THE RYAN WHITE COMPREHENSIVE
AIDS RESOURCES EMERGENCY (CARE) ACT:
TITLE I HIV EMERGENCY RELIEF
FY 2002 GRANT APPLICATION GUIDANCE
Division of Service Systems
5600 Fishers Lane, Room 7A-55
Rockville, Maryland 20857
TABLE OF CONTENTS
SECTION I: INTRODUCTION .................................................................... Page - 4
A. Program Authority and Eligibility ................................................... Page - 5
B. Purpose of Funds and FY 2002 HRSA/HAB Title I Program Focus Page - 5
C. Availability of Federal Funds........................................................... Page - 7
D. Overview of Application Guidance for FY 2002............................. Page - 7
E. Review and Scoring of the Application ........................................... Page - 8
F. Post-Award Responsibilities and DSS Monitoring during FY 2002. Page - 9
SECTION II: INSTRUCTIONS FOR FILING THE FY 2002 APPLICATION ... Page - 11
A. Application Deadline and Filing Instructions .................................. Page - 12
1. Deadline ............................................................................... Page - 12
2. Extensions ............................................................................ Page - 12
3. For Further Information ....................................................... Page - 12
B. General Information ......................................................................... Page - 13
C. Application Checklist ...................................................................... Page - 15
D. Instructions for Completing Standard Form (SF) 424 ..................... Page - 18
E. Budget Narrative and Justification ................................................... Page - 19
1. Grantee Administrative Costs .............................................. Page - 20
2. Travel .................................................................................. Page - 20
3. Planning Council Support .................................................... Page - 21
4. Program Support .................................................................. Page - 22
5. Quality Management … ....................................................... Page - 22
6. Service Costs… .................................................................... Page - 22
F. Funding Restrictions ........................................................................ Page - 23
G. Funding for Women, Infants, Children and Youth .......................... Page - 26
H. Reporting Requirements .................................................................. Page - 27
1. FY 2002 Program Progress Reports..................................... Page - 27
2. The Annual Administrative Report (AAR).......................... Page - 27
3. Title I Allocations Reports………………………………… Page - 28
SECTION III: INSTRUCTIONS FOR COMPLETING DOCUMENTATION TO MEET
REQUIREMENTS FOR FORMULA FUNDING ......................... Page - 29
A. Formula Funding: Summary of Required Information .................... Page - 30
B. Formula Funding: The Review Process ........................................... Page - 30
C. Instructions for Preparing the Formula Application ........................ Page - 31
1. Application Abstract and EMA Map ................................... Page - 31
2. EMA HIV/AIDS Epidemiologic Data ................................. Page - 31
3. HIV Health Services Planning Council Functions ............... Page - 32
4. Letters of Assurance from Planning Council Chair(s) ........ Page - 35
5. Maintenance of Effort ........................................................ Page - 35
6. FY 2002 Agreements, Compliance Assurances, and
Intergovernmental Agreements (IGAs)……………….…… Page - 36
2 - Title I FY 2002 Grant Application Guidance
SECTION IV: INSTRUCTIONS FOR COMPLETING DOCUMENTATION TO MEET
REQUIREMENTS FOR SUPPLEMENTAL FUNDING ............... Page - 38
A. Supplemental Funding: Summary of Required Information ............ Page - 39
B. Supplemental Funding: The Review Process................................... Page - 40
C. Instructions for Preparing the Supplemental Application ................ Page - 40
1. Compliance with FY 2000 and FY 2001 Title Requirements and
Conditions of Award (COA) and Grantee Administration. . Page - 40
2. Severe Need ......................................................................... Page - 45
3. Impact of Title I Funding: Access to Care Services,
Funding Mechanisms, and Planning .................................... Page - 51
4. Planning Council Mandated Roles/Responsibilities ............ Page - 54
5. Update on Quality Management and Evaluation Activities. Page - 59
6. Progress in Implementing FY 2001 Plan ............................. Page - 61
7. Plan for FY 2002 .................................................................. Page - 62
SECTION V: TABLES TO BE INCLUDED WITH THE FY 2002
APPLICATION ....................................................................... Page - 65
Table 1: AIDS Incidence, AIDS Prevalence and HIV Prevalence ..... Page - 67
Table 2: Roster of the FY 2002 Title I Planning Council Members .. Page - 70
Table 3: Matrix for Planning Council Membership Categories ......... Page - 72
Table 4: Matrix for Planning Council Areas of Interest/Expertise .... Page - 75
Table 5: Co-morbidity, Poverty, and Insurance Status ...................... Page - 78
Table 6: Assessment of Populations With Special Needs .................. Page - 80
Table 7: Data/Information Used for Priority Setting and Allocation
of Funds ............................................................................... Page - 82
Table 8: Title I Funding in the Context of Other HIV Service
Funding ................................................................................ Page - 84
Table 9: Summary of Priority Services to Be Funded in FY 2002 .... Page - 88
Table 10: FY 2002 Implementation Plan ............................................. Page - 90
SECTION VI: APPENDICES ......................................................................... Page - 93
Appendix 1: FY 2002 Agreements and Compliance Assurances ............. Page - 94
Appendix 2-A: Jurisdictions with at Least 10% of the EMA's Cases .......... Page - 98
Appendix 2-B: Geographic Definitions For The 51 EMAs ......................... Page - 101
Appendix 2-C: Estimated Number of Women, Infants, Children and
Youth Living with AIDS...................................................... Page - 104
Appendix 3: Glossary of HIV-Related Service Categories....................... Page - 105
Appendix 4: HIV/AIDS Epidemiology Data for the EMA ....................... Page - 112
Appendix 5: FY 2000 Reauthorization Issue Letters ............................... Page - 114
3 - Title I FY 2002 Grant Application Guidance
Section I: Introduction
4 - Title I FY 2002 Grant Application Guidance
Section I: Introduction
I. A. PROGRAM AUTHORITY AND ELIGIBILITY
This document is provided to assist communities eligible for funds under Title I, the "HIV
Emergency Relief Grant Program" of the Ryan White Comprehensive AIDS Resources
Emergency (CARE) Act of 1990, amended in 1996 and 2000, in preparing their Fiscal Year (FY)
2002 single-grant application for formula and supplemental funds. Eligible Metropolitan Areas
(EMAs) are those metropolitan areas that were eligible under Title I for FY 2001. These EMAs
also include communities with a population of 500,000 or more and that have reported to the
Centers for Disease Control and Prevention a total of more than 2,000 cases of AIDS in the most
recent five calendar years [Section 2601 (a), (c) and (d)].
Funding for the CARE Act is authorized by Public Law 101-381, as amended by Public Laws
104-146 and 106-345, the Ryan White CARE Act Amendments of 1996 and 2000. The CARE
Act amends Title XXVI of the Public Health Service Act (42 U.S.C. 300ff-11 et seq., Public Law
106-345, and the Ryan White CARE Act Amendments of 2000). The Title I program is
administered by the U.S. Department of Health and Human Services (DHHS), Health Resources
and Services Administration (HRSA), HIV/AIDS Bureau (HAB), Division of Service Systems
I.B. PURPOSE OF FUNDS AND FY 2002 HRSA/HAB TITLE I PROGRAM FOCUS
Section 2604(b)(1)(A) and (B) defines eligible services as “… outpatient and ambulatory health and support services,
including case-management treatment, substance-abuse treatment and mental-health treatment, and comprehensive
treatment services, which shall include treatment education and prophylactic treatment for opportunistic infections, for
individuals and families with HIV disease; and inpatient case management services that prevent unnecessary
hospitalization or that expedite discharge, as medically appropriate, from inpatient facilities.”
Title I funds provide direct financial assistance to EMAs that have been the most severely
affected by the HIV epidemic. Formula and supplemental funding components of the grant assist
EMAs to develop or to enhance access to a comprehensive continuum of high quality,
community-based care for low-income individuals and families with HIV disease. A
comprehensive continuum of care includes primary medical care for the treatment of HIV
infection that is consistent with Public Health Service guidelines. Such care must include access
to antiretrovirals and other drug therapies, including prophylaxis and treatment of opportunistic
infections as well as combination antiretroviral therapies. Comprehensive HIV/AIDS care also
must include access to substance-abuse treatment, mental-health treatment, oral health, and home
health or hospice services. In addition, this continuum of care should include supportive services
that enable individuals to access and remain in primary medical care as well as other health or
supportive services that promote health and enhance quality of life.
5 - Title I FY 2002 Grant Application Guidance
In preparing the FY 2002 grant applications, EMAs should consider the following four guiding
principles identified by HRSA/HAB.
Better serving the under-served in response to the HIV/AIDS epidemic’s growing
impact among under-served minority and hard-to-reach populations. This goal requires
Planning Councils to assess the shifting demographics of new HIV/AIDS cases in their area
and adapt/change care systems to the needs of emerging communities and populations.
EMAs and their Planning Councils should pay particular attention to reaching People Living
with HIV (PLWH) who currently are not receiving care and to ensuring they are offered
primary medical care and supportive services, directly or through appropriate linkages. To
that end, when the Planning Councils conduct their needs assessment, they should
strategically plan for the optimal location and composition of early-intervention services.
Ensuring access to existing and emerging HIV/AIDS treatments that can make a
difference. The quality of HIV/AIDS medical care--including combination antiretroviral
therapies as well as prophylaxis and treatment for opportunistic infections--can make a
difference in the lives of PLWH. EMAs should focus on ensuring that available treatments
are accessible and delivered according to established HIV-related treatment guidelines and
Adapting to changes in the health-care delivery system and the role of CARE Act
services in filling gaps in care. EMAs need to consider how CARE Act services are utilized
in filling gaps in care, including the coverage of HIV/AIDS-related services within managed-
care plans (particularly Medicaid managed care) and the coordination of CARE Act services
with other funding sources.
Documenting outcomes. Policy and funding decisions at the federal level are increasingly
being determined by outcomes. EMAs need to document the impact of CARE Act funds on
improving access to quality care/treatment. EMAs also need to ensure that they have in place
quality assurance and evaluation mechanisms to assess the impact of CARE Act resources on
improving health-status outcomes.
These four principles have significant implications for HIV/AIDS service delivery in the face of
the nation’s changing HIV/AIDS epidemic. Grantees and Planning Councils should refer to
these four principles as they develop their HIV/AIDS care implementation plans for FY 2002 and
future years. In addition to HAB’s guiding principles, the Ryan White CARE Act Amendments
of 2000 emphasize the expectation that funds will be used to address the service needs of racial,
ethnic and sexual minorities who know they have HIV disease but are not receiving HIV/AIDS
Additionally, the Congressional Black Caucus has dedicated funds to be used to expand or
support new initiatives that are intended to reduce HIV-related health disparities and to improve
HIV-related health outcomes for HIV-infected African Americans, Latinos, Native Americans,
Asian Americans, Native Hawaiians, and Pacific Islanders. These CBC Minority AIDS Initiative
funds are expected to expand or improve medical and support-service capacity in communities of
6 - Title I FY 2002 Grant Application Guidance
color, and to expand or improve peer-treatment education that is both culturally and linguistically
appropriate to individuals living with HIV. HRSA strongly encourages that the unique
capabilities of minority providers to reach communities targeted by the CBC funds be recognized
in the EMA’s allocation of funds..
I.C. AVAILABILITY OF FEDERAL FUNDS
Shortly after the President has signed a Congressional appropriation for the CARE Act, each
EMA will be notified in writing of the amount of Federal funds available under Title I for FY
2002. Notification will be sent to the Chief Elected Official (CEO) as indicated in the letter
accompanying the SF 424 and to the delegated administrative agency dispersing Title I CARE
To ensure timely notification of the release of the FY 2002 Application Guidance (Guidance) and
other important documents relating to the Title I grant, EMAs must forward personnel, address,
e-mail or telephone changes to the Grants Management Officer, HRSA/HAB, Parklawn Building,
5600 Fishers Lane, Room 7-89, Rockville, MD 20857.
I.D. OVERVIEW OF APPLICATION GUIDANCE FOR FY 2002
The Guidance contains application instructions for both formula and supplemental funds
awarded under Title XXVI of the Public Health Service (PHS) Act, including specific references
to Title XXVI of the PHS Act as they apply to each section of the Guidance. Grantees not only
will be required to complete this application, but also will be asked to provide progress reports
and other forms of documentation once awards have been made. In addition to this introduction,
the Guidance includes:
Section II: General instructions for filing the FY 2002 application.
Section III: Instructions for completing documentation required for formula funding.
Section IV: Instructions for completing documentation required for supplemental funding and
evaluation criteria for review of supplemental funding requests.
Section V: Tables to be included as Attachment 1 of the FY 2002 application.
HRSA/HAB requests additional information in the Title I progress reports and through its
ongoing monitoring and communications with EMAs. Through these mechanisms, HRSA/HAB
gathers information from EMAs regarding their engagement in required activities and program
accomplishments. Legislative and program requirements addressed in the FY 2002 Guidance
fall within the following broad categories.
Documentation of maintenance of effort ...........................................Page 35
Severe Need .......................................................................................Page 45
The Impact of Title I Funding ............................................................Page 51
Planning Council Mandated Roles/Responsibilities ..........................Page 54
Needs Assessment and Comprehensive Planning .............................Page 56
Quality management and evaluation. .................................................Page 59
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Documenting health-status outcomes ................................................Page 61
Development of the FY 2002 Implementation Plan
for the organization and delivery of health services .........................Page 62
Establishing priorities for the allocation of funds .............................Page 82
I.E. REVIEW AND SCORING OF THE APPLICATION
The FY 2002 Guidance requires applicants to demonstrate that the EMA engages in a planning
process guided by HIV/AIDS incidence and prevalence data and by a formal assessment of
service needs in communities impacted by HIV/AIDS. In response to the level of need
identified, applicants must show that an accessible continuum of care exists in the EMA that
includes comprehensive primary care services which include preventive and support services.
The EMA also must maintain linkages to other funding sources that support people living with
HIV. In addition, the EMA must clearly describe how they ensure the quality of services and
evaluate the outcome of service delivery. The EMA will be expected to describe how data were
used to plan for changes in the epidemic. Specific instructions for responding to these and other
components of the application are addressed in Sections III and IV of the Guidance.
I.E.1. Formula Funding
Under Section III, instructions are provided for completing the Formula Funding Request portion
of the application.
I.E.2. Supplemental Funding
Under Section IV, information is requested for the Supplemental Funding Request. The FY 2002
Supplemental application will be reviewed and scored by an internal HAB review based upon the
evaluation criteria in Section IV.C.1 and submission of the table and narrative information in
Sections IV.C.2 through IV.C.7. Scores assigned by the reviewers will be a principal factor in
determining the level of an applicant’s supplemental grant amount.
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I.F. POST-AWARD RESPONSIBILITIES AND DSS MONITORING DURING FY 2002
This section describes the focus of DSS program and fiscal monitoring activities for the coming
After the award of the FY 2002 grant, HAB/DSS Project Officers will monitor and assess how well
the grant is administered, the effectiveness of the Planning Council in setting priorities and
allocating funds, and the quality and availability of funded care and treatment services for HIV
disease. The nine elements highlighted below are prerequisites for effective implementation of
Title I programs and are the basis for monitoring and technical assistance activities.
I.F.1. The EMA’s ability to recruit and fill pivotal grantee and Planning Council positions as
vacancies occur, and to provide leadership and adequate infrastructure in implementing
the Title I grant. Grantee Project Director and Planning Council Chair positions should
not remain vacant for periods greater than three months. Persistent vacancies in these and
other important grantee staff positions or the inability to provide adequate Planning
Council support--as documented and requested by DSS--also will be considered in
assessing the EMA’s performance.
I.F.2. The grantee should demonstrate the ability to promptly enter into signed service contracts.
A review of required contract information submitted during the year will provide
information as to whether an EMA was able to execute contracts within 60 days of the
grant award. In addition, the timeliness with which the grantee executes contracts will be
monitored on an ongoing basis through monitoring calls with DSS project officers and
I.F.3. Documentation of problems with paying service providers promptly, that in turn impact
service delivery, will be considered.
I.F.4. Any documentation that the cooperation and efforts of the grantee and Planning Council
in communicating with community-based organizations and consumer representatives
have been compromised--and thus have affected the grantee’s or the Planning Council’s
ability to resolve conflicts, to ensure inclusiveness, or to provide information about
programs--will be taken under consideration.
I.F.5. An inability to cooperate or poor communication between the grantee and the Planning
Council will be considered.
I.F.6. The overall responsiveness and effectiveness in implementing FY 1996 and FY 2000
CARE Act reauthorization requirements will be evaluated.
I.F.7. Efforts to ensure that both the priorities set by the Planning Council and the implementation
of a continuum of care is in response to the changing demographic and changing needs of
those with HIV/AIDS as evidenced by epidemiology data also will be evaluated. Of special
concern are people who know they have HIV disease but are not receiving HIV/AIDS
9 - Title I FY 2002 Grant Application Guidance
I.F.8. Documentation of problems complying with HRSA program reporting requirements in a
timely manner, will be considered
I.F.9. A review of the process used by grantees to monitor and assess the performance of service
providers will be conducted.
During the grant year, Project Officers work closely with grantees to address the monitoring
activities described above. Lack of progress in correcting deficiencies in program administration or
service delivery could result in special conditions on an EMA’s FY 2002 Notice of Grant Award.
Any special conditions issued for FY 2001 will be subject to an internal review with the FY 2002
application (See: Section IV, C.1.).
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INSTRUCTIONS FOR FILING
THE FY 2002 APPLICATION
11 - Title I FY 2002 Grant Application Guidance
INSTRUCTIONS FOR FILING THE FY 2002 APPLICATION
II. A. APPLICATION DEADLINE AND FILING INSTRUCTIONS
The deadline for submitting the complete Ryan White CARE Act Title I Grant Application is
Monday, October 22, 2001. Complete submissions must include the original application, 2
copies of the application and 1 diskette copy of the application. Applications must be received
by the HRSA HIV/AIDS Bureau Grants Management Officer by 5:00 p.m. Eastern Time.
Submit the Title I grant application to the address indicated in the box below.
SEND APPLICATIONS TO:
Grants Management Officer
HRSA HIV/AIDS Bureau
5600 Fishers Lane, Room 7-89
Rockville, MD 20857
Note the contents, as follows, on the outside of the envelope:
“Ryan White CARE Act Title I Application (CFDA 93.914)‖
II. A.2. EXTENSIONS
No extensions to the FY 2002 Title I grant application deadline will be permitted.
II.A.3. FOR FURTHER INFORMATION
For further information about grant administration or fiscal issues related to the Title I grant,
contact Ms. Helen Harpold, Grants Management Specialist at (301) 443-3262,
Please direct any requests for program information or technical assistance to:
Douglas H. Morgan, M.P.A., Director Tel: (301) 443-6745
HRSA, HAB, DSS FAX: (301) 443-8143
Parklawn Building firstname.lastname@example.org
5600 Fishers Lane, Room 7A-55
Rockville, Maryland 20857
12 - Title I FY 2002 Grant Application Guidance
II. B. GENERAL INFORMATION
The FY 2002 Title I grant application must be prepared using the Public Health Service Grant
Application PHS 5161-1 (revised 6/99) which includes Standard Form (SF) 424 and related
forms for budget and staffing requests. These forms are contained in the Application Kit which
eligible applicants receive with this document. In addition, the application must include a
narrative and accompanying tables as described in this Guidance, a signed copy of the program
assurances, and supporting documentation in the form of attachments. See the checklist at the
end of this section for instructions on where to place these items in the final application package.
Resources on the Internet
The PHS 5161-1 is available on the HRSA Program Support website: (http://forms.psc.gov).
This Guidance also is available on the HIV/AIDS Bureau website: http://www.hab.hrsa.gov.
A MS Word version on computer diskette is enclosed with this Guidance.
In preparing the FY 2002 Title I Application, please adhere to the following technical guidelines:
Applications must be in English.
Submit the original copy of the application UNBOUND.
Include 2 copies of the application, and a diskette with electronic files of
both the narratives and tables.
Use a standard size black type that does not exceed 12 characters per inch.
Use 8.5‖ by 11‖ inch paper that can be photocopied.
Ensure that margins are not less than one inch each.
Use 1.5 or double-spaced lines in the text.
Submit an abstract, EMA map and table of contents at the beginning of your application,
as indicated in the Application Checklist.
Starting with Section III (Formula Request for Funding), number all pages of the
The Formula and Supplemental Requests for Funding (excluding attachments) must
be limited to a total of 115 pages.
The Supplemental Request for Funding narrative must be limited to a total of 65
pages. Tables, Federal forms, attachments, and copies of by-laws are not subject to
Do not submit double-sided copies. (Copy double-sided Federal forms on two
pages; however, do not reproduce the second side of a Federal form if it only provides
Do not use photo reduction or include photos, pamphlets, or over-sized documents.
Include all Tables as Attachment 1 of the application.
13 - Title I FY 2002 Grant Application Guidance
In addition, applicants are urged to consider the following recommendations provided by
program officials and reviewers from previous grant review committees:
II.B.1. Follow the written instructions in the Guidance carefully and completely. Put
required information in the sections specified in the Guidance.
II.B.2. Use the Checklist to organize the application, to plan and monitor application
preparation and to verify completion of all materials before submission. The
application checklist can be found on page 13 of the Guidance.
II.B.3. Provide accurate and honest information. A candid account of problems and
creative plans to address them is better than glossing over potential problems.
II.B.4. In order to standardize and condense the way information is presented, and
thereby facilitate the application review process, when indicated, applicants are
asked to use the tables provided in order to present the requested information.
II.B.5. Eliminate potential internal inconsistencies by ensuring that the information
provided in each table is consistent with the narrative and information included
in other tables.
II.B.6. If you omit any required information or data, explain why.
II.B.7. Your application should be self-explanatory. Therefore, the use of locally-derived
epidemiology or any other data must be described appropriately in the text and
II.B.8. Where instructed in the Guidance, provide the specific documentation requested
(e.g., By-laws or Intergovernmental Agreements).
II.B.9. Do not use attachments for information that is required in the body of the
application. Only use attachments for the purposes specified in the Guidance.
II.B.10. Prepare the application with the reader in mind,
by including the requested table of contents.
by cross-referencing all tables and attachments in the text of the application.
by carefully proofreading.
by numbering all pages consecutively as instructed.
by providing all requested information in the sequence and format requested in
14 - Title I FY 2002 Grant Application Guidance
II.C. APPLICATION CHECKLIST
The following checklist is provided to ensure that all required narrative information and tables
are included with the application. Applicants should follow the checklist to organize and present
the information required.
