**U.S. Department of Health and Human Services**

**Health Resources and Services Administration**

*HIV/AIDS Bureau*

*Division of Community Based Programs*

> ***HIV Early Intervention Services (EIS) Program - EISEGA***
>
> *Competing Continuation and New Proposals for Existing Service Areas*
>
> ***Announcement \# HRSA-06-046***
>
> ***Catalog of Federal Domestic Assistance (CFDA) No. 93.918***

**PROGRAM GUIDANCE**

Fiscal Year 2006

**Application Due Date:**

**March 10, 2006 5:00 PM ET**

**Release Date: January 24, 2006**

*[Contact:]{.underline}*

*Kathleen Treat, MSW, MS*

*Division of Community Based Programs*

*HRSA, HIV/AIDS Bureau*

*5600 Fishers Lane #7A-30*

*Rockville, Maryland 20857*

*Tel. 301 443-7602*

*Fax 301 443-1839*

Authority: Section 2651 of the Public Health Service Act, 42 USC § 300ff
-51

Guidance Table of Contents

[I. Funding Opportunity Description
2](#i.-funding-opportunity-description)

[Purpose 2](#purpose)

[Background 2](#background)

[II. Award Information 2](#ii.-award-information)

[Type of Award 2](#type-of-award)

[Summary of Funding 2](#summary-of-funding)

[III. Eligibility Information 2](#iii.-eligibility-information)

[1. Eligible Applicants 2](#eligible-applicants)

[2. Cost Sharing or Matching 2](#cost-sharing-or-matching)

[3. Other](#maintenance-of-effort)

[Maintenance of Effort 2](#maintenance-of-effort)

[IV. Application and Submission Information
2](#iv.-application-and-submission-information)

[*1. Address to Request Application Package*
2](#address-to-request-application-package)

[Application Materials 2](#application-materials)

[*2. Content and Form of Application Submission*
2](#content-and-form-of-application-submission)

[Application Format Requirements 2](#__RefHeading___Toc124659672)

[Application Format 2](#application-format)

[i. Application Face Page 2](#i.-application-face-page)

[ii. Table of Contents 2](#ii.-table-of-contents)

[iii. Application Checklist 2](#iii.-application-checklist)

[iv. Budget 2](#iv.-budget)

[v. Budget Justification 2](#v.-budget-justification)

[vi. Staffing Plan and Personnel Requirements
2](#vi.-staffing-plan-and-personnel-requirements)

[vii. Assurances 2](#vii.-assurances)

[viii. Certifications 2](#viii.-certifications)

[ix. Medicaid & Licensure 2](#ix.-medicaid-licensure)

[x. Project Abstract 2](#x.-project-abstract)

[xi. Program Narrative 2](#xi.-program-narrative)

[**a)** **Introduction** 2](#__RefHeading___Toc124659685)

[**b)** **Needs Assessment** 2](#__RefHeading___Toc124659686)

[**c)** **Methodology** 2](#__RefHeading___Toc124659687)

[**d)** **Resolution of Challenges** 2](#resolution-of-challenges)

[**e)** **Evaluation and Technical Support Capacity**
2](#evaluation-and-technical-support-capacity)

[**f)** **Organizational Information** 2](#organizational-information)

[xi. Appendices 2](#xi.-appendices)

[3. Submission Dates and Times 2](#submission-dates-and-times)

[4. Intergovernmental Review 2](#intergovernmental-review)

[5. Funding Restrictions 2](#funding-restrictions)

[6. Other Submission Requirements 2](#other-submission-requirements)

[V. Application Review Information
2](#v.-application-review-information)

[1. Review Criteria 2](#review-criteria)

[Criterion 1: Need 2](#criterion-1-need)

[Criterion 2: Response 2](#criterion-2-response)

[Criterion 3: Evaluative Measures 2](#criterion-3-evaluative-measures)

[Criterion 4: Impact 2](#criterion-4-impact)

[Criterion 5: Resources/Capabilities
2](#criterion-5-resourcescapabilities)

[Criterion 6: Support Requested 2](#criterion-6-support-requested)

[2. Review and Selection Process 2](#review-and-selection-process)

[VI. Award Administration Information
2](#vi.-award-administration-information)

[1. Award Notices 2](#award-notices)

[2. Administrative and National Policy Requirements
2](#administrative-and-national-policy-requirements)

[3. Reporting 2](#reporting)

[4. Performance Review 2](#performance-review)

[VII. Agency Contacts 2](#vii.-agency-contacts)

[VIII. Tips for Writing a Strong Application
2](#viii.-tips-for-writing-a-strong-application)

[ADDENDUM -- APPLYING THROUGH GRANTS.GOV 2](#addendum)

[Attachment A Ryan White Legislation Regarding HIV Counseling and
Testing
2](#attachment-a-ryan-white-legislation-regarding-hiv-counseling-and-testing)

[Attachment B Additional Agreements & Assurances
2](#attachment-b-additional-agreements-assurances)

[Attachment C Program Requirements and Expectations
2](#attachment-c-program-requirements-and-expectations)

[Attachment D Sample Project Abstract
2](#attachment-d-sample-project-abstract)

[Attachment E Service Areas 2](#attachment-e-service-areas)

[Attachment F Press Release on Reauthorization
2](#attachment-f-press-release-on-reauthorization)

[Attachment G President's Principles
2](#attachment-g-presidents-principles)

# I. Funding Opportunity Description

## Purpose

The Department of Health and Human Services (DHHS), Health Resources and
Services Administration (HRSA), HIV/AIDS Bureau (HAB) anticipates Title
III Early Intervention Services (EIS) grant funds will be available for
Fiscal Year (FY) 2006 to support outpatient HIV early intervention and
primary care services. These services target low-income, medically
underserved people in existing primary care systems. The authority for
this grant program is Section 2651 of the Public Health Service Act, 42
USC § 300ff -51.

The purpose of the Ryan White Comprehensive AIDS Resources Emergency
(CARE) Act Title III Program is to provide HIV primary care in the
outpatient setting. The entire CARE Act can be accessed at
[http://hab.hrsa.gov/law.htm](../%20http://hab.hrsa.gov/law.htm).
Applicants must propose to provide a comprehensive continuum of
outpatient HIV primary care services in the targeted area including: 1)
HIV counseling, testing, and referral; 2) medical evaluation and
clinical care; 3) other primary care services; and 4) referrals to other
health services. Primary care for persons with HIV disease should start
as early in the course of the infection as possible. However, entry into
a Title III EIS program may take place at any point in the spectrum of
the disease or the patient's lifespan.

The Ryan White CARE Act is reauthorized every five years to continue
funding of services for people with HIV in underserved areas. The CARE
Act Reauthorization for 2005 has not been signed into law as of the
writing of this guidance. Once signed into law, all CARE Act grantees
will be required to adhere to the new law, including budgets, work plans
and scope of work. Attached are 1) a press release from HHS (Attachment
F), and 2) the President's Principles (Attachment G), which provide
information about what the reauthorized Ryan White CARE Act may contain.
HRSA HAB will provide future instructions for grantee adherence to the
law.

For competing continuation proposals, funding levels will be reviewed in
reference to level of effort, progress and performance described in this
application.

**Minority AIDS Initiative (MAI)**

Beginning in FY 2000, Congress designated a portion of Ryan White CARE
Act Title III EIS funding for the Minority AIDS Initiative (MAI). This
initiative recognizes that many racial and ethnic minority communities
carry a heavier burden of HIV and AIDS than other communities. The goal
of the MAI is to help reduce this burden by:

-   Increasing the number of persons from racial and ethnic populations
    receiving HIV care

-   Increasing the number of persons from racial and ethnic populations
    who stay in care

Funded Title III EIS programs have either applied for (elected) MAI
funds or have been assigned funds under the MAI. Elected MAI funds are
awarded for a program, budget and work plan that the grantee presented
as part of its competing application. Assigned MAI funds are those
designated to grantees by the HRSA/HAB Division of Community Based
Programs (DCBP) which administers the Title III EIS program. This
assignment is done after Title III EIS awards have been distributed and
is based on the percentage of the population served or proposed to be
served from racial/ethnic minority communities.

Starting in FY 2005, the amount of MAI funds that were part of a
grantee's award are noted on the Notice of Grant Award (NGA).

[]{.mark}

[]{.mark}

## Background

DHHS, HRSA and 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.

[National Goal]{.underline}

Healthy People 2010 is a DHHS-led national activity for setting health
priorities. Grants funded under this guidance will meet Healthy People
2010 objectives by expanding counseling and testing and increasing the
number of primary care programs that provide comprehensive HIV services.

[HRSA Goal]{.underline}

The goal for all HRSA programs is to assure access to high quality
health care and reduce disparities in health outcomes for recipients of
services in HRSA funded programs. The result is that all persons who
need care have equal access to high quality health care, regardless of
the payment source.

[HAB Guiding Principles]{.underline}

HAB has identified four factors that have significant implications for
HIV/AIDS care services and treatment, which should be considered as the
application and program are developed and refined:

-   The HIV/AIDS epidemic is growing among traditionally underserved and
    hard-to-reach populations;

-   The quality of emerging HIV/AIDS therapies can make a difference in
    the lives of people living with HIV disease;

-   Changes in the economics of health care are affecting the HIV/AIDS
    care network; and

-   Outcomes are a critical component of program performance.

HRSA evaluates its programs through use of the Government Performance
and Results Act (GPRA), the Performance Assessment Rating Tool (PART)
and the Grantee Performance Review Protocol (GPRP). HAB has identified
specific measures under GPRA and PART to evaluate performance of
grantees. PART measures look at performance of CARE Act grantees across
all programs.

GPRA measures relevant to Title III EIS programs are:

Strategy I. Eliminate Barriers to Care

Performance Goal: Increase Utilization for Underserved Populations

-   Increase the number of people receiving primary care services under
    Early Intervention Services Programs

-   Increase the number of grant applicants that are Faith-Based and/or
    Community-Based Organizations

Strategy II. Eliminate Health Disparities

Performance Goal: Increase Utilization for Underserved Populations

-   Increase the number of racial and ethnic minorities who are
    receiving primary care services under Early Intervention Programs.

GPRA and PART measures can be included in the GPRP, as are additional
performance measures that are used to determine grantee performance. The
GPRP will be used to conduct objective grantee performance reviews,
State-level reviews, and community-level reviews HRSA-wide. These site
visit reviews are designed to analyze the key factors associated with
successful performance of HRSA programs as follows:

-   Results and Outcomes

-   Organizational Structure and Capacity;

-   Outreach and Consumer Satisfaction;

-   Business and Financial Management;

-   Leadership and Strategic Planning;

-   Partnerships

The protocol for performance reviews is available on HRSA's web site at
<http://www.hrsa.gov/grants/perpro.htm>. Performance reviews are
coordinated through HRSA's ten Regional Divisions located in Boston, New
York, Philadelphia, Atlanta, Chicago, Kansas City, Dallas, Denver, San
Francisco, Seattle as well as a sub-regional division in Puerto Rico.

# II. Award Information

## Type of Award

Funding will be provided in the form of a grant.

## Summary of Funding

Approximately \$35,638,000 is expected to be available to fund 75
grantees. Successful applicants will receive a grant for up to five
years, beginning July 1, 2006**.** Applicants should apply for a five
year project period. Awards for less than five years will be based on
scores under the objective review process and history of grantee
performance. **Current Title III EIS grantees competing in this process
can apply for no more than their Fiscal Year (FY) 2005 base award amount
for the first budget year of this new project period.** Funding beyond
the first year is dependent on the availability of appropriated funds
for Title III EIS and satisfactory grantee performance.

# 

# III. Eligibility Information

## 1. Eligible Applicants

This competition is open to Title III EIS grantees with project periods
ending June 30, 2006 and new organizations proposing to replace the
current grantee. New organizations must demonstrate that they will serve
the existing patients, populations, scope of services and service areas
currently served by the grantee they intend to replace. For information
about the current grantees, new organizations should contact Kathleen
Treat, 5600 Fishers Lane, Suite 7A-30, Rockville, MD, 20857, phone (301)
443-7602, email
[kathleen.treat@hrsa.hhs.gov](mailto:jose.morales@hrsa.hhs.gov). A list
of service areas for current EIS grantees with project periods ending
June 30, 2006 is included in Attachment E.

Eligible applicants must be public or private non-profit agencies. These
include, but are not limited to:

-   Consolidated Health Center Programs (Community Health Centers,
    Migrant Health Centers, Health Care for the Homeless, Public Housing
    Primary Care and Healthy Schools, Healthy Communities) receiving
    support under Section 330 of the PHS Act.

-   Family planning agencies under Section 1001 of the PHS Act, other
    than States.

-   Comprehensive Hemophilia Diagnostic and Treatment Centers.

-   Federally qualified health centers as described in Title XIX,
    Section 1905 of the Social Security Act.

-   Nonprofit private entities that currently provide comprehensive
    primary care services to populations at risk of HIV disease.

-   Local health departments.

-   University/Medical Center affiliated clinics.

Faith-based and community-based organizations are eligible to apply. All
applicants, including current grantees, must document Medicaid provider
status. Applicants may document formal agreements with Medicaid
providers for provision of all services covered under the Medicaid State
plan. This requirement may be waived for free clinics that do not impose
a charge for health services or accept reimbursement from Medicaid,
Medicare or private insurance. All applicants, including current
grantees, must document that they are fully licensed to provide clinical
services as required by their state and/or local jurisdiction. Medicaid
provider status and licensure must be in place prior to submitting an
application.

## 2. Cost Sharing or Matching

No cost sharing or matching funds are required for this Grant.

## 3. Other

## Maintenance of Effort

Grant funds shall not be used to take the place of current funding for
activities described in the application. Grantee must agree to maintain
non-Federal funding for grant activities at a level which is not less
than expenditures for such activities during the fiscal year prior to
receiving this grant.

# 

# IV. Application and Submission Information

## *1. Address to Request Application Package*

A complete application kit includes this Program and Application
Guidance and the DHHS Public Health Service Grant Application (Form PHS
5161-1). This guidance is also available on the web at
<http://hab.hrsa.gov/grant.htm>.

### Application Materials

Applicants must submit proposals using Public Health Service (PHS)
Application Form 5161-1. These forms contain additional general
information and instructions for grant applications, proposal
narratives, and budgets. These forms may be obtained from the following
sites:

(1) Download from <http://www.hrsa.gov/grants/forms.htm>; or

\(2\) Contact the HRSA Grants Application Center at:

> The Legin Group, Inc.
>
> 901 Russell Avenue, Suite 450
>
> Gaithersburg, MD 20879
>
> Telephone: 877-477-2123
>
> <HRSAGAC@hrsa.gov>.
>
> Instructions for preparing portions of the application that must
> accompany Form 5161-1 appear in the "Application Format" section
> below.

## *2. Content and Form of Application Submission*

[]{#__RefHeading___Toc124659672 .anchor}**Application Format
Requirements**

> The total size of all uploaded files **may not exceed the equivalent
> of 80 pages when printed by HRSA, approximately 10 MB.** **This
> 80-page limit includes the abstract, project and budget narratives,
> attachments, appendices and letters of commitment and support.**
> Standard forms are NOT included in the page limit. Pages must be
> numbered consecutively.
>
> **Applications that exceed the specified limits (approximately 10 MB,
> or that exceed 80 pages when printed by HRSA) will be deemed
> non-compliant. All non-compliant applications will be returned to the
> applicant without further consideration.**

a.  Type of Submission

> []{.mark}
>
> HRSA, in providing the grant community a single site to Find and Apply
> for grant funding opportunities, is ***requiring*** applicants for
> this funding opportunity to apply electronically through Grants.gov.
> By using Grants.gov you will be able to download a copy of the
> application package, complete it off-line, and then upload and submit
> the application via the Grants.gov site. You may not e-mail an
> electronic copy of a grant application to us.
>
> **NOTE:** All applicants ***must*** submit in this manner unless the
> applicant is granted a written exemption from this requirement in
> advance by the Director of HRSA's Division of Grants Policy. Grantees
> must request an exemption in writing from <DGPClearances@hrsa.gov>,
> and provide details as to why they are technologically unable to
> submit electronically though the Grants.gov portal. Make sure you
> specify the announcement number you are seeking relief for**. As
> indicated in this guidance, HRSA and its Grants Application Center
> (GAC) will only accept paper applications from applicants that
> received prior written approval.**
>
> .

b.  Font

> []{.mark}
>
> Please use an easily readable serif typeface, such as Times Roman,
> Courier, or CG Times. The text and table portions of the application
> must be submitted in not less than 12 point and 1.0 line spacing.
> Applications not adhering to 12 point font requirements may be
> returned. Do not use colored, oversized or folded materials.  Please
> do not include organizational brochures or other promotional
> materials, slides, films, clips, etc. For charts, graphs, footnotes,
> and budget tables, applicants may use a different pitch or size font,
> not less than 10 pitch or size font. However, it is vital that when
> scanned and/or reproduced, the charts are still clear and readable.
>
> []{.mark}

c.  Paper Size and Margins

> For duplication and scanning purposes, please ensure that the
> application can be printed on 8 ½" x 11" white paper. Margins must be
> at least one (1) inch at the top, bottom, left and right of the paper.
> Please left-align text.

[]{.mark}

d.  Numbering

> Please number the pages of the application sequentially from page 1
> (face page) to the end of the application, including charts, figures,
> tables, and appendices.

e.  Names

> Please include the name of the applicant on each page.

f.  Section Headings

> Please put all section headings flush left in bold type.

### *Application Format*

Applications for funding must consist of the following documents in the
following order:

### *i. Application Face Page*

Use Public Health Service (PHS) Application Form 5161-1, provided with
the application package. Prepare this page according to instructions
provided in the form itself. *The Catalog of Federal Domestic Assistance
Number* is 93.918.

Pay special attention to the following items on the Face Sheet:

**Item 5** Be sure the authorized representative/contact who can
communicate is consistently available, and the mailing address, phone
number, fax, and e-mail address are current.

> **DUNS Number**
>
> All applicant organizations are required to have a Data Universal
> Numbering System (DUNS) number in order to apply for a grant from the
> Federal Government. The DUNS number is a unique nine-character
> identification number provided by the commercial company, Dun and
> Bradstreet. There is no charge to obtain a DUNS number. Information
> about obtaining a DUNS number can be found at
> [http://www.hrsa.gov/grants/preview/dunsccr.htm](http://www.hrsa.gov/grants/preview/dunsccr.htm )
> or call 1-866-705-5711. Please include the DUNS number next to the OMB
> Approval Number on the application face page. Applications ***will
> not*** be reviewed without a DUNS number.
>
> Additionally, the applicant organization is required to register with
> the Federal Government's Central Contractor Registry (CCR) in order to
> do electronic business with the Federal Government. Information about
> registering with the CCR can be found at
> [http://www.hrsa.gov/grants/preview/dunsccr.htm](http://www.hrsa.gov/grants/preview/dunsccr.htm ).

**Item 6** This nine digit Employer Identification Number (EIN) is
furnished to you by the Internal Revenue Service (IRS).

**Item 10** Write "Categorical Grant Program to Provide Outpatient Early
Intervention Services with Respect to HIV Disease". Enter Catalog for
Federal Domestic Assistance Number (CFDA) 93.918.

**Item 13** Enter the dates of your project period. For new applicants,
the Project Start Date will be July 1, 2006 thru June 30, 2011. For
existing grantees the project period will be the initial award date thru
June 30, 2011.

**Item 15** Enter the total amount of Federal funds you are requesting
in this application for the first year only in 15a. This amount must
match the total from the SF-424A listed in your last Notice of Grant
Award, item 13 (a).

**Item 16** Some States require that you submit a copy of your Federal
grant application to a Single Point of Contact (SPOC) at the State
government level. If your State participates in the SPOC review process,
enter the date you sent the copy of your Ryan White CARE Act Title III
EIS grant application to the SPOC office. For a list of States and
territories that currently participate in the SPOC review process,
please download the listing from the internet at:
<http://www.whitehouse.gov/omb/grants/spoc.html>.

**Item 18** A person authorized to represent your organization must sign
this form. Please sign in blue ink to identify the original signature.

### ***ii.** **Table of Contents***

Provide a Table of Contents for the remainder of the application
(including appendices), with page numbers.

### *iii. Application Checklist* 

Use PHS Application Form 5161-1, provided with the application package.

