Form 2 Part B Expenditures Report and Changes Summary

Ryan White HIV/AIDS Program Expenditure Forms

Part B Expenditures Report and Changes Summary

Part B Expenditures Report

OMB: 0915-0390

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Changes Summary Table: Expenditures
Report Template
Current Reporting

Proposed Change

Award Information
- RWHAP Budget Year Award Information

- Change title to: Award Information

- Prior Year Carryover

- Change title to: Prior FY Carryover

- Award Amount
- Total Avail. Funds
RWHAP Part B Expenditures by Program
Component
-

Part B Program Total

- Change title to: Current FY
- Change title to: Total

- RWHAP Part B Expenditures by Program Component

- Total Prior Year Carryover

- Change title to: 4. Total Prior FY Carryover

- Carryover

- Award

Change title to: Prior FY Carryover. *Repeat tile
under:
• 1 Base Award
• 2. ADAP Earmark + ADAP Supplmenetal
• 3. Emergeging Communities Award
Change title to: Current FY. *Repeat tile under:
• 1 Base Award
1

- 5. Total (including carryover) Percent column

- 2. RWHAP Part B Health Insurance Premium &
Cost Sharing Assistance

3. RWHAP Part B Home and Community-based
Health Services

• 2. ADAP Earmark + ADAP Supplmenetal
• 3. Emergeging Communities Award
5. Total (including carryover) Percent column’s
following rows are blacked out:
4a – 4c RWHAP Part B HIV Care Consortia
Admin, P&E, and CQM.
6. RWHAP Part B Clinical Quality Management
7. RWHAP Part B Recipient Planning & Evaluation
Activities
8. Recipient Administration
9. Column Totals
10.Total RWHAP Part B Expenditures (excluding
carryover)
2. RWHAP Part B Health Insurance Premium &
Cost Sharing Assistance . Back out the following
amounts and percent columns:
• 1. Base Award
• 2. ADAP Earmark + ADAP Supplemental
• 3. Emerging Communities Award
• 4. Total Priro FY Carryover
• 5. Total (Including Carryover)
3. RWHAP Part B Home and Communitybased Health Services. Black out the following
amounts and percent columns :
• 1. Base Award
• 2. ADAP Earmark + ADAP Supplemental
• 3. Emerging Communities Award
• 4. Total Priro FY Carryover

• 5. Total (Including Carryover)

- Previously, not available

- 4b. RWHAP Part B HIV Care Consortia Planning
& Evaluation

- Previously, not available

- Previously, not available
- Previously, not available

-Previously, not available

- 11. Total Part B X07 Allocations

4b. RWHAP Part B HIV Care Consortia Planning &
Evaluation’s. Black out the following columns:
- 1. Base Award Prior FY Carryover
- 2. ADAP Earmark + ADAP Supplemental Prior FY
Carryover, Current FY and Percent
- 3. Emerging Communities Award Prior FY
Carryover
- 4. Total Prior FY Carryover Amount and Percent
- 4c. RWHAP Part B HIV Care Consortia CQM
- 4c. RWHAP Part B HIV Care Consortia CQM.
Black out the following columns:
- 1. Base Award: Prior FY Carryover
- 2. ADAP Earmark + ADAP Supplemental: Prior
FY Carryover, Current FY and Percent
- 3. Emerging Communities Award: Prior FY
Carryover
- 4. Total Prior FY Carryover: Amount and Percent
- 10.Total RWHAP Part B Expenditures (excluding
carryover)
- Removed

