FH Banner

OverviewApproachEligibility Training At-A-GlanceWebinarsResourcesRequest Training

Hot Off The Press!


Fiscal sustainability is a very broad topic. There are so many financial components that impact the fiscal health of an organization. Almost every decision has a financial element or cost. Some decisions the cost is readily apparent and immediate such as the decision to purchase new computers or even as simple as buying office supplies. Other decisions the cost is harder to see and often will not surface until much later such as the decision to expand staff, increase services to recipients or even decrease insurance coverage all of which can lead to increased cost and exposure in the future. Then there are the unforeseen circumstances such as unexpected rising costs of medical services, new grant compliance requirements or funding changes.

Organizations that are not constantly searching for fiscal improvement opportunities are at severe risk of damaging their fiscal sustainability. High performing organizations greatly increase their chances to improve their fiscal health and sustainability by remaining vigilant in their fiscal monitoring, accounting practices and financial management.

There are ten fiscal sustainability improvement practices that have time proven effectiveness and only take vigilance and patience to implement. The first critical element on the checklist is:

To learn more, click here and read the full article...



Fiscal Health: Systems to Sustainability is a capacity building program of HealthHIV that addresses the fiscal sustainability of Ryan White funded grantees by building their organizational fiscal management capacity. This HRSA/HAB-supported Fiscal Health project utilizes a diverse and culturally competent team of fiscal management experts to design and implement effective trainings focusing on HRSA program and fiscal requirements and contracts management with specifications for the states in which training are slated to take place.

The goal of Fiscal Health: Systems to Sustainability is to ensure the fiscal sustainability of Ryan White funded grantees. Health: Systems to Sustainability trainings help develop and/or enhance operational fiscal systems, with emphasis on monitoring standards, budgeting, fiscal standards, diversifying income streams, and quality controls for sub grantees and vendors.

HealthHIV meets this goal through multiple activities offering various ways for individuals to learn. HealthHIV provides onsite group trainings, individualized technical assistance, and online components.

Click here to download a Fiscal Health program factsheet. 



FH Lansing Combo


Fiscal Health: Systems to Sustainability is an enhanced approach to building the organizational and specifically the fiscal health of Ryan White-funded organizations and providers. This program focuses on the aggregate and individual-level fiscal management capacity-building needs identified by HealthHIV and collected over the past six years. The Program considers the current and future healthcare funding and organizational environment in which programs operate. HealthHIV utilizes a diverse and culturally competent team of fiscal management experts to design and implement their effective training curriculum targeting Ryan White providers. The current funding cycle is from the period of 2011 to 2014.

Project deliverables include:

  • Convening a fiscal management key informant panel
  • Designing and implementing a virtual Learning Community targeting up to 250 present or previously trained Ryan White providers
  • Designing and facilitating four regional training locations each year
  • Implementing 20 to 25 episodes of individualized technical assistance to Ryan White providers.
  • Produce two webinars reaching 100 Ryan White providers.
  • Host two sustainability seminars focused on fiscal health and organizational sustainability for 30-50 targeted Ryan White service providers, subgrantees and vendors.


HealthHIV offers training eligible organizations as requested by HRSA/HAB. The following Ryan White HIV/AIDS program recipients are eligible for this training:

Training content is developed specifically for Executive Directors, Finance Directors, CEOs, CFOs, or other organizational leaders with significant fiscal oversight.

Training At-A-Glance

Training Content and Impact Areas

Fiscal Sustainability & Infrastructure Development 
  • Ryan White Program Monitoring
    Revenue Generation & Income Diversification
  • Financial Management and Accountability for Nonprofits
  • Components of an Annual Audit
  • Strategic & Business Planning
  • Indirect Cost Rate Administration and Negotiation
  • Fiscal Systems Development for Program Administrators & Fiscal Staff
Ryan White Program Monitoring
  • Program Income
  • Indirect Cost Allocation
  • Establishing a HIV Medical Home Model or FQHC
  • HRSA/HAB Fiscal & Program Monitoring Standards & Compliance
  • Ryan White Eligibility Determination & Sliding Fee Scales
  • Establishing Third Party Reimbursement Systems - Medicaid Expansion

Training Sessions



Staying Alive: Fiscal Health & Sustainability for Ryan White-Funded Programs


Description: Fiscal sustainability is a significant issue for ASOs, CBOs and health departments in the current fiscal and political environment. It is imperative for these agencies to focus on strengthening fiscal portfolios and maintaining strict monitoring of existing funds received by federal programs. Fiscal and program monitoring standards are relevant in the life cycle of funded programs. Meeting these demands can be challenging for programs to grasp and implement. 

Learning Objectives: At the conclusion of this seminar, participants will be able to:

  • Address the emerging demands of ASO, CBOs, and health departments regarding fiscal sustainability.
  • Understand key organizational sustainability components such as program income and fiscal/programmatic monitoring standards.
  • Enhance the fiscal management infrastructure of Ryan White-funded providers.
  • Prepare for programmatic changes in regards to possible political and economic funding shifts.
Ryan White Program Monitoring & Technical Assistance

Description: It is important for agencies to consistently review their monitoring standards and increase awareness and understanding of HRSA's expectations. During this session, participants will gain greater awareness and understanding of HRSA's expectations, improve upon their monitoring practices, and obtain a heighten consciousness of potential changes coming to the Ryan White program, Medicaid and healthcare delivery in general.