### *iv. Budget*

The Title III EIS Program divides allowable costs among three different
Title III EIS Cost Categories. These categories are Primary Care Costs,
Other Program Costs and Administrative Costs.

**[Primary Care Costs]{.underline}** are those costs associated with the
direct provision of primary care services. In accordance with
legislation, Primary Care Costs must be at least 50 percent of your
Federal Title III EIS budget. You are encouraged to propose a percentage
greater than 50 percent. Primary care costs include:

-   Salaried personnel, contracted personnel or visit fees associated
    with the provision of HIV counseling/testing, primary medical care,
    oral health care, outpatient mental health and substance abuse
    treatment, specialty and subspecialty care, and adherence
    monitoring/ education services. Types of providers typically
    included under primary care are physicians, mid-level providers,
    nurses, pharmacists, dentists, dental hygienists, lab technicians,
    medical assistants, nutritionists, mental health/substance abuse
    service professionals, specialists and sub-specialists. Lab, x-ray,
    and other diagnostic tests.

-   Pharmaceuticals.

-   Medical/dental equipment and supplies.

-   Continuous Quality Improvement (CQI) activities related to primary
    care, including CQI personnel and data entry.

    **[Other Program Costs]{.underline}** are those services that
    support the provision of primary care services. Other Program Costs
    include:

-   Case management.

-   Eligibility Assistance.

-   Outreach to identify people with HIV, or at-risk of contracting HIV,
    to educate them about the benefits of early intervention and link
    them into primary care.

-   Translation services, including interpretation services for deaf
    persons.

-   All travel expenses, including patient travel, e.g., bus tokens, cab
    fare, gas vouchers; local travel by staff, travel related to
    continuing education for staff, and participation in the HIV/AIDS
    Bureau's Grantee Meeting and Clinical Update.

-   Consumer Involvement related expenses such as staff time to
    facilitate consumer involvement activities and expenses related to
    consumer participation such as travel costs and supplies.

-   Patient education materials.

-   Participation in Statewide Coordinated Statement of Need process.

    **[Administrative Costs]{.underline}** are those not directly
    associated with service provision. By law, no more than 10 percent
    of your Federal Title III EIS budget can be allocated to
    administrative costs. Staff activities that are administrative in
    nature should be allocated to administrative costs. Examples of
    administrative costs include:

-   Indirect Costs, which are allowed only if the applicant has a
    negotiated indirect cost rate approved by a recognized Federal
    agency. A copy of the latest negotiated cost agreement that covers
    the period for which funds are requested must be submitted in the
    appendix of the application. Indirect costs are those costs incurred
    by the organization that are not readily identifiable with a
    particular project or program, but are considered necessary to the
    operation of the organization and performance of its programs. All
    indirect costs are considered administrative for the Title III EIS
    program and therefore are subject to the 10 percent limitation on
    administrative expense.

-   Rent, utilities, and other facility support costs.

-   Personnel costs and fringe benefits of staff members responsible for
    the management of the project (such as the Project Director),
    non-CQI program evaluation, non-CQI data collection/reporting,
    supervision, and other administrative or clerical duties.

-   Telecommunications, including telephone, fax, pager and internet
    access.

-   Postage.

-   Liability insurance.

-   Office supplies.

-   Audits.

-   Payroll/Accounting services.

-   Computer hardware/software.

-   Data collection activities related to the Annual CARE Act Data
    Report.

    ***Title III EIS funds [cannot]{.underline} be used to pay for
    inpatient services, hospice, residential treatment, clinical
    research, nursing home care, needle exchange services, cash payments
    to clients, or purchasing or improving real property.***

The Title III EIS Budget is composed of the following: (1) Standard Form
424A for Non-Construction Programs and (2) the Line-Item Budget. These
items should include your requested Federal Title III EIS funds only.
Other funding sources for your HIV program (such as in-kind resources,
private donations, other grant funds, etc.) should be described in the
section titled "Organizational Capabilities and Experience."

(1) **Standard Form 424A** - Use PHS Application Form 5161-1, provided
    with the application package. On the Standard Form 424A for
    Non-Construction Programs, please complete Sections A, B, E and F.
    The CFDA Number should read 93.918. Only Title III EIS Federal
    resources proposed to support the Title III EIS program should be
    included on this form. Selected portions of the instructions are
    highlighted below to help you complete the form.

-   SF 424A, Section A, Budget Summary, Line 1: title Line 1 "Primary
    Care " and present the Title III EIS project costs for primary care.
    This must represent at least 50 percent of the budget; applicants
    are encouraged to propose a higher level than the minimum
    requirement. Do not include administrative or other program costs.
    Columns C, D and F should be left blank.

-   SF 424 A, Section A, Budget Summary, Line 2: title Line 2 "Other
    Program Costs" and present the Title III EIS other program costs for
    the project. Do not include administrative costs.

-   SF 424 A, Section A, Budget Summary, Line 3: title Line 3
    "Administrative" and present the Title III EIS administrative costs.
    This must include all indirect costs. Not more than 10 percent of
    the approved Federal grant funds may be used for administrative
    costs. This limitation is statutorily imposed per Section 2664 (g).
    Cell 3e must not exceed 10 percent of the total Title III EIS funds
    requested.

-   SF 424A, Section B, Budget Categories, Column 1: title Column 1
    "Primary Care." Represent all costs associated with the provision of
    primary care by the identified object class categories. The total
    amount should equal that listed in Section A, Cell 1g.

-   SF 424A, Section B, Budget Categories, Column 2: title Column 2
    "Other Program." Present the total of other program costs by the
    identified object class categories. The total amount should equal
    that listed in Section A, Cell 2g.

-   SF 424A, Section B, Budget Categories, Column 3: title Column 3
    "Administrative." Present the total administrative costs by the
    identified object class categories. The total amount should equal
    that listed in Section A, Cell 3g.

-   SF 424A, Section B, Budget Categories, Column 5: present the total
    Title III EIS costs of the project. The total amount, Cell 5k,
    should equal that listed in Section A, Cell 5g.

-   SF 424A, Section B, Budget Categories, Line 7: for the purposes of
    this budget, leave this section blank.

-   SF 424A, Section C, Non-Federal Resources: leave blank.

-   SF 424A, Section D, Forecasted Cash Needs: leave blank.

-   SF 424A, Section E, Budget Estimates of Federal Funds: project the
    budget estimates for project years 2 through 5 in cells 16(b)
    through 16(e), respectively.

-   SF 424A, Section F, Other Budget Information, Line 21: a separate
    line item budget is required to further delineate the Object Class
    Categories, therefore, Line 21 does not need to be completed.

-   SF 424A, Section F, Other Budget Information, Line 22: leave blank

(2) **Line-Item Budget** -- The line-item budget should list cost
    separately for each line item. Personnel should be listed separately
    and include names. It is recommended that you present your line item
    budget in table format, listing the program category costs (Primary
    Care Costs, Other Program Services Costs and Administration Costs)
    across the top and object class categories (Personnel, Fringe
    Benefits, etc) in a column down the left hand side. The amount
    requested on the SF424A and the amount listed on the line-item
    budget should match.

Your [budget period is for one year]{.underline} while your project
period may be up to five years. Currently funded Title III EIS grantees
competing in this process can apply for no more than their FY 2005 base
award amount for each budget year. Your budget should be realistic, well
justified and relate to the needs identified throughout your
application.

### *v. Budget Justification*

This announcement is inviting applications for project periods of five
years. Awards, on a competitive basis, will be for a one-year budget
period, although project periods may be granted for up to five years.
Applications for continuation grants funded under these awards beyond
the one-year budget period but within the project period will be
entertained in subsequent years on a noncompetitive basis, subject to
availability of funds, satisfactory progress of the grantee and a
determination that continued funding would be in the best interest of
the Government.

Provide a narrative that explains the amounts requested for each item in
the line-item budget according to appropriate Title III EIS budget
categories: Primary Care Costs, Other Program Services Costs and
Administration Costs. **The budget justification should clearly describe
each cost element and describe how each item will support achievement of
proposed objectives**. Be very careful about showing how each item in
the "other" category is justified. The budget justification MUST be
concise. Do NOT use the justification to expand the project narrative.
The budget period is for ONE year, from July1, 2006 to June 30, 2007.

Explain how you estimate or calculate each proposed line-item amount by
providing a calculation that contains the estimated cost per unit and
the estimated number of units. For example, if your budget includes a
\$30,000 line-item for lab tests, justify this expense with an
explanation in your Budget Justification as follows: "25 viral load
tests at \$100.00 each per month x 12 months = \$30,000."

Include the following in the Budget Justification narrative:

-   **Personnel:** For each position, provide the total annual salary,
    the Title III EIS full time employee (FTE) allocation, and briefly
    describe the major job responsibilities. Provide the names of each
    person or indicate if the position is vacant. All Personnel should
    be allocated based on primary care, other program or administrative
    costs. Contracted personnel should be listed under the appropriate
    contractual budget object class category below.

-   **Fringe Benefits:** Itemize the components that comprise the fringe
    benefit rate, e.g., health insurance, FICA, SUTA, life insurance,
    retirement plan, and tuition reimbursement. The fringe benefits
    should be directly proportional to that portion of personnel costs
    that are primary care, other program, or administrative costs.
    Provide a clear justification if the expenses are not proportionally
    allocated.

-   **Equipment:** Itemize equipment costs and provide justification for
    the need of the equipment to carry out the program's goals. All
    equipment should be allocated based on primary care, other program,
    or administrative costs.

-   **Travel:** Itemize travel costs according to local and long
    distance travel. International travel is not an allowable expense.
    For local travel, the mileage rate, number of miles, reason for
    travel and staff member completing the travel should be outlined.
    For long distance travel, the number of trips, number of travelers,
    costs and staff members completing the travel should be outlined.
    **All travel is considered to be Other Program Services Costs.
    Grantees are expected to include in their budgets travel expenses
    for up to three (3) persons to attend the Ryan White CARE Act
    Grantee Meeting. Grantees also are expected to send one clinical
    care provider to the Annual HIV Clinical Update Meeting.**

-   **Supplies:** Categorize supplies according to type: medical or
    office. Explain how the amounts were developed. For example,
    "Medical supplies are based on 3,600 encounters at \$2.50 per
    encounter for a total of \$9,000." Supplies should be allocated
    based on primary care, other program, or administrative costs.

-   **Contractual:** Categorize all contract costs according to type,
    e.g., medical referral, lab referral, translation services,
    management consultant. In the budget narrative, clearly explain the
    purpose of the contract, itemize each subcontract and demonstrate
    how the amounts were developed. All contractual items should be
    allocated based on primary care, other program, or administrative
    costs.

-   **Other:** Itemize all costs in this category and explain in
    sufficient detail to enable HAB to determine if each cost is
    allowable. In most cases, pharmaceuticals, legal fees, insurance,
    membership dues, continuing education/conference fees and audit
    related costs would fall under this category.

> **Indirect Costs:** **You may include indirect costs in this
> application if you have an approved indirect cost rate for costs other
> than research or instruction. Such costs are part of the 10%
> administrative cap**. Indirect costs are those costs incurred for
> common or joint objectives which cannot be readily identified but are
> necessary to the operations of the organization, e.g., the cost of
> operating and maintaining facilities, depreciation, and administrative
> salaries. For institutions subject to Office of Management and Budget
> (OMB) Circular A-21, the term "facilities and administration" is used
> to denote indirect costs. *If an organization applying for an
> assistance award does not have an indirect cost rate, the applicant
> may wish to obtain one through HHS's Division of Cost Allocation
> (DCA).  Visit DCA's website at: 
> [http://rates.psc.gov](http://rates.psc.gov/)/ to learn more about
> rate agreements, the process for applying for them, and the regional
> offices which negotiate them.*

### *vi. Staffing Plan and Personnel Requirements*

Applicants must present a staffing plan and provide a justification for
the plan that includes education and experience qualifications and
rationale for the amount of time being requested for each staff
position. Biographical sketches for key employed personnel (HIV Program
Coordinator and HIV Clinical Director at a minimum) that will be
assigned to work on the proposed project must be included in the
***Appendix***. The biographical sketches are brief narratives of each
key employee including their background and role in the proposed
project, regardless of payment through this grant. Job descriptions and
additional biographical sketches may be requested by HRSA as part of the
post-award process.

Specifically describe the experience and expertise of your clinical care
staff. Include a description of the staff's knowledge of the community
and the clients, their commitment to clinical outcomes, cultural
competence, and evaluation capabilities.

### *vii. Assurances*

Please include all assurances required in Application Form 5161-1,
provided with the application package. Please include Additional
Agreements and Assurances specific to the EIS program, included as
Attachment B of this application package.

### *viii. Certifications*

Please include all certifications required in Application Form 5161-1,
provided with the application package.

### *ix. Medicaid & Licensure*

Include documentation of your Medicaid provider number and clinic
licensure (where applicable). If the grantee of record does not provide
primary care, please include Medicaid provider number for
sub-contractor(s)/primary care provider(s). 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. **Documentation for this application should be in the form of a
table that identifies all providers' Medicaid number and clinic
licensure status, if applicable. Official documentation may be required
prior to an award being made or in the post-award period.**

[]{.mark}

> []{.mark}

### *x. Project Abstract*

Provide a one-to-two page summary of the application. Because the
abstract is often distributed to provide information to the public and
Congress, please prepare this so that it is clear, accurate, concise,
and without reference to other parts of the application. It may be
helpful to prepare your abstract after the rest of the application has
been written because most of the information required in this section
can be taken from other sections of the completed application. See
sample Project Abstract in Attachment D.

> **Please place the following at the top of the abstract:**

-   Project Title (FY 2006 Title III EIS)

-   Applicant Name

-   Address

-   Contact Phone Numbers (Voice, Fax)

-   E-mail Address

-   Web Site Address, if applicable.

The Project Abstract must have the following five subheadings:

> **1. Summary of Request:** A short statement briefly describing the
> requested services and specific sites where they will be provided.
> Indicate whether you are applying for (electing) funding under the
> MAI. Indicate whether you are requesting funding preferences and/or
> funding special considerations as described in the Review and
> Selection Process Section of this guidance.
>
> **2. Target Population(s):** A brief description of the geographic
> area to be served by the proposed project, including demographic
> characteristics of the target population(s) affected by HIV in the
> area. Include estimates of the number of persons infected with HIV and
> estimated rates of increase in the immediate service area. Indicate
> any shift in the demographics of the infected population within the
> past two years. If applicable, describe racial and ethnic minorities
> (communities of color) impacted by HIV/AIDS that you are specifically
> targeting.
>
> **3. Current HIV Service Activities:** A description of the HIV
> services currently available in your service area. Include both Title
> III EIS and non-Title III EIS HIV services supported by Federal, State
> or other resources that contribute to the continuum of care provided
> in your service area. Also list those HIV services that are provided
> specifically by your organization.
>
> **4. Problem:** A summary of the principal problems and unmet needs of
> people living with HIV in your service area that will be addressed if
> the proposed project receives funding.
>
> **5. Goals and Objectives:** A presentation of the major goals and
> objectives for the project period as described in your Work Plan.
>
> []{.mark}

### *xi. Program Narrative*

> The "Program Narrative" provides a comprehensive framework and
> description of all aspects of the proposed program. It should be
> succinct, self-explanatory and well organized so reviewers can
> understand the proposed project. Use the following six section headers
> for the Narrative:

a)  []{#__RefHeading___Toc124659685 .anchor}**Introduction**

> This section should briefly describe the problem and the associated
> factors contributing to it. You may wish to expand on information
> presented in the "Problem" section of the abstract. Indicate whether
> you are requesting funding preference and/or funding special
> consideration as described in the Review and Selection Process Section
> of this guidance.

b)  []{#__RefHeading___Toc124659686 .anchor}**Needs Assessment**

This section outlines the needs of your community. The four (4) required
components of this section are:

1.  HIV Seroprevalence and Surrogate Markers.

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1.  Target Populations.

2.  The Social Context of HIV/AIDS.

3.  The Local HIV Service Delivery System and describe changes to that
    system.

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1.  **HIV Seroprevalence and Surrogate Markers:** The Ryan White CARE
    Act gives preference to applicants that make services available in
    geographic areas that have experienced an increase in the burden of
    providing services for people with HIV. Use this section to provide
    and discuss data on the incidence and prevalence of HIV and AIDS in
    your area. Request information on AIDS incidence, AIDS prevalence
    and HIV prevalence from your State grantee of record for Title II,
    and from your EMA grantee of record for Title I, if applicable.

> In this section, you should discuss the epidemic in your service area
> as compared to State or EMA data. Discuss the similarities,
> differences and trends noted in such areas as race, ethnicity, gender,
> and exposure category. You may also discuss the rates of diseases such
> as syphilis, gonorrhea, tuberculosis, Hepatitis C, and substance abuse
> that indicate a prevalence of high risk behaviors associated with HIV
> transmission. Show the impact of the HIV epidemic in your area by
> answering these questions:

-   How many people are newly reported with AIDS and how many are living
    with HIV and AIDS for each of the past three years? Include 2002 and
    2003 if that information is available in your area. You may also use
    2004 data if available.

-   What is the estimated rate of increase or decrease in the number of
    reported HIV or AIDS cases for this period? Highlight any new groups
    that show a rapid growth in HIV or AIDS cases.

    You may find other measures that show the impact on your community.
    Use data from a reliable source in this section of the application
    and clearly identify the source(s) for that data (e.g., the State
    Department of Health or the Centers for Disease Control and
    Prevention).

    **2. Target Populations:** Clearly identify the populations that
    your organization will serve. It is important that you compare the
    populations you serve or propose to serve to the general population
    in your area. Specifically address the communities of color you
    serve or propose to target. Include statistics on persons most
    affected by the epidemic in your area, such as persons of color,
    women, and adolescents, as well as characteristics such as the
    general and adolescent pregnancy rate in the area. To the extent
    possible, your presentation of the target population(s) should
    include the distribution by race/ethnicity, gender, age, and mode of
    HIV transmission for both your organization and for the proposed
    service area. Be sure to indicate the date and source for the data
    you provide. Identify trends that have occurred over the last three
    years as your organization has confronted increases or decreases
    among specific groups (e.g., a 10 percent increase in the number of
    women seeking services.)

    **3. The Social Context of HIV/AIDS:** Describe and discuss the
    social and economic characteristics of the community you propose to
    serve. Discuss the community infrastructure for primary health care
    services in general, including community health centers and other
    publicly funded entities. Focus your discussion on how these
    conditions have an impact on the provision of HIV services in your
    geographical area. Examples of questions you may ask include:

-   What percentage of the population is African American, Hispanic,
    Native American, and/or Asian American/Pacific Islander?

-   What percentage of the population is homeless?

-   What percentage of the population use drugs?

-   What percentage of the population is single head-of-household?

-   What percentage of the population is unemployed?

-   What percentage of the population is adolescent (ages 13-24)?

-   What percentage of the population is uninsured?

    The statistics that you include must be specific to the area from
    which the majority of the proposed clients will be drawn. Statistics
    from your State or larger area within your State may be cited for
    purposes of comparison or contrast. You also may include a
    description of other relevant characteristics of the target
    populations that affect their access to primary care. These factors
    may include primary language, citizenship status, education (e.g.,
    high school graduation rate for the area), and access to
    transportation.

    **4. The Local HIV Service Delivery System and recent changes:** In
    this section you must show what HIV primary care services are
    currently available in your service area. Refer to a map of your
    service area that shows the locations of local providers of primary
    health care in your area, and include this map in the appendices of
    your application.

    Your presentation of the local HIV service delivery system should
    cover three broad areas:

    1\) the HIV service providers in your area, including your own
    organization, and the specific services they provide; 2) public
    funding for those services; and 3) the gaps in services in your
    area, particularly those that affect the populations that you have
    targeted.

    A.  HIV service providers in your area: List the public and private
        organizations that provide HIV services in your area, the
        specific services each one provides, and, if possible, the
        number of unduplicated clients/patients each one serves
        annually.

    B.  Public funding in support of HIV services in your area: Identify
        all Federal, State, and local funding sources for HIV prevention
        and care in the proposed service area. Include providers funded
        by CDC, NIH, and SAMHSA. A flow chart can be very helpful in
        showing how these entities work together, but is not required.

