REGULATIONS AND GUIDANCE  

Policies, regulations, and guidance assist in codifying minimum standards and expectations for all funded subrecipients. They also help to ensure consistency and compliance with applicable Federal and State expectations.  

To ensure program fidelity, it is an expectation that all subrecipients comply with program expectations and use funding in an efficient manner and remain fiscally responsible. As the Administrative Agency, TRG provides robust oversight, guidance and technical assistance to help ensure all grant funds are expended appropriately and to prevent fraud, waste and abuse. 

 

Ryan White HIV/AIDS Program Legislation 

The U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB) administers the Ryan White HIV/AIDS Program (RWHAP). This is the largest federal program focused on HIV. To address HIV care and support services HRSA has established legislative provisions and issues periodic Policy Notices, which provide guidance to understand and implement program legislative requirements. 

As a subrecipient, all services provided must be in accordance with the Health Resources and Services Administration (HRSA) Policy Notices (including administrative and fiscal requirements) located at https://ryanwhite.hrsa.gov/grants/policy-notices  

RWHAP Part B Manual, located at https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/resources/hab-part-b-manual-2013.pdf   

 

Texas Department of State Health Services (DSHS) 

The Texas Department of State Health Services (DSHS), HIV/STD Prevention and Care Branch (the State) coordinates all federal and state funds for HIV client services through selected Administrative Agencies. Administrative Agencies administer and disburse funds to various providers and provide administrative services, including planning, data management, contract and financial management, and quality assurance and management. 

The Texas Department of State Health Services (DSHS) establishes policies and guidelines to assure consistent and quality delivery of HIV core medical and support services with sound implementation, in accordance with HRSA/HAB requirements. 

As a subrecipient, all services provided must be in accordance with the applicable DSHS Policies located at http://www.dshs.texas.gov/hivstd/policy/  

 DSHS HIV Assurances located at https://www.dshs.state.tx.us/hivstd/funding/docs/HIV_Contractor_Assurances.pdf  

HRSA DUNS phase out announcement: https://www.gsa.gov/about-us/organization/federal-acquisition-service/office-of-systems-management/integrated-award-environment-iae/iae-information-kit/unique-entity-identifier-update 

 

 

ADMINISTRATIVE MANAGEMENT 

As a subrecipient of grant funding, you are responsible for the oversight and operations of award activities. This assures us that you are in compliance with applicable federal, state and local requirements and performance expectations. 

As the awarding administrative agency, we are responsible for the programmatic monitoring and business management or oversight until the project period ends, and we close out your contract. 

 

Uniform Administrative Requirements 

The Office of Management and Budget (OMB) issued Uniform Administrative Requirements to streamline the regulations and requirements for grants management across the federal government. 

Link: https://ryanwhite.hrsa.gov/about/parts-and-initiatives/part-c-early-intervention  

Link: https://ryanwhite.hrsa.gov/about/parts-and-initiatives/part-d-swic  

 

DSHS Universal Standards 

The DSHS Universal Standards are applicable to all service categories funded under the Ryan White Part B Program for direct care service providers. These Universal Standards are taken directly from the HRSA Standards listed in the Part B HIV/AIDS Bureau (HAB) Universal National Monitoring Standards and expanded to include DSHS program requirements for all Ryan White Part B and State Service sub-recipients.  

Link: https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/resources/hab-part-b-manual.pdf  

Link: https://www.dshs.state.tx.us/hivstd/taxonomy/default.shtm#section7  

 

Program Integrity 

Grant funding (Federal and State) must be spent as intended. As a subrecipient, you need to comply with program expectations, use funds in an efficient manner, and remain fiscally responsible. 

TRG provides oversight, guidance, and technical assistance to help ensure you spend grant dollars appropriately and you prevent waste, fraud, and abuse. 

 

Guidance 

Subrecipients must comply with all grant policy terms and conditions outlined in applicable U.S. Department of Health and Human Services (USHHS) Grants Policies and Regulations, and requirements imposed by program statutes and regulations and HHS grant administration regulations, as applicable; as well as any requirements or limitations in any applicable appropriations acts.  The USHHS Grants Policies and Regulations is currently available at https://www.hhs.gov/grants/grants/grants-policies-regulations/index.html. 

Subrecipient will ensure services are provided in accordance with the Health Resources and Services Administration (HRSA) Policy Notices (including administrative and fiscal requirements) located at https://ryanwhite.hrsa.gov/grants/policy-notices.  

