Ryan White HIV/AIDS Program Part D Grants for Coordinated HIV Services and Access to Research for Women, Infants, Children, and Youth (WICY) Limited Competitive Service Areas (Georgia, Louisiana, and Western Pennsylvania)
This announcement solicits applications for fiscal year (FY) 2013 Ryan White HIV/AIDS Program Part D – Grants for Coordinated HIV Services and Access to Research for Women, Infants, Children, and Youth (WICY) Limited Competitive Service Areas (Georgia, Louisiana, and western Pennsylvania). The purpose of this grant program is to provide family-centered primary medical care involving outpatient or ambulatory care to women, infants, children, and youth (WICY) living with HIV/AIDS when payments for such services are unavailable from other sources. Ryan White HIV/AIDS Program Part D funding is intended to improve access to primary HIV medical care for HIV-infected women, infants, children, and youth through the provision of coordinated, comprehensive, culturally and linguistically competent services. This competition is open to new organizations proposing to provide Part D funded services in the service areas as described in Appendix B.  Applicants must define their proposed service area, which may be a portion of or the entire published service area. New organizations must demonstrate that they will serve all of the eligible WICY patients and each of the four target populations.  Part D grantees are expected to provide HIV primary care, specialty medical care, and support services to the clients they serve. For the purpose of implementing programs funded by Part D, HIV primary medical care refers to outpatient or ambulatory care, including behavioral health, nutrition, and oral health services. Family-centered care refers to services that address the health care needs of the persons living with HIV in order to achieve optimal health outcomes. Specialty care refers to specialty HIV care and specialty medical care such as obstetrics and gynecology, hepatology, and neurology. Support services may include the following: (1) Family-centered care including case management. (2) Referrals for additional services including— (A) referrals for inpatient hospital services, treatment for substance abuse, and mental health services; and (B) referrals for other social and support services, as appropriate. (3) Additional services necessary to enable the patient and the family to participate in the program established by the applicant pursuant to such subsection including services designed to recruit and retain youth with HIV. (4) The provision of information and education on opportunities to participate in HIV/AIDS-related clinical research. GEOGRAPHIC CONSIDERATION: The goal of the HRSA in making this funding announcement is to respond to the changing HIV epidemiology and provide comprehensive HIV health services to WICY populations in areas of greatest need without duplication of effort. HAB encourages applications that propose comprehensive, coordinated HIV services to WICY patients in the entire service area or to a portion of the service area as listed in Appendix B. Decisions on funding level and service area boundaries will be based on Objective Review Committee evaluation of the need for funded services and the strength of proposed projects to provide comprehensive services to all eligible WICY patients in the proposed service area.  The Department of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA), and HIV/AIDS Bureau (HAB) are committed to meeting the national goals and principles described below. As you complete your application, consider how your program supports and helps to implement these goals and principles. HRSA Goal HRSA, as the primary Federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable, has four goals: Improve Access to Quality Care and Services, Strengthen the Health Workforce, Build Healthy Communities, and Improve Health Equity. HAB Program Requirements and Expectations for Part D Programs Every Part D program will: 1)     Design and coordinate services that address the current HIV/AIDS epidemiologic data, the unmet need, and gaps in services for each of the target populations (women, youth, infants, and children living with HIV) in the proposed service area. 2)     Demonstrate a direct linkage with CDC-funded counseling and testing activities and with Parts A and B efforts to identify diagnosed and undiagnosed HIV positive individuals in the target populations and ensure they are linked into primary medical care and retained in care. 3)     Develop, expand, and support a comprehensive, coordinated system of HIV care which increases access to primary medical care for each and every target group (women, youth, infants, and children). The care in this system must be comprehensive, culturally and linguistically competent, and coordinated. Part D programs must assure their patients and clients receive state-of-the-art medical care, including behavioral health, nutrition, dental care, specialty HIV care, and specialty medical care (such as OB/GYN, hepatology, and neurology). 4)     Recruit & retain HIV infected women in primary medical care. Address the age specific health care needs of pregnant women, women of child-bearing age, and older women. For pregnant women, this includes care to prevent the transmission of HIV from mother to infant and processes to track the health outcomes of the births. 5)     Recruit and retain HIV infected youth (ages 13 to 24), including behaviorally infected, in primary medical care. Demonstrate and document a transition plan for HIV positive youth moving into adult medical care. Males over the age of 24 are not eligible for Part D funded services. 