    C.  Gaps in local services and barriers to care: Describe current
        gaps in HIV early intervention services in the area. Identify
        those populations that are not being served, and describe the
        barriers that prevent them from receiving the services they
        need. If cultural/linguistic gaps in services exist in your
        community, describe how you plan to address these gaps.

    D.  Describe the need for HIV-related health services by individuals
        with HIV disease who are aware of their HIV status, but are not
        receiving primary medical care in your service area.

E. Treatment protocols that require additional staff resources;

F. The health care delivery system that affect your delivery of HIV
primary care services, e.g., managed care, Medicaid, availability of
ADAP funding;

> G. The project's key personnel, i.e., project director,
> clinical/medical director, and clinical providers. In the appendix,
> include resumes for new key staff, not to exceed two pages each;
>
> H. Utilization of funds compared to the original approved budget; and

I.  The populations you target for HIV primary care services

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c)  []{#__RefHeading___Toc124659687 .anchor}**Methodology**

    Use this section to describe your organization's scope of work for
    each of the "Required Services" and "Other Program" services" as
    described. The minimal information you should provide in each of
    these sections is described below. A complete description of Program
    Requirements and Expectations is included in Attachment C. You may
    provide additional information that will help reviewers to
    understand how your services are delivered and the policies and
    procedures that ensure that your program maintains professional
    standards of care.

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1.  **HIV Counseling, Testing, Referral, Partner Counseling, and Linking
    to Care**

-   Describe the counseling, testing and referral services that are or
    will be available through the proposed program and through other
    organizations in the community.

-   Describe the steps taken to ensure the confidentiality or anonymity
    of clients and test results.

-   Describe protocols for counseling HIV infected pregnant women and
    women of childbearing age about the use of antiretroviral therapy to
    reduce perinatal HIV transmission.

-   Describe how clients who test HIV-positive receive facilitated and
    timely referrals to primary care and other services.

-   Describe how you will identify and link people at high risk or
    living with HIV into your program.

-   Describe policies and procedures for partner counseling services.

-   Describe efforts over the most recent project period to increase
    referrals from counseling and testing services to your primary care
    program, return rates for counseling and testing services and your
    efforts to improve return rates.

-   Describe special efforts over the most recent project period to
    increase enrollment in your services by persons most affected by the
    epidemic such as persons/communities of color, women and
    adolescents.

2.  **Medical Evaluation and Clinical Care**

-   Describe the process of confirming HIV infection and determining the
    extent of immune deficiency.

-   Describe the proposed diagnostic and therapeutic measures that are
    available for preventing and treating the deterioration of the
    immune system and related conditions. Include periodic medical
    evaluations, appropriate treatment of HIV infection, prophylactic
    and treatment interventions for complications of HIV infection,
    including opportunistic infections, opportunistic malignancies and
    other AIDS defining conditions.

-   Describe plans for handling referrals to and enrollment in clinical
    trials offered through biomedical research facilities or community
    based organizations that conduct experimental treatments for HIV
    disease.

-   Describe the on-site or contract laboratory that you plan to use to
    support CD4, viral load, and other tests. Discuss the availability
    of state laboratory reimbursement (Title II) programs.

-   Discuss the availability of your State(s) AIDS Drug Assistance
    Program or other locally available pharmacy assistance programs.

-   Describe plans for staff education related to HIV primary care.

-   Describe how consumers are or will be involved in decisions
    regarding their personal health care regimens.

-   Describe the policy/procedure for after-hours and weekend coverage
    for urgent or emergency medical and dental care needs.

-   If you are a new organization applying to replace an existing
    grantee, describe how your organization will improve services to the
    existing patients, population and service area of the existing
    grantee.

3.  **Other Primary Care Services**

-   Describe how oral health care (diagnostic, preventive, and
    therapeutic services) will be provided to patients with HIV
    infection.

-   Describe how adherence education will be provided.

-   Describe how outpatient mental health treatment services will be
    provided.

-   Describe how substance abuse treatment services will be provided.

-   Describe how nutritional services will be provided.

-   Describe how palliative care and other end of life support will be
    provided.

-   Describe how you incorporate HIV prevention into medical care for
    persons living with HIV, including screening patients for behavioral
    risk, offering behavioral interventions, and providing partner
    counseling and referral services.

4.  **Referral System**

-   Describe how referrals to specialty and subspecialty medical care
    and other health and social services will be provided.

-   Discuss formal mechanisms for facilitating and tracking referrals.

-   Describe how coordination with admission/emergency room staff and
    discharge planners will occur during inpatient hospital visits.

5.  **Other Program Services**

-   Describe specific outreach efforts for targeted communities of color
    you serve or propose to serve.

-   Describe how your clients will have access to case management
    services.

-   Describe how your program will assist clients in determining their
    eligibility for financial support and services under Federal, State
    or local programs providing health services, mental health services,
    social services or other appropriate services.

6.  **MAI**

[]{.mark}

If you are an existing Grantee note how much MAI funding your program
received on the 2005 NGA. All applicants should note the racial and
ethnic minority groups you specifically serve. If your program serves
one particular group because of geography, you must still answer the
questions below. Please do not use this section for any additional
demographic information about the communities your program serves.
Provide that in the work plan.

If your award for 2005 lists MAI funds or if you target minority
populations, your application must include a description of the MAI
population(s) served by your program. For each target population, you
must describe briefly these items:

-   The specific ethnic or minority group your program serves

-   Outreach your program does to recruit infected members of that group

-   How you identify infected persons who are members of that group

-   How you enroll these persons in care after you have identified them
    as infected

-   How you retain these persons in care after they are enrolled

Also, provide the following data for each ethnic or minority group:

-   Number enrolled in care at the beginning of the budget year

-   Number newly identified during the budget year

-   Number newly enrolled during the budget year

-   Number enrolled at the end of the budget year

7.  **Coordination and Linkages with Other HIV Programs**

    Describe your participation, coordination and/or linkage(s) with
    other publicly funded HIV care and prevention programs in your
    proposed service area. Address the following questions.

    **Title I:** If your program is in a Title I EMA, describe the level
    of Title I funds utilized in your community for primary care
    services and other program services that are proposed in this
    application. If your organization receives Title I funding:

-   Identify the amount of funding you receive for each Title I service
    category.

-   Describe how the services proposed in this application are
    consistent with, but not duplicative of services supported by Title
    I.

-   Include in the appendices to your application a letter from the
    Title I Grantee of Record that documents your organization's
    involvement with Title I and in the Ryan White CARE Act HIV Planning
    Council. The letter must also address why Title III EIS funds are
    necessary to address the needs described in your application. If you
    cannot obtain this letter, explain why. A list of Title I grantee
    contacts is found at
    <http://www.hab.hrsa.gov/programs/t1list.htm>[.]{.underline}

    **Title II:** If your program is located in a State/territory that
    has created a Title II HIV Care Consortium, use this section to:

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-   Describe the Title II consortium's service plan.

-   Include in the appendices a letter from the Title II Grantee of
    Record documenting your organization's involvement in Consortium
    activities. This letter must also explain why Title III EIS funds
    are needed to address the needs described in your application. If
    you cannot obtain a letter, explain why. A link to Title II grantee
    contacts is found at
    [http://www.hab.hrsa.gov/programs/granteecontact.htm.](http://www.hab.hrsa.gov/programs/granteecontact.htm)

    **Title III EIS:** If your program is located near other Title III
    EIS funded programs, explain how your program does not duplicate
    services provided in your proposed service area and target
    population. If there are other Title III EIS supported programs in
    your area, including planning grants and capacity building grants,
    identify those organizations, and describe the mechanisms in place
    for collaborating with them, sharing resources, and ensuring against
    duplication of services. If possible include a map in the appendix
    showing the location of all Title III EIS programs in the area.

    **Other Ryan White CARE Act funded providers in your area:**
    Describe your organization's participation, coordination and/or
    linkage with Title IV, Dental Reimbursement Program, Community Based
    Dental Partnership, SPNS, if any exist in your area, and the nearest
    AIDS Education and Training Center.

    **HIV prevention activities in your area:** Describe your
    organization's collaboration with ongoing HIV prevention activities
    in your area, and how HIV-positive individuals are referred to HIV
    primary care services. Describe the availability, accessibility, and
    your program's coordination/linkage with CDC-funded HIV counseling,
    testing, and referral, and prevention programs, TB control programs
    as well as STI control programs. Describe your program's
    collaboration with other organizations involved in prevention for
    those already HIV positive.

    **Other federally funded services in your area:** Describe your
    organization's collaboration with primary health care services, if
    any exist in your area, including publicly-funded Community Health
    Centers, mental health and substance abuse treatment programs
    including those funded by SAMHSA, and research programs including
    those funded by NIH.

    Because of space limitations, it is not necessary to include
    memoranda of agreement or understanding or contracts with other
    organizations in the appendix. Instead, include a list of those
    organizations with which you have signed agreements with a brief
    description of what activities are covered. HAB may request copies
    of those agreements and/or contracts as part of post-award
    administration.

8.  **Work Plan**

    The Work Plan delineates your steps to implement and evaluate your
    HIV primary care program. The Work Plan should address any needs
    previously identified in your needs assessment. If you do not
    address a certain need, explain why in the relevant section of your
    application.

    The Work Plan must be written for your [entire]{.underline}
    outpatient HIV Primary Care Program (regardless of funding stream)
    and must include goals for your entire proposed five-year project
    period. Work Plan objectives should be written for one year. Your
    Work Plan should be a tool that will help you actively manage your
    program by measuring progress, identifying necessary changes, and
    quantifying your accomplishments.

    The Work Plan must be written to include problem statements, goals,
    objectives, action steps, person responsible for each step, and
    evaluation methods. Grantees will revise and update the Work Plan in
    their non-competing continuation applications, which are due at the
    end of each budget period. Information in the Work Plan may be used
    as part of the GPRP site-visit reviews as performance measures.

**Work Plan Objectives:**

The Work Plan should cover four major areas, as well as any other goals
and objectives that will guide you in implementing your HIV Primary Care
Program. These areas are:

-   Access To Care, which should include Counseling and Testing
    activities; linkage and referral with other programs which do
    Counseling and Testing; Outreach to bring people into care; and the
    number of new patients to be provided primary HIV medical care
    services for each year of the grant. Applicants serving or targeting
    communities of color should include one or more goals and objectives
    relating to reaching and serving these communities.

-   Comprehensive, Coordinated Primary HIV Medical Care, which shall
    include the total number of patients to be provided primary HIV
    medical care services for each year of the grant. It should address
    the full range of services which should be provided under the
    program expectations, including frequency of visits, laboratory
    testing, adherence education, oral health care, nutrition services,
    outpatient substance abuse treatment and outpatient mental health
    treatment.

-   Planning and implementation of a Continuous Quality Improvement
    Program. It should include specifics on what indicators you will be
    looking at and what improvement you expect. You are encouraged to
    use indicators of health outcomes as well as process indicators.

-   The planning and implementation of Consumer Involvement Activities,
    as described in the program expectations.

**Making Your Work Plan Specific, Time-Framed, and Measurable:**

Your Work Plan objectives must be specific, time-framed and measurable.
Information is provided below about how to write a Problem Statement,
Goal, Objective, Action Step, and Evaluation Method that may assist you
in writing your Work Plan.

a)  **The Problem Statement (also called the Statement of Need)** helps
    you design your Goals and Objectives. Relate these to the mission of
    your organization and to the goals of the Title III EIS Program.

b)  **Goals** are generally broad statements, which describe the
    long-term benefits you seek.

c)  **Objectives** should identify your target population(s), state what
    will change, how much change will occur and by when. The objective
    should lead to measurable outcomes that will make it easy for you to
    report on progress made. If you use either numbers or percentages in
    your objectives, be clear about where you are starting from (the
    baseline number).

> Are your Objectives realistic? Give yourself a target you can reach.
> Do not commit to an objective that is out of reach. For example, can
> you really achieve 100 percent compliance with TB testing? Remember
> that objectives should contain "action verbs" such as the following
> phrases: "to enroll..."; "to provide..."; and "to reduce." Keep your
> objectives simple and obtainable, in accordance with the program
> expectations.

d)  **Action Steps** describe the specific activities undertaken to
    accomplish your Objectives. Action Steps should flow logically from
    your Problem Statement, Goal and Objectives. They should clearly
    describe your program activities as well as the sequence of
    activities, and they should be reasonable. Remember to build in
    start-up time for new initiatives. How long does it really take to
    recruit and hire someone in your system?

e)  **Person Responsible:** specify the individual(s) responsible for
    accomplishing each action step by what date.

f)  **Evaluation Method:** The purpose of evaluation is to measure the
    results of your program. Evaluation is also a tool that provides
    information and feedback so that you can make appropriate
    adjustments to your program during the project period. Effective
    evaluation methods will help your organization determine the extent
    to which your objectives have been accomplished as well as the
    extent to which this is attributable to your program or
    intervention. Your Evaluation Method is how you will measure whether
    or not a particular Objective has been achieved.

####### **Resolution of Challenges**

Discuss challenges that are likely to be encountered in designing and
implementing the activities described in the Work Plan, and approaches
that will be used to resolve such challenges.

> **Progress Report (Current Grantees Only):** Any information included
> in the progress report which is vital to the proposed program for the
> next project period should be repeated in the appropriate section. The
> progress report should highlight the major accomplishments achieved
> during the prior project period. Address each of the following:

-   Indicate the level of Title III EIS funding received in each year of
    the most recent three-year project period. Include any ongoing and
    one-time expansion funds received. If the project was approved for
    less than three years, explain why.

-   Provide the total number and demographics (e.g., race/ethnicity,
    age, gender) of clients served in each year of the most recent
    project period. Use information from the CARE Act Data Report (CADR)
    and other program data to describe the number and type of clients
    served by each type of service (i.e., counseling/testing/referral,
    primary medical care, dental care, outreach, case management). The
    total number testing positive and overall seroprevalence for
    counseling/testing should be included. These numbers are most
    clearly presented in a chart or table.

-   Summarize the major accomplishments for the project period,
    including program expansion activities, and describe the degree to
    which the objectives were achieved. List the service objectives from
    the most recent work plan and indicate progress made on each
    objective over the last project period. (Progress toward meeting the
    work plan may be submitted as a chart).

-   Describe the factors that facilitated and hindered implementation of
    any of your project's goals, objectives and activities. Describe
    specific actions taken to overcome any barriers.

-   Indicate whether a Title III EIS-specific site visit occurred during
    the most recent project period. If a Title III EIS site visit or
    GPRP site visit occurred, list the major program deficiencies cited
    and describe actions taken to correct deficiencies.

-   Indicate whether you have received separate technical assistance
    from HAB. Describe the focus of the technical assistance. What has
    changed as a result of the technical assistance?

####### **Evaluation and Technical Support Capacity**

-   Outline the program's evaluation strategy that is used to measure
    achievement of program objectives and impact of the program.

-   Describe the existing Continuous Quality Improvement (CQI) or other
    mechanisms for evaluating quality of care and program quality on a
    regular basis.

