[Federal Register Volume 89, Number 161 (Tuesday, August 20, 2024)]
[Notices]
[Pages 67448-67452]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-18649]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


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

AGENCY: Health Resources and Services Administration (HRSA), Department 
of Health and Human Services.

ACTION: Request for public comment on updates to uniform standard for 
waiver of the Ryan White HIV/AIDS Program core medical services 
expenditure requirement.

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SUMMARY: The Ryan White HIV/AIDS Program (RWHAP) statute of the Public 
Health Service Act requires that RWHAP Parts A, B, and C recipients 
expend 75 percent of Parts A, B, and C grant funds on core medical 
services for individuals who are identified with HIV/AIDS and eligible 
for RWHAP services under the statute, after reserving statutorily 
permissible amounts for administrative and clinical quality management 
costs. The statute also grants the Secretary authority to waive this 
requirement if certain factors are met. HRSA is proposing to update 
Policy Notice 21-01, ``Waiver of the Ryan White HIV/AIDS Program Core 
Medical Services Expenditure Requirement,'' pertaining to the 
associated data collection form to clarify applicants' proposed 
allocation of resources between core medical and support services.

DATES: Submit comments no later than September 19, 2024.

ADDRESSES: Written/and or electronic comments should be submitted to 
Division of Policy and Data, HRSA, HIV/AIDS Bureau, 5600 Fishers Lane, 
Rockville, MD 20857, or [email protected].

FOR FURTHER INFORMATION CONTACT: Kristina Barney, Senior Public Health 
Policy Analyst, Division of Policy and Data, HRSA, HIV/AIDS Bureau, 
5600 Fishers Lane, Rockville, MD 20857, email 
[email protected].

SUPPLEMENTARY INFORMATION: The RWHAP statute grants the Secretary 
authority to waive this requirement for RWHAP Parts A, B, or C 
recipients if certain factors are met and a waiver request is submitted 
to HRSA for approval. RWHAP Parts 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.
    For a core medical services waiver request to be approved, core 
medical services must be available and accessible, regardless of the 
payment source, within 30 days to all RWHAP-eligible individuals 
identified in the recipient's service area. The recipient may use 
existing, non-RWHAP resources in the service area to ensure 
availability and access to core medical services. Additionally, there 
must be no AIDS Drug Assistance Program waiting lists in the 
recipient's service area. Finally, a public process must be used to 
obtain input from impacted communities on the availability of core 
medical services and the decision to request the waiver. Impacted 
communities include clients and RWHAP-funded core medical services 
providers. The same method 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 may be used to meet this 
requirement.
    Policy Notice 21-01, ``Waiver of the Ryan White HIV/AIDS Program 
Core Medical Services Expenditure Requirement,'' outlines the 
requirements and includes the one-page ``HRSA RWHAP Core Medical 
Services Waiver Request Attestation Form'' that must be submitted to 
request a waiver.
    HRSA proposes to modify Policy Notice 21-01 to reflect a new policy 
requiring that the proposed percentages of HIV service dollars 
allocated to core medical and support services be included on the 
waiver request form. This information will inform HRSA as to whether 
recipients are able to meet the statutory requirements found in 
sections 2604(c), 2612(b), and 2651(c) of the Public Health Service Act 
and will

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clarify what proposed portion of funds will be allocated to core 
medical and support services. In response to stakeholder feedback, 
minor changes will also be made to the policy notice. The current 
policy notice is accessible at the following link: https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/pn-21-01-core-medical-services-waivers.pdf and the proposed revised policy notice is 
included in this announcement. This notice provides the opportunity for 
public comment before implementation. In a separate notice entitled, 
Ryan White HIV/AIDS Program Core Medical Services Waiver Form, OMB No. 
0906-0065-Revision, 89 FR 122, 53110-12 (June 25, 2024), HRSA seeks 
comment on the changes to the data collection form associated with this 
proposed policy notice change.
    Summary of Proposed Changes: Sections 2604(c), 2612(b), and 2651(c) 
of the Public Health Service Act require recipients to spend not less 
than 75 percent of funds on core medical services after reserving 
statutorily permissible amounts for administrative and clinical quality 
management costs. HRSA intends to add a requirement to include the 
proposed percentages of HIV service dollars allocated to core medical 
and support services. This proposed change will be included as a 
requirement on the Ryan White HIV/AIDS Program Core Medical Services 
Waiver Form and will be used to clarify what portion of HIV service 
dollars will be allocated to core medical and support services. The 
section of this notice entitled ``Requesting a Waiver'' contains a 
description of the new information that must be included on the waiver 
request form. Language and editorial changes have been made throughout.
    The proposed change is in addition to the underlying requirements 
necessary to obtain a waiver: ensuring that the state AIDS Drug 
Assistance Program has no waiting lists, all core medical services are 
available and accessible within 30 days in the jurisdiction or service 
area, and that the recipient has used a public process to determine the 
need for a waiver. HRSA will consider public comment on these changes 
and intends for the policy to become effective on October 1, 2024.

