OPPHRSA-19-033-CFDA93.914-CIDHRSA-19-033-INSTRUCTIONS.PDF

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
HIV/AIDS Bureau
Division of Metropolitan HIV/AIDS Programs
Ryan White HIV/AIDS Program Part A
HIV Emergency Relief Grant Program
Funding Opportunity Number: HRSA-19-033
Funding Opportunity Type(s): Competing Continuation
Catalog of Federal Domestic Assistance (CFDA) Number: 93.914
NOTICE OF FUNDING OPPORTUNITY
Fiscal Year 2019
Application Due Date: September 21, 2018
Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!
Deadline extensions are not granted for lack of registration.
Registration in all systems, including SAM.gov and Grants.gov,
may take up to one month to complete.
Issuance Date: May 30, 2018
Steven R. Young, MSPH
Director, Division of Metropolitan HIV/AIDS Programs
Telephone: (301) 443-9091
Fax: (301) 443-5271
Email: SYoung@hrsa.gov
Authority: Public Health Service Act, Sections 2601-2610, and 2693 (42 USC 300ff-11 – 300ff-20, and
300ff-121), as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law
111-87)

EXECUTIVE SUMMARY
The Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB),
Division of Metropolitan HIV/AIDS Programs (DMHAP) is accepting applications for
fiscal year (FY) 2019 Ryan White HIV/AIDS Program (RWHAP) Part A HIV Emergency
Relief Grant Program. The purpose of this program is to provide direct financial
assistance to an Eligible Metropolitan Area (EMA) or a Transitional Grant Area (TGA)
that has been severely affected by the HIV epidemic. This competition is open only to
Part A jurisdictions to provide RWHAP services in the geographic service areas
described in Appendix B.
Eligible jurisdictions may apply for an amount up to the defined funding ceiling listed in
Appendix B, which represents a level five percent above the final FY 2018 award.
Funding Opportunity Title: Ryan White HIV/AIDS Program Part A
HIV Emergency Relief Grant Program
Funding Opportunity Number: HRSA-19-033
Due Date for Applications: September 21, 2018
Anticipated Total Annual Available $618,140,400, of which approximately
FY 2019 Funding: $10,098,500 will be used for priority
funding, and $50,992,100 will be
available for MAI funding.*
Estimated Number and Type of Award(s): Up to 52 grants
Estimated Award Amount: Varies, see Appendix B
Cost Sharing/Match Required: No
Project Period/Period of Performance: March 1, 2019 through February 29, 2020
(one (1) year)
Eligible Applicants: RWHAP Part A recipients that are
classified as an EMA or as a TGA and
continue to meet the eligibility criteria as
defined in the statute are eligible to apply
for these funds.
See Section III-1 of this notice of funding
opportunity (NOFO), formerly known as
the funding opportunity announcement
(FOA), for complete eligibility information.
*Estimated annual available funding level based on current projections.
Application Guide
You (the applicant organization/agency) are responsible for reading and complying with
the instructions included in HRSA’s SF-424 Application Guide, available online at
http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf, except where
HRSA-19-033 i

instructed in this NOFO to do otherwise. A short video explaining the Application Guide
is available at http://www.hrsa.gov/grants/apply/applicationguide/.
Technical Assistance
All interested applicants are encouraged to participate in a technical assistance
(TA) webinar for this funding opportunity. The purpose of this webinar is to assist
potential applicants in preparing applications that address the requirements of this
funding notice. Participation in the pre-application TA webinar is optional.
HRSA has scheduled the following technical assistance webinar:
Day and Date: Thursday, July 19, 2018
Time: 2 – 4 p.m. ET
Call-In Number: 1-888-396-9925
Participant Code: 1527602#
Weblink: https://hrsa.connectsolutions.com/ryanwhite_parta_fy19/
Playback: Webinar will be available on the TARGET Center website.
HRSA-19-033 ii

Table of Contents
I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION ........................................................ 1
1. PURPOSE .......................................................................................................................... 1
2. BACKGROUND ................................................................................................................... 3
II. AWARD INFORMATION ...................................................................................................... 6
1. TYPE OF APPLICATION AND AWARD .................................................................................... 6
2. SUMMARY OF FUNDING ...................................................................................................... 6
III. ELIGIBILITY INFORMATION .............................................................................................. 7
1. ELIGIBLE APPLICANTS ....................................................................................................... 7
2. COST SHARING/MATCHING ................................................................................................. 8
3. OTHER .............................................................................................................................. 8
IV. APPLICATION AND SUBMISSION INFORMATION........................................................... 9
1. ADDRESS TO REQUEST APPLICATION PACKAGE .................................................................. 9
2. CONTENT AND FORM OF APPLICATION SUBMISSION ............................................................ 9
i. Project Abstract .................................................................................................... 10
ii. Project Narrative ................................................................................................... 10
iii. Budget ................................................................................................................... 25
iv. Budget Narrative ................................................................................................... 26
See Section 4.1.v. of HRSA’s SF-424 Application Guide. Note: The Budget
Narrative/Justification required for this application should be uploaded under Budget
Narrative in grants.gov. .................................................................................................. 26
v. Attachments .......................................................................................................... 29
3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER AND
SYSTEM FOR AWARD MANAGEMENT ...................................................................................... 31
4. SUBMISSION DATES AND TIMES ........................................................................................ 32
5. INTERGOVERNMENTAL REVIEW ......................................................................................... 32
6. FUNDING RESTRICTIONS .................................................................................................. 32
V. APPLICATION REVIEW INFORMATION........................................................................... 34
1. REVIEW CRITERIA ............................................................................................................ 34
2. REVIEW AND SELECTION PROCESS ................................................................................... 38
3. ASSESSMENT OF RISK AND OTHER PRE-AWARD ACTIVITIES .............................................. 39
4. ANTICIPATED ANNOUNCEMENT AND AWARD DATES .......................................................... 39
VI. AWARD ADMINISTRATION INFORMATION ................................................................... 39
1. AWARD NOTICES ............................................................................................................. 40
2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS .................................................. 40
3. REPORTING ..................................................................................................................... 40
VII. AGENCY CONTACTS ...................................................................................................... 41
VIII. OTHER INFORMATION .................................................................................................. 42
APPENDIX A ........................................................................................................................... 43
APPENDIX B ........................................................................................................................... 46
HRSA-19-033 iii

I. Program Funding Opportunity Description
1. Purpose
This notice solicits applications for the Ryan White HIV/AIDS Program (RWHAP) Part
A HIV Emergency Relief Grant Program. The purpose of this program is to provide
direct financial assistance to an eligible metropolitan area (EMA) or a transitional grant
area (TGA) that has been severely affected by the HIV epidemic. Grant funds assist
eligible jurisdictions to develop or enhance access to a comprehensive continuum of
high quality, community-based care for low-income people living with HIV (PLWH)
through the provision of formula, supplemental, and Minority AIDS Initiative (MAI)
funds.
RWHAP Part A recipients must provide comprehensive primary health care and support
services throughout the entire designated geographic service area. The goal is to
provide optimal HIV care and treatment for low-income, uninsured, and underserved
PLWH to improve their health outcomes. Your application must address the entire
service area, as defined in Appendix B.
Comprehensive HIV care consists of core medical services and support services that
enable PLWH and those affected by HIV to access and remain in HIV primary medical
care to improve their medical outcomes. Based on an annual assessment of the
services and gaps in the HIV care continuum within a jurisdiction, HIV Planning
Councils/Planning Bodies (PC/PB) and recipients identify specific service categories to
fund. Funded service categories should facilitate improvements at specific stages of
the HIV care continuum.
RWHAP Part A EMAs and TGAs must use grant funds to support, further develop,
and/or expand systems of care to meet the needs of low income PLWH within the
EMA/TGA and strengthen strategies to reach disproportionately impacted
subpopulations. The Health Resources and Services Administration (HRSA)
HIV/AIDS Bureau (HAB) requires EMAs/TGAs to collect data to identify need, set
priorities, make allocations, and validate the use of RWHAP funding. A
comprehensive application should reflect how you have used those data to develop
and expand the system of care in EMA/TGA jurisdictions. HRSA encourages
innovation and collaboration with other agencies and organizations to maximize impact
on health outcomes and effectively meet the needs of PLWH within the EMA/TGA.
Important Notes:
• Budget: HAB has updated the budget section. You must submit a detailed
budget narrative/justification as part of the application. You may apply for no
more than the published ceiling amount in Appendix B. Please note that your
application budget that is approved, or subsequently amended during the
award process, will be your approved budget for the 2019 period of
performance. HAB no longer requires you to provide a revised budget with the
Program Submission reporting requirement.
HRSA-19-033 1

• Work Plan: HAB has updated the Work Plan requirements. You are required
to submit an HIV Care Continuum Table, Service Category Plan Table, and
narratives with this NOFO. You will not submit the Implementation Plan Table
as part of your application or as a component of your Program Submission
reporting requirement.
• Unmet Need: HAB has integrated the Unmet Need requirement in this NOFO
into the Demonstrated Need section. New estimates for unmet need should not
be submitted with this application. Please review carefully when preparing this
section of your application.
The following information will assist you in understanding and completing your FY
2019 application:
• Policy Clarification Notices: Information on the RWHAP and HAB Policy
Clarification Notices (PCN) are available online at
http://hab.hrsa.gov/manageyourgrant/policiesletters.html.
• Allowable Services and Service Category Definitions: Core medical
services are listed in Section 2604(c)(3) of the Public Health Service (PHS)
Act. Support services allowed under RWHAP Part A are limited to services
that are needed for PLWH to achieve their medical outcomes, as defined by
RWHAP. The service definitions effective for awards issued on or after
October 1, 2016 are listed in PCN 16-02 Ryan White HIV/AIDS Program
Services: Eligible Individuals and Allowable Uses of Funds.
• Core Medical Services Waiver: RWHAP Part A funds are subject to Section
2604(c) of the PHS Act, which requires that not less than 75 percent of the
funds remaining after reserving funds for administration and Clinical Quality
Management (CQM) be used to provide core medical services. Applicants may
seek a waiver of the core medical services requirement; a waiver request must
be submitted prior to submission of the grant application, with this application, or
up to four (4) months after the budget period start date. Submission should be
in accordance with the PCN 13-07 Uniform Standard for Waiver of Core Medical
Services Requirement for Grantees Under Parts A, B, and C. You can find
sample letters to fulfill the requirements of the Core Medical Services Waiver at
https://hab.hrsa.gov/sites/default/files/hab/Global/samplereqwaiverletters.pdf.
In addition, your RWHAP Part A core medical services waiver request
must include funds awarded under MAI. HAB will not consider a waiver
request that does not include MAI funds. If submitting with the
application, a core medical services waiver request should be included
as Attachment 9. The waiver request does count toward the 100-page
limit.
• Agreements and Compliance Assurances: The agreements and assurances,
found in Appendix A of this NOFO, require the signature of the chief elected
official (CEO), or the CEO’s designee. Include this document as Attachment 2.
HRSA-19-033 2

2. Background
This program is authorized by the PHS Act, Sections 2601-2610, and 2693 (42 USC
300ff-11– 300ff-20, and 300ff-121), as amended by the Ryan White HIV/AIDS Treatment
Extension Act of 2009 (Public Law 111-87). Fifty-two (52) eligible metropolitan
jurisdictions receive Part A formula, supplemental, and MAI funding through this
program.
The Centers for Disease Control and Prevention (CDC) estimated in 2015 that more
than 1.2 million people were living with HIV in the United States (U.S.) and one (1) in
seven (7) (14 percent) are not aware of their HIV status. The ultimate goal in the U.S.
is to inform all people who test positive for HIV of their status and bring them into care
to improve their health status, prolong their lives, and slow the spread of HIV to end
the epidemic in the U.S.
Goals to End the HIV Epidemic
The RWHAP promotes robust advances and innovations in HIV health care using
national goals to end the epidemic as its framework. Therefore, activities funded by
RWHAP focus on addressing these four goals:
1) Reduce new HIV infections;
2) Increase access to care and improve health outcomes for PLWH;
3) Reduce HIV-related health disparities and health inequities; and
4) Achieve a more coordinated national response.
To achieve these shared goals, recipients should align their organization’s efforts, within
the parameters of the RWHAP statute and program guidance, to ensure that PLWH are
linked to and retained in care, and have timely access to HIV treatment and the
supports needed (e.g., mental health and substance use disorder services) to achieve
HIV viral suppression.
HIV Care Continuum
Diagnosing PLWH, linking PLWH to HIV primary care, and PLWH achieving viral
suppression are important public health steps toward ending the HIV epidemic in the
U.S. The HIV care continuum has five main “steps” or stages that include: HIV
diagnosis, linkage to care, retention in care, antiretroviral use, and viral suppression.
The HIV care continuum provides a framework that depicts the series of stages a
person with HIV engages in from initial diagnosis through their successful treatment with
HIV medication. It shows the proportion of individuals living with HIV or individuals
diagnosed with HIV who are engaged at each stage. The HIV care continuum allows
recipients and planning groups to measure progress and to direct HIV resources most
effectively.
According to recent data from the 2016 Ryan White Services Report (RSR), the
RWHAP has made tremendous progress toward ending the HIV epidemic in the U. S.
From 2010 to 2016, HIV viral suppression among RWHAP patients who have had one
or more medical visits during the calendar year and at least one viral load with a result
of <200 copies/mL reported, has increased from 69.5 percent to 84.9 percent, and
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racial/ethnic, age-based, and regional disparities have decreased.1 These improved
outcomes mean more PLWH in the U.S. will live near normal lifespans and have a
reduced risk of transmitting HIV to others.2 In a September 27, 2017, Dear Colleague
letter, CDC notes that scientific advances have shown that antiretroviral therapy (ART)
preserves the health of PLWH. There is also strong evidence of the prevention
effectiveness of ART. When ART results in viral suppression, it prevents sexual HIV
transmission. This means that people who take ART daily as prescribed and achieve
and maintain an undetectable viral load have effectively no risk of sexually transmitting
the virus to an HIV-negative partner. Such findings underscore the importance of
supporting effective interventions for linking PLWH into care, retaining them in care, and
helping them adhere to their ART.
RWHAP recipients are encouraged to assess the outcomes of their programs along this
continuum of care. Recipients should work with their community and public health
partners to improve outcomes across the HIV care continuum. HRSA encourages
recipients to use the performance measures developed for the RWHAP at their local
level to assess the efficacy of their programs and to analyze and improve the gaps
along the HIV care continuum.
Minority AIDS Initiative
The purpose of the RWHAP Part A MAI is to “improve HIV-related health outcomes to
reduce existing racial and ethnic health disparities” (Section 2693 of the PHS Act). It is
intended to address the disproportionate impact of HIV and to address the disparities in
access, treatment, care, and outcomes for racial and ethnic minorities, including
Black/African Americans, Alaska Natives, Hispanic/Latinos, American Indians, Asian
Americans, Native Hawaiians, and Pacific Islanders.
As such, MAI funds provide direct financial assistance to RWHAP Part A recipients to
develop or enhance access to high quality, community-based HIV core medical and
support services for low-income minority PLWH and their families. You may target MAI
funds to any new/emerging racial/ethnic minority populations identified in this
application.
Clinical Quality Management
Section 2618(b)(E) of the PHS Act requires recipients to establish a clinical quality
management program to:
• Assess the extent to which HIV health services provided to clients under the
grant are consistent with the most recent PHS guidelines (otherwise known
as the HHS Guidelines), for the treatment of HIV disease and related
opportunistic infections; and
1 Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level
Data Report 2016. http://hab.hrsa.gov/data/data-reports. Published December 2017. Accessed December
1, 2017.
2 National Institute of Allergy and Infectious Disease (NIAID). Preventing Sexual Transmission of HIV with
Anti-HIV Drugs. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000-
[cited 2016 Mar 29]. Available from: https://clinicaltrials.gov/ NCT00074581 NLM Identifier:
NCT00074581.
HRSA-19-033 4