-   Discuss your current information system and its capacity to manage
    and report the required administrative and clinical data noted
    below:

```{=html}
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```
-   The number of individuals provided early intervention
    services/primary care, counseling and testing, outreach, and case
    management services.

-   Demographic data on the clients receiving services, in total and for
    special funding initiatives.

-   Epidemiological data on the population receiving services, including
    the extent of new TB infections, active cases, and MDR-TB.

-   Exposure and diagnostic categories on the population receiving
    services.

-   The number of HIV infected individuals and the CDC classification of
    their disease.

-   The extent to which the costs of HIV‑related health care are paid by
    third party payers.

-   The average costs of providing each category of early intervention
    service/primary care.

####### **Organizational Information**

In this section, describe your organization's capacity and expertise to
provide primary care by describing your administrative, fiscal, and
clinical operations. At minimum, you should provide the following
information:

-   The mission of your organization. How does a Title III EIS project
    fit within the scope of this mission?

-   The structure of your organization. Include in the appendices an
    Organizational Chart that clearly shows how your program is divided
    into departments, the professional staff positions that administer
    those departments, and the reporting relationships.

-   Your organization's experience with the fiscal management of grants
    and contracts. What kind of accounting system is in place? What
    internal systems are used to monitor grant expenditures? How will
    your organization manage and monitor subcontractor performance and
    compliance with Title III EIS requirements?

-   If you are targeting specific communities of color, are you
    indigenous to that community? An indigenous organization is a
    community based or public organization local to and supported by the
    community(ies) of color proposed to be served. Describe your
    relationship and collaboration with the targeted community(ies) of
    color.

-   Your knowledge of and ability to implement culturally and
    linguistically appropriate services.

-   The management information system of your organization. What are
    your immediate and long-range plans in this area?

-   The status of the implementation of managed care contracts for
    persons with HIV.

-   The discounted fee schedule that is being used, and how it is
    implemented.

-   The annual cap on patient charges related to HIV services and how it
    is monitored.

-   How program income is collected, tracked and used to support your
    HIV program.

-   In-kind, private donations, or other grant funds that will be used
    to support your HIV program.

-   Your organization's participation or intent to participate in the
    340 (B) Drug Discounting program. If your organization purchases or
    reimburses for outpatient drugs, an assessment must be made to
    determine whether the organization's drug acquisition practices meet
    Federal requirements regarding cost-effectiveness and reasonableness
    (See 42 CFR Part 50, Subpart E, and OMB Circulars A-Section 340B of
    the Public Health Service Act and the assessment shows that
    participating in the 340B Drug Pricing Program and its Prime Vendor
    Program is the most economical and reasonable manner of purchasing
    or reimbursing for covered outpatient drugs (as defined in section
    340B), failure to participate may result in a negative audit
    finding, cost disallowance or grant funding offset.

-   Your organization's experience providing HIV primary care services.
    Include primary medical and specialty care, mental health care,
    substance abuse services, and psychosocial support services. Also
    describe your organization's ability to respond to emerging
    populations with HIV.

-   What systems are in place to ensure that the most recent HIV/AIDS
    clinical standards and protocols are being followed? Describe your
    organization's ability to define and measure clinical outcomes and
    make adjustments, as indicated.

-   Consumer involvement. Describe how consumers have been involved in
    the planning, implementation and evaluation activities of your
    program over the most recent project period and indicate the number
    of consumers involved. How will consumers be meaningfully and
    routinely involved in the future in your HIV primary care program?

-   If you are a new organization proposing to replace a current
    grantee, describe your plan to provide services to the existing
    patients, population, scope of services, and service area that that
    grantee currently serves

###  *xi. Appendices*

> Please provide the following items to complete the content of the
> application. Please note that these are supplementary in nature, and
> are not intended to be a continuation of the project narrative.
> **Appendices must include**:

1.  Biographical sketches of key staff (HIV Program Coordinator and HIV
    Clinical Director, at a minimum).

2.  An organizational chart.

3.  Map of service area that depicts the proposed service sites and the
    specific HIV services that will be offered at each site.

4.  List all provider organizations who have signed major contracts
    and/or memoranda of agreement, with a brief description of the
    covered activities.

5.  Required letters from Title I and Title II Grantees.

6.  For current grantees, Section 6.1 of the most recent CADR

7.  Documentation of Medicaid provider status and applicable facility
    licensure to provide clinical services. Documentation for this
    application should be in the form of a table that identifies all
    providers' Medicaid number and clinic licensure status, if
    applicable. Official documentation may be required prior to an award
    being made or in the post-award period.

8.  If applicable, copy of negotiated indirect cost rate agreement.

## 3. Submission Dates and Times

**Application Due Date**

> The due date for applications under this grant announcement is March
> 10, 2006 at 5:00 P.M. ET.
>
> Applications will be considered as meeting the deadline if they are E
> marked on or before the due date, and received in time for the
> Independent Review Committee review.
>
> The Chief Grants Management Officer (CGMO) or a higher level designee
> may authorize an extension of published deadlines when justified by
> circumstances such as acts of God (e.g. floods or hurricanes),
> widespread disruptions of mail service, or other disruptions of
> services, such as a prolonged blackout. The authorizing official will
> determine the affected geographical area(s).
>
> Applications must be submitted by 5:00 P.M. ET. **To ensure that you
> have adequate time to follow procedures and successfully submit the
> application, we recommend you start [submission]{.underline} no later
> than noon on the due date.** Applications submitted electronically
> will be time/date stamped electronically, which will serve as receipt
> of submission. After you electronically submit your application, you
> will receive an automatic acknowledgement from Grants.gov that
> contains a Grants.gov tracking number. HRSA will retrieve your
> application from Grants.gov.
>
> **Please refer to the Addendum for important specific information on
> registering and applying through Grants.gov.**
>
> **Late applications:**
>
> Applications which do not meet the criteria above are considered late
> applications. Health Resources and Services Administration (HRSA)
> shall notify each late applicant that its application will not be
> considered in the current competition.

## 4. Intergovernmental Review

The EIS Program is a program subject to the provisions of Executive
Order 12372, as implemented by 45 CFR 100. Executive Order 12372 allows
States the option of setting up a system for reviewing applications from
within their States for assistance under certain Federal programs.
Application packages made available under this guidance will contain a
listing of States which have chosen to set up such a review system, and
will provide a State Single Point of Contact (SPOC) for the review.
Information on states affected by this program and State Points of
Contact may also be obtained from the Grants Management Officer listed
in the Agency Contact(s) section, as well as from the following Web
site: [http://www.whitehouse.gov/omb/grants/spoc.html.]{.underline}

All applicants other than federally recognized Native American Tribal
Groups should contact their SPOC as early as possible to alert them to
the prospective applications and receive any necessary instructions on
the State process used under this Executive Order. Letters from the
State Single Point of Contact (SPOC) in response to Executive Order
12372 are due sixty days after the application due date.

## 5. Funding Restrictions

Awards to support projects are always contingent upon Congressional
appropriation, satisfactory progress in meeting the project's
objectives, and a determination that continued funding would be in the
best interest of the government.

Title III EIS funds [cannot]{.underline} be used to pay for inpatient
services, hospice, residential treatment, clinical research, nursing
home care, needle exchange services, cash payments to clients, or
purchasing or improving real property.

Administrative costs are limited to 10%.

Under current OMB regulations, funds under this announcement may not be
used for the following purposes:

-   Research;

-   Fundraising expenses;

-   Lobbying activities and expenses;

-   Pre-award costs;

-   Foreign travel;

-   Construction, unless it is minor alterations to an existing
    facility, to make it more suitable for the purposes of the grant
    program. In such cases prior authorization must be sought.

## 6. Other Submission Requirements 

> **Except in rare cases (please refer back to IV.2.a for specifics),
> HRSA will no longer accept applications for grant opportunities in
> paper form**. Applicants submitting for this funding opportunity are
> ***required*** to submit ***electronically*** through Grants.gov. To
> submit an application electronically, please use the
> [http://www.Grants.gov](http://www.Grants.gov/) apply site. When using
> Grants.gov you will be able to download a copy of the application
> package, complete it off-line, and then upload and submit the
> application via the Grants.gov site.
>
> As soon as you read this, whether you plan on applying for a HRSA
> grant later this month or later this year, it is incumbent that your
> organization ***immediately register*** in Grants.gov and become
> familiar with the Grants.gov site application process. If you do not
> complete the registration process you will be unable to submit an
> application. The registration process can take up to one month, so you
> need to begin immediately.
>
> To be able to successfully register in Grants.gov, it is necessary
> that you complete all of the following required actions:
>
> • Obtain an organizational Data Universal Number System (DUNS) number
>
> • Register the organization with Central Contractor Registry (CCR)
>
> • Identify the organization's E-Business POC (Point of Contact)
>
> • Confirm the organization's CCR "Marketing Partner ID Number (M-PIN)"
> password
>
> • Register an Authorized Organization Representative (AOR)
>
> • Obtain a username and password from the Grants.gov Credential
> Provider
>
> Instructions on how to register, tutorials and FAQs are available on
> the Grants.gov web site at [www.grants.gov](http://www.grants.gov/).
> Assistance is also available from the Grants.gov help desk at
> <support@grants.gov> or by phone at 1-800-518-4726.
>
> More specific information, including step-by-step instructions on
> registering and applying, can be found in the Addendum to this
> guidance.
>
> Please understand that we will not consider additional information
> and/or materials submitted after your initial application. You must
> therefore ensure that all materials are submitted together.
>
> Online applications are still required to submit ONE form in signed
> hard copy: the SF-424/5161 Face Sheet, since all other elements of the
> application have been captured and transmitted electronically. 
>
> **Formal submission of the electronic application:** Applications
> completed online are considered formally submitted when the
> Authorizing Official electronically submits the application to HRSA.
> However, to complete the submission requirements, a hard-copy of the
> SF-424/5161 Face Sheet must be printed, signed, and submitted to the
> HRSA Grants Application Center. The SF-424/5161 can be printed from
> the online application.
>
> For an online application, the signed SF-424/5161 must be sent to the
> HRSA GRANTS APPLICATION CENTER at the following address and received
> by HRSA by no later than five days after the application due date:
>
> The HRSA Grants Application Center
>
> The Legin Group, Inc.
>
> Attn: Title III EISEGA
>
> Program Announcement No. HRSA-06-046
>
> CFDA No. 93.918
>
> 901 Russell Avenue, Suite 450
>
> Gaithersburg, MD 20879
>
> Telephone: 877-477-2123
>
> In addition, please scan the signed Face Sheet and include it as an
> attachment in your electronic submission.
>
> Applications will be considered as having met the deadline if: (1) the
> application has been successfully transmitted electronically by your
> organization's Authorizing Official through Grants.gov on or before
> the deadline date and time, and (2) the signed SF-424/5161 Face Sheet
> is received by HRSA no later than five days after the deadline date.
>
> It is incumbent on applicants to ensure that the AO is available to
> submit the application to HRSA by the application due date. We will
> [not]{.underline} accept submission or re-submission of incomplete,
> rejected, or otherwise delayed applications after the deadline.

# V. Application Review Information 

## 1. Review Criteria

Procedures for assessing the technical merit of grant applications have
been instituted to provide for an objective review of applications and
to assist the applicant in understanding the standards against which
each application will be judged. Critical indicators have been developed
for each review criterion to assist the applicant in presenting
pertinent information related to that criterion and to provide the
reviewer with a standard for evaluation. Review criteria are outlined
below with specific detail and scoring points. Funding levels will be
reviewed in reference to level of effort, progress and performance
described in this application. For current Title III EIS grantees, past
performance in meeting legislative requirements and program expectations
will be taken into account regarding continuation of funding and the
level of funding awarded.

Applications will be scored on the basis of 100 points as a perfect
score. Points will be allocated based on the extent to which the
proposal addresses each of the criteria listed below.

#### Criterion 1: Need 

**The extent to which the application describes the problem and
associated contributing factors to the problem.**

*Weight- 15 points*

Does the applicant document the impact of the HIV epidemic in the
proposed service area by demonstrating growth in the number of HIV
and/or AIDS cases and/or surrogate markers? Does the applicant clearly
describe racial and ethnic minority communities that they propose to
serve?

Does the applicant clearly describe the social and economic
characteristics of their target population(s)? Does the applicant
document the effect of the HIV epidemic on the target population(s) in
the most recent three (3) year period?

Does the applicant provide a comprehensive description of, and changes
in, the existing HIV service delivery system? Does the applicant
document the public funding sources for HIV prevention and care in the
proposed service area?

Does the applicant identify gaps in service and barriers to care? Does
the applicant describe the need for HIV-related health services by
individuals with HIV disease who are aware of their HIV status, but are
not receiving primary medical care in its service area?

#### Criterion 2: Response 

**The extent to which the proposed project responds to the "Purpose"
included in the program description. The clarity of the proposed goals
and objectives and their relationship to the identified project. The
extent to which the activities described in the application is capable
of addressing the problem and attaining the project objectives.**

*Weight: 30 Points*

Does the applicant document that the organization has an adequate system
in place to provide the required early intervention services/primary
care? The required services are: HIV counseling, testing and referral;
appropriate medical evaluation and clinical care (such as CD4
monitoring, viral load testing, antiretroviral therapy, prophylaxis and
treatment of opportunistic infections, and malignancies); other primary
medical services which include outpatient oral health, adherence, mental
health/substance abuse, nutritional services; and referrals to other
health services. Does the applicant describe how HIV prevention services
are incorporated into medical care?

Does the applicant document the ability of the organization to provide,
internally and/or by referral, the full comprehensive continuum of HIV
care? Does the applicant document that there is a staffing plan
appropriate for the provision of early intervention services/primary
care?

Does the applicant demonstrate that there are formal systems in place
that will facilitate referrals of individuals to health and support
services that are not directly provided by the applicant? Does the
applicant demonstrate that there are mechanisms in place for receiving
feedback from the providers of health and support services to which
patients are referred?

Does the applicant describe a policy for after-hours and weekend
coverage for urgent or emergency medical and dental care needs?

Does the applicant describe the organization's formal arrangements to
refer and enroll clients in clinical trials?

Does the applicant describe a plan to identify and link people at high
risk for or living with HIV into care at the proposed program?

Does the applicant discuss how clients will be linked with case
management services? Does the applicant explain how clients will be
assisted in determining eligibility for financial support and services
from other publicly funded programs?

Is the work plan realistic with specific, measurable, and time-framed
goals and objectives?

Does the work plan contain objectives which reflect the comprehensive
continuum of HIV care*?*

If applicable, does the work plan contain objectives specific to the
MAI?

#### Criterion 3: Evaluative Measures 

**The effectiveness of the method proposed to monitor and evaluate the
project results. Evaluative measures must be able to assess 1) to what
extent the program objectives have been met, and 2) to what extent these
can be attributed to the project.**

*Weight: 20 Points*

Does the applicant describe organizational capability to measure
clinical outcomes?

Does the applicant describe how the applicant organization will evaluate
the program?

Does the evaluation plan provide a mechanism to assess attainment of
program's objectives and to assess the impact of the program?

Does the applicant describe an adequate CQI process?

Does the applicant demonstrate the ability to comply with reporting
requirements of the program?

#### Criterion 4: Impact

**The effect and effectiveness of plans for dissemination of project
results and/or the extent to which project results may be national in
scope and/or degree to which the project activities are replicable,
and/or the sustainability of the program beyond the Federal Funding.**

*Weight: 5 Points*

Overall, does the applicant demonstrate the need for funding for HIV
primary care services in the proposed service area?

If applicable, does the applicant describe whether they are an
indigenous organization (a community based or public organization local
to and supported by the community(ies) of color proposed to be served?
Do they document support through letters of support or other means?

If applicable, does the applicant document linkages and coordination
with Title I? Is a letter from the Title I Grantee of Record included in
the application? Does this letter document the need for Title III EIS
funding to support the proposed services?

If applicable, does the applicant document steps taken to participate in
the HIV Care Consortium? Is a letter from the Title II Grantee of Record
included in the application? Does this letter document the need for
Title III EIS funding to support the proposed services?

If applicable, does the applicant document steps taken to assure
effective collaboration and linkages with existing CDC funded testing
and counseling, prevention programs, TB and STI control programs in the
proposed service area?

If applicable, is there documentation of steps taken to assure effective
collaboration and linkages with Titles I, II, III, IV, AETC, SPNS,
Dental Reimbursement and Community-Based Dental Partnership funded
programs in the proposed service area?

If applicable, is there documentation of steps taken to assure effective
collaboration and linkages with Community Health Centers and with SAMHSA
and NIH funded programs in the proposed service area?

#### Criterion 5: Resources/Capabilities 

**The extent to which project personnel are qualified by training and
/or experience to implement and carry out the project. The capabilities
of the applicant organization, and quality and availability of
facilities and personnel to fulfill the needs and requirements of the
proposed project. For competing continuations, past performance will
also be considered.**

*Weight: 20 Points*

Does the applicant fully describe organizational and staff expertise in
providing HIV primary care services?

Does the applicant demonstrate knowledge of and ability to implement
culturally and linguistically appropriate services?

Does the applicant describe the level of involvement of consumers in the
development, implementation, and evaluation of the Title III EIS
program?

Does the applicant have systems in place to ensure that the most recent
HIV/AIDS clinical standards and protocols will be followed?

Does the applicant describe organizational capability to measure
clinical outcomes?

Does the applicant document the organization's fiscal and MIS capacity
to manage this grant?

Does the applicant demonstrate the organization's ability to implement
the proposed project?

Does the applicant describe the extent to which the proposed services
complement, and does not duplicate existing early intervention
services/primary care?

Does the applicant describe challenges anticipated and a plan to meet
those challenges?

If applicable, does the applicant demonstrate satisfactory progress in
meeting prior goals and objectives? Has the applicant successfully
implemented a Title III EIS program which meets program expectations?

If applicable, does the applicant demonstrate that a new proposal for an
existing service area will serve the existing patients, populations,
scope of services and service areas currently served by the grantee they
intend to replace?

#### Criterion 6: Support Requested

**The reasonableness of the proposed budget in relation to the
objectives, the complexity of the activities, and the anticipated
results.**

*Weight: 10 Points*

Does level of effort and performance support the funding level?

Does the applicant present a budget that is appropriate to the proposed
program plan?

Does the budget allocate resources to ensure that at least 50 percent of
funds are for the provision of primary care?

Does the budget adhere to the **10 percent** limit on administrative
costs?

Does the applicant provide a clearly presented budget justification that
fully explains each line item?

## 2. Review and Selection Process

The Division of Independent Review is responsible for managing objective
reviews within HRSA. Applications competing for Federal funds receive an
objective and independent review performed by a committee of experts
qualified by training and experience in particular fields or disciplines
related to the program being reviewed. In selecting review committee
members, other factors in addition to training and experience may be
considered to improve the balance of the committee, e.g. geographic
distribution, race/ethnicity, and gender. Each reviewer is screened to
avoid conflicts of interest and is responsible for providing an
objective, unbiased evaluation based on the review criteria noted above.
The committee provides expert advice on the merits of each application
to program officials responsible for final selections for award.

Applications that pass the initial HRSA eligibility screening will be
reviewed and rated by a panel based on program elements and review
criteria presented in relevant sections of this program announcement.
The review criteria are designed to enable the review panel to assess
the quality of a proposed project and determine the likelihood of its
success. The criteria are closely related to each other and are
considered as a whole in judging the overall quality of an application.

**Funding Preferences**

The Ryan White CARE Act provides a funding preference for some
applicants. Applicants receiving the preference will be placed in a more
competitive position among applications that can be funded. Applications
that do not receive a funding preference will be given full and
equitable consideration during the review process. The law provides that
a funding preference be granted to any qualified applicant that
specifically requests the preference and meets the criteria for the
preference as follows:

Qualification 1: Increased Burden

An applicant can request funding preference if they demonstrate an
increase in the burden of providing services regarding HIV disease, as
described by AIDS cases, sexually transmitted diseases, tuberculosis,
