Executive Committee Meeting Minutes July 18, 2019

EXECUTIVE COMMITTEE
NYC DOHMH, Long Island City, NY
Thursday, July 18, 2019, 2:40 – 4:45PM
MINUTES

Members Present: Jan Carl Park (Governmental Co-chair), Matthew Lesieur (Community Co-chair), Fay Barrett,

Matthew Baney (by phone), Danielle Beiling, Lisa Best, Maria Diaz, Billy Fields, Graham Harriman, Jan Hudis, Amanda Lugg (by phone), Andrea Straus, Marcy Thompson 

Members Absent: Joan Edwards, Steve Hemraj, Saul Reyes, Dorella Walters 

Other Planning Council Members Present: Randall Bruce,Paul Carr, Micah Domingo, Charmaine Graham, Donald Powell

Staff Present: NYC DOHMH:David Klotz,Melanie Lawrence, Amber Casey, Kimbirly Mack, Merline Jean-

Casimir; Public Health Solutions: Bettina Carroll, Gucci Kaloo; Joan Corbisiero (Parliamentarian); HRSA Project Officer: Sera Morgan  

The Committee met in executive session to approve the Rules & Membership Committee’s proposed slate of candidates for appointment to the Council for the 2019-22 term.  The slate of diverse candidates, presented by Ms. Barrett, was approved unanimously and will be sent to the Mayor’s Office on Appointments.  

Mr. Park and Mr. Lesieur opened the meeting, followed by introductions and a moment of silence.  Mr. Park encouraged members to attend the August 8^th memorial for late AIDS Institute Director Humberto Cruz.   The minutes from the June 19, 2019 meeting were approved no changes.  The co-chairs, staff and committee members acknowledged the retirements from the Council at the end of this session of Mr. Baney, Mr. Fields and Ms. Hudis.  All were commended for their outstanding commitment to the Council and the community. 

Ms. Morgan reported that the FY 2020 Ryan White Part A (RWPA) Grant Application Guidance has been issued, with applications due on September 30^th.  The guidance is substantially the same as last year’s.  There will also be a notification of funding opportunity (NoFo) this fall for the federal Ending the Epidemic initiative. 

Mr. Harriman reported that the US Dept. of Health and Human Services officially kicked off the implementation phase of its Ending the HIV Epidemic, A Plan for America initiative by announcing the award of $1.5 million each to three jurisdictions to jumpstart activities to further reduce the number of new HIV transmissions.  Funded through the Minority HIV/AIDS Fund, the three jurisdictions are Dekalb County, Ga; Baltimore City, MD; and East Baton Rouge, LA.  In addition, the Indian Health Service (IHS) awarded $1.5 million in pilot funds to the Cherokee Nation in Oklahoma.  Funds will allow the jurisdictions’ health departments to move swiftly to implement key parts of the initiative, including providing treatment for those living with HIV, increasing HIV testing, and expanding preventative services, including PrEP.  Information gleaned from these pilot site activities will inform further efforts in all jurisdictions that have been prioritized for Phase I of the initiative, should it be fully funded in 2020.

The FY2020 RWPA Grant Application NoFo was released on July 1st.  Recipient staff is starting to prepare and looks forward to the thoughtful edits of Planning Council members.  Council staff will make arrangements for Council members to review and comment on the second draft in mid-August.  

The NY EMA Quality Management Committee is meeting on in August to finalize priorities for the NY EMA Quality Management Program for this year.  The priorities will include expanding the audience and distribution of a printed guide to RWPA-funded services, making updates to the consumer committee a routine quality management activity, introducing protocols for value-based payment, and other activities.  The quality management program also released the call for abstracts for the Power of QI conference.  This year’s conference theme is “Using Unexpected Results to Improve Performance.”

The Bureau of HIV (BHIV) engaged in a cross-program collaboration, including both the Planning Council and HIV Planning Group, to submit a proposal to support strategic partnerships, communication, peer-to-peer technical assistance, and jurisdictional planning efforts to address emerging needs of targeted jurisdictions through CDCfunded state and local health departments and their ability to end the HIV epidemic in the U.S.  BHIV staff and their grant writing consultant began the process of planning and drafting a proposal and budget.  BHIV outlined in their proposal efforts to enhance the existing jurisdictional epidemiological profile and develop a situational analysis at the beginning of the project and will use this tool to engage existing community bodies, consumers, and providers, and host listening sessions and conduct other engagement activities to solicit feedback to inform the development of a draft plan by June 2020.  The plan will be presented to the Planning Council and HIV Prevention Group and will seek their concurrence with the plan by September 2020, the end of the project.