TITLE I FY 2002
____ I. TITLE PAGE
____ Table of Contents
____ Application Abstract and Map of the EMA
____ II. FEDERAL FORMS: PHS GRANT APPLICATION, FORM PHS 5161-1 (REVISED 6/99)
[This section of the application should be numbered separately from the
remainder of the application (i.e., i, ii, iii, etc.).]
____ SF 424: Application for Federal Assistance, signed Face page, and letter updating the
name and title of the authorized representative of the applicant EMA.
____ SF 424-A: Budget Information--Non-construction Programs
____ Section-A: Budget Summary (CFDA: 93.914)
____ Section-B: Budget Categories
____ Section-C: Non-Federal Resources (DO NOT COMPLETE)
____ Section-D: Forecasted Cash Needs (DO NOT COMPLETE)
____ Section-E: Budget Estimates for Balance of Project (DO NOT COMPLETE)
____ Budget Narrative/Justification
____ SF 424-B: Assurances--Non-Construction Programs (Signed)
____ PHS 5161-1 Certifications--Debarment and Suspension, Drug-Free Workplace,
Lobbying, Program Fraud, and Certification Regarding Environmental Tobacco Smoke
____ Checklist from PHS 5161-1 Application Kit, Page 25. The name, address, and telephone
number should be provided for both the individual responsible for day-to-day program
administration and the finance officer (See: Section II.C.)
____ Intergovernmental Review under Executive Order (EO) 12372 if required by the State
____ III. FORMULA FUNDING REQUEST
[Starting here, number all pages consecutively, beginning with page 1.]
____ 1. EMA HIV/AIDS Epidemiology
____ 2. HIV Health Services Planning Council
____ Planning Council Representation and Reflectiveness (narrative)
____ 3. Letters of Assurance from Planning Council Chair(s)
____ Assurance of FY 2001 Expenditure of Funds
____ Assurance of FY 2002 Priority Setting and Allocation of Funds
____ Assurance of FY 2002 Planning Council Training Plan
15 - Title I FY 2002 Grant Application Guidance
____ 4. Maintenance of Effort Documentation
____ 5. FY 2002 Agreements and Compliance Assurances and Inter-governmental
____ IV. SUPPLEMENTAL FUNDING REQUEST
[The narrative for this section is limited to 65 pages. Completed tables are to be
included in Attachment 1.]
____ 1. Compliance with FY 2001 Title I Requirements and Conditions of Award and
____ 2. Severe Need
____ HIV/AIDS Epidemiology (Narrative)
____ Co-Morbidity, Poverty, Insurance Status (Narrative)
____ Assessment of Populations with Special Needs (Narrative)
____ 3. Impact of Title I Funding
____ The Current Continuum of Care (Narrative)
____ Access to Care (Narrative)
____ Coordination of Services and Funding Streams (Narrative)
____ System-Level Outcomes (Narrative)
____ 4. Planning Council Mandated Roles and Responsibilities: Priority Setting
____ Data/Information Used for Priority Setting and Allocation of Funds (Narrative)
____ Needs Assessment and the Planning Process (Narrative)
____ Compatibility with Statewide Coordinated Statement of Need (Narrative)
____ Early-Intervention Services (Narrative)
____ 5. Assuring Quality of Services and Evaluation Activities
____ Quality Management Programs and Activities (Narrative)
____ Use of Costs in Evaluating Services (Narrative)
____ Progress in Developing Outcome-based Service Evaluation (Narrative)
____ 6. Progress in Implementing the FY 2001 Plan
____ Accomplishments to Date (Narrative)
____ Ongoing Challenges (Narrative)
____ Services for Women, Infants, Children and Youth
____ 7. Plan for FY 2002
____ Service Goals and Objectives
____ Providing Access and Reducing Disparities (Narrative)
____ V. ATTACHMENTS
____ Attachment 1 - Tables
____ Table 1: AIDS Incidence, AIDS Prevalence and HIV Prevalence by Demographic
Group and Exposure Category
____ Table 2: Roster of FY 2001 Planning Council Members
____ Table 3: Matrix for Planning Council Membership Categories
____ Table 4: Matrix for Planning Council Areas of Interest/Expertise
____ Table 5: Co-Morbidity, Poverty, Insurance Status
____ Table 6: Assessment of Populations with Special Needs
16 - Title I FY 2002 Grant Application Guidance
____ Table 7: Data/Information Used for Priority Setting and Allocation of Funds
____ Table 8: Title I Funding in the Context of Other Public Funding
____ Table 9: Summary of Priority Services to be Funded in FY 2002
____ Table 10: Quantified, Time-Limited Goals/Objectives for FY 2002
____ Attachment 2 – Grantee Organization Chart
Attachment 3 – Completed Planning Council Assessment of the Administrative
____ VI. DISKETTE CONTAINING THE FOLLOWING DOCUMENTS IN MS WORD
____ Formula Application
____ Supplement Application
____ Attachment I: Tables
17 - Title I FY 2002 Grant Application Guidance
II.D. INSTRUCTIONS FOR COMPLETING STANDARD FORM (SF) 424
The Public Health Service Application Kit, PHS Form 5161-1, is included in this mailing with
the FY 2002 Guidance. The following information supplements the instructions for completing
the SF 424 and related forms.
II.D.1. SF- 424 FORM
II.D.1.a. Item 6 of the face page and part C on page 5 of PHS 5161: EMAs must provide
the 12-digit Employer Identification Number (EIN) assigned by the Public Health
Service (PHS) and used by the grantee for requesting payment from the Payment
Management System. The 12-digit number can be found on the most recent
Notice of Grant Award.
II.D.1.b. Item 10: The OMB Catalog of Federal Domestic Assistance Number for the
CARE Act Grant program is 93.915.
II.D.1.c. Item 13: All EMAs should submit a 12-month budget covering the period
March 1, 2002 through February 28, 2003. Contracts may not extend beyond
the budget period (2/28/2003) (See: Section II.F, #11 - Unobligated Funds).
II.D.1.d. Item 14a.: Identify the specific Congressional District in which the applicant’s
organization is located. Only one Congressional District may be included in 14a.
Item 14b.: Identify all Congressional Districts affected by the program or project.
II.D.1.e. Item 15: On line 15a, enter the amount of financial support requested from HRSA,
under the Title I grant program for a 12-month budget period. Grantees will
receive information on the availability of funds for FY 2002 shortly after the
President has signed a Congressional appropriation for the CARE Act. Until such
time as an appropriation is signed, the amount of funds requested should be based
on the annualized amount of the FY 2001 formula funding level and supplemental
funding needed to support activities described in this application.
II.D.1.f. Item 16: Executive Order (EO) 12372 establishes a system for State and local
government review of proposed Federal assistance applications. Applicants
should contact their State Single Point of Contact (SPOC) as early as possible to
alert him/her to the prospective application and to receive any necessary
instructions on the State process. For proposed projects serving more than one
State, the applicant is advised to contact the SPOC of each affected State. A
current list of SPOCs for participating States is included in the application kit.
This information also is available on the HHS website
18 - Title I FY 2002 Grant Application Guidance
SPOCs should send State process recommendations to the attention of the Grants
Management Officer in HRSA/HAB. The SPOC has 60 days after the application
deadline date to submit recommendations to HRSA/HAB for competing renewal
applications (all EMAs). HRSA/HAB will take all recommendations made during
the time period under advisement, but cannot be bound by any recommendations
received after that date.
II.D.1.g. Enter the signature of the authorized representative of the applicant EMA. All
requests for Federal assistance require this signature. In the case of Title I
Applicants the authorized representative is the Chief Elected Official (CEO) of
the applicant EMA. A letter updating the name and title of the authorized
representative must accompany the FY 2002 Title I Grant Application. If the
CEO designates authority to sign Title I applications, the letter must state the
name(s) and/or position(s) of the designee and all others who have been granted
additional signature authority.
II.D.2. SF-424 A, BUDGET INFORMATION--NON-CONSTRUCTION PROGRAMS
Sections A and B of Form SF-424-A should be completed for a one-year period. Do not
complete Sections C, D or E. Section B is a breakdown of the budget by specific categories.
Line item 6(f) requests a total budget of all contract arrangements. Allowable costs and how
those costs may be allocated by States and local governments receiving PHS grants is set forth in
45 CFR Part 92. The cost principles prescribed for grant recipients are contained in the Office of
Management and Budget (OMB) Circular A-87 for State and local governments. These
documents are available on the HHS website (http:\\www.hhs.gov\progorg\grantsnet).
II.D.3. CHECKLIST FROM PHS 5161-1 GRANT APPLICATION KIT, PAGE 25, PART C
Indicate the Administrative Official responsible for the Title I grant. The Administrative Official
refers to the official responsible for the fiscal integrity of the grant (usually the Chief Financial
Officer). Program/Project Director refers to the official responsible for the day-to-day
administration of the program. The Administrative Official and the Program/Project Director
should not be the same person. Do not include the name of the CEO in this section.
II.E. BUDGET NARRATIVE/JUSTIFICATION
Applications for grant funds must provide a categorical budget and a budget
narrative/justification. General guidance on costs by budget category is provided below. For
more information on allowable administrative, quality management, planning council and
program support costs, refer to the HAB/DSS ―Issue Paper on Administrative Costs‖ (January
31, 1997), the Quality Management letter and consult the Title I Manual.
19 - Title I FY 2002 Grant Application Guidance
II.E.1. GRANTEE ADMINISTRATIVE COSTS
A budget narrative must be included which provides a line-item breakout of the budget, detailing
the amount of funds budgeted for each item. Administrative costs are funds to be used by the
grantee for routine grant administration and monitoring activities. These activities include the
development of this application under Title I, the receipt and disbursal of program funds, the
development and establishment of reimbursement and accounting systems, the preparation of
routine programmatic and financial reports, and compliance with grant conditions and audit
requirements. Administrative costs also may include all activities associated with the grantee’s
contract award procedures, including the development of requests for proposals, contract
proposal review activities, negotiation and award of contracts, as well as the development and
implementation of grievance procedures. In addition, administrative funds may be used for post-
award activities such as monitoring of contracts, written documentation of on-site visits,
reporting on contracts, and funding reallocation activities. Finally, administrative costs should
address expenses related to participation in the Statewide Coordinated Statement of Need. These
costs cannot exceed 5% of the grantee’s award (See: Section 2604 (e)(2)).
Applicants are instructed to limit the use of CARE Act funds for travel to the following
II.E.2.a. Applicants should include travel funds in their administrative budgets for travel
from the EMA to Washington, DC for technical-assistance meetings such as the
National Grantee Meeting. A minimum of two round trips should be budgeted for
II.E.2.b. Applicants should include three additional round trips for relevant Planning
Council members to attend technical-assistance meetings. This travel expense
may be included in either the administrative or Planning Council support budget.
If such meetings are not held, the grantee is encouraged to re-budget these funds
II.E.2.c. Applicants should limit all other travel to that which is related to the
administration of the grant and which is justified in the budget narrative.
II.E.2.d. Applicants should budget for expenses related to the support of PLWH during
technical assistance meetings with Title I or other funds. Applicants also should
be sure to budget for the support of PLWH during the National Grantee Meeting.
II.E.2.e. All travel for contractors must be local and directly related to the services
provided under the specific contract.
Finally, please be advised that budgeting for international travel is not allowed.
20 - Title I FY 2002 Grant Application Guidance
II.E.3. PLANNING COUNCIL SUPPORT
Funds to be used to support the operation of the Planning Council must be identified as a priority
by the Planning Council and may not be included in the grantee’s administrative cost budget.
Planning Council support includes the reasonable and necessary activities listed below.
II.E.3.a. Funds may be used for staff support (i.e. clerical and professional expenses
required by the Planning Council for the performance of required Planning
Council activities, including routine Planning Council administrative activities).
II.E.3.b. Funds may be used for costs incurred by Planning Council members as a result of
their participation on the Planning Council and in the conduct of their required
Planning Council activities, in accordance with Chapter 7, Allowable and
Unallowable Costs of the Public Health Service (PHS) Grants Policy Statement.
The Statement describes such items as reimbursement of reasonable and actual
out-of-pocket costs incurred solely as a result of attending a scheduled meeting:
including transportation, meals, baby-sitting fees, and lost wages. Allowable
costs are further described in the letter on reimbursable costs for members of
consumer/provider boards from the HAB Associate Administrator dated January
5, 2000 which was sent to all grantees.
II.E.3.c. Funds may be used for costs associated with out-of-town travel for Planning
Council members to and from HRSA/HAB sponsored technical assistance
meetings; however, no international travel is allowed.
II.E.3.d. Funds may be used for costs associated with conducting a needs assessment and
other methods for obtaining input on community needs and priorities, such as
public meetings, focus groups and ad-hoc panels for the purpose of assisting the
Planning Council in setting service priorities in accordance with Sections
2602(b)(4)(A) and (E).
II.E.3.e. Funds may be used for costs associated with the development of the
comprehensive plan for the organization and delivery of HIV-related services in
accordance with Section 2602(b)(4)(B).
II.E.3.f. Funds may be used for costs associated with assessing the efficiency of the
administrative mechanism in rapidly allocating funds within the EMA in
accordance with Section 2602(b)(4)(C).
II.E.3.g. Funds may be used for costs associated with participation in the development of
the Statewide Coordinated Statement of Need in accordance with Section
2602(b)(4)(D). Enter the Signature of the authorized representative of the
applicant EMA on the request.
21 - Title I FY 2002 Grant Application Guidance
II.E.3.h. Funds may be used for activities associated with publicizing the Planning
Council’s activities and programs for HIV-affected/infected populations and sub-
populations, and for efforts to substantively enhance community participation in
Planning Council activities.
II.E.3.i. Funds may be used for the administration of Planning Council grievance
procedures for decisions related to funding as required by the CARE Act in
accordance with Section 2602(b)(6).
II.E.3.j. Costs associated with local travel must be specifically related to legislative
mandates of the Planning Council and must be budgeted under Planning Council
Support. Therefore, all travel costs must be fully justified in the budget narrative.
II.E.3.k. Costs for each Planning Council support activity should be listed separately with a
budget justification for each activity.
II.E.4. PROGRAM SUPPORT
Funds may be used to support program activities that are not service-oriented or administrative in
nature, but which contribute to or help to improve service delivery. Such activities may include
capacity building, technical assistance, program evaluation (including outcome assessment),
quality assurance, and assessment of service-delivery patterns. These activities must be
established as priorities by the Planning Council and linked to the findings of a comprehensive
needs assessment. Activities must meet all other criteria of priority setting in accordance with
Sections 2602(b)(4)(A) and (E). Costs for each program-support activity should be listed
separately with a narrative justification for each activity. Travel outside of the EMA may not be
funded under program support.
II.E.5. QUALITY MANAGEMENT
Funds may be used to support quality management programs that assist direct-service medical
providers in assuring that funded services adhere to established HIV clinical practice standards
and Public Health Services (PHS) Guidelines. In addition, quality management programs must
ensure that strategies for improvements to quality medical care include health-related supportive
services and that available demographic, clinical and health-care utilization information is used
to monitor HIV-related illnesses and trends in the local epidemic. In FY 2001 grantees are
allowed to allocate up to 5% of the total grant award or $3,000,000 (whichever is less) for
quality- management activities.
II.E.6. SERVICE COSTS
Service costs are the proposed expenditures for services based upon the priorities established by
the Planning Council. Aggregate amounts for each category of services must be included. The
budget narrative must be consistent with budget information required on Standard Form 424A
and service categories outlined in Appendix 3 of this Guidance.
22 - Title I FY 2002 Grant Application Guidance
II.F. FUNDING RESTRICTIONS
II.F.1. Grant funds may not be used to supplant or replace current State or local HIV-related
funding. In addition, the applicant must ensure that political subdivisions within the
EMA will maintain their current level of contributions by setting the expenditures for
services provided to individuals with HIV disease at a level equal to that of the preceding
fiscal year. The applicant can meet this requirement by providing such an assurance for
the political subdivision, which the CEO is responsible for administering, using
Appendix 1 of this Guidance, and by establishing a system which will provide
documentation that all other political subdivisions meet this requirement.
II.F.2. Funds may not be used to purchase or improve land, or to purchase, construct, or make
permanent improvement to any building except for minor remodeling.
II.F.3. Funds may not be used to make payments to recipients of services, except for the
reimbursement of reasonable and allowable out-of-pocket expenses associated with
consumer participation in grantee and Planning Council activities.
II.F.4. Under certain circumstances, as determined by the HIV Health Services Planning
Council, up to 10 percent of the total amount of the Title I formula and supplemental
grant funds may be used to reduce severe personnel shortages in public or non-profit
private institutional, inpatient settings--such as hospitals and nursing homes. These
II.F.4.a. the council has determined that a shortage exists of specific health,
mental health, or support service personnel at certain institutions or
entities within the EMA;
II. F.4.b. the council has determined that such personnel shortages have
resulted in the inappropriate utilization of inpatient services within the
II.F.4.c. the inpatient facility can assure that it will comply with the criteria
established by the CARE Act for receiving Title I funds, and that
Title I funds will not be used to supplant or replace existing personnel
II.F.5. Recipients of grant funds must participate in a community-based continuum of care. A
continuum of care is defined on page 5 of the Guidance.
II.F.6. The CEO may not use more than 5 percent of funds awarded under this grant program for
administration, as defined in the legislation and in Section II.E. of this Guidance. The
CEO may use 5% of the grant award but not more than $3 million, for quality-
23 - Title I FY 2002 Grant Application Guidance
II.F.7. Of the aggregate amount of funds allocated to frontline service providers under this
grant, the total of expenditures by those subcontractors for administrative expenses shall
not exceed 10 percent (without regard to whether any of these subcontractors expend
more or less than 10 percent for such expenses). Funds available to subcontractors to
carry out Planning Council support, program support, and service-related activities are
subject to the 10% aggregate administrative cost cap. While subcontractors of the
frontline service providers are not included in the 10% aggregate cap, HRSA strongly
recommends that all subcontracts of funded providers include a cap on administrative
expenses. For the purposes of the 10% aggregate cost cap, administrative activities
II.F.7.a. usual and recognized overhead, including established indirect rates;
II.F.7.b. management and oversight of specific programs funded under this Title; and
II.F.7.c. other types of program support (e.g., capacity building; technical assistance;
program evaluation, including outcome assessment; quality assurance; and
assessment of service-delivery patterns that affect the care of the individuals in
II.F.8. If a particular service is available under the State Medicaid Plan, the political subdivision
involved either must provide the service directly or must enter into an agreement with a
public or private entity to provide the service. The subcontractor providing the service
must enter into a participation agreement under the State Medicaid Plan and must be
qualified to receive payment under the State Medicaid Plan. The Planning Council may
waive the requirement regarding participation agreements with the State Medicaid Plan if
the subcontractor providing the service does not impose charges or accept payment for
services (with the exclusion of voluntary donations for the provision of services) from
any third-party payer, including any insurance policy or any Federal or State health-
II.F.9. Funds may not be used to provide items or services for which payment already has been
made, or reasonably can be expected to be made, by third-party payers, including
Medicaid, Medicare, and/or other State or local entitlement programs, prepaid health
plans, or private insurance. It is therefore incumbent upon grantees to assure that eligible
individuals are expeditiously enrolled in Medicaid and that CARE Act funds are not used
to pay for any Medicaid-covered services for Medicaid-eligible PLWH.
HIV health care and support services provided by the CARE Act must be offered without
regard to the individual’s ability to pay, the individual’s past or present health condition,
and in a setting accessible to low-income individuals living with HIV disease. The Act
allows fees to be charged for services to patients with HIV disease. However, grantees
must develop a sliding fee schedule that takes into account the patient’s level of income
and limits total service charges to a percentage of the individual’s yearly income.
24 - Title I FY 2002 Grant Application Guidance
Applicants are reminded that CARE Act grantees are subject to audit on this and other
restrictions on use of funds.
II.F.10. If an EMA or Title I service provider receiving Title I funds charges for services, it must
do so on a sliding-fee schedule that is made available to the public. All charges to clients,
for services provided over the course of one year, may not exceed the calculations offered
in the chart below. Individual, annual aggregate charges to clients receiving Title I
services must conform to statutory limitations (see chart). The term aggregate charges
applies to the annual charges imposed for all such services under Title I of the CARE Act
without regard to whether they are characterized as enrollment fees, premiums,
deductibles, cost sharing, co-payments, coinsurance, or other charges for services. This
requirement applies to all providers of Title I-funded services. This requirement may be
waived by the Planning Council for an individual service provider in those instances
when the provider does not impose a charge or accept reimbursement available from any
third-party payer--including reimbursement under any insurance policy or any Federal or
State health-benefits program. The intent is to establish a ceiling on the amount of
charges to recipients of services funded under Title I. Please refer to the following chart
for allowable charges.
Individual/Family Annual Gross Income
And Total Allowable Annual Charges
Individual/Family Total Allowable
Annual Gross Income Annual Charges
Equal to or below the official poverty line No charges permitted
101 to 200 percent above the official poverty line 5% or less of gross income
201 to 300 percent above the official poverty line 7% or less of gross income
More than 300 percent above the official poverty line 10% or less of gross income
Establishing a fee schedule should not result in a bureaucratic system to means-test
individuals or families before Title I supported services are provided. A simple
application that requests information on the annual gross salary of the individual/family
should provide the baseline by which the caps on fees will be established. The client
should ensure that the information provided is accurate.
Unexpended funds at the end of the budget period are restricted and remain in the grant
account for future HRSA disposition. Unexpended funds are those reported on the annual
Financial Status Report (FSR) which is required to be submitted to HRSA/HAB 90 days
after the end of the budget period. These funds may be approved for carry-over or may be
used to adjust the grant amount for the next fiscal year. However, after FY 2003, requests
for carry-over funds will not be approved for program years FY 1991 through FY 1997.