Subrecipient will ensure services are provided in accordance with the DSHS Standards of Care and Monitoring Guidelines http://www.dshs.texas.gov/hivstd/taxonomy/ when HRSA-specific Standards of Care do not exist. 

 

Program Participant Eligibility  

The following eligibility criteria must be established for individuals to receive funded services through Ryan White HIV/AIDS Program (RWHAP). Upon initiation of any services, subrecipients must determine whether an applicant meets the following eligibility criteria: 

• Have a diagnosis of HIV infection  

• Provide documentation of Texas Residency (in the approved service area), and  

• Provide complete and accurate income documentation 

• Annual gross income must be equal to or below the approved income limit  

 

Following approval of initial eligibility, clients must be screened for program eligibility every six months to continue receiving assistance. See the DSHS Eligibility to Receive HIV Services policy https://www.dshs.texas.gov/hivstd/policy/policies/220-001.shtm for full details. 

 

Conflict of Interest 

A conflict of interest occurs when an individual’s personal interests – family, friendships, financial, or social factors – could compromise his or her judgment, decisions, or actions in the workplace. Any potential (either actual or perceived) conflicts of interest must be disclosed on an annual basis. This disclosure includes the Board of Directors, employees (full-time & part-time), subcontractors, and volunteers. 

Link: TRG Policy Conflict of Interest- DOCUMENT #8 

Link: DSHS Policy 241.005 https://www.dshs.texas.gov/hivstd/policy/policies/241-005.shtm  

Link: HRSA COI Policy https://www.hrsa.gov/grants/standard-terms/conflict-interest-policy  

 

Confidentiality  

Strict confidentiality of all records is essential. Subrecipient must have a system, including detailed policies and/or procedures, in effect to protect client or patient records and all other documents deemed confidential by law that are maintained in connection with the activities funded under this grant. All disclosures or transfers of client or patient information must be done in full compliance with applicable laws, including appropriately signed release of information forms, where applicable. All release of confidential information forms must comply with TRG Policy SR-1704 Exchange/Release of Information (Make the highlighted a hyperlink to document)-DOC #9. 

All Subrecipient agencies must be in full compliance with the current regulations and rules of the Health Insurance Portability and Accountability Act (HIPAA).  

The “Health and Safety Code” of the State of Texas provides for both civil and criminal penalties against anyone who violates the confidentiality of persons protected under the law. All employees, volunteers, and members of the Board of Directors of Subrecipient agencies are required to sign statements of confidentiality assuring compliance with applicable laws on an annual basis.   

On an annual basis, TRG requires funded staff have a signed confidentiality statement and accompanying training on confidentiality and protected health information (PHI). To comply with this expectation, The Texas Department of State Health Services (DSHS) has created an online training on the TRAIN Texas website (https://www.train.org/texas/welcome).  Subrecipients can complete the TRAIN Texas online training or use internal confidentiality/PHI trainings that have reviewed and approved by TRG.   

Link: TRG Confidentiality Policy- DOCUMENT #10 

Link: DSHS https://www.dshs.state.tx.us/thsvh/account.shtm 

 

FINANCIAL MANAGEMENT 

The TRG Finance Department is committed to ensuring good stewardship of public resources by helping subrecipients comply with their contracts and compliance with State and Federal requirements for fiscal monitoring. As the Administrative Agency it is our expectation that all awarded subrecipients have effective internal controls to managing funding and prevent fraud, waste and abuse. 

Do you have the fiscal foundation to meet financial reporting requirements? 

Financial Management Standards 

Subrecipients are required to follow 2/5/2018 Texas Health and Human Services Grant Technical Assistance Guide (GTAG) and 45 CFR 75 - Title 45 Public Welfare Part 75 Uniform Administrative Requirements, Cost Principles and Audit Requirements for HHS Awards (Uniform Guidance) for administration of grant funds.  Where applicable, federal law will supersede the GTAG.  Technical assistance in the use of these procedures is available from TRG’s Finance Department.  

