Department of Health and Human Services

OFFICE OF 

INSPECTOR GENERAL 

 

THE CORE MEDICAL SERVICES 

REQUIREMENT IN THE RYAN 

WHITE PROGRAM 

 

Daniel R. Levinson 

Inspector General 

October 2009 

OEI-07-08-00240 
Office of Inspector General 

http://oig.hhs.gov 

The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as 

amended, is to protect the integrity of the Department of Health and Human Services 

(HHS) programs, as well as the health and welfare of beneficiaries served by those 

programs. This statutory mission is carried out through a nationwide network of audits, 

investigations, and inspections conducted by the following operating components: 

Office of Audit Services 

The Office of Audit Services (OAS) provides auditing services for HHS, either by conducting 

audits with its own audit resources or by overseeing audit work done by others. Audits 

examine the performance of HHS programs and/or its grantees and contractors in carrying 

out their respective responsibilities and are intended to provide independent assessments of 

HHS programs and operations. These assessments help reduce waste, abuse, and 

mismanagement and promote economy and efficiency throughout HHS. 

Office of Evaluation and Inspections 

The Office of Evaluation and Inspections (OEI) conducts national evaluations to provide 

HHS, Congress, and the public with timely, useful, and reliable information on significant 

issues. These evaluations focus on preventing fraud, waste, or abuse and promoting 

economy, efficiency, and effectiveness of departmental programs. To promote impact, OEI 

reports also present practical recommendations for improving program operations. 

Office of Investigations 

The Office of Investigations (OI) conducts criminal, civil, and administrative investigations 

of fraud and misconduct related to HHS programs, operations, and beneficiaries. With 

investigators working in all 50 States and the District of Columbia, OI utilizes its resources 

by actively coordinating with the Department of Justice and other Federal, State, and local 

law enforcement authorities. The investigative efforts of OI often lead to criminal 

convictions, administrative sanctions, and/or civil monetary penalties. 

Office of Counsel to the Inspector General 

The Office of Counsel to the Inspector General (OCIG) provides general legal services to 

OIG, rendering advice and opinions on HHS programs and operations and providing all 

legal support for OIG’s internal operations. OCIG represents OIG in all civil and 

administrative fraud and abuse cases involving HHS programs, including False Claims Act, 

program exclusion, and civil monetary penalty cases. In connection with these cases, OCIG 

also negotiates and monitors corporate integrity agreements. OCIG renders advisory 

opinions, issues compliance program guidance, publishes fraud alerts, and provides other 

guidance to the health care industry concerning the anti-kickback statute and other OIG 

enforcement authorities. 
 

Δ EXECUTIVE SUMMARY 

OBJECTIVE

1. To determine the extent to which Ryan White grantees expended 

grant funds on core medical services, as required. 

2. To describe effects of the core medical services requirement on 

grantee operations. 

3. To assess the Health Resources and Services Administration’s 

(HRSA) guidance on and project officers’ oversight of the core 

medical services requirement. 

BACKGROUND 

Enacted in 1990, the Ryan White CARE Act (the Act), as amended, 

established the Ryan White program to provide funding to grantees to 

develop, organize, coordinate, and operate effective and cost-efficient 

health care and support services for people with HIV and AIDS. 

Administered by HRSA, the Ryan White program had a budget of 

$2.1 billion in 2008. 

The Ryan White HIV/AIDS Treatment Modernization Act of 2006 

changed how Ryan White funds may be used, emphasizing life-saving 

and life-extending services for people living with HIV/AIDS. A key 

change made by this law provided more funds for direct health care 

services for Ryan White clients and established a requirement that 

certain grantees spend at least 75 percent of awarded grant funds on 

core medical services unless they receive waivers of this requirement. 

The requirement went into effect in 2007. Section 703 of the law 

repealed the entire Ryan White program effective October 1, 2009, 

unless it is again reauthorized. In late 2009, Congress was holding 

hearings on reauthorization of the program. 

Ryan White grantees must submit financial and performance reports 

throughout the grant period, and each grantee is assigned a HRSA 

project officer to oversee and assist with the proper use of grant funds. 

This evaluation is based on grantee interviews, grantee expenditure and 

allocation information, project officer interviews, and a review of HRSA 

guidance. 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM i 
 

EXECUTIVE SUMMARY 

FINDINGS 

Almost all grantees complied with the core medical services 

requirement; grantee expenditures for core medical services 

changed little from 2006 to 2007. Ninety-six percent of Part A 

grantees complied with the requirement in 2007, and 98 percent 

allocated their grant funds in compliance with the requirement in 2008. 

All Part B and Part C grantees were in compliance with the 

requirement based on 2007 expenditure and 2008 allocation reports. 

Even though grantee expenditures on core medical services changed 

little from 2006 to 2007, 55 of the 92 grantees responding to the 

question reported that they could better serve the goals of their 

programs and meet the needs of their clients if more flexibility were 

built into the requirement (e.g., more local control over funding, options 

to adjust the percentage spent on core medical services). Additionally, 

71 of the 121 grantees that responded to the question provided 

suggestions for Congress to consider during the next reauthorization. 

The core medical services requirement affected support services 

and administrative processes for some grantees. When compared to 

Part B and C grantees, a higher percentage of Part A grantees reported 

that the core medical services requirement had a significant effect on 

support services provided to their clients. When asked, 14 percent of all 

grantees reported that the core medical services requirement increased 

their administrative burden. 

HRSA guidance was helpful, but project officer turnover created 

program management difficulties. Of the 81 percent of grantees that 

received guidance from HRSA, 95 percent found HRSA guidance helpful. 

However, 71 percent of grantees reported experiencing project officer 

turnover in recent years that created program management difficulties. 

Further, OIG found that issues with project officer oversight continue to 

cause vulnerabilities within the Ryan White program. 