On Tuesday, June 25, 2019, New York Knows, NYC DOHMH’s HIV testing initiative, hosted National HIV Testing Day community events in Union Square Park in Manhattan and at the Staten Island ferry terminal.  New York Knows and over 70 of its community partners distributed condoms, safer sex products, and other health promotional items, and community partners offered free HIV testing.

On June 27th, BHIV hosted a community event celebrating “Made Equal,” DOHMH’s latest sexual health marketing campaign.  “Made Equal” promotes the evidence-based finding that HIV cannot be passed through sex if the virus is undetectable (“U=U”), and is designed to reduce HIV-related stigma, celebrate healthy sexuality and sexual pleasure, and redefine what it means to live with HIV.  “Made Equal” is currently appearing in subway cars, subway stations, buses, and bus shelters across the city, as well as on digital media.

BHIV is launching a new storytelling initiative this fall in venues throughout New York City.  This special collaboration will gather LGBTQI people of color in storytelling forums and events that will create connections, build community, illuminate, and inspire.  The project workgroup will be holding its first meeting at The Center on July 26, 2019 (info below) and is seeking community members to contribute to this project.

FY 2018 Fourth Quarter Close-out Report

Ms. Casey presented the FY 2018 fourth quarter close-out report, which showed final spending data for the fiscal year ending February 28, 2019.  Noting that the award was received in three parts, the master contractor, Public Health Solutions, worked to ensure that contractors did not over-spend during the period before the final award was received.  The final amounts left unspent at the end of the fiscal year were: $167,102 in NYC Base programs, $4 in MAI, $12 in Tri-County, $29,809 in grant administration and $44,718 in Quality Management.  The grand total unspent for the EMA was $241,645 (0.3%), a record low amount.  All unspent funds were from the formula portion of the award (100% of the supplemental award was spent due to the accounting work of Ms. Jean-Casimir).  Lineitem details were described, including modifications from the approved spending plan due to take-downs and enhancements as per the Council’s reprogramming plan.  Some notable details included: under-spending in Care Coordination due to the start-up period for newly re-solicited contracts, continuing higher than average underspending in Mental Health due to payer of last resort issues (which indicates that the service model is ripe for revision), and the on-going difficulty in spending in Housing Placement Assistance due to lack of available affordable units.  The Recipient and Master Contractor were commended for their excellent stewardship of the grant.  

FY 2018 Assessment of the Administrative Mechanism

Mr. Klotz presented the annual table summarizing the elements of the assessment of the administrative mechanism. 

Concerning executed contract and renewals, the Recipient received the award from HRSA in three parts.  The first Notification of Award included funding approximately equal to approximately 31.5% of our FY2017 formula award and 20.5% of MAI, the second was for an additional 37% of the FY2017 formula and 24% of MAI, and the third NOA was for the balance of the award.  Subcontracts were executed and renewed on a timely basis using the partial award.  Insofar as it is within the Master Contractor’s control, all contracts were executed within six (6) weeks of receipt of a complete and accurate contract package and necessary approval from DOHMH.  The NY EMA received a slight decrease to its award in FY2018.  Contracts were adjusted and executed on a timely basis. Uncommitted funds resulting from contract negotiations and/or contract terminations were reprogrammed on a onetime basis as per the PC’s Reprogramming Plan. It is a tremendous challenge for program planning and executing contracts without a full award as City of New York oversight agencies do not allow the program to make commitments without a full award.  

Regarding procurement, in order to procure new services in line with the Planning Council’s EIS service directive, an RFP was released June 27, 2017.  Successful applicants and new awards were distributed to the PC in the Recipient Report in January 2018.  Regarding subcontractor payments, subcontractors were paid in a timely manner (within 30-60 days) of receipt of a complete and accurate expenditure report/invoice, as confirmed during site visits by BHIV Administration staff monitoring the master contractor. 

Regarding spending, as described above, FY 2018 expenditures by service category were reported to the EC and PC as requested and scheduled.  Spending rates continued at high rates.  Close-out reports as described above show virtually no carryover in MAI and approximately $241K in formula funding as unobligated.  Modifications to the spending plan were reported by service category to the EC and PC and matched the PC’s reprogramming plan.

A motion was made, seconded and approved 11Y-0N to accept the FY 2018 assessment of the administrative mechanism as presented.   

