Monitoring Standards - Administrative Part A Overview.hjp edits

Overview of Site Visit Process Ryan White HIV/AIDS Program Part C, D, and F-Dental

Department of Health and Human ServicesHealth Resources and Services AdministrationHIV/AIDS BureauDivision of Community HIV/AIDS Programs

FiscalWelcome to the Division of Community HIV/AIDS Programs Overview of the Site Visit Process!Todays presentation will be focusing on the site visit process for Ryan White HIV/AIDS Program Part C, D, and F-Dental. The webinar will be presented in two parts The first portion of the webinar will be providing an overview of the site visit process and be presented by Sandra Lloyd and Karen Gooden. The second portion of the webinar will provide an overview of the Fiscal Requirements from the new site visit assessment tool presented by Stephanie Bogan and Gail Williams-Glasser. The webinar will last approximately 120 minutes. Please do not use the chat box to enter questions during the webinar. Due to the fact that the webinar will be taped for future reference, all questions should be sent to the contact that will be provided at the end of the webinar, so that a summary of frequently asked questions from the initial webinars can be uploaded to the Target Center. If participants would like to view the webinar again at a later date, it will be available on the Target Center website within 5 business days. I am Sandra Lloyd, Project Officer for the Division of Community HIV/AIDS Programs Western Branch and Co-Lead for the Site Visit Workgroup and I will be presenting the first half of the Overview of the Site Visit Process.

5/8/141Webinar Goal To increase the knowledge of Consultants and Project Officers on how to effectively assess and report on the HRSA/HAB/DCHAPs Ryan White HIV/AIDS Program Part C, D, and F-Dental grantees provision of comprehensive, high quality healthcare for people living with HIV/AIDS, compliance with legislative and programmatic requirements, and the National HIV/AIDS Strategy.

The goal of todays webinar is to:5/8/142Webinar Objectives By the end of the webinar, participants will:Become familiar with all applicable Federal statutes and regulations relative to the administration of grants. Increase knowledge of how to properly use the Site Visit Assessment Tool.Compare and contrast the Ryan White HIV/AIDS Program Parts A,B,C,D, and F, and Minority AIDS Initiative.Describe the reasons for conducting a site visit and how to prepare for pre and post site visit activities. Identify Whats New? with the 2013 Site Visit Assessment Tool. Increase knowledge of the site visit process.Apply tools to write a concise and comprehensive report.

Seven objectives have been identified for the presentation and include..

5/8/143Webinar Outline Overview of HRSA/HABAuthorities that Govern Site VisitsRyan White HIV/AIDS Program Parts A,B,C,D, and F, and MAIMonitoring Site VisitsSite Visit Roles and ResponsibilitiesTeam Member Professional StandardsSite Visit Assessment ToolSite Visit Reporting CriteriaTips for Writing a Concise and Comprehensive Report During the first part of the presentation we will provide an overview of the Health Resources and Services Administration/ HIV/AIDS Bureau and the Division of Community HIV/AIDS ProgramsPresent the authorities that govern site visitsProvide an overview of the RW Program PartsDiscuss the roles and responsibilities of Team Members and Project Officers as well as the standards that Team Members should be in compliance with while monitoring site visitsWe will present our newly revised Site Visit Assessment Tool and Site Visit Report formatAnd provide tips for writing a concise and comprehensive Site Visit Report 5/8/144Health Resources and Services Administration (HRSA)Vision Healthy Communities, Healthy People

Mission To improve health and achieve health equity through access to quality services, a skilled health workforce, and innovative programs. Before we present an overview of the various parts within the Ryan White Program it is important to review the vision and mission for HRSA and the HIV/AIDS Bureau. The vision for HRSA is Healthy Communities, Healthy People with a mission to improve health and achieve health equity through access to quality services, a skilled health workforce, and innovative programs. 5/8/145HIV/AIDS BureauVision Optimal HIV/AIDS care and treatment for all.

Mission Provide leadership and resources to assure access to and retention in high quality, integrated care and treatment services for vulnerable people living with HIV/AIDS and their families.

The HIV/AIDS Bureau was created in 1997 and declares a vision of optimal HIV/AIDS care and treatment for all with a mission to provide leadership and resources to assure access to and retention in high quality, integrated care and treatment services for vulnerable people living with HIV/AIDS and their families. 5/8/146Authority The site visit process is governed by:

Ryan White HIV/AIDS LegislationTitle XXVI of the Public Health Service ActHAB Policy Notice National HIV/AIDS StrategyFunding Opportunity Announcement

The primary authorities that govern the site visit process are the Ryan White CARE Act Legislation, Title 26 of the Public Health Service Act, HAB Policy Notice; and the National HIV/AIDS Strategy. All of these are outlined within the funding opportunity announcement that is specific for each type of grant award. The next several slides will define these authorities!

5/8/147Ryan White HIV/AIDS Legislation Congress enacted the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act in 1990 to improve the quality and availability of care for low-income, uninsured, and underinsured individuals and families affected by HIV disease. The CARE Act was amended and reauthorized in 1996, 2000, and 2006; in 2009 it was reauthorized as the Ryan White HIV/ AIDS Treatment Extension Act of 2009 (Public Law 11187).

The RW Comprehensive AIDS Resources Emergency (CARE) Act was enacted by Congress in 1990 to improve the quality and availability of care for low-income, uninsured, and underinsured individuals and families affected by HIV disease. Amendments occurred in 1996, 2000, and 2006. In 2009 the CARE Act was reauthorized as the Ryan White HIV/AIDS Treatment Extension Act.