drug abuse, lack of availability of early intervention services, lack of
primary health providers other than the applicant, and the distance
patients have to travel for care.

Qualification 2: Rural or underserved areas

An applicant can request funding preference if they provide services in
rural (outside urbanized areas and urban clusters as described by the
U.S. Census Bureau) or underserved communities where the HIV epidemic is
increasing and in areas that receive limited or no Ryan White CARE Act
monies.

Qualification 3: Communities of color

An applicant can request funding preference if they serve communities of
color that are highly impacted by HIV/AIDS and are supported by the
communities of color proposed to be served. This preference is
consistent with Congressional direction to maximize the participation of
minority community-based organizations that have a history of serving
communities of color.

Funding special consideration will be given to applicants that maintain
continuity of care for persons living with HIV/AIDS who are currently in
care in the Title III EIS programs competing under this announcement.

# VI. Award Administration Information

## 1. Award Notices

Each applicant will receive written notification of the outcome of the
objective review process, including a summary of the expert committee's
assessment of the application's merits and weaknesses, and whether the
application was selected for funding. Applicants who are selected for
funding may be required to respond in a satisfactory manner to
Conditions placed on their application before funding can proceed.
Letters of notification do not provide authorization to begin
performance.

The Notice of Grant Award sets forth the amount of funds granted, the
terms and conditions of the grant, the effective date of the grant, the
budget period for which initial support will be given, the non-Federal
share to be provided (if applicable), and the total project period for
which support is contemplated. Signed by the Grants Management Officer,
it is sent to the applicant agency's Authorized Representative, and
reflects the only authorizing document. It will be sent prior to the
start date of July 1, 2006.

## 2. Administrative and National Policy Requirements

Successful applicants must comply with the administrative requirements
outlined in 45 CFR Part 74 or 45 CFR Part 92, as appropriate.

**PUBLIC POLICY ISSUANCE**

**HEALTHY PEOPLE 2010**

**Healthy People 2010** is a national initiative led by HHS that sets
priorities for all HRSA programs. The initiative has two major goals:
(1) To increase the quality and years of a healthy life; and (2)
Eliminate our country's health disparities. The program consists of 28
focus areas and 467 objectives. HRSA has actively participated in the
work groups of all the focus areas, and is committed to the achievement
of the Healthy People 2010 goals.

Applicants must summarize the relationship of their projects and
identify which of their programs objectives and/or sub-objectives relate
to the goals of the Healthy People 2010 initiative.

Copies of the Healthy People 2010 may be obtained from the
Superintendent of Documents or downloaded from the Healthy People 2010
website: [http://www.health.gov/healthypeople/document]{.underline}/.

[]{.mark}

The Public Health Service strongly encourages all award recipients to
provide a smoke-free workplace and to promote the non-use of all tobacco
products. Further, Public Law 103-227, the Pro-Children Act of 1994,
prohibits smoking in certain facilities (or in some cases, any portion
of a facility) in which regular or routine education, library, day care,
health care or early childhood development services are provided to
children*.*

## 3. Reporting

The successful applicant under this guidance must:

a\. Comply with audit requirements of OMB Circular A-133. Information on
the scope, frequency, and other aspects of the audits can be found on
the Internet at [www.whitehouse.gov/omb/circulars;]{.underline}

b\. Submit a Payment Management System Quarterly Report. The report
identifies cash expenditures against the authorized funds for the grant.
Failure to submit the report may result in the inability to access grant
funds. Submit report to the:

Division of Payment Management

DPM/FMS/PSC/ASAM/HHS

PO Box 6021

Rockville, MD 20852

Telephone: (301) 443-1660;

c\. Submit a Financial Status Report. A financial status report is
required within 90 days of the end of each grant year. The report is an
accounting of expenditures under the project that year;

d.  Submit a CARE Act Data Report; and

e.  Submit a noncompeting continuation application on specified dates
    prior to the end of each budget period prior to the end of the
    project period. The noncompeting continuation application will
    include a progress report, budget for the upcoming budget period,
    and revised work plan.

## 4. Performance Review

HRSA's Office of Performance Review (OPR) serves as the agency's focal
point for reviewing and enhancing the performance of HRSA funded
programs within communities and States. On a regularly scheduled basis,
HRSA grantees are required to participate in a performance review of
their HRSA funded program(s) by a review team from one of the ten OPR
regional divisions. Grantees should expect to participate in a
performance review at some point during their project period. When a
grantee receives more than one HRSA grant, each of the grantee's HRSA
funded programs will be reviewed during the same performance review.

The purpose of performance review is to improve the performance of HRSA
funded programs. Through systematic pre-site and on-site analysis, OPR
works collaboratively with grantees and HRSA Bureaus/Offices to measure
program performance, analyze the factors impacting performance, and
identify effective strategies and partnerships to improve program
performance, with a particular focus on outcomes. Upon completion of the
performance review, grantees are expected to prepare an Action Plan that
identifies key actions to improve program performance as well as
addresses any identified program requirement issues. Performance reviews
also provide direct feedback to the agency about the impact of HRSA
policies on program implementation and performance within communities
and States.

For additional information on performance reviews, please visit:
<http://www.hrsa.gov/performancereview>.

# VII. Agency Contacts

> []{.mark}

Applicants may obtain additional information regarding business,
administrative, or fiscal issues related to this grant announcement by
contacting:

Helen Harpold

Lead Grants Management Specialist

Division of Grants Management Operations, HRSA/OFAM

Parklawn Building, Room 11A-16

5600 Fishers Lane

Rockville, Maryland 20857

Telephone: (301) 443-3262

E-mail: helen.harpold@hrsa.hhs.gov

Additional information related to overall program issues and technical
assistance may be obtained by contacting your current Title III EIS
Project Officer or:

Kathleen Treat, MSW, MS

Chief, Southern Regional Branch

Division of Community Based Programs

HRSA, HIV/AIDS Bureau

5600 Fishers Lane #7A-30

Rockville, Maryland 20857

Tel. 301 443-7602

Fax 301 443-1839

Email: kathleen.treat@hrsa.hhs.gov

[]{.mark}

[]{.mark}

# VIII. Tips for Writing a Strong Application

> **Include DUNS Number.** You must include a DUNS Number to have your
> application reviewed. Applications ***will not*** be reviewed without
> a DUNS number. To obtain a DUNS number, access
> [www.dunandbradstreet.com]{.underline} or call 1-866-705-5711. Please
> include the DUNS number next to the OMB Approval Number on the
> application face page.
>
> []{.mark}
>
> **Keep your audience in mind.** Reviewers will use only the
> information contained in the application to assess the application. Be
> sure the application and responses to the program requirements and
> expectations are complete and clearly written.
>
> **Start preparing the application early.** Allow plenty of time to
> gather required information from various sources.
>
> **Follow the instructions in this guidance carefully.** Place all
> information in the order requested in the guidance.
>
> **Be brief, concise, and clear.** Make your points understandable.
> Provide accurate and honest information, including candid accounts of
> problems and realistic plans to address them. If any required
> information or data is omitted, explain why. Make sure the information
> provided in each table, chart, attachment, etc., is consistent with
> the proposal narrative and information in other tables.
>
> **Be organized and logical.** Many applications fail because the
> reviewers cannot follow the thought process of the applicant or
> because parts of the application do not fit together.
>
> **Be careful in the use of appendices.** Do not use the appendices for
> information that is required in the body of the application. Be sure
> to cross-reference all tables and attachments located in the
> appendices to the appropriate text in the application.
>
> **Carefully proofread the application.** Misspellings and grammatical
> errors will impede reviewers in understanding the application. Be sure
> pages are numbered (including appendices) and that page limits are
> followed. Limit the use of abbreviations and acronyms, and define each
> one at its first use and periodically throughout application.
>
> **Print out and carefully review an electronic application**. If
> submitting electronically, print out the application before submitting
> it to ensure appropriate formatting and adherence to page limit
> requirements.

# ADDENDUM 

**APPLYING THROUGH GRANTS.GOV**

**Prepare to Apply through Grants.gov:**

HRSA, in providing the grant community a single site to Find and Apply
for grant funding opportunities, is [requiring]{.underline} applicants
for this funding opportunity to apply electronically through Grants.gov.
By using Grants.gov you will be able to download a copy of the
application package, complete it off-line, and then upload and submit
the application via the Grants.gov site. You may [no]{.underline}t
e-mail an electronic copy of a grant application to us.

Please understand that we will not consider additional information
and/or materials submitted after your initial application. You must
therefore ensure that all materials are submitted together.

**Note: Except in rare cases, paper applications will NOT be accepted
for this grant opportunity. If you believe you are technologically
unable to submit an on-line application you MUST contact the Director of
the Division of Grants Policy, at <DGPClearances@hrsa.gov> and explain
why you are technologically unable to submit on-line.** Make sure you
specify the announcement number you are seeking relief for. **HRSA and
its Grants Application Center (GAC) will only accept paper applications
from applicants that received prior written approval.**

In order to apply through Grants.gov the Applicant must register with
Grants.gov. This is a three step process that must be completed by any
organization wishing to apply for a grant opportunity. The registration
process will require some time. Therefore, applicants or those
considering applying at some point in the future should register
**[immediately]{.underline}**. Registration in Grants.gov does not
require the organization to apply for a grant; it simply provides the
organization the required credentials so that the organization may apply
for a grant in the future. Registration is required only once.

**Get started now and complete the one-time registration process to
begin submitting grant applications as soon as you read this.**

You don't need to be registered to search or to begin selecting,
downloading and completing grant applications. Registration is required
to submit applications. Therefore, it is essential that your
organization be registered prior to attempting to submit a grant
application or your organization will not be able to do so. **Be sure to
complete the process early as the registration process may take some
time (anywhere from 5 days to 1 month)**.

**There are three steps to the registration process:**

**Step 1:** Register your organization

**Step 2:** Register yourself as an Authorized Organization
Representative

**Step 3:** Get authorized by your organization to submit grants

These instructions will walk you through the three basic registration
steps. Additional assistance is available at Grants.gov at
[www.grants.gov](http://www.grants.gov/). Individual assistance is
available at <http://www.grants.gov/Support> or 1-800-447-8477.
Grants.gov also provides a variety of support options through online
Help including Context-Sensitive Help, Online Tutorials, FAQs, Training
Demonstration, User Guide, and Quick Reference Guides.

Follow this checklist to complete your registration---

1\. Register Your Organization

\- Obtain your organization's Data Universal Number System (DUNS) number

\- Register your organization with Central Contractor Registry (CCR)

\- Identify your organization's E-Business POC (Point of Contact)

\- Confirm your organization's CCR "Marketing Partner ID Number (M-PIN)"
password

2\. Register Yourself as an Authorized Organization Representative (AOR)

\- Obtain your username and password

\- Register your username and password with Grants.gov

3\. Get Yourself Authorized as an AOR

\- Contact your E-Business POC to ensure your AOR status

\- Log in to Grants.gov to check your AOR status

The Grants.gov/Apply feature includes a simple, unified application
process to enable applicants to apply for grants online. The information
applicants need to understand and execute the steps is at
[http://www.grants.gov/GetStarted](../www.grants.gov/GetStarted).
Applicants should read the Get Started steps carefully. The site also
contains registration checklists to help you walk through the process.
HRSA recommends that you download the checklists and prepare the
information requested before beginning the registration process.
Reviewing information required and assembling it before beginning the
registration process will save you time and make the process faster and
smoother.

**REGISTER YOUR ORGANIZATION**

Before you can apply for a grant via Grants.gov, your organization must
obtain a Data Universal Number System (DUNS) number and register early
with the Central Contractor Registry (CCR).

**Obtain your organization's DUNS number**

A DUNS number is a unique number that identifies an organization. It has
been adopted by the Federal government to help track how Federal grant
money is distributed. Ask your grant administrator or chief financial
officer to provide your organization's DUNS number.

***-How do you do it?*** If your organization does not have a DUNS
number, call the special Dun & Bradstreet hotline at 1-866-705-5711 to
receive one free of charge.

***- How long will this take?*** You will receive a DUNS number at the
conclusion of the phone call.

**Register your organization with CCR**

The CCR is the central government repository for organizations working
with the Federal government. Check to see if your organization is
already registered at the CCR website. If your organization is not
already registered, identify the primary contact who should register
your organization.

When your organization registers with CCR, it will be required to
designate an E-Business Point of Contact (E-Business POC). The designee
authorizes individuals to submit grant applications on behalf of the
organization and creates a special password called a Marketing Partner
ID Number (M-PIN) to verify individuals authorized to submit grant
applications for the organization.

**-*How do you do it? ***Visit the CCR website at
[http://www.ccr.gov](http://www.ccr.gov/). Check whether your
organization is already registered or register your organization right
online. Be certain to enter an MPIN number during this process as this
is an optional field for the CCR registration but
[mandatory]{.underline} for Grants.gov.

***- How long will this take?*** It may take a few days for you to
collect the information needed for your organization's registration, but
once you finish the registration process, you can move on to Step 2 the
very next business day. Note it will take up to a month for the total
registration- therefore this should be done as soon as possible.

**GET AUTHORIZED as an AOR by Your Organization**

The registration process is almost complete. All that remains is the
final step ---getting authorized. Even though you have registered, your
E-Business POC must authorize you so Grants.gov will know that you are
verified to submit applications.

**- Obtain your E-Business POC authorization**

After your Authorized Organizational Representative (AOR) profile is
completed, your organization's E-Business POC will receive an email
regarding your requested AOR registration, with links and instructions
to authorize you as an AOR.

***- How do you do it?*** Instruct your E-Business POC to login to
Grants.gov at http://www.grants.gov/ForEbiz and enter your
organization's DUNS number and M-PIN. They will select you as an AOR
they wish to authorize and you will be verified to submit grant
applications.

***- How long will this take?*** It depends on how long it takes your
E-Business POC to log in and authorize your AOR status. You can check
your AOR status by logging in to Grants.gov at
http://www.grants.gov/ForApplicants.

**REGISTER YOURSELF as an Authorized Organization Representative (AOR)**

Once the CCR Registration is complete, your organization is finished
registering. You must now register yourself with Grants.gov and
establish yourself as an AOR, an individual authorized to submit grant
applications on behalf of your organization. There are two elements
required to complete this step --- both must be completed to move onto
Step 3.

**1. Obtain your username and password**

In order to safeguard the security of your electronic information, and
to submit a Federal grant application via Grants.gov, you must first
obtain a username and password from the Grants.gov Credential Provider.

***- How do you do it?*** Just register with Grants.gov's Credential
Provider at http://www.grants.gov/Register1. You will need to enter your
organization's DUNS number to access the registration form. Once you
complete the registration form you will be given your username and you
will create your own password.

***- How long will this take?*** Same day. When you submit your
information you will receive your username and be able to create your
password.

2\. **Register with Grants.gov**

Now that you have your username and password, allow about 30 minutes for
your data to transfer from the Credential Provider, then you must
register with Grants.gov to set up a short profile.

**\> *How do you do it? ***Simply visit http://www.grants.gov/Register2
to register your username and password and set up your profile.
Remember, you will only be authorized for the DUNS number which you
register in your Grants.gov profile.

**\> *How long will this take? ***Same day. Your AOR profile will be
complete after you finish filling in the profile information and save
the information at Grants.gov.

You have now completed the registration process for Grants.gov. If you
are applying for a [new or competing continuation]{.underline} you may
find the application package through Grants.gov FIND. If you are filling
out a [non-competing continuation]{.underline} application you
[must]{.underline} obtain the announcement number through your program
office, and enter this announcement number in the search field to pull
up the application form and related program guidance. Download the
required forms and enter your current grant number in the appropriate
field to begin the non-competing continuation application which you will
then upload for electronic submittal through Grants.gov. For
continuation applications which require submittal of performance
measures electronically, instructions are provided in the program
guidance on how to enter the HRSA electronic handbooks to provide this
information.

**How to submit an electronic application to HRSA via Grants.gov/Apply**

[a. Applying using Grants.gov.]{.underline} Grants.gov has a full set of
instructions on how to apply for funds on its website at
<http://www.grants.gov/CompleteApplication>. The following provides
simple guidance on what you will find on the Grants.gov/Apply site.
Applicants are encouraged to read through the page entitled, "Complete
Application Package" before getting started. Grants.gov allows
applicants to download the application package, instructions and forms
that are incorporated in the instructions, and work off line. In
addition to forms that are part of the application instructions, there
will be a series of electronic forms that are provided utilizing a
PureEdge reader. The PureEdge Reader is available free for download from
the Grants.gov/Get Started site. The PureEdge Reader allows applicants
to read the electronic files in a form format so that they will look
like any other Standard or HRSA form. The PureEdge forms have content
sensitive help. To use this feature you will need to click on the icon
at the top of the page that features an arrow with a question mark. This
engages the content sensitive help for each field you will need to
complete on the electronic form. The PureEdge forms can be downloaded
and saved on your hard drive, network drive(s), or CDs.

MacIntosh Users will need to use the Virtual PC emulator software, which
allows PC software to run on MacIntosh platforms.

[b. Mandatory Fields on PureEdge Forms.]{.underline} In the PureEdge
forms you will note fields that will appear with a yellow background
color on the data fields to be completed. These fields are mandatory
fields and they **must** be completed to successfully submit your
application.

[c. Completion of SF-424 Fields First.]{.underline} The PureEdge forms
are designed to fill in common required fields such as the applicant
name and address, DUNS number, etc., on all PureEdge electronic forms.
**To trigger this feature, an applicant must complete the SF-424
information first.** Once it is completed the information will transfer
to the other forms.

[d. Customer Support.]{.underline} The grants.gov website provides
customer support via (800) 518-GRANTS (this is a toll-free number) or
through e-mail at <support@grants.gov>. The customer support center is
open from 7:00 a.m. to 9:00 p.m. Eastern time, Monday through Friday,
except federal holidays, to address grants.gov technology issues. For
technical assistance to program related questions, contact the number
listed in the Program Section of the program you are applying for.

**Timely Receipt Requirements and Proof of Timely Submission**

a\. Electronic [Submission.]{.underline} All applications must be
received by [www.grants.gov/Apply](http://www.grants.gov/Apply) **by
5:00 P.M. Eastern Time** on the due date established for each program.

Proof of timely submission is automatically recorded by Grants.gov. An
electronic time stamp is generated within the system when the
application is successfully received by Grants.gov. The applicant will
receive an acknowledgement of receipt and a tracking number from
Grants.gov with the successful transmission of their application.
Applicants should print this receipt and save it, along with facsimile
receipts for information provided by facsimile, as proof of timely
submission. When HRSA successfully retrieves the application from
Grants.gov, Grants.gov will provide an electronic acknowledgment of
receipt to the e-mail address of the AOR. Proof of timely submission
shall be the date and time that Grants.gov receives your application.

Applications received by grants.gov, after the established due date and
time for the program, will be considered late and will not be considered
for funding by HRSA. [HRSA suggests that applicants submit their
applications during the operating hours of the Grants.gov Support Desk,
so that if there are questions concerning transmission, operators will
be available to walk you through the process.]{.underline} Submitting
your application during the Support Desk hours will also ensure that you
have sufficient time for the application to complete its transmission
prior to the application deadline. Applicants using dial-up connections
should be aware that transmission should take some time before
Grants.gov receives it. Grants.gov will provide either an error or a
successfully received transmission message. The Grants.gov Support desk
reports that some applicants abort the transmission because they think
that nothing is occurring during the transmission process. Please be
patient and give the system time to process the application. Uploading
and transmitting many files, particularly electronic forms with
associated XML schemas, will take some time to be processed.

Note the following additional information regarding submission of all
HRSA applications through Grants.gov:

• You must submit all documents electronically, including all
information typically included on the SF424 and all necessary assurances
and certifications.

• Your application must comply with any page limitation requirements
described in this program announcement.

• After you electronically submit your application, you will receive an
automatic acknowledgement from Grants.gov that contains a Grants.gov
tracking number. HRSA will retrieve your application from Grants.gov.

Online applications are required to submit ONLY one form in signed hard
copy: the SF-424/5161 Face Sheet, since all other elements of the
application have been captured and transmitted electronically. This face
page should be sent to HRSA's Grants Application Center at:

> The HRSA Grants Application Center
>
> The Legin Group, Inc.
>
> Attn: Title III EIS Competing Continuation (EISEGA)
>
> CFDA No. 93.918, HRSA-06-046
>
> 901 Russell Avenue, Suite 450
>
> Gaithersburg, MD 20879
>
> Telephone: 877-477-2123

**Formal Submission of the Electronic Application**

Applications completed online are considered formally submitted when the
Authorizing Official electronically submits the application to HRSA
through Grants.gov. However, to complete the submission requirements, a
hard-copy of the SF-424/5161 Face Sheet must be printed, signed, and
