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

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

0

20

40

60

80

100

Diagnosed Receipt ofCare

Retained inCare

ViralSuppression

72.5 56.9 57.9

0

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.

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.

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 on 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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