• Develop strategies for ensuring that such services are consistent with the
guidelines for improvement in the access to and quality of HIV services.
Please see PCN 15-02 Clinical Quality Management and the accompanying FAQs for
additional information.
Integrated Data Sharing and Use
HRSA and CDC’s Division of HIV/AIDS Prevention support integrated data sharing,
analysis, and utilization for the purposes of program planning, needs assessments,
unmet need estimates, reporting, quality improvement, the development of your HIV
care continuum, and public health action. HRSA strongly encourages RWHAP Part A
recipients to follow the principles and standards in the Data Security and
Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease, and
Tuberculosis Programs: Standards to Facilitate Sharing and Use of Surveillance Data
for Public Health Action. HRSA strongly encourages establishing data sharing
agreements between surveillance and HIV programs to ensure clarity about the
process and purpose of the data sharing and utilization. Integrated HIV data sharing,
analysis, and utilization approaches by state and territorial health departments can
help further progress toward reaching the national goals to end the HIV epidemic and
improve outcomes on the HIV care continuum.
To fully benefit from integrated data sharing, analysis, and utilization, HRSA strongly
encourages complete CD4/viral load (VL) reporting to the state and territorial health
departments’ surveillance systems. CD4 and VL data can be used to identify cases,
classify stage of disease at diagnosis, and monitor disease progression. These data
can also be used to evaluate HIV testing and prevention efforts, determine entry into
care and retention in care, measure viral suppression, and assess unmet health care
needs. Analyses at the national level to monitor progress against HIV can only occur if
all HIV-related CD4 and VL test results are reported by all jurisdictions. CDC
recommends the reporting of all HIV-related CD4 results (counts and percentages) and
all VL results (undetectable and specific values). Where laws, regulations, or policies
are not aligned with these recommendations, states/territories might consider
strategies to best implement these recommendations within current parameters or
consider steps to resolve conflicts with these recommendations. In addition, consider
reporting HIV-1 nucleotide sequences from genotypic resistance testing to monitor
prevalence of antiretroviral drug resistance and HIV genetic diversity subtypes and
transmission patterns.
Special Projects of National Significance (SPNS) Program
Through its SPNS Program, HRSA’s HAB funds demonstration project initiatives
focused on the development of effective interventions to quickly respond to emerging
needs of PLWH receiving assistance under the RWHAP. Through these demonstration
projects, SPNS evaluates the design, implementation, utilization, cost, and health
related outcomes of innovative treatment models, while promoting dissemination,
replication and uptake of successful interventions. SPNS findings have demonstrated
promising new approaches to linking and retaining into care underserved and
marginalized populations living with HIV. All RWHAP recipients are encouraged to
review and integrate a variety of SPNS evidence-informed tools within their HIV system
of care in accordance with the allowable service categories defined in PCN 16-02 Ryan
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White HIV/AIDS Program Services: Eligible Individuals and Allowable Uses of Funds as
resources permit. SPNS related tools can be found at the following locations:
• Integrating HIV Innovative Practices (IHIP) (https://careacttarget.org/ihip)
Resources on the IHIP website include easy-to-use training manuals, curricula, case
studies, pocket guides, monographs, and handbooks, as well as informational
handouts and infographics about SPNS generally. IHIP also hosts technical
assistance (TA) training webinars designed to provide a more interactive experience
with experts, and a TA help desk exists for you to submit additional questions and
share your own lessons learned.
• Replication Resources from the SPNS Systems Linkages and Access to Care
(https://careacttarget.org/library/replication-resources-spns-systems-linkages-
and-access-care)
There are Intervention Manuals for Patient Navigation, Care Coordination, State
Bridge Counselors, Data to Care, and other interventions developed for use at the
State and regional levels to address specific HIV care continuum outcomes among
hard-to-reach populations living with HIV.
• Dissemination of Evidence Informed Interventions
(https://nextlevel.careacttarget.org/)
The Dissemination of Evidence-Informed Interventions initiative runs from 2015-
2020 and disseminates four adapted linkage and retention interventions from prior
SPNS and the Secretary’s Minority AIDS Initiative Fund (SMAIF) initiatives to
improve health outcomes along the HIV care continuum. The end goal of the
initiative is to produce four evidence-informed Care And Treatment Interventions
(CATIs) that are replicable, cost-effective, capable of producing optimal HIV care
continuum outcomes, and easily adaptable to the changing healthcare environment.
Manuals are currently available at the link provided and will be updated on an
ongoing basis.
II. Award Information
1. Type of Application and Award
Type of applications sought: Competing Continuation
HRSA will provide funding in the form of a grant.
2. Summary of Funding
HRSA expects approximately $618,140,400 to be available to fund 52 recipients.
Approximately $10,098,500 will be used for priority funding, and $50,992,100 will be
available for MAI funding. You may apply for no more than the published ceiling amount
in Appendix B. HRSA established ceiling amounts based on current funding with a five
(5) percent increase to accommodate fluctuations in formula and supplemental funding.
The actual amount available will not be determined until enactment of the final FY 2019
appropriation. This program announcement is subject to the appropriation of funds, and
HRSA-19-033 6

is a contingency action taken to ensure that, should funds become available for this
purpose, HRSA can process applications and award funds in a timely manner. The
period of performance is March 1, 2019, through February 29, 2020, (one (1) year).
HRSA will send notification of awards to the CEO or to the delegated administrative
agency responsible for dispersing RWHAP Part A funds.
The RWHAP Part A provides non-discretionary formula grants that include MAI funds
and discretionary supplemental awards. These funds assist eligible areas in developing
or enhancing access to a comprehensive continuum of high quality, community-based
care for low-income PLWH within the EMA/TGA and strengthening strategies to reach
minority populations. HRSA awards two-thirds of the funds available for EMAs and
TGAs according to a formula based on the number of living cases of HIV/AIDS in the
EMAs and TGAs. HRSA awards the remaining funds as discretionary supplemental
awards based on the demonstration of additional need by the eligible EMAs and TGAs,
and as MAI funding. HRSA determines MAI awards based on the number of minorities
living with HIV and AIDS in a jurisdiction. If determined eligible for priority funding,
HRSA will calculate the additional amount awarded, and that amount will be included in
the final award.
Eligible jurisdictions may apply for an amount up to the funding ceiling listed in Appendix
B. If the RWHAP Part A award calculation results in an amount less than the budget
submitted with your application, your budget will be proportionally reduced across all
budget categories to reflect the actual award amount. If your award calculation results
in an amount greater than the budget submitted with the application, you will be
required to submit a revised budget prior to the Notice of Award (NOA) being issued.
Establishing realistic ceiling amounts ensures that there will be an approved project
budget in place at the beginning of the project period.
Please note that the U.S. Secretary of Health and Human Services (Secretary) may
reduce the amounts of grants under the RWHAP Part A to an EMA/TGA for a FY if, with
respect to such grants for the second preceding FY, the subdivision fails to prepare
audits in accordance with the procedures of Section 7502 of Title 31, United States
Code. See Section 2682(a) of the PHS Act.
All HRSA awards are subject to the Uniform Administrative Requirements, Cost
Principles and Audit Requirements in 45 CFR part 75.
Please see Policy Clarification Notice 15-01 Treatment of Costs under the 10%
Administrative Cap for Ryan White HIV/AIDS Program Parts A, B, C, and D along with
the Frequently Asked Questions for information regarding the statutory 10 percent
limitation on administrative costs.
III. Eligibility Information
1. Eligible Applicants
Eligibility for RWHAP Part A grants is based in part on the number of confirmed AIDS
cases within a statutorily specified “metropolitan area.” The Secretary uses the Office of
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Management and Budget’s (OMB) census-based definitions of a Metropolitan Statistical
Area (MSA) in determining the geographic boundaries of a RWHAP metropolitan area.
HHS utilizes the OMB geographic boundaries that were in effect when a jurisdiction was
initially funded under RWHAP Part A. For all newly eligible areas, the boundaries are
based on current OMB MSA boundary definitions.
RWHAP Part A recipients that are classified as an EMA or as a TGA and continue to
meet the status as an eligible area as defined in statute are eligible to apply for these
funds. For an EMA, this is more than 2,000 cases of AIDS reported and confirmed
during the most recent five (5) calendar years, and for a TGA, this is at least 1,000, but
fewer than 2,000 cases of AIDS reported and confirmed during the most recent five (5)
calendar years for which such data are available. In addition, for three (3) consecutive
years, recipients must not have fallen below both the required incidence levels already
specified, and required prevalence levels (cumulative total of living cases of AIDS
reported to and confirmed by the Director of CDC, as of December 31 of the most recent
calendar year for which such data are available). For an EMA, the required prevalence
is 3,000 living cases of AIDS. For a TGA, the required prevalence is 1,500 or more
living cases of AIDS. However, for a TGA with five (5) percent or less of the total
amount from grants awarded to the area under Part A unobligated, as of the end of the
most recent fiscal year, the required prevalence is at least 1,400 (and fewer than 1,500)
living cases of AIDS.
This competition is open to eligible Part A jurisdictions to provide comprehensive
primary health care and support services for low income, uninsured and underserved
PLWH in their service areas as listed in Appendix B.
2. Cost Sharing/Matching
Cost sharing/matching is not required for this program.
3. Other
HRSA will consider any application that exceeds the ceiling amount non-responsive and
will not consider it for funding under this notice.
HRSA will consider any application that fails to satisfy the deadline requirements
referenced in Section IV.4 non-responsive and will not consider it for funding under this
notice.
Maintenance of Effort – The RWHAP Part A recipient must agree to maintain
EMA/TGA political subdivision expenditures for HIV-related core medical services and
support services at a level equal to the FY preceding the FY for which the grant
recipient is applying to receive a RWHAP Part A grant. See Section 2605(a)(1)(B) of
the PHS Act. Core medical services and support services are defined in Section
2604(c)(3) and 2604(d) of the legislation. Part A recipients must document they have
met the maintenance of effort (MOE) requirement (included as Attachment 11).
NOTE: Multiple applications from an organization are not allowable.
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If for any reason (including submitting to the wrong funding opportunity number or
making corrections/updates) an application is submitted more than once prior to the
application due date, HRSA will only accept your last validated electronic submission,
under the correct funding opportunity number, prior to the Grants.gov application due
date as the final and only acceptable application.
IV. Application and Submission Information
1. Address to Request Application Package
HRSA requires you to apply electronically. HRSA encourages you to apply through
Grants.gov using the SF-424 workspace application package associated with this
NOFO following the directions provided at http://www.grants.gov/applicants/apply-for-
grants.html.
HRSA recommends that you supply an email address to Grants.gov on the grant
opportunity synopsis page when accessing this notice of funding opportunity (NOFO)
(also known as “Instructions” on Grants.gov) or workspace application package. This
allows Grants.gov to email organizations in the event HRSA changes and/or
republishes the NOFO on Grants.gov before its closing date. Responding to an earlier
version of a modified notice may result in a less competitive or ineligible application.
Please note you are ultimately responsible for reviewing the For Applicants page for all
information relevant to desired opportunities.
2. Content and Form of Application Submission
Section 4 of HRSA’s SF-424 Application Guide provides instructions for the budget,
budget narrative, staffing plan and personnel requirements, assurances, certifications,
and abstract. You must submit the information outlined in the Application Guide in
addition to the program-specific information below. You are responsible for reading and
complying with the instructions included in HRSA’s SF-424 Application Guide except
where instructed in the NOFO to do otherwise. You must submit the application in the
English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).
See Section 8.5 of the SF-424 Application Guide for the Application Completeness
Checklist.
Application Page Limit
The total size of all uploaded files may not exceed the equivalent of 100 pages when
printed by HRSA. The page limit includes the abstract, project and budget narratives,
attachments, and letters of commitment and support required in the Application Guide
and this NOFO. Standard OMB-approved forms that are included in the application
package do not count in the page limit. Indirect Cost Rate Agreement and proof of non-
profit status (if applicable) do not count in the page limit. We urge you to take
appropriate measures to ensure your application does not exceed the specified
page limit.
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Applications must be complete, within the specified page limit, and validated by
Grants.gov under the correct funding opportunity number prior to the deadline to
be considered under this notice.
Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification
1) The prospective recipient certifies, by submission of this proposal, that neither it
nor its principals is presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from participation in this transaction by
any federal department or agency.
2) Failure to make required disclosures can result in any of the remedies described
in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts
180 and 376, and 31 U.S.C. 3321)
3) Where the prospective recipient is unable to attest to the statements in this
certification, an explanation shall be included in Attachment 12.
See Section 4.1 viii of HRSA’s SF-424 Application Guide for additional information on all
certifications.
Program-Specific Instructions
In addition to application requirements and instructions in Section 4 of HRSA’s SF-424
Application Guide (including the budget, budget narrative, staffing plan and personnel
requirements, assurances, certifications, and abstract), please include the following:
i. Project Abstract
See Section 4.1.ix of HRSA’s SF-424 Application Guide. Your abstract should be
limited to one page and include the following information in this order:
• A general overview of the HIV epidemic in the EMA/TGA, including
epidemiologic, demographic and geographic information. You may present
this information as a table.
• A description of the comprehensive system of care in the entire EMA/TGA,
including the available core medical and support services funded by RWHAP
Part A and by other sources, where services are located, and how clients
access those services, including services for disproportionately impacted
subpopulation(s) supported by MAI funds.
• The overall viral suppression rate for the EMA/TGA. Use readily available and
validated data and indicate whether it represents data for Ryan White eligible
clients only, or is population-based. Also, if available and appropriate, provide
any meaningful subpopulation data that highlights disparities in this outcome
measure.
ii. Project Narrative
This section provides a comprehensive framework and description of all aspects of
the proposed project. It should be succinct, self-explanatory and well organized so
that reviewers can understand the proposed project.
Successful applications will contain the information below. Please use the
following section headers for the narrative:
HRSA-19-033 10

