3:05 – 4:25pm
Members Present: Graham Harriman (Governmental Co-chair), Dorella Walters (Community Co-chair), Billy Fields (Finance Officer), Saqib Altaf, Joan Edwards, Ronnie Fortunato, Marya Gilborn, Charmaine Graham, Steve Hemraj, Emma Kaywin, Matthew Lesieur, David Martin, Freddy Molano, MD, Jeff Natt, Julian Palmer, Guadalupe Dominguez Plummer, Marcy Thompson
Members Absent: Marcelo Maia Soares
Other Council Members Present: Gregg Bruckno
Staff Present: NYC DOHMH: Scott Spiegler, Giovanna Navoa, Renee James, Daniel Bickram; Public Health Solutions: Arya Shahi, Rosemarie Santos; NYSDOH AIDS Institute: Claire Simon
Agenda Item #1: Welcome/Introductions/Minutes/Public Comment
Mr. Harriman and Ms. Walters opened the meeting followed by a roll call and a moment of silence. The minutes from the July 15, 2022 meeting were approved with no changes.
Agenda Item #2: GY 2022 Estimated Unobligated Balance Request
Ms. Gilborn explained that HRSA requires all EMAs to complete and submit by the end of this month an “estimated unobligated balance (UOB) request”. The document tells HRSA that the EMA will ask to use unspent funds from the current grant year (i.e., 2022 carryover) in the next grant year (2023). We will not know the actual amount of carryover until next spring after closeout of the grant year. The UOB request states that next spring we will ask to carry over as much as 5% (the maximum allowed with no penalty). The UOB request uses ADAP as a placeholder for the use of the carryover funds, but we are not required to spend the carryover for that purpose. In June 2023, PSRA will develop an actual carryover plan for submission to HRSA.
A motion was made and seconded to approve the GY 2022 UOB request as presented. The motion was adopted by a roll call vote of 15Y-0N.
Agenda Item #3: Second Quarter Expenditure Report
Mr. Fields introduced the GY 2022 2nd quarter expenditure report, which shows spending for the current grant year from March 1st through August 31st. As of mid-year, the grant award is 44% spent, which is the highest it has been since 2018. This means that the award is on track to come in well under the 5% maximum underspending by the end of the grant year, which is a big improvement over the two previous years, when spending was highly impacted by the COVID-19 pandemic. The improvement in spending is largely due to a return to in-person services and the resumption of performance-based reimbursement.
Mr. Spiegler presented the details of the spending report, focusing on areas of higher-than-average underspending. As noted, there is a big improvement in spending as of the end of the 2nd quarter from the previous two years, and even surpassed the two years prior to the pandemic. Non-medical Case Management reported being only 27% spent, mostly due to late invoices from the largest provider. Harm Reduction Programs have reported staff vacancies and a slower transition to in-person services. The Recipient’s Quality Management and Technical Improvement (QMTI) team is working with them to improve this.
Low spending in Early Intervention Services is concentrated in programs funded under the PlaySure Network 2.0 program, which were in startup mode the first half of the year. Underspending in Emergency Financial Assistance is due to the large permanent enhancement the program received this year. They are working to increase outreach and client engagement to better promote the service EMA-wide. Supportive Counseling and Psychosocial Support for TINBNC programs have had difficulties with hiring, staff retention and client outreach and enrollment, affecting program performance. QMTI staff is working intensely with them on both administrative and programmatic issues. Health Education and Risk Reduction programs have had low recruitment, likely due to participants not wanting to attend in-person services and difficulty adapting the service model to virtual delivery. Several categories reporting underspending at this point, such as Housing, are projected to spend close to 100% of their allocations. This is due to factors such as late contract execution and adaptation to permanent enhancements. Tri-County Medical Transportation is underspent due to lower usage of the services due to COVID-19, but usage is picking up. TC Legal Services faced the same issue, as courts were still closed part of the year.
A summary of the discussion follows:
- Housing programs worked through staffing issues early in the year and is on target to spend their full allocation by the end of the year. It is especially important that rental assistance spend their full amount.
- Housing Placement Assistance have performed much better in the last two years after some struggles, due to the contractors who are working with clients to place people into permanent and transitional housing.