RWHAP Part B Expenditures Categories
- Part B Expenditure Categories

- Change title to: RWHAP Part B Expenditures Categories
3

4. Prior Year Carryover
b. AIDS Pharmaceutical Assistance

c. Early Intervention Services (EIS)

d. Health Insurance Premium and Cost Sharing
Assistance for Low-Income Individuals

e. Home and Community-Based Health Services

g. Hospice

- Change title to: 4. Prior FY Carryover
-

Change title to: b. AIDS Pharmaceutical Assistance
(LPAP)
-

Change title to: c. Early Intervention Services

Change title to: d. Health Insurance Premium &
Cost Sharing Assistance. Display previously
blacked out cells in the following two rows
under the Expenditures Categories table:
o 2. Direct Services
o 3. Emerging Communities
o 4. Prior FY Careover
- e. Home and Community-based Health
Services. Display previously blacked out cells in
the following two rows under the Expenditures
Categories table:
o 2. Direct Services
o 3. Emerging Communities
o 4. Prior FY Careover
Change title to: g. Hospice Services
-

h. Medical Case Management, including Treatment
Adherence Services
- 1. Core Medical Services Total

Change title to: h. Medical Case Management
(incl. Treatment Adherence Services)
- Change title to: 1. Core Medical Services Subtotal

c. Food Bank/Home Delivered Meals

Change title to: c. Food Bank/Home-Delivered Meals

o. Substance Abuse Services (residential)

- 2. Support Services Total
3. Total

Change title to: o. Substance Abuse Services - residential

- Change title to: 2. Support Services Subtotal
-

Change title to: 3. Total Service Expenditures

MAI Expenditure by Program Component
-

MAI Award

MAI Expenditure by Program Component

REPORTING YEAR AWARD

Current FY

Total Percent

Total Percent’s following rows are blacked out:
3. Clinical Quality Management: Prior FY Carryover
amount & percent
4. Recipient Planning & Evaluation Activities: Prior FY
Carryover amount & percent
5. Recipient Administration: Prior FY Carryover amount
& percent
6. Total MAI Expenditures: Percent

Legislative Requirements Checklist
-

Core Medical Services Expenditures

ADAP
Health Insurance Premium & Cost Sharing Assistance
Home- and Community-based Health Services
Total Core Medical Services Expenditures

Percent

Consortia Services + Consortia Administration

Change title to: 75% Core Medical Services
Expenditures Requirement
Change title to: ADAP Services
Removed
Removed
Change title to: Subtotal Core Medical Services
Expenditures
Change title to: Percentage (Amount / Total Service
Expenditures)
Change title to: Consortia Services (Base & EC)

Total Support Services Expenditures
CQM Language:
Total Clinical Quality Management expenditures must be
5% of the total X07 award or $3 million (whichever is
smaller.)

Below is the maximum (Capped Amount) that you can
spend on Clinical Quality Mangement as well as the
amount of Current Fiscal Year dollars spent (CQM
Expenditures) on Clinical Quality Management.
Carryover dollars are excluded from this calculation.
Please check to make sure the Expenditures do not
exceed the Capped Amount.
CQM Expenditures calculation includes Part B CQM and
MAI CQM.
P&E Language:
Total RWHAP Part B X07 Planning and Evaluation
expenditures and total Recipient Administration
expenditures must each be 10% or less than the total X07
award. Planning and Evaluation and Recipient
Administration do not necessarily need to be 10% of each
funding stream as long as the combined total of each is
10% or less of the total X07 award. In addition, Planning
and Evaluation and Recipient Administration
expenditures combined must not exceed 15% of the total
X07 award.
Below is the percentage of Planning and Evaluation
expenditures divided by the Total X07 award and
Recipient Administration expenditures divided by the

Change title to: Subtotal Support Services Expenditures
CQM Language Change:
In the aggregate, total CQM expenditures may be 5% of
the total X07 award or $3 million (whichever is smaller).
This amount includes the following for CQM: base, base
consortia, ADAP earmark/ADAP supplemental, EC, EC
consortia, and MAI.

Below is the maximum amount (capped amount) that a
recipient can spend on CQM as well as the amount of
current fiscal year dollars spent (CQM expenditures) on
CQM. Carryover dollars are excluded from this
calculation as carryover dollars may not be used for
CQM. Please check to make sure the expenditures do not
exceed the capped amount.
-

Calculation includes Part B CQM, MAI CQM, and
Consortia CQM.