CONCLUSION 

The Ryan White HIV/AIDS Treatment Modernization Act of 2006 

emphasized providing funds for direct health care services for people 

living with HIV/AIDS by establishing a requirement that certain 

grantees spend at least 75 percent of their grant funds on core medical 

services. OIG found that, overall, those grantees complied with the core 

medical services requirement in 2007 and allocated their funds in 

compliance with the requirement in 2008. There was little change in 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM ii 
 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM iii 

EXECUTIVE SUMMARY 

grantee spending on core medical services after the requirement went 

into effect. However, some grantees reported that the core medical 

services requirement affected their delivery of support services and 

increased their administrative burden. Further, when asked, just over 

half of the grantees we interviewed would welcome the opportunity to 

provide input as Congress considers reauthorization of the Ryan White 

program in 2009. Lastly, while over 90 percent of grantees found HRSA 

guidance helpful, OIG found that project officer oversight continues to 

be a vulnerabilty in the Ryan White program. 

AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL 

RESPONSE 

HRSA concurred with our findings. Regarding the finding pertaining to 

turnover among project officers affecting oversight of grantees, HRSA 

further commented that it has lost a number of experienced project 

officers in recent years, and is currently hiring new staff. HRSA also 

noted that in response to the complex requirements mandated by the 

Act, impending reauthorization of the Act, and the influx of new project 

officers, it will be intensifying training in the coming weeks. We did not 

make any changes in response to HRSA’s comments. 
Δ TABLE OF CONTENTS 

EXECUTIVE SUMMARY .....................................i

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 

FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 

Almost all grantees complied with the core medical services 

requirement; grantee expenditures for core medical services 

changed little from 2006 to 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 

The core medical services requirement affected support services 

and administrative processes for some grantees . . . . . . . . . . . . . . 10 

HRSA guidance was helpful, but project officer turnover created 

program management difficulties . . . . . . . . . . . . . . . . . . . . . . . . . 11 

CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 

Agency Comments and Office of Inspector General Response . . . 14 

APPENDIXES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 

 A: Point Estimates and Confidence Intervals . . . . . . . . . . . . . . . . 15 

B: Five Highest-Funded Core Medical Service Categories by 

Grantee Type. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 

C: Grantee Ratings of the Difficulty of Implementing the Core 

Medical Services Requirement . . . . . . . . . . . . . . . . . . . . . . . . . 19 

 D: Agency Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 

ACKNOWLEDGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
 

Δ INTRODUCTION 

OBJECTIVES 

1. To determine the extent to which Ryan White grantees expended 

grant funds on core medical services, as required. 

2. To describe effects of the core medical services requirement on 

grantee operations. 

3. To assess the Health Resources and Services Administration’s 

(HRSA) guidance on and project officers’ oversight of the core 

medical services requirement. 

BACKGROUND 

Enacted in 1990, the Ryan White CARE Act (the Act), as amended, 

established the Ryan White grant program to provide funding to 

develop, organize, coordinate, and operate effective and cost-efficient 

health care and support services to people with HIV and AIDS. 

Administered by HRSA, the Ryan White program is the largest 

federally funded program dedicated to providing services to people with 

HIV/AIDS, with funding of $2.1 billion in 2008.1 The Ryan White 

program serves nearly half a million people annually. 

The Ryan White HIV/AIDS Treatment Modernization Act of 2006, the 

most recent reauthorization of the Ryan White program, changed how 

Ryan White funds may be used, emphasizing life-saving and 

life-extending services for people living with HIV/AIDS. A key change 

made by this law established a requirement that certain grantees spend 

at least 75 percent of awarded grant funds on core medical services 

unless they receive waivers of this requirement.2 Examples of core 

medical services include outpatient health services, home health care, 

mental health services, and medications. Section 703 of the law 

repealed the entire Ryan White program effective October 1, 2009, 

unless it is again reauthorized.3 In late 2009, Congress was holding 

hearings on reauthorization of the program. 

1 HIV/AIDS Policy Fact Sheet, “The Ryan White Program.” The Henry J. Kaiser Family 

Foundation, June 2008. Available online at http://hab.hrsa.gov/reports/funding.htm. 

Accessed on June 30, 2009. 

2 The 2006 reauthorization also renamed various Titles of the Act: Title I became Part A, 

Title II became Part B, and Title III became Part C. 

3 Ryan White HIV/AIDS Treatment Modernization Act of 2006, P.L. No. 109-415 

(Dec. 19, 2006). 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM 1 
 

INTRODUCTION 

The Act is divided into six parts, and the core medical services 

requirement applies to funds provided under Parts A, B, and C; the 

majority of Ryan White grant funds are allocated to these three parts. 

Grants and grantees are referred to based on the part of the Act under 

which their grants are awarded; for example, an organization receiving 

a grant under Part A of the Act would be referred to as a Part A 

grantee. Part A grants are awarded to metropolitan areas for 

HIV-related services. Part B base grants, along with supplemental 

funds, are awarded to States and Territories to improve the quality, 

availability, and organization of health care and support services.4 

Finally, Part C Early Intervention Services (EIS) grants are made to 

public and private nonprofit organizations to fund comprehensive 

primary health care in an outpatient setting for people living with 

HIV.5 

2 

r 

 

ivers of the requirement under circumstances 

specified by statute. 

Core Medical Services Requirement 

The 2006 reauthorization of the Act established a requirement that 

Parts A, B, and C grantees spend at least 75 percent of their funds, afte

deducting funds for administration and quality management services, 

on core medical services (hereinafter referred to as the requirement).6

Grantees may seek wa

4 Many of the supplemental funds associated with Part B grants are earmarked for the 

AIDS Drug Assistance Program (ADAP). ADAP provides medications for the treatment of 

HIV. States may also use ADAP program funds to purchase health insurance for eligible 

clients and for services that enhance access to, adherence to, and monitoring of drug 

treatments. HRSA, “Part B: Grants to States and Territories.” Available online at 

http://www.hab.hrsa.gov/treatmentmodernization/partb.htm#ADAP. Accessed on 

July 14, 2009. 

5 Part C includes two categories of grants: EIS grants, which fund comprehensive 

primary health care in an outpatient setting; and Planning and Capacity Development 

grants, which support organizations in planning for service delivery and in building 

capacity to provide services. 