5/8/148Ryan White HIV/AIDS Program Administered by the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB), the Ryan White HIV/AIDS Program works with cities, states, and local community based organizations to provide services to over 559,000 people each year who do not have sufficient health care coverage or financial resources to cope with HIV disease. The majority of Ryan White HIV/AIDS Program funds support primary medical care and essential support services. A smaller but equally critical portion is used to fund technical assistance, clinical training, and research on innovative models of care. The RW HIV/AIDS Program provides services to over 559,000 people each year who do not have sufficient health coverage or financial resources to cope with HIV disease. The majority of funding supports primary medical care and essential support services. Funding also supports the provision of technical assistance, clinical training, and research on innovative models of care through the Special Projects of National Significance.

5/8/149Title XXVI of the Public Health Service Act- examines the authority of the government at various jurisdictional levels to improve the health of the general population within societal limits and norms.

HAB Policy Notices- provide updates from HAB regarding clarification of legislation and policies.

Funding Opportunity Announcement (FOA)- explains the availability of a Federal grant funding opportunity and application process and is released through Grants.gov.

Title 26 of the Public Health Service Act within our legislation examines the authority of the government at various jurisdictional levels to improve the health of the general population within societal limits and norms.Another authority is the HAB Policy Notice that provides updates from the HIV/AIDS Bureau regarding clarification of legislation and policiesAll of these authorities are cited within each Funding Opportunity Announcement that explains the availability of a Federal grant funding opportunity and is released through Grants.gov

5/8/1410National HIV/AIDS Strategy GoalsIn 2011, President Obama announced the availability of additional funding to fight HIV/AIDS in the United States for the Part C EIS Program and the AIDS Drug Assistance Program. These programs support the implementation of the National HIV/AIDS Strategy, a national framework for combating the HIV/AIDS epidemic in the United States. The National HIV/AIDS Strategy has four overarching goals:

5/8/1411Ryan White HIV/AIDS Program

Parts A,B,C,D, and F, and the Minority AIDS Initiative Now we will present a brief overview of the various Parts of the Ryan White HIV/AIDS Program.5/8/1412Ryan White HIV/AIDS ProgramParts A, B, C, D, and F of the Ryan White HIV/AIDS Program provides funding for HIV-related services in the United States. As outlined on this slide, each part focuses on funding services by specific populations in need, service areas, or categories. 5/8/1413Ryan White HIV/AIDS Program AdministrationAs a part of the reorganization of the HIV/AIDS Bureau in 2012, each Division was renamed to better define the primary focus.

The Division of Service Systems that covered Part A and B has been separated into two divisions: the Division of Metropolitan HIV/AIDS Programs and the Division of State HIV/AIDS Program. The former Division of Community Based Programs is now called the Division of Community HIV/AIDS Programs. 5/8/1414Ryan White HIV/AIDS Program Part AEmergency assistance to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs) that are most severely impacted by the HIV/AIDS epidemicAward made to Chief Elected OfficialFunding allocations determined by Planning CouncilPart A funds distribution:2/3 by formula based on the number of living cases of HIV (non AIDS) and AIDS1/3 supplemental competitive grant processEach part has a specific focus. Part A targets cities disproportionately affected by HIV disease. Todays grantees include 24 within large Eligible Metropolitan Areas and 28 grantees in smaller Transitional Grant Areas. EMAs have at least 50,000 inhabitants and >2,000 reported AIDS cases in the past 5 yearsTGAs have at least 50,000 inhabitants and between 1000 1,999 reported AIDS cases in the past 5 years or prior status as an EMA.The distribution of funds is determined by both formula and a competitive grant process as noted on the slide.

5/8/1415Ryan White HIV/AIDS Program Part BBase Grant - Provides grants to all 50 States, the District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands, 6 Pacific jurisdictions to pay for care for people living with HIV/AIDSFor jurisdictions with >1 percent of nations HIV/AIDS cases, match required $1 state: $2 federalFunds distributed by formula based on HIV/AIDS casesAward made to Chief Elected Official

AIDS Drug Assistance Program (ADAP) pays for:Medications to treat HIV diseaseInsurance continuation for eligible clientsServices that enhance access, adherence, and monitoring of drug treatment

The Part B program provides funding to U.S. States and Territories that is distributed by use of a formula. In 1995, the AIDS Drug Assistance Program was created under Part B to provide medications to treat HIV disease, health insurance premium and cost sharing assistance, and treatment adherence. ADAP is now the largest Ryan White HIV/AIDS Program component. 5/8/1416Part C EIS OverviewPurpose: To provide comprehensive continuum of outpatient HIV primary care in a service area.

Required Services:HIV counseling, testing, and referralMedical evaluation and clinical careOther primary care servicesReferrals to other health services

Medical Model of Care:AssessTreat ReferFunds for Part C Early Intervention Services must be used to provide a comprehensive continuum of outpatient HIV primary care. In order to identify people who are HIV positive, HIV Counseling, Testing, Referral, and partner counseling should be available for high risk targeted populations either through the Part C Program or via linkages and formal referral mechanisms with programs that provide the testing services. As noted on the slide, Ryan White Programs must reflect a medical model of care in which providers can assess, treat, and refer. In addition to providing HIV medical care, grantees must be able to provide other services to support HIV clinical outcomes either on site or via referrals. These services include oral health care, mental health treatment, substance abuse treatment, nutritional services, specialty care and support services.

5/8/1417Part D WICY OverviewPurpose: To provide family-centered primary medical care to women, infants, children, and youth (WICY) living with HIV/AIDS when payments for such services are unavailable from other sources. In 1994 , the Part D Program for women, infants, children, youth, and their families was included under the Ryan White CARE Act. Part D funds must now be used to provide family centered primary medical care and support services to women, infants, children, and youth living with HIV. These services must not be reimbursable from other sources, including Medicaid, other Ryan White parts, and third party insurance. 5/8/1418Ryan White HIV/AIDS ProgramPart F / DentalThe Dental Reimbursement Program was first authorized in 1991 to provide resources to cover costs of uncompensated care provided by academic dental institutions while expanding access to oral health care for PLWHA by training additional dental and dental hygiene providers. Funding is provided to dental schools, schools of dental hygiene, and post-doctoral dental education programs.

