Executive Committee Meeting Minutes December 10, 2020



Monday, December 10, 2020, 3:30 – 5:00PM

By Zoom Videoconference


Members Present: Graham Harriman (Governmental Co-chair),Dorella Walters (Community Co-chair), Paul Carr (Finance Officer), Danielle Beiling, Lisa Best, Maria Diaz, Billy Fields, Marya Gilborn, David Martin, Jeff Natt, Guadalupe Dominguez Plummer, Donald Powell, Claire Simon, Andrea Straus, Marcy Thompson

Members Absent: Randall Bruce, Joan Edwards, Amanda Lugg
Staff Present: NYC DOHMH: David Klotz,Melanie Lawrence, Karen Miller, José Colón-Berdecía, Kimbirly Mack, Giovanna Navoa; Public Health Solutions: Bettina Carroll, Gucci Kaloo; HRSA: Sera Morgan

Agenda Item #1: Welcome/Introductions/Minutes

Mr. Harriman and Ms. Walters opened the meeting followed by introductions and a moment of silence.  The minutes from the November 16, 2020 meeting were with approved no changes.

Mr. Harriman and Ms. Walters noted that, per Roberts Rules of Order, any motions must be germane to the agenda.  Any new business that is proposed will be taken up at a future meeting.

Agenda Item #2: HRSA Project Officer Update

Ms. Morgan congratulated the EMA on a successful Power of Quality Improvement Conference.  She reported that there is a new Deputy Director in charge of the HRSA/HAB Part A programs.  HRSA/HAB is simplifying the core medical services waiver process to a one-page attestation.  The Objective Review Committee has met to review the RWPA grant applications; scores will be released in January.  There is no word yet on the timing of the FY 2021 award.   

Agenda Item #3: 2nd Quarter Commitment and Expenditure Report

Mr. Carr introduced the 2nd Quarter Commitment and Expenditure Report for fiscal year 2020 (March 1, 2020 to Feb. 28, 2021).  In a normal year, we would have six months of complete data at this point.  Due to factors related to COVID and the master contract with Public Health Solutions, the data is not as complete as it normally is.  It is important that the Grantee spends the grant according to the Council’s spending plan.  The Council’s role is to review spending and ask questions to ensure that the grant is expended according to its plans.  Also, it’s this Committee’s responsibility to review the Grantee’s rate of spending.  The EMA is allowed to carry-over up to 5% of the award without penalties.  For many years, spending rates have been close to 100%, but this is an unusual year.  The Grantee team will discuss how they will work to ensure that funds are spent expeditiously with as minimal carry-over as possible.

Ms. Plummer presented the report.  Highlights include:

  • Spending in the State-Administered Drug Assistance Program (ADAP) is reported at 0% due to late billing submission, which is not unusual. 
  • Transitional Care Coordination under the Medical Case Management (MCM) service category is not listed here because the funding was reallocated to the Housing Services category by the Council.
  • Legal Services spending is low in both NYC (27%) and Tri-County (29%) because courts are closed, and no evictions are happening due to the COVID-19 pandemic.
  • RWPA programs in both NYC and Tri-County are underspent due to staff vacancies.  Many programs were badly financially hit during the first wave of the COVID-19 pandemic as they could not bill for in-person services and instituted hiring freezes and furloughs.  With staff departures and an inability to hire new staff, programs are limited in providing services. Unfortunately, it is not easy to fill vacancies during a pandemic.
  • Medical Transportation in Tri-County is at 13% due to the COVID-19 pandemic and the associated shutdowns instituted by the NYS Governor.  Clients were not going to providers as often due to limited appointments and the NYS on Pause.  Most clients switched their appointments to telehealth resulting in a drastic reduction of transportation usage. 
  • Emergency Financial Assistance (for the whole EMA, but administered in Tri-County) is at 8% due to the program receiving the $500,000 enhancement in July.  It took time to develop a protocol and policies to allow NYC providers to submit referrals.  The program is receiving referrals, but they are coming in slowly resulting in underspending.  The program has decided to add a part-time position to help with spending the contract down.  A potential candidate for this position has been identified and an offer will be made soon.
  • Housing programs have reported challenges with placing clients in housing.  This is due to delays with HASA and staff vacancies.  Updated spending data in Housing shows that 87% of the category is already expended.
  • Mental Health Services in Tri-County is at 0% with $97,243 unexpended funds due to staff vacancies and the program not having a Licensed Mental Health Practitioner to provide services.  The program is also facing additional challenges with client recruitment and enrollment.  The Grantee continues to provide technical assistance to the program.
  • The Grantee is scheduled to receive the 3rd Quarter Expenditure Report (expenses through 11/30/2020) in late January.

