[Federal Register Volume 76, Number 92 (Thursday, May 12, 2011)]
[Notices]
[Pages 27649-27651]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-11649]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


HIV/AIDS Bureau Policy Notice 11-01 (Replaces Policy Notice 99-
02)

AGENCY: Health Resources and Services Administration (HRSA), HHS.

ACTION: Final Notice.

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SUMMARY: The Health Resources and Services Administration, HIV/AIDS 
Bureau (HAB) Policy Notice 99-02 established policies for the use of 
Ryan White HIV/AIDS Program funds authorized under Title XXVI of the 
Public Health Service (PHS) Act, for housing referral services and 
short-term or emergency housing needs. Amendment 1 to Policy 
Notice 99-02, effective March 27, 2008, modified Policy Notice 99-02 by 
imposing a 24-month cumulative cap on short-term and emergency housing 
assistance. The limit on benefits would have taken effect on March 27, 
2010, and would have impacted individuals who were users of the funds 
for housing assistance. HRSA received comments from the public 
concerning the potential impact of the cap and the threat to the 
ability of clients receiving Ryan White HIV/AIDS Program funded 
services to receive housing services. In response, HRSA's Administrator 
directed that Policy Notice 99-02 Amendment 1 be rescinded, as 
published in the February 10, 2010, Federal Register notice, Volume 75, 
Issue 27, pages 6672-6673. In addition, the notice indicated that HRSA 
was conducting a comprehensive review of the Housing Policy. As a 
result of a thorough vetting and comprehensive review, HRSA is issuing 
a final notice of Housing Policy Notice 11-01 which replaces HAB Policy 
Notice 99-02, effective May 12, 2011.

SUPPLEMENTARY INFORMATION: On February 10, 2010, HRSA rescinded 
Amendment 1 to Policy Notice 99-02 effective immediately, as 
published in the Federal Register. Grantees were advised that HRSA did 
not require enforcement of the cap for beneficiaries that might have 
been at or near the 24-month limit on receipt of funds used for short-
term and emergency housing

[[Page 27650]]

assistance. HRSA announced that a comprehensive review of the Housing 
Policy would continue and HRSA's Administrator would continue to 
consider all aspects of the policy.

Comprehensive Review of the Housing Policy

    HRSA received numerous letters from consumer and housing advocates 
expressing their concerns regarding the potential effect on individuals 
reaching the 24-month cap to receive funding used for housing services. 
HRSA's Administrator responded to these concerns by conducting face-to-
face meetings with housing advocates, consumers, and HIV/AIDS 
stakeholders/organizations. In addition, Ryan White HIV/AIDS Program 
Grantees were asked to submit their views on the Housing Policy's 
lifetime 24-month cap per household. Consequently, HAB collaborated 
with other federal agencies and discussed mutual concerns with the 
Assistant Secretary of the U.S. Department of Housing and Urban 
Development and the Director of Housing Opportunities for Persons with 
AIDS.

HRSA/HAB Policy Considerations and Recommendations

    HAB's Associate Administrator solicited comments from all Part A, B 
and D Grantees asking them to review five principles that were under 
consideration for the revised Housing Policy and to provide comments, 
concerns, and additional considerations by May 21, 2010. The five 
principles were as follows:
    1. Strengthen linkages to the U.S. Department of Housing and Urban 
Development's (HUD) programs, as well as state and local housing 
resources to provide longer-term assistance;
    2. Minimize housing disruptions for people living with HIV/AIDS;
    3. Integrate housing with a broader range of supports that 
collectively support individuals in maintaining their health;
    4. Provide flexibility to respond to exceptional circumstances; and
    5. Minimize the burden on Ryan White providers who are responsible 
for assisting HAB to implement any housing policy.
    There were four responses--two from Ryan White HIV/AIDS Program 
Part A Grantees, one from a Part B Grantee and one letter from the 
National AIDS Housing Coalition's Executive Director. These responses 
supported the extension of funding for housing services beyond the 24-
month cap due to exceptions, i.e., ``Grantees allowing transitional 
housing of greater than 24 month in duration must review their decision 
periodically to assess whether this standard serves as a significant 
barrier to access to housing services for new clients.''; ``It is 
recognized that a transitional housing limit of 24 month may be a 
significant barrier for certain populations, for example a multiply-
diagnosed client who has been in housing before, but has lapsed and 
needs housing support while in treatment and recovery.''
    Other considerations included: (1) HRSA/HAB consideration to 
promote decision making at the jurisdictional level based on needs 
assessment, consistent with the Ryan White HIV/AIDS Program legislative 
mandates, and (2) acknowledging the changes in the 2006 Ryan White HIV/
AIDS Program reauthorization that limited funding for support services 
to 25 percent of available service dollars. As a result of this 
comprehensive review, HAB recommended issuance of a revised Housing 
Policy.