In the 2000 reauthorization, Congress added the Community Based Dental Partnership Program which currently funds 56 Dental Reimbursement programs across the country and 12 Community Based Dental Partnership Programs within 11 states.

5/8/1419Minority AIDS Initiative (MAI)Goal: To help reduce the disproportionate impact of HIV/AIDS and address disparities by:Increasing the number of persons from racial and ethnic minority populations receiving HIV care, and Increasing the number of persons from racial and ethnic minority populations who stay in care.MAI funds awarded are noted under the grant specific terms section of the Notice of Award (NoA) which establishes the final funding for the budget period.

Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87,October 30,2009), 2693The Minority AIDS Initiative began in 1999 and was championed by the Congressional Black Caucus in response to changes in the HIV epidemic. The goal of the Minority AIDS Initiative is to reduce health disparities among racial and ethnic minorities through outreach and education services and strengthen the capacity of community based organizations to serve more people of color and retain them in care. The desired end result is to increase the number of racial and ethnic minority populations receiving care and who remain in care. MAI funds that are awarded are noted on the grantees Notice of Award. 5/8/1420MonitoringSite VisitsIn order to ensure that grantees are providing comprehensive, high quality healthcare for people living with HIV/AIDS and complying with legislative and programmatic requirements as well as the National HIV/AIDS Strategy, it is essential that grantees programs be monitored through site visits. 5/8/1421DCHAP Site VisitsTypes of Site VisitsDescriptionComprehensive

Conducted to review a Programs ability to meet the legislative and programmatic requirements of the Ryan White HIV/AIDS Program Newly awarded and established grantees who have not had a site visit within the last five years are a priorityDiagnosticConducted to identify and clarify any programmatic deficiencies for grantees who are exhibiting challenges within one or more of the three core areas: clinical, fiscal or administrativeTechnical AssistanceConducted to offer appropriate support to enhance a grantees capacity to provide high quality, cost competitive health care and servicesThe Division of Community HIV/AIDS Program currently conducts three types of site visits: comprehensive, diagnostic, and technical assistance. Comprehensive site visits are the primary type of visits performed by DCHAP in order to conduct a complete review of a Grantees Program and assure that they are meeting legislative and programmatic requirements. Newly awarded grantees as well as established grantees who have not had a site visit within the last year are a priority. Diagnostic site visits are conducted when programmatic deficiencies are identified for a Grantee and may focus on one or more of the three core areas: clinical, fiscal, or administrative. Technical Assistance site visits are conducted to offer specific support to a Grantee.

5/8/1422Ryan White HIV/AIDS ProgramCompliance MonitoringHRSA/HAB conducts ongoing review and monitoring of grantees In addition to conducting site visits, HAB staff monitor grantees in other ways including performing ongoing reviews of a grantee performance by conducting monthly monitoring calls, reviewing RW Programmatic Reports, and by reviewing fiscal reports. Grantees are also expected to conduct ongoing reviews of any sub grantees that they have on their award. 5/8/1423Why Do We Conduct Site Visits?Support DCHAPs mission to provide grantee oversight in the delivery of comprehensive high quality HIV primary and oral health care. Verify the grantees program is in compliance with the Ryan White Legislative & Programmatic requirements.3. Ensure highest quality HIV clinical care and compliance with HHS Guidelines.4. Ensure administrative and fiscal integrity.5. Identify technical assistance needs to address any program deficiencies.

As previously mentioned, site visits are conducted to assure that a grantees program is in compliance with legislative and programmatic requirements. In addition, it is essential for DCHAP to ensure that grantees are delivering comprehensive high quality HIV primary and oral health care that is in compliance with HHS guidelines, ensure administrative and fiscal integrity, and identify any technical assistance needs that can assist a grantee to correct program deficiencies. 5/8/1424What Can Trigger a Site Visit?- Need for an initial site visit for newly awarded grantee or comprehensive site visit for established grantee- Low score on recent competitive application or lack of progress reflected within non-competing report- Habitual and problematic staff turnover for grantee - Lack of communication with Project Officer

- Continually failing to meet work plan objectives- A sense on the part of the Project Officer/Branch Chief that somethings just not right with the grantees program- Media attention- Known financial problems- Problematic spend-down patterns and/or multiple years with unobligated balances- Draw down restrictions

Comprehensive site visits are conducted for newly awarded grantees as well as established grantees; however certain reasons can trigger the need to schedule a site visit. Some of the triggers include: a grantee submits a competitive application that receives a low score by the reviewers or when a grantees progress summary report within their non-competing report does not reflect progress; if a grantee continues to experience staff turnover especially amongst key personnel; if a Project Officer reports the inability to communicate with a grantee; when work plan objectives are continuously unmet; if the Project Officer or Branch Chief feels that there is a concern or something is just not right with a program; reports of program concerns via the media; and financial problems such as continuous unobligated balances at the end of budget periods and the ongoing need to place draw down restrictions on the grant. 5/8/1425Goal of Site Visit TimelineDCHAP has a timeline that we attempt to follow in completing site visits. Approximately 10 weeks prior to a scheduled site visit, consultants are to be identified and site visit materials are emailed to the consultants. Approximately 8 weeks prior to a scheduled site visit, the Project Officer will confirm the date and time of the Pre-Site Visit Conference Call with the consultants and notify the grantee. The pre-site visit conference call is held with the Project Officer, consultants and grantee to primarily review the site visit agenda, and answer any immediate questions or concerns that the grantee may have prior to the site visit.

