Executive Committee Meeting Minutes February 23, 2023

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By Zoom

3:00 – 4:50pm

Members Present: Graham Harriman (Governmental Co-chair), Dorella Walters (Community Co-chair), Billy Fields (Finance Officer), Saqib Altaf, Ronnie Fortunato, Marya Gilborn, Charmaine Graham, Steve Hemraj, Emma Kaywin, Matthew Lesieur, David Martin, Freddy Molano, MD, Jeff Natt, Julian Palmer, Claire Simon (for Joan Edwards), Scott Spiegler (for Guadalupe Dominguez Plummer), Marcelo Maia Soares,

Members Absent: Marcy Thompson

Other Council Members Present: Rose Chestnut


Staff Present: NYC DOHMH: David Klotz, Melanie Lawrence, Doienne Saab, Scarlett Macias, Adrianna Eppinger-Meiering, Deborah Noble, Karen Miller, Renee James, Kimbirly Mack; Public Health Solutions: Barbara Silver, Arya Shahi, Rosemarie Santos; HRSA/HAB: Axel Reyes

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 December 15, 2022 meeting were approved with no changes.

Agenda Item #2: HRSA Project Officer Report

Mr. Reyes reported that HRSA is reviewing the Statewide HIV Prevention and Care Integrated Plan and will soon hold an interagency review with the CDC.  HAB is also preparing for the May 15-19 site visit to the EMA.

Agenda Item #3: GY 2023 Spending Scenario Plan

Ms. Gilborn introduced the GY 2023 spending scenario plan approved by the PSRA Committee on February 6th.  The plan is a methodology for implementing the final award when the EMA received it from HRSA, allowing the Recipient to immediately execute sub-recipient contracts.  The scenario plans for up to a 3.5% reduction to the Base award.  Even with a flat funding scenario, there will be a deficit of $1,783,000 in order to pay for Council-approved initiatives (a full year of Oral Health Services, and the new Ambulatory Outpatient Care for Aging PWH).  There is a savings of $233,000 in the cost of Tri-County programs through a Tri-County Steering Committee-approved budget that has a targeted reduction to Medical Case Management and a proportionate across-the-board reduction weighted by ranking score.  PSRA’s spending scenario addresses a potential deficit by starting with a $2M targeted reduction to ADAP.  If there is still a deficit, there will be a proportionate across-the-board reduction to other categories weighted by ranking score.  Mr. Klotz reviewed the plan on the NYC and TC spreadsheets.

In response to a question, Mr. Reyes said that a notice of award could come by April.

Ms. Gilborn, on behalf of PSRA, moved to accept the GY 2023 spending scenario plan as presented.  The motion was adopted 15Y-0N.  

Agenda Item #4: GY 2022 Third Quarter Expenditure Report

Mr. Fields prefaced the 3rd quarter expenditure report by noting that there continues to be higher than usual underspending due to systematic issues, and the Recipient is committed to working with the Council to address this long term.

Mr. Spiegler reported that as of the end of the 3rd quarter (Nov. 30, 2022), the grant was 64% spent (the same as the end of the 3rd quarter in GY 2021, and less than the 72% reported at that point in GY 2020).  Carryover funds (ADAP, value-based payments for Medical Case Management, Food & Nutrition Services, CLAS standards) were only 29% spent.  Some overarching issues explain underspending across all service categories: staff recruitment and retention, stagnant or uncompetitive salaries, administrative caps on sub-recipients, difficulties conducting outreach, and continued struggles with in-person services and hesitation to gather in groups as COVID-19 lingers.  Problems with underspending are being seen in EMAs across the country.

Several reasons for underspending unique to specific service categories were given, such as late execution of Housing contracts, the large enhancement to Emergency Financial Assistance that came several months into the year, and continued lower usage of Tri-County Medical Transportation as in-person services continue to rebound. 

In order to increase the expenditure rate, the Recipient will reprogram unspent funds to ADAP.  Longer-term, they will revisit reimbursement structures to address underspending and collaborate in addressing systemic barriers to service delivery.

