Thursday, January 20, 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, Marya Gilborn, David Martin, Jeff Natt, Guadalupe Dominguez Plummer, Donald Powell, Leo Ruiz, Finn Schubert, Marcy Thompson
Members Absent: Joan Edwards, Ronnie Fortunato, Charmaine Graham, Matthew Lesieur, Julian Palmer, Claire Simon
Staff Present: NYC DOHMH: Melanie Lawrence, Scott Spiegler, Karen Miller, Cristina Rodriguez-Hart, Jose Colon-Berdecia, Kimbirly Mack, Giovanna Navoa; Public Health Solutions: Barbara Silver, Rosemarie Santos, Arya Shahi; J. Corbisiero (Parliamentarian)
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 December 10, 2021 meeting were approved with no changes.
Agenda Item #2: GY 2020 Carryover Expenditure Report
Ms. Plummer reported that as of the end of November 2021 (end of the third quarter), $47.7M (60%) of the total GY 2021 award is spent, which is lower than the expected 75%, largely due to the use of cost-based reimbursement. About $1.8M will be reprogrammed to ADAP. Actual carryover amount from GY 2021 into GY 2022 may be lower as funds are spent between December 2021 through end of the grant year on February 28, 2022. Mr. Shahi explained that with a cost-based reimbursement structure (in place for two years), a large portion of funding is spent in the final months of the contract year. Ms. Plummer reviewed the Council’s GY 2020 into GY 2021 carryover plan. Of the $4.9M in carryover, from HRSA approval of the carryover plan to this meeting, 63% has been spent. A breakdown by line item was provided: $204K for Care Coordination Value-based Payments, $492K to Emergency Financial Assistance, $2.5M to ADAP. Mr. Shahi explained that there is no data available yet for expenditure on Food & Nutrition, staff development and training, or technological devices because PHS is currently in the process of finalizing amended budgets to allow for these expenditures.
A summary of the ensuing discussion follows:
- The ADAP program is able to absorb the amount.
- The high rate of GY 2021 underspending will be challenging to spend in the last quarter and it is important for the Council to have an accurate prediction of the final estimated carryover.
- PHS expects greater year-to-date spending in the final months of the year, so the carryover should be lower than last year’s. Additional data will be available soon – PHS is in constant contact with the contractors on their spending.
- Other federally funded programs are having similar problems with no relief from Congress on extensions of closeout periods. Staffing issues makes const-based reimbursement more difficult.
- The carryover plan was approved by the Council after discussion on payer of last resort requirements for things like devices.
- ADAP can always absorb funds and has the ability to spend down funds. Also, their RWPA allocation was reduced a lot at the beginning of the year, so the carryover only partially restores that cut. Also, if carryover funds are not spent, they are lost permanently and reduced from the next year’s award, and ADAP is always able to spend down the funds.
- The Recipient is gathering data on whether FNS programs are successfully spending when they had to pivot away from in-person services. HVCS in Tri-County has shifted to all vouchers and have been able to keep spending high.
- Staff sick with COVID, high rates of staff turnover and other staffing challenges have impacted RWPA services.
- Agencies were asked to assess what training can be paid for by the end of February. Any funds for that line item that are not spent can be rolled into ADAP. ADAP can rearrange sources of funding to spend RWPA money in a timely fashion. They have received much larger amounts from us in previous years.
- Agencies continue to receive late payments, and DOHMH is addressing this with PHS and are working to resolve the issue.
- Final GY 2020 into FY 2021 carryover expenditures will be reported in March, but an estimate of the amount to be transferred to ADAP can be provided in February.
Ms. Plummer added that the program is returning to performance-based reimbursement in GY 2022, which will help maximize spending.
Agenda Item #3: Committee Updates
Ms. Thompson reported that the Needs Assessment Committee (NAC) is working on completing a needs assessment this planning cycle year, as required by HRSA. The last one was conducted in 2014, prior to Ending the Epidemic plan. NAC has formed four workgroups to tackle the required sections of the needs assessment and each workgroup has 1-3 facilitators who compile data and discussion points for the workgroups to review during simultaneous breakout rooms at each NAC meeting. The workgroups are: epi profile, resource inventory, provider capacity, and service needs and gaps. For the next few months NAC will continue to focus on time for the workgroups to discuss relevant data sources, and to develop key takeaways, gaps, and recommendations from each data source. Any new data requests are being submitted by end of January.
Mr. Powell reported that the yesterday’s Integration of Care Committee (IOC) meeting, they reviewed draft standards of care for Legal Services and Health Education (Positive Life Workshop) and began reviewing Care Coordination. Ms. Plummer added the Recipient is working on implementing the Framing Directive.
Mr. Natt reported that the Priority Setting & Resource Allocation Committee (PSRA) The PSRA Committee is coming near to the conclusion of a year-long process to review all the service categories in the NYC portion of our Ryan White Part A portfolio. Last week we had a presentation on a study demonstrating the effect of engagement in Mental Health Services on improved mental health functioning. At the next meeting, we will review the final service category fact sheet (Mental Health), and receive additional follow-up data on two service categories of focus: Care Coordination and Harm Reduction. PSRA had requested further analysis of the overlap with between Care Coordination and Medicaid Health Homes, and on changes in Medicaid billable services for Harm Reduction. At the February meeting, the Recipient will also present information on savings in the carrying costs of programs, as well as their recommendations for consideration by the Committee. Staff liaison David Klotz put together a document that summarizes the data presented to the Committee since January 2021, which captures the Fact Sheets, additional studies and reports that were presented, and the highlights of the discussion at each PSRA meeting. With all of this information, the Committee will use the February and March meetings (which will be extended to 3 hours) to develop a set of recommendations for adjustments to the service category allocations for grant year 2022.
