Part B Minority AIDS Initiative MAI

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Part B Minority AIDS Initiative (MAI)
Prepared by Melanie Wieland, MPA Presenter
Yukiko Tani, Project Officer HRSA/HAB Division of
Service Systems Feb 5-7, 2008 Grantee
Administrative Overview Meeting
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Todays Topics

• Purpose of the Part B MAI
• Background Funding History
• Program Principles
• Program Requirements
• Reporting Requirements
• Technical Assistance Resources
• Q/A

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The Part B MAI Initiative Purpose

• Funds must be used for education and outreach
  services focused on increasing access to the Part
  B ADAP and as appropriate, to other programs
  providing HIV/AIDS prescription drugs1.
• Funds cannot be used for general HIV/AIDS
  prevention education and outreach services.
• Outreach services must comply with HRSA/HAB
  Policy Notice 02-01, The Use of Ryan White
  HIV/AIDS Program Funds for Outreach Services,
  available at http//hab.hrsa.gov/law/0201.htm.

1 As with other Ryan White Program funds, MAI
funds are the payer of last resort.
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The Part B MAI Initiative Background

• Established by Congress during FY99
  appropriations process for other Ryan White
  Programs in response to data showing disparities
  in AIDS morbidity and mortality data for minority
  communities.
• Part B component added FY 2001
• December 2006 MAI codified as a competitive
  grant program when the Ryan White Program was
  reauthorized The next three slides show some
  of the data CDC has collected and reported that
  demonstrate the continuing disproportionate
  impact of the HIV/ AIDS epidemic among
  minorities.

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Continuing Disproportionate Impact of the
HIV/AIDS Epidemic African Americans

• 2005
• 40 of cumulative AIDS cases reported through
  2005, but 13 of the U.S. population
• 48 of new AIDS cases in 2005 (adult/adolescent)
• 60 of cumulative AIDS cases in women
• 59 of children with AIDS lt 13

• 1998
• 36 of cumulative AIDS cases reported through
  1998
• 45 of new AIDS cases in 1998 (adult/adolescent)
  
• 57 of cumulative AIDS cases in women

1Source Centers for Disease Control and
Prevention
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Continuing Disproportionate Impact of the
HIV/AIDS Epidemic Hispanic Americans

• 2005
• 19 of cumulative AIDS cases through 2005, but
  13.7 of the U.S. population
• 20 of new AIDS cases reported in 2005
  (adult/adolescent)
• 19 of cumulative AIDS cases in women through
  200522 of heterosexuals at high risk
• 23 of children lt age 13

• 1998
• 18 of cumulative AIDS cases through 1998
• 20 of new AIDS casesin 1998 (adult/adolescent)
• 20 of cumulative AIDS cases in women through
  1998
• Injection drug use was the primary mode of
  transmission

1Source Centers for Disease Control and
Prevention
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Part B MAI Funding, 2001-2007 (In Millions)
Notes FY 2001 2006 51 or 52 grantees
annually funds disbursed by formula FY 2007 30
grantees applied and were funded through a
competitive application process
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FY 2007 Part B MAI Funding

• All Part B grantees are eligible to apply for MAI
  funds
• In FY07, 30 grantees applied and all were funded
• Total awards1 - 6,739,600 (1.7 less then in
  FY06)
• MAI represents 0.7 of total Part B funding in
  2007
• Award range 2,500 to 1.477 million
• Median award 96,600
• Comparison with last years awards
• 7 grantees received a decrease in MAI funds this
  year
• Of these, 4 grantees received more than a 20
  decrease
• 23 grantees received an increase in MAI funds
  this year
• Of these grantees, 16 had a 20 or greater
  increase

1 Please refer to the FY07 Part B MAI Grant Award
list provided for specific grantees and award
amounts.
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Criteria Used to Determine FY 2007 Part B MAI
Grant Awards

• FY07 Grant Application Scores External Objective
  Review Committee
• Objective and quantified measure of baseline
  need The scores were applied against the
  distribution of living minority HIV non-AIDS
  living AIDS cases for the most recent year
  available
• As reported to the Centers for Disease Control
  or,
• For States without names-based HIV reporting
  systems in place prior to 12/31/05, as reported
  to HRSA. (I.E., similar to the process used to
  determine Part A supplemental grants.)
• Minimum award 2,500

