1. Conversations with the Division of Metropolitan HIV/AIDS Programs – “Fiscal Update” January 31, 2017

2. Webinar Description and Agenda
This webinar will provide an overview and update on critical and emerging fiscal issues for Part A programs and include recipient presentations and interaction across Part A program staff to include:
•             Part A Administrative Updates
•             Federal Financial Report (FFR) Submission Requirements
•             Advance Payment
•             Monitoring and Utilization of Program Income
•             Differentiation of Clinical Quality Management and Administrative Costs

3. Part A Administrative Updates
Part A Awards
Comprehensive Site Visits
Integrated Plan Reviews
Special Projects
Future Webinars
Division of Metropolitan HIV/AIDS Programs (DMHAP) Strategic Planning

4. Division of Metropolitan HIV/AIDS Programs _____________________________________
Mission:
Provide leadership that promotes access to and retention in high quality treatment and support services for people living with HIV in metropolitan areas
DMHAP – Agent of Change and Innovation
1st year a Period of Coalescence; then:
Change agent;
Fostering innovation;
Forward thinking;
Analyze old & emerging issues w/ sensitivity to the needs of PLWH.
DMHAP has & will continue to push the envelope 4

5. Part A FFR and Carryover Process
FFR and Carryover Topics
Understanding the FFR
FFR Reconciliation
Carryover review and approval

6. HRSA FFRs FFR
Must be submitted annually through the Electronic Hand Book (EHB); due date aligned with Payment Management System (PMS) quarterly due date (currently July 30, 2017)
Used to report on annual expenditures, annual unobligated balances (UOB) by funding source and Program Income
The Reporting Requirements section of the Notice of Award (NoA) states specific due date – if when there is a change, Reporting Requirements section will be updated via a new NoA
UOB Penalties - If unobligated balances of formula award exceed five percent, two penalties are imposed:
1. Future year award is reduced by amount of UOB less the amount of approved carryover; and
2. The grantee is not eligible for a future year supplemental award
(see HAB PCN for additional information)
All Part A FFRs are considered final, and may not contain Unliquidated Obligations

7. Part A Final FFR

8. Part A – Award Totals by Source

9. This line cannot be used on the annual FFR
Transaction Section
10d. – Populated from EHBs- this is the total authorized amount and includes any carryover funds
This line cannot be used on the annual FFR

10. FFR – Program Income*
*For additional information and clarification on what constitutes program income and how it should be used, please refer to HAB PCN #15-03

11. FFR UOB Breakout
These amounts will auto- populate based on the awarded amounts reflected on the Notice(s) of Award (including carryover)
The amounts in these 2 columns are based on the amounts reported by the recipient when the FFR is filled out, and the sum of which must match the total available UOB.
These amounts are the unobligated balances of any funds previously carried over, and not the amount of funds the recipient plans to carry over!

12. FFR – Carryover Disposition
This represents the total UOB from all sources, and may include some amounts that are not eligible for carryover

13. FFR – Remarks

14. Supporting Documents

15. Review FFR Review and Reconciliation
The Grants Management Specialist (GMS) FFR review consists of determining the accuracy and completeness of reported information
This is done through a comparison of awarded amounts, expenditures, and financial reconciliation
Financial reconciliation is the comparison of the data reported on the FFR, the data reported to the PMS, and the amount of funds actually drawn from the account

16. Reconciliation PMS Report Total Amt Authorized Total Amt Expended
Total Amount Drawn
14H89HA000XX
7,084,881.00
6,263,859.25
FY-CAN-CFDA
14,150.00
42,966.00
17,178.00
210,529.50
348,831.00
7,144.75
46,040.00
460,136.00
501,942.00
3,987,453.00
4,190,965.00
1,524,302.00
1,101,787.25