- The EFA allocation was $750K at the beginning pf the year and more than doubled in November. The Recipient is confident that the program will increase capacity to meet the resources available. The Recipient has trained RWPA contractors on the availability of EFA and will continue to promote referrals.
Agenda Item #4: HRSA Project Officer Report
Mr. Reyes reported that HRSA is finishing up review of the NCC submissions (EMA applications for continuing RWPA funding). HRSA and CDC will soon review the NYS Integrated HIV Prevention and Care Plan along with CDC. He also noted that it has been one year as the NY EMA’s project officer and commended the excellent work in the EMA.
Agenda Item #5: Planning Council Chairs Report
Ms. Walters and Mr. Harriman reported that the NYS coordinating committee will continue to meet to work on implementation of the Integrated Plan. Members were urged to keep aware of the upcoming Medicaid waiver (there will be a presentation at the April Council meeting). Melanie Lawrence is co-project director of a new NIMH pilot project for case management for PWH with serious mental illness. This came out of the work of the Need Assessment sub-committee and will feed into IOC’s new Behavioral Health service directive.
Agenda Item #5: Committee Updates
Ms. Graham reported that the Consumers Committee is planning for a project to target youth. There was also an excellent presentation on benefits navigation at the last meeting.
Needs Assessment Committee
Mx. Kaywin reported that that the Committee reconvened in November to review the work-to-date on the EMA’s Comprehensive Needs Assessment. Over the previous planning cycle, the NAC formed four workgroups to focus on each of the Assessment’s main components. DOHMH undertook a procurement for a consultant to draft the document based on the findings of the four workgroups. Due to DOHMH procurement issues, the consultant will not be on board until the January meeting, where they will meet with the Committee and begin work on drafting the Needs Assessment. Mr. Harriman added that a contract has just been executed.
Integration of Care Committee
Mr. Hemraj reported that IOC has concluded presentations from subject matter experts for the Behavioral Health Directive and started line-by-line editing of the draft directive. The aim is to complete a directive for Executive Committee review by March 2023.
Ms. Gilborn reported that the Committee has begun the process of scenario planning for the actual GY 2023 award. The Committee will develop a methodology for implementing up to a 3.5% reduction to the award, using savings in carrying costs, targeted reductions and possible proportionate reductions to make up any potential deficit. As per the application spending plan, funds must be allocated to cover a full year of Oral Health Services (programs began on September 1st) and the first year of the new Ambulatory Outpatient Services for Aging PWH, so even in a flat funding scenario, there will have to be some savings in the existing portfolio. PSRA expects the final scenario plan to be presented to the Executive Committee and full Council no later than February.
Tri-County Steering Committee
Mr. Altaf and Mr. Palmer reported that the Committee just wrapped up a comprehensive review of all the services in the Tri-County RWPA portfolio. The Recipient developed fact sheets for each category with three years of data on service utilization, client enrollment, client demographics, spending rates, as well as an analysis of payer of last resort and systems-level information. In January, the Committee will begin developing a set of new allocations for the GY 2023 award based on the data.
Rules & Membership Committee
Dr. Molano reported that the Committee has begun the long process of revising the Planning Council/Recipient Memorandum of Understanding (MOU). The MOU is an agreement that governs the interactions of the two parties and was last revised in 2019. The Committee is reviewing the document line-by-line, along with suggested revisions from the Recipient. The Committee is making good progress, but it is expected to be a lengthy process.
Joint PC/HPG Policy Committee
Mr. Harriman reported that the Committee has three sub-committees working on the 340b program, overdose prevention sites, and sex education. The possible end of 340b would adversely affect the finances of RWPA providers. Mr. Palmer added that the Save NY Safety Net Coalition met today to strategize to preserve the benefit. In response to a question from Mr. Natt, Ms. Plummer noted that the Recipient does monitor RWPA program income from 340b, and that is a focus of HRSA.
Data Collection Workgroup
Mr. Bruckno reported that the workgroup, which is time-limited to develop recommendations for the Recipient, received two presentations in November: State and Federal Laws and Policies that Govern Data Sharing Across Provider Networks; and Social Determinants of Health Networks and Health Equity Regional Organizations in the NYS 1115 Medicaid Waiver. The workgroup is taking December off but will resume in January to review draft recommendations to bring to Executive Committee in February.
There being no further comment, the meeting was adjourned.