25 - Title I FY 2002 Grant Application Guidance
II.F.11. Funds are to be used in a manner consistent with current and future program policies
developed for Title I regarding allowable categories of services and eligibility for
services. Current DSS and HAB program policies include:
DSS 01 Eligible Individuals and Services for Individuals Not Infected with HIV
DSS 02 Allowable Uses of Funds for Discretely Defined Services
DSS 03 Outreach
DSS 04 Clarification of Language Regarding Contracting with For-Profit Entities
DSS 05 AIDS Drug Assistance Program: Eligibility and Formulary Parity and Uses of Funds
DSS 06 Clarification of DSS/HAB Guidance Regarding AIDS Drug Assistance Program:
Administration, Eligibility and Cost-Savings
DSS 07 Residence of Planning Council Members and Consortia
DSS 08 Staff Training
HAB99-01 The Use of ADAP Funds to Purchase Health Insurance
HAB99-02 The Use of Ryan White CARE Act Funds for Housing Referral Services and Short-term
Emergency or Emergency Housing Needs
HAB99-03 The Use of Ryan White CARE Act Funds for HIV Diagnostics and Laboratory Tests
―Amended Policy on Participation of PLWH on Title I HIV Health Services Planning Councils.‖
FY 2001 HAB Reauthorization Letters
HAB-00-01 The Use of Ryan White CARE Act Funds for American Indians and Alaskan Natives and
Indian Health Service Programs
HAB-00-02 The Use of Ryan White CARE Act, Title II, AIDS Drug Assistance Program (ADAP) Funds
for Access, Adherence and Monitoring Services
HAB-00-02 Amendment #1
HAB-01-01 The Use of Ryan White CARE Act Funds for Transitional Social Support and Primary Care
Services for Incarcerated Persons
II.G. FUNDING FOR WOMEN, INFANTS, CHILDREN AND YOUTH
Section 2604 (4)(A) Priority for Women, Infants, Children and Youth. For the purpose of providing health and
support services to infants, children, youth, and women with HIV disease, including treatment measures to prevent
the perinatal transmission of HIV, the chief elected official of the eligible area in accordance with planning council
established priorities, shall for each subpopulation use not less than the percentage constituted by the ratio of the
population involved (infants, children, youth or women) with acquired immune deficiency syndrome to the general
population of the user area.
Section 2604 (B) Waiver- With respect to the population involved, the Secretary may provide to the chief elected
official of an eligible area a waiver of the requirement of subparagraph (A) if the official demonstrates to the
satisfaction of the Secretary that the population is receiving HIV-related health services through the state Medicaid
program, the State child health-insurance program or other Federal or State programs.
Grantees are required to provide and support programs and services targeting women, infants,
children and youth, based on the percentage that they represent in the total population of people
living with AIDS. In June of 2001 grantees were required to submit plans on how they will
implement a system to assure the separate tracking of expenditures on each sub-population.
Information on the estimated number of women, infants, children and youth with AIDS by EMA
was mailed to grantees under separate cover in a letter dated March 8, 2001.
26 - Title I FY 2002 Grant Application Guidance
II.H. REPORTING REQUIREMENTS
II.H.1. FY 2002 PROGRAM PROGRESS REPORTS
II.H.1.a. Grantees must report to the HRSA/HAB Grants Management Office regarding the
progress of implementing Title I funded program activities and services in
accordance with applicable provisions of the general regulations (45 CFR Part 92,
Sub-part C, Monitoring and Reporting of Program Performance), and in
accordance with the CARE Act.
II.H.1.b. Guidance in preparing FY 2002 program progress reports will be provided to
grantees under separate cover.
II.H.2. THE ANNUAL ADMINISTRATIVE REPORT (AAR)
II.H.2.a. Grantees are required to submit Annual Administrative Reports (AARs) from all
funded providers to the Office of Science and Epidemiology (OSE),
HRSA/HAB/OSE. The AARs document services provided, demographic
characteristics of clients receiving those services and descriptive information
about the organizations that deliver care with Title I funds. The AARs can be
entered directly on the HAB website (www.hab.hrsa.gov) by the grantee of record.
The grantee is responsible for reviewing all contracted service providers’ data
reports for accuracy and completeness before submitting reports to OSE.
Instructions for completing the report online are provided at the website.
Alternatively, the AARs may be submitted on paper forms provided by OSE for
II.H.2.b. The requirements to collect the data necessary to complete the AARs must be
included in all contracts with service providers. Grantees should note two major
developments pertaining to the submission of service data to HAB:
The reauthorized Ryan White CARE Act stresses the importance of quality
management and improved health outcomes in HIV programs. The collection
and management of unduplicated client-level data are central to your efforts to
manage your patient-care services and to evaluate the care you provide. It
enables HAB to answer important questions relating to the delivery of care.
HAB therefore strongly encourages providers to collect and maintain
unduplicated client-level data that can be used to create aggregate counts for
the purpose of data reporting. To assist in unduplicated client-level data
management, HAB is offering a free software package called CAREWare,
which is available for download at the HAB website.hrsa.gov/hab. Use of
CAREWare is not required.
27 - Title I FY 2002 Grant Application Guidance
After extensive consultations with grantees, HAB has decided to move to a
cross-title data reporting (CTDR) system starting in January of 2002, whereby
all CARE Act programs will use a single form for data reporting. To facilitate
the transition to the new data collection and submission requirement, and to
work with you to improve your client-level data collection systems, HAB is
offering training sessions in the fall of 2001 and targeted technical assistance
to its grantees.
II.H.3. TITLE I ALLOCATIONS REPORTS
II.H.3.a. Planned Allocations: Grantees are required as part of COA C.3 to submit a report
of their planned allocations by services category within 90 days of receiving their
FY 2002 grant as a condition-of-award, on June 1, 2002.
II.H.3.b. Final Allocations: Grantees must also submit as part of COA B.3 a report of their
final funding allocations within 90 days following the end of a fiscal year. Final
FY 2001 allocation reports will be due on June 1, 2002; final FY 2002 allocations
reports will be due on June 1, 2003.
II.H.3.c. Planned and final allocation reports must be submitted both as hard copies and
on diskette. Guidance including electronic template, will be provided to grantees
under separate cover.
28 - Title I FY 2002 Grant Application Guidance
INSTRUCTIONS FOR COMPLETING
TO MEET REQUIREMENTS
FOR FORMULA FUNDING
29 - Title I FY 2002 Grant Application Guidance
INSTRUCTIONS FOR COMPLETING DOCUMENTATION TO MEET REQUIREMENTS
FOR FORMULA FUNDING
Section III includes a description of the legislative and program requirements for formula funding
and instructions for submitting the request for formula funding. Please refer to the Checklist on
pages 15-17 of the Guidance for the order in which the information should be presented in the
(REMEMBER: The Formula Funding Request, Section III, in conjunction with the
Supplemental Request for Funding, Section IV, may not exceed 115 pages.)
III.A. FORMULA FUNDING: SUMMARY OF REQUIRED INFORMATION
Eligible Metropolitan Areas (EMAs) are entitled to receive a Formula grant based upon an
adequate response to the documentation required in this section. The amount of Title I formula
funds awarded to an EMA will be based upon relative need as reflected in the Congressionally-
mandated formula. The Formula funding portion of the FY 2002 application requires
documentation of the following legislative and program requirements:
HIV/AIDS epidemiology data for the EMA, (See: Table 1);
an established and functioning Planning Council that is inclusive of required categories of
membership and reflective of the EMA’s HIV/AIDS epidemic, (See: Tables 2, 3, and 4);
letters of assurance from the Planning Council Chair; as referenced on page 35;
maintenance of expenditures for HIV-related services by local governments within the EMA
at a level equal to that of the preceding fiscal year (Maintenance of Effort, as outlined on
pages 35 and 36);
completion of agreements, compliance assurances, and intergovernmental agreement(s) (See:
Documents included in Appendix 1).
III.B. FORMULA FUNDING: THE REVIEW PROCESS
For purposes of awarding formula funds, information from Section III will be reviewed to
document the submission of complete and responsive narrative and tables. EMAs that do not
submit required documentation under Section III will not receive formula funds.
30 - Title I FY 2002 Grant Application Guidance
III.C. INSTRUCTIONS FOR PREPARING THE FORMULA APPLICATION
III.C.1. Application Abstract and EMA Map
Applicants are required to include a one-page abstract describing the EMA with their application.
The abstract should contain enough information about the EMA to give a context for the
reviewers who will be scoring the application. The application abstract may be single-spaced. At
a minimum, the following should be discussed:
III.C.1.a. the demographics of the EMA, both in general and among people living with
HIV/AIDS. Include a discussion of the factors to create barriers to HIV/AIDS
service delivery in the EMA, such as health, social, and economic barriers, as they
III.C.1.b. the geography of the EMA with regard to communities affected by HIV/AIDS and
with regard to the location of HIV/AIDS services.
III.C.1.c. any additional information which would provide a context for the continuum of
care offered in the EMA. Include relevant information about the primary medical
care services (e.g., are such services case-management centered, clinic centered,
university-hospital based, community-based, and so on).
III.C.I.d. In addition to the abstract, applicants are required to provide a map of the EMA
that shows the location of HIV/AIDS primary medical care, support services,
points of entry, and that identifies Title I funded agencies.
III.C.2. EMA HIV/AIDS EPIDEMIOLOGIC DATA
(Table 1, no narrative is required.)
HIV/AIDS epidemiology data are a key source of information used in comprehensive planning,
including identifying characteristics of the EMAs’ HIV/AIDS cases, conducting a needs
assessment, preparing a comprehensive plan, and establishing priorities for the allocation of
funds. Among the most important epidemiology data for use in CARE Act planning are AIDS-
prevalence data (the number of persons living with AIDS) and HIV-prevalence data (the number
of persons living with HIV; non-AIDS). HAB/DSS expects that grantees and Planning Councils
monitor recent trends in HIV/AIDS epidemiology data and that service priorities and funding
allocations are consistent with this data.
When preparing the application narrative for Section IV.A. Supplemental Funding: Severe Need,
applicants are requested to use HIV-prevalence data to discuss trends and changes in the EMA’s
HIV/AIDS epidemic. In addition, Planning Councils and grantees should develop methods to
estimate the number of persons in the EMA who know their HIV status but are not receiving
HIV/AIDS primary medical care. This quantification will require strengthening the linkages
between HIV counseling and testing programs and the access points in the EMA’s continuum of
31 - Title I FY 2002 Grant Application Guidance
Using Table 1, applicants must submit a summary report on AIDS Incidence (cases diagnosed
from 07/1/98 through 6/30/00) and both HIV and AIDS Prevalence (cases diagnosed as of
06/30/2000) for the EMA. A report on both HIV and AIDS prevalence and incidence was
prepared by the Centers for Disease Control and Prevention (CDC) and is included in the
guidance in Appendix 4.
Completed tables should be placed in Attachment 1 of the application.
III.C.3. HIV HEALTH SERVICES PLANNING COUNCIL
(Tables 2, 3, 4 and narrative)
Section 2602(b)(1) requires that the Planning Council "reflect in its composition the demographics of the epidemic in
the eligible area...with particular consideration given to disproportionately affected and historically under-served
groups and subpopulations."
Section 2602(b)(2) requires certain categories of representatives to be members of the Planning Council.
Section 2602(b)(5)(C) requires that not less than 33% of the Planning Council consist of infected and affected
individuals who are consumers and not aligned with providers of Title I-funded HIV services
Section 2602(b)(7) requires that planning council meetings be open to the public, that adequate notice be given to the
pubic regarding meeting times, and that Planning Council records, reports, transcripts, minutes, agenda or other
documents be made available for public inspection and copying at a single location. It specifies that minutes be kept
and certified by the chair of the council. It requires that in providing this information to the public, efforts be made to
protect personal privacy in regards to medical information or personnel matters.
Section 2603(b)(1)(F) requires grantees to demonstrate the inclusiveness of Planning Council membership, with
particular emphasis on affected communities and individuals with HIV disease.
Section 2602(e) requires that the Secretary provide to each CEO guidelines and materials for training members of
Planning Councils regarding the duties of the council.
Title I HIV Health Services Planning Councils are entities comprised of volunteer citizen
planners appointed by the Chief Elected Official of the EMA for the purpose of planning for the
use of Title I funds to support HIV services in the EMA. The CARE Act and HAB/DSS policy
require that their composition reflect the demographics of the population of individuals with HIV
disease in the EMA. In addition, CARE Act legislation requires that certain categories of
representation be present on all Planning Councils and that persons living with HIV disease
(PLWH) have full and effective involvement. The CARE Act Amendments of 2000 increase the
level of PLWH representation and reflectiveness, and strengthen restrictions on conflicts of
interest. They also include additional provisions requiring that Planning Council deliberations be
open and fully accessible to the public, as well as requirements that members be trained to fully
and effectively participate on Councils. Further information on these legislative requirements
32 - Title I FY 2002 Grant Application Guidance
and HRSA/HAB expectations are included in Appendix 5 in Reauthorization Issue Letters #1, #2
(including the addendum), and #6.
For the purposes of meeting the requirements of the legislation DSS has defined the following
Representation: Refers to the fifteen legislatively defined categories of membership listed
in the instructions for Table 2 in the Guidance.
Reflectiveness: Refers to the degree to which Planning Council membership is similar to
the demographics of the epidemic in the EMA.
Demographics: Characteristics of the PLWH population including gender, race/ethnicity,
age and exposure category.
Grantees and Planning Councils must demonstrate reasonable efforts to establish and sustain
reflectiveness. The Planning Council as a whole should be reflective of the affected populations
of the EMA. As of March 1, 2002, non-conflicted PLWH membership must reflect the
demographics of the HIV/AIDS population. EMAs must use HIV-prevalence data to report on
the composition of the Planning Council. EMAs also should use HIV-prevalence data in their
planning activities and in establishing the membership of Planning Councils.
PLANNING COUNCIL OPEN MEETINGS
CARE Act legislation requires that Planning Council meetings be open to all members of the general public. New
legislatively-mandated requirements further oblige all Title I Planning Councils to take steps to ensure that the
public is given adequate notice of meetings, that certified transcripts of meeting minutes be provided, and that
minutes and certain other documents are made available for public inspection and copying at a single location.
As an FY 2001 Condition-of-Award, Planning Council chairs provided brief letters with evidence of steps taken by
the Planning Council to comply with these new requirements. See Reauthorization Issue Letter #2 and its
In order to have an effective planning body, members must be trained regarding their
legislatively-mandated responsibilities, as well as other competencies necessary for full
participation in collaborative decision making. HAB/DSS has developed a variety of written
materials to ensure that Planning Council members and PLWH receive information and training,
Title I Manual
Training Guide, A Resource for Orienting and Training Planning Council and Consortia
Planning Council Primer
33 - Title I FY 2002 Grant Application Guidance
These materials are being updated to reflect recent legislative changes in the CARE Act.
HAB/DSS is in the process of developing a standard curriculum and new methods for providing
ongoing and consistent training for Planning Council leadership and members. EMAs should use
these resources as they become available (along with locally-developed materials) to ensure that
members are knowledgeable about their duties, the functions of the Council, and the Council’s
role in the organization and delivery of HIV/AIDS health and support services. The CEO and
Council Chair(s) must provide assurances with this application that training activities will take
place. A separate budget line item for training should be included in the Planning Council
Using Tables 2, 3, and 4, applicants must document an established, functioning HIV Health
Services Planning Council that meets CARE Act and HRSA/HAB program requirements.
(A) Information for these tables must be based on the composition of the Planning Council
membership as of September 1, 2001 Planning Council reflectiveness must be based on HIV
Prevalence data submitted in Table 1 of the application.
Provide a narrative addressing the areas listed below.
III.C.3.a. Based upon information provided in Tables 1, 2, 3, 4, and 4a, describe any
deficiencies in representation or reflectiveness in the full membership of the
Planning Council. Describe variations between the overall demographics of the
Planning Council and the HIV-prevalence demographics of the EMA’s epidemic,
for the past two years. Explain why these deficiencies persist. Provide a plan and
timeline for addressing each deficiency.
III.C.3.b. Based upon information provided in Tables 1, 2, 3, 4 and 4a, describe any
deficiencies in representation or reflectiveness among non-conflicted PLWH
Planning Council members. Note variations between the demographics of the
non-conflicted PLWH membership and the HIV-prevalence demographics of the
III.C.3.c. Describe any vacant seats on the Planning Council. Explain how long the seats
have been vacant and why the vacancies exist. Provide a plan and a timeline for
addressing each vacancy.
III.C.3.d. Describe how new and existing Planning Council members are trained. Provide a
plan for initial and ongoing training sessions for Planning Council members
during FY 2002. The plan must include goals, timelines and a budget for training.
The plan should address efforts to achieve proficiency in the competencies
outlined in Reauthorization Letter #6 and should include a plan for ongoing
mentoring of new members.
34 - Title I FY 2002 Grant Application Guidance
III.C.4. LETTERS OF ASSURANCE FROM PLANNING COUNCIL CHAIR(S)
(Provide requested letters)
Applicants must provide three separate letters of assurance signed by the Planning Council
Chair. The letters must include the information described below.
Letter #1 must contain an assurance by the Planning Council Chair that FY 2001 Formula and
Supplemental funds awarded to the EMA are being expended according to the priorities
established by the Planning Council and that all FY 2001 Conditions of Award for the Formula
and Supplemental grants to the EMA relative to the Planning Council have been addressed. In
addition, the Planning Council should report on how it met its legislative mandate to assess the
efficiency of the administrative agency.
Letter #2 is an assurance that the FY 2002 priorities listed in Table 10 were determined by the
Planning Council, and that the process for establishing those priorities (as described in Section
IV.4.) was used by the Planning Council.
Letter #3 is an assurance that Planning Council member training, based on the plan submitted in
the application, will take place.
III.C.5. MAINTENANCE OF EFFORT
(Submit required documentation)
Section 2603(b)(1)(C) requires that grantees demonstrate the commitment of local resources, both financial and
in-kind, to combating the HIV epidemic.
Section 2605(a)(1)(B) requires “that the political subdivisions within the eligible area will maintain the level of
expenditures by such political subdivisions for HIV-related services for individuals with HIV disease at a level that is
equal to the level of such expenditures by such political subdivisions for the preceding fiscal year.”
Section 2605(a)(1)(C) requires “that political subdivisions within the eligible area will not use [Title I funds]... in
maintaining the level of expenditures for HIV-related services.”
To be eligible to receive Title I funding, grantees must maintain a commitment of both financial
and in-kind resources for HIV-related services by local governments within the EMA at a level
equal to that of the preceding fiscal year. The HAB/DSS Maintenance of Effort Issue Paper for
Title I Programs describes requirements in detail. If you do not have a copy of this paper, please
contact your Project Officer.
35 - Title I FY 2002 Grant Application Guidance
Applicants must submit the following with their FY 2002 Title I application:
III.C.5.a. an assurance signed by the CEO, stating that the EMA is complying with the
maintenance-of-effort requirement, as required under the assurances section
III.C.5.b. a written description of the methodology used to track and report on maintenance
III.C.5.c. a report detailing year-to-year HIV-related expenditures by local governments
within the EMA. The report must include:
a brief narrative explaining any changes in the data set where HIV-related
expenditures have been reduced or where the purpose of an HIV-related
expenditure has changed; and
documentation proving that the overall level of HIV-related expenditures
has been maintained year-to-year for the previous two complete fiscal
III.C.6. FY 2002 AGREEMENTS, COMPLIANCE ASSURANCES, AND INTERGOVERNMENTAL
III.C.6.a. Agreements and Compliance Assurances
A signed copy of the FY 2002 Agreements and Compliance Assurances must be
submitted with the application. A blank form is found in Appendix 1 of this
Guidance. This form must be completed and signed by the chief elected official
(CEO) of the EMA, or the individual designated by the CEO to sign the
assurances. In the latter instance, a letter documenting the delegation of authority
must be submitted with the application (this letter may be from a previous year
but must be valid for the current application period).
III.C.6.b. Intergovernmental Agreements:
The CARE Act requires all EMAs to establish an inter-governmental agreement
(IGA) with each political subdivision within the EMA that meets both of the
following criteria: 1) the subdivision provides HIV-related health services; and 2)
the subdivision has 10 percent or more of the total reported AIDS cases in the
EMA over the previous 5-year period ending December 31, 2000.
A copy of all IGAs must be submitted with the application. A listing of political
subdivisions that meet the 10 percent threshold is included as Appendix 2.A. of
the Guidance. If those subdivisions do not provide HIV-related health services,
36 - Title I FY 2002 Grant Application Guidance
an IGA is not required. Appendix 2.B. of the Guidance provides a listing of
geographic definitions for EMAs.
The IGAs must include a description of and justification for the method used to
allocate funds among the political subdivisions. The justification should be
explained in terms of 1) the number of AIDS cases; 2) the severity of need for
outpatient and ambulatory care services; and 3) health and support personnel
needs. Future application guidance will require the severity of need among
political subdivisions to be explained in terms of those persons in care whose
needs are not being met and those who know their HIV status but are not
receiving HIV/AIDS primary medical care.
37 - Title I FY 2002 Grant Application Guidance
INSTRUCTIONS FOR COMPLETING
TO MEET REQUIREMENTS FOR
38 - Title I FY 2002 Grant Application Guidance
INSTRUCTIONS FOR COMPLETING DOCUMENTATION TO MEET REQUIREMENTS FOR
IV.A. SUPPLEMENTAL FUNDING: SUMMARY OF REQUIRED INFORMATION
Section IV of the Guidance outlines the information requested for the Supplemental Funding
Request. The information requested directly relates to legislative requirements and program
expectations for recipients of Ryan White CARE Act Title I funds. Applicants should use tables
and narrative text as instructed to provide the required information. The application tables to be
included as Attachment 1 of the application are used to standardize information across EMAs.
(PLEASE NOTE: The Supplemental Funding Request, Section IV, is limited to a
maximum of 65 pages, excluding tables.)
The FY 2002 Guidance requires applicants to demonstrate that the EMA engages in a planning
process based upon a strong understanding of HIV/AIDS-incidence and prevalence data, as well
as HIV-prevalence data. EMAs are expected to describe:
how data, especially HIV/AIDS epidemiology data, were used to plan for and to respond
to changes in the epidemic;
the extent to which an accessible continuum of care exists in the EMA that includes
access to primary medical care as well as to supportive services that facilitate access to
primary medical care;
efforts to ensure access to the continuum of HIV/AIDS health care and related support
services for persons who are receiving primary medical care for treatment of HIV disease
but whose needs are not being met and for those who know their status but are not
receiving primary medical care for the treatment of HIV disease.
how Title I programs are linked to other HIV/AIDS care and prevention services,
especially to HIV counseling and testing programs; and
how the quality of services and service outcomes is evaluated.
Point values have been assigned by HAB/DSS to the required sections for use by the reviewers in
scoring the application. The following table lists the categories and the maximum number of
points awarded for each category.
