Thursday, July 23, 2020, 3:00 – 4:50PM
By Zoom Videoconference and Dial-in
M I N U T E S
Members Present: David Klotz (Acting Governmental Co-chair), Matthew Lesieur (Community Co-chair), Steve Hemraj (Finance Officer), Fay Barrett, Lisa Best, Randall Bruce, Paul Carr, Maria Diaz, Joan Edwards, Graham Harriman, Amanda Lugg, Jeff Natt, Donald Powell, Claire Simon, Andrea Straus, Marcy Thompson, Dorella Walters
Members Absent: Danielle Beiling
Staff Present: NYC DOHMH: Melanie Lawrence, Guadalupe Dominguez Plummer, Karen Miller, Kimbirly Mack, Giovanna Novoa, Dave Ferdinand, May Wong; Public Health Solutions: Christine Nollen, Bettina Carroll; HRSA: Sera Morgan; Joan Corbisiero (Parliamentarian)
Agenda Item #1: Welcome/Introductions/Minutes
Mr. Klotz and Mr. Lesieur opened the meeting and a moment of silence. The minutes from the May 21, 2020 meeting were with approved no changes.
Agenda Item #2: HRSA Project Officer Report
Ms. Morgan reported that an unlimited number of people can participate in the virtual National Ryan White Conference, but registration is required. The NY EMA will have a record ten presentations/workshops. The conference will include presentations and seminars devoted to planning councils and consumers, and a forum to gather information from participants on how they have responded to COVID-19.
Agenda Item #3: Recipient (Grantee) Report
Ms. Dominguez Plummer reported that a Request for Proposals (RFP) was released on 12/31/2019 for a Master Contract for Disease Control on behalf of the Department of Health and Mental Hygiene (DOHMH). Public Health Solutions (PHS) was awarded the contract with an anticipated start date of September 1, 2020. This contract allows for PHS to continue to manage Ryan White Part A services contracts with Hospitals, Clinics, and Community Based Organizations.
The 2020 RWHAP Part A Program Submission was submitted on July 14, 2020, including a Council chairs letter, membership roster and reflectiveness, demonstrating the PC’s endorsement of the FY2020 priorities and allocations and that the Council’s membership is in compliance with legislative requirements. The 2020 RWHAP Part A Federal Financial Report (FFR) will be submitted by July 30, 2020.
Several RWPA service category programs are approaching expiration and will need to be re-bid soon. Programs with expiration dates in 2023 and 2024 include Mental Health, Harm Reduction, Housing, Supportive Counseling, Health Education, and Non-Medical Case Management (Incarcerated and Recently Released).
The EMA’s Emergency Financial Assistance (EFA) program, which provides clients financial help in the event of a crisis and is administered in Westchester, has been extended to clients throughout the EMA in response to the hardship imposed by the COVID-19 pandemic.
PHS, on behalf of BHIV, released two concept papers on June 26, 2020: 1) Building Equity: Intervening Together for Health (BE InTo Health) Program to address health inequities faced by priority populations; and 2) Enhanced Data-to-Care (eD2C) Project to improve linkage, re-engagement, and durable retention in HIV care; and sustained viral load suppression. Finally, two new staff joined BHIV in Research and Evaluation and Quality Management.
Agenda Item #4: Oral Health Service Directive
Ms. Lawrence presented an overview of the Oral Health Service Directive, approved by the Integration of Care Committee (IOC) last week. Based on CHAIN data, consumer and provider testimony, a Needs Assessment (NAC) subcommittee identified the need (approved by PC in June 2019) for an Oral Health service. The need for RWPA-funded oral health services was due to the fact that the current service landscape did not meeting the needs of PWH, with gaps in coverage even after Medicaid and Part F programs were taken into account.
The service directive has many innovating features, including a screening tool to identify oral health discomfort and issues among consumers, screenings for HPV and oral cancers, and timely and appropriate linkage to oral health services. The core of the service model is: provision of comprehensive preventative dental care, ensuring coverage of four dental cleanings per year; development of recommendations for common co-morbidities with oral health implications, i.e. Diabetes, Hepatitis C; required trainings to build provider capacity to deliver services in a way that is anti-racist and dismantles stigma; complementing Medicaid, Medicare, ADAP and Part F services to ensure a robust system of care; and development of guidance on how viral load impacts oral care. There is a cap of 20% of allocated funding that may be used to cover the following high-cost services on a case by case basis: gum and bone grafts, and/or partials/implants when one or more teeth is missing. The model also supports service delivery through telehealth as appropriate; ensures that dental materials utilized are long lasting and of high quality; and supports replacement of dentures and other apparatus as needed.
