Final Policy: Updates to Uniform Standard for Waiver of the Ryan White HIV/AIDS Program Core Medical Services Expenditure Requirement

Citation86 FR 54458
Published date01 October 2021
Record Number2021-21241
SectionNotices
CourtHealth Resources And Services Administration
Federal Register, Volume 86 Issue 188 (Friday, October 1, 2021)
[Federal Register Volume 86, Number 188 (Friday, October 1, 2021)]
                [Notices]
                [Pages 54458-54462]
                From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
                [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 [email protected]. 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 [email protected] 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 www.grants.gov. 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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