Notice2021-21241
Final Policy: Updates to Uniform Standard for Waiver of the Ryan White HIV/AIDS Program Core Medical Services Expenditure Requirement
Primary source
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Published
October 1, 2021
Effective
October 1, 2021
Issuing agencies
Health and Human Services DepartmentHealth Resources and Services Administration
Abstract
The Ryan White HIV/AIDS Program (RWHAP) statute of the Public Health Services Act requires that RWHAP Part A, B, and C recipients expend not less than 75 percent of Parts A, B, and C grant funds on core medical services for individuals with HIV/AIDS identified and eligible under the statute, after reserving statutory permissible amounts for administrative and clinical quality management (CQM) costs. The statute also grants the Secretary of HHS authority to waive this requirement if certain requirements are met. HRSA has simplified the process for RWHAP Part A, B, and C recipients to request a waiver of the core medical services expenditure amount requirement by replacing HRSA Policy Number 13-07, "Uniform Standard for Waiver of Core Medical Services Requirement for Grantees Under Parts, A, B, and C" with Policy Notice 21-01, "Waiver of the Ryan White HIV/AIDS Program Core Medical Services Expenditure Requirement."
Full Text
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<title>Federal Register, Volume 86 Issue 188 (Friday, October 1, 2021)</title>
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[Federal Register Volume 86, Number 188 (Friday, October 1, 2021)]
[Notices]
[Pages 54458-54462]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2021-21241]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Final Policy: Updates to Uniform Standard for Waiver of the Ryan
White HIV/AIDS Program Core Medical Services Expenditure Requirement
AGENCY: Health Resources and Services Administration (HRSA), Department
of Health and Human Services (HHS).
ACTION: Notice of final policy.
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SUMMARY: The Ryan White HIV/AIDS Program (RWHAP) statute of the Public
Health Services Act requires that RWHAP Part A, B, and C recipients
expend not less than 75 percent of Parts A, B, and C grant funds on
core medical services for individuals with HIV/AIDS identified and
eligible under the statute, after reserving statutory permissible
amounts for administrative and clinical quality management (CQM) costs.
The statute also grants the Secretary of HHS authority to waive this
requirement if certain requirements are met. HRSA has simplified the
process for RWHAP Part A, B, and C recipients to request a waiver of
the core medical services expenditure amount requirement by replacing
HRSA Policy Number 13-07, ``Uniform Standard for Waiver of Core Medical
Services Requirement for Grantees Under Parts, A, B, and C'' with
Policy Notice 21-01, ``Waiver of the Ryan White HIV/AIDS Program Core
Medical Services Expenditure Requirement.''
DATES: The final policy is effective on October 1, 2021.
FOR FURTHER INFORMATION CONTACT: Lieutenant Commander Emeka Egwim, U.S.
Public Health Service, Senior Policy Analyst, Division of Policy &
Data, HRSA, HIV/AIDS Bureau, 5600 Fishers Lane, Rockville, MD 20857,
Phone: (301) 945-9637 or by emailing <a href="/cdn-cgi/l/email-protection#dc8e8b949d8c8cb3b0b5bfa59cb4aeafbdf2bbb3aa"><span class="__cf_email__" data-cfemail="6e3c39262f3e3e0102070d172e061c1d0f40090118">[email protected]</span></a>. When
requesting information, please include this Federal Register notice
title for reference.
SUPPLEMENTARY INFORMATION: The RWHAP statute also grants the Secretary
of HHS authority to waive this requirement for RWHAP Parts A, B, or C
recipients if a number of requirements are met and a waiver request is
submitted to HRSA for approval. RWHAP Part A, B, and C core medical
services waiver requests--if approved--are effective for a 1-year
budget period, and apply to funds awarded under the Minority AIDS
Initiative.
Currently, for a core medical services waiver request to be
approved, (1) core medical services must be available and accessible to
all individuals identified and eligible for the RWHAP in the
recipient's service area within 30 days, without regard to payer
source; (2) there cannot be any AIDS Drug Assistance Program (ADAP)
waiting lists in the recipient's service area; and (3) a public process
to obtain input on the waiver request from impacted communities,
including clients and RWHAP-funded core medical services providers, on
the availability of core medical services and the decision to request
the waiver must have occurred. The public process may be a part of the
same one used to seek input on community needs as part of the annual
priority setting and resource allocation, comprehensive planning,
statewide coordinated statement of
[[Page 54459]]
need, public planning, and/or needs assessment processes.
HRSA has simplified the waiver request process for RWHAP Parts A,
B, and C recipients by revising and replacing HRSA Policy Number 13-07:
Uniform Standard for Waiver of Core Medical Services Requirement for
Grantees Under Part, A, B, and C. The changes reduce the administrative
burden for recipients by lessening the documentation they must submit
to HRSA when requesting a waiver. Under this final policy, recipients
are required to submit a one-page ``HRSA RWHAP Core Medical Services
Waiver Request Attestation Form'' to HRSA in lieu of the multiple
documents previously required to submit a waiver request.
