Executive Committee Meeting Minutes April 20, 2023


By Zoom

3:05 – 4:35pm

Members Present: Graham Harriman (Governmental Co-chair), Dorella Walters (Community Co-chair), Billy Fields (Finance Officer), Saqib Altaf, Marya Gilborn, Charmaine Graham, Steve Hemraj, Emma Kaywin, Matthew Lesieur, David Martin, Freddy Molano, MD, Jeff Natt, Julian Palmer, Guadalupe Dominguez Plummer, Claire Simon (for Joan Edwards), Marcelo Maia Soares, Marcy Thompson

Members Absent: Ronnie Fortunato

Staff Present: NYC DOHMH: David Klotz, Melanie Lawrence, Doienne Saab, Johanna Acosta, Deborah Noble, Patrick Chan, Jimmy Jaramillo, Kimbirly Mack; Public Health Solutions: Barbara Silver, Arya Shahi, Gemma Barclay, Rosemarie Santos; Joan Corbisiero (Parliamentarian)

Agenda Item #1: Welcome/Introductions/Minutes/Public Comment

Mr. Harriman and Mr. Fields opened the meeting followed by a roll call and a moment of silence.  The minutes from the March 23, 2023 meeting were approved with no changes.

Agenda Item #2: GY 2023 Planning Council Support Budget

Mr. Harriman and Mr. Klotz presented the revised GY 2023 Planning Council support budget.  As per the Executive Committee’s request, a survey of Council members was conducted on the question of in-person and virtual meetings.  A majority of respondents expressed a preference for three in-person meetings per year.  The budget presented last month was adjusted to cover three in-person Council and Consumer Committee meetings with corresponding higher amounts for space rental, audio, transportation and food.

A motion was made, seconded and approved 13Y-ON to accept the GY 2023 Planning Council support budget as presented.

Agenda Item #3: Reprogramming

GY 2023 Reprogramming Plan

Mr. Natt explained that the Council approved a reprogramming plan each year to spend funds that become uncommitted during the course of the year.  The plan gives the Recipient the latitude to shift funds between service categories in order to enhance overperforming contracts.  No service category will be enhanced by more than 20% of its original allocation in the spending plan without Council approval, and categories are enhanced internally before funds are shifted between categories.  ADAP will be included as a category for enhancement after all other service categories have been considered, but will not be subject to the 20% cap.  The plan will allow the EMA to maximize spending during the year and reduce the levels of carryover.

A motion was made, seconded and approved 13Y-0N to approve the GY2023 reprogramming plan.

GY 2022 Additional Reprogramming

Mr. Shahi explained that an initial close-out analysis of GY 2022 (ended February 28, 2023) shows that there are additional funds available for reprogramming to over-performing service categories above the 20% cap allowed under the Council’s reprogramming plan.  DOHMH/PHS has reprogrammed funds from underperforming service categories to overperforming service categories per the Council’s approved GY 2022 Reprogramming Plan.  Two proposed service category enhancements need Planning Council approval, as they exceed the 20% enhancement cap in the Reprogramming Plan: Medical Case Management/Tri-County: 39% increase ($577,959), and Psychosocial Support Services/Tri-County: 26% increase ($39,491).  The reprogramming methodology was explained.

A summary of the discussion follows:

  • The underspending came from throughout the portfolio, including Emergency Financial Assistance, Legal Services (TC), Supportive Counseling (NYC) and Care Coordination (NYC). 
  • The under- and over-spending in each category will be detailed in the 4th quarter close-out report, due in June, which the Executive Committee and Council reviews as part of the assessment of the administrative mechanism.
  • The reprogrammed funds are for one-time use to reimburse for services provided beyond a contracts maximum reimbursable amount (MRA).  They cannot be used for on-going expenses, such as salary increases.
  • When the PSRA considers the service category allocations, they start with the same baseline allocation as the previous year, not the amount modified through reprogramming.  PSRA takes into account historical spending when considering changes to allocations.
  • The Recipient should consider if high rates of overspending in some categories is indicative that the MRA’s rates are not adequate to cover the true costs of providing the service.
  • A considerable proportion of the overspending was in deliverables, many related to the Framing Directive, such as training, cultural competence, etc., which were incentivized by the Recipient.
  • Overperforming subrecipients are spending more than what is in their contracts not knowing if they will be reimbursed through reprogramming.
  • EFA is an EMA-wide service provided by a subrecipient located in Westchester, but with most clients in NYC. The Recipient can consider moving the EFA contract to a NYC-based provider, but that could only be done through a procurement.
  • One TC Medical Case Management provider worked hard to keep service levels up despite increased costs and no money to increase staff salaries.

A motion was made, seconded and approved 8Y-0N to approve the additional GY2022 reprogramming request as presented.

In response to a question, Ms. Corbisiero explained that an abstention is not counted toward the vote total.

Agenda Item #4: Service Standards

Mr. Harriman explained that Service Standards are required by HRSA for all funded services.  The documents consist of excerpts from and references to existing documents: Council Directives, HRSA Service Category Definitions, Requests for Proposals, and contractual language, hence much of these documents may not be edited.  Service Standards are not service directives.  Directives are developed by the IOC and describe goals and objectives, service types, service models, outcomes and client and agency eligibility for each category.  Service Standards outline the elements and expectations a Ryan White HIV/AIDS Program (RWHAP) service provider follows when implementing a specific service category.  The purpose of Service Standards is to ensure that all RWHAP service providers offer the same fundamental components of the given service category across a service area.  Service Standards establish the minimal level of service or care that a RWHAP funded agency or provider may offer within a state, territory or jurisdiction.  Service Standards set a benchmark by which services are monitored and subrecipient contracts are developed. Each funded service category must have a unique set of service standards.  There may be some overlap of service standards among two or more service categories (e.g., medical case management and non-medical case management may both assist with enrolling clients in insurance assistance programs).  

Committee members noted that this is the end of a long, multi-year process that involved extensive review, including by members of the IOC subcommittee.  This documents merely compile information from existing documents to satisfy a HRSA requirement.  Any changes (e.g., to a service model) would be done when the IOC revises the Service Directive for a category. 

A motion was made, seconded and approved 13Y-0N to approve the Service Standards as presented.

Agenda Item #5: Council Co-chairs Report and Public Comment

Mr. Harriman and Mr. Martin reported that the Consumers Committee submitted a letter to the Recipient expressing additional feedback and concerns on the EMA’s Quality Management plan, asking that the QM include additional measures to enhance responsiveness to consumers. 

Mr. Palmer reported that the 340B issue is still not resolved as the State budget is not final, but that the end of the rebates is already having an impact on providers who are losing funding, and on clients, who are being asked for prior authorization to continue needed prescriptions.  Mr. Lesieur added that if the program is restored in the State budget, it would have to be phased back in.

Members of the Consumers Committee were commended for their presentation on HIV and aging at the AIDS Institute’s recent conference.  There being no further comment, the meeting was adjourned.