Overview of Site Visit Process

1. Overview of Site Visit Process Ryan White HIV/AIDS Program Part C, D, and F-Dental Department of Health and Human Services Health Resources and Services Administration HIV/AIDS Bureau Division of Community HIV/AIDS Programs Fiscal

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

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

4. Webinar Outline • Overview of HRSA/HAB • Authorities that Govern Site Visits • Ryan White HIV/AIDS Program Parts A,B,C,D, and F, and MAI • Monitoring Site Visits • Site Visit Roles and Responsibilities • Team Member Professional Standards • Site Visit Assessment Tool • Site Visit Reporting Criteria • Tips for Writing a Concise and Comprehensive Report

5. Vision Healthy Communities, Healthy People Mission To improve health and achieve health equity through access to quality services, a skilled health workforce, and innovative programs. Health Resources and Services Administration (HRSA)

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

7. Authority • The site visit process is governed by: • Ryan White HIV/AIDS Legislation • Title XXVI of the Public Health Service Act • HAB Policy Notice • National HIV/AIDS Strategy • Funding Opportunity Announcement

8. Ryan White HIV/AIDS Legislation • Congress enacted the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act in 1990 to improve the quality and availability of care for low-income, uninsured, and underinsured individuals and families affected by HIV disease. The CARE Act was amended and reauthorized in 1996, 2000, and 2006; in 2009 it was reauthorized as the Ryan White HIV/ AIDS Treatment Extension Act of 2009 (Public Law 111–87).

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

10. Title XXVI of the Public Health Service Act- examines the authority of the government at various jurisdictional levels to improve the health of the general population within societal limits and norms. • HAB Policy Notices- provide updates from HAB regarding clarification of legislation and policies. • Funding Opportunity Announcement (FOA)- explains the availability of a Federal grant funding opportunity and application process and is released through Grants.gov.

11. National HIV/AIDS Strategy Goals

12. Ryan White HIV/AIDS Program • Parts A,B,C,D, and F, and the Minority AIDS Initiative

13. Ryan White HIV/AIDS Program

14. Ryan White HIV/AIDS Program Administration

15. Ryan White HIV/AIDS Program Part A Emergency assistance to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs) that are most severely impacted by the HIV/AIDS epidemic Award made to Chief Elected Official Funding allocations determined by Planning Council Part A funds distribution: 2/3 by formula – based on the number of living cases of HIV (non AIDS) and AIDS 1/3 supplemental – competitive grant process

16. Ryan White HIV/AIDS Program Part B Base Grant - Provides grants to all 50 States, the District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands, 6 Pacific jurisdictions to pay for care for people living with HIV/AIDS For jurisdictions with >1 percent of nation’s HIV/AIDS cases, match required $1 state: $2 federal Funds distributed by formula based on HIV/AIDS cases Award made to Chief Elected Official AIDS Drug Assistance Program (ADAP) pays for: Medications to treat HIV disease Insurance continuation for eligible clients Services that enhance access, adherence, and monitoring of drug treatment

17. Part C EIS Overview Purpose: To provide comprehensive continuum of outpatient HIV primary care in a service area. Required Services: HIV counseling, testing, and referral Medical evaluation and clinical care Other primary care services Referrals to other health services Medical Model of Care: Assess Treat Refer

18. Part D WICY Overview Purpose: To provide family-centered primary medical care to women, infants, children, and youth (WICY) living with HIV/AIDS when payments for such services are unavailable from other sources.

19. Ryan White HIV/AIDS ProgramPart F / Dental

20. Minority AIDS Initiative (MAI) • Goal: To help reduce the disproportionate impact of HIV/AIDS and address disparities by: • Increasing the number of persons from racial and ethnic minority populations receiving HIV care, and • Increasing the number of persons from racial and ethnic minority populations who stay in care. • MAI funds awarded are noted under the grant specific terms section of the Notice of Award (NoA) which establishes the final funding for the budget period. Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87,October 30,2009), §2693

21. MonitoringSite Visits

22. DCHAP Site Visits

23. Ryan White HIV/AIDS ProgramCompliance Monitoring HRSA/HAB conducts ongoing review and monitoring of grantees

24. Why Do We Conduct Site Visits? • Support DCHAP’s mission to provide grantee oversight in the delivery of comprehensive high quality HIV primary and oral health care. • Verify the grantee’s program is in compliance with the Ryan White Legislative & Programmatic requirements. 3. Ensure highest quality HIV clinical care and compliance with HHS Guidelines. 4. Ensure administrative and fiscal integrity. 5. Identify technical assistance needs to address any program deficiencies.