HRSA also revised the waiver request submission deadlines. This
final policy, ``Waiver of the Ryan White HIV/AIDS Program Core Medical
Services Expenditure Requirement,'' replaces HRSA Policy Number 13-07
effective October 1, 2021.
In administering the RWHAP, HRSA continually evaluates its policies
and processes, and considers making updates where necessary to ensure
programmatic efficiency while facilitating recipients' ability to
provide care and support services to people with HIV. To inform its
policy evaluation and development processes with perspectives
representative of the communities served by the RWHAP, HRSA welcomes
and considers input from stakeholders of the RWHAP, including
recipients, providers, people with HIV, and the general public. To that
end, on April 20, 2021, HRSA sought public input when it published the
proposed updates to the waiver request process for RWHAP Parts A, B,
and C recipients in the Federal Register (86 FR 20500), and released a
listserv message informing stakeholders where to access and review the
Federal Register notice. In addition, during the April 27, 2021, ``HAB
You Heard'' RWHAP recipient webinar, HRSA conducted a walkthrough of
the proposed policy, comparing and contrasting it to the existent
policy outlined in HRSA Policy Number 13-07. Subsequently, on August
20, 2021, HRSA published a Federal Register notice for 30-day public
comment period, and submitted the ICR to OMB for review and approval.
Overview of Public Comments
In response to the proposed policy published in 86 FR 20500, HRSA
received 52 responses from stakeholders. The vast majority of
respondents were individuals from the general public, followed by RWHAP
recipients and HIV patient care advocacy organizations. HRSA considered
all feedback in the finalization of the policy, and a discussion of the
public comments is included below.
Discussion of Public Comments on the Proposed Policy
Availability of Core Medical Services, ADAP Waiting Lists, and Evidence
of a Public Process
Public Comment: Commenters were unanimously supportive of
submitting a one-page attestation form in lieu of the multiple pages of
supporting documentation required per HRSA Policy Number 13-07 because
it would reduce administrative burden. They were equally supportive of
the stipulation that, if requested, recipients would need to submit
supportive documentation to HRSA if requested.
Response: HRSA appreciates the comments and agrees the new policy
will reduce burden for recipients, as well as for HRSA as it reviews
the waiver applications. HRSA is finalizing the policy as proposed. As
such, when submitting waiver requests, RWHAP recipients will only need
to submit the one-page ``HRSA RWHAP Core Medical Services Waiver
Request Attestation Form'' to HRSA in lieu of multiple documents
currently required to submit a waiver request. HRSA may request
additional information or supporting documentation. HRSA approximates
this process would require 4 hours per response, representing a
reduction of 1.5 hours when compared to the current process, or a total
of 88 hours across all recipients expected to submit a waiver
application.
Submission Deadlines
Public Comment: Commenters were supportive of the proposed changes
regarding waiver request submissions deadlines. One commenter expressed
some concern that specific submission deadlines may reduce flexibility
for some recipients and may not take into account the urgency of a
potential waiver in the case of an emergency or unexpected situation on
the part of the recipient. The commenter recommended that HRSA
adequately advertise this tenet of the policy and evaluate the
deadlines to ensure this change does not adversely impact recipients.
Response: HRSA will finalize the policy as proposed by requiring
specific submission deadlines. RWHAP Part A recipients will need to
submit the waiver request as an attachment with the grant application
or non-competing continuation (NCC) progress report. RWHAP Part B
recipients will need to submit the waiver request either in advance of
the grant application, with the grant application, with the mandatory
NCC progress report, or up to 4 months into the grant award budget
period for which the waiver is being requested. RWHAP Part C recipients
will need to submit the waiver request as an attachment with the grant
application or the mandatory NCC progress report. HRSA thanks the
commenters for their input, and will monitor the impact of the new
policy on the RWHAP in order to ensure recipients' ability to timely
submit waiver requests and their ability to provide care and support
services to people with HIV.
Concluding Points
HRSA continues to find opportunities to streamline its policies and
processes to facilitate RWHAP recipients' ability to continue to
deliver quality care and support services to people with HIV, while
increasing HRSA's efficiency in administering the program. Given the
participation of RWHAP stakeholders in the public process, HRSA
believes HRSA Policy Number 21-01 titled ``Waiver of the Ryan White
HIV/AIDS Program Core Medical Services Expenditure Requirement'' meets
the overall goal and objective of the RWHAP, and is inclusive of the
perspectives of stakeholders, while reducing burden to RWHAP
recipients. HRSA expects a period of adjustment to the new process. To
that end, HRSA will provide timely technical assistance and other
resources to assist recipients with the transition to and
implementation of the final policy. Recipients are encouraged to
contact HRSA at <a href="/cdn-cgi/l/email-protection#a2f0f5eae3f2f2cdcecbc1dbe2cad0d1c38cc5cdd4"><span class="__cf_email__" data-cfemail="91c3c6d9d0c1c1fefdf8f2e8d1f9e3e2f0bff6fee7">[email protected]</span></a> for questions or feedback on the
new process.
