Monday, February 18, 2021, 3:30 – 4:45PM
By Zoom Videoconference
M I N U T E S
Members Present: Graham Harriman (Governmental Co-chair),Dorella Walters (Community Co-chair), Paul Carr (Finance Officer), Lisa Best, Randall Bruce, Maria Diaz, Joan Edwards, Billy Fields, Marya Gilborn, Amanda Lugg, Jeff Natt, Guadalupe Dominguez Plummer, Claire Simon, Andrea Straus, Marcy Thompson
Members Absent: Danielle Beiling, David Martin, Donald Powell
Other Council Members Present: Saqib Altaf
Staff Present: NYC DOHMH: David Klotz, Melanie Lawrence, Jose Colon-Berdecia, Karen Miller, Eleonora Jimenez-Levi, Giovanna Navoa, Kimbirly Mack; Public Health Solutions: Gucci Kaloo, Rosemarie Santos; HRSA: Sera Morgan; Joan Corbisiero (Parliamentarian)
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 January 21, 2021 meeting were with approved no changes.
The Committee paid tribute to Ms. Straus, who is retiring and ending her term on the Council. She was thanked for her service to the Council and her leadership in the Tri-County community. It was announced that Mr. Altaf will become the new co-chair of the Tri-County Steering Committee.
Agenda Item #2: Planning Council Chairs Update
Mr. Harriman reported he has been holding one-on-one meetings with Executive Committee members to discuss Council-related issues and thanked everyone for their valuable time and input. He congratulated Ms. Lawrence and the Needs Assessment Committee for a successful virtual forum on PWH Serious Mental Illness. There was a great collaboration with the DOHMH Mental Hygiene Division and with NY State Mental Health agencies.
The revised Ending the HIV Epidemic (EHE) Plan was circulated by email in advance of next week’s concurrence vote at the Council meeting. Members were encouraged to review the changes.
The DOHMH Division of Disease Control is undertaking a reorganization, which will split the Division’s bureaus into two sectors: Syndemic Disease (HIV, STI, Hepatitis), and Clinical Services (Immunizations, TB, STI clinics). Administrative functions would be centralized. The plans are in their early stage and the timeline is ambitious, so Council staff are working with the Acting Deputy Commissioner of Disease Control, Darrin Taylor, to ensure that the Council maintains its independence and support. Updates will be provided to the Executive Committee.
Agenda Item #3: HRSA Project Officer Update
Ms. Morgan reported that HRSA/HAB is holding a virtual RWPA and EHE stakeholders meeting next Thursday to discuss HAB’s new organizational structure, which includes a new EHE division. Also, the New York EMA is due for comprehensive site visit in 2023.
HAB has a new unmet need framework, which has three components: 1) Late Diagnoses, 2) Unmet Need, and 3) In Care, but Not virally suppressed. This new framework expands on the previous framework, which looked only at unmet need, by adding estimates of those late diagnosed and those in care but not virally suppressed. In addition to these 3 estimates, recipients will select 3 focus populations that are disproportionately represented across the unmet need framework components in their jurisdictions. There are ongoing trainings on the new framework.
The RWPA grant cycle is moving to new 3-year grant periods A. The FY 2022 application will be competitive; then there will be “Progress Reports” for Years 2 and 3. Application scores in year 1 will be used to calculate supplemental awards for years 1, 2, and 3.
Agenda Item #4: Grantee Report
Ms. Plummer reported that HRSA /HAB observed National Black HIV Awareness Day focusing on education, testing and treatment. They also issued a new program letter and FAQ sheet on the CIVOD-19 vaccines, which will be continuously updated.
On February 3rd, Public Health Solutions ne behalf of DOHMH BHIV/CTP released the RFP for Psychosocial Support Services for TIGNCNB Individuals. The RFP will fund two programs with an anticipated start date of September 1, 2021.
