[Federal Register Volume 90, Number 215 (Monday, November 10, 2025)] [Notices] [Pages 50747-50750] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 2025-19838] ======================================================================= ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Improving Ryan White HIV/AIDS Program Part A and B Formula Awards Using Most Recent Address Data AGENCY: Health Resources and Services Administration (HRSA), Department of Health and Human Services ACTION: Notice. ----------------------------------------------------------------------- SUMMARY: The Ryan White HIV/AIDS Program (RWHAP) Part A and B funding formulas are defined by the Public Health Service (PHS) Act and rely on the living HIV/AIDS cases reported to and confirmed by the Centers for Disease Control and Prevention (CDC). Advancements in HIV surveillance have improved the mapping of the epidemic, leading to better care strategies. Since 2017, CDC has shifted to using the most recent addresses of people with HIV for reporting, raising questions about whether RWHAP funds follow clients or remain in the jurisdiction of diagnosis. HRSA has analyzed the effects of this updated methodology on formula funding and is now seeking public feedback on proposed changes to better direct resources to where clients currently live and receive care. DATES: Submit comments no later than December 10, 2025. ADDRESSES: Written 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: Paul Mandsager, Senior Public Health Analyst, Division of Policy and Data, HRSA, HIV/AIDS Bureau, 5600 Fishers Lane, Rockville, MD 20857, Phone 301-594-4055, Email [email protected]. [[Page 50748]] SUPPLEMENTARY INFORMATION: The RWHAP Part A formula is set forth in the RWHAP authorizing statute at Sec. 2603(a) of the PHS Act, 42 U.S.C. 300ff-13(a), and is based on the relative distribution of living HIV/ AIDS cases within a statutorily specified metropolitan area reported to and confirmed by CDC. The RWHAP Part B formulas are found in Sec. Sec. 2618(a)(2) and (a)(2)(F) of the PHS Act, 42 U.S.C. 300ff-28(a)(2) and (a)(2)(F) and use weighted or relative distribution of living HIV/AIDS cases within the state reported to and confirmed by CDC. Recent advancements in HIV surveillance data have resulted in more accurate mapping of the HIV epidemic, allowing for more efficient and effective HIV care and treatment efforts at the state, local, and national levels. As a result of these advancements, beginning in 2014, CDC began the transition to reporting surveillance data based on the most recent address of a person with HIV, usually reported via CD4/ viral load lab reports, rather than residence at HIV diagnosis. Since that time, HRSA has received several inquiries about whether RWHAP funds follow clients as they move or if the funds stay in the jurisdiction in which the clients were originally diagnosed. HRSA conducted multiple analyses on the impact the updated HIV surveillance data would have on the RWHAP Part A and B formula award funding after maturation of the CDC methodology and when all jurisdictions were reporting most recent address to CDC. Now that this transition has been fully realized, to better allocate resources to the jurisdictions where clients currently reside and receive care, HRSA is seeking public comment on this proposed change in methodology and timing. Proposed Methodology The funding methodology used to calculate RWHAP Part A and B formula awards would use living HIV and AIDS case data based on most recent address, rather than residence at diagnosis, with a phase-in timeline and use of appropriate action to minimize funding fluctuations. The methodology for determining RWHAP Part A and B eligibility would remain unchanged. Proposed Timing of Implementation The statute requires the use of ``distribution factor'' but the distribution factor requires only that the data be reported to and confirmed by CDC. Once CDC certifies that the data are sufficiently robust to confirm, HRSA has the authority to accept those data based on the most recent address. It does not, however, have the authority to phase in that change without providing the public with notice and an opportunity to comment. HRSA determined that using most recent address data without a phased approach would lead to a disruption in the HIV care and treatment system across RWHAP Part A and Part B jurisdictions as some would experience substantial funding increases or decreases. HRSA is therefore proposing a phased approach over a 5-year period (fiscal year (FY) 2026 to FY 2030) to allow for a gradual transition. Any funding increase or decrease that occurs in year one (FY 2026) as a result of the new methodology will be spread out over a 5-year period (see Tables 1 and 2). This will minimize disruption and ensure that recipients and systems of care have the time and resources to adapt. By gradually phasing in the changes, RWHAP recipients can better manage potential increases or decreases in funding and adjust their resource allocation strategies accordingly. The RWHAP statute included a phased approach for implementation of a similar change from code-based HIV case surveillance reporting to name-based reporting in prior RWHAP reauthorizations. The statutory language permitted a phased approach to minimize disruption, allow for implementation on the local level, and for CDC verification of data. This prior approach is codified at Sec. 2603(a)(3)(C) of the PHS Act, 42 U.S.C. 300ff-13(a)(3)(C), and Sec. 2618(a)(2)(D) of the PHS Act, 42 U.S.C. 300ff-28(a)(2)(D). HRSA proposes to use the same phased approach as was used in the transition from code-based to name-based HIV reporting and seeks public comment on this proposal. Table 1--Estimated Future Part A Total Awards, 5-Year Transition [Based on the FY 2025 Appropriation, not any future appropriations] -------------------------------------------------------------------------------------------------------------------------------------------------------- Est. % change Part A jurisdiction FY 2025 final FY 2026 FY 2027 FY 2028 FY 2029 FY 2030 FY 2025- FY 2030 -------------------------------------------------------------------------------------------------------------------------------------------------------- Atlanta, GA............................. $32,339,493 $32,974,435 $33,609,378 $34,244,320 $34,879,263 $35,514,205 10 Austin, TX.............................. 5,702,606 5,769,180 5,835,753 5,902,327 5,968,900 6,035,474 6 Baltimore, MD........................... 15,660,695 15,631,048 15,601,402 15,571,755 15,542,109 15,512,462 -1 Baton Rouge, LA......................... 4,551,433 4,540,914 4,530,395 4,519,876 4,509,357 4,498,838 -1 Boston, MA.............................. 15,183,838 15,195,167 15,206,495 15,217,824 15,229,152 15,240,481 0 Charlotte, NC........................... 6,913,452 6,897,092 6,880,732 6,864,371 6,848,011 6,831,651 -1 Chicago, IL............................. 27,666,573 27,284,549 26,902,525 26,520,500 26,138,476 25,756,452 -7 Cleveland, OH........................... 4,772,432 4,773,163 4,773,894 4,774,625 4,775,356 4,776,087 0 Columbus, OH............................ 5,006,629 4,994,876 4,983,123 4,971,369 4,959,616 4,947,863 -1 Dallas, TX.............................. 21,184,061 21,442,742 21,701,423 21,960,103 22,218,784 22,477,465 6 Denver, CO.............................. 7,340,580 7,368,672 7,396,764 7,424,857 7,452,949 7,481,041 2 Detroit, MI............................. 10,075,549 9,998,181 9,920,813 9,843,444 9,766,076 9,688,708 -4 Fort Lauderdale, FL..................... 16,023,456 16,393,018 16,762,580 