5/8/1426Goal of Site Visit Timeline continuedThe timeline for completion of the Site Visit Report has recently been revised by HRSA for all Bureaus to be a total of four weeks. Within one week of completion of the site visit the report must be submitted by the consultants to the Team Leader. The Team Leader has one week to submit the completed report to the Project Officer. Over the following two weeks, approval of the site visit report is completed by the Project Officer, Branch Chief, DCHAP clinical reviewer, and the Deputy Director of DCHAP for a total of four weeks from the completion of the site visit. At that time the Project Officer is required to release the completed site visit report to the Grantee. 5/8/1427Pre-Site Visit PrepPre-Site Visit PreparationCopy of most recent applicable Funding Opportunity Announcement (FOA)Most recent Competing Application and Non-Competing Progress ReportMost recent Ryan White Services Report (RSR)Three most recent Federal Financial ReportsCurrent line item budget and justificationCopies of any previous Site Visit Reports (as applicable)Most recent A-133 Audit2. Team Pre-Site Visit Conference CallTeam Leader, Consultant Team Members and Project Officer.3. Pre-Site Visit Conference Call with the GranteePrior to a site visit, there are certain activities that take place.Initially the Project Officer will arrange to have materials sent to the consultants for review. These may include a copy of the Funding Opportunity Announcement that applies to either Part C, D, or F-Dental grants; the grantees most recent competing application and their non-competing progress report that is submitted annually; three of the most recent federal financial reports; the most recent approved line item budget and justification narrative; copies of any previous site visit reports; and the grantees most recent A-133 audit. Approximately one month prior to the Site Visit the Team Leader, Consultant team members, and project officer will have a conference call for approximately 30 minutes followed by the call to the Grantee that is scheduled for approximately one hour. 5/8/1428How Does Grantee Prepare for the Site Visit?Extensive instructions from their Project OfficerMaterials provided to grantee:Site Visit Assessment Tool Pre-Site Visit Conference Call AgendaList of Materials to be Available for review on-siteSample Site Visit AgendaSite Visit Evaluation Form3. Site Visit Agenda jointly developed with Team Leader

Now we are going to discuss how a grantee prepares for a site visit? As you can imagine, the grantee may have some anxiety when it comes to preparing for the site visit, the goal of the Project Officer should be to provide guidance and clearly describe what they should expect during the upcoming visit. Grantees should not only be provided with the Site Visit Assessment Tool, Pre-Site Visit Conference Call Agenda, List of Materials to be available for review on site, and the Site Visit Evaluation Form but they should also be reassured that the site visit allows for DCHAP to have an opportunity to see first hand the services that they are providing as well as assist them in identifying any technical assistance that they could benefit from. At this time I will turn the presentation over to Karen Gooden. 5/8/1429Site Visit Roles and Responsibilities

As the cartoon, depicts everyone plays a part of this process. Lets discuss the site visit roles and responsibilities. 5/8/1430Pre-Site Visit ActivitiesRole of Project OfficerThe Project Officer starts the process by (Read first bullet).

Establishes the site visit date. This is usually a date agreed upon by all parties

Pre-Site Visit Conference call and prepares packet. This call is important in establishing the foundation with team members regarding the goals, objectives, and plan of action.5/8/1431Pre-Site Visit ActivitiesRole of Team LeaderThe Team Leader plays an equally important role. He/She takes lead in ensuring that all team members are kept well informed throughout the process. Read slide. 5/8/1432Pre-Site Visit ActivitiesRole of Team LeaderPre-Site Visit Conference CallFacilitates the Pre-Site Visit Conference Call (re-iterate purpose, introduce Team, and ensure that a review of the site visit process is presented to the grantee).Ensures the grantee will arrange for a confidential Consumer Panel interview (preferably during a lunch).Ensures the grantees necessary staff and subcontractors (if applicable) are available for interviews during the site visit.

The Team Leader os 5/8/1433Pre-Site Visit ActivitiesRole of Team MembersResponsible for making personal travel arrangements with contractor.Reads the Pre-Site Visit Informational Packet.Responsible for participating on the Pre-Site Visit Conference Call. Makes him/herself directly available by phone or email to the other Consultants and to the grantees staff.5/8/1434On-Site ActivitiesRole of Project OfficerThe Project Officer ensures that the grantees feels at ease but still maintains role as Site Visit Leader5/8/1435On-Site ActivitiesRole of Project Officer (cont)Periodically throughout the day the PO will check in to determine how it is going and provide guidance as the needs arises. 5/8/1436On-Site ActivitiesRole of Team LeaderTeam Leaders also play an essential role in the onsite activities. 5/8/1437On-Site ActivitiesRole of Team Leader (cont)5/8/1438On-Site ActivitiesRole of Team MembersParticipates in the following meetings: Entrance Conference, Consumer Panel, Pre-Exit and/or Exit Conference.Efficiently conducts review of materials and staff interviews.Checks-in with the Project Officer and Team Leader on a regular basis.Is fully prepared to make their remarks at the Pre-Exit and/or Exit Conference.

An essential part of the team is the team member, he/she should be just as knowledgeable as the Team Leader. 5/8/1439Post-Site Visit ActivitiesRole of Team MembersSubmit written report to Team Leader within one week of completion of site visit.Provide any clarification or edits as requested.

The site visit is over. Now what? All team members must submit their written report within one week to the Teal Leader. If you were previously our consultant, you will note that the time period has changed. Please ensure that you adhere to the one work week time frame. 5/8/1440Post-Site Visit ActivitiesRole of Team LeaderCompiles and submits final Site Visit Report within two weeks of completion of site visit.Contacts Team Members for edits requested by Project Officer.

Again, please note the new time frame for completion of site visit report. 5/8/1441Post-Site Visit ActivitiesRole of Project OfficerReviews and provides feedback to Team Leader on Site Visit Report.Assures the completion and release of the Site Visit Report to the grantee within four weeks of the conclusion of the site visit. Monitors completion of grantees Corrective Action Plan and provides technical assistance when necessary.

5/8/1442Contractor and Project Officers RolesThe Contractor is responsible for issuing all reimbursement for consultants out of pocket expenses and honorariums for site visits. Honorariums are issued by the contractor upon final approval of the Site Visit Report by the Project Officer. All communication concerning consultant reimbursement should be sent to the Contractor.