6)     Establish and maintain collaborative relationships with Ryan White funded programs, other federally funded projects, and other primary medical care providers, including community health centers, in the proposed service area. Participate in the Part B Statewide Comprehensive Statement of Need (SCSN) and ensure that Part D funded activities are consistent with the SCSN and other applicable needs assessments in the geographic area (e.g., Part A). Collaborate with the regional AIDS Education and Training Center (AETC) to provide activities that ensure the Part D staff has current HIV knowledge and skills. 7)     Establish and maintain a Clinical Quality Management (CQM) program utilizing HAB-developed Performance Measures in quality improvement activities to monitor and evaluate clinical outcomes & process improvement. Demonstrate consumer participation in program evaluation activities. 8)     Demonstrate a direct linkage between Part D funded support services and HIV primary medical care services to women, youth, infants, and children living with HIV/AIDS. Supportive services must help patients and clients access primary HIV medical care and be linked to measurable health outcomes. Funding allocated for support services must be proportional to the number of WICY clients who will receive medical services through the proposed applicant organization. Co-location of medical and support services is strongly encouraged. 9)     Submit the required HRSA/HAB client level data reports in coordination with other Ryan White funded providers in the proposed service area to ensure that the data is unduplicated for the PLWH served and funded services provided. 10)    Limit administrative costs to no more than 10% of the total annual Part D award.  [[]Administrative costs are defined in Sec. 2671 as funds that are to be used by grantees for grant management and monitoring activities, including costs related to any staff or activity unrelated to services or indirect costs.] 11)    Ensure systems are in place to maximize collections and reimbursement for costs in providing medical care and other billable services. These systems should track program income and allow agencies to report the enhancement of HIV services resulting from such income. Part D programs are expected to use Ryan White funds for services not covered by other Ryan White Parts or public/private insurance. 12)    Ensure appropriate oversight and authority over all contracted services, including assuring that subcontracts adhere to Part D program requirements and expectations, including proposed work plan objectives, specification of the number of PLWH to be served per target population, appropriate data sharing, and unduplicated Ryan White data submission. 13)    Involve consumers as partners in their own care through education about HIV infection, treatment adherence, participation in program implementation and evaluation, and self-care management. Prevention of new infections by working with persons diagnosed with HIV and their partners: Programs are encouraged to incorporate the “Recommendations for Incorporating HIV Prevention into Medical Care of Persons Living with HIV.” These recommendations were developed jointly by the Centers for Disease Control and Prevention (CDC), HRSA, the National Institutes of Health (NIH) and the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA). They were published by CDC as the Morbidity and Mortality Weekly Report, July 18, 2003, Volume 52, Number RR-12 (www.cdc.gov/mmwr/preview/mmwrhtml/rr5212a1.htm). (Please note: An erratum has been published for this article.) These recommendations describe how health care providers can help to reduce the number of new HIV infections by:  Screening patients for behavioral risk through interviews or questionnaires regarding sexual and needle-sharing behaviors and screening for Sexually Transmitted Infections (STIs) and pregnancy. Offering behavioral interventions to change knowledge, attitudes, and behaviors to reduce personal risk of transmitting or acquiring other STIs. Providing partner counseling and referral services (PCRS) which includes partner notification and suggests offering services that can help the sex and needle-sharing partners of HIV-infected patients. Programs are encouraged to incorporate the Advancing HIV/AIDS Prevention (AHP) initiative developed by the CDC to further decrease perinatal transmission. These strategies encourage clinicians to offer rapid HIV testing to pregnant women in labor with an unknown HIV status and/or undocumented prenatal HIV screening consistent with CDC and American College of Obstetrics and Gynecology (ACOG) recommendations (www.cdc.gov/HIV/topics/perinatal). HAB Expectations Post Award Clinical care, diagnostic services, periodic medical evaluations, and therapeutic measures to treat HIV/AIDS must be provided to patients within 90 days from award start date. The ability to provide primary medical care includes hiring clinical staff, providing HIV primary medical care, and having the capability to bill for services. When services are provided through contracts, grantees must be able to provide a copy of the contracts signed by both parties to HRSA within 60 days of award. These must document the total number of HIV positive patients to be served; the number of HIV positive pregnant and non-pregnant women, children, youth, and exposed infants to be served by the program; eligibility for Medicaid certification of the medical providers; agreements that providers will comply with Part D legislative and program requirements, including data sharing, submission of Ryan White unduplicated data