P&E Language Change:
In the aggregate, total recipient administration
expenditures may not exceed 10% of the total X07
award. In the aggregate, total P&E expenditures may not
exceed 10% of the total X07 award. When the two (i.e.,
recipient administration and P&E) are combined it may
not exceed in the aggregate 15% of the total X07 award.
This includes recipient administration and P&E for the
following: base, base consortia, ADAP earmark/ADAP
supplemental, EC, EC consortia, and MAI. Carryover
dollars are excluded from this calculation as carryover
dollars may be used for neither recipient administration
nor P&E.
Below reflects in the aggregate expenditures for recipient
administration, P&E, and recipient administration/P&E.
It also reflects the percentage for each in the aggregate.
Please check to make sure these percentages are not
greater than 10% individually and 15% collectively (i.e.,
recipient administration and P&E).
6

Total X07 award. Please check to make sure these
percentage are not greater than 10%. Also shown is the
percentage of the combined Planning and Evaluation and
Recipient Administration expenditures divided by the
Total X07 Award. Carryover dollars are excluded from
this calculation. Please check to make sure this percentage
is not greater than 15%.
P&E Expenditures calculation includes Part B P&E.

Calculation includes Part B P&E, MAI P&E, and
Consortia P&E.

Recipient Admin Expenditures calculation includes Part
B recipient admin.

Calculation includes Part B RA, MAI RA, and Consortia
RA.

Consortia Administration and EC Administration

Removed

Previously, not available

Adding a requirement for a Financial Officer
(FO)/Designee to certify subrecipient aggregated
administrative expenditures
•

Section A
1. Total Current FY Grant Award (including
approved Prior FY carryover)
2. Recipient Administrative Expenses
i. (This includes ADAP Base
Administrative Expenses, excluding
Pharmacy Benefits Manager and
Insurance Benefits Manager
Administrative Costs.)
3. Recipient Planning and Evaluation Expenses
4. Recipient Clinical Quality Management
Expenses
5. FY 2023 Award (line 1) minus Recipient
Administration/Planning and
Evaluation/Clinical Quality Management
Expenses (lines 2, 3 and 4)
6. Subrecipients Aggregate Allowable
Administrative Cost Cap (10% of line 5)
7

7. Actual Subrecipients Administrative Costs
i. (This includes Direct Services (non
ADAP Base Direct Services) and does
not include Pharmacy Benefits Manager
or Insurance Benefits Manager Costs.)
8. Subrecipients Administrative Expenditures as a
Percentage of Amount of Funds on line 5 (leave
blank if receive minimum allotment)
Note: Divide line 7 / line 5 then
multiply 100%

•

Section B: This certifies that administrative
expenses for the RWHAP Part B does not exceed
allowable cap
o Recipient Budget(Fiscal) Officer/Designee
Name:
o Recipient Budget(Fiscal) Officer/Designee
Signature:
o Date

FYxx RWHAP Part B & MAI Expenditures Report
Award Information
Prior FY
Carryov
er

Current FY

Total

1. RWHAP Part B Base Award
2. RWHAP Part B ADAP Earmark Award
3. RWHAP Part B ADAP Supplemental Award
4. Total RWHAP
Part B Base +
ADAP + ADAP
Supplemental
Funds
5. RWHAP Part B Emerging Communities
Award
6. Total RWHAP Part B Funds
7. RWHAP Part B MAI Funds
8. Total RWHAP Part B + MAI Funds
9