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MAI Part B Grant Program FY07 FY09

• FY 2007 Competitive application process.
  Awarded for 3-year project period
  8/1/2007 7/31/2010
• FY 2008 and FY 2009 Grantees must submit a
  non-competing continuation (NCC) grant
  application
• FY08 NCC guidance Expect to be released shortly
  
• It will be emailed to all current Part B
  grantees
• Technical assistance conference call will be
  scheduled 1-2 weeks later
• 2-step application process with 2 deadlines
• Grants.gov deadline approximately March 7th to
  March 14th
• EHB deadline approximately March 21st to March
  28th
• FY08 MAI awards The grantees FY 2007 scores
  will be applied against an updated distribution
  of living minority HIV-non AIDS AIDS cases.

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Part B MAI Principles

• While the Part B MAI is a separate competitive
  grant program, it is still an integral component
  of the Part B/ADAP program.
• Use the same planning process to establish
  priorities and disburse funds
• Importance of obtaining community input
• Grantees must have policies and procedures in
  place to avoid simply placing new clients on ADAP
  waiting lists.
• MAI services must be linked to ADAP and other
  Part B services
• Grantees must document and report outcomes and
  other program results
• HRSA strongly encourages grantees to use the same
  Part B grantee administrative agency/department/un
  it to administer the MAI

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Part B MAI Requirements

• In general, Part A program requirements apply to
  the MAI, such as
• Payer of last resort status (as with all Ryan
  White funds)
• Cost caps for Grantee Administration, Planning
  and Evaluation, Clinical Quality Management, and
  first-line entities
• Payer of last resort status
• Part B Core Medical Services requirement is
  calculated on the total Part B award combined
  (Part B base ADAP ADAP supplemental
  Emerging Communities MAI grant funds.)
• Because MAI funds may only be used to provide
  education and outreach services to increase
  minority population access to the Part B ADAP,
  MAI funded services are considered support
  services and therefore will not count toward the
  75 percent Core Medical Services requirement.
• For States/Territories that applied for and are
  determined by HRSA to be eligible for a FY 2008
  Part B Core Medical Services waiver, the waiver
  will include FY 2008 MAI grant funds that are
  awarded.
• Grantees that are eligible for and apply for a
  Core Medical Services waiver must consider their
  MAI funds at the time they apply for a waiver
  (i.e., at the same time the Part B grant
  application is submitted). Waiver applications
  will NOT be considered with the MAI applications.

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Part B MAI Requirements (Continued)

• Exception The Unobligated Balances requirement
  does NOT apply to the Part BMAI.
• Grantees must submit a separate FSR for the MAI,
  due 90 days after the budget period end date
  (10/31/08).
• MAI Carry-over requirements
• If the State/Territory has unexpended FY07 Part B
  MAI funds after the budget period ends on
  7/31/2008, the grantee may request carryover of
  those funds into FY 2008.
• However, carryover requests must be submitted no
  later than 30 days after the FSR has been
  submitted, i.e. by 12/1/2008.

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Part A MAI Requirements (Continued)

• Allowable Services Only education and outreach
  activities that are designed to increase minority
  participation in ADAP
• Entities eligible to receive MAI funds The same
  as for Part B. That is, not for profit or
  publicly funded
• Community-based Providers
• Faith-based organizations
• Community health centers
• Clinics and hospitals
• Health Departments
• Other State or local government agencies
• Tribal government and tribal/urban Indian
  entities

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Part B MAI Requirements (Continued)

• The Part B MAI Quick Reference handout included
  in your information packet is a summary of all
  information grantees must submit to HRSA in
  relation to FY07. (A similar summary will be
  provided when FY08 awards are issued.)
• Condition-of-Awards
• Program Terms
• Reports
• The deadline for each item
• How to submit the required item to HRSA

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Part B MAI Reporting Requirements