 INTRODUCTION -- Corresponds to Section V’s Review Criterion #1
This section must briefly describe how the EMA/TGA will utilize RWHAP Part A
grant funds in support of a comprehensive continuum of high-quality care and
treatment for PLWH in the RWHAP Part A service area, as defined in Appendix B.
 NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion #1
The purpose of this section is to demonstrate the severity of the HIV epidemic
in the EMA/TGA, using quantifiable data on HIV epidemiology, the HIV care
continuum, co-occurring conditions, complexity of providing care, service
needs of emerging populations, past unmet need estimates, and unique
service delivery challenges as required and cited in Section 2603(b)(2)(B) of
the PHS Act.
A. Demonstrated Need
The Demonstrated Need section includes the Epidemiological Overview, HIV Care
Continuum, Co-occurring Conditions, and Complexities of Providing Care sub-
sections.
Since 2003, unmet need has been defined as the number of individuals with
HIV in a jurisdiction who are aware of their HIV status and are not in care.
HAB continues to consider the best approach to developing a new framework
and methodology for accurately estimating unmet need based on current HIV
treatment guidelines. No new unmet need estimates are required. For this
NOFO, unmet need elements (as specified in Section 2603(b)(2)(B) of PHS
Act) are captured in the Epidemiologic Overview and the Complexities of
Providing Care sub-sections below. You may use your past unmet need
estimate to help inform planning, resource allocation and work plan
development for this application.
HAB will target supplemental funds to those eligible areas where epidemiologic
data demonstrate that HIV infection prevalence rates are increasing, where
there is documented demonstrated need and service gaps, and where there is
a demonstrated disproportionate impact on vulnerable populations.
1) Epidemiologic Overview
An epidemiologic overview provides a description of the demonstrated
need for HIV care in the population of an area in terms of socio-
demographic, geographic, behavioral, and clinical characteristics of
persons newly diagnosed with HIV, PLWH, and persons at higher risk for
infection. Understanding the populations affected by HIV provides the
basis for setting priorities, identifying appropriate interventions and
services, allocating funding to HIV care services, implementing
appropriate service standards, and evaluating programs and policies.
The epidemiologic overview should focus on the most recent year for
which data are available; when presenting trends, a minimum of three (3)
years of data are recommended. Please cite data sources. Submit the
HRSA-19-033 11

HIV/AIDS Demographic Table as Attachment 3.
a) Provide a summary of the HIV epidemic in your EMA/TGA geographic
area.
b) Describe the socio-demographic characteristics of: (1) persons newly
diagnosed, (2) PLWH, and (3) persons at higher risk for HIV infection in
the service area. Include the following, as available in the geographical
region of the jurisdiction:
i. Demographic data (e.g., race, age, sex, transmission category,
current gender identity); and
ii. Socioeconomic data (e.g., percentage of federal poverty level (FPL),
income, education, health insurance status, language barriers).
c) Describe the relative rates of increase in HIV diagnosed cases within new
and emerging populations.
i. Include information on how you identified emerging populations, any
unique challenges, and estimated costs to the RWHAP Part A
program, if applicable.
ii. Describe the increasing need for HIV-related services based on the
relative increase of HIV cases.
2) HIV Care Continuum
Provide a graphic depiction of the HIV care continuum of the jurisdiction
using the most current calendar year data. The definitions of the numerator
and the denominator must be clearly stated for each step of the care
continuum. Use readily available and validated data, and indicate whether it
represents data for Ryan White eligible clients only or is population-based.
In addition, describe the viral suppression rates for three of the most
disproportionately impacted minority populations that highlight disparities.
Pay special attention to populations where specific sub-populations may
experience the greatest health disparities, for example, young black men
who have sex with men (YBMSM) ages 13-24.
The steps of the diagnosed-based HIV care continuum using the HHS
indicators are found at https://www.hiv.gov/federal-response/policies-
issues/hiv-aids-care-continuum.
3) Co-occurring Conditions
Using the list below, provide quantitative evidence (i.e., incidence,
prevalence, and estimates) describing the conditions co-occurring with HIV in
the EMA/TGA in a table format (submit as Attachment 4) and document the
data sources used. The table must include:
a) Hepatitis C virus
b) Sexually transmitted infection rates, including syphilis, gonorrhea, and
chlamydia
c) Mental illness
d) Substance use disorder
HRSA-19-033 12

e) Homeless/Unstably Housed
f) Former incarceration
4) Complexities of Providing Care
a) If the EMA/TGA experienced a reduction in RWHAP Part A formula
funding last year, provide a narrative that addresses both the impact and
response to the funding reduction, as follows:
i. Impact: The specific services that were eliminated or reduced, and by
how much, and
ii. Response: Any cost containment measures implemented (e.g.,
waiting lists, client cost sharing, or other measures), PC/PB response
to the reduction in formula funding, and any transitional planning for
clients receiving services that were either eliminated or reduced.
b) Provide, in a table format, current estimates on poverty and health care
coverage status of PLWH in your jurisdiction. Include the following
information, as available:
i. The number and percentage of PLWH who are enrolled in Medicaid,
Medicare, and other health care coverage;
ii. The number and percentage of PLWH who are uninsured; and
iii. The number and percentage of PLWH living at or below 138 percent
and 400 percent of the 2018 federal poverty level (FPL). Also, include
the percentage of FPL used to determine RWHAP eligibility in the
jurisdiction.
c) Discuss any relevant factors that limit access to health care, including
geographic variation, adequacy of health insurance coverage, and
language barriers. Also, describe any service gaps, especially for PLWH
who are not in care, and how these service gaps will be addressed with
FY 2019 RWHAP Part A funding.
B. Early Identification of Individuals with HIV/AIDS (EIIHA)
The purpose of this section is to describe the data and information associated with
ensuring that individuals who are unaware of their HIV status are identified,
informed of their status, referred to supportive services, and linked to medical care
if HIV positive. The goals of the EIIHA initiative are to present a strategy for: (1)
identifying individuals with HIV who do not know their HIV status; (2) making such
individuals aware of such status and enabling such individuals to use the health
and support services; and (3) reducing barriers to routine testing and disparities in
access and services among affected subpopulations and historically underserved
communities. See Section 2603(b)(2)(A) of the PHS Act.
1) Describe the planned EMA/TGA EIIHA activities for the 2019 project period.
Include the following information:
a) The primary activities that will be undertaken, including system level
interventions (e.g., routine testing in clinical settings, expanding partner
services);
HRSA-19-033 13

b) Major collaborations with other programs and agencies, including HIV
prevention and surveillance programs; and
c) The anticipated outcomes of the jurisdiction’s overall EIIHA strategy.
2) Describe any planned efforts to remove legal barriers, including state laws
and regulations, to routine HIV testing in medical settings, or program/policy
efforts to expand implementation of routine HIV testing.
3) Select three (3) distinct target populations for the 2019 project period EIIHA
Plan. For each selected target population describe:
a) Why you chose the target population and how the epidemiological data,
social determinants of health, or other data supports that decision;
b) Specific challenges or opportunities for working with the target population;
and
c) The specific strategies that will be utilized with the target population.
C. AIDS Pharmaceutical Assistance (i.e., Local Pharmaceutical Assistance
Program) – Not Scored
Only complete this section if requesting funds for a Local Pharmaceutical
Assistance Program (LPAP) that will be newly funded in the 2019 project period.
The purpose of this section is to describe the need for an LPAP, including a
description of the systems and activities required to effectively operate an LPAP.
The RWHAP Part A needs assessment must determine that the State/Territory’s
AIDS Drug Assistance Program (ADAP) does not adequately address the
medication assistance needs of clients in the jurisdiction (e.g., existence of an
ADAP waiting list, restrictive ADAP financial eligibility criteria, or a limited ADAP
formulary). The needs assessment must also demonstrate that other resources
are inadequate to meet the medication needs of clients residing in the jurisdiction.
The National Monitoring Standards and LPAP letter of clarification sent to RWHAP
Parts A and B recipients on August 29, 2013, outline the systemic requirements
necessary to comply with the LPAP service category definition. Implementation of
an LPAP requires the development of a drug distribution system that includes, but
is not limited to: client enrollment and eligibility determination process that includes
screening for ADAP and LPAP eligibility, with rescreening at a minimum every six
months; an LPAP advisory board; uniform benefits for all enrolled clients;
compliance with RWHAP requirement of payor of last resort; and a drug formulary
approved by the local advisory committee/board. An LPAP may not be used to
provide short-term or emergency medication assistance. Please refer to the
RWHAP Part A National Monitoring Standards and PCN 16-02 Ryan White
HIV/AIDS Program Services: Eligible Individuals and Allowable Uses of Funds for
a complete list of LPAP requirements.
If you are planning to fund LPAP for the first time in the 2019 project period,
describe the following:
1) The need for an LPAP in detail: include how the ADAP, other RWHAP funded
service categories, and other resources (e.g., pharmaceutical assistance
HRSA-19-033 14

programs, patient assistance programs, local/state funded medication
assistance programs) are failing to meet the jurisdiction’s medication needs.
2) How the LPAP will be coordinated with the ADAP.
3) The client enrollment and eligibility process, including how the payor of last
resort requirement is ensured.
4) The LPAP advisory board composition. Describe the process and timeframe
for development of the LPAP advisory board.
5) How the recipient ensures that the LPAP follows the most recent HHS
HIV/AIDS Clinical Guidelines.
6) The mechanism to ensure “best price” for medications (e.g., 340B Drug
Pricing Program and/or Prime Vendor Program).
 METHODOLOGY -- Corresponds to Section V’s Review Criteria #2 & #4
A. Impact of the Changing Health Care Landscape
The availability of health care coverage options have an impact on RWHAP service
needs and how services are provided in jurisdictions.
1) Provide an overall description of health care coverage options available to
PLWH in the jurisdiction.
a) Explain how coverage options in the jurisdiction negatively or positively
influence access to direct health care services and health outcomes.
2) Describe how changes in the health care landscape affect the following:
a) Service provision and the complexity of providing care to PLWH in the
EMA/TGA.
b) Changes in RWHAP Part A allocations, including activities related to
health insurance premium and cost sharing assistance.
B. Planning Responsibilities
Section 2602(b)(4)(C) of the PHS Act requires PC/PBs to determine the priority for
RWHAP allowable services and service allocations of RWHAP Part A funds every
year. To fulfill this responsibility, EMA/TGA PC/PBs set service priorities and
allocate RWHAP Part A funds based on the size, demographics, and needs of
people living with or affected by HIV, with particular focus on individuals who know
their HIV status but are not in care. The RWHAP Part A PC/PBs also are
responsible for evaluating the efficiency of the recipient in distributing funds to
service providers.
PC/PBs analyze information to develop an in-depth understanding of the current
HIV epidemic and its impact on the service area. PC/PBs review needs
assessment data, HIV epidemiologic data, and co-occurring conditions data. The
review includes service utilization data related to complexity of providing care,
including service availability and unit cost per service, as well as service needs of
emerging populations. The purpose of these data reviews is to guide decisions
about HIV-related services and resources in the EMA/TGA. Furthermore, planning
HRSA-19-033 15