1. Base Award
Prior FY
Carryover
1. RWHAP Part B
AIDS Drug
Assistance
Program Subtotal

Curr
ent
FY

Percent

Prior FY
Carryover

Curr
ent
FY

Perc
ent

3. Emerging
Communities Award
Prior
FY
Carry
over

Curr
ent
FY

Perc
ent

4. Total
Prior FY
Carryover
Amo
unt

Perc
ent

5. Total
(including
carryover)
Amo
unt

Perc
ent

a. ADAP Services
b. Health
Insurance to
Provide
Medications
c. ADAP
Access/Adherence
/Monitoring
Services
2. RWHAP Part B
Health Insurance
Premium & Cost
Sharing
Assistance
3. RWHAP Part B
Home and
10

FY2023 RWHAP Part B Expenditures Report Changes
The table below provides a summary of proposed changes to the RWHAP Part B Expenditures Report. A draft template of the report with is also
provided below.
Community-based
Health Services
4. RWHAP Part B
HIV Care Consortia
4a. RWHAP Part B
HIV Care Consortia
Administration
4b. RWHAP Part B
HIV Care Consortia
Planning &
Evaluation
4c. RWHAP Part B
HIV Care Consortia
CQM
5. RWHAP Part B
State Direct
Services
6. RWHAP Part B
Clinical Quality
Management
7. RWHAP Part B
Recipient Planning
& Evaluation
Activities
8. Recipient
Administration
9. Column Totals
10.Total RWHAP Part B
Expenditures (excluding carryover)

FY2023 RWHAP Part B Expenditures Report Changes
The table below provides a summary of proposed changes to the RWHAP Part B Expenditures Report. A draft template of the report with is also
provided below.
RWHAP Part B Expenditures Categories
1. Consortia
Award
Core Medical
Services
a. AIDS Drug
Assistance
Program (ADAP)
Treatments
b. AIDS
Pharmaceutical
Assistance (LPAP)
c. Early
Intervention
Services
d. Health
Insurance
Premium & Cost
Sharing Assistance
e. Home and
Community-based
Health Services
f. Home Health
Care

2. Direct Services
Perc
ent

Award

Percent

3. Emerging
Communitie
s
Awa Perc
rd
ent

4. Prior FY
Carryover
Amou
nt

Perc
ent

5. Total
(including
carryover)
Amo Perc
unt
ent

g. Hospice Services
12

FY2023 RWHAP Part B Expenditures Report Changes
The table below provides a summary of proposed changes to the RWHAP Part B Expenditures Report. A draft template of the report with is also
provided below.
h. Medical Case
Management (incl.
Treatment
Adherence
Services)
i. Medical Nutrition
Therapy
j. Mental Health
Services
k. Oral Health Care
l. Outpatient
/Ambulatory
Health Services
m. Substance
Abuse Outpatient
Care
1. Core Medical
Services Subtotal
Support Services
a. Child Care
Services
b. Emergency
Financial
Assistance
c. Food
Bank/HomeDelivered Meals

FY2023 RWHAP Part B Expenditures Report Changes
The table below provides a summary of proposed changes to the RWHAP Part B Expenditures Report. A draft template of the report with is also
provided below.
d. Health
Education/Risk
Reduction
e. Housing
f. Linguistics
Services
g. Medical
Transportation
h. Non-Medical
Case Management
Services
i. Other
Professional
Services
j. Outreach
Services
k. Psychosocial
Support Services
l. Referral for
Health Care and
Support Services
m. Rehabilitation
Services
n. Respite Care
o. Substance
Abuse Services residential
2. Support
Services Subtotal
14

FY2023 RWHAP Part B Expenditures Report Changes
The table below provides a summary of proposed changes to the RWHAP Part B Expenditures Report. A draft template of the report with is also
provided below.
3. Total Service
Expenditures
MAI Expenditure by Program Component
Prior FY Carryover
Amount
1. Education to
increase minority
participation in
ADAP
2. Outreach to
increase minority
participation in
ADAP
3. Clinical Quality
Management
4. Recipient
Planning &
Evaluation
Activities
5. Recipient
Administration