1. Compliance With FY 00-01 Title I Requirements and Conditions of Award 26 Points
2. Grant Administration 5 Points
3. Severe Need 33 Points
4. Impact of Title I Funds 6 Points
5. Planning Council Mandated Roles/Responsibilities 10 Points
6. Update on Assuring Quality of Services and Evaluation Activities 10 Points
7. Progress in Implementing the FY 2001 Plan 5 Points
8. Plan for FY 2002 5 Points
MAXIMUM TOTAL: 100 Points
39 - Title I FY 2002 Grant Application Guidance
IV.B. SUPPLEMENTAL FUNDING: THE REVIEW PROCESS
The FY 2002 Supplemental application will be reviewed and scored based upon the evaluation
criteria in Section IV.C.1 and submission of the table and narrative information in Section
IV.C.2. through IV.C.7. Scores assigned by reviewers are a principal factor in determining the
level of an applicant’s supplemental grant amount. The amount of Title I supplemental funds
awarded to an EMA will depend on the amount of the FY 2002 appropriation, the relative need
in the EMA as reflected in the Congressionally-mandated formula used to determine the Title I
formula award, the amount of supplemental funds available after requirements in the formula
award have been met, and the applicant's numerical score on the supplemental application as
determined by the review. In addition, HRSA reserves the right to offset FY 2002 awards
with unexpended balances from previous years.
IV.C. INSTRUCTIONS FOR PREPARING THE SUPPLEMENTAL APPLICATION
IV.C.1. COMPLIANCE WITH FY 2000 AND FY 2001 TITLE I CONDITIONS OF AWARD
(COA) AND ADMINISTRATION BY THE GRANTEE
[Conditions of award as submitted to HAB Office of Grants Management (IV.C.1.a.) and narrative
The purpose of this section is to assess the EMA’s compliance with conditions of grant award for
prior years and to describe how Title I funds are administered. Note: None of the materials
listed in the table below need to be resubmitted as a part of the application. The score you will
receive is based on materials you already have submitted.
IV.C.1.a. Compliance with FY 2000 and FY 2001 Title I Requirements and Conditions of
Award (COA) As Previously Submitted …………………………………(26 Points)
Points for this section will be assigned based on the timeliness of COA submissions by the
grantee to the HRSA/HAB Grants Management Officer. FY 2002 grant awards will not be
issued to an EMA that is not in full compliance with FY 2001 and all the conditions established
in the previous years.
40 - Title I FY 2002 Grant Application Guidance
Condition of Award Due Date Point Values Comments
FY 2000 Compliance Issues
FY 2000 final Financial Status Report (FSR) received by due 5/31/01 2 - if submitted by Requests for late submission must
date or by approved late submission date. due date have been received not later than
(FY2000 COA.B.1) 5/31/01. Final FSRs received after
9/30/2001 will be considered late.
Maximum: 2 pts.
FY 2000 Expenditure Rate 5/31/01 5 - 95%+ No points will be given for
(as documented in the final FY 2000 FSR) 4 - 94% submission of an ―interim‖ FSR.
3 - 93% Points will be awarded based on
2 - 92% percent of funds expended.
1 - 91%
0 - 90% or less
Maximum: 5 pts.
FY 2000 Annual Progress Report received not later than due 5/15/01 2 - if submitted by Requests for late submission must
date or by an approved late submission date. due date have been received not later than
(FY 2000 COA.B.3) This includes submission of the FY 2000 5/1/01. Complete reports must
Final CBC Report Format. Maximum: 2 pts. include final FY 2000 service
FY 2000 Annual Administrative Report (AAR) Data received 3/15/01 1 - if submitted by Requests for late submission must
by HRSA contractor not later than due date or by an approved due date have been received not later than
late submission date Maximum: 1 pt. 3/15/00.
FY 2001 Compliance Issues
COA A2. Revised budget and narrative justification for 4/15/01 2 - if submitted by Based on actual level of FY 2001
administration, Planning Council, Program Support and due date funding by 4/15/01.
Quality Management based on actual FY 2001 funding level.
1 - for condition
lifted by 9/30/01
Maximum: 3 pts.
COA C.1 New Planning Council Legislative Mandates 5/1/01 1 - if submitted by
1-for condition lifted
Maximum: 2 pts.
COA C.2 Plan for Tracking Issues for Women, Infants, 6/1/01 1 - if submitted by
Children, and Youth. due date
1- for condition lifted
Maximum: 2 pts.
COA C.3 (a, b, c) Budgeted allocation of Title I funds by 6/1/01 2 - if all sections Must include amount allocated to
service category, letter of endorsement by Planning Council, submitted by due date each category and priority number
and revised FY 2001 Implementation Plan (Table 10) as determined by the Planning
1- if condition lifted Council
Maximum: 3 pts.
41 - Title I FY 2002 Grant Application Guidance
COA C.4 (a-e) Categorical budget for each grant-funded 7/31/01 3 - if all funds Budgets must include narrative
contract, Contract Review Certifications and Attachment E, accounted for on due justification for each contract
Other Sources of Funds. date funded.
1 – if condition lifted
COA D (1-3) CBC Minority AIDS Initiative 5/18/01 2 - if all sections
Plan for the use of FY 2001 CBC Funds, including summary, submitted by due date
Report Format and Narrative.
1 - if condition
lifted by 9/30/01
Special Conditions of Award See Notice -1 if not submitted by
of Grant due date
-1 for each condition
not lifted by 9/30/01
42 - Title I FY 2002 Grant Application Guidance
IV.C.1.b. Grantee Administration of Title I Funds……………………………………..5 POINTS
HAB/DSS expects that the Chief Elected Official in each EMA will disburse Title I funds
quickly and will closely monitor their use. Provide a brief description of how Title I funds are
administered in the EMA. The narrative must include the following.
IV.C.1.b.i Describe the process used to monitor compliance with contracts and other
agreements for HIV/AIDS services in the EMA. Address the following in this
Describe contract monitoring protocols and tools used by the administrative
agent to conduct fiscal site visits.
Indicate how often fiscal monitoring site visits are conducted by the
Indicate what percent of current providers received a site visit for fiscal
monitoring purposes during this fiscal year.
Explain how often fiscal reports are required from subcontractors to the
Describe the fiscal information that subcontractors are required to report on,
including how expenditures are being tracked for women, infants, children and
Indicate what percentage of current providers submitted all required fiscal
reports in FY 2001.
Describe the process of corrective action once a fiscal-related concern is
Describe contract monitoring protocols and tools used by the administrative
agent to conduct programmatic site visits.
Indicate how often programmatic monitoring site visits are conducted by the
Indicate what percent of current providers received a site visit for
programmatic monitoring purposes during this fiscal year.
Explain how often program progress reports are required from subcontractors
to the grantee.
Describe the program information that subcontractors are required to report,
including requirements for tracking services to women, infants, children, and
Indicate what percent of current providers submitted all required program
progress reports in FY 2001.
43 - Title I FY 2002 Grant Application Guidance
Describe the process of corrective action taken once a programmatic concern
44 - Title I FY 2002 Grant Application Guidance
Pursuant to OMB Circular A-133, grantees and sub-grantees that expend $300,000 or more federal funds shall have
audits made by an independent auditor in accordance with generally accepted government auditing requirements
covering financial audits. The new authorized CARE Act also states in Sec. 2675A. AUDITS. “For fiscal year 2002 and
subsequent fiscal years, the Secretary may reduce the amounts of grants under this title to a State or political
subdivision of a State for a fiscal year if, the State or political subdivision fails to prepare audits in accordance with
the procedure of 7502 of title 31, United States Code. The Secretary shall annually select representative samples of
such audits, prepare summaries of the selected audits and submit summaries to Congress.”
IV.C.1.b.ii. Describe how the grantee ensures that contractors and other service providers
comply with the audit requirement in OMB Circular A-133.
How often are subcontractors who receive CARE Act funds required to
submit fiscal audits?
How often are sub-contractors required to submit fiscal audits that receive
CARE Act funds?
What percent of contractors submitted results of fiscal audits in FY 2001?
How many agencies had significant findings on their audits and what
corrective actions plans were put in place?
IV.C.1.b.iii. Explain how subcontractors document that clients have been screened for
eligibility for Medicaid, Veterans Benefits, private health insurance or other
programs to ensure that CARE Act funds are the payer of last resort.
Provide a copy of the most recent Planning Council evaluation of the
administration of the Title I Grant.
IV.C.1.b.iv. If deficiencies were noted by the Planning Council in its evaluation in terms of
activities such as timely payments to contractors or data collection, what
corrective action was recommended and what is the current status.
IV.C.2. SEVERE NEED….…………………………………………………………….33 Points
(Tables 1, 5, 6 and narrative)
In this section applicants are asked to describe the severity of the HIV/AIDS epidemic in the
EMA and why local funding for health services is insufficient to meet the needs of under-served
people living with HIV. To the extent possible, applicants should quantify the unmet-service
needs of those PLWH receiving HIV/AIDS primary medical care and those who know their HIV
status but are not presently in the system of HIV/AIDS primary medical care. Points will be
awarded based on submission of completed tables and a narrative.
45 - Title I FY 2002 Grant Application Guidance
Section 2603(b)(1)(B) requires EMA’s to submit an application for funding “ that demonstrates the severe need in
such area for supplemental financial assistance to combat the HIV epidemic.”
Section 2603(b)(1)(B) requires that “the amount of each grant made for purposes of this subsection shall be
determined by the Secretary based on a weighing of factors…with severe need…counting one-third.”
Section 2603 (b)(2)(B) further defines severe need and the relevant factors which impact the cost and complexity of
delivering heath care and support services to people with HIV disease in the EMA.
The Reauthorized CARE Act of 2000 provides additional guidance on how HRSA/HAB is to
consider the Severe Need factor in distributing Title I Supplemental grant funds among EMAs.
The Manager’s Statement that accompanies the CARE Act Amendments of 2000 defines areas
with severe need as having ―the greatest or expanding public health challenges in confronting the
epidemic.‖ In order to meet the legislative mandates relating to severe need, DSS will implement
the following changes effective with the FY 2002 application.
In order to target funding to areas in greatest need of assistance, severity of need now is given
a greater weight in the scoring process. In the award of Title I supplemental grants, severe
need is accorded 34 points.
Supplemental awards are to be directed principally to those eligible areas with the greatest
Additional factors to be considered in the assessment of severe need include:
- current prevalence of HIV disease;
- relative rates of increase in the number of cases of HIV disease;
- new or growing subpopulations of individuals with HIV disease;
- increasing need for HIV-related services;
- unmet need for such services as determined by the needs assessment data; and
- co-morbidities including high rates of STD, Hepatitis B & C, TB, substance use, severe
mental illness, and;
- other comorbid factors that contribute to the cost of providing primary medical care and
Quantifying Severe Need
In determining severe need for the awarding of supplemental funds, it is the intent of Congress that the Secretary
use national quantitative incidence data to the greatest extent possible. HAB is engaged in studies with the Institute
of Medicine and others to develop tools to be used in meeting this mandate. In the future, severe need will be
determined solely by quantitative measures.
46 - Title I FY 2002 Grant Application Guidance
The CARE Act clearly states that determining the size, demographics, and epidemiology of the
PLWH population is the basis from which a Planning Council should develop its three-year
comprehensive plan, set priorities for the allocation of resources, and develop its yearly
implementation plan. Severe need also should be considered in these planning processes. For FY
2002, applicants must clearly describe how priority setting and funding-allocation decisions were
based on detailed needs assessments that included both quantitative and qualitative information.
When describing severe need, applicants should document the use of multiple data sources,
including HIV/AIDS epidemiologic data, co-morbidity data, poverty and insurance-status data,
and assessments of populations with special needs. Applications must demonstrate an
understanding of both the quantity and nature of unmet needs in populations of special need.
Applications should also discuss the increased difficulty and cost of meeting these needs among
the following populations:
PLWH in communities newly affected by HIV/AIDS;
those who know their HIV status but are not receiving primary medical care; and
those who are in the EMA system of care but whose needs are only being partially met.
Grantees and Planning Councils must ensure that the needs assessment and planning processes
adequately address the unmet needs of those in care as well as those PLWH who are not in care.
To assist applicants in responding to this section of the Guidance, DSS has developed the
following definitions for key terms used to describe Severe Need.
Severe Need: The degree to which providing primary medical care to people with HIV
disease in any given area is more complicated and costly than in other
areas based on a combination of the adverse health and socio-economic
circumstances of the populations to be served.
Primary Medical The provision of care that is consistent with U.S. Public Health
Care for HIV guidelines for the treatment of HIV/AIDS. Such care must include access
Disease: to antiretrovirals and other drug therapies, including prophylaxis and
treatment of opportunistic infections and combination antiretroviral
Health Related Those non-medical support services that contribute to PLWH accessing
Support Services: and remaining in primary medical care.
In Care: The receipt of primary medical care for HIV disease that is consistent with
US Public Health Service Treatment Guidelines. Persons who are
accessing support services but are not receiving primary medical care are
not considered ―in care.‖
47 - Title I FY 2002 Grant Application Guidance
IV.C.2.a. HIV/AIDS Epidemiology…………………………………………....(11 of 33 Points)
As outlined in Section III, applicants must complete and submit Table 1: AIDS Incidence, AIDS
Prevalence and HIV Prevalence by Demographic Group and Exposure Category. HRSA/HAB
will provide EMAs with CDC-generated HIV/AIDS prevalence and incidence data in a separate
mailing. HIV/AIDS prevalence and incidence data should be reported for the period through
June 30, 2001.
Using the information in Table 1, provide a narrative summary of the EMA’s HIV/AIDS
epidemic describing the elements listed below.
IV.C.2.a.i. In order to document the trends and changes in the EMA’s HIV/AIDS cases, use
Table 1 to provide a comparative description of the estimated number of people
living with HIV, the number of people living with AIDS, and the number of new
AIDS cases reported within the past two years.
IV.C.2.a.ii. As a means of explaining the demographics of the EMA’s HIV/AIDS cases,
explain the specific disproportionate impact of HIV/AIDS on populations in terms
of the ratio of cases in the specific populations as compared to the general
IV.C.2.a.iii. Explain the level of unmet need among PLWH in the EMA by using the
demographic categories and data provided in Table 1 along with local service-
utilization data. Provide a brief narrative describing which populations of PLWH
in the EMA are under-represented in the CARE Act-funded system of HIV/AIDS
primary medical care. Include all CARE Act-funded services (i.e., Titles I-IV).
HRSA/HAB has asked all CARE Act Titles to encourage their funded service
providers to make this information available to Title I Planning Councils for this
48 - Title I FY 2002 Grant Application Guidance
IV.C.2.b. Co-Morbidity, Poverty, and Insurance Status………………(11 of 33 Points)
Using Table 5, provide quantitative data on each required co-morbidity as it has been measured or
estimated for the EMA’s general population. Provide quantitative data for insurance coverage and
poverty as it has been measured or estimated for the EMAs general population. Data should
include the percent and number of persons without insurance coverage (including those without
Medicaid) and the percent and number of persons living at or below 300% of the Federal Poverty
Level for FY 2000. Use the most recent data available and document data sources.
CDC NATIONAL SYPHILIS ELIMINATION PLAN
A 1997 study conducted by the Institute of Medicine entitled, The Hidden Epidemic: Confronting Sexually Transmitted
Diseases found that ulcerative STDs, such as chancroid, syphilis and genital herpes as well as inflammatory STDs
such as gonorrhea, chlamydia infection and trichomoniasis increased the risk of HIV. Early detection and treatment
of STDs can have a major impact on the transmission of HIV. Thus efforts that seek to eliminate syphilis, particularly
in those areas of high HIV seroprevalence can lead to the reduction of HIV in those areas. Of the 31 areas identified
in the 1997 study as having a high incidence of syphilis, 20 of these are Title I EMAs. The detection and treatment of
STDs can be enhanced through cooperation between HIV primary medical care providers and STD treatment
programs. HRSA recommends that
grantees familiarize Planning Councils and HIV primary medical care providers with the efforts proposed by the
CDC to eliminate syphilis;
grantees should work closely with local and State STD program directors; and
grantees should include STD program directors on Planning Councils and advisory groups who develop support
services and treatment plans for PLWH.
Provide a narrative summarizing the information contained in Table 5 regarding the overall
impact of co-morbidity, poverty, and insurance status, and describing how both service costs and
the complexity of providing care to PLWH in the EMA are affected. Data should include the
percent and number of persons without insurance coverage (including those without Medicaid)
and the percent and number of persons living at or below the Federal Poverty Level for FY 2000.
Use the most recent data available and document all data sources.
49 - Title I FY 2002 Grant Application Guidance
Prevention of Tuberculosis Among HIV-Infected Persons
In September 1997, the CDC convened a committee of expert consultants, including persons from local and state health
departments, who reviewed and considered background information about HIV-related tuberculosis (TB) in the United
States and the scientific principles of prevention and therapy for both HIV and for TB. The committee updated and
published recommendations for the treatment and prevention of TB among HIV-infected persons. The committee
concluded that not only did HIV-1 have an impact on the natural progression of TB, but also that mounting
immunologic and virologic evidence indicates that the host immune response to M. tuberculosis enhances HIV
replication and may accelerate the natural progression of HIV infection. Treatment for HIV-infected persons who are
latently infected with M. tuberculosis is an important personal health intervention because of the serious complications
associated with active TB. Clinicians caring for persons with HIV infection should make aggressive efforts to identify
and treat those who are infected with M. tuberculosis. The detection and treatment of latent TB infection, as well as
active TB disease, can be enhanced through cooperation between HIV primary care providers and state and local TB
control programs. HRSA recommends that:
Grantees should familiarize planning councils and HIV primary care providers with CDC recommendations
for the treatment and prevention of TB among patients with HIV infection;
Grantees should work closely with local and State TB Control Program Directors; and
Grantees should include TB control program directors on Planning Councils and advisory groups that are
developing HIV care and treatment plans.
CARE Act grantees should read “Prevention and treatment of tuberculosis among patients infected with human
immunodeficiency virus; principles of therapy and revised recommendations” MMWR. 1998:47 (No. RR-20)1-58 for
further information. The information is available at www.cdc.gov.
IV.C.2.c. Assessment of Populations with Special Needs………………….11 of 33 Points
The CARE Act requires that needs assessments and comprehensive plans used by Planning
Councils to set priorities and allocate funds identify and address unmet-service needs of special
populations. For purposes of this application, unmet need refers to service needs of those
individuals not currently in the system of HIV/AIDS care as well as those in the system of
HIV/AIDS care whose needs are only partially being met. Determining unmet need should be
carried out during the needs-assessment process and is an important activity in determining how
to target Title I resources to those PLWH who may be disenfranchised from existing HIV/AIDS
(Table 6. No narrative is required for this section.)
Using Table 6, identify and describe the service needs of populations of PLWH in the EMA who
are to be served in FY 2002. This table places special emphasis on identifying and planning for
the unmet service needs for special populations. Applicants must include the following six
populations specified by HAB/DSS:
Youth 13-24 years of age,
Injection drug users,
50 - Title I FY 2002 Grant Application Guidance
Substance users other than injection drug users,
Men of Color who have sex with men,
White/Anglo men who have sex with men, and
Women of child-bearing age (13 years of age and older).
In addition, applicants should complete Table 6 for other populations that have been significantly
or disproportionately impacted by the epidemic. Whether or not a population has been impacted
significantly should be evidenced by the data provided for under-served populations in Table I:
AIDS incidence, AIDS Prevalence, and HIV Prevalence by Demographic Group, and Exposure
Category; by the data provided from needs assessments; and by locally-gathered data. For FY
2002, applicants are required to complete a separate Table 6 for each population identified as
under-served in Section IV.C.2. Severe Need. Populations for whom service delivery is
especially challenging should be included. For each population, applicants should describe
efforts to provide access to HIV/AIDS care for those persons who know their HIV status but are
not presently receiving primary medical care.
IV.C.3. IMPACT OF TITLE I FUNDING: ACCESS TO CARE SERVICES, FUNDING
MECHANISMS, AND PLANNING ……………………………………..(5 Points)
(Table 8 and narrative)
The purpose of this section is to provide a narrative summary describing the EMA’s continuum
of care during FY 2001, explaining access to care for those who know their status but are not
presently in the system of HIV/AIDS primary medical care; discussing access to primary medical
care, substance-abuse treatment, and care for special populations; describing how service and
funding mechanisms are coordinated, and discussing the impact of Title I funds in terms of
outcomes and other quantitative evaluation data.
Section 2602(b)(4)(E) requires that the Planning Council establish methods for obtaining input on community needs
and priorities (e.g., public meetings, focus groups, ad-hoc panels).
Section 2602(b)(4)(B) requires that Planning Councils develop a comprehensive plan for the delivery of HIV-related
Section 2603(b)(1)(A) requires grantees to report on the dissemination of emergency relief funds.
Section 2602(c) requires that grantees demonstrate that grants made in the preceding fiscal year were expended in
accordance with the priorities of the Planning Council.
Section 2603(b)(1)(D) requires grantees to demonstrate the ability of the area to utilize supplemental resources in a
manner that is immediately responsive and cost effective.
Section 2602(b)(4)(C) requires Planning Councils to assess the administrative mechanism in rapidly allocating funds
and allows the Planning Council to assess the services offered in meeting identified need.
51 - Title I FY 2002 Grant Application Guidance
Complete Table 8, which shows other funding streams for HIV-care services in the EMA.
IV.C. 3.a. Current Continuum of HIV/AIDS Care
Briefly describe the current continuum of HIV/AIDS care in the EMA, beginning with testing
and counseling sites, including early-intervention services, and addressing case-management and
primary medical care services. Special emphasis should be given to the changing epidemiology
of HIV/AIDS and how the system of care is changing to address the service needs of newly-
affected and under-served populations—including those who know their HIV status but are not
presently in the system of HIV/AIDS primary medical care. When completing the narrative,
applicants are reminded that a comprehensive continuum of care is a system of related services
linkage(s) of Early-Intervention Services to primary medical care services;
pimary medical care for the treatment of HIV infection that is consistent
with Public Health Service guidelines;
access to drug therapies (including prophylaxis and treatment of
opportunistic infections) and combination antiretroviral therapies;
substance abuse treatment, mental health treatment, oral health, and
integration of other public health programs; and
support services that enhance access to and retention in a system of care as
well as improved quality of life.