and implementation of the RWHAP Part A is driven by overall comprehensive
planning and the recently developed Integrated HIV Prevention and Care Plan,
including the Statewide Coordinated Statement of Need, CY 2017- 2021 as a
roadmap for relevant goals, objectives, and strategies for delivering RWHAP Part
A services along the HIV continuum of care.
Please see the December 4, 2013 letter to Transitional Grant Areas and Planning
Councils Moving Forward for expectations and responsibilities of PBs.
1) Planning and Resource Allocation
The purpose of this section is to document the existence of a functioning
planning process in the EMA/TGA that is consistent with RWHAP and HRSA
program requirements. Such a planning process is imperative for effective
local and state decision making to develop systems of prevention and care
that are responsive to the needs of persons at risk for HIV infection and
PLWH. Both HRSA and CDC support activities that facilitate collaboration
and/or develop a joint planning body to address prevention and care.
Community engagement is an essential component for planning
comprehensive, effective HIV prevention and care programs in the United
States.
The composition of the PC/PB must reflect the demographics of the HIV
epidemic in the EMA/TGA and be representative of various required
categories of membership as cited in Sec. 2602(b)(1)-(2) of the PHS Act.
PC/PB members must be trained regarding their legislatively mandated
responsibilities and other competencies necessary for full participation in
collaborative decision-making. PC/PBs are encouraged to educate
members about service issues related to the prevention of domestic and
sexual violence, opioid and other drug use, and trauma informed care as
part of their ongoing training. PC/PBs should also consider recruiting
members who are knowledgeable about these issues.
a) Description of the Community Input Process
Describe the overall community input process and how it informs the
PC/PB priority setting and resource allocation process for the jurisdiction
and include a summary of how the process was conducted. Also, include
a discussion of how the Integrated HIV Prevention and Care Plan (IP) has
helped inform the RWHAP Part A service priorities and resource
allocations, as well as a description of how the IP is interwoven into your
Part A activities.
Specifically, address:
i. How PLWH were involved in the planning and allocation processes
and how their priorities were considered in the process;
ii. How the input of the community was considered and whether the
community input process adequately addressed any funding
increases or decreases in the RWHAP Part A award;
HRSA-19-033 16

iii. How MAI funding was considered during the planning process to
enhance services to minority populations;
iv. How data were used in the priority setting and allocation processes to
increase access to core medical services, ensure access to services
for women, infants, children, and youth (WICY) and to reduce
disparities in access to HIV care in the EMA/TGA; and
v. Any significant changes in the prioritization and allocation process
from 2018 to 2019 project periods and the rationale for making those
changes.
2) Administrative Assessment
The RWHAP authorizing legislation mandates that EMA/TGA PC/PBs assess
the efficiency of the administrative mechanism to rapidly allocate funds to the
areas of greatest need within the EMA/TGA. See section 2602(b)(4)(E) of the
PHS Act. Include in your application a narrative that describes the results of
the PC/PB’s assessment of the administrative mechanism in terms of the
following:
a) Assessment of grant recipient activities to ensure timely
allocation/contracting of funds and payments to contractors; and
b) The RWHAP Part A jurisdiction’s response to any deficiencies identified by
the PC/PB and the status of your corrective actions in response to
administrative assessment findings.
3) Letter of Assurance from Planning Council Chair(s) or Letter of
Concurrence from Planning Bodies
Provide a letter of assurance signed by the PC chair(s) or a letter of
concurrence signed by PB leadership as Attachment 6. The letter must
address the following:
a) How all 2018 project period Conditions of Award relative to the PC or PB
have been addressed;
b) How the 2018 project period formula, supplemental, and MAI funds
awarded to the EMA/TGA are being expended according to the priorities
established by the PC or PB;
c) How the PC or PB determined the 2019 project period priorities, and how
the PC or PB used the approved process for establishing those priorities;
and
d) That ongoing, annual membership training occurred, including the
date(s).
4) Resource Inventory
RWHAP Part A EMA/TGA planning efforts should expand the availability of
services, reduce duplication of services, coordinate with all other public
HRSA-19-033 17

funding for HIV, and bring newly diagnosed PLWH into care or engage
PLWH who know their status but are not presently in HIV care. RWHAP Part
A planning efforts should also consider service needs not currently being met
(defined as service gaps).
a) Coordination of Services and Funding Streams
i. Provide, in a table format, a jurisdictional HIV resources inventory,
that includes: (1) public funding sources for HIV prevention, care, and
treatment services in the jurisdiction (RWHAP Parts B-D and F,
federal/state and local); (2) the dollar amount and the percentage of
the total available funds in the 2018 project period for each funding
source; and 3) how the resources are being used (i.e., services
delivered). Submit as Attachment 5.
ii. Provide a narrative description identifying any needed resources
and/or services in the jurisdiction that are not being provided and the
steps taken to secure them.
 WORK PLAN -- Corresponds to Section V’s Review Criteria #2 & #4
The purpose of this section is to provide tables and a narrative summary
describing the EMA/TGA service provision proposed for the 2019 project
period. It should describe how RWHAP Part A funded services are used to
have a positive impact on the HIV care continuum. The EMA/TGA system of
HIV care should be consistent with HRSA’s goals of increasing access to
services and decreasing HIV health disparities among affected subpopulations
and historically underserved communities.
Under RWHAP Part A, MAI formula funding provides core medical and related
support services to improve access and reduce disparities in health outcomes.
The services have to be consistent with the epidemiologic data.
Similar to other components of the RWHAP, the goal of the MAI is improved
health outcomes among racial and ethnic minorities living with HIV as
demonstrated by viral suppression. MAI funds must be used to deliver services
designed to address the unique barriers and challenges faced by hard-to-reach,
disproportionately impacted individuals within the EMA/TGA.
A. HIV Care Continuum Table and Narrative
1) FY 2019 HIV Care Continuum Table
Based on your HIV care continuum, develop an HIV Care Continuum Table
that is either prevalence-based or diagnosed-based. The table is comprised
of the stages of the HIV care continuum, baseline indicators for each stage,
the desired target outcome to be achieved during the project period, and the
RWHAP-funded service categories to help support achieving the desired
outcome. The target outcome must be developed based on one of the seven
common indicators for HHS funded HIV programs and services or one of the
HAB Core Performance Measures that corresponds to each stage of the HIV
care continuum. You must express the baseline and target indicators as a
HRSA-19-033 18

numerator and denominator, as well as a percentage. List the service
categories funded by the RWHAP Part A that will aid in achieving the desired
target outcomes in the last column of the HIV Care Continuum Table. Submit
as Attachment 7.
2) HIV Care Continuum Narrative
Please provide a narrative on your HIV care continuum addressing the
following:
a) How you currently utilize the HIV care continuum in planning and
prioritizing RWHAP Part A funding, in addition to monitoring available
resources in response to the needs of PLWH in order to maximize the
impact on health outcomes in the jurisdiction.
b) Any changes in your HIV care continuum from 2015 to 2017, or the most
current three (3) years for which data are available, the impact it has had
on your program, and how you responded or addressed those identified
changes.
B. Funding for Core and Support Services
RWHAP Part A funds are subject to Section 2604(c) of the PHS Act, which
requires that RWHAP Part A recipients expend 75 percent of RWHAP Part A
funds remaining after reserving funds for administration and CQM on core
medical services for individuals with HIV who are identified and eligible under the
RWHAP.
1) Service Category Plan
Please provide a Service Category Plan in table format as described below
that utilizes core medical and support service categories as prioritized and
funded by the PC or through local community planning processes. The plan
should consist of both RWHAP Part A and MAI funds. Please indicate if
you submitted a core medical services waiver for the 2019 project
period (either approved or pending) prior to submission of this
application. Allocations in the Service Category Plan should match
the submitted waiver. If you have not yet, or will not submit a core
medical services waiver for the 2019 project period, the allocations
must align with the 75 percent core medical services requirement. The
Service Category Plan must also correlate with the budget and budget
narrative section of the application.
a) Service Category Plan Table
The Service Category Plan Table illustrates how you fund RWHAP Part A
and MAI core medical and support services in the EMA/TGA. It is
comprised of service categories, priority number, funding amount,
unduplicated clients served, service unit definition, number of service
units, and target populations (MAI only) for the 2018 and 2019 project
periods. For every service category funded by RWHAP Part A in the
jurisdiction, provide in table format the following (submit as Attachment
8):
HRSA-19-033 19

i. RWHAP Part A
(a) 2018 project period service categories with priority number,
allocated funding amount, and number of projected unduplicated
clients to be served per the Service Category Plan Table
submitted with the 2018 grant application, service unit definitions,
and number of service units. Include total dollar amounts and
percentages of expenditures for core and support services.
(b) 2019 project period service categories with priority number,
anticipated funding amount, anticipated number of unduplicated
clients to be served, service unit definitions, and anticipated
number of service units. Include total dollar amounts and
percentages of expenditures for core and support services.
ii. MAI
(a) 2018 project period service categories with priority number,
allocated funding amount, and number of projected unduplicated
clients to be served per the Service Category Plan Table
submitted with the 2018 grant application, service unit definitions,
and service units. Include total dollar amounts and percentages
of expenditures for core and support services and subpopulations.
(b) 2019 project period service categories with priority number,
anticipated funding amount, anticipated number of unduplicated
clients to be served, service unit definitions, and anticipated
number of service units. Include total dollar amounts and
percentages of expenditures for core and support services and
subpopulations.
b) MAI Service Category Plan Narrative
Describe how the services included in the MAI Service Category Plan
Table are specific and population-tailored, with special emphasis on the
three subpopulations identified in the Demonstrated Need/HIV Care
Continuum section. Explain how you target activities to improve HIV-
related health outcomes, reduce existing racial and ethnic health
disparities, and increase the bars/percentages on the HIV care continuum.
Also, describe how these activities address the unique needs of the
targeted MAI populations.
c) Core Medical Services Waiver (if applicable – not scored)
You must provide a separate allocation table that is reflective of the
results of the priority setting and resource allocation process, only if you
submit a core medical services waiver with this application. The
allocation table must be consistent with the waiver request. Include the
allocation table and the core medical services waiver request as
Attachment 9.
HRSA-19-033 20

 RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review
Criterion # 2
In lieu of a narrative for this section, HAB suggests providing information on
implementing both the RWHAP Part A overall and the HIV care continuum in
table format with the following headers: Challenges/Barriers, Proposed
Resolutions, Intended Outcomes, and Current Status.
Please consider the following when completing your table:
• Challenges and barriers identified in the larger context of implementing the
RWHAP Part A (e.g., changes in the health care landscape, community
engagement, barriers for populations experiencing inequities in health
outcomes);
• Proposed resolutions that have been encountered in integrating the HIV
care continuum into planning and implementing the RWHAP Part A (e.g.,
test to care, and retention strategies) and approaches that will be used to
resolve such challenges;
• Intended outcomes once the proposed resolution is implemented; and
• Current status of implementing the proposed resolution.
 EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to
Section V’s Review Criterion # 3
A. Clinical Quality Management (CQM) Program
Section 2604(h)(5) of the PHS Act requires the establishment of a CQM program.
Please describe:
1) How performance measure data are analyzed to evaluate disparities in care
and actions taken in the last grant year to eliminate disparities; and
2) How CQM data have been used to improve patient care, health outcomes, or
patient satisfaction and/or change service delivery in the jurisdiction, including
strategic long-range service delivery planning.
You can find more information about the HRSA RWHAP expectations for CQM
programs in:
• PCN 15-02 Clinical Quality Management and Frequently Asked Questions
• HIV/AIDS Bureau Performance Measures
• Department of Health and Human Services HIV/AIDS Medical Practice
Guidelines
• HIV/AIDS Bureau RWHAP Part A Monitoring Standards (RWHAP Part A
specific, Universal Monitoring Standards, and Frequently Asked
Questions)
• Part A Manual
HRSA-19-033 21

 ORGANIZATIONAL INFORMATION -- Corresponds to Section V’s Review
Criterion # 5
A. Grant Administration
The purpose of this section is to demonstrate the extent to which the CEO or
designee in the EMA/TGA has met the legislative requirements to disburse
funds quickly, closely monitor their use, and ensure the RWHAP is the payor of
last resort. RWHAP stresses the importance of timely obligation of RWHAP
funds. Timely obligation of RWHAP funds ensures that services can be
provided as rapidly as possible and decreases the possibility that unobligated
funds will remain at the end of the program year. Please refer to Section
2603(c) of the PHS Act regarding the RWHAP Part A formula and
supplemental unobligated balance (UOB) requirement, as well as PCN 12-02
Part A and Part B Unobligated Balances and Carryover. The UOB requirement
does not apply to MAI funds. If the recipient reports unobligated formula
funds of five (5) percent or less, HRSA does not impose penalties,
although a future year award may be subject to an offset.
Note: UOB Penalties
If the UOB of a formula award exceeds five (5) percent, two penalties are
imposed:
• The future year award is reduced by the amount of the UOB, less the
amount of approved carryover; and
• The grant recipient is not eligible for a future year supplemental award.
Note that like all other recipients with a UOB, the amount of the UOB not
covered by a waiver for carryover is subject to an offset.
Supplemental Funds
Under the RWHAP legislation, unobligated supplemental funds cannot be carried
over, but are subject to offset. If a grant recipient has a UOB of supplemental
funds, the recipient remains eligible for a future year RWHAP Part A award,
including supplemental funds.
1) Program Organization
a) Describe how RWHAP Part A funds are administered within the EMA/TGA
with reference to the staff positions, including program and fiscal staff,
described in the budget narrative and the program organizational chart
included as Attachment 10. The narrative should describe the local
agency responsible for the grant and identify the entity responsible for
administering the RWHAP Part A, including the department, unit, staffing
levels (full-time equivalent staff [FTE], including any vacancies), fiscal
agents, PC/PB staff, and in-kind support staff. Describe the approaches
to fill vacant staff positions that are essential for delivery, oversight, and
monitoring of the RWHAP Part A and MAI services/activities. Submit
staffing plan, job descriptions, and biographical sketches for key personnel
as Attachment 1.
HRSA-19-033 22

