Why Is This So Complicated? Understanding Ryan White and Managing - - PowerPoint PPT Presentation

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Why Is This So Complicated? Understanding Ryan White and Managing - - PowerPoint PPT Presentation

Aug 03, 2023 27 likes •450 views

Why Is This So Complicated? Understanding Ryan White and Managing Your Awards Carol M Smith, MA Fiscal and Administrative Director, Southeast AIDS Education and Training Center Sr. Program Manager, Vanderbilt Comprehensive Care Clinic

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Why Is This So Complicated? Understanding Ryan White and Managing Your Awards

Carol M Smith, MA Fiscal and Administrative Director, Southeast AIDS Education and Training Center

  • Sr. Program Manager, Vanderbilt Comprehensive Care Clinic
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Objectives

At the end of this webcast, attendees will be able to

  • Define the difference between Prevalence- and Diagnosis-

based care continuums

  • Compare viral suppression rates between Ryan White and

non-Ryan White clients

  • Recognize and explain the various Ryan White Parts
  • Describe NOFOs, NoAs, and PCNs
  • Identify key online resources to help manage grants, budgets,

and reporting

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Question 1

  • When was the Ryan White HIV/AIDS legislation first

enacted?

  • 1987
  • 1990
  • 1991
  • 1994

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Question 1 – Answer

  • When was the Ryan White HIV/AIDS legislation first

enacted?

  • 1987
  • 1990
  • 1991
  • 1994

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HIV Disease in the US

  • First cases of HIV/AIDS reported in US in 1981.
  • More than 700,000 people with HIV Disease have died since

the beginning of the epidemic.

  • Antiretroviral therapy (ART) has substantially reduced AIDS-

related mortality

  • Research has shown that those on ART with undetectable

viral loads have effectively no risk of sexually transmitting HIV.

Source: Kaiser Family Foundation, The HIV/ADIS Epidemic in the United States: The Basics, December 2017.

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HIV Disease in the US

  • Estimated number of new infections annually – 37,600
  • New infections have decreased 17.7% since 2008
  • Approximately 1.1 million people living with HIV
  • Percent of people who are virally suppressed – 49% (per

prevalence-based HIV care continuum)

Source: Kaiser Family Foundation, The HIV/ADIS Epidemic in the United States: The Basics, December 2017.

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HIV Care Continuums

Prevalence-Based (%) Diagnosis-Based (%)

85.0 62.0 48.0 49.0 20 40 60 80 100

Diagnosed Receipt of Care Retained in Care Viral Suppression

72.5 56.9 57.9 20 40 60 80 100

Receipt of Care Retained in Care Viral Suppression

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Source: Centers for Disease Control and Prevention, Understanding the HIV Care Continuum, July 2017.

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Viral Suppression Ryan White Clients 2010 & 2016

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Source: Office of Disease Prevention and Health Promotion, HP2020 Progress Report Webinar on STDs and HIV, August 2017.

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The Ryan White Program makes a big difference in the lives of PLWH and reduces community viral load.

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Who Was Ryan White

Ryan White was 13 years old when he was diagnosed with AIDS following a blood transfusion in December 1984. At the time he was given six months to live. When he tried to return to school, he fought AIDS- related discrimination in his Indiana

  • community. Along with his mother Jeanne

White Ginder, Ryan White rallied for his right to attend school - gaining national attention - and became the face of public education about his disease. Surprising his doctors, Ryan White lived five years longer than

  • predicted. He died in April 1990, one month

before his high school graduation and only months before Congress passed the legislation bearing his name in August 1990.

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Overview of the Ryan White Program

  • Largest federal program designed specifically for PLWH
  • Serves over half of all those diagnosed
  • Safety net for PLWH who are uninsured, underinsured
  • Is 3rd largest source of federal funding for HIV care in the

US, following Medicare and Medicaid.

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Overview of Ryan White Clients

  • 550,462 clients served by RW program in 2016
  • 63% of clients had incomes at or below the federal

poverty level ($11,880 for a single person in 2017) and an additional 28% had incomes between 101% and 250%.

  • 71.4% male, 27.3% female, 1.3% transgender
  • 47% Black/African American, 27% white, 23% Hispanic
  • 14% of clients were in either temporary or unstable

housing

Source: Ryan White Annual Client Level Data Report, 2016.

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Ryan White Legislation

  • First enacted in 1990
  • Reauthorized by Congress in 1996, 2000, 2006, and

2009 – revised somewhat each time

  • Current authorization lapsed in 2013 but program has

continued to be funded through annual appropriations process

  • No “sunset” provision or end date attached to legislation

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The Ryan White Parts

  • There are 5 Ryan White Parts labeled
  • Part A
  • Part B
  • Part C
  • Part D
  • Part F
  • There is no Part E

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Ryan White Part A

  • Part A – Metropolitan areas
  • Eligible Metropolitan Areas (EMAs)
  • Transitional Grant Areas (TGAs)

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Ryan White Part B

  • Part B – States, Washington, DC, and

territories

  • Part B AIDS Drug Assistance Program

(ADAP) and ADAP Supplemental

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Ryan White Part C

  • Part C – Early Intervention Services,

Capacity Development, and Planning Grants

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Ryan White Part D

  • Part D – Women, Infants, Children,

and Youth

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Ryan White Part F

  • Part F
  • AIDS Education and Training Centers (AETCs)
  • Dental Reimbursement and Community-based Dental