submitted to the HRSA Grants Application Center. The SF-424/5161 can be
printed from the online application.

For an online application, the signed SF-424/5161 must be sent to the
HRSA GRANTS APPLICATION CENTER at the above address and received by HRSA
by no later than five days after the due date.

Applications will be considered as having met the deadline if: (1) the
application has been successfully transmitted electronically by your
organization's Authorizing Official through Grants.gov on or before the
deadline date and time, and (2) the signed SF-424/5161 Face Sheet is
received by HRSA no later than five days after the deadline date.

# Attachment A Ryan White Legislation Regarding HIV Counseling and Testing

**ASEC. 2661. CONFIDENTIALITY AND INFORMED CONSENT.**

A(a) CONFIDENTIALITY.‑‑The Secretary may not make a grant under this
part unless, in the case of any entity applying for a grant under
section 2651, the entity agrees to ensure that information regarding the
receipt of early intervention services is maintained confidentially
pursuant to law or regulations in a manner not inconsistent with
applicable law.

A(b) INFORMED CONSENT.‑‑

\(1\) IN GENERAL.‑‑The Secretary may not make a grant under this part
unless the applicant for the grant agrees that, in testing an individual
for HIV disease, the applicant will test an individual only after
obtaining from the individual a statement, made in writing and signed by
the individual, declaring that the individual has undergone the
counseling described in section 2662(a) and that the decision of the
individual with respect to undergoing such testing is voluntarily made.

A(2) PROVISIONS REGARDING ANONYMOUS TESTING.‑‑

A(A) If, pursuant to section 2664(b), an individual will undergo testing
pursuant to this part through the use of a pseudonym, a grantee under
such section shall be considered to be in compliance with the agreement
made under paragraph (1) if the individual signs the statement described
in such subsection using the pseudonym.

A(B) If, pursuant to section 2664(b), an individual will undergo testing
pursuant to this part without providing any information relating to the
identity of the individual, a grantee under such section shall be
considered to be in compliance with the agreement made under paragraph
(1) if the individual orally provides the declaration described in such
paragraph.

ASEC. 2662. PROVISION OF CERTAIN COUNSELING SERVICES.

A(a) COUNSELING BEFORE TESTING.‑‑The Secretary may not make a grant
under this part unless the applicant for the grant agrees that, before
testing an individual for HIV disease, the applicant will provide to the
individual appropriate counseling regarding the disease based on the
most

recently available scientific data), including counseling on‑‑

A (1) measures for the prevention of exposure to, and the transmission
of, HIV;

\(2\) the accuracy and reliability of the results of testing for HIV
disease;

\(3\) the significance of the results of such testing, including the
potential for developing acquired immune deficiency syndrome;

A (4) encouraging the individual, as appropriate, to undergo such
testing;

A (5) the benefits of such testing, including the medical benefits of
diagnosing HIV disease in the early stages and the medical benefits of
receiving early intervention services during such stages;

A (6) provisions of law relating to the confidentiality of the process
of receiving such services, including information regarding any
disclosures that may be authorized under applicable law and information
regarding the availability of anonymous counseling and testing pursuant
to section 2664(b); and

A (7) provisions of applicable law relating to discrimination against
individuals with HIV disease.

\(b\) COUNSELING OF INDIVIDUALS WITH NEGATIVE TEST RESULTS.‑‑The
Secretary may not make a grant under this part unless the applicant for
the grant agrees that, if the results of testing conducted for HIV
disease indicate that an individual does not have the disease, the
applicant will review for the individual the information provided
pursuant to subsection (a), including‑‑

> A(1) the information described in paragraphs (1) through (3) of such
> subsection; and
>
> A(2) the appropriateness of further counseling, testing, and education
> of the individual regarding such disease.

A(c) COUNSELING OF INDIVIDUALS WITH POSITIVE TEST RESULTS.‑‑The
Secretary may not make a grant under this part unless the applicant for
the grant agrees that, if the results of testing for HIV disease
indicate that the individual has the disease, the applicant will provide
to the individual appropriate counseling regarding such disease,
including‑‑

> A(1) reviewing the information described in paragraphs (1) through (3)
> of subsection (a);
>
> A(2) reviewing the appropriateness of further counseling, testing, and
> education of the individual regarding such disease; and

A(3) providing counseling on‑‑

A(A) the availability, through the applicant, of early intervention
services;

A(B) the availability in the geographic area of appropriate health care,
mental health care, and social and support services, including providing
referrals for such services, as appropriate;

A(C)(i)the benefits of locating and counseling any individual by whom
the infected individual may have been exposed to HIV and any individual
whom the infected individual may have exposed to HIV; and

\(ii\) that emphasizes it is the duty of infected individuals to
disclose their infected status to their sexual partners and their
partners in the sharing of hypodermic needles; that provides advice to
infected on the manner in which the disclosures can be made; and that
emphasizes that it is the continuing duty of the individuals to avoid
any behaviors that will expose others to HIV.

A(D) the availability of the services of public health authorities with
respect to locating and counseling any individual described in
subparagraph (C).

A(d) ADDITIONAL REQUIREMENTS REGARDING APPROPRIATE COUNSELING.‑‑The
Secretary may not make a grant under this part unless the applicant for
the grant agrees that, in counseling individuals with respect to HIV
disease, the applicant will ensure that the counseling is provided under
conditions appropriate to the needs of the individuals.

A(e) COUNSELING OF EMERGENCY RESPONSE EMPLOYEES.‑‑The Secretary may not
make a grant under this part to a State unless the State agrees that, in
counseling individuals with respect to HIV disease, the State will
ensure that, in the case of emergency response employees, the counseling
is provided to such employees under conditions appropriate to the needs
of the employees regarding the counseling.

\(f\) RULE OF CONSTRUCTION REGARDING COUNSELING WITHOUT TESTING.‑‑
Agreements made pursuant to this section may not be construed to
prohibit any grantee under this part from expending the grant for the
purpose of providing counseling services described in this section to an
individual who does not undergo testing for HIV disease as a result of
the grantee or the individual determining that such testing of the
individual is not appropriate.

**ASEC. 2663. APPLICABILITY OF REQUIREMENTS REGARDING CONFIDENTIALITY,
INFORMED CONSENT, AND COUNSELING**.

AThe Secretary may not make a grant under this part unless the applicant
for the grant agrees that, with respect to testing for HIV disease, any
such testing carried out by the applicant will, without regard to
whether such testing is carried out with Federal funds, be carried out
in accordance with conditions described in sections 2661 and 2662.

# Attachment B Additional Agreements & Assurances

######### Ryan White CARE Act Title III EIS

The authorized representative of the applicant must include a signed
original copy of the attached form with the grant application. This form
lists the program assurances which must be satisfied in order to qualify
for a Part C grant, as required by section 2665.

NOTE: The text of the assurances has been abbreviated on this form for
ease of understanding; however, grantees are required to comply with all
aspects of the assurances as they are stated in the Act.

I, the authorized representative of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ in
applying for a grant under Part C of Title XXVI, Public Health Service
Act, as amended by the Ryan White Comprehensive AIDS Resources Emergency
Act of 2000, P.L. 104-146, 42 U.S.C. 300ff-51 - 300ff-67, hereby certify
that:

I understand I can obtain a copy of the Title XXVI, PHS Act Part C,
Subparts II and III at http://www.hab.hrsa.gov/ to gain full knowledge
of its contents.

Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

In addition, I certify that:

I. As required in section 2651 (b):

A. Grant funds will be expended for the purposes of providing, on an
outpatient basis, each of the following early intervention Required
Services:

1\. Counseling individuals with respect to HIV disease in accordance
with section 2662;

2\. Testing to confirm the presence of HIV infection; to diagnose the
extent of immune deficiency; to provide clinical information on
appropriate therapeutic measures for preventing and treating the
deterioration of the immune system and for preventing and treating
conditions arising from the disease;

3\. Other clinical preventive and diagnostic services regarding HIV
disease, and periodic medical evaluations of individuals with the
disease;

4\. Providing the therapeutic measures described in 2. above; and

5\. Referrals described in section 2651(b) (3);

B. Grantee will expend not less than 50% of grant funds awarded for
activities described in 2-5 above.

C. Each of the early intervention services in A. will be available
through the applicant entity.

D. Grant funds may also be expended to provide, on an optional basis,
the following services:

1\. Outreach services to individuals who may have HIV disease or may be
at risk, and who may be unaware of the availability and potential
benefits of early treatment of the disease, and to provide outreach
services to health care professionals who may be unaware of such
availability and potential benefits; and

2\. Case-management services to provide coordination in the provision of
the health services to the individuals and to review the extent of
utilization of the services by the individuals; and

3\. Assistance to the individuals regarding establishing the eligibility
of the individuals for financial assistance and services under Federal,
State, or local programs providing for health services, mental health
services, social services and other appropriate services.

II\. As required under section 2651 (c): The applicant for the grant
agrees to make reasonable efforts to participate in a consortium
established with a grant under section 2612(a)(1), if such a consortium
exists in the geographic area.

III\. As required under section 2654 (a): Provisions of services to
persons with hemophilia will be made and/or coordinated with the network
of comprehensive hemophilia diagnostic and treatment centers.

IV\. As required under section 2661 (a) : The confidentiality of all
information relating to the person(s) receiving services will be
maintained in accordance with applicable law.

V. As required under section 2661 (b) : Informed consent for HIV testing
will be obtained.

VI\. As required under section 2663: All testing, without regard as to
whether funded by Federal funds, will be carried out in accordance with
sections 2661 and 2662.

VII\. As required under section 2664 (a) (2): A report to the Secretary
in the form and on the schedule specified by the Secretary will be
submitted.

VIII\. As required under section 2664 (b): Opportunities for anonymous
counseling and testing will be provided.

IX\. As required under section 2664 (c): Individuals seeking services
will not have to undergo testing as a condition of receiving other
health services.

IX\. As required under section 2664 (d): The level of pre-grant
expenditures for early intervention services will be maintained at the
level of the year prior to the grant year.

X. As required under section 2664 (e): A sliding fee schedule with
limits and conditions specified in section 2664 (e) will be utilized.

XI\. As required under section 2664 (f): Funds will not be expended for
services covered, or which could reasonably be expected to be covered,
under any State compensation program, insurance policy, or any Federal
or State health benefits program; or by an entity that provides health
services on a prepaid basis.

XII\. As required under section 2664 (g): Funds will be expended only
for the purposes awarded, such procedures for fiscal control and fund
accounting as may be necessary will be established, and not more than 10
percent of the grant will be expended for administrative expenses

XIII\. As required under section 2667: Agreement that counseling
programs shall not be designed to promote, or encourage directly,
intravenous drug abuse or sexual activity, homosexual or heterosexual;
shall be designed to reduce exposure to and transmission of HIV disease
by providing accurate information; and shall provide information on the
health risks of promiscuous sexual activity and intravenous drug abuse.

Signature:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

# Attachment C Program Requirements and Expectations 

Funded EIS programs must provide the proposed services directly and/or
through formal agreements with public or private nonprofit entities.
Programs may contract with for-profit entities to provide some of the
services if these are the only available providers of quality HIV care
in the area.

A minimum of 50 percent of funds awarded must be spent on providing
primary care services to HIV-positive individuals. The HAB encourages
applicants to exceed this minimum requirement. No more than 10 percent
of the grant may be spent on administrative expenses.

**Required Services**

The following primary care services must be provided to all persons
living with HIV/AIDS, whether on-site or at another facility:

1.  **HIV counseling, testing, referral, and partner counseling
    services.**

HIV counseling, testing, referral, and partner counseling should be
provided for all individuals in your targeted service population but
should not be duplicative if these are available and accessible to your
target population(s). Instead, linkages and formal referral mechanisms
should be established with these programs to ensure follow-up and
evaluation for those persons identified as HIV-positive.

If HIV counseling, testing, referral and partner counseling are provided
directly by your program, these services must comply with provisions
stipulated by the Centers for Disease Control and Prevention (CDC) in
accordance with Sections 2661, 2662 and 2663 of the Ryan White CARE Act
(see Attachment A). Your program also must agree to assure the
confidentiality of patient information in compliance with applicable
Federal, state and local law.

2.  **Medical evaluation and clinical care, such as CD4 cell monitoring,
    viral load testing, antiretroviral therapy, prophylaxis and
    treatment of opportunistic infections, malignancies and other
    related conditions, routine immunizations, prevention of perinatal
    transmission, and patient education including linkage to prevention
    services.**

Individuals must be offered a comprehensive continuum of HIV care
including primary medical care and, when applicable, perinatal care. At
a minimum, your program, in accordance with the latest Public Health
Service (PHS) standards, should provide periodic medical evaluations;
appropriate treatment of HIV infection; and prophylactic and treatment
interventions for complications of HIV infection, including
opportunistic infections, opportunistic malignancies and other AIDS
defining conditions. Your program also must provide for a system to
confirm the presence of HIV infection, and must provide tests to
diagnose the extent of deficiency in the immune system. Individuals must
have access to ongoing prevention services while other treatment is
being administered. The system of care must provide appropriate
diagnostic and therapeutic measures for preventing and treating the
deterioration of the immune system and related conditions, conforming to
the most recent clinical care protocols. Your program must also have a
system in place for after-hours and weekend clinical coverage for
medical and dental services.

> Your program is required to have a plan for handling referrals to and
> enrollment in clinical trials offered by biomedical research
> facilities or community-based organizations that conduct HIV-related
> clinical trials. For information on these protocols call the AIDS
> Clinical Trials Information Service at 1-800-TRIALS-A.
>
> Tuberculosis, Hepatitis B and C, and sexually transmitted infections
> (STI) evaluation and treatment are indispensable components of an HIV
> primary care program. To the extent that a service area or
> sub-population within the service area is experiencing accelerating
> case rates of tuberculosis, Hepatitis B and C, or STDs, HIV programs
> should develop diagnosis, prophylaxis and treatment services. For
> example, tuberculosis screening should be routine follow-up for all
> patients diagnosed as HIV-positive.

To ensure consistency and continuity of care, your program's clinical
staff should track and coordinate all inpatient care and referrals.
Staff should develop plans for the resumption of the patient\'s care at
your program once discharged from the hospital.

> Please note the following types of patient care, services and costs
> are not supported by Title III EIS:

-   inpatient hospitalization

-   hospice

-   residential treatment

-   clinical research

-   nursing home care

-   needle exchange services

-   cash payments to clients

-   purchasing or improving real property

    In the face of rapidly changing clinical management of HIV disease,
    continuing education opportunities must be provided to EIS program
    staff to ensure they remain abreast of clinical advances and adjust
    clinical protocols accordingly. In addition, your program must
    implement and practice recommendations as presented in the following
    Public Health Service Guidelines. These publications are available
    on-line at *http://www.aidsinfo.nih.gov/* or may be obtained by
    calling: 1-800-HIV-0440.

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-   Guidelines for the Use of Antiretroviral Agents in HIV-Infected
    Adults and Adolescents

-   Guidelines for the Prevention of Opportunistic Infections in Persons
    Infected with HIV

-   Guidelines for the Use of Antiretroviral Agents in Pediatric HIV
    Infection

-   Public Health Service Task Force Recommendations for the Use of
    Antiretroviral Drugs in Women Infected with HIV-1 for Maternal
    Health and Interventions to Reduce Perinatal HIV-1 Transmission in
    the U.S.

Your program should ensure patients have the opportunity to actively
participate in decision-making about their personal health care regimen.
Patients should be involved and fully educated about their medical needs
and treatment options within the standards of medical care. A document
describing patient rights and responsibilities should be posted in a
prominent place within the facility, and policies should be reviewed
with each patient at intake. The policies and posted document should
clearly describe the recourse a patient has if he/she is dissatisfied
with the care provided.

3.  **Other primary care medical services provided either directly or
    through a formal referral mechanism, including oral health care,
    adherence counseling, outpatient mental health care, outpatient
    substance abuse treatment, nutritional services, and specialty
    medical care.**

In addition to providing each patient with a thorough medical evaluation
and related clinical care, your program should provide, directly or via
referral, access to oral health care, adherence counseling, outpatient
mental health care, outpatient substance abuse treatment, nutritional
services and specialty medical care as described below. If you are
unable to provide any of these services on-site, your program must
establish and demonstrate formal arrangements such as contracts or
memoranda of understanding with appropriate providers. It is recommended
that all practitioners for these services have experience working with
the target population and with HIV.

-   **Oral Health:** Grant funds may be used to support the provision of
    oral health services by general dental practitioners, dental
    specialists, dental hygienists and other trained dental providers in
    on-site facilities. You also may use these funds to secure or
    subsidize such services obtained off-site by referral. Funding may
    also be available through Title I, Title II and Title IV-supported
    programs in your area. If a HRSA supported HIV/AIDS Dental
    Reimbursement Program exists in your service area, document efforts
    to collaborate with that program. A list of HRSA supported HIV/AIDS
    Dental reimbursement programs is available on-line at:
    [http://www.hab.hrsa.gov/programs/dentallist.htm.]{.underline}

-   **Adherence:** Successful adherence programs are most effective when
    they use a multi-disciplinary approach. Your adherence program might
    include readiness assessments, patient education, adherence
    monitoring and counseling.

-   **Outpatient Mental Health:** Outpatient mental health services
    include assessment, diagnosis, and treatment. Optimal mental health
    treatment requires a multidisciplinary approach involving primary
    care or specialty physicians and mental health professionals who are
    trained, experienced, and/or certified in the field.

-   **Substance Abuse Services:** Outpatient substance abuse services
    include assessment, diagnosis, and treatment. Optimal substance
    abuse treatment requires a multidisciplinary approach involving
    primary care or specialty physicians and substance abuse
    professionals who are trained, experienced, and/or certified in the
    field.

-   **Nutritional Services:** Nutritional services include
    dietary/nutritional evaluation, nutritional supplements, and
    nutrition education or counseling, optimally provided by a licensed
    registered dietitian or nutritionist.

-   **Specialty Care:** Clients must have access to specialty and
    subspecialty care. Such services include oncology, dermatology,
    ophthalmology, gynecology and pulmonary.

**Prevent new infections by working with persons diagnosed with HIV and
their partners:**

> You are encouraged to incorporate the ***"Recommendations for
> Incorporating HIV Prevention into Medical Care of Persons Living with
> HIV"*** into your clinical program. These recommendations were
> developed jointly by the Centers for Disease Control and Prevention
> (CDC), the Health Resources and Services Administration (HRSA), the
> National Institute of Health (NIH) and the HIV Medicine Association
> (HIVMA) of the Infections Diseases Society of America (IDSA)
> (Morbidity and Mortality Weekly Report July 18, 2003, Volume 52,
> Number RR-12).
>
>  
>
> *Recommendations for Incorporating HIV Prevention into Medical Care of
> Persons Living with HIV"*
> ([www.cdc.gov/mmwr/preview/mmwrhtml/rr5212a1.htm)]{.underline} provide
> rationale and guidance for making risk screening, STD screening, and
> prevention messages part of the routine medical care you deliver to
> patients with HIV infection. As health care providers, you are in a
> unique position to help persons living with HIV/AIDS stop the spread
> of HIV. Because physicians, nurses, nurse's practitioners, and
> physician assistants have a strong influence on patients' behavior,
> you can positively impact health issues by screening for STDs,
> delivering brief prevention messages and asking patients about risk
> behaviors, in ways that are culturally and linguistically appropriate,
> during patient visits. Health care providers can help to reduce the
> number of new HIV infections and impact the HIV epidemic by:
>
>  

-   **Screening patients for behavioral risk** through interviews or
    questionnaires regarding sexual and needle-sharing behaviors and
    screening for STDs and pregnancy.

-   **Offering behavioral interventions** to change knowledge,
    attitudes, and behaviors to reduce personal risk of transmitting or
    acquiring other STDs. These might include posters and brochures in
    waiting and exam rooms; verbal discussions with patients
    supplemented by written materials; condoms readily accessible in the
    clinic; and referral to other persons or organizations providing
    services such as substance abuse treatment.

-   **Providing partner counseling and referral services (PCRS**),
    including partner notification, as described above. Such services
    can help the sex and needle-sharing partners of HIV-infected
    patients learn their HIV status and take steps to avoid becoming
    infected (or, if infected, to avoid infecting others) and gain
    earlier access to medical evaluation, treatment, and other services.

    Copies of the recommendations can be ordered by calling the National
    Prevention Information Network (NPIN) at (800) 458-5231 or visiting
    the NPIN Website at [www.cdcnpin.org.]{.underline}

    **Other Program Services**

    When funds are not available from other sources, EIS programs may
    use Title III EIS funds to provide other program services necessary
    to ensure a comprehensive continuum of primary care services. To
    obtain funding for these services, justify why they cannot be
    purchased using other funding sources. Other program services
    include:

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-   **Outreach** to: a) those who may be at high risk of contracting the
    disease and need referral for counseling and testing; b) those who
    may have HIV disease in order to explain the benefits of early
    intervention and link them into care; and c) providers to make them
    aware of the availability and benefits of EIS/primary care.

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-   **Eligibility Assistance** to individuals in establishing