• Uniform Guidance: https://www.govinfo.gov/content/pkg/CFR-2016-title45-vol1/pdf/CFR-2016-title45-vol1-part75.pdf  

• GTAG: https://www.hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/vendor-contract-information/grant-technical-assistance-guide.pdf  

 Minimal financial management and controls include:  

1. Financial planning including the development and monitoring of budgets that adequately reflect all functions and resources necessary to carry out authorized activities and the adequate determination of costs,  

1. Financial management system and corresponding policies including accurate, correct, and complete payroll, accounting, and financial reporting records; cost source documentation, effective internal and budgetary controls; determination of reasonableness, allowability, and allocability of costs; and timely and appropriate audits and resolution of any findings; and,  

1. Billing and collection policies including a charge schedule, a system for discounting or adjusting charges based on a person's income and family size, and a mechanism capable of billing and making reasonable efforts to collect from patients and third parties.  

 

Payer of Last Resort (PoLR)/Medicaid 

The costs of delivering services should be reasonably shared by the state and federal governments, private health insurers, and, to the extent possible, by the person with an HIV-related condition.  To maximize the limited program funds, Ryan White funds should be considered payer of last resort. Subrecipient must agree to bill third party payers for applicable (where the cost of the service is reimbursable from any third-party source) services provided, at no cost to the client, except for co-payments required by third party payers.  These potential payers include private insurance carriers, Medicaid, other available federal, state, local, and private funds, etc.  

Subrecipient shall maximize efforts to obtain payment from Medicaid and all other available sources. Subrecipient who provide Medicaid reimbursable services are required to become Medicaid providers for applicable program activities.  Where applicable, Subrecipient must establish the ability to bill private insurance including private health insurance, employer insurance plans, marketplace (ACA) plans and prepaid health plans.  

Link: DSHS Funds as Payment of Last Resort, www.dshs.texas.gov/hivstd/policy/policies/590-001.shtm;  

Link: TRG Payer of Last Resort (SR-0202-20)- DOC #11 

 

Consumer Charges for Billable Services 

In compliance with PoLR requirements, it is expected that all subrecipients have a sliding-fee schedule in place that uses as its premise the latest Federal Poverty Guidelines. Persons with an annual gross family income at or below 100% of the Federal Poverty Guidelines shall not be charged for any services covered by this funding. In accordance with Title 25 Texas Administrative Code §1.91, no one shall be denied services due to their inability to pay. 

The most current HHS poverty guidelines can be found: https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines  

Additional resources on MAGI can be located at DSHS’s Website https://dshs.texas.gov/hivstd/magi/ 

 

Program Income 

All revenues received for services provided by these funds are considered program income. Any revenues generated from third-party reimbursements/private insurance, Medicaid, Medicare or 340b pharmacy constitute program income. Subrecipient must report how such program income is used by the sub-recipients to advance the objectives of the HIV/AIDS program.  All program income generated as a result of program funding must be used for allowable current costs, and the income shall be budgeted and expended during the budget period in which it is realized.  The receipt and expenditure of all program income shall be reported on the monthly expense report and the quarterly financial report. Please refer to the 2/5/2018 Texas Health and Human Services GTAG (at https://dshs.texas.gov/contracts/gtag.aspx) and the 2017 HHSC Uniform Terms and Conditions, Version 2.15 (at https://apps.hhs.texas.gov/PCS/HHS0000310/Exhibit-B-UTC-Grantee.pdf) for detailed requirements for program income.  

DISCLAIMER: The information provided is not all inclusive of all financial management requirements. All requirements will be explicitly detailed in the Request for Proposal, with applicable links to Federal and State guidance. 

 

REPORTING REQUIREMENTS 

As a condition of your award of funding, we require that you report on your use of funding. 

Sample Reporting Schedule 

Due Date 

Fiscal Reporting 

Monthly Expense Report  

10th of each month with accompanying data report (below)  

Budget vs. Actual 

Houston HSDA: Quarterly 30 days after the quarter ends per service category  

All Other HSDAs: 10th of each month with expense report.  

Final Expense Report Due  

April 15  

Financial Status Report (FSR 269A)  

Quarterly (based on grant year)- 30 days after the quarter ends  

941 (plus proof of payment)  

May 20, Aug 20, Nov 20, Feb 20  

Data Reporting (if applicable)  

ARIES/TCT Data Entry  

Within 5 business days of service  

Monthly CPCDMS/ARIES STAR Report  

10th of each month with expense report  

Quarterly RSR Update Report 

July 20, Oct 20, Jan 20, Apr 20  

Annual RSR Report 

February 15, 2022 & 2023  

Programmatic Reporting  

Unified Quarterly Report 

July 20, Oct 20, Jan 20, Apr 20