reports, and participation in CQM activities. Medicaid Provider Status and Clinic Licensure: All applicants, including proposed subcontractors, should document Medicaid provider status for all primary medical care providers and case management agencies. Applicants should also document for their primary medical care providers and case management agencies that they are fully licensed to provide clinical and case management services, as required by their State and/or local jurisdiction. If clinic licensure is not required in your jurisdiction, describe how that can be confirmed in State regulation or other information. This information is required each year. You must also ensure that Medicaid billable services are billed to Medicaid. Ryan White HIV/AIDS Program funds are expected to be used when payment cannot be reasonably be expected to be made, i.e., after billing Medicaid, Children’s Health Insurance Program (CHIP), other public/private health insurance resources, and after billing clients for allowable costs using a sliding fee scale. Ryan White HIV/AIDS Program funds cannot be used to supplement payments by Medicaid, Medicare, or other insurance programs. Drug Discounts: If your program provides medications for patients, you may be able to get lower prices for your drugs through the 340B program of HRSA’s Healthcare Systems Bureau. Detailed program information is available on-line at www.hrsa.gov/opa/. For more information, contact: Office of Pharmacy Affairs 5600 Fishers Lane, Parklawn Building, mail stop 10C-03 Rockville, MD 20857 1-800-628-6297 National HIV/AIDS Strategy (NHAS) Over the past year, the Office of HIV/AIDS and Infectious Disease Policy in the Department of Health and Human Services (HHS) has worked with a group of Federal Agencies, National Partners and grantees to identify indicators, data systems, and elements used across HHS programs to monitor HIV prevention, treatment, care services. A set of common indicators is being implemented within 7 domains: 1) HIV testing; 2) Late HIV diagnosis; 3) Initial linkage to HIV medical care; 4) Retention/engagement in HIV medical care; 5) ARV Therapy; 6) Viral Load suppression; and 7) Housing Status. Six of the seven indicators are covered under the Ryan White HIV/AIDS Program Services Report (RSR) that grantees and service providers report to the Health Resources and Services Administration (HRSA) on an annual basis, and thus HRSA/HIV/AIDS Bureau (HAB) will be positioned to calculate and report on these indicators.  Programs providing direct services should comply with federally-approved guidelines for HIV Prevention and Treatment (see http://www.aidsinfo.nih.gov/Guidelines/Default.aspx as a source for current guidelines). More information can also be found at http://www.whitehouse.gov/administration/eop/onap/nhas Based on HAB’s evaluation and the NHAS, the focus of the Ryan White HIV/AIDS Program Part D changed in FY 2012. The NHAS and recent research findings emphasize the importance of effectively using scarce resources to provide clinical care and treatment to PLWH and to ensure that those resources are being directed to the populations most in need. There have been significant changes in the HIV epidemiologic trends in the U.S. Effective antiretroviral (ARV) drugs for therapy and prophylaxis have been discovered and are widely available. In addition, the Affordable Care Act will expand access to healthcare insurance coverage. Transmission of HIV from mother to infant has decreased tremendously with universal prenatal HIV testing and ARV prophylaxis.  Today, children comprise only about 1 percent of the HIV epidemic in the United States.  Women, especially women of color, now comprise 25 percent of all people living with HIV (PLWH) in the U.S.  The greatest increases in HIV incidence are occurring in adolescents and young adults with 34 percent of new HIV infections in those ages 13-29. Additionally young Black males having sex with males (MSM) represent the most impacted racial/ethnic group. (Prejean, PLoS ONE 2011, www.ncbi.nlm.nih.gov/pubmed?term=Prejean%2C%20PLoS%20ONE%202011.) Ryan White-funded services should ensure that newly identified PLWH, especially young Black/African American MSM, are linked into healthcare, provided ARV medications with resources for ARV adherence, and retained in care. Minority AIDS Initiative (MAI) Beginning in Fiscal Year 2000, Congress designated a portion of Ryan White HIV/AIDS Program Part D Coordinated Services for Women, Infants, Children, Youth and Families funding for the Minority AIDS Initiative (MAI). The Minority AIDS Initiative (MAI) is intended to address the disproportionate impact that HIV/AIDS has on racial and ethnic minorities and to address the disparities in access, treatment, care, and outcomes for racial and ethnic minorities, including African Americans, Alaskan Natives, Latinos, American Indians, Asian Americans, Native Hawaiians, and Pacific Islanders. The goal of MAI is to help reduce this burden by: MAI funds are granted to health care organizations that provide culturally and linguistically appropriate care and services to racial and ethnic minorities.  Funded Part D WICY programs will be assigned funds under the MAI by the HRSA/HAB Division of Community HIV/AIDS Programs (DCHAP), which administers the Part D program. This assignment is based on the percentage of the WICY populations proposed to be served from racial/ethnic minority communities. The amount of MAI funds awarded is noted under the grant specific terms section of the Notice of Award (NOA) which establishes the final funding for the budget period.
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