6 Sections 2604(c), 2612(b), 2620(e), and 2651(c) of the Act (42 U.S.C. §§ 300ff-14(c), 

300ff-22(b), 300ff-29a(e), and 300ff-51(c)). 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM
 

INTRODUCTION I N T R O D U C T I O N 

The requirement applies to the formula funding, most supplemental 

funding,7 and Minority AIDS Initiative (MAI) funding received by 

Parts A, B, and C grantees.8 The requirement also applies to most 

funding awarded under Part C, including MAI grants.9

The requirement applies to the formula funding, most supplemental 

funding,7 and Minority AIDS Initiative (MAI) funding received by 

Parts A, B, and C grantees.8 The requirement also applies to most 

funding awarded under Part C, including MAI grants.9

The core medical services specified in the Act are: 

• outpatient and ambulatory health services; 

• pharmaceutical assistance, including medications provided through 

ADAP; 

• oral health care; 

• early intervention services; 

• health insurance premium and cost-sharing assistance for 

low-income individuals; 

• home health care; 

• medical nutrition therapy; 

• hospice services; 

• home and community-based health services; 

• mental health services; 

• outpatient substance abuse care; and 

• medical case management, including treatment adherence services.10 • medical case management, including treatment adherence services.10

3 

7 The core medical services requirement does not apply to the supplemental grants 

awarded under Part B for Emerging Communities. Section 2621 of the Act 

(42 U.S.C. § 300ff-30a); “HRSA HIV Care Grant Program Part B Program Guidance, FY 

2008,” p. 38 (November 30, 2007). 

8 HRSA awards MAI grants to Parts A, B, C, D, and F grantees through a competitive 

process. The goal of these grants is to reduce HIV-related health disparities among 

minority populations. Section 2693 of the Act (42 U.S.C. § 300ff-121). When a Part A, B, or 

C grantee receives MAI funding, the requirement applies to the total combined award. 

HRSA Announcement No. 07-135, Part A Minority AIDS Initiative Grant Program, 

“Application Guidance for New Competing Discretionary Grants, 2007.” HRSA 

Announcement No. HRSA 5-H3M-08-001, Part A Minority AIDS Initiative Grant Program, 

“Non-Competing Continuation Discretionary Grants, 2008.” HRSA Announcement No. 

07-136, Part B Minority AIDS Initiative Grant Program, “Application Guidance for New 

Competing Discretionary Grants, 2007.” HRSA Announcement No. HRSA 5-G24-08-001, 

Part B Minority AIDS Initiative Grant Program, “Non-Competing Continuation 

Discretionary Grants, 2008.” 

9 Only Part C EIS grantees are subject to the core medical services requirement. 

Hereinafter, we refer to Part C EIS grantees as simply Part C grantees. HRSA 

Announcement No. 5-H76-07-002, “Ryan White Title III: Categorical Grant Program for 

Outpatient EIS, Non-Competing Continuation Application, 2007.” HRSA Announcement 

No. 5-H76-08-001, “Ryan White Part C (Title III): Categorical Grant Program for 

Outpatient EIS, Non-Competing Continuation Application, 2008.” 

10 Sections 2604(c)(3), 2612(b)(3), 2620(e), and 2651(c)(3) (42 U.S.C. §§ 300ff-14(c)(3), 

300ff-22(b)(3), 300ff-29a(e), and 300ff-51(c)(3)). 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM
 

INTRODUCTION I N T R O D U C T I O N 

Grantees may spend up to 25 percent of their Ryan White grant funds 

on support services needed for individuals with HIV/AIDS to achieve 

their desired medical outcomes (e.g., outreach, medical 

transportation, linguistic services, respite care, and referrals for 

health care and support services). 

Grantees may spend up to 25 percent of their Ryan White grant funds 

on support services needed for individuals with HIV/AIDS to achieve 

their desired medical outcomes (e.g., outreach, medical 

transportation, linguistic services, respite care, and referrals for 

health care and support services). 

Grantees may apply on an annual basis for waivers, which allow them 

to spend less than 75 percent of their Ryan White grant funds on core 

medical services. To qualify for a waiver, there must be no ADAP 

waiting list in the grantee’s State and core medical services must be 

available to all individuals identified and eligible to receive services 

under the Act.11 Grantees applying for waivers in grant years 2007 and 

2008 self-certified that they met these requirements.12

Grantees may apply on an annual basis for waivers, which allow them 

to spend less than 75 percent of their Ryan White grant funds on core 

medical services. To qualify for a waiver, there must be no ADAP 

waiting list in the grantee’s State and core medical services must be 

available to all individuals identified and eligible to receive services 

under the Act.11 Grantees applying for waivers in grant years 2007 and 

2008 self-certified that they met these requirements.12

According to HRSA, 5 of the 56 Part A grantees and 3 of the 59 Part B 

grantees received waivers of the requirement for the 2007 funding cycle. 

For the 2008 funding cycle, 5 of the 56 Part A grantees were granted 

waivers, 3 of which also received waivers in 2007. No Part C grantees 

have applied for waivers. To date, HRSA has approved all requests for 

waivers. 

According to HRSA, 5 of the 56 Part A grantees and 3 of the 59 Part B 

grantees received waivers of the requirement for the 2007 funding cycle. 

For the 2008 funding cycle, 5 of the 56 Part A grantees were granted 

waivers, 3 of which also received waivers in 2007. No Part C grantees 

have applied for waivers. To date, HRSA has approved all requests for 

waivers. 

HRSA Grantee Oversight 

HRSA requires Ryan White grantees to submit reports throughout the 

grant period, including performance reports and financial reports at the 

end of each annual grant period.13 HRSA also requires grantees to 

submit a number of standardized reports annually on clients, services 

provided, and expenditures. These reports are important for 

determining grantees’ compliance with the requirement.14 

HRSA requires Ryan White grantees to submit reports throughout the 

grant period, including performance reports and financial reports at the 

end of each annual grant period.13 HRSA also requires grantees to 

submit a number of standardized reports annually on clients, services 

provided, and expenditures. These reports are important for 

determining grantees’ compliance with the requirement.14 

HRSA project officers have primary responsibility for overseeing 

grantees. Each grantee is assigned a project officer to oversee and 

assist with the proper use of grant funds. Project officers use grantees’ 

4 

11 Sections 2604(c)(2), 2612(b)(2), 2620(e), and 2651(c)(2) (42 U.S.C. §§ 300ff-14(c)(2), 

300ff-22(b)(2)), 300ff-29a(e), and 300ff-51(c)(2)). Some States have more people needing 

medications than their ADAP funding can provide for; these States have had to institute 

waiting lists of people needing medications. 