b) If you administer the RWHAP Part A funds by a contractor or fiscal agent,
describe the staffing, fiscal agent scope of work or services to be
provided, and how you will evaluate the performance of the scope of work
or services being provided.
2) Grant Recipient Accountability
HRSA holds recipients accountable for the expenditure of funds awarded
under RWHAP Part A and requires recipients to monitor subrecipient fiscal
and programmatic compliance. Recipients also are required to have on file a
copy of each subrecipient’s procurement document (contracts), and fiscal,
program, and site visit reports. Also see the requirements outlined in the
Uniform Administrative Requirements, Cost Principles, and Audit
Requirement for HHS Awards (45 CFR part 75) - Subrecipient Monitoring and
Management (45 CFR § 75.351 and 352) and National Monitoring Standards.
a) Monitoring - Provide a narrative that describes the following:
i. The three most common program and fiscal subrecipients’ monitoring
findings for the 2018 project period to date or for the 2017 project
period, and the process and timeline for corrective actions;
ii. The process for ensuring subrecipient compliance with the single
audit requirement in Subpart F of the Uniform Administrative
Requirements, Cost Principles, and Audit Requirement for HHS
Awards (45 CFR part 75) (45 CFR part 75); and
iii. If there were findings in any subrecipient single audit or program-
specific audit reports, describe what you have done to ensure that
subrecipients have taken appropriate corrective action. Corrective
actions may include, but are not limited to, HRSA sponsored technical
assistance and training requests from the grant recipient of record.
b) Third Party Reimbursement
The RWHAP is the payor of last resort and you must vigorously
pursue alternate sources of payments. Eligibility must be certified
every twelve (12) months/annually and recertified at least every six
(6) months (see PCN 13-02, Clarifications on Ryan White Program
Client Eligibility Determinations and Recertifications Requirements).
Recipients and subrecipients are required to use effective strategies
to coordinate between RWHAP Part A and third party payers who are
ultimately responsible for covering the cost of services provided to
eligible or covered persons. Subrecipients providing Medicaid eligible
services must be Medicaid certified.
Provide a narrative that describes the following:
i. The process used to ensure that subrecipients are pursuing third party
reimbursement and the contract language or other mechanism to
ensure that this takes place;
HRSA-19-033 23

ii. The process to conduct screening and eligibility to ensure the
RWHAP is the payor of last resort; and
iii. How you monitor and track the source and use of any program
income earned at both the recipient and subrecipient levels.
c) Fiscal Oversight - Provide a narrative that describes the following
information:
i. The process used by program and fiscal staff to coordinate activities,
ensuring adequate reporting, reconciliation, and tracking of program
expenditures (e.g., meeting schedule, information sharing regarding
subrecipient expenditures, UOB, and program income);
ii. The process used to separately track formula, supplemental, MAI, and
carryover funds, including information on the data systems utilized;
and
iii. The process for reimbursing subrecipients, from the time a
voucher/invoice is received to payment.
B. Maintenance of Effort (MOE)
The RWHAP legislation requires RWHAP Part A recipients to maintain, as a
condition of award, EMA/TGA political subdivision expenditures for HIV-related
core medical services and support services at a level equal to the FY preceding
the FY for which the recipient is applying to receive a RWHAP Part A grant.
Core medical services and support services are defined in Section 2604(c)(3)
and 2604(d) of the PHS Act and PCN 16-02 Ryan White HIV/AIDS Program
Services: Eligible Individuals & Allowable Uses of Funds. RWHAP Part A
recipients must document that they will meet the MOE requirement.
You must submit the following information as Attachment 11:
1) A table that identifies the baseline aggregate for actual non-federal EMA/TGA
political subdivision expenditures for HIV-related core medical and support
services during your most recently completed FY prior to the application
deadline and an estimate for your next fiscal year, and
2) A description of the process and elements used to determine the amount of
expenditures in the MOE calculations.
NARRATIVE GUIDANCE
To ensure that you fully address the review criteria, this table provides a crosswalk
between the narrative language and where each section falls within the review
criteria.
Narrative Section Review Criteria
Introduction (1) Need
Needs Assessment (1) Need
• Demonstrated Need
• Early Intervention of
Individuals with HIV/AIDS
HRSA-19-033 24

Methodology (2) Response and (4) Impact
• Impact of Funding
• Planning Responsibilities
Work Plan (2) Response and (4) Impact
• FY 2019 HIV Care
Continuum Table and
Narrative
• Funding for Core and
Support Services
Resolution of Challenges (2) Response
Evaluation and Technical Support (3) Evaluative Measures
Capacity
• Clinical Quality Management
Organizational Information (5) Resources/Capabilities
• Grant Administration
Budget and Budget Narrative (6) Support Requested – the budget section
should include sufficient justification to allow
reviewers to determine the reasonableness
of the support requested.
iii. Budget
See Section 4.1.iv of HRSA’s SF-424 Application Guide. Please note: the directions
offered in the SF-424 Application Guide may differ from those offered by Grants.gov.
Follow the instructions included in the Application Guide and the additional budget
instructions provided below. A budget that follows the Application Guide will ensure
that, if HRSA selects the application for funding, you will have a well-organized plan
and by carefully following the approved plan can avoid audit issues during the
implementation phase.
Reminder: The Total Project or Program Costs are the total allowable costs
(inclusive of direct and indirect costs) incurred by the recipient to carry out a HRSA-
supported project or activity. Total project or program costs include costs charged to
the award and costs borne by the recipient to satisfy a matching or cost-sharing
requirement, as applicable.
In addition, the RWHAP Part A HIV Emergency Relief Grant Program requires the
following:
Completion of Sections A, B, and F of the SF-424A Budget Information – Non-
Construction Programs form. In Section B, the three required columns are:
(1) Administrative (Part A and MAI)
HRSA-19-033 25

(2) CQM (Part A and MAI)
(3) HIV Services (Part A and MAI)
Caps on expenses: RWHAP Part A grant administration costs (including PC or PB
support) may not exceed ten (10) percent of the grant award. The aggregate total
of administrative expenditures for subrecipients, including all indirect costs, may not
exceed ten (10) percent of the aggregate amount of all subawards. Please see
Policy Clarification Notice 15-01 Treatment of Costs under the 10% Administrative
Cap for Ryan White HIV/AIDS Program Parts A, B, C, and D along with the
Frequently Asked Questions for information regarding the statutory ten (10) percent
limitation on administrative costs.
Recipients are allowed to allocate up to five (5) percent of the total grant award or
$3,000,000 (whichever is less) for CQM activities.
The Consolidated Appropriations Act, 2018 (P.L. 115-141), Division H, § 202 states,
“None of the funds appropriated in this title shall be used to pay the salary of an
individual, through a grant or other extramural mechanism, at a rate in excess of
Executive Level II.” See Section 4.1.iv Budget – Salary Limitation of HRSA’s SF-424
Application Guide for additional information. Note that these or other salary
limitations may apply in FY 2020, as required by law.
iv. Budget Narrative
See Section 4.1.v. of HRSA’s SF-424 Application Guide. Note: The Budget
Narrative/Justification required for this application should be uploaded under Budget
Narrative in grants.gov.
In order to evaluate your adherence to RWHAP Part A legislative budget
requirements, you must submit a program-specific budget narrative/justification. To
reduce the burden of recipient reporting that previously required multiple post-award
budget revisions, you must submit a budget that does not exceed the ceiling amount
listed for the service area in Appendix B. The MAI component of your budget must
not exceed a five (5) percent increase from your FY 2018 MAI award. In addition,
the total amount requested on the SF-424A and the total amount listed on the budget
narrative/justification must match. The budget allocations must relate to the activities
proposed in the project narrative, including the work plan.
You should submit the budget narrative/justification in table format. When completing
the budget narrative/justification submit an overall summary table and a separate
table for each of the cost categories. It should list separately by funding type (Part A
and MAI), the program cost categories: Administrative, CQM, and HIV Services
across the top and object class categories (i.e., Personnel, Fringe Benefits, Travel,
Equipment, Supplies, Contractual, Other, and Indirect Charges) in a column down the
left-hand side. If the EMA/TGA is administrated by a contractor or fiscal agent,
clearly detail the costs for administering the grant in the budget narrative/justification.
You must also show a separate PC/PB support budget narrative/justification.
HRSA-19-033 26

Each of the specific budget narrative/justification tables should describe and
adequately justify how every item with a cost associated under each object class
category makes a contributing impact and supports the overall RWHAP Part A HIV
service delivery system.
Additional cost category information to use when completing the RWHAP Part A
grant budget narrative/justification tables is as follows:
A. Administrative Costs are costs associated with the administration of the
RWHAP Part A grant. By law, no more than 10 percent of the RWHAP Part A
budget can be spent on administrative costs. You should allocate staff
activities that are administrative in nature to administrative costs. Costs
associated with grant administration and PC/PB support are all subject to the
10 percent limit on costs associated with administering the award. Recipients
must determine the amounts necessary to cover all administrative and
program support activities. The RWHAP Part A recipient must also ensure
adequate funding for PC/PB mandated functions within the administrative line
item. PC/PB support should cover reasonable and necessary costs
associated with carrying out legislatively mandated functions.
If a RWHAP Part A grant recipient has contracted with an entity to provide
regional RWHAP management and fiscal oversight (i.e., the entity is acting
on behalf of the recipient), the cost of that contract, exclusive of subawards
to providers, would count toward the recipient’s 10 percent administrative
cap. Providers that have contracted to provide healthcare services for the
lead agency are considered to be subrecipients of the recipient and are
subject to the aggregate 10 percent administrative cap for subrecipients.
Likewise, recipients who provide services directly should apply
administrative costs related to the provision of such service to the aggregate
10percent administrative cost cap.
The aggregate total of administrative expenditures for subrecipients, including
all indirect costs, may not exceed 10 percent of the aggregate amount of all
subawards. Subrecipient administrative activities include:
• Usual and recognized overhead activities, including established indirect
rates for agencies;
• Management oversight of specific programs funded under the RWHAP;
and
• Other types of program support such as quality assurance, quality control,
and related activities (exclusive of RWHAP CQM).
As a reminder: All indirect costs charged by the subrecipient are considered an
administrative cost subject to the 10 percent aggregate limit.
For further guidance on the treatment of costs under the 10 percent
administrative limit, refer to PCN 15-01 Treatment of Costs under the 10%
Administrative Cap for Ryan White HIV/AIDS Program Parts A, B, C, and D
and Frequently Asked Questions.
HRSA-19-033 27

B. CQM Costs are costs required to maintain a CQM program to assess the
extent to which services are consistent with the current HHS guidelines for
the treatment of HIV and to develop strategies to improve access to and
quality of services. Examples of CQM costs include:
• Implementation of CQM program;
• Clinical Quality Improvement activities;
• Data collection for CQM purposes (collect, aggregate, analyze, and
report on measurement data on a quarterly basis at a minimum );
• Recipient CQM staff training/TA (including travel and registration) - this
includes HRSA sponsored or HRSA approved training; and
• Training of subrecipients on CQM.
Please note that quality assurance activities are not considered CQM costs.
For further guidance on CQM, refer to PCN 15-02 Clinical Quality
Management Policy Clarification Notice.
C. HIV Services costs are associated with the provision of core medical and
support services to RWHAP eligible clients. Core medical and support
services are important to assist in the diagnosis of HIV infection, linkage to
care for PLWH, retention in care, and the provision of HIV treatment. To be
an allowable cost under the RWHAP, all services must relate to HIV
diagnosis, care, and support, and must adhere to established HIV clinical
practice standards consistent with HHS treatment guidelines. In addition, all
providers must be appropriately licensed and in compliance with state and
local regulations. Recipients are required to work toward the development
and adoption of service standards for all RWHAP-funded services.
For further guidance on core medical and support services, refer to PCN 16-
02 Ryan White HIV/AIDS Program Services: Eligible Individuals & Allowable
Uses of Funds.
1) Core Medical Services Costs
At least 75 percent of the award – minus amounts for administrative costs,
including planning/evaluation – must be used to provide core medical services.
You may seek a waiver to this requirement.
2) Support Services Costs –Support services are those services needed
by PLWH to achieve optimal HIV medical outcomes.
Object Class Category Details
The budget narrative/justification should explain how the amounts requested
support the overall service delivery system and include justification for any of the
following applicable object class categories: Personnel, Fringe Benefits, Travel,
Equipment, Supplies, Contractual, Construction, Other, and Indirect Charges.
HRSA-19-033 28

For employees who are less than one (1) FTE on the award, please identify all
funding sources outside of RWHAP Part A funding for Personnel and Fringe
Benefits costs.
Personnel: All costs must include the name and position title. The annual
salary, program FTE, and program salary subtotal must be listed for each staff
position with adequate justification clearly explaining how the roles have an
impact on the RWHAP Part A HIV service delivery system and/or program
outcomes/goals. Please list personnel separately by position title and the name
of the individual for each position title, or note if position is vacant. Descriptions
must be specific to the cost category. A general description for personnel
repeated across the categories is not acceptable. HRSA will consider a general
personnel description across categories as non-responsive. For personnel
whose duties occur across categories, the FTE allocation must not exceed 1.0.
Contractual: Provide a clear explanation of the purpose of each contract, how
you estimated the costs, and the specific contract deliverables. List the amounts
allocated for personnel or services contracted to outside providers for all HIV
services (subrecipients). Show the amount allocated to any activities that are not
conducted “in-house” on the Contractual line. Subrecipients providing services
under this award must adhere to the same requirements as the recipient. All
RWHAP Part A legislative requirements, the requirements outlined in 45 CFR
part 75, and program expectations that apply to recipients also apply to
subrecipients. Your organization is accountable for your subrecipients’
performance of the project, program, activity, and appropriate expenditure of
funds under the award.
NOTE: HRSA recommends that the budgets be converted or scanned into PDF
format for submission. Do not submit Excel spreadsheets.
v. Attachments
Provide the following items in the order specified below to complete the content
of the application. Unless otherwise noted, attachments count toward the
application page limit. Indirect cost rate agreements and proof of non-profit
status (if applicable) will not count toward the page limit. You must clearly label
each attachment.
Attachment 1: Staffing Plan, Job Descriptions, and Biographical Sketches for
Key Personnel (required; see Section 4.1.vi. of the HRSA’s SF-424 Application
Guide).
Attachment 2: FY 2019 Agreements and Compliance Assurances, Certifications
(required)
Submit the RWHAP Part A Grant Program FY 2019 Agreements and
Compliance Assurances signed by the CEO or the CEO’s designee (see
Appendix A).
Attachment 3: HIV/AIDS Demographic Table (required)
HRSA-19-033 29