Team Member Professional Standards5/8/1444Confidentiality CONFIDENTIALITY: As a Consultant, you must fully understand the confidential nature of the site visit discussions related thereto and agree:

(1) to return all copies of review-related materials; (2) to erase all electronic review-related materials; (3) not to discuss these materials or the site visit review proceedings with any individual except the staff of Health Resources and Services Administration (HRSA) and Grants Management Officials; and (4) to refer all inquiries made concerning any aspect of the review proceedings to the HRSA Project Officer in charge of the review. 5/8/1445Team Member Professional StandardsMaintain utmost degree of professionalism at all times.Strike a balance in decorum. Avoid opposite extremes - being condescending or being overly-friendly.Avoid expressing personal opinions on the policies and procedures of DHHS, HRSA, or HAB. Avoid personal biases (Thats not how WE do it at OUR clinic.)

5/8/1446Refrain from conducting personal business on Federal time.Avoid even the slightest PERCEPTION of a Conflict of Interest.Never market personal consulting services or products (e.g. books you have authored, etc.). Team Member Professional Standards5/8/1447Refrain from accepting significant gifts, meals, drinks, etc. from grantees. Items of nominal value (e.g. t-shirt, pens, button, coffee mug, etc.) are permissible.

If the Consumer Panel is during lunch (optimal), the Team Members are expected to contribute their portion of the cost of the meal.

Team Member Professional Standards5/8/1448Be respectful of the time and availability of the grantees staff, consumers, Board Members, and subcontractors. Be thorough in your review with as little disruption of the grantees workplace as possible.Be respectful of your fellow Team Members time and efforts. Be fully prepared for Pre-Exit and Exit Conferences.Be respectful of the grantees organizational culture! Frame your closing remarks to be sensitive to the culture of the grantee.Team Member Professional Standards5/8/1449Site Visit Assessment Tool 5/8/1450Site Visit Assessment Tool

Whats New?Name Site Visit Assessment Tool Core Site Visit Requirements At A GlanceIntroduction pageMission, Vision, and respective websitesReason to familiarize the Consultant with our services and brand

Whats New?: The Name- Site Visit Assessment Tool

Reason - to relay the message to the reader that this tool is a guide and not an inventory

Core Site Visit Requirements At A Glance

Introduction pageReason to provide an explanation of how the tool is organized and the use of the tooReason to have one location for the consultant to review and easily reference the requirements, authority, and respective page number

5/8/1451Site Visit Assessment Tool

Whats Old?Whats New?Site Visit Categories4 Administrative5 Fiscal8 ClinicalSite Visit RequirementsWe have identified a separate authority and resource for each requirement for a total of:4 Administrative4 Fiscal4 Clinical

MIS included as a separate category at the end of each module

MIS we have integrated MIS into all requirements

Improvement options

All improvement options were removed.Reason to place focus on legislative authorities and essential elements versus citing grantees for trivial issues. This approach will lead to a more streamlined report and concise corrective action plan.

Site Visit Assessment Tool

Whats Old?Whats New?Fiscal reference toolsA separate document that will accompany the Site Visit Assessment Tool with reference material. Resources added below each requirement.Reason to assist Consultants in identifying materials for reviewNo sub-categoriesSub-categories added under each requirementReason for relative ease in reviewing the tool by grouping similar subject matterFindings potential for numerous findingsConsultants will identify findings based on 12 requirements. Each finding will not be addressed individually within the report. Reason provide a more tailored approach to the exit conference, report, and corrective action plan. Project Officer can provide more targeted TA based on respective requirement. 5/8/1453Core Site Visit Requirements At A GlanceSection I: Administrative1Administrative Structure and ManagementGrantee maintains a fully staffed management and clinical team as appropriate for the size and needs of the program. The organization has established appropriate oversight and authority over all aspects of the program. Sections 2601-2692 of title XXVI of the PHS Act; 42 USC 300ff-11, 300ff-111; 45 CFR 74; 45 CFR 92; 2 CFR 215; HHS Grants Policy Statement (2007); HAB Policy Notice 11-022Data ReportingGrantee has systems which accurately collect and organize data for program reporting and which support management decision making. Section 2664 (a), Section 2671 (c), and Section 2691 (b) of title XXVI of the PHS Act; 42 USC 300ff-64, 300ff-71, and 300ff-101; FOA

3System CoordinationGrantee makes efforts to establish and maintain collaborative relationships with medical and support providers.Section 2651 (e) and Section 2671 (c) of title XXVI of the PHS Act; 42 USC 300ff-51 and 300ff-71; HAB Policy Notice 12-01

4Accessibility, Confidentiality, and Cultural CompetencyGrantee has policies and procedures that address HIV/AIDS related confidentiality and program processes that include limiting access to passwords, electronic files, medical records, faxes and release of client information. Grantee adheres to accessibility and National Standards on Culturally and Linguistically Appropriate Services (CLAS).Section 2652 (a) (2) and Section 2661 (a) of title XXVI of the PHS Act; PL104-191 HIPPAA; CLAS Standards

1) What role is the Board playing in decision making?2- Is the EMR or other database used to inform programming?

3) Are you noting continuum of care?