12 FY 2007 Interim Waiver Eligibility Guidance; 72 Fed. Reg. 66181 (November 27, 

2007); 73 Fed. Reg. 33097 (June 22, 2008). 

13 Requirements for grantees to submit performance and financial reports are found at 

45 CFR §§ 92.40(b)(1) and 92.41(b)(3) (for governmental grantees) and 45 CFR §§ 74.51(b) 

and 74.52 (for nongovernmental grantees). 

14 Grantees receiving ADAP funds must submit the quarterly ADAP report; MAI funds 

are included on the allocation and expenditure reports. 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM
 

INTRODUCTION 

performance and financial reports to determine compliance with 

spending requirements. Project officers also give feedback in response 

to grantees’ reports, including acknowledging receipt of the documents, 

providing clarifying information, and asking grantees to make any 

necessary budget revisions. 

Previous Office of Inspector General Work 

A previous Office of Inspector General (OIG) report found that 

53 percent of Titles I and II (now known as Parts A and B) Ryan White 

expenditures in 1992 were for medical services and pharmaceuticals.15 

In 2004, an OIG report found that project officers were not adequately 

monitoring the Ryan White grantees studied and that HRSA provided 

little support to its project officers.16 OIG made recommendations to 

improve the monitoring of Ryan White grantees, including: specifying 

and enforcing standards and guidelines for how project officers should 

monitor grantees; addressing ongoing training for project officers; 

standardizing a corrective action process and addressing grantee issues 

more formally; increasing frequency and comprehensiveness of site 

visits; and improving project officer continuity. HRSA agreed to make 

changes in its monitoring of grantees in response to those 

recommendations. 

In May 2008, HRSA informed OIG that it had taken a variety of steps to 

implement the recommendations. These steps included enhancing 

training for project officers, developing a site visit protocol for onsite 

monitoring, and increasing the number of grantee site visits. 

Additionally, HRSA reported that it has consolidated its grants 

management offices, relocated all Title II (Part B) monitoring 

responsibilities from regional offices to headquarters, and redefined the 

Office of Field Operations as the Office of Performance Review.17 

METHODOLOGY 

We limited our grantee population for this study to grantees located in 

the 50 States, the District of Columbia, and Puerto Rico. This 

15 “The Ryan White Care Act: Fiscal Year (FY) 1992 Title I and Title II Expenditures,” 

OEI-05-93-00331, April 1994. 

16 “Monitoring of Ryan White CARE Act Title I and Title II Grantees,” OEI-02-01-00640, 

March 2004. 

17 “Compendium of Unimplemented Office of Inspector General Recommendations,” 

Department of Health and Human Services OIG, May 2009, p. 87. 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM 5 
 

INTRODUCTION 

population included all 56 Part A grantees, 52 of 59 Part B grantees, 

and 361 of the 363 Part C grantees. Our sample consisted of all 

56 Part A grantees, all 52 Part B grantees, and a simple random sample 

of 90 of 361 Part C grantees. This study also included all 

HRSA-identified project officers responsible for working with the Ryan 

White Parts A, B, and C grantees. We requested responses to a 

structured interview guide from all Part A, all Part B, and sampled 

Part C grant officials through in-person interviews, telephone 

interviews, or email. For all grantees included in this study, we 

requested, in writing, the grantees’ expenditures for FYs 2006 and 2007 

and their allocated expenditures for FY 2008.18 We also sent an 

electronic structured survey to all HRSA-identified project officers. 

Additionally, we reviewed HRSA-developed guidance documents. 

Grantee Interviews 

We requested responses to a structured interview guide from all Part A, 

all Part B, and sampled Part C grant officials responsible for 

administering each of the Ryan White grants. In their responses, 

grantees provided us with information regarding their experiences with 

the core medical services requirement and any changes in operations 

resulting from the requirement. Grantee responses also provided 

information regarding why they did or did not apply for waivers and 

about their guidance and oversight experiences with HRSA. Grantee 

response rates were 98 percent for Part A grantees (55/56), 85 percent 

for Part B grantees (44/52), and 80 percent for Part C grantees (72/90). 

Grantee Expenditure and Allocation Report Review 

We requested that all Part A, all Part B, and sampled Part C grant 

officials complete a form to provide us with Ryan White grant 

expenditures for 2006 and 2007 and allocated expenditures for 2008.19 

We analyzed the information provided to determine whether each 

grantee complied with the requirement in 2007 and whether each 

allocated at least 75 percent of its 2008 funds to core medical services, 

6 

18 We requested information on grantees’ total Ryan White funds, including their 

Parts A, B, and C base grants and any supplemental funding, such as ADAP or MAI 

funding they received in each year. 

19 The grant year for Part A and Part C funds is March 1 to February 28; for 

Part B funds, April 1 to March 31; and for Part F funds, August 1 to July 31. We requested 

that grantees provide expenditures and allocations for the 2006, 2007, and 2008 grant years 

for Parts A, B, and C grants. 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM
 

INTRODUCTION 

after deducting funds for administration and quality management.20 

We also analyzed the information provided to determine whether and 

how grantee expenditures on core medical and support services changed 

from 2006, prior to the implementation of the requirement, to 2007 and 

2008. Rates of response to our request for grantee expenditures in 2006 

and 2007 and allocated expenditures in 2008 varied among Part A, 

Part B, and Part C grantees; see Table 1. 

Table 1: Percentage of Grantees Responding to Requests for 

Expenditure and Allocation Information 

Grantee Type Expenditure Information

Allocation 

Information 

2006 2007 2008 

 Part A 89.9 98.2 98.2 

 Part B 86.5 86.5 86.5 

 Part C 78.9 81.1 78.9 

Source: OIG analysis of grantee expenditure and allocation information. 

HRSA Project Officer Interviews and HRSA Guidance Review 

We reviewed HRSA-developed guidance regarding Ryan White grant 

requirements. We also requested responses to a structured interview 

guide from all 42 HRSA Ryan White project officers for Parts A, B, and 

C grants in early 2009. The interviews included questions about the 

training and guidance project officers received, project officers’ 

interactions with grantees, project officers’ oversight of grantees, 

implementation of the requirement, and waivers of the requirement. 

The project officer interview response rate was 100 percent. 