Ms. Beiling and Ms. Lawrence presented the IOC’s recommendations concerning eliminating the TCC model, currently funded at $1,443,228.  After extensive review by multiple committees, IOC reviewed the directive in light of new presentations from the Recipient, clients and providers.  The model provides care coordination for homeless and unstably housed individuals.  Clients expressed both appreciation and frustration with the program, and it was found that Care Coordination requires significantly more time than the program model acknowledges, and that TCC is sometimes in competition with Short Term Housing, which is an unintended consequence of the model, due to duplicative services.  IOC recommends that the TCC service model be discontinued and that PSRA consider moving the TCC funding allocation, in whole, to the Housing service category to increase short-term housing.  With additional funding, Housing will enhance and strengthen the current service model to provide additional outreach, housing and care coordination/client stabilization services.  

Ms. Beiling, on behalf of the IOC, made a motion to accept the elimination of the TCC model as presented.  The motion was approved 11Y=0N.

Ms. Beiling, Mr. Powell, Mr. Domingo and Ms. Lawrence presented the IOC’s recommendation for a new service directive to provide Psycho-social Support Services for people of Transgender, Intersex, Non-Binary and Nonconforming (TGINBNC) experience.  The goals of the service model are: 1) Provide individualized supportive counseling services that aim to overcome barriers to access and facilitate continued engagement in medical care for PLWHA; 2) Provide family-focused services that reduce stressors in the lives of PLWHA in order to remove barriers to engagement in HIV care and adherence to treatment; 3) Increase the proportion of newly diagnosed individuals who enter into primary care within 30 days of HIV diagnosis; 4) Increase retention in HIV care and treatment; 5) Increase the proportion of clients who have an optimal level of antiretroviral therapy (ART) adherence; 6) Increase the proportion of clients with an undetectable viral load and to improve immunological health; 7) Support comprehensive, coordinated patient-centered care for people with HIV, including addressing HIV related co-occurring conditions and challenges in meeting basic needs, such as housing; 8) Reduce mortality; and 9) Reduce (and then maintain below significance) socio-demographic differences in: prompt linkage to HIV/AIDS care following HIV diagnosis, retention in primary medical care, and undetectable viral load and HIV related mortality.  The objectives are: 1) Provide coordinated access to medically appropriate levels of health and support services and continuity of care; 2) Provide referrals and linkages to medical or supportive services that improve clients’ physical and behavioral health.

The service model elements are: 1) Conduct an initial client intake assessment and periodic reassessments, in a gender affirming manner that appropriately and sensitively identifies a patient’s unmet medical and social needs, and to appropriately support client’s capacity for self- management; 2) Coordinate all levels of medical and behavioral health, as needed; 3) Ensure access to consistent and sustainable use of ART using motivational interviewing techniques and other adherence tools; 4) Provide individual and group support services that promote engagement and maintenance in care, adherence to primary medical care, inpatient/residential treatment (as necessary) and modes of healthy living; 5) Provide linkage/referrals to clients for programs and services that facilitate client stabilization, including but not limited to credit repair, financial literacy, estate planning, end of life planning, job readiness, housing readiness, housing starter kits, legal services and representation, basic and continuing educational opportunities; 6) Implement broad based education, prevention, intervention and remediation programming to address stigma and discrimination such as intimate partner violence, hate based crimes and state/institutional violence; and 7) Agencies should engage in outreach, recruitment and employment practices that attract TGINBNC staff with life experience and expertise that is shared by the agency’s target population in order to improve access to and ensure optimal utilization of health care services. 

Client and agency eligibility were described, including for non-profit organizations with expertise in delivering gender affirming care and experience with people of TGINBNC experience living with HIV and preference for agencies run and staffed by persons that identify as being of TGINBNC experience and who are able to provide gender affirming environments.  All staff (including staff such as administration, maintenance and security) should be trained in gender affirmation, TGINBNC sensitivity, health education, harm reduction, and motivational interviewing techniques.  Agencies must implement a plan or policy that ensures that staff across the program, including clinical and non-clinical partners, affirm and respect gender identity and expression.  Programs must ensure that staff are/will be able to provide care according to current best practices in care of persons of TGINBNC experience, and can engage this population in evaluations of and satisfaction with program services.

Ms. Beiling, on behalf of the IOC, made a motion to accept the TBINBNC PSS service directive as presented.  The motion was approved 11Y=0N.

The IOC’s TGINBNC Sub-committee was commended for its excellent work developing this directive, which had extensive input from the affected community.

Mr. Park and Ms. Thompson noted that there will need to be an Executive Committee meeting in August to consider the Needs Assessment Committee’s recommendations for enhancing access to RWPA services for people with disabilities.  Members will be polled for an available date. 

There being no further comment, the meeting was adjourned.