    eligibility for financial support and services under Federal, state,
    or local programs providing health services, mental health services,
    social services, or other appropriate services.

-   **Case Management to persons infected with HIV including referrals
    for appropriate social support services.**

    Outreach and case management services may not be duplicative of
    other existing and accessible community resources. They must be
    coordinated with the outreach and case management activities funded
    under Title I, Title II, or Title IV of the Ryan White CARE Act, or
    any other funding source. Outreach must be consistent with HAB
    Policy Notice 02-01: Use of Ryan White CARE Act Funds for Outreach
    Services, available on the web at
    [http://hab.hrsa.gov/law/0201.htm.]{.underline}

    Although you are not required to provide case management and
    eligibility assistance services, you must ensure your clients have
    access to these services. Although you are not required to provide
    outreach services, you must have a plan for identifying and linking
    people at high risk for HIV into counseling and testing and linking
    those living with HIV into care at your program.

**Required Policies and Procedures for Program Operations**

**Referral System**

Your program must have a system in place for referring patients to
health and social services. You may use Title III EIS funds to create
and implement a referral process, and for related evaluation,
diagnostic, and treatment services. Your system should include a
referral mechanism for specialty and subspecialty care. However, because
the emphasis of Title III EIS funding is for primary medical care, Title
III EIS funds should not be used for specialty consultations and
treatment at the expense of providing basic HIV primary care services.

Your referral system must include a process for tracking and monitoring
referrals. Your system also should have a mechanism in place for
documenting the results of the referral from the providers of health and
support services to which patients are referred.

**Coordination and Linkages to Other HIV Programs**

Optimum patient care results when grantees are knowledgeable about and
coordinate with all available and accessible community resources. These
resources may include federally-funded and non-federally-funded programs
such as homeless, housing, substance abuse treatment, mental health
treatment and other supportive services. Your proposed program must:

-   **Be consistent with the Statewide Coordinated Statement of Need
    (SCSN).**

-   **Agree to participate in the ongoing revisions of the SCSN.**

    A copy of the SCSN can be obtained from your State's Ryan White CARE
    Act Title II Director. In addition, your program is required to
    coordinate services with other providers of health care services
    funded by the Ryan White CARE Act including Title I, Title II, Title
    III EIS, Title IV, Special Projects of National Significance, AIDS
    Education and Training Centers, the Dental Reimbursement Program,
    and the new Community Based Dental Partnership Program. If your
    organization is located in an Eligible Metropolitan Area (EMA), you
    are encouraged to participate in the activities of the Ryan White
    CARE Act Title I Planning Council. Applicants must demonstrate that
    they have coordinated with and not duplicated Title I services. If
    your program is located in a State/territory that has created a
    Title II HIV Care Consortium, you must make reasonable efforts to
    participate in that consortium. If your program is located near
    existing Title III EIS funded programs or Title III EIS HIV Planning
    Grant Programs, you are expected to demonstrate that your program
    does not duplicate services provided in your service area and target
    population. You also are expected to coordinate and collaborate with
    other Title III EIS programs. If your program is located in the
    service area of an existing Title IV program you are expected to
    collaborate and coordinate services for women, infants, children and
    youth. A listing of Ryan White CARE Act grantee contact information
    can be found on
    [http://www.hab.hrsa.gov/programs/granteecontact.htm.]{.underline}

    You are expected to collaborate with ongoing HIV prevention
    activities and establish formal linkages for referrals of
    HIV-positive individuals for care. You are also expected to
    collaborate with Community Health Centers and other publicly funded
    primary care services, mental health and substance abuse treatment
    services including those funded by the Substance Abuse and Mental
    Health Services Administration (SAMHSA) and research programs
    including those funded by the National Institutes of Health (NIH).

**Continuous Quality Improvement (CQI)**

HAB has defined quality as follows:

> "Quality is the degree to which a health or social service meets or
> exceeds established professional standards and user expectations.
> Evaluations of the quality of care should consider (1) the quality of
> inputs, (2) the quality of the service delivery process, and (3) the
> quality of outcomes, in order to continuously improve systems of care
> for individuals and populations."

Your CQI program should ensure that systematic and continuous processes
are in place for planning, implementing, and evaluating improvement
strategies. If other organizations provide primary care for your
organization via subcontract, you are responsible for assuring that CQI
systems are in place at those organizations. Your subcontracts must
include provisions regarding monitoring and CQI, and you may require
regular reporting from your subcontractors on this issue.

The three-fold purpose of CQI is to ensure:

-   Funded services adhere to established HIV clinical practice
    standards and Public Health Service (PHS) guidelines.

-   Strategies for improvements to quality medical care include vital
    health-related supportive services in achieving appropriate access
    and adherence with HIV medical care.

-   Available demographic, clinical, and health care utilization
    information is used when developing and adapting programs to address
    changing trends in the epidemic.

All Title III EIS CQI programs must include clinical goals and outcomes.
Examples of clinical outcomes you may choose to measure include, but are
not limited to the following:

-   Change in the number of patients with CD4+ (cells/mm^3^) count under
    350.

-   Change in the number of patients with viral load (HIV-1 RNA
    copies/mL) under 10,000.

-   Change in the number of patients on highly active antiretroviral
    therapy (HAART) who received adherence counseling/intervention at
    their last visit.

-   Use of prophylaxis for *pneumocystis carinii* pneumonia (PCP) and/or
    *mycobacterium avuim complex* (MAC) at a prescribed point in time
    among active patient load.

-   Change in the number of female patients receiving pap smears in the
    last six months.

-   Change in the frequency or duration of hospitalizations.

-   Change in the average waiting time for first appointment.

-   Change in the percent of patients with visit(s) in the last three
    months.

    In addition to clinical outcomes, your CQI program also must have:

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-   Designated leaders and accountability.

-   Routine data collection and analyses of data on measurable outcomes.

-   A system for ensuring that data are fed back into your
    organization's quality improvement process to assure goals are
    accomplished.

-   Consistency, to the extent possible, with other programmatic quality
    improvement activities such as the Joint Commission on the
    Accreditation of Healthcare Organizations (JCAHO), Medicaid, and
    other HRSA funded programs.

    HAB also encourages grantees to conduct CQI for the administrative
    and fiscal components of their organization.

**Program Evaluation**

Your program is required to develop an evaluation strategy with outcome
measures that demonstrate achievement of your program goals and
objectives and the impact of the program. You are required to have an
information system that has the capacity to manage and report the
following administrative, fiscal, and clinical data:

-   The number of individuals provided early intervention
    services/primary care.

-   Demographic data on the clients receiving services.

-   Epidemiological data on the population receiving services, including
    the extent of new TB infections, active TB cases, and multi-drug
    resistant tuberculosis (MDR-TB).

-   Exposure and diagnostic categories on the population receiving
    services.

-   The number of HIV infected individuals and the CDC classification of
    their disease.

-   The extent to which the costs of HIV‑related health care are paid by
    third party payers.

-   The average costs of providing each category of early intervention
    service/primary care.

-   The aggregate totals for each category of data.

    Routinely analyzing these data will assist you in making
    programmatic or fiscal adjustments that will benefit your program
    and patients. In addition, you will utilize these data when you
    write the Progress Report of your annual non-competing grant
    application and the annual CARE Act Data Report that is due each
    March.

**Medicaid Participation**

Your program must be a participating Medicaid entity for all services
that are covered under your state plan, and must document that status.
If you subcontract with a public or private entity to provide Medicaid
reimbursable services, that entity must also be a participating Medicaid
provider. If you or a subcontractor does not impose a charge or accept
reimbursement for health services from any third party, HAB may grant a
waiver of this requirement. Submit the waiver request as part of your
grant application.

If your State or local government requires a license or certification
before clinical services can be provided, provide documentation that you
are licensed to provide such services.

**Patient Payment for Services**

Your program must develop consistent and equitable policies and
procedures related to verification of patients' financial status,
implementation of a sliding fee scale, and ensuring a cap on patient
charges for HIV-related services. In order to comply with these
requirements, your program may need to provide additional staff
training, develop patient education materials, and/or place notices in
patient waiting rooms and reception areas.

-   **Sliding Fee Scale** Clients cannot be denied primary care if they
    are not able to pay for services. Title III EIS programs must
    provide a system to discount patient payment for charges by
    developing and utilizing a sliding discounted fee schedule that is
    published and made readily available. The scale must be based on the
    patient's income. The law prohibits imposing a first-party charge on
    individuals whose income is at or below 100 percent of the Federal
    Poverty Level and requires that individuals with incomes above the
    official poverty level be charged for services. Each program is
    responsible for creating its own sliding fee scale in accordance
    with the most recent Federal Poverty Level guidelines. Federal
    Poverty Guidelines are updated each year in early spring, and are
    available on the web at
    <http://aspe.hhs.gov/poverty/index.shtml#latest.>

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-   **Patient Cap on Charges** The law limits the annual cumulative
    charges to an individual for HIV‑related services to:

+----------------------------+-----------------------------------------+
| **Family Income**          | > **Maximum Charge**                    |
+----------------------------+-----------------------------------------+
| At or below 100% of        | \$0                                     |
| Poverty                    |                                         |
+----------------------------+-----------------------------------------+
| 101% to 200% of Poverty    | No more than 5% of gross annual income  |
+----------------------------+-----------------------------------------+
| 201% to 300% of Poverty    | No more than 7% of gross annual income  |
+----------------------------+-----------------------------------------+
| Over 300% of Poverty       | No more than 10% of gross annual income |
+----------------------------+-----------------------------------------+

Your Title III EIS program must have a system in place to ensure that
these annual caps on charges to patients are not exceeded.

**Program Income** Programs are required to maximize the service
reimbursement available from private insurance, Medicaid, Medicare, and
other third-party sources. Programs are required to track and report all
sources of service reimbursement as program income on the annual
Financial Status Report and in annual data reports. All program income
earned must be used to further your HIV program objectives.

**Limitation on Administrative Expenses** Not more than 10 percent of
the approved Title III EIS Federal grant funds may be used for
administrative costs. Indirect costs will be allowed only if the
applicant has a Federal negotiated indirect cost rate. All indirect
costs are considered administrative and subject to the 10 percent
limitation.

**Other Financial Issues** Programs must have appropriate financial
systems in place that provide for internal controls, safeguarding
assets, ensuring stewardship of Federal funds, maintaining adequate cash
flow to meet daily operations, assuring access to care, and maximizing
revenue from non-Federal sources.

There is no required match or other cost participation requirement for
these categorical grants. However, the level of non-Federal expenditures
for HIV early intervention services/primary care must be maintained at
the level for the year prior to the grant award. Grantees are expected
to maximize revenues from grant-supported services and other
government/private grants and not supplant existing services using Title
III EIS funds.

Clients who need medications and are eligible for state drug
reimbursement programs funded under Title II of the Ryan White CARE Act
or other pharmaceutical programs should be assisted in accessing these
resources prior to the use of Title III EIS grant funds for such
purposes.

**Additional Policies and Procedures for Program Operations**

**Consumer Involvement**

It is a program expectation that EIS programs will actively involve
consumers in program development, implementation, and evaluation
activities. "Consumers" are defined as persons living with HIV/AIDS
(PLWH's) or their representatives (i.e., those who represent PLWH's who
are unable to speak for themselves such as HIV+ children and severely
ill individuals) who are served by your program.

There are many ways to involve consumers, and each program should design
consumer involvement that best suits its situation. To accomplish
effective consumer involvement, programs should provide necessary
training, mentoring, supervision, and reimbursement of expenses.
Examples of consumer involvement are:

-   HIV consumer representation on the organization's Board of
    Directors.

-   Establishment of an HIV specific Consumer Advisory Board.

-   HIV consumer representation on an existing consumer advisory board.

-   Involvement of HIV consumers on workgroups, committees and task
    forces, such as a Program Committee, an Outreach Task Force, or a
    Patient Education Committee.

-   Using HIV consumers as peer educators, outreach workers, or staff in
    the clinic, with fair and equitable pay for the job they are hired
    to perform.

-   Involving HIV consumers through surveys, consumer forums, and focus
    groups.

-   Using HIV peer trainers to work directly with patients to help them
    address issues. related to making healthy decisions, gaining access
    to clinical trials, managed care, etc.

**Drug Discount Purchasing Program**

Programs funded under this grant are eligible for and should demonstrate
participation in the HRSA Bureau of Primary Health Care 340B Drug
Discount Purchasing Program. This program enables Title III EIS grantees
to purchase medications at a reduced rate. Detailed program information
is available on-line at http://www.hrsa.gov/odpp/default.htm

For more information, contact:

Office of Pharmacy Affairs

4350 East West Highway, 10th Floor

Bethesda, MD 20814

1-800-628-6297

# Attachment D Sample Project Abstract

**PROJECT ABSTRACT**

**Rainbow City Health Center**

SUMMARY OF REQUEST: The Rainbow City Health Center (RCHC), is proposing
to provide comprehensive primary care services to HIV-positive clients.
Services to be provided will include counseling and testing, nutrition,
and oral health. RCHC also proposes to implement a continuous quality
improvement plan. RCHC requests funding preference for both increased
burden and rural and underserved areas.

> TARGETED POPULATION: RCHC, a not-for profit agency, has served five
> rural counties in Central New York for the last 37 years. Of the
> clients served, approximately 56 percent are Caucasian, 35 percent
> African-American, 6 percent Latino and 3 percent Native American. The
> city of Rainbow City is a depressed community with 47 percent of the
> population living at or below the Federal poverty level. Alcohol is
> the drug of choice in the community though reports of crack cocaine
> use are on the rise. The level of homelessness has maintained a
> constant level over the past three years. Local data suggests that an
> average of 260 individuals and families are homeless at any one point
> in time.
>
> A total of 1,760 cases of AIDS have been diagnosed in the health
> center=s service area. Within the last year, 157 AIDS cases have been
> diagnosed in the five county area and an additional 432 cases of HIV
> disease have also been identified. This represents a 17 percent
> increase from data obtained in 2000. Unprotected sex is the most
> common risk factor. The majority of AIDS cases diagnosed have been
> reported in white, men having sex with men. The second largest segment
> of AIDS cases has been reported in women of color. More than
> two-thirds of the cases of AIDS occurred in men and women between the
> ages of 21 and 40 years. Seven cases of dually diagnosed HIV and TB
> were reported in 2001 which represents a 7 percent increase from 2000.
>
> The proposed project targets men and women at-risk for HIV disease in
> the five-county service area. Specific activities will be implemented
> to reach the high risk populations with particular emphasis on men
> having sex with men and women of color. Many of the individuals in
> most need of health care services are the least likely to obtain care
> due to issues surrounding confidentiality and stigma. The project is
> designed to impact the service delivery system in such a way that many
> of the obstacles and barriers to care will be overcome.
>
> CURRENT HIV SERVICE ACTIVITIES: Over the last 7 years, Rainbow City
> Health Center has increased the number and range of services available
> to HIV-infected and affected individuals. Primary care services are
> provided by a part-time physician and nurse practitioner. Care is
> coordinated by a nurse case manager. Primary care services include the
> diagnosis and treatment of HIV disease, prophylactic and treatment
> interventions for opportunistic infections and other complications,
> referral for clinical trials and specialty care. Inpatient hospital
> care is coordinated with the local hospital through frequent
> communication with the attending physicians and discharge planners. A
> local hospice and a home health agency participate in monthly case
> conferences as appropriate.
>
> In 2001, a total of 275 HIV-positive patients received primary care
> services through the Rainbow City Health Center. This represented
> 2,510 medical encounters. Of the patients served, 29 percent had a CD4
> count of less than 200, while 37 percent and 34 percent had CD4 counts
> between 200 and 500 and greater than 500, respectively. Approximately
> 23 percent of the clients are on combination therapy and 14 clients
> participated in clinical trials.
>
> In addition to the services provided directly by the health center,
> the local health department conducts anonymous and confidential HIV
> counseling and testing on site three days a week. This arrangement
> ensures easy access to care when an individual is newly diagnosed with
> HIV infection. A support group is offered by the local AIDS Service
> Organization at the health center twice a month.
>
> Counseling and testing activities and partner notification are
> supported by the CDC and the State of New York. The AIDS service
> organization receives funding through Title II funds. RCHC receives no
> Title II funds. The State drug assistance program is routinely
> accessed for persons living with HIV disease in need of pharmaceutical
> support. Limited funding is available for transportation. Because
> Rainbow City is not part of a Title I eligible metropolitan area, no
> Title I funds are available. The health center receives financial
> support from the State and other local organizations.
>
> PROBLEM: Within the last 12 months, the total number of patients
> served by the health center has increased by 27 percent. This increase
> is attributed to improved case finding and dissemination of services
> that are available at the health center. Aside from the local
> hospital, no other primary care centers are available for clients to
> receive quality medical care. Only a handful of private physicians
> care for HIV-positive patients in the private practice setting. The
> health center currently has a two-month waiting list for new patients.
> Because of the current case load, the amount of time allocated for
> patient education is limited. The advent of combination treatment
> requires increased patient education. Currently, no nutritional
> services are provided by the health center. The proposed project will
> expand the clinic hours and increase the number of clinicians able to
> provide quality primary care. Additional opportunities for patient
> education will be provided and a patient advisory board will be
> established. A part-time nutritionist will be available for consult,
> nutritional assessments and patient education and a dental services
> will be provided through a contract.
>
> GOALS AND OBJECTIVES: The overall goal of the project is to increase
> the accessibility of services to clients at-risk or infected with HIV
> disease. The major objectives of the project include the
> provision/implementation of:
>
> 1\. primary care services to 110 new clients;
>
> 2\. counseling and testing for 400 clients in conjunction with the
> local health department;
>
> 3\. patient education for 250 clients, family members and significant
> others around issues such as combination therapy, health maintenance,
> clinical trials, complementary therapies, food safety and infection
> control;
>
> 4\. nutritional services to 75 clients;
>
> 5\. oral health care services to 110 new clients;
>
> 6\. improved follow-up with referrals to specialty care;
>
> 7\. a patient advisory board; and
>
> 8\. a continuous quality improvement plan

# Attachment E Service Areas 

These service areas are up for competition for July 1, 2006. New
proposals to replace existing grantees are expected to cover the entire
service area of the existing grantee. Each grantee's service area is
listed separately.

  ----------------- ---------------- ------- ---------------------------------
  Service areas of                           
  Title III EIS                              
  grantees up for                            
  competition for                            
  July, 2006:                                

  Grantee           City             State   Service Area (counties)

  MOBILE COUNTY     MOBILE           AL      BALDWIN, CHOCTAW, CLARKE, MOBILE,
  HEALTH DEPARTMENT                          MONROE, WASHINGTON

  UNIVERSITY OF     BIRMINGHAM       AL      BLOUNT, CULLMAN, JEFFERSON,
  ALABAMA AT                                 SHELBY, ST CLAIR, WALKER, WINSTON
  BIRMINGHAM                                 

  REGENTS OF        LA JOLLA         CA      SAN DIEGO
  UNIVERSITY OF                              
  CALIFORNIA                                 

  SANTA BARBARA     SANTA BARBARA    CA      SANTA BARBARA
  COUNTY HEALTH                              
  DEPARTMENT                                 

  CATHOLIC          LONG BEACH       CA      LOS ANGELES EMA
  HEALTHCARE WEST                            

  SONOMA COUNTY     SANTA ROSA       CA      SONOMA
  HEALTH SERVICES                            
  DEPARTMENT                                 

  SHASTA COMMUNITY  REDDING          CA      SHASTA
  HEALTH CENTER                              

  CONTRA COSTA      MARTINEZ         CA      CONTRA COSTA
  COUNTY HEALTH                              
  SERVICES DEPT                              

  CENTRO DE SALUD   SAN YSIDRO       CA      SAN DIEGO
  DE LA COMUNIDAD                            
  SAN YSIDRO                                 

  CHARLES R DREW    LOS ANGELES      CA      LOS ANGELES
  UNIVERSITY OF                              
  MEDICINE AND                               
  SCIENCE                                    

  FAIR HAVEN        NEW HAVEN        CT      NEW HAVEN
  COMMUNITY HEALTH                           
  CLINIC, INC.                               

  FAMILY AND        WASHINGTON       DC      WASHINGTON DC
  MEDICAL                                    
  COUNSELING                                 
  SERVICE                                    

  CHRISTIANA CARE   WILMINGTON       DE      KENT, NEW CASTLE, SUSSEX
  HEALTH SERVICES,                           
  INC.                                       

  ORANGE COUNTY     ORLANDO          FL      ORANGE
  HEALTH DEPARTMENT                          

  UNCONDITIONAL     MELBOURNE        FL      BREVARD
  LOVE, INC.                                 

  ST. JOHNS COUNTY  SAINT AUGUSTINE  FL      ST JOHNS