Limitations 

This evaluation did not assess the accuracy of expenditure and 

allocation information provided by grant officials. We also did not 

determine grantees’ compliance with HRSA’s policies and practices used 

to oversee grantees. 

Standards 

This study was conducted in accordance with the “Quality Standards for 

Inspections” approved by the Council of the Inspectors General on 

Integrity and Efficiency.

20 Because data collection occurred during FY 2008, final expenditure reports were not 

yet available. 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM 7 
 

Overall, Parts A, B, and C 

grantees collectively spent an 

average of 93 percent of their 

Ryan White grant funds on core 

medical services in 2007. Part A 

grantees’ average spending on core medical services in 2007 

and their allocated expenditures in 2008 were 82 percent. Part B and 

Part C grantees each had average spending on core medical services in 

2007 of 94 and 95 percent, respectively; their allocated expenditures for 

core medical services in 2008 were both 94 percent. The five Part A and 

three Part B grantees that received waivers of the requirement spent 

between 54 and 99 percent of their grant funds on core medical services. 

Point estimates and confidence intervals for selected statistics are 

presented in Appendix A. Appendix B shows that the proportion of 

funds devoted to core medical service categories changed little from 

2006 to 2008. 

Almost all grantees complied with the core 

medical services requirement; grantee 

expenditures for core medical services changed 

little from 2006 to 2007 

Δ FINDINGS 

Overall, Parts A, B, and C grantees complied with the core medical services 

requirement in 2007 and 2008 

Ninety-six percent of Part A grantees complied with the requirement in 

2007, and 98 percent allocated their grant funds in compliance with the 

requirement in 2008. The two grantees that did not have waivers and 

spent less than 75 percent on core medical services in 2007 spent 71.0 

and 73.9 percent, respectively.21 At the time of our review, only one 

grantee expected to spend less than 75 percent of its grant funds on core 

medical services in 2008.22 All Part B and Part C grantees were in 

compliance with the requirement based on 2007 expenditure reports 

and 2008 allocation reports.23 

8 

21 These grantees reported that difficulties with midyear implementation and budget 

changes contributed to their noncompliance with the requirement. HRSA project officers 

reported that they anticipated that these two grantees would comply with the requirement 

in 2008. 

22 One Part A grantee allocated only 69.0 percent of its grant funds to the core medical 

services in 2008. However, at the time of our data collection, 2008 final expenditure reports 

were not due. Therefore, we cannot report how grantees actually spent their funds in 2008. 

23 While all 71 responding Part C grantees were in compliance with the core medical 

services requirement, we estimate with 95-percent statistical confidence that between 

94.1 and 100 percent of all Part C grantees were in compliance in 2007 and between 

95.9 and 100 percent of all Part C grantees were in compliance in 2008. 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM
 

FINDINGS 

Parts A, B, and C grantees’ expenditures for core medical services changed 

little from 2006 to 2007 

Our analysis of grantees’ 2006 expenditures showed that they were 

already spending a high proportion of their grant funds on core medical 

services prior to implementation of the requirement. From 2006 to 

2007, Part A grantees’ average spending on core medical services 

changed from 74 percent to 82 percent, Part B grantees’ average 

spending changed from 95 percent to 94 percent, and Part C grantees’ 

average spending remained at 95 percent. 24 

Even though there was little change in grantee spending on core 

medical services, 55 of the 92 grantees that responded to the question 

reported that they could better serve the goals of their program and 

meet the needs of their clients if more flexibility were built into the 

requirement (e.g., more local control over funding, options to adjust the 

percentage spent on core medical services). Further, when asked, 71 of 

the 121 grantees that responded to the question provided suggestions 

for Congress to consider during the next reauthorization.25

The most common suggestions included: expanding the definitions of 

the core medical service categories to include case management, 

inpatient substance abuse treatment, and transportation; and seeking 

provider and consumer input during the next reauthorization. One 

grantee stated, “The distribution of funds formula should be 

reconsidered, including those [living] with HIV as well as those 

[diagnosed] with AIDS, as the trend of the epidemic is that people with 

HIV are surviving and improving.” Another grantee offered that 

“. . . during [the] last reauthorization, there was very little chance for 

communities and consumers to provide input. [We] encourage Congress 

to provide more opportunities for input from people who use and run the 

program.” 

9 

24 These estimates are based on grantee-reported expenditure information. 

25 Because of the low rates of response to these interview questions, we could not project 

the number of grantees in the population that reported that they could better serve the 

goals of their programs and meet the needs of their clients if more flexibility were built into 

the requirement or that provided suggestions for Congress to consider during the next 

reauthorization. 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM
 

FINDINGS 

 

The circumstances of 

individual grantees and 

their clients’ needs played a 

role in the degree to which 

the requirement affected their programs. Part A grantees reported that 

the requirement had a significant effect on the provision of support 

services to their clients more often than Part B or C grantees. Although 

Parts A, B, and C grantees rated implementing the requirement as 

easy, they also indicated that the requirement and other changes 

established in the reauthorization created additional burdens on 

administrative practices. 

The core medical services requirement affected 

support services and administrative processes 

for some grantees 

The core medical services requirement affected the delivery of support 

services for 27 percent of Part A grantees, 7 percent of Part B grantees, and 

1 percent of Part C grantees 

Twenty-seven percent of Part A grantees reported that the requirement 

had a significant effect on support services provided to their clients, 

compared to only 7 percent of Part B and 1 percent of Part C grantees. 

Because the requirement imposed a minimum percentage for spending 

on core medical services and a maximum percentage for spending on 

support services, grantees that devoted a greater percentage of their 

funds to support services either made greater changes to how they spent 

their grant funds and the services they provided to clients or sought 

waivers of the core medical services requirement. 