4) Is the grantee providing culturally competent services5/8/1454Core Site Visit Requirements At A GlancecontinuedSection II: Clinical5HIV Counseling, Testing, Referral, and Patient EnrollmentGrantee maintains formal linkages to HIV Counseling, Testing, Referral, and partner counseling either on site or from other sources that are available and accessible to the targeted population(s). Section 2651 (e) (1) (A) and (B), Section 2661 (a) and (b), and Section 2662 (a) and (b) of title XXVI of the PHS Act6HIV Medical CareGrantee provides a comprehensive continuum of outpatient HIV primary care services within a targeted area that attempts to link persons with HIV disease as early in the course of infection as possible and retain them in medical care. Program must reflect a medical model of care that remains abreast of clinical advances in which providers can assess, treat, and refer patients.Section 2651 (c) (3), (e) (D) and (E) of title XXVI of the PHS Act7Other Services to Support HIV Clinical OutcomesGrantee ensures access, either directly or via referral, to oral health care, adherence counseling, outpatient mental health care and substance abuse treatment, nutritional services, and specialty medical care. Formal arrangements such as contracts or memoranda of agreements are established with appropriate providers as applicable. Section 2651 (c) (3), (d) of title XXVI of the PHS Act.8Clinical Quality Management ProgramGrantee has established a clinical quality management (CQM) program that assesses the extent to which HIV health services are consistent with performance standards as defined by HHS benchmarks and quality indicators. Grantees CQM program includes an evaluation component that measures performance and continuously plans, implements, evaluates, and incorporates strategies to improve delivery of care. Section 2664 (a) (3), (g) (5) and Section 2671 (f) (2) of title XXVI of the PHS ActThis section covers the full continuum of patient care. The grantee should be able to demonstrate how services yield particular outcomes. A slide set specific to this section will immediately follow this presentation 5/8/1455Core Site Visit Requirements At A GlancecontinuedSection III: Fiscal9Ryan White Budget and Use of FundsGrant Funds are budgeted and expended for approved activities in alignment with applicable Federal legislation and program requirements.Section 2664 (g), Section 2651 and Section 2671 of title XXVI of the PHS Act; 2 CFR Parts 215, 220, 225, and 230; 45 CFR Part 92; and OMB Circular A-13310Fiscal Management and OversightGrantee maintains accounting and internal control systems appropriate to the size and complexity of the organization reflecting Generally Accepted Accounting Principles (GAAP) and separates functions appropriate to organizational size to safeguard assets, maintain financial stability, and account for the appropriate expenditure of Ryan White funds. Section 2664 (g) of title XXVI of the PHS Act; 2 CFR Parts 215, 220, 225, and 230; 45 CFR Part 92; and OMB Circular A-13311Third Party Reimbursement: Billing, Collections, and Program Income ReportingGrantee has systems in place to identify and maximize collections and reimbursement for its costs in providing health services, including written billing, credit and collection policies and procedures, and how such revenue is invested in the Ryan White funded program. Section 2652 (b) and Section 2664 of title XXVI of the PHS Act; 2 CFR 215 and 45 CFR 9212Sliding Fee Discounts and Annual Cap on ChargesGrantee has a system in place to determine eligibility for patient discounts and maintains legislative Sliding Fee Scale and Annual Cap on Charges to ensure no one is denied services based on an inability to pay. Section 2652 (b) and Section 2664 of title XXVI of the PHS Act; 2 CFR 215 and 45 CFR 92The Fiscal section is solely based on ensuring that grantees are using monies in accordance with RW legislation. A slide set specific to this section will immediately follow this presentation . 5/8/1456Snapshot of a RequirementRequirement 3: System Coordination

Authority: Section 2651 (e) and Section 2671 (c) of title XXVI of the Public Health Service Act; 42 USC 300ff-51 and 300ff-71; HAB Policy Notice 12-01

Yes/MetNoN/APartially MetNot MetResources: 1) Contracts/MOAs; 2) SOPS; and 3) EHR/EMR

ManagementDoes the program have collaborative relationships with other health care providers, other community centers, other RW providers, as well as local, state, and private organizations providing similar or complimentary services in the community?5/8/1457

Site Visit Report

5/8/1458Title XXVI of the PHS Act as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009 (Ryan White Program) Site Visit ReportGrantee Information:Grantee Name: Grant Number: Type of Visit:Comprehensive ____ Diagnostic ____ Technical Assistance____Purpose of Visit:The purpose of this site visit was to assess grantees compliance with the legislative and programmatic requirements of the Ryan White Part [C Early Intervention Services (EIS)] Program. The site visit team reviewed the clinical, fiscal, Management Information Systems (MIS), administrative and support services of the HIV program operations.[State Reason that prompted this particular site visit]Date(s) of Visit:Project Officer:Consultant(s):Overview of Grantee Organization: Include brief summary of organizations model of care, hours of operations, services provided, client demographics, third party payors, summary of chart audit review, and consumer panel.

As previously mentioned, the Site Visit Report template has been simplified to include only information respective to the grant requirements. The information is self explanatory and should be taken from information you have obtained during the site visit. 5/8/1459

Defining Use of Met / Partially Met / Not Met

So let us define Met, Partially Met and Not Met. Read Slide5/8/1460Site Visit Report Sample of a Requirement

Section I. Administrative3. System Coordination: Grantee makes efforts to establish and maintain collaborative relationships with medical and support providers.Authority: Section 2651 (e), and Section 2671 (c) of title XXVI of the Public Health Service (PHS) Act; 42 USC 300ff-51 and 300ff-71; HAB Policy Notice 12-01Met/ Partially Met/Not Met: Finding(s): Recommendations: Reminder: If the section is met, you do not have to list any findings or identify and recommendations5/8/1461Tips for Writing a Concise and Comprehensive Site Visit Report Limit overview to one page (Refer to Site Visit Report for an example)Limit total pages to 10. If a Requirement is not met or partially met provide a short description of finding(s) and recommendation(s).Only include findings related to the Requirements.