  HEALTH DEPARTMENT                          

  UNIVERSITY OF     GAINESVILLE      FL      DUVAL
  FLORIDA                                    

  ALBANY AREA       ALBANY           GA      BAKER, CALHOUN, COLQUITT,
  PRIMARY HEALTH                             DECATUR, DOUGHERTY, EARLY, GRADY,
  CARE, INC.                                 LEE, MILLER, MITCHELL, SEMINOLE,
                                             TERRELL, THOMAS, WORTH

  GLYNN COUNTY      BRUNSWICK        GA      BRYAN, CAMDEN, GLYNN, LIBERTY,
  HEALTH DEPARTMENT                          LONG, MCINTOSH

  COLUMBUS          COLUMBUS         GA      CHATTAHOOCHEE, CLAY, CRISP,
  DEPARTMENT OF                              DOOLY, HARRIS, MACON, MARION,
  PUBLIC HEALTH                              QUITMAN, RANDOLPH, SCHLEY,
                                             STEWART, SUMTER, TALBOT, TAYLOR,
                                             WEBSTER, MUSCOGIE

  SIOUXLAND         SIOUX CITY       IA      WOODBURY, LYON, OSCEOLA,
  COMMUNITY HEALTH                           DICKENSON, IDA, SUE, O'BRIEN,
  CENTER                                     CLAY, PLYMOUTH, CHEROKEE, BUENA
                                             VISTA, UNION, SAC, MINONA,
                                             CRAWFORD, CARROLL, GREEN; NE:
                                             DAKOTA, DICKENSON, THURSTON, AND
                                             WAYNE

  ERIE FAMILY       CHICAGO          IL      COOK
  HEALTH CENTER,                             
  INC.                                       

  ACCESS COMMUNITY  CHICAGO          IL      COOK: CHICAGO, CHICAGO HEIGHTS,
  HEALTH NETWORK                             FORD HEIGHTS

  SOUTHERN ILLINOIS EAST ST LOUIS    IL      CLINTON, JERSEY, MADISON, MONROE,
  HEALTHCARE                                 ST CLAIR
  FOUNDATION                                 

  ROSELAND          CHICAGO          IL      COOK
  CHRISTIAN HEALTH                           
  MINISTRIES                                 

  UNIVERSITY OF     CHICAGO          IL      COOK
  ILLINOIS @                                 
  CHICAGO                                    

  UNIVERSITY OF     LOUISVILLE       KY      BULLITT, HENRY, JEFFERSON,
  LOUISVILLE                                 OLDHAM, SHELBY, SPENCER, TRIMBLE;
  RESEARCH FND                               IN: CLARK, FLOYD

  CHARITY HOSPITAL  NEW ORLEANS      LA      ORLEANS
  OF LOUISIANA AT                            
  NEW ORLEANS                                

  LOUISIANA STATE   SHREVEPORT       LA      BIENVILLE, BOSSIER, CLAIBORNE, DE
  UNIVERSITY HSC                             SOTO, RED RIVER, SABINE, WEBSTER

  GREATER LAWRENCE  LAWRENCE         MA      ESSEX, MIDDLESEX
  FAMILY HEALTH                              
  CENTER, INC                                

  CAMBRIDGE HEALTH  CAMBRIDGE        MA      MIDDLESEX
  ALLIANCE                                   

  JORDAN HEALTH     PLYMOUTH         MA      BARNSTABLE, PLYMOUTH
  SYSTEMS, INC                               

  TOTAL HEALTH CARE BALTIMORE        MD      BALTIMORE CITY

  GREATER BADEN     UPPER MARLBORO   MD      CHARLES, PRINCE GEORGE\'S
  MEDICAL SERVICES                           

  MINNEAPOLIS       MINNEAPOLIS      MN      ANOKA, CARVER, DAKOTA, HENNEPIN,
  MEDICAL RESEARCH                           RAMSEY, SCOTT, WASHINGTON
  FOUNDATION                                 

  DEPORRES DELTA    MARKS            MS      COAHOMA, PANOLA, QUITMAN
  MINISTRIES, INC.                           

  NEW HANOVER       WILMINGTON       NC      BLADEN, BRUNSWICK, COLUMBUS,
  REGIONAL MEDICAL                           DUPLIN, NEW HANOVER, ONSLOW,
  CENTER                                     PENDER

  METROPOLITAN      WASHINGTON       NC      BEAUFORT, BERTIE, CHOWAN, CRAVEN,
  COMMUNITY HEALTH                           GATES, HERTFORD, HYDE, MARTIN,
  SERVICES, INC                              PAMLICO, PASQUOTANK, PERQUIMANS,
                                             PITT, TYRRELL, WASHINGTON

  CAROLINA FAMILY   WILSON           NC      EDGECOMBE, NASH, WILSON
  HEALTH CENTERS,                            
  INC.                                       

  PLAINFIELD        PLAINFIELD       NJ      UNION
  NEIGHBORHOOD HLTH                          
  SERV CORP                                  

  SOUTHWEST         SANTA FE         NM      COLFAX, HARDING, LOS ALAMOS,
  C.A.R.E. CENTER                            MORA, RIO ARRIBA, SAN MIGUEL,
                                             SANTA FE, TAOS, UNION

  SETTLEMENT HEALTH NEW YORK         NY      NEW YORK
  AND MEDICAL                                
  SERVICES                                   

  JOSEPH P. ADDABBO ARVERNE          NY      QUEENS: Rockaway Peninsula,
  FAMILY HEALTH                              Queens County, New York City, New
  CENTER                                     York

  MORRIS HEIGHTS    BRONX            NY      BRONX
  HEALTH CENTER                              

  BROOKLYN PLAZA    BROOKLYN         NY      KINGS
  MEDICAL CENTER,                            
  INC.                                       

  BETANCES HEALTH   NEW YORK         NY      BRONX, KINGS, NEW YORK, QUEENS
  CENTER                                     

  ST LUKE\'S -      NEW YORK         NY      NEW YORK
  ROOSEVELT                                  
  HOSPITAL CENTER                            

  CATSKILL REGIONAL HARRIS           NY      SULLIVAN
  MEDICAL CENTER                             

  COMMUNITY HEALTH  NEW YORK         NY      BRONX, KINGS, NEW YORK, QUEENS,
  PROJECT, INC                               RICHMOND

  NORTH GENERAL     NEW YORK         NY      NEW YORK
  HOSPITAL                                   

  PROJECT RENEWAL,  NEW YORK         NY      NEW YORK
  INC.                                       

  COLUMBUS AIDS     COLUMBUS         OH      ATHENS, BELMONT, DELAWARE,
  TASK FORCE, INC.                           FAIRFIELD, FRANKLIN, GALLIA,
                                             GUERNSEY, HARRISON, HOCKING,
                                             JACKSON, LAWRENCE, LICKING,
                                             MADISON, MEIGS, MONROE, MORGAN,
                                             MUSKINGUM, PERRY, PICKAWAY, PIKE,
                                             ROSS, SCIOTO, UNION, VINTON,
                                             WASHINGTON

  CARE ALLIANCE     CLEVELAND        OH      ASHTABULA, CUYAHOGA, GEAUGA,
                                             LAKE, LORAIN, MEDINA, SUMMIT,
                                             TRUMBULL

  MCP HAHNEMANN     PHILADELPHIA     PA      PHILADELPHIA
  UNIVERSITY                                 

  AIDS CARE GROUP   CHESTER          PA      DELAWARE, PHILADELPHIA Primary
                                             targeted area is Chester, PA (in
                                             Delaware County)

  PINNACLE HEALTH   HARRISBURG       PA      DAUPHIN
  HOSPITALS                                  

  THE PENNSYLVANIA  HERSHEY          PA      BEDFORD, BLAIR, CUMBERLAND,
  STATE UNIVERSITY                           DAUPHIN, FULTON, HUNTINGDON,
                                             JUNIATA, LEBANON, MIFFLIN, PERRY

  ALBERT EINSTEIN   PHILADELPHIA     PA      BUCKS, MONTGOMERY, PHILADELPHIA:
  MEDICAL CENTER                             primary service/target area is
                                             Philadelphia zip codes of: 19119,
                                             19120, 19124, 19125, 19126,
                                             19134, 19135, 19138, 19140,
                                             19141, 19144, 19159.

  KEYSTONE RURAL    CHAMBERSBURG     PA      ADAMS, BERKS, FRANKLIN, LANCASTER
  HEALTH CENTER                              

  ST. JOSEPH        READING          PA      BERKS, SCHUYLKILL
  MEDICAL CENTER                             

  CONCILIO DE SALUD LOIZA            PR      MUNICIPALITIES OF LOIZA, CITIES
  INTEGRAL DE                                OF LOIZA AND CANAVANAS
  LOIZA, INC                                 

  RICHLAND          EASTOVER         SC      FAIRFIELD, RICHLAND, SUMTER
  COMMUNITY HEALTH                           
  CARE ASSN                                  

  NEW HORIZON       GREENVILLE       SC      ABBEVILLE, ANDERSON, EDGEFIELD,
  FAMILY HEALTH                              GREENVILLE, GREENWOOD, LAURENS,
  SERVICES, INC.                             MCCORMICK, OCONEE, PICKENS,
                                             SALUDA

  LOW COUNTRY       FAIRFAX          SC      AIKEN, ALLENDALE, BAMBERG,
  HEALTH CARE                                BARNWELL, CALHOUN, ORANGEBURG
  SYSTEM, INC.                               

  ROPER ST. FRANCIS CHARLESTON       SC      BERKELEY, CHARLESTON, COLLETON,
  FOUNDATION                                 DORCHESTER, FLORENCE, GEORGETOWN,
                                             HORRY

  REGIONAL MEDICAL  MEMPHIS          TN      SHELBY
  CENTER AT MEMPHIS                          

  COMPREHENSIVE     NASHVILLE        TN      BEDFORD, CANNON, CHEATHAM, CLAY,
  CARE CENTER                                COFFEE, CUMBERLAND, DAVIDSON, DE
                                             KALB, DICKSON, FENTRESS, GILES,
                                             HICKMAN, HUMPHREYS, JACKSON,
                                             LAWRENCE, LEWIS, LINCOLN, MACON,
                                             MARSHALL, MONTGOMERY, MOORE,
                                             OVERTON, PERRY, PICKETT, PUTNAM,
                                             ROBERTSON, RUTHERFORD, SMITH,
                                             STEWART, SUMNER, TROUSDALE, VAN
                                             BUREN, WARREN, WAYNE, WHITE,
                                             WILLIAMSON, WILSON

  HOUSTON REGIONAL  HOUSTON          TX      ANDERSON, CAMP, CHEROKEE, GREGG,
  HIV/AIDS RESOURCE                          HENDERSON, MARION, PANOLA, RAINS,
  GROUP INC.                                 RUSK, SMITH, UPSHUR, VAN ZANDT,
                                             WOOD, ANGELINA, HOUSTON, JASPER,
                                             NACOGDOCHES, NEWTON, POLK,
                                             SABINE, SAN AUGUSTINE, SAN
                                             JACINTO, SHELBY, TRINITY, TYLER,
                                             HARDIN, JEFFERSON, ORANGE,
                                             AUSTIN, CHAMBERS, COLORADO, FORT
                                             BEND, LIBERTY, MONTGOMERY,
                                             WALLER, WALKER, WHARTON

  INOVA HEALTH CARE FALLS CHURCH     VA      ARLINGTON, FAIRFAX, LOUDOUN,
  SERVICES                                   PRINCE WILLIAM

  VIRGINIA          RICHMOND         VA      RICHMOND
  COMMONWEALTH                               
  UNIVERSITY                                 

  MEDICORP HEALTH   FREDERICKSBURG   VA      CAROLINE, KING GEORGE, ORANGE,
  SYSTEM                                     SPOTSYLVANIA, STAFFORD,
                                             WESTMORELAND

  FREDERIKSTED      FREDERIKSTED     VI      ST. CROIX
  HEALTH CARE INC.                           

  YAKIMA VALLEY     TOPPENISH        WA      BENTON, COLUMBIA, YAKIMA
  FARMWORKERS                                
  CLINIC                                     

  COUNTRY DOCTOR    SEATTLE          WA      KING
  COMMUNITY CLINIC                           

  AIDS RESOURCE     MILWAUKEE        WI      ASHLAND, BARRON, BAYFIELD, BROWN,
  CENTER OF                                  BURNETT, CHIPPEWA, CLARK, DOOR,
  WISCONSIN                                  DOUGLAS, DUNN, EAU CLAIRE,
                                             FLORENCE, FOREST, KENOSHA,
                                             KEWAUNEE, LANGLADE, LINCOLN,
                                             MANITOWOC, MARATHON, MARINETTE,
                                             MENOMINEE, OCONTO, ONEIDA,
                                             OZAUKEE, RACINE, WALWORTH,
                                             WASHINGTON, WAUKESHA
  ----------------- ---------------- ------- ---------------------------------

[]{.mark}

[]{.mark}

[]{.mark}

# Attachment F Press Release on Reauthorization

[]{.mark}

![](media/image1.png){width="7.151388888888889in"
height="1.1395833333333334in"}**[HHS OUTLINES PRESIDENT'S PRINCIPLES FOR
REAUTHORIZATION]{.mark}**

[**OF RYAN WHITE CARE ACT**]{.mark}

[]{.mark}

[Comprehensive Approach Will Help Extend and Improve the Lives of Those
Living with HIV/AIDS and Increase Prevention Efforts]{.mark}

[]{.mark}

[]{.mark}

At a meeting today with members of the President's Advisory Committee on
HIV/AIDS, the CDC/HRSA Advisory Committee on HIV and STD Prevention and
Treatment and a broad range of stakeholder organizations, HHS Secretary
Mike Leavitt called on Congress to reauthorize the Ryan White CARE Act
in ways that will strengthen the program, support compassionate care and
treatment, and encourage prevention efforts.

"President Bush has made stemming the spread of HIV/AIDS a top priority
of his Administration, and the Ryan White CARE Act is essential to the
fight against this terrible disease here at home," Secretary Leavitt
said. "This act must be improved and modernized so we can bring
compassionate care and treatment to those Americans living with
HIV/AIDS. We urge Congress to reauthorize this vital legislation this
year."

Secretary Leavitt announced that President Bush has outlined five key
principles to make the legislation more responsive to those in need.
These principles include:

-   Serve the neediest first;

-   Focus on life-saving and life-extending services;

-   Increase prevention efforts;

-   Increase accountability; and

-   Increase flexibility.

For example, under these principles, funding would be distributed by
severity of need; unspent funds would be reallocated to state AIDS drug
assistance programs with the greatest need; a list of core medical
services would be developed to prioritize federal funding; states and
local providers would be required to increase coordination of delivery
of care; and states would be required to implement routine voluntary HIV
testing in public facilities.

"I am pleased to see the President's solid framework for the
reauthorization of the Ryan White CARE Act, which the Administration is
unveiling today. The general principles outlined are very similar to the
ones we on the HELP Committee adopted when we began our work on this key
legislation," Senator Mike Enzi (R-Wyo.) said. "I look forward to
working with the Administration, Senator Kennedy, my colleagues and
stakeholders in a bipartisan and bicameral way to reauthorize this
critical program. Together, we will develop crucial legislation that
will appropriately target key funding to domestic HIV/AIDS programs,
increase accountability, and recognize the evolving needs of those
infected and affected by HIV."

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act is a
broad-based approach to providing medical care, antiretroviral
treatments, and other services for those in greatest need of HIV/AIDS
assistance. The legislation must be reauthorized every five years, and
the next reauthorization is set for September 2005.

The President's FY 2006 budget request provides a total of \$2.1 billion
for Ryan White activities to address the health needs of Americans
living with HIV/AIDS, an increase of \$276 million since FY 2001.

In the United States although men who have sex with men represent the
largest proportion of HIV/AIDS diagnoses, the percentage of women being
infected has increased sharply with women now accounting for 27 percent
of new cases. Minority populations are particularly severely impacted:
in 2003 half the new cases of HIV/AIDS diagnosed were among African
Americans, a population that comprises only 12 percent of the U.S.
population.

"The need for modernization and improvement of the Ryan White CARE Act
is more evident than ever," Secretary Leavitt said. "HIV/AIDS in the
United States is becoming more and more like the global epidemic, which
challenges us to enact legislation that is more flexible and responsive
to a segment of the population who otherwise would not have access to
modern treatment and care."

The Ryan White CARE Act funds primary health care and support services
that improve access and extend time on treatment for people living with
HIV. First enacted by Congress in 1990, it was amended and reauthorized
in 1996 and again in 2000. The CARE Act reaches over 500,000 individuals
each year, making it the federal government's largest program
specifically for people living with HIV disease.

CARE Act services provide medical care, antiretroviral treatments, and
counseling and testing for those in greatest need. The CARE Act works by
funding local and state programs that provide primary medical care and
support services; health care provider training; and technical
assistance to help programs address implementation and emerging HIV care
issues.

# Attachment G President's Principles

**Ryan White CARE Act Reauthorization Principles**

\"Because HIV/AIDS brings suffering and fear into so many lives, I ask
you to reauthorize the Ryan White Act to encourage prevention, and
provide care and treatment to the victims of that disease. And as we
update this important law, we must focus our efforts on fellow citizens
with the highest rates of new cases, African-American men and women.\"

-President George W. Bush, State of the Union Address, February 2, 2005

**[Background: Extending And Improving The Lives Of Those Living With
HIV/AIDS]{.underline}**

In his State of the Union Address, President Bush called for the
reauthorization of the Ryan White Comprehensive AIDS Resources Emergency
(CARE) Act based on the principles of focusing Federal resources on
life-extending care; ensuring flexibility by targeting resources to
address areas of greatest need; and achieving results.

The President has made fighting the spread of HIV/AIDS a top priority of
his Administration, and he will continue to work with Congress to
support effective prevention and compassionate care and treatment. The
President\'s FY06 budget request provides a total of \$2.1 billion for
Ryan White activities to address the health needs of Americans living
with HIV/AIDS.

The Ryan White CARE Act is a comprehensive approach to providing medical
care, antiretroviral treatments, and counseling and testing for those in
greatest need of HIV/AIDS assistance. The legislation must be
reauthorized every five years, and the next reauthorization is set for
September 2005.

**[Principles For Reauthorization: Greater Flexibility To Serve Those
Most In Need]{.underline}**

Much has changed in the epidemiology and medical management of HIV/AIDS
since the Ryan White CARE Act was enacted in 1990. While it used to be
that those diagnosed with the disease had little hope, patients today
are living longer and healthier lives.

In order to make the legislation more responsive going forward,
especially for African-American and other minority communities who
disproportionately suffer from the disease, the Administration is
proposing the following principles for reauthorization:

      **Serve The Neediest First**

>       **Establish Objective Indicators To Determine Severity Of Need
> For Funding Core Medical Services.**
>
> Those in greatest need of HIV/AIDS assistance, including
> African-American and low-income individuals, have the fewest resources
> available to meet them. There are also significant differences in
> access to HIV care throughout the country. Recognizing the
> circumstances that contribute to different care needs is an important
> part of assisting those hardest to reach. To address the needs of
> these populations, the Secretary of Health and Human Services (HHS)
> would develop a \"severity of need\" for core services index (SNCSI).
> This index would be based upon objective criteria and be focused on
> core services. It would take into account not only HIV incidence, but
> levels of poverty, availability of other resources including local,
> state, and federal programs and support, and private resources. This
> SNCSI would determine formula allocations among states and eligible
> metropolitan areas. When combined with a requirement of maintenance of
> effort on the part of state and local governments, the SNCSI would
> address the differences in HIV/AIDS care.

      **Focus on Life-Saving and Life-Extending Services**

>       **Establish A Set Of Core Medical Services.** It is essential to
> identify the basic, primary medical care and medication needs of
> individuals with HIV/AIDS.
>
>       **Require That 75 Percent Of Ryan White Funds In Titles I-IV Be
> Used For Core Medical Services So That Federal Funds Are First Used To
> Support Life-Saving Services For The Most Impoverished Americans.** A
> person living with HIV/AIDS receives benefits from a range of
> services. Some of these are clearly life prolonging and essential to
> maintaining physical and mental health; others are not. Services that
> are essential (core services) should be prioritized for Federal
> funding.
>
>       **Maintain A Federal List Of AIDS Drug Assistance Plan (ADAP)
> Core Medications.** The HHS Secretary will develop and maintain a list
> of core ADAP drugs based upon those included in the *U.S. Department
> of Health and Human Service\'s Public Health Service HIV/AIDS Clinical
> Practice Guidelines for use of HIV/AIDS Drugs,* drugs needed for the
> treatment and prophylaxis of opportunistic diseases and drugs needed
> to manage symptoms associated with HIV infection. These medications
> should be prioritized for Federal funding.

      **Increase Prevention Efforts**

>       **Require States To Implement Routine Voluntary HIV Testing In
> Public Facilities And Work With Private Healthcare Providers To That
> Same End.** With an estimated 250,000 HIV-positive individuals unaware
> of their HIV-positive status, testing is a key element in prevention
> efforts. States will be encouraged, upon receipt of their Ryan White
> allocations, to adopt various important HIV prevention strategies,
> such as routine opt out HIV testing, contact tracing, and the
> recommendations of the CDC Advancing HIV Prevention Initiative.

      **Increase Accountability**

>       **Maintain The Current Statutory Requirement That All States
> Submit HIV Data By The Start Of Fiscal Year 2007.** Having a full
> picture of the scope of HIV is critical to successful care and
> treatment programs that prevent people from advancing to AIDS; because
> newer infections are increasingly likely to take place among
> minorities, this provision will better target funds to heavily
> impacted communities and aid in getting people into care sooner.
>
>       **Hold Grantees Accountable For Reporting On System And
> Client-Level Data And Progress.** Accurate counts of those served and
> those receiving core services will help better serve those in need, as
> well as enable caregivers to define performance measures and evaluate
> progress.
>
>       **Maximize Investments Through Stronger And More Specific
> Payer-Of-Last-Resort Provisions And Require Grantees To Seek
> Alternative Payment Sources Before Using Ryan White Funds.** The Ryan
> White program is to be used as a last resort for only HIV-positive
> individuals who are not able to access medical care through other
> means. To ensure that this is the case, other payers of care need to
> be exhausted before turning to Ryan White funds. HHS would conduct
> regular audits to ensure RWCA funds are used as the payer of last
> resort. Federal and state investments would be directed to fill gaps
> in the existing health care system rather than duplicate existing
> public or private activities.
>
>       **Require State And Local Care Delivery Coordination.** A
> coordinated effort between the states, cities, and other care
> providers is essential to effective, comprehensive care and prevention
> services. HHS would consult with state AIDS officials on discretionary
> grants and would provide to state AIDS officials all information
> necessary for states to coordinate HIV care and treatment with other
> Federally funded projects to maximize efficiency and effectiveness of
> AIDS services.
>
>       **Eliminate The Double Counting Of HIV/AIDS Cases Between Major
> Metropolitan Areas And The States.** Currently, in major metropolitan
> cities, AIDS cases are counted once as part of a city count and a
> second time in the overall state count. Therefore, HIV/AIDS cases in
> major metropolitan cities are counted twice. In an effort to ensure
> that every AIDS case is counted equally and to make sure that Federal
> funds are distributed fairly to those most in need of assistance, we
> must eliminate this double counting.
>
>       **Eliminate Current Provisions That Entitle Cities To Be \"Held
> Harmless\" In Funding Reductions.** Today, because of the way the
> existing formulae count the number of AIDS cases (by including cases
> spanning the last 10 years), metropolitan areas with newer epidemics
> receive disproportionately less than those with more longstanding
> problems. In order to more accurately reflect the current status of
> the epidemic, we must eliminate provisions that entitle cities to be
> \"held harmless\" in funding reductions.

      **Increase Flexibility**

>       **Allow The Secretary Of HHS To Redistribute Unallocated
> Balances Based On Need As Determined By Severity Of Need Measures.**
> To maximize all Ryan White funding, unspent funds from Titles I and II
> would revert to the Secretary of HHS for discretionary reprogramming
> to state ADAP programs with the greatest need.
>
>       **Allow Planning Councils To Serve As Voluntary And Advisory
> Bodies To Mayors.** State and local officials need maximum flexibility
> to respond to the epidemic and to direct funding to those in greatest
> need. Planning councils would be structured at the discretion of the
> mayor; could not have conflicts of interest; and would no longer be
> required to set priorities for spending.

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