discretionary supplemental awards based on the demonstration of additional need by the eligible EMAs and TGAs. Further, if determined eligible for priority funding, HRSA will calculate the additional amount awarded, and that amount will be included in the final award.

As stated, eligible jurisdictions may apply for an amount up to the funding ceiling listed in Appendix B. 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 the period of performance.

HRSA will send the NOA to the CEO or to the delegated administrative agency responsible for dispersing RWHAP Part A funds.

Please note that the HHS Secretary (Secretary) may reduce the amount of grant funds under the RWHAP Part A to an EMA/TGA for a FY if, with respect to such grants for the second preceding FY, the subdivision 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.

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

Please see Policy Clarification Notice 15-01 Treatment of Costs under the 10% Administrative Cap for Ryan White HIV/AIDS Program Parts A, B, C, and D along with the FAQs for information regarding the statutory 10 percent limitation on administrative costs.

III. Eligibility Information

1. Eligible Applicants

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.

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. For an EMA, this is more than 2,000 cases of AIDS reported and confirmed during the most recent five calendar years, and for a TGA, this is at least 1,000, but 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 https://hab.hrsa.gov/sites/default/files/hab/Global/pcn1501.pdf https://hab.hrsa.gov/sites/default/files/hab/Global/faqpolicyclarificationnotice15-01.pdf

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fewer than 2,000 cases of AIDS reported and confirmed during the most recent five calendar years for which such data are available. In addition, for three consecutive years, recipients must not have fallen below both the required incidence levels already specified, and required prevalence levels (cumulative total of living cases of AIDS reported to and confirmed by the Director of CDC, as of December 31 of the most recent calendar year for which such data are available). For an EMA, the required prevalence is 3,000 living cases of AIDS. For a TGA, the required prevalence is 1,500 or more living cases of AIDS. However, 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 who are low income, uninsured, and underserved in their service areas as listed in Appendix B.

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.

Maintenance of Effort (MOE) 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 legislation. Complete the MOE information and submit as Attachment 11.

HRSA will consider any application that fails to satisfy the requirement to provide MOE information non-responsive and will not consider it for funding under this notice.

Other Eligibility Limitations

NOTE: Multiple applications from an organization are not allowable.

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 select “Subscribe” and provide your email address for each NOFO you are reviewing or preparing in the workspace application package in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov. You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. You are ultimately responsible for reviewing the For Applicants page for all information relevant to this NOFO.

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 100 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments, and letters of commitment and support required in the Application Guide and this NOFO. Standard OMB-approved forms that are included in the workspace application package do not count in the page limit.

Please note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-21-055 it may count against the page limit. Therefore, we strongly recommend you only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. It is therefore important 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.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You certify on behalf of the applicant organization, 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 13: Other Relevant Documents.

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

Temporary Reassignment of State and Local Personnel during a Public Health Emergency

Section 319(e) of the PHS Act provides the Secretary of HHS with discretion upon request by a state or tribal organization to authorize the temporary reassignment of state, tribal, and local personnel during a declared federal public health emergency. The temporary reassignment provision is applicable to state, tribal, and local public health department or agency personnel whose positions are funded, in full or part, under PHS programs and allows such personnel to immediately respond to the public health emergency in the affected jurisdiction. Funds provided under the award may be used to support personnel who are temporarily reassigned in accordance with § 319(e). Please reference detailed information available on the HHS Office of the Assistant Secretary for Preparedness (ASPR) website via http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx.

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. Your abstract should be limited to one page and include the following information in this order:

• 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 readily available and validated data and indicate whether it represents data for RWHAP-eligible clients only, or is population-based. Also, if available and appropriate, provide any meaningful subpopulation data that highlights disparities in this outcome measure.

http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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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

This section must briefly describe how the EMA/TGA will utilize RWHAP Part A grant funds in support of a comprehensive continuum of high-quality care and treatment for people with HIV in the RWHAP Part A service area, as defined in Appendix B.

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

The purpose of this section is to demonstrate the severity of the HIV epidemic in the EMA/TGA using quantifiable data on HIV epidemiology, the HIV care continuum, co-occurring conditions, complexity of providing care, service needs of emerging populations, past unmet need estimates, and unique service delivery challenges as required and cited in Section 2603(b)(2)(B) of the PHS Act.

A. Demonstrated Need The Demonstrated Need section includes Epidemiological Overview, HIV Care Continuum, Co-occurring Conditions, and Complexities of Providing Care sub-sections.

Since 2003, unmet need has been defined as the number of individuals with HIV in a jurisdiction who are aware of their HIV status and are not in care. HAB continues to consider the best approach to developing a new framework and methodology for accurately estimating unmet need based on current HHS Guidelines. No new unmet need estimates are required. For this NOFO, unmet need elements (as specified in Section 2603(b)(2)(B) of PHS Act) are captured in the Epidemiologic Overview and the Complexities of Providing Care sub-sections below. You may use your past unmet need estimate to help inform planning, resource allocation, and work plan development for this application.

HAB will target 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 vulnerable populations.

