Executive Committee Meeting Minutes February 22, 2024


By Zoom

3:00 – 4:10pm

Members Present: David Klotz (Governmental Co-chair), David Martin (Community Co-chair), Billy Fields (Finance Officer), Saqib Altaf, Raffi Babakhanian, Joan Edwards, Ronnie Fortunato, Marya Gilborn, Charmaine Graham, Emma Kaywin, Matthew Lesieur, Freddy Molano, MD, Julian Palmer, Scott Spiegler (for Guadalupe Dominguez Plummer, ex-officio), Marcelo Maia Soares, Marcy Thompson

Members Absent: Paul Carr, Steve Hemraj

Staff Present: NYC DOHMH: Doienne Saab, Kimbirly Mack, Patrick Chan, Jimmy Jaramillo, Alyssa Prince; Public Health Solutions: Barbara Silver, Gemma Ashby-Barclay, Arya Shahi, Rosemarie Santos

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

Mr. Klotz and Mr. Martin opened the meeting followed by a roll call and a moment of silence.  The minutes from the January 18, 2024 meeting were approved with no changes.  Mr. Maia Soares remembered the contributions of HIV and trans activist Cecilia Gentili, who passed away recently.  Mr. Martin added that young activist Hydeia Broadbent, who was born with HIV and began her advocacy work at age 6, passed yesterday.  

Mr. Klotz reported that a candidate has been named to fill the open community planner position on the Council staff.  OMB is reportedly lifting the freeze on hiring and spending for grant-funded programs, which should help the hiring process and expenditure of Council support funds.

Agenda Item #2: Revised Directive: Non-Medical Case Management/Inmates & Releasees (NMI)

Ms. Fortunato presentedthe revised service directive for NMI, approved by the Integration of Care Committee (IOC) on January 24th.  NMI) is a program to support RWPA eligible clients who are being held by the NYC jail system and those who have been recently released from NYC or NYS jails and returned to the EMA.  There are two unique components to this program.  One delivered on Riker’s Island by Correctional Health Services (CHS) which is part of NYC Health and Hospitals Corporation (H+H).  CHS is the only entity who can provide these services to clients held by NYC’s jail system.  The second component, delivered by a non-profit community-based organization, works with clients once they’ve been discharged to support re-entry and link clients to care. This is bid through a competitive request for proposal.  (New RFP out soon for services beginning March 1, 2025).  The goals of the program are to provide support services to soon-to-be released and recently released innates living with HIV to ensure engagement in ongoing HIV medical care and support services, and provide advice and assistance to PWH in obtaining medical, social, community, legal, financial, and other needed services to improve their physical and mental health status.  IOC added a new goal to reduce disparities in health outcomes for PWH involved with the correctional system.  The goals from the new Integrated Plan that align with the program goals were revised.

Key activities of the program were described (e.g., initial assessment, client advocacy, reevaluation).  Details of the service model were given: Provide HIV-specific discharge planning to incarcerated individuals living with HIV in New York City correctional facilities to ensure linkage to medical care through referral to medical case management, oral health services, mental health services, alcohol and substance use services, and housing services post-release.  Provide time-limited (pre-release and 90 days post-release) assistance with benefits and entitlements, including enrollment in/restoration of Medicaid and ADAP resources, treatment education, risk reduction counseling, linkage, referral and follow-up for recently released individuals living with HIV. 

These programs have access to some of the most vulnerable and hardest to engage clients across the city.  This is a vital program for engaging PWH and linking them to care.  IOC received data and reports from the Recipient, providers and clients that attest to the success of the service model.  No substantive changes were made to the service model.  Minor tweaks included: post-1115 Medicaid Waiver allows enrollment in Medicaid prior to release, and the addition of oral health to list of referrable services.  There are no changes to Client or Agency Eligibility Criteria.

Mr. Lesieur pointed out that the 1115 waiver includes language for a health home-style program for people about to be released from prison.  The Recipient will monitor that as part of the payor of last resort (POLR) requirements for RWPA programs.  Ms. Thompson added that the NYS DOH provides similar services for releasees from State prisons, which may overlap with the RWPA service, although the majority of releasees that the RWPA are from the NYC prison system.  Also, it was reported that from 2020-2022 the average annual enrollment was about 500 clients.

On behalf of the IOC, Ms. Fortunato made a motion to accept the revised service directive as presented.  The motion was adopted 14Y-0N. 

Agenda Item #3: Third Quarter Expenditure Report

Mr. Fields introduced the 3rd quarter expenditure report, noting that as part of the Council’s mandate to assess the efficiency of the administrative mechanism, we receive quarterly expenditure reports from the Recipient.  The report covers the grant year from March 1 to November 31, 2023.  As of the end of the 3rd quarter, overall spending is close to the target of 75%, with the exception of certain categories that will be explained by the Recipient.

Mr. Spiegler presented the details of the report.  Categories in the NYC Base portfolio with higher than expected underspending (<70%) include: NMI (due to staff vacancies and a deliverables-based budget that often is reimbursed in the 4th quarter), Mental Health and Oral Health (due to POLR issues); Supportive Counseling (due to a contract termination); Psychosocial Services for TGINBNC (staff issues and low client enrollment).  In Tri-County (TC), Medical Transportation is rebounding from COVID, but still slightly underspent due to the delivery of some telehealth services.  It was noted that there will always be a demand for in-person appointments.  Also, Legal Services is underspent due to a contract termination.  NYC and TC Base and MAI Mental Health and Early Intervention programs are all experiencing underspending and IOC is reviewing the EIS service directive for an upcoming rebid.

The Council will also consider Emergency Financial Assistance, which started as a TC-specific category but expanded to the entire EMA during COVID, and may benefit from having providers in both regions.  

It was explained that underspending is reprogrammed to overperforming contracts as per the Council’s plan (up to a maximum of 20% over the original service category allocation without Council approval).  It was added that the PSRA Committee will review allocations for categories that have spending issues due to POLR and enrollment issues.