A summary of the ensuing discussion follows:

  • If the 3rd quarter report only has data through Sept. or Oct., that will not help the Council ensure that under-spending ends up below 5%.  BHIV should be able to get complete data two months after the close of the quarter.
  • Usually, performance-based programs only have a one month lag in billing with invoices submitted and paid within 30 days. 
  • The change to cost-based reimbursement due to COVID does not mean that programs receive 1/12 of their contract amount monthly.  They still have to document their expenditures, and there have been difficulty filling staff vacancies due to COVID.
  • The DOHMH master contract with PHS requires a report 60 days after the close of each quarter.  It takes providers 15 days to submit invoices to PHS and then 30 days for payment.  This makes it difficult to see the full picture in the report to DOHMH, which is compounded by COVID-related delays.
  • The CAEAR Coalition is working with other partners to get Congress to ease the 5% cap on carry-over.
  • Not all providers were prepared to change to providing services and reporting remotely.  DOHMH and PHS made adjustments to assist providers.  The take-down and reprogramming process is still on-going and will help keep spending rates high. 
  • In a cost-based environment, it is difficult to see under- and over-spending, but providers are able to project their expenditures.
  • The 2nd quarter report shows the early days of the pandemic, but as the reporting of the year progresses, spending rates will change.

Agenda Item #4: Planning Council Direction – Draft 2020-21 Work Plan

Mr. Harriman and Ms. Walters, building on the discussion at last month’s meeting on the direction of the Planning Council, presented a draft work plan for committees, the Council as a whole, and Council staff.  All parties will work to accommodate itself to the COVID-19 pandemic.  All parties will also be responsible for promoting an anti-racist and stigma-free care environment and incorporating the voices of marginalized populations.  All parties except for Rules & Membership will need to improve data collection and use of data within Ryan White Part A and across bureaus and funders.  Incorporating implementation science and evidence-based practices is the responsibility of committees that assess needs, develop service directives and do allocations (Needs Assessment, IOC, PSRA, Tri-County Steering Committee).  There was a consensus to re-title this task “Evidence-Informed” to not confuse it with the strict parameters of evidence-based interventions in the prevention field.  NAC, IOC, Consumers and TCSC will take the lead on strengthening our partnership with the Recipient around their quality management work.  Advocacy for systemic changes that can benefit, protect and improve the health and health outcomes of PWH should be a focus of NAC, IOC, Consumers and TCSC.  Collaboration across prevention and care to implement a status neutral continuum of care is the focus of NAC and IOC.  RMC will assess the feasibility of merging NAC and IOC, and the Executive Committee will take the lead on creating a more robust assessment of the administrative mechanism (Council staff has begun collecting survey instruments from other EMAs).  The Executive Committee, full Council and Staff will partake in all of these actions. 

The next step is to begin conversations in the appropriate committees about approaches to achieving the plan’s goals, starting with the pre-meeting planning calls with the committee chairs. 

Agenda Item #5: Public Comment

Ms. Best thanked the Committee for their support and encouragement upon receiving an award from DOHMH on World AIDS Day for her contributions to the fight against HIV.

There being no further comment, the meeting was adjourned.