BHIV/CTP is holding two virtual capacity building trainings facilitated by the NYS AIDS Institute. The goal of the trainings is to build organizational capacity to implement comprehensive quality management programs and promote continuous improvement of services. The BHIV Quality Management and Technical Assistance Unit has also developed a Program Navigation Guide to navigating services for PWH with co-occurring mental health conditions.
Finally, Governor Cuomo has expanded COVID-19 vaccine eligibility to include all people with a list of co-occurring conditions, including HIV.
Agenda Item #5: FY 2021 Spending Scenario Plan
Ms. Gilborn presented the FY 2021 spending scenario plan developed and approved by the Priority Setting & Resource Allocation Committee (PSRA). The application spending plan approved last summer was a request for an increase to the grant award. The last time the EMA received an increase was seven years ago. Every year, prior to the receipt of the actual award, PSRA plans for a possible reduction. A spending scenario is developed that determines how to implement a cut up to a certain percentage of the award. This is a methodology that allows the Grantee to apply the actual award amount as soon as we receive it from HRSA and to implement the spending plan without delay. For many years, the EMA has received reductions in the range of 1.5 – 2.5%. This is because Ryan White has been flat funded nationally, and the NY EMA has received reductions in the formula portion of our award due to our successful prevention efforts, which have resulted in the EMA having a smaller proportion of HIV cases relative to other EMAs.
The Scenario plan covers up to a 2.5% cut to the award. The plan also accounts for the fact that the one million dollars in coronavirus stimulus CARES Act funds will not be renewed. PSRA reviewed the enhancements made last spring to respond to needs that arose from the COVID pandemic: $1,900,000 to Housing; and half a million dollars to enable the Emergency Financial Assistance program to expand from Tri-County to include NYC residents. The Housing enhancement was funded with all of the CARES money, plus additional funds taken from the EMA’s ADAP allocation. Funds from the ADAP allocation were also used for the EFA expansion. The Council also committed to fund a new initiative: Psycho-social Support for Transgender, Intersex, Gender Non-binary and Non-conforming individuals.
PSRA reviewed the performance of and the expected needs of the Housing and EFA categories. The Committee also received data from the NYS Uninsured Care Program on the ability of the ADAP program to sustain a reduction in their Part A allocation without having any effect on services or enrollment. We will be able to restore a portion of the ADAP allocation through the use of 2020 carry-over and 2021 reprogramming funds, but PSRA is aware that the ADAP allocation has shrunk considerably. That pot of money will not always be available to help absorb reductions to the award and fund new initiatives. PSRA will be looking at the entire portfolio over the next planning sessions to continue exploring areas where we can streamline services and provide the maximum benefit in a challenging funding environment with new needs arising.
For 2021, the amount that the Council would have to take from ADAP to balance the budget in a reduction scenario is offset by a savings of $1.7 million. This savings is from the elimination of the category of Non-medical Case Management (approved by the PC last summer) and reductions in the carrying costs of programs in three categories (EIS, Legal, MCM) due to permanent take-downs from lower than expected performance or terminated contracts. The Scenario Plan that PSRA has developed allows us to maintain service levels, continue enhancements to Housing and EFA, and pay for PSS. The total reduction to ADAP in a 2.5% Base reduction scenario is $2,590,884.
Mr. Klotz reviewed the details of the spreadsheets, pointing out where all of the elements described above are shown. Additional details include that the PSS allocation includes funds for direct services (two programs beginning mid-year), as well as a training curriculum and collaboration with a community-based health center to enhance an existing online directory of trans-affirming services (Callen-Lorde’s TransAtlas). Also, Oral Health Services will begin in FY 2022, as the Grantee is unable to issue another RFP this year due to the majority of staff being activated to the COVID response. One portion of the Oral Health directive, a centralized Dental Case Management program, can be funded through the existing MCM allocation.