KISS- Keep it short and simple. Please make certain to review for grammatical errors and typos.5/8/1462Remember to:5/8/1463Questions should be emailed to David Pitman at DPitman@hrsa.gov

This concludes the first portion of todays webinar. We would like to remind you that due to the fact that the webinar will be taped for future reference, all questions should be emailed to David Pitman at DPitman@hrsa.gov. We will respond to your question by email. A summary of frequently asked questions from the initial webinars will also be posted on the Target Center website within the next 10 business days. At this time I would like to turn the presentation over to Stephanie Bogan. 5/8/1464FY 2013 Fiscal Requirements

Part C HIV Early Intervention Services (EIS)

Part D Grants for Coordinated HIV Services and Access to Research for Women, Infants, Children, and Youth (WICY)

Part F Dental

Presented by: Department of Health and Human ServicesHealth Resources and Services AdministrationHIV/AIDS BureauDivision of Community HIV/AIDS Programs

Webinar GoalTo ensure Consultants and Project Officers are equipped to effectively assess and report on Ryan White HIV/AIDS Program Part C, D, and F Dental grantees provision of comprehensive, high quality healthcare for people living with HIV/AIDS in compliance with the legislative and programmatic requirements supportive of the National HIV/AIDS Strategy.

5/8/1466Learning Objectives67Webinar OutlineApplicable Laws and Regulations

Fiscal Module:RequirementsExpectationsResourcesSample Findings

Next Steps

Questions and Answers

68Applicable Laws and RegulationsAuthorizing Legislation:Sections 2651 through 2693 of the Public Health Service (PHS) Act (42 USC 300ff -51), as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009 (P.L. 111-87)

Appropriations Act:Consolidated Appropriations Act, 2012 (P.L. 112-74)

69Federal Regulations:

45 CFR Part 92 Uniform Administrative Requirements for Grants and Cooperative Agreements to State, Local, and Tribal Governments2 CFR Part 215 Uniform Administrative Requirements for Grants and Cooperative Agreements to Institutions of Higher Education, Hospitals, and other Non-Profit Organizations2 CFR Part 220 Cost Principles for Educational Institutions2 CFR Part 225 Cost Principles for State, Local, and Indian Tribal Governments

2 CFR Part 230 Cost Principles for Non-Profit Organizations

OMB Circular A-133: Audits of States, Local Governments, and Non-Profit Organizations

Applicable Laws and Regulations70Fiscal Module

71Ryan White Budget and Use of Funds(Requirement 9)RequirementResourcesGrant funds are budgeted and expended for approved activities in alignment with applicable Federal legislation and program requirements. Notice of Grant AwardAnnual Budget Most Recent RSRContracts Time and Effort Documentation Invoices and Payments Staff Interviews72Part C Cost Categories Early Intervention Services (at least 50%)

Core Medical Services (at least 75%)

Support Services

Clinical Quality Management (CQM)

Administrative Costs (not to exceed10%)

Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87,October 30,2009), 2651(b)(2)-(c)(1) Part C Sample Line-Item Budget

50%PayrollPurchasingAccounts Payable10%75% (less Admin & CQM)Part D Cost CategoriesMedical ServicesSupport Services Clinical Quality Management (CQM) Administrative Costs (not to exceed 10%, including indirect costs)

Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87,October 30,2009), 2671(f)(1)

Part D Sample Line Item BudgetLine ItemAnnual SalaryProgram FTEsProgram Salary SubtotalMedical ServicesCQMSupport ServicesAdministrativeProgram TOTALPersonnel, Name & PositionSalaryFTESubtotalFringe benefit rateTotal PersonnelTravelTotal TravelSuppliesTotal SuppliesContractualTotal ContractualOtherTotal OtherTotal Direct CostsIndirect CostsGRAND TOTAL% budgeted by cost category%10.0% cap10%Included in 10% administration76Part F Dental Cost Categories(Community Based Dental Partnership Program)Dental Costs

Program Costs

Clinical Quality Management (CQM) Costs

Administrative Costs (must be reasonable, there is no 10% limitation)

Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87,October 30,2009), 2692(b)Grantee:Budget Period: Line ItemSalaryFTEDentalCosts ProgramCostsCQMCostsAdministrationCostsProgram TOTALPersonnel$0$0Subtotal Salaries$0Fringe Benefit Rate$0Subtotal Personnel$0TravelMileage (local & statewide)$0All Grantee meetingsNational Meetings$0Total Travel$0Equipment$0Total Equipment$0SuppliesDental$0Office$0Total Supplies$0Contractual$0Total Contractual$0Other$0$0Total Other$0Total Direct Costs$0Indirect Expenses**Total Requested Grant FundsPart F Dental Sample Line Item Budget78Administrative Expenses: Ryan White Part C, D, and F DentalAuditsPayroll/accounting services

Clerical Support/Receptionist Rent, utilities, and other facility support costsComputer hardware and softwareEMR/EHRIndirect costs (with approved Federally negotiated indirect cost rate )* PostageLiability insuranceTelephoneProgram Coordination Office suppliesPersonnel CostsClinic Receptionist79Unallowable Costs: Ryan White Part C, D, and F Dental

Services must be consistent with HAB Policy Notice 10-02http://hab.hrsa.gov/manageyourgrant/pinspals/eligible1002.html

Salary Limitation: Ryan White Part C, D, and F Dental Consolidated Appropriations Act, 2012 (P.L. 112-74)

81Example: Salary limitationIndividuals full time salary: $350,000

A

Amount that may be claimed on the Federal grantIndividuals base full time salary adjusted to Executive Level II: $179,700

50% of time will be devoted to projectDirect salary: $175,000Fringe (25% of salary): $43,750Total: $218,75050% of time will be devoted to projectDirect salary: $89,850Fringe (25% of salary): $22,462.50Total: $112,312.5082Grantee subcontracts with nephrologist for half day clinic at $100/hr. Does this subcontract meet FY2012 salary limitations? No, the salary limitation applies to subcontractors and less than full time salaries.

The hourly equivalent of the salary limitation is $86/hr. Draw Downs84Unobligated BalanceUnobligated Balance (UoB)- portion of the authorized financial assistance not obligated by the recipient during the budget period.

Carryover unobligated balance remaining at the end of one budget period approved for expenditure in the next successive budget period.