IV.C.3.b. Access to Care
Describe the services in the EMA’s system of HIV/AIDS care that contribute toward meeting the
HRSA goal of 100% access and 0 % disparity in all of its funded programs. The narrative should
show the extent to which a comprehensive continuum of HIV/AIDS care is accessible to PLWH
in the EMA, particularly to those who know their status but are not presently in the system of
HIV/AIDS primary medical care. Applicants should highlight how CBC Minority AIDS
Initiative funds have been used to reduce disparities and to improve access for communities of
color. The description should include the information requested below.
Provide a broad overview of mechanisms within the EMA that enable newly-infected, under
served and/or hard-to-reach individuals or communities first to access and then to remain in
primary medical care. Specifically describe the EMA’s case management system and how
case-management services facilitate access to primary medical care and related HIV/AIDS
52 - Title I FY 2002 Grant Application Guidance
services. Address the following in the narrative.
Provide a description of the case management system in terms of the types of case
management being provided in the EMA (e.g. medical, psycho-social, client
advocacy, or benefits counseling). Explain how people are referred to case-
management services. Describe the types of provider-agencies where case managers
are located (HIV-counseling and testing sites, primary medical care clinics, AIDS
service organizations, or other community-based organizations). Include a
description of the services provided by each component of the system and a
description of how their various services are coordinated.
Describe the standards of care or written definitions for case management services in
the EMA. If there are none, describe the process whereby the grantee will develop
them and include a timeline for implementation. Also define the cultural competency
requirements for case managers in the EMA.
Describe how case managers are linked to counseling and testing sites as well as
early-intervention services, and how care managers then link clients to primary-
medical care and ensure that the clients remain in care.
On July 23, 2001, HRSA/HAB issued its draft policy for the use of Ryan White
CARE Act funds for Transitional Social Services and Primary Medical Care Services
for Incarcerated Persons (See: Enclosure). Describe any transitional social services
and/or primary medical care services for incarcerated or recently released PLWH in
your EMA funded by Title I.
IV.C.3.c. Coordination of Services and Funding Streams
The CARE Act requires that services be provided in a manner that is coordinated, cost-effective
and ensures that Title I funds are the payer of last resort for HIV/AIDS services. Describe how
Title I funds are coordinated with other CARE Act and non-CARE Act programs in the EMA. In
the description, provide the following information.
Coordination With Other CARE Act Programs
Discuss how services provided by the Titles II, ADAP, III, IV, SPNS and Dental
Reimbursement programs in the EMA are taken into consideration during the Title I
priority and allocation process. Explain how programs receiving these funds are
coordinated to maximize the number of and accessibility of services available.
Describe how the EMA coordinates with the AIDS Education and Training Center
53 - Title I FY 2002 Grant Application Guidance
(AETC) program. Describe the role of the AETC program in expanding the pool of
qualified HIV/AIDS care providers and in ensuring that Public Health Service (PHS)
HIV/AIDS Treatment Guidelines are widely disseminated and practiced by primary
medical care professionals in the EMA.
Coordination With Other State and Federal Resources
Discuss how services funded by the sources listed below are taken into consideration
in planning for the continuum of HIV care and during the priority setting and
allocation process. Specifically describe the extent to which planning for Title I
funded services includes efforts to expand the availability of services, to reduce
duplication of services, to bring people into care who know their status but are not
presently in the system of HIV/AIDS primary medical care and to ensure that CARE
Act funds are the payer of last resort.
CDC Prevention Program
State Child Health Insurance Program
Veterans Affairs Programs, especially VA HIV/AIDS Clinics
Services for Women and Children, [i.e., Special Supplemental Food Program for
Women, Infants, and Children (WIC) Program and Substance Abuse Treatment
Programs for Pregnant Women]
Other State and Local Social Service Programs (i.e. Medicare, IHS, General
Assistance, Food Stamps, Vocational Rehabilitation).
Coordination with the State’s Medicaid Program
Describe which HIV/AIDS services are covered under the State’s Medicaid Program
and how CARE Act funds fill in the gaps in Medicaid-funded services. Discuss how
Medicaid resources are considered in setting service priorities and in allocating Title I
Discuss how substance-abuse treatment services for people living with HIV/AIDS in
the EMA are covered under other federal and State resources and how CARE Act
funds fill in the gaps in these other-funded services. Discuss how these other
resources are considered in setting service priorities and in allocating Title I funds.
IV.C.4. PLANNING COUNCIL MANDATED ROLES/RESPONSIBILITIES: PRIORITY
SETTING, NEEDS ASSESSMENT AND COMPREHENSIVE PLANNING…… (10
(Tables 7, 9 and narrative)
The purpose of this section is to describe how the Planning Council carried out its mandated
roles and responsibilities in FY 2001. To that end, you should describe how the size and
demographics of the population of individuals with HIV was determined, and how the needs of
54 - Title I FY 2002 Grant Application Guidance
this population were determined. In addition, you should indicate how priorities for the
allocation of funds for FY 2002 were established, you should in particular indicate what data
were regarded as relevant in establishing funding priorities. You will be asked to describe how
the Planning Council responded to new requirements related to needs assessment,
comprehensive planning and the consideration of early intervention services as a service
category. Finally, you will be asked to discuss by the Planning Council in the Statewide
Coordinated Statement of Need process. In the narrative, describe the involvement of Planning
Council members, including PLWH. Points will be awarded on the basis of submission of
completed tables and a narrative that includes information in response to the specific areas
Section 2602(b)(4) defines the duties of the Planning Council including determining the size and demographics of the
population of individuals with HIV disease; determining the needs of such population, establishing priorities for the
allocation of funds within the EMA, developing a comprehensive plan, assessing the efficiency of the administrative
mechanism in rapidly allocating funds, assessing the services offered in meeting identified needs, and establishing
methods for obtaining input on community needs and priorities.
Section 2602(b)(4)(A) requires that the Planning Council determine the size and demographics of the population of
individuals with HIV disease, establish priorities for the allocation of funds within the EMA, including how best to
meet those priorities.
Section 2602(b)(4(B)) requires that the Planning Council determine the needs of this population with particular
attention to (i) individuals with HIV disease who know their HIV status and are not receiving primary medical care;
and (ii) disparities in access and services among affected subpopulations and historically under-served communities.
Section 2602(b)(4(C)) requires that the Planning Council establish priorities for the allocation of funds within the
EMA, including how best to meet such a priority and additional factors that the grantee should consider in allocating
funds under a grant based on (i) size and demographics of the population of individuals with HIV disease…; (ii)
demonstrated (or probable) cost effectiveness and outcome effectiveness of proposed strategies and interventions...;
(iii) priorities of the communities with HIV disease for whom the services are intended; (iv) coordination in the
provision of services to such individuals with programs for HIV prevention and for the prevention and treatment of
substance abuse, including programs that provide comprehensive treatment of such abuse; (v) availability of other
governmental and nongovernmental resources…; (vi) capacity development needs resulting from disparities in the
availability of HIV–related services in historically under-served communities.
Section 2602(b)(4)(D) requires Planning Councils to develop a comprehensive plan for the organization and delivery
of health and support services described in section 2604.
Section 2603(b)(1)(E) requires grantees to demonstrate that resources will be allocated at no less than the percentage
constituted by the ratio of the population of infants, children, youth, and women with AIDS to the general population
IV.C.4.a. Data/Information Used for Priority Setting and Allocation of Funds
Complete the following tables:
55 - Title I FY 2002 Grant Application Guidance
Table 7: Data/Information Used for Priority Setting and Allocation of Funds.
Table 9: Summary of Priority Services to Be Funded in FY 2002, summarized the results of
the priority-setting and resource-allocation process. List in descending order the FY 2002
service and geographic or population-based priorities determined by the Planning Council.
Also, as an attachment to Table 9, list for each priority any language developed by the
Planning Council regarding how that priority should be met.
Describe how the data listed in Table 7 were used in the priority-setting and allocations process
to increase access to services and reduce disparities in the EMA’s continuum of HIV care. In the
narrative, describe in detail changes in priority rankings based on the Planning Council’s use of
this data and information. Explain how changes and trends in HIV/AIDS epidemiology data
were used to inform the priority-setting process. In addition, explain how each data/information
item checked in Table 7 was used in determining the amounts of funds allocated for services.
Specifically describe changes in the percent or amounts of funds allocated to priorities based on
the Planning Councils use of data, especially HIV/AIDS epidemiology data. Finally, discuss
efforts by the Planning Council to use quantitative data on the unmet HIV/AIDS services needs
of members of this population who are not in care.
Describe the involvement of PLWH in the priority-setting and allocation process.
Specifically, describe how the priorities of HIV-infected communities, for whom CARE Act
services are intended, are considered in the process of setting priorities and allocating funds.
Describe the rationale used by the Planning Council to reach its decision to allocate or not
allocate Title I funds for substance use services; whether or not Title I funds are allocated for
substance-abuse services; and what type of services are funded.
Since Planning Councils may provide specific instructions to the grantee on how best to meet
the service priorities they have established, describe any instructions provided by the
Planning Council to address the needs of and to reduce the barriers for the populations
identified in Table 6.
IV.C.4.b. Needs Assessments and the Comprehensive Planning Process
Needs assessment is the cornerstone of the Ryan White CARE Act planning process. It is
impossible for Planning Councils to set priorities locally and responsibly without clearly
understanding the characteristics and trends of the local HIV epidemic. To that end, Planning
Councils should identify services needs and assess the resources that currently are available to
meet those needs during the needs assessment process. In previous years, EMAs primarily have
targeted persons living with HIV disease who were receiving HIV-related services. The FY 2000
reauthorization language now requires Planning Councils to develop or expand needs-assessment
56 - Title I FY 2002 Grant Application Guidance
processes that will determine the needs of those individuals who know their status and presently
are not receiving primary medical care. There also are new requirements for the comprehensive
plan developed by an EMA. See the Reauthorization Letter on Needs Assessment and
Comprehensive Planning (Appendix 5) to address the questions below.
Describe the EMA’s latest needs-assessment process including dates of your latest needs
assessment and the methodology employed to incorporate new legislative requirements.
Describe significant results of the latest needs assessment and how these results
impacted the priorities and allocations for FY 2002.
Describe the EMA’s plan to update or to develop a three-year comprehensive plan,
according to the new legislative requirements by providing timelines and identifying
responsible parties for each task.
Describe how the EMA will ensure that the comprehensive plan is compatible with
existing State and local plans, particularly with the Statewide Coordinated Statement
Describe how the needs assessment process identified capacity development needs of
disproportionately impacted and under-served communities and how they are
IV.C.4.c. Early-Intervention Services: Priority Setting and Allocation of Funds
As a result of the 2000 Reauthorization of the CARE Act, Early Intervention Services (EIS) is a
new fundable Title I service category. HAB defines EIS as counseling, testing and referral
services designed to bring HIV-positive individuals into care and treatment. The new service
category is intended to support efforts to increase access to primary medical care and to identify
and create relationships with key points of access to health care for individuals who know their
status and are not in primary medical care and for those newly diagnosed with HIV who are not
in primary medical care. Planning Councils should consider the need for such services as part of
their FY 2002 priority setting and planning processes. Planning should include consideration of
the availability of other EIS resources to meet EMA needs. Considerations should be given to
locally-identified key points of access in determining the strategic location, funding and
composition of services. Details on the EIS requirements and DSS/HAB expectations are
outlined in Reauthorization letter #7 in the appendix.
Briefly provide an overview of the availability of HIV EIS in your EMA and the impact of such
57 - Title I FY 2002 Grant Application Guidance
services in bringing PLWH into care. Specifically explain:
whether or not Title I funds were allocated for EIS and what type of services are
how the Planning Council considered information (e.g., resource inventories, surveys,
and needs assessments) that identified key points of access and existing HIV
counseling, testing, and referral services available in the EMA in determining whether
or not to allocate funds for EIS;
what rationale was used by the Planning Council to reach its decision to allocate or
not allocate Title I funds for EIS;
if Title I funds were allocated to EIS, explain how these services will be coordinated
with EIS funded by other federal, state, or local funding sources.
IV.C.4.d. Compatibility with Statewide Coordinated Statement Of Need
The purpose of this section is to demonstrate that the services proposed in this application are
compatible with the Statewide Coordinated Statement of Need (SCSN) developed by the State in
which the EMA is located. Points will be awarded on the basis of a narrative that responds to
the areas outlined below.
Section 2603 (b)(1)(G) requires that grantees demonstrate the manner in which proposed services are compatible with
the local needs assessment and the Statewide Coordinated Statement of Need.
Section 2605 (a) (8) indicates that to be eligible to receive a grant under Section 2601, an eligible area shall prepare and
submit to the Secretary an application . . .including assurances the . . . the applicant has participated or will agree to
participate in the statewide coordinated statement of need process.
Describe how the Planning Council and grantee participated in developing the current SCSN.
If the SCSN was updated in FY 2001, please describe any new issues identified. Cite the
major issues in the SCSN and indicate where they are addressed within the EMA’s FY 2002
Title I Implementation Plan (Table 10).
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IV.C.5. UPDATE ON QUALITY MANAGEMENT AND EVALUATION
The purpose of this section is to allow applicants to describe their progress in implementing quality
management programs and describing current activities associated with quality in the EMA.
Applicants are requested to show that services meet quality standards, are outcome oriented and are
provided at a reasonable cost.
Section 2604(C) requires that the chief elected official of an eligible metropolitan area provide for the establishment
of a quality-management program to assess the extent to which HIV health services provided to patients are consistent
with the most recent Public Health Service guidelines for the treatment of HIV disease and related opportunistic
infections, and to develop strategies for ensuring that such services are consistent with the guidelines for improvement
in the access to and quality of health services.
Quality management programs, as set forth in the reauthorization language should accomplish a
1. Assist direct service medical providers in assuring that funded services adhere to established HIV
clinical practice standards and Public Health Services (PHS) guidelines;
2. Ensure that strategies for improvements to quality medical care include vital health-related
support services in achieving appropriate access and adherence with HIV medical care;
3. Ensure that available demographic, clinical and primary medical care utilization information is
used to monitor HIV-related illnesses and trends in the local epidemic.
The ultimate goal of quality management programs is improved health status for clients. Quality
management programs accomplish this goal by establishing and monitoring standards for clinical
services and the supportive services that link clients with primary medical care. At a minimum,
grantees must be able to demonstrate that primary medical care and services supported by Title I
funds are consistent with Public Health Service (PHS) treatment guidelines for adults,
adolescents, pediatrics, perinatal exposure, non-occupational exposure, primary medical care
worker exposure, opportunistic infections and tuberculosis. Current treatment guidelines are
available on the Internet at www.hivatis.org.
Grantees must ensure that sub-contractors have in place quality management programs that will
enable them to measure improved health status for HIV clients. Through quality management
efforts, service providers should be able to identify problems in service delivery that impact
health status outcomes at the client and system levels. Evidence that such programs/systems are
in use should be present in contract language with service providers, in site-visit protocols and
other monitoring efforts performed by the grantee. Periodically, HAB/DSS initiates or
collaborates with other government agencies, universities, or national organizations to evaluate
59 - Title I FY 2002 Grant Application Guidance
the outcomes of Title I Programs. Grantees are expected to participate in HRSA sponsored
Provide a description of current and planned activities that have been implemented in the EMA
to assure the quality of services. Where both the grantee and the Planning Council fund Quality
Management, describe how the activities are coordinated. The narrative must address the
following three areas:
IV.C.5.a. Quality Management
i. Describe current and planned quality management activities addressing standards of
care for the treatment of HIV disease in adults, adolescents, pediatric populations,
and for the prevention of HIV perinatal transmission. Examples of activities
Grantees activities such as including provisions in provider subcontracts that require
quality improvement activities;
monitoring activities conducted by the grantee during program and fiscal monitoring
activities conducted such as an evaluation/quality assurance team;
Planning Council activities to establish and maintain quality care services such as
review and input on the development of service delivery approaches, and
participation in special studies, to improve the quality of HIV services;
ii. In cases where both the grantee and the planning council fund quality management
activities, describe how activities are coordinated.
Describe how service costs are considered in assessing the quality and effectiveness of services.
CEOs are required to establish a quality management program.
Describe Title I service categories for which client-level outcomes (benefits or change for clients
during or after receiving services) and outcome indicators (specific items of information that
track a program’s success in achieving desired results) have been developed and implemented in
the EMA to date. Include a discussion of health-status outcomes and other outcome indicators
specific to primary medical care.
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IV.C.6. PROGRESS IN IMPLEMENTING THE FY 2001 PLAN……………………..5 Points
(Narrative and updated 2001 Table 10)
The purpose of this section is to provide information regarding accomplishments and challenges
in implementing the FY 2001 Title I plan. This section of the application also serves as the mid-
year FY 2001 Program Progress Report.
Section 2603(c) requires applicants to demonstrate that . . .grants made to the area for the preceding fiscal year were
expended in accordance with the priorities. . . that were established by the Planning Council serving the area.
Section 2601(a) limits the awarding of funds to eligible areas whose application under section 2605 (b) contains a
report concerning the dissemination of emergency relief funds under subsection (a) and the plan for utilization of such
Applicants are required to submit an updated and approved version of Table 10 (the FY 2001
Implementation Plan) showing spending and service utilization through July 31, 2001.
IV.C.6.a. Accomplishments to Date
Using the objectives outlined in Table 10 of the FY 2001 application, identify ten program
accomplishments from March 1, 2001 through August 31, 2001. Specifically, address how these
objectives contributed to increasing access to the continuum of care and maintaining clients in
IV.C.6.b. Ongoing Challenges
Identify current challenges in providing HIV/AIDS services; challenges to accomplishing the
goals you set forth in your plan; your progress to date; the corrective actions taken; and the
challenges you encountered. Indicate whether or not there is a need for technical assistance.
(Please note that a formal request for technical assistance must be submitted to your DSS project
IV.C.6.c. Services for Women, Infants, Children and Youth
The CARE Act requires grantees to demonstrate that resources for women, infants, children and
youth in the EMA are allocated at no less than the percentage constituted by the ratio of the
population of women, infants, children and youth with AIDS to the general population with
AIDS. An estimate of the percentage of Women, Infants, Children and Youth with AIDS will be
61 - Title I FY 2002 Grant Application Guidance
provided under separate cover.
Also, as in the past, services directed to infants, children, youth, and women must be funded in
accordance with the service priorities established by the Title I Planning Council. However, due
to the continuing expansion of the HIV epidemic among youth and women—especially women
of color—it is the intent of Congress to assure the availability of, and access to, primary medical
care and health-related supportive services for these four specified populations.
Please note that in order to avoid over-lapping counts, grantees should define women as
females aged 25 and older, infants as birth through 12 months of age, children as 1 through
12 years of age, and youth as 13 through 24 years of age.
Unlike prior years, grantees now must track and report both the amount of and the percentage of
Title I Funds expended for each priority population separately. That is to say, EMAs must
demonstrate that expenditures for each priority population either meet or exceed the ratio of
recorded cases for the specified populations.
For FY 2000: report the total dollar amount and % of Title I service dollars expended on
services for to Women, Infants and Children.
For FY 2001: provide an update on the efforts of the EMA to separately track and report
expenditure data by each subpopulation (Women, Infants, Children and Youth)
For FY 2001: describe the % of Title I service allocations to each subpopulation and how
those percentages were determined.
For the FY 2003 application, Grantees will be required to report on allocations for youth also.
Guidance describing how grantees can seek a waiver for meeting all or part of their WICY
requirements is being developed.
IV.C.7. PLAN FOR FY 2002……………………………………………………..(5 POINTS)
(Table 10 and narrative)
The purpose of this section is to present the FY 2002 HIV/AIDS service plan, with specific
attention to ensuring increased access to a continuum of HIV/AIDS care. The plan should clearly
show how the EMA will reduce or eliminate service and health outcome disparities among
populations with specific needs as identified in Table 6. The Plan must include objectives to
address the unmet needs of those persons in care as well as those who know their HIV status but
are not in HIV/AIDS primary medical care. The FY 2002 Plan must clearly identity those
initiatives funded with CBC Minority AIDS Initiative.
62 - Title I FY 2002 Grant Application Guidance
Section 2603(b)(1)(A) requires grantees to report on the plan for utilization of CARE Act funds.
Section 2605(b) requires that the application for funds include information concerning the individuals to be served
with those funds
Section 2604(b)(3) Priority for Women, Infants, Children and Youth. “For the purpose of providing and supporting
services to infants, children, youth and women with HIV disease, including treatment measures to prevent the perinatal
transmission of HIV, the chief elected official of the eligible area in accordance with Planning Council established
priorities, shall use, of the grants made available for the area under section 2601(a) for a fiscal year, not less than the
percentage constituted by the ratio of the population in such area of infants, children, youth, and women with acquired
immune deficiency syndrome to the general population in such area of individuals with such syndrome.”
IV.C.7.a. Quantified, Time-Limited Service Goals and Objectives for FY 2002
For each of the priorities listed in Table 9, the applicant must develop one or more service goals
with time-limited and measurable program objectives in Table 10. These service goals and
objectives comprise the FY 2002 implementation plan which must specify what will be provided,
in what quantity, and according to what time frame funds will be expended. For each objective,
define the service unit, identify the number of persons to be served and units of service to be
delivered, and estimate the cost of meeting the objective. Include and clearly label CBC
Minority AIDS Initiative objectives under the service priority to which the funds have been
IV.C.7.b. FY 2002 Plan: Providing Access to HIV Care and Reducing Disparities
Describe how the EMA’s FY 2002 Implementation Plan will ensure access to HIV/AIDS primary
medical care and support services and reduce disparities in care across the EMA. The narrative
should highlight goals and objectives in Table 10 that focus on services to PLWH in
communities where HIV prevalence is increasing. Discuss those initiatives funded by the CBC
Minority AIDS Initiative where appropriate. Indicate how your FY 2002 Implementation Plan
will respond to changes in the epidemic in the EMA.
Identify objectives in your FY 2002 Implementation Plan that will provide access to
the HIV continuum of care for communities where HIV prevalence is increasing and for
persons who know their HIV status but are not in HIV/AIDS primary medical care.
63 - Title I FY 2002 Grant Application Guidance
Describe the % of Title I service allocations to each subpopulation and how those
percentages were determined.
Describe objectives in your FY 2002 Implementation Plan that will ensure parity of
HIV services throughout the EMA. Parity of services should be addressed in terms of
geographic location of services, compatibility of quality, comprehensiveness of
services, and cultural appropriateness.
Describe objectives in your FY 2002 Implementation Plan that will ensure that
PLWH remain engaged in HIV/AIDS primary medical care and adherent to HIV
Describe objectives in your FY 2002 Implementation Plan that will ensure that the
EMA meets the requirement for allocating resources for services to women, infants,
children and youth according to their proportion of the EMA’s AIDS cases.