Ms. Gilborn made a motion on behalf of the PSRA Committee to accept the FY 2021 spending scenario plan as presented. Ms. Plummer moved to amend the original motion to add $20,000 to the Tri-County Legal Services allocation to allow for ongoing cost-based reimbursement. The amendment was seconded and adopted 14Y-0N. The amended original motion was restated and adopted 13Y-1N.
Mr. Carr explained that he voted no to register his concern that the ADAP allocation has dwindled and will not be available much longer to cover further reductions to the award and future new initiatives (e.g., Oral Health, recommendations around older PWH). PSRA needs to find savings and efficiencies in the service portfolio. Mr. Natt added that PSRA had a long discussion about this issue at the last meeting and intends to continue evaluating the entire portfolio to make it more efficient and responsive. Also, with expected larger than usual carry-over, PSRA will discuss using that to restore a large portion of any reduction to ADAP. Mr. Harriman added that the Committee will also look at impact of services and take that into consideration in future allocations decisions. Ms. Edwards added that the PSRA and Council have been engaged in this process, eliminating a number of categories over recent years (NMG, Home Health, Transitional Care Coordination). Ms. Edwards and Ms. Simon noted that the Part A contribution is a very small part of the ADAP budget. ADAP Director Julie Vara has presented to PSRA and affirmed that and the program is able to use efficient management of their funding streams to absorb the reduction without any change to services, as well as spend any money that it gets through carry-over and reprogramming.
Agenda Item #6: Third Quarter Commitment and Expenditure Report
Mr. Carr introduced the 3rd quarter commitment and expenditure report. Overall, as of the end of the third quarter (Nov. 30, 2020) programs are spending close to the expected 75 percent. Due to the pandemic, carry-over will be higher than usual this year (about 2-3% of the formula award, or about $1.5M), but still comfortably below the 5% limit. This will allow the EMA to restore much of the planned reduction to ADAP in the FY 2021 spending plan.
Ms. Plummer explained the areas with higher than expected under-spending. Short-term Rental Assistance was 55% spent as of the end of the 3rd quarter. During the NYS Pause last spring, consumers were afraid to seek housing assistance/leave home, landlords were unwilling to show apartments, and staffing vacancies posed challenges to scaling up services. The eviction moratorium also prevented hundreds of evictions which would have resulted in increased costs to service category but never materialized. The full allocation is expected to be spent by the end of the year. Early Intervention Services and Non-Medical Case Management/Rikers also have higher underspending, the latter due to restrictions on visits to jails due to COVID-19. The Tri-County Mental Health program is severely under-spent despite ongoing technical assistance from BHIV. Steps will be taken to ensure that a provider is capable of providing the service in the region. Tri-County Medical Transportation is also under-spent due to the halt in in-person services due to COVID-19.
Cost-based reimbursement will continue indefinitely due to the pandemic. Contractors have been successful rearranging their reporting to accommodate this change and maximize spending. The change has also meant a lower administrative burden to providers, allowing them to concentrate more on providing client-centered care. PSRA will discuss the implications of continued cost-based reimbursement on the FY 2021 reprogramming plan. Mr. Harriman noted that HRSA fiscal policy focuses on cost-based reimbursement and there needs to be a more detailed discussion on the pros and cons. Ms. Plummer added that if the programs switch back to performance-based reimbursement, there will be plenty of advance notice and technical assistance.
Ms. Miller reported that the RWPA administration and Quality Management budgets are underspent due to staff vacancies that DOHMH was not able to fill due to the City’s hiring freeze and to many staff being activated for the DOHMH Incident Command Structure, which means that their time working on COVID-related activities is paid through other funding, not Ryan White.
Mr. Kaloo added that the 3rd quarter report does not include reprogramming, which will result in reallocation of about $1.6M, mostly to ADAP.
Mr. Klotz thanked all the staff who assisted PSRA with the spending scenario planning process, particularly Ms. Plummer and Scott Spiegler, Ms. Jimenez-Levi and the BHIV Housing Unit, and Mr. Kaloo.
There being no further comment, the meeting was adjourned.