17,132,143 17,501,705 17,871,267 12 Fort Worth, TX.......................... 5,547,578 5,642,526 5,737,474 5,832,422 5,927,370 6,022,318 9 Hartford, CT............................ 2,944,998 2,951,034 2,957,070 2,963,107 2,969,143 2,975,179 1 Houston, TX............................. 27,558,403 27,795,071 28,031,740 28,268,408 28,505,077 28,741,745 4 Indianapolis, IN........................ 4,910,030 4,898,222 4,886,414 4,874,605 4,862,797 4,850,989 -1 Jacksonville, FL........................ 6,108,505 6,117,798 6,127,091 6,136,385 6,145,678 6,154,971 1 Kansas City, MO......................... 4,513,410 4,415,080 4,316,750 4,218,421 4,120,091 4,021,761 -11 Las Vegas, NV........................... 7,551,492 7,755,684 7,959,876 8,164,067 8,368,259 8,572,451 14 Los Angeles, CA......................... 46,295,740 45,729,574 45,163,409 44,597,243 44,031,078 43,464,912 -6 Memphis, TN............................. 6,902,702 6,886,126 6,869,550 6,852,973 6,836,397 6,819,821 -1 Miami, FL............................... 26,788,349 26,566,917 26,345,485 26,124,054 25,902,622 25,681,190 -4 Mineola, NY............................. 5,653,528 5,638,727 5,623,925 5,609,124 5,594,322 5,579,521 -1 Minneapolis, MN......................... 6,129,008 6,180,187 6,231,366 6,282,546 6,333,725 6,384,904 4 [[Page 50749]] Nashville, TN........................... 4,443,640 4,432,440 4,421,239 4,410,039 4,398,838 4,387,638 -1 New Brunswick, NJ....................... 2,803,890 2,764,620 2,725,349 2,686,079 2,646,808 2,607,538 -7 New Haven, CT........................... 5,273,601 5,275,392 5,277,183 5,278,974 5,280,765 5,282,556 0 New Orleans, LA......................... 8,058,405 7,911,429 7,764,453 7,617,477 7,470,501 7,323,525 -9 New York, NY............................ 89,662,231 90,053,722 90,445,213 90,836,703 91,228,194 91,619,685 2 Newark, NJ.............................. 12,277,381 12,122,018 11,966,656 11,811,293 11,655,931 11,500,568 -6 Norfolk, VA............................. 5,990,787 5,892,750 5,794,712 5,696,675 5,598,637 5,500,600 -8 Oakland, CA............................. 7,360,883 7,304,436 7,247,989 7,191,542 7,135,095 7,078,648 -4 Orlando, FL............................. 10,939,376 11,032,797 11,126,219 11,219,640 11,313,062 11,406,483 4 Paterson, NJ............................ 3,918,044 3,864,059 3,810,075 3,756,090 3,702,106 3,648,121 -7 Philadelphia, PA........................ 22,766,093 22,594,485 22,422,877 22,251,268 22,079,660 21,908,052 -4 Phoenix, AZ............................. 11,049,463 11,194,456 11,339,448 11,484,441 11,629,433 11,774,426 7 Portland, OR............................ 4,088,295 4,182,057 4,275,820 4,369,582 4,463,345 4,557,107 11 Sacramento, CA.......................... 3,832,752 3,919,081 4,005,410 4,091,739 4,178,068 4,264,397 11 Saint Louis, MO......................... 6,388,344 6,243,701 6,099,057 5,954,414 5,809,770 5,665,127 -11 San Antonio, TX......................... 6,221,586 6,228,572 6,235,558 6,242,543 6,249,529 6,256,515 1 San Bernardino, CA...................... 9,283,666 9,971,030 10,658,395 11,345,759 12,033,124 12,720,488 37 San Diego, CA........................... 12,325,778 12,221,689 12,117,599 12,013,510 11,909,420 11,805,331 -4 San Francisco, CA....................... 14,841,000 14,267,393 13,693,786 13,120,180 12,546,573 11,972,966 -19 San Jose, CA............................ 3,496,090 3,418,963 3,341,836 3,264,708 3,187,581 3,110,454 -11 San Juan, PR............................ 10,360,633 10,045,103 9,729,573 9,414,043 9,098,513 8,782,983 -15 Santa Ana, CA........................... 6,679,132 6,523,893 6,368,654 6,213,416 6,058,177 5,902,938 -12 Seattle, WA............................. 7,189,780 7,135,849 7,081,919 7,027,988 6,974,058 6,920,127 -4 Secaucus, NJ............................ 4,797,408 4,679,436 4,561,464 