A summary of the ensuing discussion follows:

  • The Recipient cannot mandate that contractors raise salaries, many of which are determined by union contracts. 
  • The Recipient can now only adjust reimbursement rates when timed with a new procurement.
  • There might be payer of last resort issues related to programs like EFA and FNS where there were additional resources under the Families First Coronavirus Relief Act. 
  • Difficulties accessing services due to onerous paperwork or applications should be addressed (note: the Data Collection Workgroup is finalizing recommendations to address that issue).
  • The cap on administrative funds for sub-recipients is in the Ryan White legislation and cannot be changed unilaterally by HRSA.

Mr. Reyes added that the NY EMA has applied for a waiver of the 5% cap on underspending (the waiver had been automatic for GY 2020 and 2021).

Agenda Item #5: Committee Updates

Consumers Committee (CC)

Ms. Graham reported that the CC recently conducted a survey to support 2023 committee work, which identified several areas of focus.  The CC is in the process developing a responsive agenda, including the organization of a virtual Community Town Hall featuring speakers on COVID-19, Long COVID, 340b held last Tuesday.  Due to issues with procurement, the youth work is happening in the background, but the CC is plunging ahead to address a myriad of other concerns that impact PWH.  There will be a meeting on consumer input into the RWPA Quality Management Plan on March 7th

Needs Assessment Committee (NAC)

Mx. Kaywin reported that that the NAC is in the process of drafting the Needs Assessment, with Ms. Saab as the lead writer for the report.  The Assessment will be a compilation of work conducted last year by the workgroups: Epidemiology; Resource Inventory; Needs and Utilization; Provider Capacity (Workforce Inventory). Data gathering for this report includes data sources up until December 2022 (that includes HIV Surveillance data updates).  NAC members will provide their feedback on the content of the report through slide presentations in each meeting.  The review process will take place using Google docs allowing for members’ shared input on sections of the narrative.  The content for each section will be summarized and presented during each monthly meeting.  The final Needs Assessment will be presented to the Executive Committee during the HRSA site visit in mid-May. 

Integration of Care Committee (IOC)

Ms. Fortunato reported that IOC remains focused on line-by-line editing of the Behavioral Health directive, which seeks to integrate three distinct, but related, HRSA service categories: Mental Health, Harm Reduction and Psychosocial Support.  The combined directive will work toward achieving the best practice of integrated care for clients to mitigate the barriers to access frequently faced by PWH.  The committee expects to complete this work before the end of the current planning session. 

PSRA Committee (PSRA)

Ms. Gilborn reported that PSRA, after completing the GY 2023 spending scenario, will take March off and resume in April with the GY 2023 reprogramming plan and planning for the GY 2024 application spending plan. 

Tri-County Steering Committee (TCSC)

Mr. Altaf reported that TCSC, after completion of the GY 2023 spending plan, will have its annual HIV epi and surveillance report from the NYS AIDS Institute.  Mr. Palmer added that the Committee discussed the action around preserving the 340b program.

Rules & Membership Committee (RMC)

Dr. Molano reported that RMC is continuing the process of revising the Planning Council/Recipient Memorandum of Understanding (MOU).  The committee is about halfway through the document and expects to be finished with the initial review by April.  After that, the Committee will meet with a representative of the Recipient to work out an agreement on a revised version.

Joint PC/HPG Policy Committee

Mr. Lesieur reported that the Committee recently focused on the Governor’s budget plans, including the 340b program, as well as other State legislative initiatives.

Data Collection Workgroup

Mr. Harriman reported that the workgroup will finalize next week its recommendations for the Recipient on streamlining the data collection process to bring to the next Executive Committee meeting.

Agenda Item #6: Planning Council Chairs Report

Mr. Harriman reviewed the upcoming Planning Council meeting agendas.  At next week’s meeting, in addition to the Spending Scenario Plan and 3rd Quarter Report, there will be a presentation on the implementation of the local EHE initiatives.  Also, he will be seeking Executive Committee input into the job description for the Council director. 

Agenda Item #7: Public Comment

Mr. Soares called for systems to address the upcoming Medicaid recertification requirement, as well as the crystal meth epidemic, which has a disproportionate impact on PWH.

Ms. Simon encouraged everyone to fill out an AIDS Institute survey on participation in the development of the Integrated Plan.  The survey results will be considered at the next meeting of the IP Coordinating Committee.

There being no further comment, the meeting was adjourned.