Learning Objectives: At the conclusion of this seminar, participants will be able to

  • Decipher HRSA's Ryan White program monitoring requirements for care service programs.
  • Identify strategies and best practices related to program monitoring.
  • Describe three potential impacts of Healthcare Reform on CBOs.
  • Identify action steps for developing strategic community partnerships.
  • Describe strategies or tips to consider when marketing their agency
Third Party Reimbursement & Billing 

Description: Ryan White is the payer of last resort. It is a requirement that all providers are able to bill Medicaid, Medicare and private insurance first. In order to properly set up for third party reimbursement, a global look at the patient needs and agency resources is needed. During this two-part session, participants will walk through key related issues. With support and permission of a successful agency with TA, a case study will be used to illustrate an effective coordination process. Part One (Wednesday) will set up the issues to be examined. Part Two (Thursday) will address how the agency addressed the issues.

Learning Objectives: At the conclusion of this seminar, participants will be able to:

  • Decipher HRSA's Ryan White program monitoring requirements for care service programs.
  • Identify strategies and best practices related to program monitoring.
  • Describe three potential impacts of Healthcare Reform on CBOs.
  • Identify action steps for developing strategic community partnerships.
  • Describe strategies or tips to consider when marketing their agency
Finding and Managing Program Income...A Key to Financial Sustainability 

Description: One of the top financial sustainability traits of successful nonprofit healthcare organizations is a well-diversified source of funds. Program income derived from fees for patient services, contracts or products sold is often a viable route to pursue. This session will cover both the up-front planning required, and the all-important administrative management aspect, commonly known as the revenue cycle.

Learning Objectives: At the conclusion of this seminar, participants will be able to:

  • Recognize the purpose and value of income diversification.
  • Obtain baseline knowledge of external and nontraditional funding entities.
  • Learn the vital resources available and where to obtain.
  • Understand how to develop a plan for income diversification.  

Fiscal Health Webinars


The Fiscal Health Webinar series is designed for a range of audiences including, but not limited to, Ryan White Administrators, HIV prevention and care providers, and HIV organization fiscal managers as an effective distance learning tool. Topics are selected based upon needs assessment and evaluation received from Ryan White grantees, subgrantees, and other organizations requesting Fiscal Health Technical Assistance. 

Upcoming Webinar topics include:


To register, contact Julio Fonseca at


Web Training Icon
Let's Build an
Indirect Rate Together

 Overview: Session will focus on the practical aspects of building a compliant indirect rate. Faculty will discuss the tools and techniques for preparing an indirect rate and pitfalls to avoid, such as consistency of direct charges. The session will cover various situations including how to develop an indirect rate when you have some grants that permit the recovery of occupancy cost as a direct line item and other grant awards that do not. The session will conclude by reviewing the HHS model template for preparing an indirect rate.

Access the Webinar slide deck here.

Access the Indirect Rates Guide here.

 Web Training Icon

How to Develop Indirect Rates for Nonprofits: OMB Circular A-122 vs. the New Super Circular

 Overview: This training focuses on the fundamental requirements of developing an indirect rate for negotiating with your cognizant agency. The session presents the existing OMB Circular A-122, new rules from2 CFR 200.400, and Appendix IV to underscore the changes from the new Super Circular. New options from the Super Circular are presented, such as the 10% de minimis indirect rate that does not require backup for negotiation. It also covers some of the more onerous certifications.

Access Part 1 of 2 of the Webinar slide deck here.

Access Part 2 of 2 of the Webinar slide deck here.

Access the Indirect Rates Handout here.

   Web Training Icon
Five Essential Lessons for Sound Fiscal Management


Overview: This five part training covers a range of financial management issues, including:  strategic budgeting, general finance, budgeting, accounting controls, financial statements.  Each section of the training can be taken individually, or the webinar can be viewed in its entirety.

 HH Webinar Icon
Eligibility Determination for Ryan White Primary Care Providers

Overview:  Specifically designed for members of the Ryan White Community, this webinar is a comprehensive overview of issues related to determining the eligibility of patients applying to Ryan White programs.

Learning Objectives At the conclusion of this course, participants will be able to:

  • Understand federal requirements regarding Ryan White eligibility determination, fiscal requirements, benefits coordination, and chart documentation.
  • Identify federal and state disability income and health insurance programs most likely to benefit HIV positive clients.
  • Explain eligibility determination practices, policies, and procedures used by members of the Ryan White community that can be adopted by organizations.
  • Recognize the roles that staff and community partners can play in Ryan White eligibility determination.

HealthHIV's Published Resources

FH Booklet Cover
 Maximizing - Logo

 Successfully Managing
Fiscally Healthy HIV Nonprofits:
From Systems to Sustainability

 Maximizing Third Party
Reimbursement through Enhanced
Medical Documentation and Coding


Requests for Training

For additional information or if you are interested in partnering with HealthHIV to bring a Fiscal Health training to your area, please  HealthHIV's Training & Education Manager, or call (202) 232-6749.

Interested cities or regions can complete a Fiscal Health: Systems to Sustainability online partnership application here. The proposed partner, typically a Ryan White Administrator, should complete the application.

This training is offered free-of-charge to participants through a cooperative agreement with the Division of Training and Technical Assistance in the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA).

Prepare to print

Share Our Site:

Get link code to this page