4,443,491 4,325,519 4,207,547 -12 Tampa, FL............................... 10,650,266 10,961,615 11,272,965 11,584,314 11,895,664 12,207,013 15 Washington, DC.......................... 32,044,482 31,995,758 31,947,034 31,898,309 31,849,585 31,800,861 -1 West Palm Beach, FL..................... 7,428,827 7,419,646 7,410,465 7,401,284 7,392,103 7,382,922 -1 -------------------------------------------------------------------------------------------------------------------------------------------------------- Table 2--Estimated Future Part B Total Awards, 5-Year Transition [Based on the FY 2025 Appropriation, not any future appropriations] -------------------------------------------------------------------------------------------------------------------------------------------------------- Est. % change Part B grantee FY 2025 final FY 2026 FY 2027 FY 2028 FY 2029 FY 2030 FY 2025- FY * 2030 -------------------------------------------------------------------------------------------------------------------------------------------------------- Alabama................................. $20,126,410 $19,941,311 $19,756,212 $19,571,114 $19,386,015 $19,200,916 -5 Alaska.................................. 1,057,741 1,055,218 1,052,695 1,050,173 1,047,650 1,045,127 -1 Arizona................................. 17,593,880 17,802,676 18,011,473 18,220,269 18,429,066 18,637,862 6 Arkansas................................ 8,467,112 8,412,595 8,358,077 8,303,560 8,249,042 8,194,525 -3 California.............................. 140,896,380 139,520,418 138,144,456 136,768,493 135,392,531 134,016,569 -5 Colorado................................ 13,159,341 13,301,576 13,443,811 13,586,047 13,728,282 13,870,517 5 Connecticut............................. 10,028,100 10,018,521 10,008,941 9,999,362 9,989,782 9,980,203 0 Delaware................................ 4,559,579 4,643,438 4,727,296 4,811,155 4,895,013 4,978,872 9 District of Columbia.................... 15,877,251 15,577,494 15,277,736 14,977,979 14,678,221 14,378,464 -9 Florida................................. 117,953,889 118,297,990 118,642,091 118,986,193 119,330,294 119,674,395 1 Georgia................................. 65,937,492 66,625,016 67,312,540 68,000,063 68,687,587 69,375,111 5 Hawaii.................................. 3,352,217 3,285,288 3,218,358 3,151,429 3,084,499 3,017,570 -10 Idaho................................... 1,567,448 1,639,775 1,712,102 1,784,428 1,856,755 1,929,082 23 Illinois................................ 43,632,706 42,894,324 42,155,943 41,417,561 40,679,180 39,940,798 -8 Indiana................................. 14,826,971 14,923,455 15,019,939 15,116,423 15,212,907 15,309,391 3 Iowa.................................... 3,671,105 3,783,456 3,895,806 4,008,157 4,120,507 4,232,858 15 Kansas.................................. 3,874,733 3,864,859 3,854,986 3,845,112 3,835,239 3,825,365 -1 Kentucky................................ 10,928,564 11,047,437 11,166,309 11,285,182 11,404,054 11,522,927 5 Louisiana............................... 23,907,778 23,576,125 23,244,472 22,912,820 22,581,167 22,249,514 -7 Maine................................... 1,744,812 1,866,696 1,988,579 2,110,463 2,232,346 2,354,230 35 Maryland................................ 31,501,279 31,596,615 31,691,952 31,787,288 31,882,625 31,977,961 2 Massachusetts........................... 20,049,557 20,111,599 20,173,642 20,235,684 20,297,727 20,359,769 2 Michigan................................ 18,646,797 18,494,389 18,341,980 18,189,572 18,037,163 17,884,755 -4 Minnesota............................... 8,739,953 8,871,333 9,002,713 9,134,092 9,265,472 9,396,852 8 Mississippi *........................... 14,270,758 14,037,073 13,803,388 13,569,703 13,336,018 13,102,333 -8 Missouri................................ 