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TABLES TO BE FILED WITH FY 2002
65 - Title I FY 2002 Grant Application Guidance
TABLES TO BE INCLUDED WITH THE FY 2002 APPLICATION
Applicants needing assistance with preparing responses to any of the tables should call their
Project Officer, Division of Service Systems, HIV/AIDS Bureau, HRSA at the address and
telephone number below:
Health Resources and Services Administration
HIV/AIDS Bureau, Division of Service Systems
5600 Fishers Lane, Room 7A-55
Rockville, MD 20857
Tel: (301) 443-9086
Tables should be included with the application as Attachment 1.
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TABLE 1: AIDS Incidence, AIDS Prevalence and HIV Prevalence
BY DEMOGRAPHIC GROUP AND EXPOSURE CATEGORY
Complete Table 1 using HIV/AIDS incidence and prevalence data by demographic group and
exposure category. HAB/DSS has provided a print out of AIDS incidence and prevalence data in
Appendix 4 of the guidance. Please see appendix 4 for additional information on the availability
of HIV data. All data should be reported through June 30, 2000.
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TABLE 1: AIDS INCIDENCE, AIDS PREVALENCE AND HIV PREVALENCE
BY DEMOGRAPHIC GROUP AND EXPOSURE CATEGORY
STATE/ELIGIBLE METROPOLITAN AREA (EMA)_______________________________________
Demographic Group/ AIDS INCIDENCE: AIDS PREVALENCE HIV PREVALENCE
Exposure Category 07/01/98 TO 6/30/00 AS OF 6/30/00 AS OF 06/30/00
AIDS incidence is defined as the number of AIDS Prevalence is defined as the HIV Prevalence is defined as the estimated
new AIDS cases diagnosed during the period number of people living with AIDS as of number of people living with HIV, (non-
specified. the date specified. AIDS), as of the date specified.
Race/Ethnicity # % of Total # % of Total # % of Total
White, not Hispanic
Black, not Hispanic
American Indian/Alaska Native
Age at Diagnosis (Years)
20- 44 years
45 + years
Adult/Adolescent AIDS # % of Total # % of Total # % of Total
Men who have sex with men
Injection drug users
Men who have sex with men and inject
68 - Title I FY 2002 Grant Application Guidance
Demographic Group/ AIDS INCIDENCE: AIDS PREVALENCE HIV PREVALENCE
Exposure Category 07/01/98 TO 6/30/00 AS OF 6/30/00 AS OF 06/30/00
Receipt of blood transfusion,
blood components, or tissue
Risk not reported or identified
Pediatric AIDS Exposure
Mother with/at risk for HIV infection
Receipt of blood transfusion, blood
components or tissue
Risk not reported or identified
Please Complete: Does your State have HIV reporting? (Check one.) _____Yes _______No
69 - Title I FY 2002 Grant Application Guidance
TABLE 2: ROSTER OF THE FY 2002 TITLE I PLANNING COUNCIL MEMBERS
The CARE Act requires that Title I HIV Health Services Planning Councils reflect in their
composition the demographics of the epidemic, with particular consideration given to
disproportionately affected and historically under-served groups and subpopulations. The 2000
amendment to the CARE Act increased the participation of non-aligned PLWH to 33% and
required that this membership also reflect the demographics of individuals living with
HIV/AIDS. In addition, Planning Councils are required to include representatives of each of the
following membership categories:
1. Health-care providers, including federally-qualified health centers;
2. Community-based organizations serving affected populations and AIDS-service
3. Social-service providers, including housing and homeless-services providers;
4. Mental-health providers;
5. Substance-abuse providers;
6. Local public health agencies;
7. Hospital planning agencies or health-care planning agencies;
8. Affected communities, including individuals with HIV disease or AIDS, and
historically under-served groups and subpopulations;
9. Non-elected community leaders;
10. State Medicaid agency;
11. State agency administering the Title II program;
12. CARE Act grantees under section 2671 which provide coordinated services and
access to research for women, infants, children or youth; or, if none exists,
representatives of organizations with a history of serving children, youth, and
families living with HIV and operating in the EMA;
13. CARE Act grantees under Title III and Title IV,
14. Grantees under other Federal HIV programs, including HIV-Prevention
15. Formerly-incarcerated PLWH or their representatives.
Complete Tables 2, 3, and 4 based on the membership of the Planning Council as of
September 1, 2001.
Table 2 is comprised of a roster of Planning Council members. In addition to answering
questions 1 through 4, list each Planning Council member's name, the category she or he
represents (1-14, above), and the beginning and end dates of appointment. While individual
members may be able to fill more than one legislatively-mandated category, for the purposes of
completing this chart, members may only represent one category. Alternates may be listed and
identified on the roster, but they should not be included in responding to questions 1-4.
70 - Title I FY 2002 Grant Application Guidance
TABLE 2: ROSTER OF THE FY 2001 TITLE I PLANNING COUNCIL MEMBERS
1. What is the total authorized/prescribed number of Planning Council members according to council
2. How many individuals were officially serving as Planning Council members on 09/01/01? ___________
3. Of the number of members identified in #2, what percent are PLWH? _________ *
4. Do at least two members of the Planning Council publicly disclose their HIV status? ________*
*The Amended Ryan White CARE Act requires that PLWH must constitute a minimum of 33% of the Planning Council
voting membership and that at least two members are persons who publicly disclose their HIV status.
REPRESENTATIVE: Category of DATES OF APPOINTMENT
Name, Title, and Affiliation Representation (month and year, beginning and
(Add additional pages as needed.)
71 - Title I FY 2002 Grant Application Guidance
TABLE 3: MATRIX FOR PLANNING COUNCIL MEMBERSHIP CATEGORIES
Table 3 is a chart of the legislatively-mandated membership categories that must be represented
on the Planning Council. Table 3 also is used to determine the extent to which the Planning
Council membership is reflective of the epidemic in the EMA.
Representation of Mandated Categories
For each mandated category, enter the number of Planning Council members by race/ethnicity
and gender. Each Planning Council member should be included on this chart only once. While
individual members may be able to fill more than one legislatively-mandated category, for the
purposes of completing this chart, they only may represent one category. EMAs may include as
many representatives for each membership category as locally determined to be appropriate in
order to achieve adequate community representation. However, at a minimum, Planning
Councils must include at least one member to SEPARATELY represent each of the 15 mandated
categories. In the second TOTAL row at the bottom of the table, enter the number of non-
conflicted persons living with HIV/AIDS by race/ethnicity and gender. Non-conflicted is defined
as having no financial or governing interest in Title I funded agencies.
[Please note: Three exceptions exist to the rule on separate representation. For example, one
person can represent a substance-abuse provider and a mental-health provider if the agency
represented by the member provides both types of services and the person is familiar with both
programs. Similarly, a single Planning Council member may represent both CARE Act-Title II
grantee and the State Medicaid Agency, if that person is in a position of responsibility for both
programs. Finally, one person can represent any combination of CARE Act Part F grantees
(Special Projects of National Significance (SPNS), AIDS Education and Training Centers
(AETC), the Dental Reimbursement Program, and the HUD Housing Opportunities for People
with AIDS (HOPWA) grantees if the agency represented by the member received grants from a
combination of those four funding streams (e.g., a provider that receives both HOPWA and
The category ―grantees under other Federal HIV programs‖ is to include, at a minimum, grantees
of: CARE Act Special Projects of National Significance (SPNS), AIDS Education and Training
Centers (AETC), the Dental Reimbursement Program, and the HUD Housing Opportunities for
Persons With AIDS (HOPWA). Planning Councils must include a representative of each of
these grantees providing services within the EMA. Local grantees of, or participants in, other
Federal categorical HIV and STD programs (e.g., CDC Prevention grants, NIH Community
Programs for Comprehensive Research on AIDS, HIV specific SAMHSA or NIMH programs),
should be considered for representation on the Planning Council, but they are not specifically
required. The totals at the bottom of Table 3 should add to the total number of Planning Council
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Planning Council Reflectiveness of the HIV Epidemic
On the last line of Table 3, enter the distribution of non-conflicted PLWH membership on the
Planning Council by race/ethnicity and gender. The figures in the last two lines should
demonstrate that the Planning Council and its PLWH membership are reflective of the epidemic
in the EMA. For purposes of this application, the epidemic in the EMA is considered to be the
distribution of HIV (non-AIDS) cases in the EMA through 06/30/00.
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TABLE 3: MATRIX FOR PLANNING COUNCIL MEMBERSHIP CATEGORIES
EMA: RACE/ETHNICITY, AND GENDER
Mandated Categories of Representation and White/not Hispanic Black/not Hispanic Hispanic Asian/Pacific Islander Am. Indian/ Alaska
Reflectiveness of the Epidemic in the EMA Native
Male Female Male Female Male Female Male Female Male Female
1. Health-care providers, including
Federally Qualified Health Centers
2. CBOs serving affected populations/AIDS
Service Organizations (ASOs)
3. Social Service Providers, including housing
and homeless services providers
4. Mental Health
5. Substance-Abuse Providers
6. Local Public Health Agencies
7. Hospital planning agencies or other health-
care planning agencies
8. Affected Communities, including PLWH
and historically under-served
9. Non-elected community leaders
10. State Medicaid Agency
11. State Title II Agency
12. Title III
13. Title IV, or if none present, representatives
of organizations addressing the needs of
children, youth, and families with HIV
14. Other Federal HIV Programs, including
HIV Prevention programs
15. Representatives of/or formerly-
TOTAL Non-conflicted PLWH
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TABLE 4: MATRIX FOR PLANNING COUNCIL AREAS OF INTEREST/EXPERTISE
TABLE 4A: WORKSHEET FOR DETERMINING DEMOGRAPHIS OF NON-CONFLICTING PLANNING
Table 4 is a chart that outlines the principal areas of interest/expertise that each member brings to
the Planning Council. For each area of interest/expertise, enter the number of Planning Council
members by race/ethnicity and by the groups listed on the form. Each Planning Council member
can be counted in up to three different interest/expertise areas. Unlike Table 3, the totals at the
bottom of the chart could add up to more than the total number of Planning Council members.
Alternates should not be included in Tables 3 and 4.
Instructions: For each expertise category, enter the number of Planning Council members by
race/ethnicity and the following groupings of Federally-mandated categories.
Each Planning Council member can be counted in up to three areas of
Group 1: governmental representatives and non-elected community leaders,
Group 2: representatives of community-based health and social-service providers,
Group 3: representatives of infected communities.
Table 4a: Table 4a is a demographic worksheet to aid you in determining your Planning
Council Membership and the reflectiveness of PLWH on the Planning Council.
75 - Title I FY2002 Grant Application Guidance
TABLE 4: MATRIX FOR PLANNING COUNCIL AREAS OF INTEREST/EXPERTISE
Principal Interest/ Expertise White/not Hispanic Black/not Hispanic Hispanic Asian/Pacific Am. Indian/ Alaska
Group 1 Group 2 Group 3 Group 1 Group 2 Group 3 Group 1 Group 2 Group 3 Group 1 Group 2 Group 3 Group 1 Group 2 Group 3
Health needs of Men of Color who
have sex with men
Health Needs of White men who
have sex with men.
Women’s HIV Health Needs
Children’s HIV Health Needs
Youth’s HIV Health Needs
General Public Health
Substance Use/Abuse Services,
Including injecting drug users health
Mental Health Services
Other Non-Medical Support Services
Primary Medical Care:
Primary Medical Care: Antiretroviral
76 - Title I FY 2002 Grant Application Guidance
TABLE 4A: WORKSHEET FOR DETERMINING THE REFLECTIVENESS OF NON-CONFLICTED
PLWH ON THE PLANNING COUNCIL BY DEMOGRAPHIC GROUP
STATE/ELIGIBLE METROPOLITAN AREA
Race/Ethnicity # and % Living with HIV in # and % of NON Conflicted
the EMA through 06/30/00 PLWH on Planning Council
White, not Hispanic
Black, not Hispanic
American Indian/Alaska Native
*Age at Diagnosis (Years)
Men who have sex with men
Injection drug users … (Continues with categories from
Application Table 1)
Men who have sex with men and inject drugs
Receipt of blood transfusion, blood components, or tissue
Risk not reported or identified
Pediatric AIDS Exposure Categories
Mother with/at risk for HIV infection
Receipt of blood transfusion, blood components or tissue
Risk not reported or identified
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TABLE 5: CO-MORBIDITY, POVERTY, AND INSURANCE STATUS
1. Using Table 5, provide quantitative data on each co-morbidity for the EMA’s general
population. Document data sources using the most recently available data.
2. Using Table 5, provide quantitative data for the EMA’s general population including
percent/number without insurance coverage, including percent/number without Medicaid
and the percent/number below 300% Federal poverty level for FY 2001. Document data
sources, using the most recently available data.
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TABLE 5: CO-MORBIDITY, POVERTY, AND INSURANCE STATUS
CO-MORBIDITIES, QUANTITATIVE DATA
Co-morbidity Prevalence Within the General Population Data Source
Within the EMA
Intravenous Drug Users
Other Substance Abuse (i.e. alcohol,
inhalents) Please specify.
Other co-morbidities (optional)
INSURANCE AND POVERTY STATUS
Estimated percentage and number in EMA without insurance coverage, including
Percentage and number of people in EMA below 300% of the Federal poverty level
79 - Title I FY 2002 Grant Application Guidance
TABLE 6: ASSESSMENT OF POPULATIONS WITH SPECIAL NEEDS
Reports are required for youth (13 - 24 years old), injecting drug users (IDUs), other substance
users, men of color who have sex with men, white/Anglo men who have sex with men, women
of child bearing age (13 years old and older). Additional categories (which may or may not be
mutually exclusive) are to be determined by each EMA. Examples of such populations might
include homeless, immigrants (e.g. undocumented, documented, newly arrived), residents of a
specific geographic location who are particularly impacted by the epidemic, or any other
identified population, sub-population, or group, that an EMA feels needs more qualitative
All questions should be answered for all populations (i.e., those required by the application and
those identified by the EMA). Therefore, at minimum, the applicant should fill out a separate
table for each of the six populations identified above as well as any additional tables for
identified categories of populations with special needs in your EMA.
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TABLE 6: ASSESSMENT OF POPULATIONS WITH SPECIAL NEEDS
1. Estimated number of persons in this population in the EMA (all persons, regardless of HIV
2. Estimated number of persons in this population in the EMA living with AIDS:________
3. Estimated number of persons in this population in the EMA with HIV infection (including
4. Estimated HIV prevalence rate in the EMA for this population: __________
5. Briefly describe this population. Include the geographic distribution in the EMA, income level, any
language barriers, and other characteristics.
6. What are the HIV infection and risk trends in this population?
7. Describe the HIV/AIDS service needs of individuals in this population who know their status and who
are in primary medical care.
8. Describe the extent to which members of this population are not in a system of HIV/AIDS care.
Provide quantitative estimates or discuss efforts by the Planning Council to gather and use quantitative
data to identify and address the unmet HIV/AIDS service needs of members of this population who are
not currently in the health-care system.
9. Describe the HIV/AIDS service needs of those individuals who know their status and are not in
primary medical care.
10. Discuss how members of this population were involved in the Need Assessment upon which the
Planning Council based its service priority and funding allocation decisions?
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TABLE 7: DATA/INFORMATION USED FOR PRIORITY SETTING AND ALLOCATION OF FUNDS
Check each data or information element used in FY 2002 Priority Setting and Allocations
Provide the date the information was last updated.
Provide information on who used the information (e.g., the Full Planning Council or
Priorities/Allocations Committees) and for what purpose, i.e., priority setting, allocation of
funds, or both.
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TABLE 7: DATA/INFORMATION USED FOR PRIORITY SETTING AND ALLOCATION OF FUNDS
Current as of Used by:(e.g. Full Planning
Check Data/Information Used for Priority Setting (Mo/Yr) Council, Priorities/
if used and Allocation of Funds Allocation Committees)
Trends/changes in HIV Incidence and/or Prevalence
Trends/changes in AIDS Incidence and/or Prevalence
Changes in the demographics of the EMA's HIV/AIDS cases in
relation to the total population as a measure of disproportionate impact
on specific populations.
Information regarding populations with special needs as documented
in Table 6, including barriers to care and other access issues.
Quantitative data regarding persons living in the EMA who know they
have HIV but are not in HIV/AIDS primary medical care.
Outcome Evaluation Data
e.g., Effects on clients receiving specific services.
Client-level Health-Status Outcomes – Primary Medical Care
Other Health-Status Outcomes (Describe in narrative)
System-Level Health-Status Outcomes
Service Utilization Data
Numbers of unduplicated clients, numbers of units of service provided.
Demographic information regarding who is and is not accessing care.
Service Cost Data
Unit Cost for each service, known or estimated.
Cost-effectiveness data, if available.
Qualitative and Needs Assessment Data
Key Informant Interviews
Estimates of unmet need among clients in the EMA’s Title I
continuum of HIV/AIDS care.
Estimates of unmet need among clients not in the EMA’s
Title I continuum of HIV/AIDS care
Other Relevant Data
Co-morbidity, poverty, insurance status data from Table 5.
Information on other funding streams, including those listed in Table
83 - Title I FY 2002 Grant Application Guidance
TABLE 8: TITLE I FUNDING IN THE CONTEXT OF OTHER
HIV SERVICE FUNDING
Table 8 is to be used by the applicant to report on the availability of public funding for HIV-
related care services within the EMA from Federal, State and local sources for the fiscal year that
most closely corresponds to the Title I FY 2002 budget period. Applicants are requested to use
the five broad service categories listed below.
Home- and Community-Based Support Services - This service category includes funds
available to serve persons/families with HIV/AIDS, by funding source, to provide:
child welfare services
psychosocial support services
day/respite care (for children or adults)
health education/risk reduction
food services (home-delivered meals, food banks, nutritional supplements)
housing assistance/housing related services
emergency financial assistance
other support services
Ambulatory/Outpatient Medical Care - This service category includes funds available to serve
persons/families with HIV/AIDS to provide the following services that are defined in Appendix 3
of this Guidance:
ambulatory/outpatient medical care
State AIDS Drug Assistance Program (ADAP) - This service category includes funds available
to support the State ADAP. In the first column include the amount of the EMA’s Ryan White
Title I funding that supports the State ADAP program. For the other funding sources on the
table, include only the amount of funding supporting people with HIV/AIDS within the EMA.
84 - Title I FY 2002 Grant Application Guidance
Other Outpatient/Community-Based Primary Medical Care Services - This service category
includes funds available to serve persons/families with HIV/AIDS to provide:
home primary medical care
mental health services
substance abuse services
other outpatient/community-based health-care services not included in the service categories
Inpatient Care Services - This service category includes funds available to serve
persons/families with HIV/AIDS to provide:
Inpatient personnel costs that prevent unnecessary hospitalizations and/or that expedite
discharge as medically appropriate, as specified under Title I of the CARE Act.
Other inpatient medical care services (not fundable with Ryan White funds)
Grantee Administrative Costs, Planning Council Support, and Program Support - Do not
list direct service providers' administrative costs here; rather, include them in the allocation to
specific services. The row headings in column 1 of Table 8 identify the categories of funding
available to the EMA which are to be reported as: (1) an aggregate amount for each service
category; and (2) as a proportion of the amount of Ryan White Title I, Federal, State, and local
funding available for a service category. Except where specifically noted, applicants should use
the best available fiscal data for a 12-month period corresponding to the FY 2002 Title I fiscal
Ryan White Title I Funds - In column 1, enter the amount of FY 2001 formula and
supplemental funds allocated to each broad service category, together with any prior year(s)
funds which were carried over or available for expenditure in FY 2001. In column 2, indicate the
proportion that the aggregate amounts represent out of the total amount of funds available for
each service category from all Ryan White Title I, Federal, State, and local funding sources.
Other Federal Funds - Include in column 3, the total amount of FY 2001 funds available for
each broad service category from the following Federal sources: Ryan White Titles II, III, IV, and
Special Projects of National Significance (SPNS); HRSA-funded pediatric/family demonstration
projects; HOPWA; locally-allocated Community Development Block Grant funding (CDBG);
National Institutes of Health (NIH) AIDS Clinical Trials Group (ACTG) and Community
Projects for Clinical Research in AIDS (CPCRA); Substance Abuse and Mental Health Services
Administration (SAMHSA) HIV funds; and other identifiable Federal funding. In column 4,
indicate the proportion that the aggregate amounts represent out of the total amount of funds
available for each service category from all Ryan White Title I, Federal, State, local, and other
State Funds - Include in column 5, the aggregate amount of State-appropriated funds allocated
85 - Title I FY 2002 Grant Application Guidance
to each of the four broad service categories listed in the Table. In column 6, indicate the
proportion that the aggregate amounts represent out of the total amount of funds available for
each service category from all Ryan White Title I, Federal, State, local, and other funding
Local Funds - Include in column 7, the total amount of local city and/or county general revenue
spent on services to persons with HIV/AIDS, for each broad service category. To the extent
possible, figures reported should reflect all funding supporting persons with HIV/AIDS (e.g.,
local general assistance or "welfare" payments to this population). In column 8, indicate the
proportion that the aggregate amounts represent out of the total amount of funds available for
each service category from all Ryan White Title I, Federal, State, local, and other funding
sources. Include totals for the funds both horizontally and vertically.
86 - Title I FY 2002 Grant Application Guidance
TABLE 8: TITLE I FUNDING IN THE CONTEXT OF OTHER PUBLIC FUNDING
Amount and Percent of Public Funding by Source
Ryan White Title I Other Federal Funds State Funds Local Funds TOTAL FUNDS
Services (1) (2) (3) (4) (5) (6) (7) (8)
$ % $ % $ % $ %
AIDS Drug Assistance Program
Grantee Administrative Costs,
Program Support, and Planning Council
87 - Title I FY 2002 Grant Application Guidance
TABLE 9: SUMMARY OF PRIORITY SERVICES TO BE FUNDED IN FY 2002
Use Column 1 to numerically order priorities. If a community has "sub-priorities" (see next
paragraph), a logical and self-evident ordering system (e.g., 1.1, 1.2, 1.3, or 1.a., 1.b., 1.c., etc.)
should be followed for listing them. Additional pages may be added as required.
In Column 2, enter the service categories (using the Glossary in Appendix 3 of the Guidance) or
communities in priority order as determined by the Planning Council for FY 2002 Title I funding.