HRSA HAB Policy Notice 11-01 (Replaces 99-02)

    Document Title: The Use of Ryan White HIV/AIDS Program Funds for 
Housing Referral Services and Short-term or Emergency Housing Needs.
    The following policy establishes guidelines for allowable housing-
related expenditures under the Ryan White HIV/AIDS Program. The purpose 
of all Ryan White HIV/AIDS Program funds is to ensure that eligible 
HIV-infected persons and families gain or maintain access to medical 
care.
    A. Funds received under the Ryan White HIV/AIDS Program (Title XXVI 
of the Public Health Service Act) may be used for the following housing 
expenditures:
    i. Housing referral services defined as assessment, search, 
placement, and advocacy services must be provided by case managers or 
other professional(s) who possess a comprehensive knowledge of local, 
state, and federal housing programs and how these programs can be 
accessed; or
    ii. Short-term or emergency housing defined as necessary to gain or 
maintain access to medical care and must be related to either:
    a. Housing services that include some type of medical or supportive 
service: including, but not limited to, residential substance treatment 
or mental health services (not including facilities classified as an 
Institution for Mental Diseases under Medicaid), residential foster 
care, and assisted living residential services; or
    b. Housing services that do not provide direct medical or 
supportive services, but are essential for an individual or family to 
gain or maintain access and compliance with HIV-related medical care 
and treatment; necessity of housing services for purposes of medical 
care must be certified or documented.
    B. Short-term or emergency assistance is understood as transitional 
in nature and for the purposes of moving or maintaining an individual 
or family in a long-term, stable living situation. Thus, such 
assistance cannot be permanent and must be accompanied by a strategy to 
identify, relocate, and/or ensure the individual or family is moved to, 
or capable of maintaining, a long-term, stable living situation.
    C. Housing funds cannot be in the form of direct cash payments to 
recipients or services and cannot be used for mortgage payments.
    D. The Ryan White HIV/AIDS Program must be the payer of last 
resort. In addition, funds received under the Ryan White HIV/AIDS 
Program must be used to supplement, but not supplant funds currently 
being used from local, state, and federal agency programs. Ryan White 
HIV/AIDS Program Grantees must be capable of providing HAB with 
documentation related to the use of funds as the payer of last resort 
and the coordination of such funds with other local, state, and federal 
funds.
    E. Ryan White HIV/AIDS Program Grantees and local decision making 
planning bodies, i.e. Part A and Part B, are strongly encouraged to 
institute duration limits to provide transitional and emergency housing 
services. HUD defines transitional housing as 24 month, and HRSA/HAB 
recommends that grantees consider using HUD's definition as their 
standard.
    F. Grantees must develop mechanisms to allow newly identified 
clients access to housing services.
    G. Upon request, Ryan White HIV/AIDS Program Grantees must provide 
HAB with an individualized written housing plan, consistent with this 
Housing Policy, covering each client receiving short term, transitional 
and emergency housing services.
    H. Housing-related expenses are limited to Part A, Part B, and Part 
D of the Ryan White HIV/AIDS Program and are not allowable expenses 
under Part C. Part A and Part B Grantees must adhere to the Core 
Medical Services requirement; only 25 percent of Ryan White HIV/AIDS 
Program funding may be used for support services without a waiver.


[[Page 27651]]


    Dated: May 5, 2011.
Mary K. Wakefield,
Administrator.
[FR Doc. 2011-11649 Filed 5-11-11; 8:45 am]
BILLING CODE 4165-15-P