Attachment 4: Co-occurring Conditions Table (required)
Attachment 5: Coordination of Services and Funding Streams Table (required)
Provide in table format a jurisdictional HIV resources inventory, that
includes: (1) public and private funding sources for HIV prevention, care,
and treatment services in the jurisdiction; (2) the dollar amount and the
percentage of the total available funds in the 2018 project period for each
funding source; (3) how the resources are being used (e.g., services
delivered).
Attachment 6: Letter of Assurance from Planning Council Chair/Letter of
Concurrence from Planning Body (required)
Attachment 7: HIV Care Continuum Table (required)
Attachment 8: Service Category Plan Tables (required)
Attachment 9: Core Medical Services Waiver Request and
Allocation Table (if applicable)
Attachment 10: Program Organizational Chart (required)
Provide a one-page illustration that depicts the organizational
structure of the program. Include the names of department
and/or program managers and coordinators.
Attachment 11: Maintenance of Effort Documentation (required)
Provide a baseline aggregate for actual non-federal EMA/TGA political
subdivision expenditures for HIV-related core medical and support services
during the most recently completed FY prior to the application deadline and
an estimate for the next fiscal year using a table similar to the one below.
Also include a description of the process and elements used to determine the
amount of expenditures in the MOE calculations. [See Section 2605(a)(1)(B)
of the PHS Act. Core medical services and support services are defined in
Section 2604(c)(3) and 2604(d) of the legislation and HRSA service
definitions distributed to all recipients.] HRSA will enforce statutory MOE
requirements through all available mechanisms.
HRSA-19-033 30

NON-FEDERAL EXPENDITURES
FY Prior to Application (Actual) Current FY of Application (Estimated)
Actual prior FY non-federal Estimated current FY non-federal
EMA/TGA political subdivision EMA/TGA political subdivision
expenditures for HIV-related core expenditures for HIV-related core
medical and support services. medical and support services.
Amount: $_____________ Amount: $______________
Attachment 12: Letters of Agreement, Memorandum of Understanding,
Intergovernmental Agreements, and Other Relevant Documents (optional)
Include here any other documents that are relevant to the application,
including letters of support that are dated and specifically indicate a
commitment to the project/program (in-kind services, dollars, staff, space,
equipment, etc.). Any other support letters can be listed on one page.
3. Dun and Bradstreet Data Universal Numbering System (DUNS) Number and
System for Award Management
You must obtain a valid DUNS number, also known as the Unique Entity Identifier, for
your organization/agency and provide that number in the application. You must also
register with the System for Award Management (SAM) and continue to maintain active
SAM registration with current information at all times during which you have an active
federal award or an application or plan under consideration by an agency (unless the
applicant is an individual or federal agency that is exempted from those requirements
under 2 CFR § 25.110(b) or (c), or has an exception approved by the agency under 2
CFR § 25.110(d)).
HRSA may not make an award to an applicant until the applicant has complied with all
applicable DUNS and SAM requirements and, if an applicant has not fully complied with
the requirements by the time HRSA is ready to make an award, HRSA may determine
that the applicant is not qualified to receive an award and use that determination as the
basis for making an award to another applicant.
If you have already completed Grants.gov registration for HRSA or another federal
agency, confirm that the registration is still active and that the Authorized Organization
Representative (AOR) has been approved.
The Grants.gov registration process requires information in three separate systems:
• Dun and Bradstreet (http://www.dnb.com/duns-number.html)
• System for Award Management (SAM) (https://www.sam.gov)
HRSA-19-033 31

• Grants.gov (http://www.grants.gov/)
For further details, see Section 3.1 of HRSA’s SF-424 Application Guide.
ALERT from SAM.gov: You must now provide an original, signed notarized letter
stating that you are the authorized Entity Administrator before your registration
will be activated by SAM.gov. Please read these FAQs to learn more about this
process change. Plan for additional time associated with submission and review
of the notarized letter. This requirement is effective March 22, 2018 for new
entities registering in SAM. This requirement is effective April 27, 2018 for
existing registrations being updated or renewed. Entities already registered in
SAM.gov are advised to log into SAM.gov and review their registration
information, particularly their financial information.
If you fail to allow ample time to complete registration with SAM or Grants.gov,
you will not be eligible for a deadline extension or waiver of the electronic
submission requirement.
4. Submission Dates and Times
Application Due Date
The due date for applications under this NOFO is September 21, 2018, at 11:59 p.m.
Eastern Time. HRSA suggests submitting applications to Grants.gov at least 3 days
before the deadline to allow for any unforeseen circumstances.
See Section 8.2.5 – Summary of emails from Grants.gov of HRSA’s SF-424 Application
Guide for additional information.
5. Intergovernmental Review
The RWHAP Part A Emergency Relief Grant Program is a program subject to the
provisions of Executive Order 12372, as implemented by 45 CFR part 100. See
Executive Order 12372 in the HHS Grants Policy Statement.
See Section 4.1 ii of HRSA’s SF-424 Application Guide for additional information.
6. Funding Restrictions
You may request funding for a project period up to one (1) year, using the ceiling
amount provided in Appendix B.
In addition to the general Funding Restrictions included in Section 4.1 of the SF-424
Application Guide, RWHAP Part A funds cannot be used for the following purposes:
• Cash payment to intended recipients of RWHAP services;
• Construction (minor alterations and renovations to an existing facility to make it
more suitable for the purpose of the program are allowable with prior HRSA
approval);
HRSA-19-033 32

• International travel;
• Pre-exposure prophylaxis (PrEP) or Post-Exposure Prophylaxis (PEP)
medications or the related medical services. (See the June 22, 2016 RWHAP
and PrEP program letter);
• Syringe Services Programs (SSPs). Some aspects of SSPs are allowable with
HRSA's prior approval and in compliance with HHS and HRSA policy;
• Payment for any item or service to the extent that payment has been made (or
reasonably can be expected to be made), with respect to that item or service,
under any state compensation program, insurance policy, federal or state
benefits program, or any entity that provides health services on a prepaid basis,
(except for a program administered by or providing the services of the Indian
Health Service); and
• Development of materials designed to promote or encourage, directly,
intravenous drug use or sexual activity, whether homosexual or heterosexual.
Please see PCN 15-01 and Frequently Asked Questions for information regarding the
statutory ten (10) percent limitation on administrative costs.
You can find other non-allowable costs in 45 CFR part 75 – Subpart E Cost Principles.
The General Provisions in Division H of the Consolidated Appropriations Act, 2018 (P.L.
115-141) apply to this program. Please see Section 4.1 of HRSA’s SF-424 Application
Guide for additional information. Note that these or other restrictions will apply in FY
2020, as required by law.
You are required to have the necessary policies, procedures and financial controls in
place to ensure that your organization complies with all legal requirements and
restrictions applicable to the receipt of federal funding including statutory restrictions on
use of funds for lobbying, executive salaries, gun control, abortion, etc. Like those for
all other applicable grants requirements, the effectiveness of these policies, procedures
and controls is subject to audit.
All program income generated as a result of RWHAP Part A awarded funds is
considered additive and must be used for otherwise allowable costs to further the
objectives of the RWHAP Part A HIV Emergency Relief Grant Program. For RWHAP
Part A, allowable costs are limited to core medical services, support services, CQM and
administrative expenses [Section 2604(a)(2) of the PHS Act]. Program income may be
utilized for elements of the program that are otherwise limited by statutory provisions,
such as administrative and CQM activities that might exceed statutory caps, or unique
services that are needed to maintain a comprehensive program approach, but that
would still be considered allowable under the award. (See PCN 15-03, Clarifications
Regarding the Ryan White HIV/AIDS Program and Program Income).
You can find post-award requirements for program income at 45 CFR § 75.307. Per 45
CFR § 75.305 (b)(5), to the extent available, you must disburse funds available from
program income before requesting grant funds.
HRSA-19-033 33

V. Application Review Information
1. Review Criteria
HRSA has instituted procedures for assessing the technical merit of applications to
provide for an objective review of applications and to assist you in understanding the
standards against which your application will be judged. HRSA has developed critical
indicators for each review criterion to assist you in presenting pertinent information
related to that criterion and to provide the reviewer with a standard for evaluation. See
the review criteria outlined below with specific detail and scoring points.
These criteria are the basis upon which the reviewers will evaluate and score the merit
of the application. The entire proposal will be considered during objective review.
Review criteria are used to review and rank applications. The RWHAP Part A has six
review criteria:
Criterion 1: NEED (66 points) – Corresponds to Section IV’s ii, Project Narrative:
Introduction, Needs Assessment, Demonstrated Need, including the Epidemiologic
Overview, HIV Care Continuum, Co-occurring Conditions, and Complexities of
Providing Care and associated attachments. Note: This section includes EIIHA, which
is worth 33 points, per Section 2602(b)(4)(D)(vi) of the PHS Act.
The extent to which the application demonstrates the problem and associated
contributing factors to the problem.
A. Demonstrated Need (33 points): Provides a description of the demonstrated
needs of PLWH, both those in care and not in care. The needs assessment
provides information on the size, geographic distribution, and the socio-
demographics of the HIV population within the EMA/TGA. It also provides
information on strategies for reducing barriers to accessing care as well as services
targeted to individuals who are aware of and those unaware of their HIV status.
1) Epidemiological Profile (9 points)
a) Provides a clear and comprehensive description of the HIV epidemic in the
EMA/TGA geographic area.
b) Clarity and completeness of the HIV Demographic Table(s) (Attachment 3),
including use of the most recent data available and clearly cited sources of
data.
c) Clearly describes any increases in rates of HIV cases within emerging
populations, how emerging populations were identified, and justifies the need
for HIV-related services.
2) HIV Care Continuum (8 points)
a) Provides a clear graphic depiction of the HIV care continuum of the
jurisdiction using the most current calendar year data.
b) Clearly describes viral suppression rates for three of the most
disproportionately impacted minority populations that highlights disparities,
HRSA-19-033 34

with special attention on populations where specific sub-populations
experience the greatest health disparities.
3) Co-occurring Conditions (7 points)
The strength of the table that quantifies the co-occurring conditions discussed in
this section and clearly cites the data sources used (Attachment 4).
4) Complexities of Providing Care (9 points)
a) Demonstrates a thorough understanding of both the impact and response to
funding reduction (if applicable). Provides a clear and comprehensive
description of any cost containment measures implemented, (e.g., waiting
lists, client cost sharing, or other measures); PC or community PB response
to the reduction in formula funding; and any transitional planning for clients
receiving services that were either eliminated or reduced.
b) Provides comprehensive estimates on poverty and health care coverage of
PLWH in table format.
c) Demonstrates a thorough understanding of relevant factors that limit access
to health care in the jurisdiction, including adequacy of health care coverage,
geographic variation, language barriers, and service gaps related to PLWH
who have fallen out of care.
B. Early Identification of Individuals with HIV/AIDS (EIIHA) (33 points)
1) EIIHA Plan (12 points)
The strength and clarity of the EIIHA Plan that includes the following:
a) Primary activities which will be undertaken, including system level
interventions (e.g., routine testing in clinical settings, expanding partner
services);
b) Major collaborations with other programs and agencies, including HIV
prevention and surveillance programs; and
c) Anticipated outcomes of the program’s overall EIIHA strategy.
2) Clarity and completeness of plans to address legal barriers, including state laws
and regulations, to routine HIV testing in medical settings, or program/policy
efforts to expand implementation of routine HIV testing. (3 points)
3) Appropriateness of the description of three (3) distinct target populations, which
includes a clear explanation of the following: (18 points)
a) Why the target populations were chosen and how the epidemiological data,
social determinants of health or other data supports that decision;
b) Specific challenges or opportunities presented by the target populations; and
c) Specific strategies to be utilized with the target populations.
Criterion 2: RESPONSE (12 points) – Corresponds to Section IV. ii. Project Narrative:
Methodology/Planning Responsibilities, Work Plan/Funding for Core and Support
Services, Resolution of Challenges, and associated attachments.
The extent to which the proposed project responds to the “Purpose” included in the
program description. The extent to which the activities described in the application are
capable of addressing the problem.
HRSA-19-033 35

A. Methodology (5 points)
1) Strength and clarity of the Community Input Process description that includes
PLWH and community involvement, MAI needs, and utilization of data in
priority setting and resource allocation.
2) Completeness of description of any significant changes in the prioritization and
allocation processes from 2018 to 2019 project periods and clarity of rationale
for making those changes.
3) Clarity and completeness of the Coordination of Services and Funding Streams
table (Attachment 5) and the narrative identifying any needed resources
and/or services in the jurisdiction, which are not provided, and the feasibility of
the proposed steps to secure them.
4) Completeness of the description for the assessment of the recipient’s process
to ensure timely allocation/contracting and payments to contractors, and
recipient’s response to any deficiencies identified.
5) Letter of Assurance from Planning Council Chair(s) or Letter of Concurrence
from Planning Bodies (Attachment 6) fully addresses and provides evidence
that 2018 project period funding was expended according to PC/PB priorities,
that the PC/PB approved a process for determining 2019 project period
priorities and provided evidence of annual membership training.
B. Work Plan (5 points)
Funding for Core Medical and Support Services
a) Service Category Plan (Attachment 8) (3 points)
The clarity and completeness of the table that illustrates how RWHAP
Part A and MAI core medical and support services are funded in the
EMA/TGA as evidenced by the inclusion of complete data on service
categories, priority number, funding amount, unduplicated clients,
service unit definition, service units, and target populations (for MAI
services only) for 2018 and 2019 project periods.
b) MAI Service Category Plan Narrative (2 points)
Clearly describes how the services included in the MAI Service Category
Plan Table are specific and population-tailored, with special emphasis on
the three subpopulations identified in the Demonstrated Need/HIV Care
Continuum subsection. Clearly explains how targeted activities improve
HIV-related health outcomes, reduce existing racial and ethnic health
disparities, and increase the bars/percentages on the HIV care continuum,
along with a description of how these activities address the unique needs
of the targeted MAI populations.
C. Resolution of Challenges (2 points)
The strength and feasibility of approaches to resolve challenges and barriers
identified throughout the application (e.g., changing health care landscape,
community engagement), as well as challenges encountered in integrating the HIV
care continuum into planning and implementing the RWHAP Part A grant.
HRSA-19-033 36