13,771,559 13,679,499 13,587,439 13,495,380 13,403,320 13,311,260 -3 Montana................................. 868,081 897,158 926,235 955,311 984,388 1,013,465 17 Nebraska................................ 3,366,792 3,400,072 3,433,352 3,466,632 3,499,912 3,533,192 5 Nevada.................................. 10,233,918 10,494,661 10,755,404 11,016,148 11,276,891 11,537,634 13 New Hampshire........................... 1,408,963 1,453,490 1,498,017 1,542,545 1,587,072 1,631,599 16 New Jersey.............................. 36,785,442 36,225,650 35,665,857 35,106,065 34,546,272 33,986,480 -8 New Mexico.............................. 4,461,845 4,593,522 4,725,199 4,856,877 4,988,554 5,120,231 15 New York................................ 121,693,828 121,502,862 121,311,896 121,120,931 120,929,965 120,738,999 -1 [[Page 50750]] North Carolina.......................... 36,933,968 37,344,393 37,754,819 38,165,244 38,575,670 38,986,095 6 North Dakota............................ 865,271 870,269 875,267 880,265 885,263 890,261 3 Ohio.................................... 25,253,858 25,312,408 25,370,959 25,429,509 25,488,060 25,546,610 1 Oklahoma *.............................. 9,505,525 9,559,364 9,613,203 9,667,041 9,720,880 9,774,719 3 Oregon.................................. 6,647,795 6,823,869 6,999,943 7,176,016 7,352,090 7,528,164 13 Pennsylvania............................ 41,565,377 42,048,395 42,531,413 43,014,432 43,497,450 43,980,468 6 Puerto Rico............................. 20,773,717 20,155,207 19,536,697 18,918,186 18,299,676 17,681,166 -15 Rhode Island............................ 3,586,062 3,617,595 3,649,129 3,680,662 3,712,196 3,743,729 4 South Carolina.......................... 25,101,893 25,026,412 24,950,930 24,875,449 24,799,967 24,724,486 -2 South Dakota............................ 1,018,404 1,028,291 1,038,178 1,048,066 1,057,953 1,067,840 5 Tennessee............................... 19,798,995 19,775,561 19,752,126 19,728,692 19,705,257 19,681,823 -1 Texas................................... 118,321,330 118,926,803 119,532,276 120,137,749 120,743,222 121,348,695 3 Utah.................................... 5,084,544 5,130,773 5,177,003 5,223,232 5,269,462 5,315,691 5 Vermont................................. 863,866 895,162 926,459 957,755 989,052 1,020,348 18 Virginia................................ 25,905,308 25,818,054 25,730,801 25,643,547 25,556,294 25,469,040 -2 Washington.............................. 15,920,820 16,212,199 16,503,578 16,794,956 17,086,335 17,377,714 9 West Virginia........................... 2,779,989 2,808,260 2,836,530 2,864,801 2,893,071 2,921,342 5 Wisconsin............................... 8,976,297 9,042,676 9,109,055 9,175,435 9,241,814 9,308,193 4 Wyoming................................. 759,202 763,113 767,024 770,936 774,847 778,758 3 Guam.................................... 280,781 279,217 277,652 276,088 274,523 272,959 -3 Virgin Islands.......................... 966,648 951,454 936,259 921,065 905,870 890,676 -8 American Samoa.......................... 50,001 50,004 50,007 50,009 50,012 50,015 0 Marshall Islands........................ 50,702 50,699 50,696 50,694 50,691 50,688 0 Mariana Island.......................... 59,834 59,794 59,755 59,715 59,676 59,636 0 Republic of Palau *..................... 56,322 56,297 56,271 56,246 56,220 56,195 0 F. States Micronesia.................... 50,702 50,975 51,247 51,520 51,792 52,065 3 -------------------------------------------------------------------------------------------------------------------------------------------------------- Note: Mississippi, Oklahoma, and Palau FY 2025 amounts are estimates that do not include penalties assessed in FY 2025 and as such do not reflect actual FY 2025 funding amounts. Thomas J. Engels, Administrator. [FR Doc. 2025-19838 Filed 11-7-25; 8:45 am] BILLING CODE 4165-15-P