Waiver of the Ryan White HIV/AIDS Program Core Medical Services 
Expenditure Requirement

Policy Notice 21-01(Revised 10/01/24) Replaces Policy Notice 13-07

Scope of Coverage
    Health Resources and Services Administration (HRSA) HIV/AIDS Bureau 
Ryan White HIV/AIDS Program (RWHAP) Parts A, B, and C.
Purpose of Policy Notice
    This Policy Notice provides the processes and requirements for 
RWHAP Parts A, B, and C recipients to request waivers of the statutory 
requirement regarding expenditure amounts for core medical services.
    The revised policy notice describes a new requirement included on 
the RWHAP Core Medical Services Waiver Attestation Form. It also 
includes various editorial changes to respond to stakeholder feedback 
to make the form clearer. The revised policy is effective beginning on 
October 1, 2024.
Background
    Recipients must spend at least 75 percent of grant funds on core 
medical services. See Title XXVI of the Public Health Service Act (the 
RWHAP legislation, Part A section 2604(c), Part B section 2612(b), and 
Part C section 2651(c)). Grant funds include Minority AIDS Initiative 
funding but exclude the amounts allowable by statute for administrative 
and clinical quality management costs. The Secretary can waive this 
requirement for a recipient if: (1) there are no waiting lists for the 
AIDS Drug Assistance Program (ADAP), (2) core medical services are 
available and accessible to all HRSA RWHAP eligible individuals in the 
recipient's service area, and (3) a public process must be used to 
obtain input on the waiver request. Approved RWHAP Part A, Part B, and 
Part C core medical services waivers are effective for one budget 
period of a grant award, which is 1 year.
Requirements
    A HRSA RWHAP Parts A, B, or C recipient must meet the following 
requirements:
    (1) Core medical services must be available and accessible, 
regardless of the payment source, within 30 days to all HRSA RWHAP 
eligible individuals identified in the recipient's service area. The 
recipient may use existing non-RWHAP resources in the service area to 
ensure availability and access to core medical services.
    (2) There must be no ADAP waiting lists in the recipient's service 
area.
    (3) There must be a public process to obtain input on the waiver 
request. This public process must seek input from impacted communities 
on the availability of core medical services and the decision to 
request the waiver. Impacted communities include clients and RWHAP-
funded core medical services providers. The same method 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 may be used.
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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 (attached 
below) to HRSA as specified by the deadlines and methods described 
below.
Update to the Waiver Request Form
    The form must specify the percentages of HIV service dollars, 
including Minority AIDS Initiative funds, the recipient proposes to 
allocate to core medical and support services, if the waiver is 
approved. Signature indicates attestations for eligibility and the 
requirement of documentation upon request.
    No other documentation is required to be submitted with the HRSA 
RWHAP Core Medical Services Waiver Request Attestation Form.
Submitting Waiver Requests
    RWHAP Part A and RWHAP Part C waiver requests must be submitted as 
an attachment with the grant application or the mandatory non-competing 
continuation (NCC) progress report. Waiver requests do not count 
towards grant application or NCC progress report page limits.
    RWHAP Part B recipients may submit a waiver request prior to the 
submission of a grant application, with the grant application or NCC 
progress report as an attachment or up to 4 months after the start of 
the budget period for which the waiver is requested.
    RWHAP Part B recipients may request a waiver for the RWHAP Part B 
States/Territories Formula and ADAP Formula and ADAP Supplemental 
Awards (X07) and/or the RWHAP Part B States/Territories Supplemental 
Grant Program (X08). Recipients must request each waiver separately.
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 Electronic Handbooks.
    Part B recipients planning to request a waiver before or after the 
submission of a grant application or NCC progress report must notify 
their project officer who will send a Request for Information through 
the Electronic Handbooks.
Waiver Review and Notification Process
    HRSA will review waiver requests and notify recipients of its 
approval or denial within 4 weeks of receipt of the request.
    Approved core medical services waivers are only effective for one 
budget period. Approved waivers are not required to be implemented, 
should circumstances change. Recipients must submit a new request(s) 
each budget period.
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Carole Johnson,
Administrator.
[FR Doc. 2024-18649 Filed 8-19-24; 8:45 am]
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