Criterion 3: EVALUATIVE MEASURES (2 points) – Corresponds to Section IV. ii.
Project Narrative: Evaluation and Technical Support Capacity/CQM
The strength and effectiveness of the method proposed to monitor and evaluate the
program. Evidence that the evaluative measures will be able to assess: 1) to what
extent the program objectives have been met, and 2) to what extent these can be
attributed to the project.
1) Fully describes how performance data are used to evaluate disparities in care,
and the strength of the actions taken in the last grant year to eliminate disparities.
2) Clearly describes how CQM data are used to improve and/or change service
delivery in the jurisdiction.
Criterion 4: IMPACT (10 points) – Corresponds to Section IV. ii. Project Narrative:
Methodology/Impact of Funding, Work Plan/HIV Care Continuum Table, and
associated attachments.
1) The strength and completeness of the HIV Care Continuum Table depicting how
RWHAP-funded services will aid in achieving the desired target outcomes and
have a positive impact on the HIV care continuum (Attachment 7);
2) A clear description of how the HIV care continuum is utilized in planning and
prioritizing RWHAP Part A funding, in addition to monitoring available resources in
response to the needs of PLWH in order to maximize the impact on health
outcomes in the jurisdiction.
3) Clearly demonstrates a thorough understanding of the changes in the HIV care
continuum from 2015 to 2017, or most current three years for which data are
available, and the impact the changes have had on the program, including a clear
description of how those changes were addressed.
4) Demonstrates a thorough understanding of how changes in the health care
landscape, including, but not limited to service provision, changes in allocations,
and health care coverage options, affect health outcomes of PLWH in the
EMA/TGA.
Criterion 5: RESOURCES/CAPABILITIES (5 points) – Corresponds to Section IV. ii.
Project Narrative: Organizational Information/Grant Administration and associated
attachments.
The extent to which project personnel are qualified by training and/or experience to
implement and carry out the project. The capabilities of the applicant organization and
the quality and availability of facilities and personnel to fulfill the needs and
requirements of the proposed project.
1) Program Organization (2 points)
The completeness and appropriateness of the Staffing Plan, Job Descriptions
and Biographical Sketches for Key Personnel (Attachment 1) and Program
Organizational Chart (Attachment 10) that includes the names of managers
HRSA-19-033 37

and/or coordinators and that demonstrates capacity of the department, unit,
staffing levels (FTEs, including any vacancies), fiscal and/or management
agents, planning and evaluation bodies, and in-kind support staff necessary
to carry out the project.
2) Recipient Accountability (3 points)
a) Monitoring
The strength and completeness for the description of the FY 2018 (if
available) or FY 2017 subrecipients’ most common findings, corrective
actions to address findings, and compliance with single audit requirements.
b) Third Party Reimbursement
The strength and completeness of the process used to ensure RWHAP is the
payor of last resort by vigorously pursuing alternate sources of payment,
tracking source and use of program income earned at recipient and
subrecipient levels, and conducting annual RWHAP eligibility determinations
and recertifications.
c) Fiscal Oversight
The strength and effectiveness of the process used to ensure adequate
reporting, timely payment, reconciliation, and tracking of program
expenditures separately by formula, supplemental, MAI, and carryover funds.
Criterion 6: SUPPORT REQUESTED (5 points) – Corresponds to Section IV. ii.
Project Narrative: Organizational Information/MOE, Budget and associated
attachments.
The reasonableness of the proposed budget for the project period in relation to the
objectives, the complexity of the activities, and the anticipated results.
1) The extent to which costs, as outlined in the budget, are reasonable given the
scope of work, and aligned with demonstrated need and the Service Category
Table.
2) The extent to which the budget reflects that key personnel have adequate time
(FTEs) devoted to the project and allocated to appropriate budget categories.
2. Review and Selection Process
The independent review process provides an objective evaluation to the individuals
responsible for making award decisions. The highest ranked applications receive
consideration for award within available funding ranges. HRSA may also consider
assessment of risk and the other pre-award activities described in Section 3 below.
See Section 5.3 of HRSA’s SF-424 Application Guide for more details.
Funding Priority
This program includes a funding priority for some applicants as authorized by section
2603(b)(2)(C) of the PHS Act. HAB will determine the funding factor as outlined below.
HRSA-19-033 38

Section 2603(b)(2)(C) of the PHS Act directs the Secretary to provide funds to areas to
address the decline or disruption of services related to the decline in the amount of
formula funding. HRSA sets aside a portion of the Part A supplemental funding to
award priority funds in conformance with this statutory requirement. Applicants eligible
for supplemental funding that received greater than a 20 percent loss in their RWHAP
Part A formula award when comparing their FY 2006 award to their FY 2019 award are
eligible for and will receive priority funding.
3. Assessment of Risk and Other Pre-Award Activities
HRSA may elect not to fund applicants with management or financial instability that
directly relates to the organization’s ability to implement statutory, regulatory or other
requirements (45 CFR § 75.205).
HRSA reviews applications receiving a favorable objective review for other
considerations that include past performance, as applicable, cost analysis of the
project/program budget, assessment of your management systems, ensuring continued
applicant eligibility, and compliance with any public policy requirements, including those
requiring just-in-time submissions. HRSA may ask you to submit additional
programmatic or administrative information (such as an updated budget or “other
support” information) or to undertake certain activities (such as negotiation of an indirect
cost rate) in anticipation of an award. However, even at this point in the process, such
requests do not guarantee that HRSA will make an award. Following review of all
applicable information, HRSA’s approving and business management officials will
determine whether HRSA can make an award, if special conditions are required, and
what level of funding is appropriate.
Award decisions are discretionary and are not subject to appeal to any HRSA or HHS
official or board.
Effective January 1, 2016, HRSA is required to review and consider any information
about your organization that is in the Federal Awardee Performance and Integrity
Information System (FAPIIS). You may review and comment on any information about
your organization that a federal awarding agency previously entered. HRSA will
consider any of your comments, in addition to other information in FAPIIS in making a
judgment about your organization’s integrity, business ethics, and record of
performance under federal awards when completing the review of risk posed as
described in 45 CFR § 75.205 HHS Awarding Agency Review of Risk Posed by
Applicants.
HRSA will report to FAPIIS a determination that an applicant is not qualified (45 CFR §
75.212).
4. Anticipated Announcement and Award Dates
HRSA anticipates issuing/announcing awards prior to the start date of March 1, 2019.
VI. Award Administration Information
HRSA-19-033 39

1. Award Notices
HRSA will issue the Notice of Award prior to the start date of March 1, 2019. See
Section 5.4 of HRSA’s SF-424 Application Guide for additional information.
2. Administrative and National Policy Requirements
See Section 2.1 of HRSA’s SF-424 Application Guide.
Requirements under Subawards and Contracts under Grants
The terms and conditions in the NOA apply directly to the recipient of HRSA funds.
The recipient is accountable for the performance of the project, program, or activity;
the appropriate expenditure of funds under the award by all parties; and all other
obligations of the recipient, as cited in the NOA. In general, the requirements that
apply to the recipient, including public policy requirements, also apply to subrecipients
and contractors under grants, unless the NOA specifies an exception. See 45 CFR §
75.101 Applicability for more details.
3. Reporting
Award recipients must comply with Section 6 of HRSA’s SF-424 Application Guide and
the following reporting and review activities:
1) Program Terms Report and Program Submission. The RWHAP Part A
recipient must submit a Program Terms Report and Program Submission to HRSA
90 days after the final award is issued. The CQM Plan is included within the
Program Submission reporting requirement. HRSA will provide further information
in the award notice.
2) Estimated Unobligated Balance (UOB). The recipient must submit an estimate
of anticipated UOB and an estimate of anticipated carryover funding to HRSA no
later than December 31, 2019. HRSA will provide further information in the award
notice.
3) RWHAP Part A & MAI Final Expenditure Report. The recipient must submit a
RWHAP Part A & MAI Final Expenditure Report no later than 90 days after the end
of the 2019 budget period. HRSA will provide further information in the award
notice.
4) Annual Progress Report. The recipient must submit an Annual Progress Report
no later than 90 days after the end of the 2019 budget period. HRSA will provide
further information in the award notice.
5) Carryover Request. If applicable, the RWHAP Part A recipient must submit a
Carryover Request no later than 30 days after the Federal Financial Report (FFR)
submission deadline. HRSA will provide further information in the award notice.
6) Ryan White HIV/AIDS Program Services Report (RSR). Acceptance of this
award indicates that you assure that you will comply with data requirements of the
RSR and that you will mandate compliance by each of your subrecipients. The
HRSA-19-033 40

RSR captures information necessary to demonstrate program performance and
accountability. All RWHAP core medical and support service providers are
required to submit client level data as instructed in the RSR manual. Please refer
to the Ryan White HIV/AIDS Program Client Level Data website at
http://hab.hrsa.gov/manageyourgrant/clientleveldata.html for additional information.
Further information will be provided in the award notice.
VII. Agency Contacts
You may request additional information and/or technical assistance regarding business,
administrative, or fiscal issues related to this NOFO by contacting:
Olusola Dada
Grants Management Specialist
Division of Grants Management Operations, OFAM
Health Resources and Services Administration
5600 Fishers Lane, Mailstop 10SWH03
Rockville, MD 20857
Telephone: (301) 443-0195
Email: ODada@hrsa.gov
You may request additional information regarding the overall program issues and/or
technical assistance related to this NOFO by contacting:
Steven R. Young, MSPH
Director, Division of Metropolitan HIV/AIDS Programs
Attn: HIV/AIDS Bureau
Health Resources and Services Administration
5600 Fishers Lane, Room 09W12
Rockville, MD 20857
Telephone: (301) 443-9091
Fax: (301) 443-5271
Email: SYoung@hrsa.gov
You may need assistance when working online to submit your application forms
electronically. Always obtain a case number when calling for support. For assistance
with submitting the application in Grants.gov, contact Grants.gov 24 hours a day, 7 days
a week, excluding federal holidays at:
Grants.gov Contact Center
Telephone: 1-800-518-4726 (International Callers, please dial 606-545-5035)
Email: support@grants.gov
Self-Service Knowledge Base: https://grants-
portal.psc.gov/Welcome.aspx?pt=Grants
Successful applicants/recipients may need assistance when working online to submit
information and reports electronically through HRSA’s Electronic Handbooks (EHBs).
HRSA-19-033 41

For assistance with submitting information in HRSA’s EHBs, contact the HRSA Contact
Center, Monday-Friday, 8 a.m. to 8 p.m. ET, excluding federal holidays at:
HRSA Contact Center
Telephone: (877) 464-4772
TTY: (877) 897-9910
Web: http://www.hrsa.gov/about/contact/ehbhelp.aspx
VIII. Other Information
Technical Assistance
HRSA has scheduled following technical assistance:
Webinar
Day and Date: Thursday, July 19, 2018
Time: 2 – 4 p.m. ET
Call-In Number: 1-888-396-9925
Participant Code: 1527602#
Weblink: https://hrsa.connectsolutions.com/ryanwhite_parta_fy19/
Playback: Webinare will be available on the TARGET Center website.
Tips for Writing a Strong Application
See Section 4.7 of HRSA’s SF-424 Application Guide.
HRSA-19-033 42

Appendix A
FY 2019 AGREEMENTS AND COMPLIANCE ASSURANCES
Ryan White HIV/AIDS Program
Part A HIV Emergency Relief Grant Program
I, the Chief Elected Official of the Eligible Metropolitan Area or Transitional Grant Area
, (hereinafter referred to as the EMA/TGA) assure that:
Pursuant to Section 2602(a)(2)3, 4
The EMA/TGA will establish a mechanism to allocate funds and a Planning Council that
comports with section 2602(b).
Pursuant to Section 2602(a)(2)(B)
The EMA/TGA has entered into intergovernmental agreements with the Chief Elected
Officials of the political subdivisions in the EMA/TGA that provide HIV-related health
services and for which the number of AIDS cases in the last 5 years constitutes not less
than 10 percent of the cases reported for the EMA/TGA.
Pursuant to Section 2602(b)(4)
The EMA/TGA Planning Council will determine the size and demographics of the population
of individuals with HIV/AIDS, as well as the size and demographics of the estimated
population of individuals with HIV/AIDS who are unaware of their HIV status; determine the
needs of such population, and develop a comprehensive plan for the organization and
delivery of health and support services. The plan must include a strategy with discrete
goals, a timetable, and appropriate funding, for identifying individuals with HIV/AIDS who do
not know their HIV status, making such individuals aware of their HIV status, and enabling
such individuals to use the health and support services. The strategy should particularly
address disparities in access and services among affected subpopulations and historically
underserved communities.
Pursuant to Section 2603(c)
The EMA/TGA will comply with statutory requirements regarding the timeframe for obligation and
expenditure of funds, and will comply with any cancellation of unobligated funds.
Pursuant to Section 2603(d)
The EMA/TGA will make expenditures in compliance with priorities established by the
Planning Council/Planning Body.
Pursuant to Section 2604(a)
The EMA/TGA will expend funds according to priorities established by the Planning
Council/Planning Body, and for core medical services, support services, and administrative
3 All statutory references are to the Public Health Service Act, unless otherwise specified.
4 TGAs are exempted from the requirement related to Planning Councils, but must provide a process for
obtaining community input as described in section 2609(d)(1)(A) of the PHS Act. TGAs that have currently
operating Planning Councils are strongly encouraged to maintain that structure.
HRSA-19-033 43

