Thursday, February 17, 2022, 3:05-4:30pm
By Zoom Videoconference
Members Present: Graham Harriman (Governmental Co-chair), Dorella Walters (Community Co-chair), Paul Carr (Finance Officer), Saqib Altaf, Billy Fields, Ronnie Fortunato, Marya Gilborn, Charmaine Graham, Matthew Lesieur, David Martin, Jeff Natt, Julian Palmer, Guadalupe Dominguez Plummer, Donald Powell, Leo Ruiz, Claire Simon, Marcy Thompson
Members Absent: Joan Edwards, Finn Schubert
Staff Present: NYC DOHMH: Melanie Lawrence, Scott Spiegler, Scarlet Macias, Karen Miller, Kimbirly Mack; Public Health Solutions: Barbara Silver, Arya Shahi, Rosemarie Santos
Agenda Item #1: Welcome/Introductions/Minutes/Public Comment
Ms. Walters and Mr. Harriman opened the meeting followed by introductions and a moment of silence. The minutes from the January 20, 2022 meeting were approved with no changes. Mr. Ruiz reported that Ryan Center is looking for nurses. Mr. Powell reported that SAMHSA has a new grant for capacity building.
Agenda Item #2: GY 2021 Third Quarter Commitment and Expenditure Report
Ms. Plummer presented the GY 2021 third quarter commitment and expenditures report, focusing on service categories that were spending lower than 60% as of November 30, 2021, starting with NYC Base-funded categories. PSS TIGNCNB was 42% spent, as this was a newly implemented program as of mid-year and startups always spend less than their allocation. Non-Medical Case Management underspent due to high staff turnover (some related to mandatory in-person work), as well as factors related to reduced inmate populations. Medical Case Management underspending was also related to staff turnover, as well as that some service types (e.g., accompaniment) were not provided when services were virtual. Mental Health Services was at 43% spent, which is not unusual for this category due to long-standing payer of last resort issues, compounded by staff turnover due to burnout. The Recipient has been providing technical assistance across the board around staff retention. Staff turnover and vacancies affected all programs that underspent. Also, some Food & Nutrition programs moved from in-person services to vouchers during the pandemic. It was also noted that Housing Services are spending at the expected levels and are providing their full amount of service. MAI programs were doing well at 70%. In Tri-County, Medical Transportation was underspent due to continued use of telehealth during the pandemic, but the program reports that usage is picking up again. Other underspending TC categories are due to the same staffing issues experienced by NYC programs. Administration and Quality Management budgets are underspent due to staff turnover and vacancies, compounded by the long time it takes for the City to approve new hires. Also, some Recipient staff are still activated to the COVID response. The total grant expenditure at the end of the third quarter is 64 percent, which is not far off from where we would want to be and is an improvement over last year.
Overall spending through December was at 84%, with about $14.5M available for reprogramming to ADAP. Some can be retained as carryover to spend in GY 2022 on staffing issues, value-based payments and other needs. A large portion of the remaining budget will be spent before the end of the year, as is common in a cost-based reimbursement environment.
A summary of the ensuing discussion follows:
- A recent statewide survey of Health Homes staff showed that vaccine mandates were not a big factor in people’s employment decisions.
- There are fewer MCM programs in MAI and they happen to be performing better on average than Base funded MCM programs.
- Procurement rules have a time limit in which to fund an additional applicant for funding.
- Some Food programs are capable of spending additional funds given the demand.
- There could be an effort to identify actions that would help with staff retention (e.g., money for pay raises). The Recipient does try to enhance the work environment to help with retention. There are other models too, such as a program at Exponents that provides therapy for staff that could be scaled up.
Ms. Plummer reported that there is no updated data on the spending of the carryover from GY 2020 due to late reporting by contractors. Complete data will not be available until early March. The Recipient has urged contractors to spend quickly to ensure that all carryover is spent, as any unspent carryover must be returned to HRSA. The Recipient is also communicating with the AIDS Institute to ensure that ADAP can absorb any carryover left over after the other priorities have been funded to their maximum extent. Also, HRSA has issued another waiver this year allowing EMAs to carryover more than usual without penalty.
A summary of the ensuing discussion follows:
- Monitoring is needed to ensure that the funds for phones and data plans is only spent for people who need it. Programs must justify usage and pay only for when it is used for telehealth. The Recipient is working on how to document this, as it must be reported to HRSA. The documentation should not be too burdensome or create a barrier to supporting clients who need it.
- Fiscal reports need to be made to the Council on time so that any needed responses can be done in a timely manner. The Recipient noted the major leadership changes at both DOHMH and PHS, but both are strategizing on ensuring timely reporting.
- Funds for data plans should include home Internet, as it is crucial for accessing services.
- FNS programs are allowed to engage in cooperative buying to save money. Also, some vouchers get lost and are never used. Homebound clients need actual food delivered. Clients should be allowed to access local grocery stores.
- Bulk buying for other costs (e.g., office supplies, insurance) is encouraged in the new Framing Directive. The Council should push the Recipient to implement it quickly.
- Given that food is a persistent need for clients, it is unclear why FNS programs are still having trouble fully spending. Maybe the Recipient can consider funding an agency that could scale up quickly (although funds would be needed for ongoing costs).
Agenda Item #3: Council Chairs Report
Ms. Walters and Mr. Harriman reported that they represented the Council at a State-led meeting around the new Integrated HIV Prevention and Care Plan, which will be due December 2022. Along with planning bodies across the State, they are working on how to complete the Plan within the federal plan guidance. The Plan will reflect all the work already done in the State, including the ETE blueprint. A high-level timeline was shared including Council feedback, community input, and a Council letter of concurrence.
A community forum on providing in-person services is tentatively scheduled for March 25th to get input on recommendations for reopening services and how consumers can feel safe in in-person environments. Some agencies are doing a hybrid model, offering an option to provide services both in-person and virtually. There was a discussion on the challenges of providing in-person services (which anecdotally clients prefer), especially groups that require physical distancing. There are also issues around vaccine and mask requirements, cleaning and PPP issues, etc.
Mr. Lesieur reported that the Council-HPG Joint Policy Committee reviewed the new White House National HIV/AIDS Strategy. A long list of topics was generated and Committee members were surveyed on areas of focus. Topics chosen to begin working on were: 1) HIV testing and PEP/PrEP distribution on demand in pharmacies (issues around counseling and referrals will be explored); 2) health needs of sex workers; 3) expanding harm reduction; 4) housing; and 5) 340B funding.
Mr. Harriman reported that a new permanent HRSA project officer, Axel Reyes, has been appointed, and he will be invited to future Executive Committee meetings.
Mr. Martin asked that restrictions around communications concerning concept papers that are part of a procurement be made clear. Mr. Harriman and Ms. Walters noted that the paper has an email for all questions or comments. City procurement rules require that once a procurement is underway there are strict boundaries around communication. Also, Council staff reviews concept papers and RFPs before they are issued to ensure that they align with the Council’s directives. Issues brought up by any stakeholder through the prescribed channels may be addressed in the RFP and any supplements.
There being no further comment, the meeting was adjourned.