One Part A grantee reported that the limitations placed on how Ryan 

White funds could be spent reduced funding for transportation in their 

rural area and caused clients difficulty in obtaining services, saying, 

“Many support services are just as important as core [medical services] 

in some ways. How can [a client] go to work when going to the doctor 

takes all day on the bus?” Another grantee noted the lack of funds for 

food assistance, saying, “Food is critical to [the] success of medications; 

sometimes food banks don’t have food that patients can eat or that will 

help them absorb their medications.” Finally, one grantee reported that 

as a result of their own evaluation, they “found that these [support] 

services were absolutely critical as part of health outcomes, which put a 

lot more pressure on the county to provide [support] services.” 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM 10 
 

FINDINGS 

The core medical services requirement increased the administrative burden 

for 14 percent of all grantees 

When we asked grantees to rate the degree of difficulty they 

experienced with implementing the requirement on a 5-point scale, 

where 1 indicated easiest and 5 indicated most difficult, the most 

common rating was 1 (see Appendix C for further information on 

grantees’ ratings). However, when we asked grantees whether the 

requirement affected their administrative practices, 14 percent reported 

that it increased their administrative burden. Examples of changes 

made to administrative practices included: modifying program policies 

and practices, changing strategic planning practices, allocating and 

budgeting funds, reporting and tracking program expenditures, 

renegotiating contracts with providers, and identifying additional 

community resources. 

Other changes established by the reauthorization also affected grantees’ 

administrative practices. For example, prior to the reauthorization, 

MAI funds were applied for and disbursed in conjunction with Parts A, 

B, and/or C grant funds; now these funds are applied for and disbursed 

separately.26 Grantees reported that these activities lessened their 

focus on service delivery to clients. As one grantee stated, “We spend so 

much time on reporting and completing grant applications that it leaves 

little time to think about service delivery.” 

HRSA guidance was helpful, but project officer 

turnover created program management 

difficulties

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM 11 

Eighty-one percent of Ryan White 

grantees reported receiving 

guidance from HRSA on the 

requirement, and 95 percent of 

grantees that received guidance indicated that they found the guidance 

helpful. However, grantees also reported that the turnover in and 

limited experience of Ryan White project officers contributed to 

inconsistent grantee oversight. Grantee and project officer responses 

about the difficulties caused by turnover indicate that consistent 

grantee monitoring by project officers continues to be a vulnerabilty 

26 In a Government Accountability Office report on the implementation of the 

requirements of the Act for MAI grants, HRSA officials said that they changed the MAI FY 

for 2007 so that HRSA could complete the new guidance necessitated by the changes made 

by the Act. The FY for MAI funding is from August 1 to July 31. “Ryan White Care Act: 

Implementation of the New Minority AIDS Initiative Provisions,” GAO-09-315, 

March 2009, p. 19. 
 

FINDINGS 

within the Ryan White program, as previously identified in a 2004 OIG 

report.27 

Eighty-one percent of grantees reported receiving guidance on the core 

medical services requirement 

According to grantees, HRSA provides guidance through written 

materials, conference calls, and electronic mail, as well as in-person 

meetings and telephone conversations with project officers. Of the 

grantees that received guidance from HRSA, 95 percent found it helpful. 

However, 21 percent of all grantees reported that some of the core 

medical services’ definitions were unclear. Specifically, grantees 

reported that the definitions of medical case management, 

transportation, and early intervention services were unclear. 

Thirty-eight percent of project officers confirmed that grantees seek 

additional information and clarification on service definitions. 

Turnover affects project officer oversight of grantees 

At the time of our review, 71 percent of grantees reported experiencing 

project officer turnover in recent years. Of these, 62 percent reported 

that project officer turnover created program management difficulties. 

Twenty-eight percent of the grantees that reported turnover said that 

they have to repeatedly train project officers on both the Ryan White 

program and the individual grantees’ unique organizations and 

processes. Further, 26 percent of these grantees reported experiencing 

varying project officer expectations, and 23 percent of grantees reported 

a lack of consistency in project officer interactions. Grantees offered the 

following comments about project officer turnover and oversight: 

• “In my 10 years, we have had eight project officers. Continuity is 

an issue. We [the grantee] have to retrain them.” 

• “We have had three different project officers in the past year. Each 

has had different expectations and . . . differing methods to monitor 

[the] program.” 

• “[Project officer] turnover has occurred without notification, and 

sometimes submissions [reports] appear to have been lost in the 

shuffle.” 

12 

27 “Monitoring of Ryan White CARE Act Title I and Title II Grantees,” OEI-02-01-00640, 

March 2004. 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM
 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM 13 

FINDINGS 

• “Our new project officer has to consult with others constantly and 

never makes decisions on her own. She is not familiar with the 

program . . . her relative inexperience creates a lot of trouble.” 

Project officers generally agreed with the grantees’ assessments of high 

turnover within their ranks, explaining that HRSA has experienced 

staffing shortages in the past few years. As HRSA project officers turn 

over, grantees are reassigned among the available staff. Project officers 

noted problems resulting from turnover similar to those that grantees 

reported, including difficulties establishing relationships with grantees, 

inconsistent project officer expectations of grantees, and differing 

project officer approaches for grant oversight. Of the forty-two project 

officers we interviewed, 21 reported that the frequent reassignment of 

grantees affected their ability to effectively oversee their grantees. 

Twenty-one project officers reported having no Ryan White experience 

prior to becoming Ryan White project officers, and 31 reported having 

no prior project officer experience. Further, 19 project officers also 

reported that they came to their positions with limited prior experience 

and had only recently joined HRSA. 
 

ΔFINDINGS CONCLUSION CONCLUSION 

The Ryan White HIV/AIDS Treatment Modernization Act of 2006 

emphasized providing funds for direct health care services for people 

living with HIV/AIDS by establishing a requirement that certain 

grantees spend at least 75 percent of their grant funds on core medical 

services. OIG found that, overall, those grantees complied with the core 

medical services requirement in 2007 and allocated their funds in 

compliance with the requirement in 2008. Our analysis of grantees’ 

2006 expenditures showed that most grantees were already spending a 

high proportion of their grant funds on core medical services in 2006, 

prior to the implementation of the requirement. Therefore, there was 

little change in grantee spending on core medical services since the 

requirement went into effect. 

Despite the small amount of change in spending, a higher percentage of 

Part A grantees reported being affected by the core medical services 

requirement in the delivery of support services, compared to Part B and 

Part C grantees. Additionally, 14 percent of all grantees reported that 

since implementation of the requirement, they have experienced an 

increase in their administrative burden. Further, when asked, just over 

half of the grantees we interviewed would welcome the opportunity to 

provide input as Congress considers reauthorization of the Ryan White 

program in 2009. Lastly, while 95 percent of the grantees who received 

guidance from HRSA found it helpful, grantee and project officer 

responses about the difficulties caused by turnover indicate that project 

officer oversight continues to be a vulnerabilty in the Ryan White 

program. 

AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL 

RESPONSE 

HRSA concurred with our findings. Regarding the finding pertaining to 

turnover among project officers affecting oversight of grantees, HRSA 

further commented that it has lost a number of experienced project 

officers in recent years, and is currently hiring new staff. HRSA also 

noted that in response to the complex requirements mandated by the 

Act, impending reauthorization of the Act, and the influx of new project 

officers, it will be intensifying training in the coming weeks. We did not 

make any changes in response to HRSA’s comments. For the full text of 

HRSA’s comments, see Appendix D. 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM 14 
 

Δ APPENDIX ~ A 

Point Estimates and Confidence Intervals 

Statistic Description Grantee 

Type

Sample 

Size 

Point 

Estimate

95% Confidence

Interval*

Estimates from expenditure and allocation reports

Average percentage of grantee funds expended on 

core medical services in 2007

All

A

B

C

171

55

45

71

92.9

81.7

93.5

94.9

92.0–93.7

93.8–96.1

Average percentage of grantee funds allocated for 

core medical services in 2008

All

A

B

C

169

53

45

71

93.3

81.5

93.9

95.4

92.5–94.2

94.3–96.5

Grantees in compliance 

services requirement in 

with the 

2007

core medical 

A

B

C

55

45

71

96.4

100.0

100.0 94.9–100.0

Grantees in compliance 

services requirement in 

with the 

2008

core medical 

A

B

C

53

45

71

98.1

100.0

100.0 94.9–100.0

Average percentage of grantee funds expended on 

core medical services in 2006

A

B

C

50

45

70

74.3

95.0

94.8 93.4–96.1

Estimates from interview responses

Percentage of grantees reporting 

on service delivery

significant effects 

A

B

C

49

43

71

26.5

7.0

1.4 0.0–3.8

Percentage of grantees reporting 

on administrative processes

significant effects 

All

A

B

C

172

47

42

83

13.5

19.1

28.6

10.8

8.9–18.2

5.0–16.7

* Statistics presented for Parts A and B grantees are descriptive population statistics and therefore have no confidence interval.

-

-

-

-

-

-

-

-

-

-

-

-

-

-

O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM 15 
 

APPENDIX ~ A 

Point Estimates and Confidence Intervals (continued) 

Statistic Description Grantee 

Type

Sample 

Size 

Point 

Estimate

95% Confidence

Interval*

Percentage of grantees reporting receiving guidance 

on the core medical services requirement All 171 80.9 74.7–87.0

Percentage of grantees that received guidance 

reporting finding the guidance helpful All 141 94.8 91.6–97.9

Percentage of grantees reporting that the core 

medical service definitions are unclear All 171 21.4 15.4–27.4

Percentage of 

turnover

grantees reporting project officer All 170 70.5 64.2–76.9

Percentage of 

reporting that t

grantees with project officer turnover 

urnover created difficulties All 96 61.7 51.9–71.5

Percentage of grantees with project officer turnover 

reporting that turnover resulted in need to help 

project officer understand program

All 96 28.0 19.1–36.8

Percentage of grantees with project officer turnover 

reporting that turnover resulted in experiencing 

varying project officer expectations

All 96 26.3 17.5–35.2

Percentage of grantees with project officer turnover 

reporting that turnover resulted in lack of consistency 

in project officer interactions

All 96 23.4 15.3–31.5

* Statistics presented for Parts A and B grantees are descriptive population statistics and therefore have no confidence interval.

Source: Office of Inspector General analysis of grantee survey responses, expenditure reports, and allocation reports, 2009.

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM 16 
 

Δ APPENDIX ~ B 

Five Highest-Funded Core Medical Service Categories by Grantee Type 

* " Other" includes early interventio n services, prem ium assistance, ho m e 

co m m unity-based services, and substance abuse.

So urce: Office o f Inspecto r General (OIG) analysis o f P art A R yan White gr

health, nutritio n, ho spice, ho m e- and 

antees' expenditures and allo catio ns.

Proportions of Part A Grantees' 2006 and 2007 Expe

Allocations

0%

10%

20%

30%

40%

50%

Outpatient

Medical Case Managemen

nditures and 2008 

t

ADAP

Mental Health

Ora

Five Highest-Funded Core Medical Service 

Percentage of Grant Funds

l

Other*

Catagories

2006

2007

2008

17 

Proportions of Part B Grantees' 2006 and 2007 Expenditures and 2008 

Allocations 

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

ADAP

Outpatient

Medical Case Mangement

Premium Assistance

Oral

Other*

Five Highest-Funded Core Medical Service Catagories

Percentage of Grant Funds

2006

2007

2008

* "Other" includes substance abuse, home health, nutrition, hospice, home- and community-based services, early intervention 

services, and mental health.

Source: OIG analysis of Part B Ryan White grantees' expenditures and allocations.

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM
 

APPENDIX ~ B 

Five Highest-Funded Core Medical Service Categories by Grantee Type 

(continued) 

Proportions of Part C Grantees' 2006 and 2007 Expenditures and 2008 

Allocations

0%

10%

20%

30%

40%

50%

60%

70%

Outpatient

Early Intervention Services

Medical Case Management

Oral

Mental Health

Other*

Five Highest-Funded Core Medical Service Categories

Percentage of Grant Funds

2006

2007

2008

* "Other" includes A DA P , premium assistance, ho me health, nutritio n, ho spice, ho me- and co mmunity-based services, 

and substance abuse.

So urce: OIG analysis o f P art C Ryan White grantees' expenditures and allo catio ns.

Point Estimates and Confidence Intervals Relating to Part C Grantees’ 

Expenditures and Allocations

Statistic Description Fiscal 

Year

Sample 

Size 

Point 

Estimate

95% 

Confidence 

Interval

2006 72 57.6 47.6–67.6

2007 71 54.5 47.0–62.1

2008 73 52.9 45.6–60.3

2006 72 21.3 13.8–28.7

2007 71 22.8 14.9–30.6

2008 73 22.4 14.7–30.2

2006 72 9.0 6.6–11.4

2007 71 7.9 5.6–10.1

2008 73 8.5 6.4–10.6

2006 72 5.5 3.4–7.6

2007 71 5.6 3.6–7.6

2008 73 6.7 4.3–9.1

2006 72 3.5 2.5–4.6

2007 71 4.1 2.9–5.2

2008 73 4.5 3.0–6.0

2006 72 5.6 3.9–7.3

2007 71 5.2 3.7–6.7

2008 73 4.9 3.5–6.4

Source: OIG analysis of Part C Ryan White grantees' expenditures and allocations, 2009.