Partnership Program

  • Minority AIDS Initiative (MAI)
  • Special Projects of National Significance (SPNS)

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Question 2

  • Funding for the Ryan White program between 2013 and

2017 has

  • Increased by 10%
  • Decreased by 10%
  • Stayed pretty much the same

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Question 2 – Answer

  • Funding for the Ryan White program between 2013 and

2017 has

  • Increased by 10%
  • Decreased by 10%
  • Stayed pretty much the same

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Overview of Ryan White Funding

  • Funding in FY 2016 was approximately $2.3 billion
  • Part B – 57% of funds in FY 2015 - provided to states and

territories

  • Part A – 29% in FY 2015 - cities/metropolitan areas
  • Parts C, D, and F – 14% in FY 2015 – awarded to

providers, community-based and other organizations

Source: Kaiser Family Foundation, Ryan White HIV/AIDS Program: The Basics, February 2017.

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Notice of Funding Opportunity

  • Funding opportunities are listed on grants.gov and on

HRSA’s website – hab.hrsa.gov

  • NOFOs provide detail on how to complete a competitive

grant application but also provide important information about the program, the RW legislation, and the Uniform Guidance

  • NOFOs also tell you how competitive applications will be

scored.

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Notice of Award

  • Provided by HRSA when you have received award
  • Includes awarded budget
  • Grant specific and program specific terms and

requirements; reporting requirements

  • Contact information for program and grants management

queries

  • Think of this as your contract with HRSA/HAB

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hab.hrsa.gov

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To learn about:

  • Who Ryan White was
  • The RW program and its

component parts

  • The legislation
  • Funding
  • The HIV/AIDS Bureau
  • Fact Sheets

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To learn about:

  • Policy Notices and Program

Letters

  • Recipient Resources
  • Data Reporting & TA
  • CAREWare
  • Bureau contacts and funding

by Ryan White Part

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Policy Clarification Notices

  • https://hab.hrsa.gov/program-grants-management/policy-

notices-and-program-letters

  • Provide additional information to award recipients to help

them understand legislative requirements

  • This is also the site for program letters, typically formal

communication from Laura Cheever, Associate Administrator, HIV/AIDS Bureau (HAB)

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Policy Clarification Notices

Policy Notices Implemented in 2016

  • 16-02 Ryan White HIV/AIDS Program Services: Eligible Individuals and

Allowable Uses of Funds (Effective for awards made on or after 10/1/16)

  • Housing Services Frequently Asked Questions for Policy Clarification

Notice 16-02

  • Standalone Dental Insurance Frequently Asked Questions for Policy

Clarification Notice 16-02

  • Frequently Asked Questions for Policy Clarification Notice 16-02
  • 16-01 Clarification of the Ryan White HIV/AIDS Program (RWHAP) Policy
  • n Services Provided to Veterans (PDF - 44 KB)

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Policy Clarification Notices

Policy Notices Implemented in 2015

  • 15-04 Utilization and Reporting of Pharmaceutical Rebates
  • FAQs for PCNs 15-03 and 15-04
  • 15-03 Clarifications Regarding the Ryan White HIV/AIDS Program

and Program Income

  • 15-02 Clinical Quality Management Policy Clarification Notice
  • FAQs for PCN 15-02
  • 15-01 Treatment of Costs under the 10% Administrative Cap for

Ryan White HIV/AIDS Program Part A, B, C, and D

  • FAQs for PCN 15-01

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hrsa.gov/grants/

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In addition to TA calls and webinars, find

  • Policies
  • Financial

Management

  • Uniform Guidance
  • Progress Reports
  • Property
  • Award Management

Tutorial

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Grant FAQs and Tip Sheet

FAQs regarding

  • NOA, Performance and

Progress Reports

  • Prior Approval Request
  • FFRs submitted,

revisions

  • Scoring applications

Tip Sheet

  • Guide for Effective Financial

Management Practices

  • Specific tips to ensure

recipients spend federal funds appropriately and do not have unallowable costs.

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HRSA Top 5 Audit Findings (2016)

# 1 – Reporting # 2 – Program income # 3 – Cash management # 4 – Allowable costs / cost principles # 5 – Special tests and provisions

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Electronic Handbook (EHB)

  • All reports such as RSR, Allocation, Expenditure, FFR
  • Non-competing Continuations and Progress Reports
  • Prior Approval and Other Requests
  • https://help.hrsa.gov/display/public/EHBSKBFG/Index -

link to the EHB Knowledge Base – contains information, FAQs, and interactive videos

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Target Center

careacttarget.org

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Question 3

  • In what online system/website would you submit prior

approval requests

  • Grants.gov
  • The EHB
  • The TARGET Center
  • Via email to your project officer

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Question 3 – Answer

  • In what online system/website would you submit prior

approval requests

  • Grants.gov
  • The EHB
  • The TARGET Center
  • Via email to your project officer

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Thank You!

Contact me Carol Smith carol.m.smith@vanderbilt.edu Slides will be up on the SE AETC web site at seaetc.com

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