Part A Minority AIDS Initiative MAI

1
Part A 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
2
Todays Topics

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

3
The Part A MAI Initiative Purpose

• Purpose Improving HIV-related health outcomes
  to reduce existing racial and ethic health
  disparities. (Section 2693(b)(2)(A) of the
  Public Health Service Act)
• As such, the purpose has remained unchanged since
  the Congress first established the MAI 8 years
  ago during the FY99 appropriations process.
• Important MAI funds are NOT the only or even
  the primary Part A funding source to address
  HIV/AIDS care needs of minorities.
• In setting priorities for Part A
  formula/supplemental funds, an EMA/ TGA must
  consider the HIV/AIDS care needs of
  disproportionately impacted minority communities.

4
The Part A MAI Initiative Background

• Established by Congress during FY99
  appropriations process in response to data
  showing disparities in AIDS morbidity and
  mortality data for minority communities.
• FY99 Part A 5 million in new supplemental
  funds
• FY00 FY06 Congress continued the MAI in the
  same manner, increasing the funding level through
  2003
• 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.

5
(No Transcript)
6
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
7
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
8
Part A MAI Funding, FY 2000 2007 (In Millions)
2000 2003 Part A MAI funding increased 65
percent 2003 2007 Essentially level funding
9
FY 2007 Part A MAI Funding

• 56 Part A grantees All funded, including the 5
  new TGAs
• Total awards1 - 42, 041,430 (2 less then FY06)
• MAI represents 7.4 of total Part A funding in
  2007
• Award range 50,000 to 9.35 million
• Median award 348,411
• Comparison with last year for 51 previously
  funded grantees
• ½ received an increase ranging between 1 to 75
  more funds
• Of these, 19 grantees received more than a 20
  increase
• ½ had a decrease of between 4 to 42 in MAI
  funds this year
• Of these grantees, 9 had a 20 or greater
  decrease

1 Please refer to the FY07 Part A MAI Grant Award
list provided for specific grantees and award
amounts.
10
Criteria Used to Determine FY 2007 Part A 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 EMAs/TGAs in 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 50,000 (Rationale to assure
  administrative feasibility.)
• Maximum award 10,750,000 (Rationale to assure
  funds available for 5 new TGAs, particularly with
  the 2 decrease in available funds.)

11
MAI Part A 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 published Jan 18th and emailed
  to all grantees
• Technical assistance conference call 11 a.m. ET
  on February 14th
• 2-step application process with 2 deadlines
• Grants.gov deadline March 7th
• EHB deadline March 21st
• FY08 MAI awards The grantees FY 2007 scores
  will be applied against an updated distribution
  of living minority HIV-non AIDS AIDS cases.

12
Part A MAI Principles

• While the Part A MAI is a separate competitive
  grant program, it is still an integral component
  of Part A
• Use the same planning process to establish
  priorities and allocate funds
• Importance of obtaining community input
• MAI plan must be based on documented
  demonstrated need, with a special focus on the
  unmet needs of minority clients who know their
  HIV status but are not currently in care
• MAI services must be part of, and linked to, the
  Part A care continuum of care
• Grantees must document and report client-level
  health outcomes for all funded services outcome
  measures used must be consistent with HRSA
  guidance .
• HRSA strongly encourages grantees to use the same
  Part A grantee administrative agency/department/un
  it to administer the MAI

13
Part A 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)
• 10 Grantee Administration cap
• 5 Clinical Quality Management cap
• Use the same planning/priority-setting/allocations
  processes
• Part A Core Medical Services requirement
  EMAs/TGAs must take into account their MAI funds.
  However, all MAI funds could be used for support
  services, so long as when the Part A formula
  supplemental MAI funds are added together, at
  least 75 is allocated to Core Medical Services.
• 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 A grant
  application is submitted). Waiver applications
  will NOT be considered with the MAI applications.

14
Part A MAI Requirements (Continued)

• Exception The Unobligated Balances requirement
  does NOT apply to the Part A MAI.
• 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 EMA/TGA has unexpended FY07 Part A 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.

15
Part A MAI Requirements (Continued)

• Allowable/Unallowable Services The same as for
  Part A funded services
• Entities eligible to receive MAI funds The same
  as for Part A. 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

16
Part A MAI Requirements (Continued)

• The Part A 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

17
Part A MAI Reporting Requirements

• Must submit Ryan White Data Report (formerly
  CADR)
• Initial MAI Plan submitted with the grant
  application
• Revised plan submitted post-award via
  Electronic Handbook (EHB)
• FY07 Plan was due 11/30/07 (Requested changes
  approved by 1/31/08)
• FY08 Plan will be due 9/30/08
• Annual Report submitted via EHB after the budget
  period end date
• FY07 Report currently due 12/1/08 likely to
  change to Nov 1, 2008
• FY08 Report will be due 9/30/09

18
Part A MAI Reporting Requirements Plan Annual
Report

• Using the EHB to submit Plan/Report
• Web-forms one per service for each racial/ethnic
  population
• Use standard service unit definitions as much as
  possible elaborate on specifics in the
  narrative.
• Required Unduplicated client counts and
  client-level health outcomes (Note This has been
  a requirement since 2000)

19
Part A MAI Reporting Requirements

• FY07 Plan narrative Please refer to FY07
  Reporting Instructions
• FY07 Report narrative
• Background information needed to explain the data
  submitted in the Web Forms
• A summary of program achievements in relation to
  planned goals and objectives, including
  client-level health outcomes and capacity
  development or technical assistance activities
• Challenges and lessons learned in providing
  MAI-funded services

20
Part A MAI Reporting Requirements

• Selecting client-level health outcomes
• Must be consistent with HRSA guidelines.
• Important to work with planning council and
  providers to select outcomes, but as with the
  clinical quality management (CQM) program,
  ultimate responsibility rests with the grantee.
• Whenever possible, use at least one standard HRSA
  outcome measure for each Core Medical and Support
  Service.
• For any given service, use several consistent
  key measures across racial/ethnic populations
  to be served.
• 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 on the
  next slide.

21
Part A 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

22
For more information

• General Information about Part A MAI program
  guidelines and reporting requirements contact
  your Project Officer.
• Submitting MAI Reports/Plans on the EHB
• TA Conference Calls are scheduled prior to due
  dates
• Online at https//performance.hrsa.gov/hab/maiApp
  /help/
• The HRSA Call Center at callcenter_at_hrsa.gov or by
  phone at 877-go4-HRSA (877-464-4772). Also the
  Call Center also provides TA on submitting grant
  applications using Grants.gov and the EHB.
• FY 2007 Part A Reporting Instructions call your
  project officer
• 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