Part C grantees' expenditures on mental health 

services

Part C grantees' expenditures on all other core 

medical services

Part C grantees' expenditures on outpatient services

Part C grantees' expenditures on early intervention 

services

Part C grantees' expenditures on medical case 

management

Part C grantees' expenditures on oral health services

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM 18 
 

Δ APPENDIX ~ C 

Grantee Ratings of the Difficulty of Implementing the Core Medical Services 

Requirement 

We asked grantees to rate the difficulty they experienced in 

implementing the core medical services requirement on a scale from 

1 to 5, with 1 being the easiest and 5 being the most difficult. The chart 

below illustrates how each type of grantee responded. 

19 

Ryan White Grantees' Rating of the Difficulty of Implementing

the Core Medical Services Requirement

0

10

20

30

40

50

ABC

Grantee Type

Percentage of 

Grantees

1

2

3

4

5

So urce: Office o f Inspecto r General (OIG) analysis o f grantee respo nses, 2009.

Point Estimates and Confidence Intervals Relating to Part C Grantees’ Ratings of 

Difficulty

Statistic Description Grantee 

Type

Sample 

Size 

Point 

Estimate

95%

Confidence

Interval

A 51

1 - 37.3

2 - 21.6

3 - 17.6

4 - 19.6

5 - 3.9 

-

B 44

1 - 36.4

2 - 20.5

3 - 29.5

4 - 9.1

5 - 4.5

-

C 70

1 - 47.1

2 - 24.3

3 - 18.6

4 - 8.6

5 - 1.4

36.9–57.4

15.4–33.1

10.6–26.6

2.8–14.3

0.0–3.9

Percentages of grantees rating the difficulty of 

implementing the core medical services requirement 

(1=easy through 5=difficult)

Source: OIG analysis of grantee survey responses, 2009.

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM
i11l<!i11h f!f!!ic.m:..s, end $~

Mni'llstr.atlofl 

OCT 1 2099 

FROM: Adminisfrator 

SUBJECt: oro OTllfi Report: ''TheCore MediCllJ SlTI'i.<lCB Rcquin;ment ill thcR~11 White 

Progr,lml" (OEJ.07.Q8><QQ240) 

This ls in fCSlJQ1111<l to Ole OIG's request fw commcl1(ij em tbe draft roport. "The CORE Medical 

Scrvi«:s.Roquinmlc:nl. in the Ryan White Program" (O~I~7~fI,.OO2Mi). Auaclled atO the Health 

ResCMlrces and S1l:rvicGS Adl11inistrwol]'~ comments.. Ifyou have any quesHcns. please contact 

Patricia A. R~&c in mSA'sOffice of FalmLl A9Sismncc Management at (30 t) 443·0l70. 

Milry K. Wllkefield, Pn.D., R.N. 

Altachmel1t 

A P PEN D x D 

Agency Comments 

OEI·07·08·00240 THE CORE MEDICAL SERVICES REQUIREMENT IN THE RYAN WHITE PROGRAM 20 
Health Re_ourcu and ~sAdmillJiltrllltlo.o·s Commeots 00 tile OlG Dl'aftRepon ­

'VCbe CON M~BI Stlitvku Requlre1lilent III dteR,yo White Program" 

(m(j..OO'·~OO14lJ,

The ReQh'l1 ResollfCes and. Slmit~ Admini¥tr:amm.hBs the 0(1'1$ dm:ft repon lIIld hl\i$ 

the following oommei1lg, 

In poerat lhe ExecWvj,l Sl.IlliUUary,liItmdw:tioo, Mcthodo1Qgy and FlllltilJjlI BectiQn~ ofthe 

report are clear ome) tcebnitally llllCllJrllie. RRSA ~WIl1mr.mtl> witb l~t t<}I'heifullowillj 

specifIc nndinp: 

p, 3 QJGF!pding: 

Almon aD grnnteelioompUell db tile core medlelll ilIrvl~ nqulre1lileotsl fiJ1l.lItee 

expenditures til' COR mdl<Bl servkesehllnged little from 2006-2007. 

RRSA Rem>lID,lU;: 

HRSA OOtlCllfil willi J!IliB filJlding, 

Tbl! (:1;lJI1l Jmlldh::al $tlM'lee requirment idf~ted i$UPport swvillel and adIlllnlBtrnlive 

P~mlS for some grll111ees. 

HRSA coll¢UT$ with this fmding. 

P. 11 QjQ Findi!lJl: 

HRSAgoild:llnfJe WIIS l1elpl'lIl, but pr!JJeet ofllce:r mmover' enAted proal'lim mauage:mem 

diffh:ultWs. 

HRSA ().onoors wi6l d,liS findins, HRSA hllll>1011t a number of experlencedproject t!iffit:el'S In 

ret1entyem, Ha~. WI.!' Me· :nOM' 1m. tbe proOOli15ol'biring ncwstllff'to fill tbisvoid, 

A P PEN D x D 

OE 1-0 7-08-00240 THE CORE MEDICAL SERVICES REQUIREMENT IN THE RYAN WHITE PROGRAM 21 
 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM 22 

APPENDIX ~ D 
 

 O E I - 0 7 - 0 8 - 0 0 2 4 0 T HE C ORE MEDICAL S ERVICES REQUIREMENT IN THE RYAN WHITE P ROGRAM 23 

Δ ACKNOWLEDGMENTS 

This report was prepared under the direction of Brian T. Pattison, 

Regional Inspector General for Evaluation and Inspections in the Kansas 

City regional office. 

Michala Walker served as the lead analyst for this study. Other 

principal Office of Evaluation and Inspections staff from the Kansas 

City regional office who contributed to the report include Rae 

Hutchison, Amber Meurs, Dennis Tharp, and Deborah Walden; central 

office staff who contributed include Talisha Searcy and Kevin Farber.