17. Part A Carryover Process
Carryover Basics
Carryover must be submitted within 30 days of submission of the FFR, but no later August 29th
Request must include:
Explanation of why the recipient was unable to expend the funds, as well as the source of the funds by service category
Line item budget and budget narrative
Explanation of how the fund will be used during current budget year
Breakout of carryover request based on funding source*
*Please note that supplemental funds are not eligible for carryover, and any UOB from this funding source will be used as an offset on the next available award

18. FFRs and Carryover Together
Part A Carryover Process
FFRs and Carryover Together
Submission and acceptance of FFR
Submission of Carryover
Programmatic Review
Division of Grants Management Office (DGMO) Review
Issuance of NoA

19. Part A Carryover Process

20. Part A Carryover Process

21. Part A Carryover Process
Once carryover request is submitted, DGMO waits for programmatic approval before reviewing/approving the request
Approval Process in EHB: Project Officer → Branch Chief → Deputy/Division Director → GMS → QC/Branch Chief
Part A carryovers require 2 actions to complete:
Deobligation of funds from old award
Reobligation of funds to new award
Both actions must be processed in the same calendar month
A carryover is not official until the second NoA is released

22. Common Reasons Carryover Requests are Delayed:
FFR has not been submitted
FFR was incorrectly submitted and requires revision
Funding source by sub-program/prior year UOB not submitted correctly or properly explained

23. Common Reasons Carryover Requests are Disapproved or Reduced:
Funds are requested for inappropriate items or restricted funds, such as requests for use of funds from restricted sources (prior year carryover/supplemental funds) or for unallowable costs
Incorrect calculation of UOB
Late submission of FFR or carryover request in EHB

24. Advance Payment
Requirement for Recipients and Subrecipients – 45 CFR §75.305(b)(1)
Implementation Approaches

25. Discussion - Monitoring and Utilization of Program Income
At this time we request that everyone respond to the poll questions that will appear on your screen so that we may discuss.

26. Important Policy Clarification Notices
Clinical Quality Management
Important Policy Clarification Notices
15-01 Treatment of Costs under the 10% Administrative Cap for Ryan White HIV/AIDS Program Parts A, B, C, and D
15-02 Clinical Quality Management Policy Clarification Notice
notices-and-program-letters
Two policy clarification notices are important when considering if expenses are treated as an administrative cost or clinical quality management cost. These policy clarification notices are and
These policy clarification notices provide valuable information to guide you as your prepare your budget.
You can find these and other policy clarification notices and corresponding frequently asked questions under the program and grants management tab on the HIV/AIDS Bureau website or at the address listed on the slide.

27. 15-01 Treatment of Costs under the 10% Administrative Cap for Ryan White HIV/AIDS Program Parts A, B, C, and D (page 3)
For all recipients (grantees) funded by RWHAP Parts A, B, C, or D, costs subject to the 10% administrative cap include, but are not limited to:
Routine grant administration and monitoring activities,
Preparation of routine programmatic and financial reports
Subrecipient monitoring activities including telephone consultation, written documentation, and onsite visits
Policy clarification notice outlines costs that are allowable under the administrative cost category. There are a variety of administrative costs that are explained in the policy clarification notice. From page 3 of the policy clarification notice, I have highlighted a few administrative costs. These are costs that we have discussed with grant recipients. The routine grant activities including routine reporting (AKA RSR) and monitoring of subrecipients is considered an administrative activity; and therefore, allocated to the administrative cost category.

28. 15-02 Clinical Quality Management Policy Clarification Notice
A clinical quality management program is the coordination of activities aimed at improving patient care, health outcomes, and patient satisfaction.
Infrastructure
Performance measurement
Quality improvement
The other policy clarification notice I wanted to highlight is Policy clarification notice provides background information regarding clinical quality management program, the components of a clinical quality management program, and other related concepts (grant administration and quality assurance activities). The components are: infrastructure, performance measurement, and quality improvement. The expenses directly related to your clinical quality management program and components can be allocated under the clinical quality management cost category.
Most of the clinical quality management costs are clear cut – meaning easily identify and allocate to the clinical quality management cost category. A examples include: staff time and effort to support the clinical quality management program including staff who direct and coordinate the clinical quality management program activities, analyze performance measure data train subrecipient on quality improvement tools and techniques.