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 socio-demographic, geographic, behavioral, and clinical characteristics of persons newly diagnosed with HIV, people with HIV, and persons at https://hab.hrsa.gov/sites/default/files/hab/About/RyanWhite/legislationtitlexxvi.pdf

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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 as Attachment 3.

a) Provide a summary of the HIV epidemic in your EMA/TGA geographic area.

b) Describe the socio-demographic characteristics of (1) persons newly diagnosed, (2) people with HIV, and (3) persons at higher risk for HIV in the service area. Include the following, as available in the geographical region of the jurisdiction:

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) Describe the relative rates of increase in HIV diagnosed cases within new and emerging populations.

i. Include information on how you identified emerging populations, any unique challenges, and estimated costs to the RWHAP Part A program, if applicable, and

ii. Describe the increasing need for HIV-related services based on the relative increase of HIV cases.

2) HIV Care Continuum

a) Provide a graphic depiction of the HIV care continuum for the jurisdiction using the most current calendar year data. You must clearly state the definitions of the numerator and the denominator for each stage of the care continuum. Use readily available and validated data and indicate whether it represents data for RWHAP-eligible clients only or is population-based.

The steps of the diagnosed-based HIV care continuum using the HHS indicators are found at https://www.hiv.gov/federal-response/policies-issues/hiv-aids-care-continuum.

b) Under RWHAP Part A, the purpose of MAI formula funding is to “improve

HIV-related health outcomes to reduce existing racial and ethnic health disparities” by providing core medical and related support services that enhance health outcomes of minority populations in metropolitan areas https://www.hiv.gov/federal-response/policies-issues/hiv-aids-care-continuum https://www.hiv.gov/federal-response/policies-issues/hiv-aids-care-continuum

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hardest hit by the epidemic. Similar to the other components of RWHAP Part A, the goal of the MAI is viral suppression among identified minority subpopulations.

MAI funds are to be used to deliver services designed to address the unique barriers and challenges faced by hard-to-reach, disproportionately impacted minorities within the EMA or TGA. The services have to be consistent with the epidemiologic data, the needs of that community, and be culturally appropriate. This requires the use of population-tailored, innovative approaches, or interventions that differ from usual service methodologies and that specifically address the unique needs of targeted sub-groups.

In addition to the HIV care continuum, include a narrative describing the viral suppression rates for three of the most disproportionately impacted minority populations. Pay special attention to subpopulations that experience health disparities, e.g., young black men who have sex with men ages 13-24. Your narrative must include a description of the needs of each identified minority population, as well as the barriers to care.

3) Co-occurring Conditions

Using the list below, provide quantitative evidence (i.e., incidence, prevalence, and estimates) describing the conditions co-occurring with HIV in the EMA/TGA in a table format (submit as Attachment 4) and document the data sources used. The table must include:

a) Hepatitis C virus

b) Sexually transmitted infection rates, including syphilis, gonorrhea, and chlamydia

c) Mental illness

d) Substance use disorder

e) Homeless/unstably housed

f) Former incarceration Note: you may include additional conditions unique to your jurisdiction, as applicable.

4) Complexities of Providing Care

a) If the EMA/TGA experienced a reduction in RWHAP Part A formula funding last year (FY 2020), provide a narrative that addresses both the impact and response to the funding reduction, as follows:

i. Impact: The specific services that were eliminated or reduced, and by how much.

ii. Response: Any cost containment measures implemented (e.g., waiting lists, client cost-sharing, or other measures), PC/PB response to the reduction in formula funding, and any transitional plans implemented for clients who received services that were either eliminated or reduced.

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b) Provide, in a table format, current estimates on poverty and health care coverage status of people with HIV in your jurisdiction. Include the following information, as available:

i. The number and percentage of people with HIV who are enrolled in Medicaid, Medicare, and other health care coverage;

ii. The number and percentage of people with HIV who are uninsured;

and

iii. The number and percentage of people with HIV living at or below 138 percent and 400 percent of the FY 2020 FPL. Also, include the percentage of FPL used to determine RWHAP eligibility in the jurisdiction.

c) Discuss any relevant factors that limit access to health care, including geographic variation, adequacy of health insurance coverage, language barriers, or other major SDOH. Also, describe any service gaps, especially for people with HIV who are not in care, and how you will address these service gaps with FY 2021 RWHAP Part A funding.

B. Early Identification of Individuals with HIV/AIDS (EIIHA) The purpose of this section is to describe the data and 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.

1) Describe the planned EMA/TGA EIIHA activities for the FY 2021 period of performance. Include the following information:

a) The primary activities that will be undertaken, including system-level interventions that will positively impact outcomes along the HIV care continuum (e.g., routine testing in clinical settings, expanding partner services);

b) Major collaborations with other programs and agencies, including HIV prevention and surveillance programs; and

c) The anticipated outcomes of the jurisdiction’s overall EIIHA strategy.

2) Select three distinct target populations for the EIIHA Plan in the FY 2021 period of performance. For each selected target population describe:

a) Why you chose the target population and how the epidemiological data, SDOH, or other data support that decision;

b) Specific challenges or opportunities for working with the target population;

and

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c) The specific strategies that you will utilize with the target population.

3) Describe any planned efforts to remove legal barriers, including state laws and regulations, to routine HIV testing in medical settings, or program/policy efforts to expand implementation of routine HIV testing.

C. AIDS Pharmaceutical Assistance (i.e., Local Pharmaceutical Assistance Program) – Not Scored Only complete this…