Mr. Altaf reported that the Tri-County Steering Committee (TCSC) took the month of January off. At our December meeting, we approved a spending plan for Grant Year 2022, which will be considered by the PSRA Committee at their next meeting. For several years, the Steering Committee has requested level funding, given that there are fewer local resources in the TC region (e.g., no HASA). The Committee is recommending this strategy again for GY 2022. The Committee understands that the Tri-County region’s percentage of program dollars has grown while the proportion of the EMA’s PWH who live in region has decreased. The Committee also understands that NYC programs have been reduced over the years to absorb cuts to the award, mostly by taking the funds from the ADAP allocation, which is partially restored through reprogramming and carry-over. Over the next year the Committee will conduct planning for 2023 and will use a similar methodology as the PSRA Committee used this year for NYC programs, using service category data on client enrollment, spending rates, priority populations and payer of last resort considerations to readjust Tri-County allocations.
Ms. Fields reported that the Rules & Membership Committee has its first meeting of this planning cycle on January 24th. We will review the attendance records of Council and Committee members for the first half of the planning year, addressing any members who are not meeting their obligations per the Council Bylaws. In a couple of months we will begin outreach for the next round of applications for Council membership. With the help of outreach coordinator Jose Colon-Berdecia, we will work to expand participation from under-represented communities, including youth with HIV.
Mr. Lesieur reported that the Joint Council/HPG Policy Committee is trying to strengthen the attendance from both planning bodies and focus on priorities, particularly state and federal ending the epidemic initiatives, to see where the committee can be most effective.
Mr. Ruiz reported that the Consumers Committee (CC) spent the fall getting the new HIV & Aging service directive approved by the Planning Council and developing a workshop on this directive for the December Power of QI Conference. The CC is now developing its process and timeline to review the unique needs of youth and young adults ages 13-29 with HIV in the NY EMA, which will result in a set of recommendations by July 2022. In January, Cristina Rodriguez-Hart presented to the CC on NYC HIV surveillance for youth and young adults for 2019 and coming up in February, Jeff Birnbaum of the SUNY Downstate Health & Education Alternatives for Teens Program and Claude Mellins of Columbia University will present on the HIV-related needs of youth and young adults that they have found through their HIV programs and research. The CC will also invite youth-serving providers and youth and young adults with HIV to CC meetings in the spring. If any Council members know of providers or youth they think would be good to invite, please contact Cristina or Graham with these names. The CC is forming a workgroup to explore the development of a member button that Council members may choose to wear when conducting HIV outreach.
Agenda Item #4: Chairs Report
Ms. Walters and Mr. Harriman reported that the State is working on an outline of the new Integrated HIV Prevention and Care Plan, which will be due December 2022. We will be able to use existing documents (e.g., EHE plan).
Mr. Harriman noted that the RWPA program has had numerous data collection challenges over the years, including but not limited to; barriers to provider data access, inefficient data entry including double data entry and inefficient data entry processes, inability to import or export data to/from other data bases, and significant data collection burden on consumers and providers. The Planning Council is initiating a time-limited ad hoc workgroup to develop recommendations that will be shared with the Recipient, colleagues in DOHMH, and HRSA to improve data collection through improved database technology that will increase user access to data for quality improvement, reduce required data collection, and increase capacity to share information across programs so that consumer and provider data collection burden will be reduced. There was support for the committee, with recommendations to consult other EMAs on best practices. Ms. Thompson stressed the need for a statewide unified data collection system. Mr. Martin stressed the importance of reducing the burden on consumers. Mr. Natt noted that Ryan White and HOPWA data systems are also not consolidated. Also, NYS and NYC surveillance reports for NYC are not consistent. This committee should have representation from the AIDS Institute. Mr. Harriman clarified that the committee’s charge is limited to Ryan White data, not surveillance, which is a much larger issue. Also, the committee cannot get into the minutiae of data collection specifics, but will outline broader recommendations. Mr. Schubert added that the committee should set discrete goals and benchmarks. Also, a stigma lens should be applied, with the possible assistance of trained facilitators. Initial volunteers for the workgroup are: Mr. Carr, Mr. Fields, Mr. Natt.
Mr. Harriman reported that the new interim HRSA project officer is Deborah Medina, who has a lot of experience at HRSA. She will join future EC meetings.
Mr. Carr recommended that the Council and Recipient begin discussions about planning for a post-COVID era, as there are many consumers who are not accessing services remotely. Ms. Plummer stated that the Recipient understands the importance of in-person services, but also the need to balance the need to work during an on-going public health emergency. Mr. Lesieur noted that the State has allowed nursing homes to restart in-person dining, which involves a very vulnerable population. Mr. Harriman added that a Council letter was drafted about this issue but set it aside when the omicron variant emerged. Hopefully, as cases and hospitalizations abate, this can be resurrected.
There being no further comment, the meeting was adjourned.