29. Policy Clarification Notice 15-02: Quality Assurance
Quality assurance refers to a broad spectrum of activities aimed at ensuring compliance with minimum quality standards (e.g. site visits and chart reviews).
Quality assurance is not the same as quality improvement. Data collected as part of quality assurance processes should feed back into the clinical quality management program to ensure improvement in patient care, health outcomes, and patient satisfaction.
Quality assurance is part of the larger administrative function of a recipient’s program or organization and informs the clinical quality management program, but quality assurance activities by themselves do not constitute a clinical quality management program.
The CQM PCN also talk in a little more depth about quality assurance.
Quality assurance activities are defined as a broad spectrum of activities aimed at ensuring compliance with minimum quality standards. By compliance with minimum quality standards we mean conducting site visits to assure the subrecipient is compliant with the national monitoring standards, local service standards/standards of care. Much of this compliance is completed through site visits and chart reviews. As you can see, quality assurance activities are essential subrecipient monitoring activities. As outlined in policy clarification notice 15-02, quality assurance activities are administrative funds. And thus, those costs should be allocated under the administrative cost category.
I want to pause here. Susan and I have discussed this matter with grant recipients on site visits. Some grant recipient have been unclear that monitoring standards of care is considered an administrative activity and cost.

30. Grants Management
Grant administration refers to the activities associated with administering a RWHAP grant or cooperative agreement (e.g. contracting of services, receipt and disbursal of program funds, data collection and submission of reports, monitoring of subrecipients, and compliance with audit requirements).
Although these functions are necessary to comply with the terms and conditions of the award, their intent is not on improving health outcomes. Therefore, they are not clinical quality management activities.
Policy clarification notice also discusses grants management activities. Similar to quality assurance activities, grants management activities are allocated under the administrative portion of the budget. Good examples of these activities include the data collection for routine program reporting. In other words, data collection for and submission of the Ryan White Services Report (or RSR).
Many grant recipients have a data system that is serving functions for both the grants management and clinical quality management components of their program. In this case, the costs associated with the data system can be allocated across both the administrative and clinical quality management cost categories. I know the question you want to ask. How much of the data systems costs should be to administration and clinical quality management cost categories? There is not exact formula.

31. Clinical Quality Management
Relevant Activities under Quality Assurance and Clinical Quality Management
Activity
Quality Assurance
(Admin. Costs)
Clinical Quality Management
Performance measurement prioritization and alignment with other RWHAP Parts in the service area X
Development of service standards
Data extraction for clinical quality management purposes (collect, aggregate, analyze, and report on measurement data)
Chart audits/reviews
Monitoring site visits
If the purpose for the site visit is to assess or monitor the CQM Program
Extracting data for reporting to internal and external stakeholders
Electronic health records interface with other providers; system operations
CQM committee in planning for quality improvement projects
The chart below demonstrates the overlap between Quality Assurance activities and CQM activities. Within the last year, we have discussed with grant recipients how to handle the expenses associated with data collection --- more specifically, how to handle the expense when one data system is used for both routine report and clinical quality management. We engage in a discussion with the project officer and grant recipient regarding what are all uses (and frequency) for the data system, the associated costs, etc. Based on this information, we have come to a reasonable allocation of the expenses.

32. Speakers
Brad K. Barney, MPA Chief, HIV/AIDS and Rural Health Branch HRSA Division of Grants Management Operations Marlene Matosky, MPH, RN Branch Chief, Clinical and Quality Branch HAB Division of Policy and Data Susan Robilotto, DO Medical Officer HAB Division of Metropolitan HIV/AIDS Programs Gary Cook, MPH Deputy Director Steven R. Young, MSPH Director

33. Thank You
Questions?