APPENDIX A.PDF

Appendix A
FY 2015 AGREEMENTS AND COMPLIANCE
ASSURANCES
Ryan White HIV/AIDS Program
Part-A 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) 1, 2
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 I-ITV/AIDS who are unaware of their }]IV 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 unobligatecl
funds.
Pursuant to Section 2603(d)
The EMA/TGA will make expenditures in compliance with priorities established by the
Planning Council.
Pursuant to Section 2604(a)
The EMA/TGA will expend funds according to priorities established by the Planning
Council, and for core medical services, support services, and administrative expenses only.
All statutory references are to the Public Health Service Act, unless otherwise specified.
The six new TGAs (Baton Rouge, Columbus, Charlotte, Indianapolis, Memphis, and Nashville)
are exempted from these requirements, but must provide a process for obtaining community
input as described in Section 2609(d)(1)(A).
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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 EMAJTGA will, for each of such populations in the eligible area use, from the grants
made for the area under Section 2601(a) for a FY. expend not less than the percentage
constituted by the ratio of the population involved (infants, children, youth, or women in such
area) with IIIV/A1DS 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(4)(3), Section 2604(h)(4)
The EMA/TGA will expend no more than 10 percent of the grant on administrative costs, and
in accordance with the leaislative definition of administrative activities and the allocation of
funds to entities and subcontractors, will not exceed an aggregate amount of 10 percent of
such funds for administrative purposes.
Pursuant to Section 2604(1)(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 5 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 PHS Act will be used to supplement,
not supplant, state funds made available in the year for which the grant is awarded to
provide ETV related services to individuals with HIV disease:
b. during the grant period, 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 FIIV related services as required in the
above paragraph; and
d. documentation of this MOE will be retained.
Pursuant to Section 2605(a)(3)
The EMAJTGA will maintain appropriate referral relationships with entities considered
key points of access to the healthcare system for the purpose of facilitating EIS for
individuals diagnosed as being HIV positive.
Pursuant to Section 2605(05)
The EMAJTGA will participate in an established HIV community based continuum of care,
if such continuum exists within the EMA/T'GA
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Pursuant to Section 2605(06)
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)(13)
Part A funded ELIV primary medical care and support will be provided in set -firms 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 such services
Pursuant to Section 2605(08)
The EMAJTGA has participated in the Statewide Coordinated Statement of Need (SCSN)
process initiated by the state, and the services provided under the EMAJTGA'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(010)
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 proQrams (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 promote
or encourage, directly, intravenous drug use or sexual activity, whether homosexual or
heterosexual.
Date
Signature
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