If communities (geographic or population-based) are identified as priorities, categories of
services must be listed as "sub-priorities" under each community priority.
In Column 3a, enter total FY 2002 funds allocated to each category. In Column 3b, enter the
percent of the total funds that the allocation represents. Show the total for column for 3a and the
total for column 3b.
88 - Title I FY 2002 Grant Application Guidance
TABLE 9: SUMMARY OF PRIORITY SERVICES TO BE FUNDED IN FY 2002
EMA: Page of
(1) (2) (3)
FY 2002 Award
# Priority/Sub-priority Service or Community (a) (b)
Please use additional pages as needed and number them consecutively.
89 - Title I FY 2002 Grant Application Guidance
TABLE 10: FY 2002 IMPLEMENTATION PLAN
For each of the FY 2002 priorities listed in Table 9, the applicant must provide one or more
service goals with measurable program objectives. Applicants also must indicate the amount of
funds allocated to each program objective. The service goals and objectives comprise the
FY2002 Implementation Plan and must show:
what will be provided,
to or for whom,
in what quantity,
during what time frame, and
an estimate of the amount of funds required to meet the objectives.
For each objective, the applicant must define the service unit to be provided and list the number
of service units to be delivered, the total number of clients to be served and the amount of Title I
funds allocated to that objective. Where multiple objectives exist beneath one service goal, the
estimated amount of funding must be broken out by objective. Service goals or objectives for
which CBC Minority AIDS Initiative funding is to be used must be identified clearly.
Examples of goals and objectives developed for Title I service priorities are provided in the
sample Implementation Plan on the next page.
90 - Title I FY 2002 Grant Application Guidance
TABLE 10: FY 2002 IMPLEMENTATION PLAN
EMA: Prepared by: Page of
Service Priority #: Service Priority Name:
Objective/s Service Unit Quantity Time Frame FY 2002 Funds
List quantifiable and time-limited objectives relating to Definition Provide the number of Indicate the Provide the approximate amount of
the Service Priority named above. Where appropriate, Provide the name and people to be served and estimated Title I funds to be used to provide
list multiple objectives that are required to implement a definition of the unit of service units to be provided duration of this service. Where possible, divide
new or to continue an existing service. For example, a service to be provided during the grant year. activity relating funding among individual
new case-management program may require multiple (e.g. a one hour face- # of People Total # of Service to the objective objectives.
objectives such as 1) hire two case managers; 2)train to-face encounter, one to be Served Units to be listed.
case managers in EMA protocols; 3) begin case- round-trip bus ride). Provided
management services; 4) evaluate case- management
Service Priority #: Service Priority Name:
Objective/s Service Unit Quantity Time Frame FY 2002 Funds
Definition # of People Total # of Service
to be Served Units to be
91 - Title I FY 2002 Grant Application Guidance
SAMPLE TABLE 10: FY 2001 IMPLEMENTATION PLAN SAMPLE
EMA: Anywhere, USA Prepared by: Mary Jones Page 1 of 13
Service Priority #: 1 Service Priority Name: PRIMARY MEDICAL CARE
Service Goal: 1A: To ensure accessible HIV/AIDS primary medical care that is consistent with the US
Public Health Service guidelines for all eligible PLWH in the EMA.
Objective/s Service Unit Quantity Time Frame FY 2001 Funds
Definition # of Total # of .
People to Service Units
be Served to be
Objective 1.Continue HIV/AIDS primary medical 45 minute office visit 320 2,109 3/1/01 – $560,951
care through 4 community clinics located in each 2/28/02
quadrant of the EMA.
Objective 2. Begin HIV/AIDS medical care in the 45 minute office visit 50 148 3/1/01 – $45,715
rural southwest corner of the EMA. 2/28/02
Service Goal: 1B: To improve health outcomes for HIV+ African American women and their children
Objective 1. Increase from 1 to 4 the number of 45 minute office visit 114 400 6/1/01 – $170,000
days the HIV/AIDS specialty clinic--targeting African women 2/28/02
American women and their children--is open. 52 CBC Minority Aids Initiative
Objective 2. Provide HIV/AIDS expert treatment 30 minute 80 240 3/1/01 – $12,000
consultation services at an HIV/AIDS clinic targeting consultation 2/28/02
African American women and their children. CBC Minority Aids Initiative
Service Priority #: 2 Service Priority Name: CASE MANAGEMENT
Service Goal 2A: To increase access to HIV/AIDS primary medical care and support services for multiply diagnosed
PLWH in the EMA
Objective 1: Establish case-manager-led multi- 1 hour case 100 400 5/1/01 – $26,000
disciplinary treatment teams to provide quarterly conference 2/28/02
case conferences for all multiply-diagnosed PLWH
in the EMA.
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93 - Title I FY 2002 Grant Application Guidance
FY 2002 AGREEMENTS AND COMPLIANCE ASSURANCES
The Chief Elected Official of the Eligible Metropolitan Area, or her/his designee, must include a signed 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 Title I Grant as required under the CARE Act.
RYAN WHITE COMPREHENSIVE AIDS RESOURCES EMERGENCY ACT AMENDMENTS OF 1996
TITLE I HIV EMERGENCY RELIEF GRANT PROGRAM
FY 2002 Agreements and Compliance Assurances
I, the Chief Elected Official of the Eligible Metropolitan Area (hereinafter referred to as the
EMA) of ________________________________________________________________,
designated pursuant to the provision of Title I of the Ryan White Comprehensive AIDS Resources Emergency Act of 1990
as amended, hereby certify that:
A. as required in Section 2604 (a)(1) and (2):
1. the allocation of funds and services within the EMA will be made in accordance with the priorities
established, pursuant to Section 2602 (b)(4)(A), by the HIV Health Services Planning Council that serves
the EMA; and,
2. funds provided under Section 2601 will be expended only for the purposes described in Sections 2604 (b) and
B. as required in Section 2605 (a):
1. funds received under this Title will be utilized to supplement, not supplant, State funds made available in
the year for which the grant is awarded to provide HIV-related services to individuals with HIV disease;
2. the political subdivisions within the EMA will maintain the level of expenditures by such political
subdivisions for HIV-related services for individuals with HIV disease at a level that is equal to the level
of such expenditures by such political subdivisions for the preceding fiscal year;
3. political subdivisions within the EMA will not use funds received under this Title in maintaining the level
of expenditures for HIV-related services as required in the above paragraph (2); and,
4. documentation of this Maintenance of Effort is required.
C. the EMA:
1. pursuant to Section 2602(b) has an HIV Health Services Planning Council that:
a. is reflective of the demographics of the epidemic, with particular consideration given to disproportionately
affected and historically under-served groups and subpopulations, and is inclusive of representatives from
all categories cited in the legislation;
b. is not chaired solely by an employee of the grantee (Section 2602(b)(3)(c));
c. maintains an open process for nominations for membership on the council, with candidates selected based
on locally delineated and publicized criteria, including a conflict-of-interest standard (Section 2602(b)(1);
d. is not directly involved in the administration of grants and does not designate (or is not otherwise involved
in the selection of) particular entities as recipients of this grant, in accordance with HRSA/HAB guidance on
Planning Council Roles and Responsibilities; and that individuals on the Council will not participate in the
process of selecting entities to receive funds if that person has a financial interest in the entity, is an
employee of that entity, or is a member of such entity (Sections 2602(b)(5)(A) and (B);
94 - Title I FY 2002 Grant Application Guidance
e. has procedures for addressing grievances with respect to priority setting and allocation of resources,
including procedures for submitting grievances that cannot be resolved to binding arbitration, and are
consistent with models developed by HRSA (Section 2602(b)(6);
f. has documented the duties of the Council consistent with Section 2602(b)(4) of the legislation;
g. has incorporated or referenced all of the above provisions in the Planning Council by-laws or operating
h. has ensured that meetings of the Planning Council are open to all members of the general public. Planning
Councils must have in place a system that provides for the public notice of all council meetings.
i. has ensured that Planning Council minutes must be certified by the Chair of the Planning Council and made
available to the public no later than 2 weeks after they have been approved by the Planning Council or the
Executive Committee. The entire process should take no more than six weeks.
j. has ensured that the Councils has a public-accessible location where minutes and related information can be
inspected and copied if requested.
k. has taken steps to guard against disclosure of personnel information that would constitute an invasion of
privacy, including medical or other personnel matters that should not be discussed.
l. has taken steps to ensure that when Planning Council Committee or subgroups make recommendations or
take actions subject to Planning Council review of ratification, records of the proposed recommendations
and actions should be made available for public inspection.
m. has noted that in such situations where the State, County or local statute, ordinance or regulation is more
stringent than the legislative language cited above, then the local/county/State regulation/ordinance/statute
must be followed. In the absence of such a circumstance, then the new provisions contained in the
Reauthorized CARE Act take precedence.
n. has noted that as a condition of award, grantees will be required to provide evidence that the Planning
Council is in compliance within 60-days of their FY 2002 Title I Notice-of-Grant-Award (ie., by May 1,
o. has ensured that entities within the Eligible Metropolitan Are receiving Ryan White CARE Act funds
maintain appropriate relationships with entities in the Eligible Metropolitan Area considered key points of
access to the health-care system for the purpose of facilitating early-intervention services for individuals
diagnosed as being HIV positive (Section 2605 (a)(3)).
2. has entered into intergovernmental agreements pursuant to Section 2602(a), with the Chief Elected
Officials of the political subdivisions in the EMA which provide HIV-related health services and for
which the number of AIDS cases in the last five years constitutes not less than 10 percent of the cases
reported for the EMA; and
3. has developed a comprehensive plan for the organization and delivery of health services to individuals
with HIV disease, in accordance with Section 2602 (b)(4)(B).
D. As required in Section 2605 (a)(3): entities within the EMA that will receive funds under a grant provided under
this Title shall participate in an established HIV community-based continuum of care if such continuum exists
within the EMA;
95 - Title I FY 2002 Grant Application Guidance
E. pursuant to Section 2605(a)(4), funds received under a grant awarded under this Title will not be utilized to
make payments for any item or service to the extent that payment has been made or can reasonably be expected
to be made, with respect to that item or service:
1. under any State compensation program, insurance policy, or any Federal or State health benefits
2. by an entity that provides health services on a prepaid basis; and
F. pursuant to Section 2605(a)(5) to the maximum extent practicable, that:
1. HIV primary medical care and support services provided with assistance made available under this Title will
be provided without regard to:
a. the ability of the individual to pay for such services or
b. the current or past health conditions of the individuals to be served;
2. such services will be provided in a setting that is accessible to low-income individuals with HIV
3. a program of outreach services will be provided to low-income individuals with HIV disease to inform such
individuals of such services.
G. in the provision of services with assistance provided under Title I, any charges for services will be made in
accordance with the provisions specified in Section 2605(e).
H. pursuant to Section 2604(e)(1) and in accordance with the legislative definition of administrative costs (Sections
2604(e)(2) and (3), will maintain administrative costs of the grantee at no more than 5 percent of the grant; and,
of the funds allocated to entities, will not exceed an aggregate amount of 10 percent of such funds for
H. pursuant to Sections 2602(b)(6), (c)(1) and (2), has developed grievance procedures with respect to funding that
are determined by HRSA to be consistent with its model procedures, including a process for submitting
grievances to binding arbitration.
J. pursuant to Section 2604(b)(4)(A), grant funds of not less than the percentage of Women, Infants, Children and
Youth with AIDS to the total population of persons with AIDS in the EMA shall be used to provide health and
support services to each population with HIV disease, including treatment measures to prevent the perinatal
transmission of HIV.
K. pursuant to Section 2605(a)(6), agrees to participate in the Statewide Coordinated Statement of Need process
initiated by the State, and ensure that the services provided under the EMA’s comprehensive plan are consistent
with the SCSN.
L. pursuant to the Congressional Black Caucus (CBC) Minority AIDS Initiative, agrees that CBC Minority AIDS
Initiative funds will be expended in a manner consistent with legislative intent.
M. pursuant to Section 2602(e), assures that Planning Council member training, based on the plan submitted in the
application will take place.
96 - Title I FY 2002 Grant Application Guidance
N. pursuant to Section 2604(c)(1), assures that Quality Management Programs that met HRSA requirements are in
Chief Elected Official
Eligible Metropolitan Area:
97 - Title I FY 2002 Grant Application Guidance
JURISDICTIONS WITH AT LEAST 10% OF THE EMA'S CASES
Based on cumulative cases reported to CDC from January 1996 through December 2000
EMA CITIES COUNTIES
Atlanta, GA Atlanta Fulton, De Kalb
Austin-San Marcos, TX Austin Travis
Baltimore, MD Baltimore
Bergen-Passaic, NJ Patterson Passaic, Bergen
Boston-Worcester-Lawrence-Lowell- Boston Suffolk, Middlesex, Worcester, Essex
Caguas, PR Caguas, Cayey Caguas, Cayey
Chicago, IL Chicago Cook
Dallas, TX Dallas Dallas
Denver, CO Denver Denver, Arapahoe
Detroit, MI Detroit Wayne, Oakland
Dutchess Co., NY Poughkeepsie, Stormville, Beacon, Fishkill Dutchess
Ft. Lauderdale, FL Fort Lauderdale, Pompano Beach Broward
Ft. Worth-Arlington, TX Fort Worth, Arlington Tarrant
Hartford, CT Hartford Hartford
Houston, TX Houston Harris
Jacksonville, FL Jacksonville Duval
Jersey City, NJ Jersey City Hudson
Kansas City, MO-KS Kansas City-(MO), Kansas City, (KS) Jackson (MO), Wyandotte (KS)
Las Vegas, NV Las Vegas Clark
Los Angeles, CA Los Angeles, Long Beach Los Angeles
Miami, FL Miami Dade
Middlesex-Somerset-Hunterdon, NJ New Brunswick, Perth Amboy Middlesex, Somerset
Minneapolis-St. Paul, MN-WI Minneapolis, St. Paul Hennepin, Ramsey
Nassau-Suffolk, NY Nassau, Suffolk
98 - Title I FY 2002 Grant Application Guidance
EMA CITIES COUNTIES
New Haven, CT New Haven, Bridgeport, Stamford, New Haven, Fairfield
New Orleans, LA New Orleans Orleans, Jefferson
New York, NY New York New York, Bronx, Kings, Queens
Newark, NJ Newark Essex, Union
Norfolk-Virginia Beach-Newport News, VA Norfolk, Virginia Beach, Portsmouth, Norfolk, Virginia Beach, Portsmouth,
Newport News Newport News
Oakland, CA Oakland Alameda, Contra Costa
Orange County, CA Santa Ana, Anaheim Orange
Orlando, FL Orlando Orange, Seminole
Philadelphia, PA Philadelphia Philadelphia
Phoenix, AZ Phoenix Maricopa
Ponce, PR Ponce, Juan Diaz Ponce, Juan Diaz
Portland-Vancouver, OR-WA Portland Multnomah, Clark
Riverside-San Bernardino, CA Palm Springs, Riverside Riverside, San Bernardino
Sacramento, CA Sacramento Sacramento
St. Louis, MO-IL Saint Louis Saint Louis City and County
San Antonio, TX San Antonio Bexar
San Diego, CA San Diego San Diego
San Francisco, CA San Francisco San Francisco
San Jose, CA San Jose Santa Clara
San Juan, PR San Juan, Bayamon, Rio Piedras San Juan, Bayamon
Santa Rosa, CA Santa Rosa, Guerneville Sonoma
Seattle, WA Seattle King
Tampa-Saint, Petersburg, FL Tampa, St. Petersburg Hillsborough, Pinellas
Vineland-Millville-Bridgeton, NJ Leesburg, Vineland, Bridgeton, Millvile Cumberland
Washington, DC-MD-VA-WV Washington, DC Washington, DC, Prince George's
99 - Title I FY 2002 Grant Application Guidance
EMA CITIES COUNTIES
West Palm Beach, FL West Palm Beach, Delray Beach Palm Beach
Note: Intergovernmental Agreements are required with each political subdivision within the EMA that provides
HIV-related health services and has 10% or more of the total reported cases in the EMA in the previous five years.
100 - Title I FY 2002 Grant Application Guidance
GEOGRAPHIC DEFINITIONS FOR THE 51 EMAS
EMA Name County/City
Atlanta, GA Barrow County, Bartow County, Carroll County, Cherokee County, Clayton
County, Cobb County, Coweta County, DeKalb County, Douglas County, Fayette
County, Forsyth County, Fulton County, Gwinnett County, Henry County, Newton
County, Paulding County, Pickens County, Rockdale County, Spalding County,
Austin-San Marcos, TX Bastrop County, Caldwell County, Hays County, Travis County, Williamson
Baltimore, MD Anne Arundel County, Baltimore City, Baltimore County, Carroll County, Hartford
County, Howard County, Queen Anne's County
Bergen-Passaic, NJ Bergen County, Passaic County
Boston-Worcester-Lawrence-Lowell- Brockton, Bristol County, Essex County, Middlesex County, Norfolk County, Plymouth
MA-NH County, Suffolk County, Worcester County, Hillsborough County, Rockingham
County, Strafford County
Caguas, PR Caguas Municipio, Cayey Municipio, Cidra Municipio, Gurabo Municipio, San
Chicago, IL Cook County, Dekalb County, DuPage County, Grundy County, Kane County,
Kendall County, Lake County, McHenry County, Will County
Cleveland-Lorain-Elyria, OH Ashtabula County, Cuyahoga County, Geauga County, Lake County, Lorain
County, Medina County
Dallas, TX Collin County, Dallas County, Denton County, Ellis County, Henderson County,
Hunt County, Kaufman County, Rockwall County
Denver, CO Adams County, Arapahoe County, Denver County, Douglas County, Jefferson
Detroit, MI Lapeer County, Macomb County, Monroe County, Oakland County, St. Clair
County, Wayne County
Dutchess County, NY Dutchess County
Ft. Lauderdale, FL Broward County
Ft. Worth-Arlington, TX Hood County, Johnson County, Parker County, Tarrant County
Hartford, CT Hartford County, Middlesex County, Tolland County
Houston, TX Chambers County, Fort Bend County, Harris County, Liberty County, Montgomery
County, Waller County
Jacksonville, FL Clay County, Duval County, Nassau County, St. John’s County
Jersey City, NJ Hudson County
101 - Title I FY 2002 Grant Application Guidance
EMA Name County/City
Kansas City, MO-KS Johnson County, Leavenworth County, Miami County, Wyandotte County, Cass
County, Clay County, Clinton County, Jackson County, Layfayette County, Platte
County, Ray County
Las Vegas, NV Mohave County, Clark County, Nye County
Los Angeles-Long Beach, CA Los Angeles County
Miami, FL Dade County
Middlesex-Somerset-Hunterdon, NJ Hunterdon County, Middlesex County, Somerset County
Minneapolis-St. Paul, MN-WI Anoka County, Carver County, Chicago County, Dakota County, Hennepin County,
Isanti County, Ramsey County, Scott County, Sherburne County, Washington
County, Wright County, Pierce County, St. Croix County,
Nassau-Suffolk, NY Nassau County, Suffolk County
New Haven-Bridgeport-Stamford-Waterbury- Danbury, Fairfield County, New Haven County
New Orleans, LA Jefferson Parish, Orleans Parish, Plaque Mines Parish, St. Bernard Parish, St.