HRSA remains committed to supporting RWHAP recipients in their
provision of care and support services to people with HIV. The
finalization of HRSA Policy Number 21-01, which reduces burden for
recipients requesting a waiver of the Core Medical Services expenditure
requirement, is another step indicative of this commitment.
The final policy is set forth below. Upon its Effective Date of
October 1, 2021, the policy replaces HRSA Policy Number 13-07.
[[Page 54460]]
Waiver of the Ryan White HIV/AIDS Program Core Medical Services
Expenditure Requirement
Policy Notice 21-01
Replaces Policy Number 13-07
Scope of Coverage
HRSA HIV/AIDS Bureau RWHAP Parts A, B, and C
Requirements
A HRSA RWHAP Part A, B, or C recipient must meet a number of
requirements and submit a waiver request to HRSA to receive a waiver of
the core medical services expenditure requirement. First, core medical
services must be available and accessible to all individuals identified
and eligible for the RWHAP in the recipient's service area within 30
days. Access to core medical services must be without regard to payer
source and without the need to spend at least 75 percent of funds
remaining from the recipient's RWHAP award after statutory permissible
amounts for administrative and CQM are reserved. Second, the HRSA RWHAP
recipient must ensure there are no ADAP waiting lists in its service
area. Third, a public process to obtain input on the waiver request
must have occurred. This process must seek input from impacted
communities, including clients and RWHAP-funded core medical services
providers on the availability of core medical services and the decision
to request the waiver. The public process may be a part of the same one
used to seek input on community needs as part of the annual priority
setting and resource allocation, comprehensive planning, statewide
coordinated statement of need, public planning, and/or needs assessment
processes.
Requesting a Waiver
To request a waiver, the Chief Elected Official, Chief Executive
Officer, or a designee of either must complete and submit the HRSA
RWHAP Core Medical Services Waiver Request Attestation Form (appended
below) to HRSA. The form should be submitted according to the
applicable deadlines and methods for submission outlined below. By
completing and submitting this form, the Chief Elected Official, Chief
Executive Officer, or a designee of either attests to meeting the
requirements outlined above and agrees to provide supportive evidence
to HRSA upon request. No other documentation is required to be
submitted with the HRSA RWHAP Core Medical Services Waiver Request
Attestation Form.
Deadlines for Submitting Waiver Requests
HRSA RWHAP Part A Waiver Requests
A HRSA RWHAP Part A recipient's request for a waiver should be
submitted as an attachment with the grant application or the mandatory
NCC progress report, if applicable. In each case, waiver requests do
not count towards the submission page limit. Requests for waivers
should not be submitted prior to the grant application or mandatory NCC
progress report, nor should they be submitted after the start of the
grant award budget period for which the waiver is being requested.
HRSA RWHAP Part B Waiver Requests
A HRSA RWHAP Part B recipient's request for a waiver may be
submitted either in advance of the grant application, as an attachment
to the grant application, with the mandatory NCC progress report, or up
to 4 months into the grant award budget period for which the waiver is
being requested.
HRSA RWHAP Part C Waiver Requests
A HRSA RWHAP Part C recipient's request for a waiver should be
submitted as an attachment to the grant application or the mandatory
NCC progress report. Requests for waivers should not be submitted prior
to the grant application or mandatory NCC progress report, nor should
they be submitted after the start of the grant award budget period for
which the waiver is being requested.
Methods for Submitting Waiver Requests
Waiver requests submitted with grant applications must be submitted
through <a href="http://www.grants.gov">www.grants.gov</a>. Waiver requests submitted with the mandatory
NCC progress report must be submitted through the HRSA Electronic
Handbooks (EHB). For waiver requests that are not submitted with grant
applications, and not submitted with the mandatory NCC progress report,
a recipient must notify its HRSA project officer of its intention to
request a waiver. The project officer will initiate a Request for
Information in the EHB. The recipient must respond to the EHB task
consistent with the deadlines for submitting waiver requests outlined
above.
Waiver Review and Notification Process
HRSA will review requests and notify recipients of waiver approval
or denial within 4 weeks of receipt of the request.
Approved core medical services waivers will be effective for the 1-
year budget period for which it is approved; recipients must submit a
new request for each budget period. A recipient approved for a core
medical services waiver is not required to implement the approved
waiver if it is no longer needed.
This guidance does not have the force and effect of law and is not
meant to bind the public in any way, except as authorized by law or as
incorporated into a contract. It is intended only to provide clarity to
the public regarding existing requirements under the law or agency
policies.
BILLING CODE 4165-01-P
[[Page 54461]]
[GRAPHIC] [TIFF OMITTED] TN01OC21.000
[[Page 54462]]
Diana Espinosa,
Acting Administrator.
[FR Doc. 2021-21241 Filed 9-30-21; 8:45 am]
BILLING CODE 4165-15-C
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