Additive UoB awarded in addition to the full amount otherwise approved for the non-competing continuation award for the budget period into which the funds are carried. Offset UoB awarded as part of the full amount otherwise approved for the non-competing continuation award for the budget period into which the funds are carried. 85Sub-Contracts Procurement Process

Contractual Agreements

Payment Protocols

Monitoring Standards

86Sample Unmet Findings Requirement 9Grantee expenditures are not aligned with the approved budget.

Grantee is not able to provide supporting documentation for draw down requests.

Grantee does not document subcontractor monitoring efforts. Fiscal Management and Oversight(Requirement 10)RequirementResourcesGrantee maintains accounting and internal control systems appropriate to the size and complexity of the organization reflecting Generally Accepted Accounting Principles (GAAP) and separates functions appropriate to organizational size to safeguard assets, maintain financial stability, and account for the appropriate expenditure of Ryan White funds. Most recent independent financial audit and management letter, including Audit Corrective Action plans based on prior year audit findings, if applicable;For New Starts: Most recent monthly financial statements if a first audit has not been completed; Financial Management/Accounting and Internal Control Policies and Procedures; OMB Circular A-13388Internal Controls89Auditing Standards A-133 Important to Note! If the audit report includes a going concern comment, the project officer is to be informed immediately. The fiscal report should include recommendation that the grantee address the matter through a recovery plan and provide regular status reports to the project officer. 90Reporting RequirementsReportDue DateAllocation Report60 days after budget start periodExpenditure Report 120 days after end of budget periodFederal Financial Report120 days after end of budget periodRyan White Services ReportAnnually in MarchReportDue DateFederal Financial Report120 days after end of grant periodRyan White Dental Services ReportAnnually in AprilParts C and DPart F Dental 91Sample Unmet Findings Requirement 10Workload reports are not consistent with the allocation of employee time and effort.

Grantee does not have fiscal policies and procedures in place.

Grantee does not have an adequate system for managing multiple budget streams.

Third Party Reimbursement: Billing Collections and Program Income Reporting(Requirement 11)RequirementResourcesGrantee has systems in place to identify and maximize collections and reimbursement for its costs in providing health services, including written billing, credit and collection policies and procedures and how such revenue is invested in the Ryan White funded programPolicies and Procedures for Credit, Collection, and BillingEncounter FormsMost Recent Income Statements 93Third Party BillingPart C funds will not be used for any service which payment has been or can reasonably expected to be made under any state compensation program, under an insurance policy, under any Federal or state health benefits program, except Indian Health Service, or on a pre-paid basis.

Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87,October 30,2009), 2654 (f)

NoteCollections95Third Party Reimbursement Program Income ReportingProgram income DefinitionTrackingUse and Reporting Must bill third party payors if the service is billableMust be Medicaid providerMaximizing program incomeFee for ServiceManaged CarePharmacy 96Sample Unmet Findings for Requirement 11Grantee does not have a system in place to track program income or report how the revenue is expended.

Clients are not routinely screened for eligibility for Medicaid, Medicare, and other third party coverage.

The sliding fee discount is not based on the most recent Federal Poverty Guidelines.

Sliding Fee Discounts and Annual Cap on Charges(Requirement 12)RequirementResourcesGrantee has a system in place to determine eligibility for patient discounts and maintains legislative Sliding Fee Scale and Annual Cap on Charges. Schedule of FeesSliding Fee Discount ScheduleImplementing Policies and Procedures for Sliding Fee Discount Schedule and Annual Cap on ChargesSliding Fee Signage and/or Notification MethodsMost Recent Federal Poverty Guidelines98Sliding Fee DiscountsDoes the grantee or sub-grantee have a Charge Master?Does it offer a discount on charges based on individual or household income? Is there a policy for determining eligibility? What is the procedure for determining patient eligibility?Does the grantee make reasonable efforts to collect?Does the grantee have appropriate procedures for handling delinquent accounts?

Must be based on latest FPL - http://aspe.hhs.gov/poverty/index.cfm 99Limitation ChargesCap on ChargesUnderstand that the obligation also applies to subcontractors

Highlight that the intent of the Cap is to protect patients

Responsibility of the client and recipient to track chargesCap on Charges and Sliding Fee Scale are separate requirementsCap is unique to Ryan White & under federal guidelinesFee Scale is more flexibleMust have both to be in compliance100Cap on Charges Individual IncomeMaximum ChargeAt or below 100% of federal poverty level (FPL)0101% to 200% of FPLNo more than 5% of gross annual income201% to 300% FPLNo more than 7% of gross annual income>300% FPLNo more than 10% of gross annual income101Sample Unmet Findings for Requirement 12The grantee does not have a schedule of customary charges that is available to the public.

Grantee does not track or monitor limitations on charges (Part C).

Grantee does not have a policy for determining eligibility for sliding fee discounts.

Questions should be emailed to David Pitman at DPitman@hrsa.gov

Please email all questions to David Pitman at DPitman@hrsa.gov. We will respond to your question by email. A summary of frequently asked questions from the initial webinars will also be posted on the Target Center website within the next 10 business days. 5/8/14103Next StepsPlease note that successful completion of this webinar is one qualifying component for selection as a HRSA/DCHAP Site Visit Consultant.

1) Within two business days, an email will be sent to all participants that willinclude a Consultant Questionnaire and a Post Test Exam.

Please return a signed scanned copy of the completed Post Test Exam and Questionnaire along with a current resume/CV to David Pitman at DPitman@hrsa.gov within two business days of receipt of the email... We would like to remind participants that if you would like to view the webinar again at a later date, it will be available on the Target Center website within 5 business days. 5/8/14104

Thank you for participating in todays webinar. 5/8/14105Contact InformationKaren Gooden, Co-Chair DCHAP Site Visit Workgroupkgooden@hrsa.gov

Sandra Lloyd, Co-Chair DCHAP Site Visit Workgroupslloyd@hrsa.gov

John Fanning, DCHAP Senior Policy Advisorjfanning@hrsa.govHHS/HRSA/HAB/DCHAP301-443-0493

5/8/14106