Charles Parish, St. James Parish, St. John the Baptist Parish, St. Tammany Parish
New York, NY Bronx County, Kings County, New York County, Putnam County, Queens County,
Richmond County, Rockland County, Westchester County
Newark, NJ Essex County, Morris County, Sussex County, Union County, Warren County
Norfolk-Virginia Beach-Newport News, VA Currituck County, Gloucester County, Isle of Wight County, James City County,
Mathews County, York County, Chesapeake City, Hampton City, Newport News
City, Norfolk City, Poquoson City, Portsmouth City, Suffolk City, Virginia Beach
City, Williamsburg City
Oakland, CA Alameda County, Contra Costa County
Orange County, CA Orange County
Orlando, FL Lake County, Orange County, Osceola County, Seminole County
Philadelphia, PA-NJ Burlingon County, Camden County, Gloucester County, Salem County, Bucks
County, Chester County, Delaware County, Montgomery County, Philadelphia
Phoenix-Mesa, AZ Maricopa County, Pinal County
Ponce, PR Guayanilla Municipio, Juan Diaz Municipio, Penuelas Municipio, Ponce
Municipio, Villalba Municipio, Yauco Municipio
Portland-Vancouver, OR-WA Clackamas County, Columbia County, Multnomah County, Washington County,
Yamhill County, Clark County
Riverside-San Bernardino, CA Riverside County, San Bernardino County
102 - Title I FY 2002 Grant Application Guidance
EMA Name County/City
Sacramento, CA El Dorado County, Placer County, Sacramento County
St. Louis, MO-IL Clinton County, Jersey County, Madison County, Monroe County, St. Clair County,
Franklin County, Jefferson County, Lincoln County, St. Charles County, St. Louis
City, St. Louis County, Warren County
San Antonio, TX Bexar County, Comal County, Guadalupe County, Wilson County
San Diego, CA San Diego County
San Francisco, CA Marin County, San Francisco County, San Mateo County
San Jose, CA Santa Clara County
San Juan-Bayamon, PR Aguas Buenas Municipio, Barceloneta Municipio, Bayamon Municipio, Canovanas
Municipio, Carolina Municipio, Catano Municipio, Ceiba Municipio, Comerio
Municipio, Corozal Municipio, Dorado Municipio, Fajardo Municipio, Florida
Municipio, Guaynabo Municipio, Humacao Municipio, Juncos Municipio, Las
Piedras Municipio, Loiza Municipio, Luquillo Municipio, Manati Municipio,
Morovis Municipio, Naguabo Muncipio, Naranjito Municipio, Rio Grande
Municipio, San Juan Municipio, Toa Alto Municipio, Toa Baja Municipio, Trujillo
Alto Municipio, Vega Alta Municipio, Vega Baja Municipio, Yabucoa Municipio
Santa Rosa, CA Sonoma County
Seattle-Bellevue-Everett, WA Island County, King County, Snohomish County
Tampa-St. Petersburg-Clearwater, FL Hernando County, Hillsborough County, Pasco County, Pinellas County
Vineland-Millville-Bridgeton, NJ Cumberland County
Washington, DC-MD-VA-WV District of Columbia, Calvert County, Charles County, Frederick County,
Montgomery County, Prince George's County, Alexandria City, Arlington County,
Clarke County, Culpepper County, Fairfax City, Fairfax County, Falls Church City,
Fauquier County, Fredericksburg City, King George County, Loudon County,
Manassas City, Manassas Park City, Prince William County, Spotsylvania County,
Stafford County, Warren County, Berkeley County, Jefferson County
West Palm Beach-Boca Raton, FL Palm Beach County
103 - Title I FY 2002 Grant Application Guidance
Estimated Number of Women, Infants, Children, and Youth Living with AIDS as a
Percentage of All Persons Living with AIDS in Eligible Metropolitan Areas
(Data Period: 7/1/1991 through 6/30/2001)
Total WICY Total % Infants % Children % Youth % Women %
Atlanta, GA 6,629 18% 1 0.01% 37 0.56% 67 1.01% 1,119 16.88%
Austin, TX 1,608 262 16% 1 0.06% 8 0.50% 21 1.32% 232 14.44%
Baltimore, MD 7,122 2,220 31% - 0.00% 50 0.71% 58 0.81% 2,113 29.66%
Bergen-Passaic, NJ 2,099 713 34% - 0.00% 18 0.86% 19 0.90% 675 32.18%
Boston, MA 5,851 1,512 26% - 0.00% 38 0.65% 44 0.76% 1,430 24.44%
Caguas, PR 702 184 26% - 0.00% 4 0.57% 9 1.33% 170 24.23%
Chicago, IL 9,052 1,833 20% 1 0.01% 70 0.77% 88 0.97% 1,675 18.50%
Cleveland, OH 1,415 256 18% - 0.00% 9 0.63% 14 1.00% 233 16.50%
Dallas, TX 4,805 647 13% - 0.00% 6 0.12% 61 1.27% 580 12.06%
Denver, CO 1,966 174 9% - 0.00% 3 0.17% 11 0.54% 160 8.12%
Detroit, MI 3,275 762 23% 1 0.03% 17 0.51% 37 1.12% 708 21.62%
Dutchess County, NY 489 92 19% - 0.00% 2 0.38% 3 0.70% 86 17.64%
Ft. Lauderdale, FL 5,634 1,603 28% 1 0.02% 69 1.22% 80 1.43% 1,453 25.79%
Ft. Worth, TX 1,356 250 18% 1 0.07% 6 0.47% 12 0.88% 230 16.99%
Hartford, CT 1,837 497 27% - 0.00% 11 0.62% 11 0.61% 474 25.81%
Houston, TX 7,483 1,472 20% - 0.00% 49 0.66% 125 1.67% 1,298 17.34%
Jacksonville, FL 1,926 573 30% - 0.00% 14 0.70% 44 2.28% 516 26.76%
Jersey City, NJ 2,435 720 30% - 0.00% 22 0.90% 24 0.97% 674 27.70%
Kansas City, MO 1,383 164 12% - 0.00% 3 0.19% 20 1.45% 142 10.24%
Las Vegas, NV 1,755 279 16% - 0.00% 8 0.48% 21 1.20% 249 14.19%
Los Angeles, CA 14,930 1,631 11% 1 0.01% 49 0.33% 150 1.01% 1,431 9.58%
Miami, FL 10,132 2,856 28% 2 0.02% 99 0.98% 166 1.64% 2,589 25.55%
Middlesex-Somerset-Hunterdon, NJ 1,204 400 33% - 0.00% 15 1.22% 13 1.12% 372 30.91%
Minneapolis-St. Paul, MN 1,279 205 16% - 0.00% 4 0.29% 13 1.01% 189 14.75%
Nassau-Suffolk, NY 2,502 721 29% - 0.00% 18 0.71% 41 1.63% 663 26.49%
New Haven, CT 2,787 864 31% - 0.00% 22 0.80% 25 0.91% 816 29.29%
New Orleans, LA 2,872 616 21% - 0.00% 18 0.62% 52 1.81% 547 19.03%
New York, NY 46,143 13,754 30% 3 0.01% 404 0.88% 485 1.05% 12,863 27.88%
Newark, NJ 6,567 2,345 36% - 0.00% 62 0.95% 68 1.04% 2,214 33.72%
Norfolk, VA 2,015 466 23% - 0.00% 19 0.96% 27 1.35% 420 20.83%
Oakland, CA 2,847 532 19% - 0.00% 9 0.31% 19 0.66% 505 17.73%
Orange County, CA 2,123 261 12% 1 0.04% 10 0.48% 25 1.20% 224 10.57%
Orlando, FL 2,872 620 22% 1 0.03% 19 0.66% 38 1.33% 562 19.58%
Philadelphia, PA 8,680 2,155 25% 5 0.06% 97 1.11% 95 1.10% 1,957 22.55%
Phoenix, AZ 2,464 275 11% - 0.00% 10 0.40% 25 1.01% 240 9.73%
Ponce, PR 1,113 311 28% - 0.00% 15 1.36% 27 2.41% 269 24.19%
Portland, OR 1,437 119 8% - 0.00% 0 0.03% 12 0.86% 106 7.36%
Riverside-San Bernardino, CA 3,023 387 13% - 0.00% 14 0.47% 24 0.78% 350 11.56%
Sacramento, CA 1,255 159 13% - 0.00% 5 0.37% 5 0.43% 149 11.87%
St. Louis, MO 1,915 297 15% 1 0.05% 12 0.65% 42 2.20% 241 12.60%
San Antonio, TX 1,612 187 12% - 0.00% 5 0.32% 21 1.27% 162 10.03%
San Diego, CA 4,091 371 9% - 0.00% 11 0.26% 32 0.78% 328 8.03%
San Francisco, CA 7,905 529 7% 1 0.01% 11 0.14% 23 0.29% 495 6.26%
San Jose, CA 1,137 129 11% - 0.00% 2 0.18% 9 0.78% 118 10.34%
San Juan, PR 6,359 1,680 26% - 0.00% 39 0.61% 84 1.33% 1,557 24.49%
Santa Rosa, CA 492 33 7% - 0.00% - 0.00% 1 0.27% 32 6.40%
Seattle, WA 2,373 209 9% - 0.00% 5 0.21% 18 0.75% 186 7.83%
Tampa-St. Petersburg, FL 3,607 799 22% - 0.00% 24 0.66% 44 1.23% 730 20.25%
Vineland-Millville-Bridgeton, NJ 348 74 21% - 0.00% 1 0.40% 1 0.37% 72 20.58%
Washington, DC 10,230 2,504 24% 2 0.02% 87 0.85% 116 1.13% 2,300 22.48%
West Palm Beach, FL 3,417 1,179 34% 1 0.03% 51 1.49% 59 1.72% 1,068 31.26%
TOTAL 228,554 52,104 23% 22 0.01% 1,581 0.69% 2,531 1.11% 47,970 20.99%
NOTE: "The Estimated Number of Living AIDS Cases All AIDS Cases" was determined by 1) 'multiplying the reported number of AIDS cases for each of
the most recent 10 years by 'survival weights' and 2) summing these products. For the "Estimated Living Cases of Women, Youth, Children & Infants
Living with AIDS" the same procedure was followed except the reported number of infants, children, youth, and women for each of the 10 years was used
instead of the total AIDS cases. The 'survival weights' that are in the Ryan White CARE Act were updated by the Centers for Disease Control and
Prevention in July, 2001, in accordance with Section 2303(a)(3)(C) of the Ryan White CARE Act Amendments of 2000 (PL 104-146).
104 - Title I FY 2002 Grant Application Guidance
GLOSSARY OF HIV-RELATED SERVICE CATEGORIES
Grantees should refer to the official Program Policy Notices as listed on page 26 of this
Guidance or on the HAB web site, www.hab.hrsa.gov.
NOTE: This glossary has been updated for the FY 2002 Application Guidance.
Ambulatory/Outpatient Medical Care: Provision of professional, diagnostic and therapeutic
services rendered by a physician, physician's assistant, clinical nurse specialist, or nurse
practitioner in an outpatient, community-based, and/or office-based setting. This includes
diagnostic testing, early intervention and risk assessment, preventive care and screening,
practitioner examination, medical history taking, diagnosis and treatment of common physical
and mental conditions, prescribing and managing medication therapy, care of minor injuries,
education and counseling on health and nutritional issues, minor surgery and assisting at surgery,
well-baby care, continuing care and management of chronic conditions, and referral to and
provision of specialty care. Primary Medical Care for the Treatment of HIV Infection includes
the provision of care that is consistent with Public Health Service guidelines. Such care must
include access to antiretrovirals and other drug therapies, including prophylaxis and treatment of
opportunistic infections and combination antiretroviral therapies.
Drug Reimbursement Program: Ongoing service/program to pay for approved
pharmaceuticals and or medications for persons with no other payment source. Subcategories
a. State-Administered AIDS Drug Assistance Program (ADAP): Title II CARE
Act-funded and administered program or other state-funded Drug Reimbursement
b. Local/Consortium Drug Reimbursement Program: A program established,
operated, and funded locally by a Title I EMA or a consortium to expand the
number of covered medications available to low-income patients and/or to
broaden eligibility beyond that established by a State-operated Title II or other
State-funded Drug Reimbursement Program.
Medications include prescription drugs provided through ADAP to
prolong life or prevent the deterioration of health. The definition does not
include medications that are dispensed or administered during the course
of a regular medical visit or that are considered part of the services
provided during that visit. If medications are paid for and dispensed as
part of an Emergency Financial Assistance Program, they should be
reported as such.
Health Insurance: A program of financial assistance for eligible individuals with HIV disease
105 - Title I FY 2002 Grant Application Guidance
to maintain a continuity of health insurance or to receive medical benefits under a health-
insurance program, including risk pools.
Home Health Care: Therapeutic, nursing, supportive and/or compensatory health services
provided by a licensed/certified home-health agency in a home/residential setting in accordance
with a written, individualized plan of care established by a case-management team that includes
appropriate health-care professionals. Component services include:
durable medical equipment;
homemaker or home-health aide services and personal care services;
day treatment or other partial hospitalization services;
intravenous and aerosolized drug therapy, including related prescription drugs;
routine diagnostic testing administered in the home of the individual; and
appropriate mental health, developmental, and rehabilitation services.
Home- and community-based care does not include inpatient hospital services or nursing home
and other long-term care facilities.
Oral Health: Diagnostic, prophylactic and therapeutic services rendered by dentists, dental
hygienists, and similar professional practitioners.
a. Home-Based Hospice Care: Nursing care, counseling, physician services, and palliative
therapeutics provided by a hospice program to patients in the terminal stages of illness in their
b. Residential Hospice Care: Room, board, nursing care, counseling, physician services,
and palliative therapeutics provided to patients in the terminal stages of illness in a residential
setting, including a non-acute care section of a hospital that has been designated and staffed to
provide hospice services for terminal patients.
In-Patient Personnel Costs: Within the limitations of the legislation, up to ten percent of the
total award is allowable for such costs, if it has been determined by the Planning Council that a
shortage of inpatient personnel exists which has in turn resulted in inappropriate utilization of
Mental Health Services: Psychological and psychiatric treatment and counseling services,
including individual and group counseling, provided by a mental-health professional who is
licensed or authorized within the State, including psychiatrists, psychologists, clinical-nurse
specialists, social workers, and counselors.
Nutritional Counseling: Provision of nutrition education and/or counseling provided by a
licensed/registered dietitian outside of a primary care visit. Nutritional Counseling provided by
other than a licensed/registered dietician should be provided under Psychosocial support
services. Provision of food, meals, or nutritional supplements should be reported as a part of the
106 - Title I FY 2002 Grant Application Guidance
sub-category, Food and/Home-Delivered Meals/Nutritional Supplements, under Support
Rehabilitation Services: Services provided by a licensed or authorized professional in
accordance with an individualized plan of care which is intended to improve or maintain a
client's quality of life and optimal capacity for self-care. This definition includes physical
therapy, speech pathology, and low-vision training services.
Substance Abuse Services: Provision of treatment and/or counseling to address substance-abuse
issues (including alcohol, legal and illegal drugs), provided in an outpatient or residential health
Treatment Adherence Services: Provision of counseling or special programs to ensure
readiness for and adherence to complex HIV/AIDS treatments.
Child Welfare Services: Assistance in placing children younger than 20 in temporary (foster
care) or permanent (adoption) homes because their parents have died or are unable to care for
them due to HIV-related illness.
Buddy/Companion Services: Activities provided by peers or volunteers to assist a client in
performing household or personal tasks. Buddies also provide mental and social support to
combat loneliness and isolation.
Case Management: A range of client-centered services that links clients with primary medical
care, psychosocial and other services to insure timely, coordinated access to medically-
appropriate levels of health and support services, continuity of care, ongoing assessment of the
client's and other family members' needs and personal support systems, and inpatient case-
management services that prevent unnecessary hospitalization or that expedite discharge, as
medically appropriate, from inpatient facilities. Key activities include initial comprehensive
assessment of the client's needs and personal support systems; development of a comprehensive,
individualized service plan; coordination of the services required to implement the plan; client
monitoring to assess the efficacy of the plan; and periodic reevaluation and revision of the plan as
necessary over the life of the client. May include client-specific advocacy and/or review of
utilization of services.
Client Advocacy: Assessment of individual need, provision of advice and assistance in
obtaining medical, social, community, legal, financial, and other needed services. Advocacy does
not involve coordination and follow-up on medical treatments.
Psychosocial support services: Individual and/or group counseling, other than mental-health
counseling, provided to clients, family, and/or friends by non-licensed counselors. May include
psychosocial providers, peer counseling/support group services, caregiver support/bereavement
counseling, drop-in counseling, benefits counseling, and/or nutritional counseling, or education.
107 - Title I FY 2002 Grant Application Guidance
Day or Respite Care: Home- or community-based non-medical assistance designed to relieve
the primary caregiver responsible for providing day-to-day care of client or client's child.
Early Intervention Services (EIS): Counseling, testing, and referral services to PLWH who
know their status but are not in primary medical care or who are recently diagnosed and are not
in primary medical care for the purpose of facilitating access to HIV-related health services.
Emergency Financial Assistance: Provision of short-term payments for transportation, food,
essential utilities, or medication assistance, which planning councils, Title II grantees, and
consortia may allocate. These short-term payments must be carefully monitored to assure limited
amounts, limited use, and for limited periods of time. Expenditures must be reported under the
relevant service category.
Food Bank/Home Delivered Meals/Nutritional Supplements: Provision of food, meals, or
Health Education/Risk Reduction: (1) Provision of information, including the dissemination
about medical and psychosocial support services and counseling or (2) preparation/distribution of
materials in the context of medical and psychosocial support services to educate clients with HIV
about methods to reduce the spread of HIV.
Housing Assistance: This assistance is limited to short-term or emergency financial assistance to
support temporary and/or transitional housing to enable the individual or family to gain and/or
maintain medical care. Use of Titles I, II and IV funds for short-term or emergency housing must
be linked to medical and/or health-care services or be certified as essential to a client’s ability to
gain or maintain access to HIV-related medical care or treatment.
Housing Related Services: Includes assessment, search, placement, and advocacy services
provided by professionals who possess an extensive knowledge of local, State and Federal
housing programs and how they can be accessed.
Legal Services: Legal services directly necessitated by a person’s HIV status including:
preparation of Powers of Attorney, Do Not Resuscitate Orders, wills, trusts, bankruptcy
proceedings, and interventions necessary to ensure access to eligible benefits, including
discrimination or breach of confidentiality litigation as it relates to services eligible for funding
under the CARE Act. See also, Permanency Planning and Child Welfare Services.
Outreach Services: Programs which have as their principal purpose identifying people with
HIV disease so that they may become aware of and may be enrolled in care and treatment
services. Outreach services do not include HIV counseling and testing nor HIV-prevention
education. Outreach services programs must be planned and delivered in coordination with local
HIV-prevention outreach programs to avoid duplication of effort, be targeted to populations
known through local epidemiologic data to be at disproportionate risk for HIV infection, be
conducted at times and in places where there is a high probability that HIV-infected individuals
will be reached, and be designed with quantified program reporting that will accommodate local
effectiveness evaluation. Broad marketing of the availability of health-care services for PLWH
108 - Title I FY 2002 Grant Application Guidance
should be prioritized and funded as Planning Council or Consortium supported activities.
Permanency Planning: The provision of social service counseling or legal counsel regarding:
a. the drafting of wills or delegating powers of attorney; and
b. the preparation for custody options for legal dependents including standby
guardianship, joint custody, or adoption.
Referral: The act of directing a person to a service in-person or through telephone, written, or
other forms of communication. Referral may be made formally from one clinical provider to
another, within a case-management system by professional case managers, informally through
support staff or as part of an outreach services program.
Transportation: Conveyance services provided to a client in order to access primary medical
care or psychosocial support services. May be provided routinely or on an emergency basis.
Other Support Services: Direct support services not listed above, such as
OTHER PLANNING COUNCIL PRIORITIES
Planning Council Support: Provision of support for the Planning Council, including the
a. costs associated with conducting a needs assessment and other methods for
obtaining input on community needs and priorities, such as public meetings,
focus groups, and ad-hoc panels, for the purpose of assisting the Planning
Council in setting service priorities;
b. staff support (clerical and professional expenses required by the Planning
Council for performance of required Planning Council activities, including
routine Planning Council administrative activities);
c. costs incurred by Planning Council members as a result of their participation on
the Planning Council and in the conduct of their required Planning Council
activities, in accordance with Chapter 7, Generally Allowable/Unallowable Costs,
pp. 7-6 to 7-7 of the Public Health Service (PHS) Grants Policy Statement, which
covers such items as reimbursement of reasonable and actual out-of-pocket costs
incurred solely as a result of attending a scheduled meeting, including
transportation, meals, babysitting fees, and lost wages;
d. costs associated with the development of the comprehensive plan for the
organization and delivery of HIV-related services;
e. costs associated with assessing the efficiency of the administrative mechanism in
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rapidly allocating funds within the EMA;
f. costs associated with participation in development of the Statewide
Coordinated Statement of Need (SCSN);
g. marketing activities associated with publicizing the Planning Council's activities
and programs for HIV-affected/infected populations and sub-populations, and
efforts to substantively enhance community participation in Planning Council
h. development and implementation of Planning Council grievance procedures for
decisions related to priorities and allocations.
Program Support: Activities that are not service oriented or administrative in nature, but
contribute to or help to improve service delivery. Such activities may include capacity building,
technical assistance, program evaluation (including outcome assessment), quality assurance, and
assessment of service-delivery patterns.
Grantee Administrative Costs: include funds to be used by the grantee for routine grant
administration and monitoring activities, which shall include the development of this application
under Title I, the receipt and disbursal of program funds, the development and establishment of
reimbursement and accounting systems, the preparation of routine programmatic and financial
reports and compliance with grant conditions and audit requirements. Grantee administrative
costs also cover all activities associated with the grantee's contract award procedures, including
the development of requests for proposals, contract proposal review activities, negotiation and
awarding of contracts, development and implementation of grievance procedures, monitoring of
contracts through telephone consultation, written documentation or on-site visits, reporting on
contracts, and funding reallocation activities. Title I Grantee Administrative costs cannot exceed
5% of the total grant award.
Beginning in FY 2002 grantees are allowed to allocate 5% of the total grant award or $3,000,000
(whichever is less) for quality management activities.
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Quality management programs, as set forth in the reauthorization language should accomplish a
1. Assist direct service medical providers in assuring that funded services adhere to established
HIV clinical practice standards and Public Health Services (PHS) guidelines;
2. Ensure that strategies for improvements to quality medical care include vital health-related
support services in achieving appropriate access and adherence with HIV medical care;
3. Ensure that available demographic, clinical and primary medical care utilization information
is used to monitor HIV-related illnesses and trends in the local epidemic.
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HIV/AIDS EPIDEMIOLOGY DATA FOR THE EMA
The following information is provided to assist applicants in responding to the FY 2002 Title I
AIDS Prevalence and Incidence;
AIDS Prevalence Data Through 06/30/00; and
AIDS Incidence Data 07/01/98 Through 06/30/00
EMAs may use local data and estimates if they feel they are more accurate. EMAs choosing to
use local data or estimates must provide an explanation of why this data was used and provide
the source of the data in the narrative in Section IV.C.2. ―Severe Need.‖
HIV Prevalence Data
The U.S. Centers for Disease Control and Prevention is currently developing new models for
estimating diagnosed HIV prevalence in states that had not implemented name-based HIV
reporting by 1995. If an appropriate model is identified, HAB/DSS will provide additional data
tables to grantees. HRSA/HAB will be contacting grantees over the next several weeks to
update you on progress on distributing this data and to discuss any additional guidance that will
be required. In addition, the CDC is also reviewing data from states that implemented name-
based HIV reporting during or after 1995 to determine if it will be feasible to provide adjusted
data based on reported prevalent cases in addition to HIV prevalence estimates derived from
Both HIV and AIDS data are statistically adjusted for delays in reporting and for unreported risk.
These tables are based on national adjustments and therefore state health departments may
choose to modify them or substitute other data that may be available locally. Please note the
following important considerations:
These data have been adjusted for delays in reporting and risk and therefore represent
estimates and not actual case counts.
Statistical adjustments to the data require a minimum lapse of two quarters. The Year end
2000 database is the most recent data available for use. Therefore, we are providing data
for the most recent time period possible, including estimates of cases diagnosed through
June 2000 and of prevalent cases as of June 2000.
Risk adjustments (i.e., risk redistribution) for HIV is performed the same way that the risk
redistribution is done for AIDS, based on historical patterns of reclassification. For both
AIDS and HIV data the redistribution is not based on the individual state or EMA’s
reclassification patterns but rather on the patterns observed in the geographic region.
These data tables have been given to state/local surveillance staff. States were advised to
distribute the data in accordance to small cell size restrictions as defined in their local
112 - Title I FY 2002 Grant Application Guidance
data release policies. Again, these data are estimates and numbers in cells do not
represent absolute counts of persons with HIV/AIDS.
As with any adjustments, the reliability of estimates is less for small numbers than for
For AIDS incidence tables, age group represents age at AIDS diagnosis. For HIV and
AIDS prevalence tables, age group reflects age as of June 2000. This is the first time
that we have distributed prevalence tables using current age. This change will also
be reflected in the upcoming year-end 2000 HIV/AIDS surveillance report for AIDS
Diagnosed prevalence of HIV (non AIDS) represents estimated cases diagnosed and
reported living with HIV and does not represent all persons living with HIV infection (i.e,
estimates do not include persons living with HIV who have not yet been diagnosed or
have been tested in an anonymous setting).
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FY 2000 REAUTHORIZATION ISSUE LETTERS
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