• Must submit Ryan White Data Report (formerly
  CADR)
• MAI Plan initial plan is submitted with the
  grant application
• Revised plan submitted post award
• FY07 Plan was due 11/30/07
• FY08 Plan will be due 9/30/08
• Annual Report due after the budget period end
  date.
• FY07 Report currently due 12/1/08 likely to
  change to Nov 1, 2008
• FY08 Plan will be due 9/30/08
• FY08 Report will be due 9/30/09

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Part B MAI Reporting Requirements

• Revised Annual Plan
• Revised Implementation Plan Table (format
  provided by HRSA)
• For each planned service/activity, provide
• Measurable, time-specific goals and objectives
• Whether it is a new, continuing or expanded
  service
• The target population
• Amount of funds budgeted
• Projected number of clients expected to be served
• Planned outcomes, e.g. the number of new clients
  expected to be enrolled in ADAP as a result of
  the activity/service.
• Plan narrative Explain any changes made to the
  Plan submitted in your application, including
  changes in planned services/activities, target
  populations, geographic area to be served, and or
  expected outcomes/program results. Similarly,
  provide updated information as appropriate
  regarding plan to disburse funds and monitor
  program services/activities.

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Part B MAI Reporting Requirements

• The MAI Annual Report
• Use Implementation Plan Table provided by HRSA to
  report actual results with respect to
• Expenditures
• Clients served
• Outcomes achieved
• The narrative portion of the report must
• Identify and describe MAI contractors by type
  (e.g., health department, community-based
  provider, minority and/or faith-based providers,
  tribal organizations, etc.), and the
  services/activities provided by each.
• If the grantee did not contract out the MAI
  funds, how did the grantee use these funds?
• The total amount of MAI funds spent that fiscal
  year.
• A breakout of expenditures by contractor and type
  of MAI activity/service

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Part B MAI Reporting Requirements

• Required Elements of the Annual Report Narrative
  (continued)
• Description of program accomplishments
• Results of the grantees MAI-funded education
  and/or outreach efforts
• If possible, compare the number and demographics
  of clients pre- and post- the MAI-funded
  activity/intervention.
• The total number of minority clients that
  receivedor benefited fromMAI-funded outreach
  and/or education service(s)/activities.
• Other Program Results
• For grantees that received 50,000 or more in MAI
  funds The racial/ethnic breakout of clients that
  received or benefited from each service/activity
  (i.e., Asian, American Indian/Alaskan Native,
  Black/African American, Hispanic/ Latino(a),
  Native Hawaiian/Pacific Islander, More Than One
  Race, Unknown/ Unreported)

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Part B MAI Reporting Requirements

• The GAO and OMB are both closely monitoring the
  MAI program and the outcomes being achieved.
• Program Assessment Rating Tool (PART) goals
  established for the MAI by OMB and the Department
  of Health and Human Services (DHHS) for the MAI,
  are defined on the next slide.

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Part B MAI Reporting Requirements

• DHHS and OMB PART goals for the MAI
• Reduce the percentage of diagnosis with AIDS when
  first diagnosed with HIV among racial and ethnic
  minority communities. 2006 baseline
  40.25 2010 target 36.25
• Increase the number of HIV infected ethnic
  racial minority individuals surviving 3 years
  after a diagnosis of AIDS. 2006 baseline
  83.5 2010 target 86.75
• Reduce the rate of new HIV infections among
  racial and ethnic minorities in the United
  States. Baseline 2010 target to be
  determined

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For more information

• General Information about Part B MAI program
  guidelines contact your Project Officer.
• Grant Application Process
• TA Conference Call 1-2 weeks after guidance is
  released
• TA on using Grants.gov and the EHB is available
  from the HRSA Call Center via email at
  CallCenter_at_hrsa.gov or by telephone at
  1-877-Go4-HRSA.
• FY 2007 Part B Reporting Instructions Will be
  emailed to Grantees in the next 2 weeks
• TA Information. For information about TA and
  training related on various topics, such as
  cultural competency, visit the TARGET Center at
  http//careacttarget.org and also the HRSA
  website at http//hab.hrsa.gov/special/culture.htm