25. What Can “Trigger” a Site Visit? • - Need for an initial site visit for newly awarded grantee or comprehensive site visit for established grantee • - Low score on recent competitive application or lack of progress reflected within non-competing report • - Habitual and problematic staff turnover for grantee • - Lack of communication with Project Officer • - Continually failing to meet work plan objectives • - A sense on the part of the Project Officer/Branch Chief that “something’s just not right” with the grantee’s program • - Media attention • - Known financial problems • - Problematic spend-down patterns and/or multiple years with unobligated balances • - Draw down restrictions

26. Goal of Site Visit Timeline

27. Goal of Site Visit Timeline continued

28. Pre-Site Visit Prep • Pre-Site Visit Preparation • Copy of most recent applicable Funding Opportunity Announcement (FOA) • Most recent Competing Application and Non-Competing Progress Report • Most recent Ryan White Services Report (RSR) • Three most recent Federal Financial Reports • Current line item budget and justification • Copies of any previous Site Visit Reports (as applicable) • Most recent A-133 Audit 2. Team Pre-Site Visit Conference Call • Team Leader, Consultant Team Members and Project Officer. 3. Pre-Site Visit Conference Call with the Grantee

29. How Does Grantee Prepare for the Site Visit? • Extensive instructions from their Project Officer • Materials provided to grantee: • Site Visit Assessment Tool • Pre-Site Visit Conference Call Agenda • List of “Materials to be Available” for review on-site • Sample Site Visit Agenda • “Site Visit Evaluation Form” 3. Site Visit Agenda jointly developed with Team Leader

30. Site Visit Roles and Responsibilities

31. Pre-Site Visit ActivitiesRole of Project Officer

32. Pre-Site Visit ActivitiesRole of Team Leader

33. Pre-Site Visit ActivitiesRole of Team Leader Pre-Site Visit Conference Call • Facilitates the Pre-Site Visit Conference Call (re-iterate purpose, introduce Team, and ensure that a review of the site visit process is presented to the grantee). • Ensures the grantee will arrange for a confidential Consumer Panel interview (preferably during a lunch). • Ensures the grantee’s necessary staff and subcontractors (if applicable) are available for interviews during the site visit.

34. Pre-Site Visit ActivitiesRole of Team Members • Responsible for making personal travel arrangements with contractor. • Reads the Pre-Site Visit Informational Packet. • Responsible for participating on the Pre-Site Visit Conference Call. • Makes him/herself directly available by phone or email to the other Consultants and to the grantee’s staff.

35. On-Site ActivitiesRole of Project Officer

36. On-Site ActivitiesRole of Project Officer (cont)

37. On-Site ActivitiesRole of Team Leader

38. On-Site ActivitiesRole of Team Leader (cont)

39. On-Site ActivitiesRole of Team Members • Participates in the following meetings: Entrance Conference, Consumer Panel, Pre-Exit and/or Exit Conference. • Efficiently conducts review of materials and staff interviews. • “Checks-in” with the Project Officer and Team Leader on a regular basis. • Is fully prepared to make their remarks at the Pre-Exit and/or Exit Conference.

40. Post-Site Visit ActivitiesRole of Team Members • Submit written report to Team Leader within one week of completion of site visit. • Provide any clarification or edits as requested.

41. Post-Site Visit ActivitiesRole of Team Leader • Compiles and submits final Site Visit Report within two weeks of completion of site visit. • Contacts Team Members for edits requested by Project Officer.

42. Post-Site Visit ActivitiesRole of Project Officer • Reviews and provides feedback to Team Leader on Site Visit Report. • Assures the completion and release of the Site Visit Report to the grantee within four weeks of the conclusion of the site visit. • Monitors completion of grantee’s Corrective Action Plan and provides technical assistance when necessary.

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

44. Team Member Professional Standards

45. Confidentiality • CONFIDENTIALITY: • As a Consultant, you must fully understand the confidential nature of the site visit discussions related thereto and agree: • (1) to return all copies of review-related materials; • (2) to erase all electronic review-related materials; • (3) not to discuss these materials or the site visit review proceedings with any individual except the staff of Health Resources and Services Administration (HRSA) and Grants Management Officials; and • (4) to refer all inquiries made concerning any aspect of the review proceedings to the HRSA Project Officer in charge of the review.

46. Team Member Professional Standards • Maintain utmost degree of professionalism at all times. • Strike a balance in decorum. Avoid opposite extremes - being condescending or being overly-friendly. • Avoid expressing personal opinions on the policies and procedures of DHHS, HRSA, or HAB. Avoid personal biases (“That’s not how WE do it at OUR clinic.”)

47. Team Member Professional Standards • Refrain from conducting personal business on Federal time. • Avoid even the slightest PERCEPTION of a “Conflict of Interest.” • Never market personal consulting services or products (e.g. books you have authored, etc.).

48. Team Member Professional Standards • Refrain from accepting significant gifts, meals, drinks, etc. from grantees. Items of nominal value (e.g. t-shirt, pens, button, coffee mug, etc.) are permissible. • If the Consumer Panel is during lunch (optimal), the Team Members are expected to contribute their portion of the cost of the meal.

49. Team Member Professional Standards • Be respectful of the time and availability of the grantee’s staff, consumers, Board Members, and subcontractors. • Be thorough in your review with as little disruption of the grantee’s workplace as possible. • Be respectful of your fellow Team Members’ time and efforts. • Be fully prepared for Pre-Exit and Exit Conferences. • Be respectful of the grantee’s organizational culture! • Frame your closing remarks to be sensitive to the culture of the grantee.

50. Site Visit Assessment Tool