expenses only.
Pursuant to Section 2604(c)
The EMA/TGA will expend not less than 75 percent of service dollars for core medical
services, unless waived by the Secretary.
Pursuant to Section 2604(f)
The EMA/TGA will, for each of such populations in the eligible area expend, from the grants
made for the area under Section 2601(a) for a FY, not less than the percentage constituted
by the ratio of the population involved (infants, children, youth, or women in such area) with
HIV/AIDS to the general population in such area of individuals with HIV/AIDS, unless a
waiver from this provision is obtained.
Pursuant to Section 2604(g)
The EMA/TGA has complied with requirements regarding the Medicaid status of providers,
unless waived by the Secretary.
Pursuant to Section 2604(h)(2), Section 2604(h)(3), Section 2604(h)(4)
The EMA/TGA will expend no more than 10 percent of the grant on administrative costs
(including Planning Council or planning body expenses), and in accordance with the
legislative definition of administrative activities, and the allocation of funds to subrecipients
will not exceed an aggregate amount of 10 percent of such funds for administrative
purposes.
Pursuant to Section 2604(h)(5)
The EMA/TGA will establish a CQM Program that meets HRSA requirements, and that
funding for this program shall not exceed the lesser of five percent of program funds or $3
million.
Pursuant to Section 2604(i)
The EMA/TGA will not use grant funds for construction or to make cash payments to
recipients.
Pursuant to Section 2605(a)
With regard to the use of funds,
a. funds received under Part A of Title XXVI of the Act will be used 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;
b. during the period of performance, political subdivisions within the EMA/TGA will
maintain at least their prior FY’s level of expenditures for HIV related services for
individuals with HIV disease;
c. political subdivisions within the EMA/TGA will not use funds received under Part A in
maintaining the level of expenditures for HIV related services as required in the
above paragraph; and
d. documentation of this MOE will be retained.
Pursuant to Section 2605(a)(3)
The EMA/TGA will maintain appropriate referral relationships with entities considered key
points of access to the health care system for the purpose of facilitating EIS for individuals
diagnosed with HIV infection.
HRSA-19-033 44

Pursuant to Section 2605(a)(5)
The EMA/TGA will participate in an established HIV community based continuum of care, if
such continuum exists within the EMA/TGA.
Pursuant to Section 2605(a)(6)
Part A funds will not be used to pay for any item or service that can reasonably be expected
to be paid under any state compensation program, insurance policy, or any Federal or
state health benefits program (except for programs related to the Indian Health Service)
or by an entity that provides health services on a prepaid basis.
Pursuant to Section 2605(a)(7)(A)
Part A funded HIV primary medical care and support services will be provided, to the
maximum extent possible, 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.
Pursuant to Section 2605(a)(7)(B)
Part A funded HIV primary medical care and support will be provided in settings that are
accessible to low-income individuals with HIV disease.
Pursuant to Section 2605(a)(7)(C)
A program of outreach services will be provided to low-income individuals with HIV disease
to inform them of the HIV primary medical care and support services.
Pursuant to Section 2605(a)(8)
The EMA/TGA has participated in the Statewide Coordinated Statement of Need (SCSN)
process initiated by the state, and the services provided under the EMA/TGA’s
comprehensive plan are consistent with the SCSN.
Pursuant to Section 2605(a)(9)
The EMA/TGA has procedures in place to ensure that services are provided by appropriate
entities.
Pursuant to Section 2605(a)(10)
The EMA/TGA will submit audits every 2 years to the lead state agency under Part B of Title
XXVI of the PHS Act.
Pursuant to Section 2605(e)
The EMA/TGA will comply with the statutory requirements regarding imposition of charges
for services.
Pursuant to Section 2681(d)
Services funded will be integrated with other such services, programs will be coordinated
with other available programs (including Medicaid), and that the continuity of care and
prevention services of individuals with HIV is enhanced.
Pursuant to Section 2684
No funds shall be used to fund AIDS programs, or to develop materials, designed to directly
promote or encourage intravenous drug use or sexual activity, whether homosexual or
heterosexual.
Signature Date
HRSA-19-033 45

Appendix B
Geographic Service Areas
Applications must propose to serve the entire service area, as defined here in
Appendix B.
The “Funding Ceiling” column identifies the total funding available for the delivery of
comprehensive primary health care and support services for low income, uninsured and
underserved PLWH for each service area. Funding requests must not exceed the
published funding ceiling amount. Please note that this amount includes MAI funding.
The MAI component of your budget must not exceed a five percent increase from your
FY 2018 MAI award.
EMA City State Funding Service area
Ceiling
Atlanta EMA Atlanta GA $27,668,037 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, and
Walton County
Baltimore EMA Baltimore MD $17,620,677 Anne Arundel County,
Baltimore City, Baltimore
County, Carroll County,
Harford County, Howard
County, and Queen Anne's
County
Boston EMA* Boston MA $15,309,898 MA: Bristol County, Essex
County, Middlesex County,
Norfolk County, Plymouth
County, Suffolk County, and
Worcester County
NH: Hillsborough County,
Rockingham County, and
Strafford County
HRSA-19-033 46

Chicago EMA Chicago IL $29,040,031 Cook County, DeKalb
County, DuPage County,
Grundy County, Kane
County, Kendall County,
Lake County, McHenry
County, and Will County
Dallas EMA Dallas TX $18,326,309 Collin County, Dallas
County, Denton County,
Ellis County, Henderson
County, Hunt County,
Kaufman County, and
Rockwall County
Detroit EMA Detroit MI $10,067,965 Lapeer County, Macomb
County, Monroe County,
Oakland County, St. Clair
County, and Wayne County
Fort Lauderdale Fort FL $16,654,320 Broward County
EMA Lauderdale
Houston EMA Houston TX $24,744,182 Chambers County, Fort
Bend County, Harris
County, Liberty County,
Montgomery County, and
Waller County
Los Angeles EMA Los Angeles CA $45,610,794 Los Angeles County
Miami EMA Miami FL $27,899,754 Miami-Dade County
Nassau-Suffolk EMA Mineola NY $5,927,042 Nassau County and Suffolk
County
New Haven EMA New Haven CT $5,869,110 Fairfield County and New
Haven County
New Orleans EMA New Orleans LA $8,216,852 Jefferson Parish, Orleans
Parish, Plaquemines Parish,
St. Bernard Parish, St.
Charles Parish, St. James
Parish, St. John the Baptist
Parish, and St. Tammany
Parish
New York EMA New York NY $100,589,013 Bronx County, Kings
County, New York County,
Putnam County, Queens
County, Richmond County,
Rockland County, and
Westchester County
Newark EMA Newark NJ $13,171,418 Essex County, Morris
County, Sussex County,
HRSA-19-033 47

Union County, and Warren
County
Orlando EMA Orlando FL $10,433,527 Lake County, Orange
County, Osceola County,
and Seminole County
Philadelphia EMA* Philadelphia PA $23,667,658 PA: Bucks County, Chester
County, Delaware County,
Montgomery County, and
Philadelphia County
NJ: Burlington County,
Camden County, Gloucester
County, and Salem County
Phoenix EMA Phoenix AZ $9,818,936 Maricopa County and Pinal
County
San Diego EMA San Diego CA $11,700,931 San Diego County
San Francisco EMA San CA $16,202,223 Marin County, San
Francisco Francisco County, and San
Mateo County
San Juan EMA San Juan PR $11,471,613 Aguas Buenas Municipality,
Barceloneta Municipality,
Bayamón Municipality,
Canóvanas Municipality,
Carolina Municipality,
Cataño Municipality, Ceiba
Municipality, Comerío
Municipality, Corozal
Municipality, Dorado
Municipality, Fajardo
Municipality, Florida
Municipality, Guaynabo
Municipality, Humacao
Municipality, Juncos
Municipality, Las Piedras
Municipality, Loíza
Municipality, Luquillo
Municipality, Manatí
Municipality, Morovis
Municipality, Naguabo
Municipality, Naranjito
Municipality, Río Grande
Municipality, San Juan
Municipality, Toa Alta
Municipality, Toa Baja
Municipality, Trujillo Alto
Municipality, Vega Alta
HRSA-19-033 48

Municipality, Vega Baja, and
Yabucoa Municipality
Tampa-St. Tampa FL $10,796,911 Hernando County,
Petersburg EMA Hillsborough County, Pasco
County, and Pinellas County
Washington, DC Washington DC $33,671,731 District of Columbia
EMA* MD: Calvert County,
Charles County, Frederick
County, Montgomery
County, and Prince
George's County
VA: Alexandria City,
Arlington County, Clarke
County, Culpeper County,
Fairfax City, Fairfax County,
Falls Church City, Fauquier
County, Fredericksburg City,
King George County,
Loudoun County, Manassas
City, Manassas Park City,
Prince William County,
Spotsylvania County,
Stafford County, and
Warren County
WV: Berkeley County, and
Jefferson County
West Palm Beach West Palm FL $7,796,721 Palm Beach County
EMA Beach
*Service area crosses state lines
HRSA-19-033 49

Current TGA City State Funding Service area
Recipient Ceiling
Austin TGA Austin TX $5,166,765 Bastrop County, Caldwell
County, Hays County,
Travis County, and
Williamson County
Baton Rouge TGA Baton Rouge LA $4,799,000 Ascension Parish, East
Baton Rouge Parish, East
Feliciana Parish, Iberville
Parish, Livingston Parish,
Pointe Coupee Parish, St.
Helena Parish, West Baton
Rouge Parish, and West
Feliciana Parish
Bergen-Passaic Paterson NJ $4,298,968 Bergen County and Passaic
TGA County
Charlotte-Gastonia Charlotte NC $6,551,004 NC: Anson County,
TGA* Cabarrus County, Gaston
County, Mecklenburg
County, and Union County
SC: York County
Cleveland-Lorain- Cleveland OH $4,965,467 Ashtabula County,
Elyria TGA Cuyahoga County, Geauga
County, Lake County, Lorain
County, and Medina County
Columbus TGA Columbus OH $4,914,156 Delaware County, Fairfield
County, Franklin County,
Licking County, Madison
County, Morrow County,
Pickaway County, and
Union County
Denver TGA Denver CO $7,997,286 Adams County, Arapahoe
County, Denver County,
Douglas County, and
Jefferson County
Fort Worth TGA Fort Worth TX $4,751,613 Hood County, Johnson
County, Parker County, and
Tarrant County
Hartford TGA Hartford CT $3,370,094 Hartford County, Middlesex
County, and Tolland County
HRSA-19-033 50

Indianapolis TGA Indianapolis IN $4,539,803 Boone County, Brown
County, Hamilton County,
Hancock County, Hendricks
County, Johnson County,
Marion County, Morgan
County, Putnam County,
and Shelby County
Jacksonville TGA Jacksonville FL $6,177,510 Clay County, Duval County,
Nassau County, and St.
Johns County
Jersey City TGA Jersey City NJ $5,312,122 Hudson County
Kansas City TGA* Kansas City MO $4,414,926 MO: Cass County, Clay
County, Clinton County,
Jackson County, Lafayette
County, Platte County, Ray
County, and Johnson
County
KS: Leavenworth County,
Miami County, and
Wyandotte County
Las Vegas TGA* Las Vegas NV $6,600,227 NV: Clark County, and Nye
County
AZ: Mohave County
Memphis TGA* Memphis TN $7,081,728 TN: Fayette County, Shelby
County, and Tipton County
AR: Crittenden County
MS: DeSoto County,
Marshall County, Tate
County, and Tunica County
Middlesex- New NJ $2,951,115 Hunterdon County,
Hunterdon- Brunswick Middlesex County, and
Somerset TGA Somerset County
Minneapolis–St. Minneapolis MN $6,156,023 MN: Anoka County, Carver
Paul TGA* County, Chisago County,
Dakota County, Hennepin
County, Isanti County,
Ramsey County, Scott
County, Sherburne County,
Washington County, and
Wright County
WI: Pierce County and St.
Croix County
HRSA-19-033 51

Nashville TGA Nashville TN $4,567,926 Cannon County, Cheatham
County, Davidson County,
Dickson County, Hickman
County, Macon County,
Robertson County,
Rutherford County, Smith
County, Sumner County,
Trousdale County,
Williamson County, and
Wilson County
Norfolk TGA* Norfolk VA $6,196,083 VA: Chesapeake City,
Gloucester County,
Hampton City, Isle of Wight
County, James City County,
Mathews County, Newport
News City, Norfolk City,
Poquoson City, Portsmouth
City, Suffolk City, Virginia
Beach City, Williamsburg
City, and York County
NC: Currituck County
Oakland TGA Oakland CA $7,410,456 Alameda County and Contra
Costa County
Orange County TGA Santa Ana CA $6,526,898 Orange County
Portland TGA* Portland OR $4,228,443 OR: Clackamas County,
Columbia County,
Multnomah County,
Washington County, and
Yamhill County
WA: Clark County
Riverside-San San CA $8,037,071 Riverside County and San
Bernardino TGA Bernardino Bernardino County
Sacramento TGA Sacramento CA $3,546,391 El Dorado County, Placer
County, and Sacramento
County
HRSA-19-033 52

Saint Louis TGA* St. Louis MO $6,604,899 MO: Franklin County,
Jefferson County, Lincoln
County, St. Charles County,
St. Louis City, St. Louis
County, and Warren County
IL: Clinton County, Jersey
County, Madison County,
Monroe County, and St.
Clair County
San Antonio TGA San Antonio TX $5,585,867 Bexar County, Comal
County, Guadalupe County,
and Wilson County
San Jose TGA San Jose CA $3,280,660 Santa Clara County
Seattle TGA Seattle WA $7,346,512 Island County, King County,
and Snohomish County
*Service area crosses state lines
HRSA-19-033 53