Perc
ent

Current FY
Amount

Percent

Total
Amo
unt

Perc
ent

6. Total MAI
Expenditures

Legislative Requirements Checklist
75% Core Medical
Services
Expenditures
Requirement

Amo
unt

Percent
age
(Amoun
t / Total
Service
Expendi
tures)

Amo
unt

Percent
age
(Amoun
t / Total
Service
Expendi
tures)

ADAP Services
State-Direct
Services: Core
Medical Services
Emerging
Communities: Core
Medical Services
Subtotal Core
Medical Services
Expenditures

Support Services
Expenditures

Consortia Services
(Base & EC)

FY2023 RWHAP Part B Expenditures Report Changes
The table below provides a summary of proposed changes to the RWHAP Part B Expenditures Report. A draft template of the report with is also
provided below.
State-Direct
Services: Support
Services
Emerging
Communities:
Support Services
MAI Allocations for
Education +
Outreach Services
Subtotal Support
Services
Expenditures
Total Service Expenditures
(excludes carryover dollars)

Clinical Quality Management
In the aggregate, total CQM expenditures may be 5% of the total X07
award or $3 million (whichever is smaller). This amount includes the
following for CQM: base, base consortia, ADAP earmark/ADAP
supplemental, EC, EC consortia, and MAI.
Below is the maximum amount (capped amount) that a recipient can
spend on CQM as well as the amount of current fiscal year dollars spent
(CQM expenditures) on CQM. Carryover dollars are excluded from this
calculation as carryover dollars may not be used for CQM. Please check
to make sure the expenditures do not exceed the capped amount.
Expenditures

Amount

Planning and Evaluation / Recipient Administration
In the aggregate, total recipient administration expenditures may not
exceed 10% of the total X07 award. In the aggregate, total P&E
expenditures may not exceed 10% of the total X07 award. When the two
(i.e., recipient administration and P&E) are combined it may not exceed
in the aggregate 15% of the total X07 award. This includes recipient
administration and P&E for the following: base, base consortia, ADAP
earmark/ADAP supplemental, EC, EC consortia, and MAI. Carryover
dollars are excluded from this calculation as carryover dollars may be
used for neither recipient administration nor P&E.
Below reflects in the aggregate expenditures for recipient administration,
P&E, and recipient administration/P&E. It also reflects the percentage
for each in the aggregate. Please check to make sure these percentages
are not greater than 10% individually and 15% collectively (i.e., recipient
administration and P&E).
Expenditures

Amount

Percent

Planning & Evaluation
Recipient Administration
Planning & Evaluation + Recipient
Administration
18

Certification of Aggregate Administrative Costs
Section A

Current FY

1. Total Current FY Grant Award (including approved
Prior FY carryover)
2. Recipient Administrative Expenses
This includes ADAP Base Administrative Expenses,
excluding Pharmacy Benefits Manager and Insurance
Benefits Manager Administrative Costs.
3. Recipient Planning and Evaluation Expenses
4. Recipient Clinical Quality Management Expenses
5. FY 2023 Award (line 1) minus Recipient
Administration/Planning and Evaluation/Clinical
Quality Management Expenses (lines 2, 3 and 4)
6. Subrecipients Aggregate Allowable
Administrative Cost Cap (10% of line 5)
7. Actual Subrecipients Administrative Costs
This includes Direct Services (non ADAP Base Direct
Services) and does not include Pharmacy Benefits
Manager or Insurance Benefits Manager Costs.
8. Subrecipients Administrative Expenditures as a
Percentage of Amount of Funds on line 5 (leave blank
if receive minimum allotment)
Note: Divide line 7 / line 5 then multiply 100%
Section B: This certifies that administrative expenses
for the RWHAP Part B does not exceed allowable cap

Recipient Budget(Fiscal)
Officer/Designee Signature:
x

Date:

File Type	application/pdf
Author	Apraku-Gyau, Kwasi (HRSA)
File Modified	2023-02-16
File Created	2023-02-16