The other principle component of the directive is a centralized Dental Case Management service to support: full integration of oral health care into the service system; improved and increased capacity across the service system to improve access and utilization; facilitation of consumer engagement and education; provision of resources to support the more complex dental needs frequently associated with HIV; development of a resource map to support completion of oral health treatment plans; support of coordination of care with client’s care team; ensuring emergency care is funded and available; and provision of coverage for implants and other highly specialized services i.e. crowns, orthodontia, and gum & bone grafting on a case-by-case basis.
PSRA recommends several small additions: 1) Include coverage for scaling/deep cleaning at least once per year. Allow Healthbucks to be used for oral health care supplies such as electric tooth brushes; 2) Add addendum that requires the Food and Nutrition Service Directive’s Medical Nutrition Therapy’s health education modules to include oral health care education; 3) Ensure that Part F funding is not a requirement to hold a Part A oral health contract.
Mr. Harriman noted that the term “Healthbucks” is not used. Also, FNS and EFA already allow for the purchase of dental supplies. The language was amended and the addition was moved to the end of the directive. Also, FNS programs cannot be compelled to add a new module to their nutrition counseling services as the programs have been procured and contracts finalized. There was an agreement to make it a recommendation and to consider adding it to the FNS directive in the future.
Mr. Powell, on behalf of the Integration of Care Committee, made a motion to approve the Oral Health Service Directive as presented with amended additions. The motion was adopted 16Y=0N.
Agenda Item #5: FY 2021 Application Spending Plans
Mr. Natt and Ms. Walters introduced the FY 2021 application spending plans by noting that the PSRA had to make difficult decisions, but did so in a data-driven, cooperative manner, producing excellent work.
Mr. Klotz presented the PSRA recommendations for the FY 2021 grant application spending requests, The EMA must submit separate Base and Minority AIDS Initiative (MAI) spending plans in the annual grant application (Base includes Tri-County’s allocation). HRSA allows EMAs to request up to 5% over the current year’s Base award. The application spending request is a wish list and must be justifiable on the grant application narrative. The PSRA’s recommendations came after thorough review of service category fact sheets that summarized multiple years’ data on spending, service unit utilization, client demographics, as well as analyses of payer of last resort and systems-level considerations. In the fall and winter, PSRA plans for a likely reduction in the actual award. During the scenario planning process, the PSRA uses the application spending request as to guide the priorities and allocations.
FY 2021 Tri-County Application Spending Plan. This plan continues the enhancement to Emergency Financial Assistance to respond to the on-going COVID-19 crisis ($424,000). The enhancement will serve NYC residents, but the program is housed at a TC agency, and so it appears in the TC spending plan. There is also a 5% across-the-board proportional increase to all other categories, based on ranking scores ($156,805 – higher ranked categories receive a proportionally larger increase).
FY 2021 MAI Application Spending Plan. MAI funding is 100% driven by a HRSA formula based on the number of non-white PWH living in EMA relative to other EMAs. The EMA always requests level funding for MAI (for FY 2021: $8,785,630 in four categories (ADAP, Housing, MCM, EIS). In the final spending plan, we combine Base and MAI into one pot, as all Base programs meet MAI criteria.
FY 2021 NYC Base Application Spending Plan. A summary of the NYC Base plan is:
- End funding for Non-Medical Case Management-General Population
- Fund the previously approved new service category of Psychosocial Support for TINBNC PWH at $434,000, including $10,000 for a revised resource guide, and $424,000 for two pilot programs at 50% of annualized amount (programs will begin mid-year).
- Fund the new service category of Oral Health Services (rank score: 6.5; 6th priority) at $500,000 for direct dental services (two programs based on staffing model in Tri-County), and $200,000 for dental case management (in Medical Case Management line on the spending plan to conform with HRSA monitoring standards). Funds for dental case management are already available and no new funding is needed.
- Other Targeted Increases, based on 2019 over-performance and need to continue FY 2020 COVID-19 enhancements:
- Housing: $1,500,000
- Food & Nutrition: $1,000,000
- Legal Services: $600,000
- Mental Health: $161,778
- Supportive Counseling: $161,779
The rationale for the elimination of NMG was described. All service types in this category (outreach, accompaniment, coordination, assistance) are provided across numerous RWPA categories (HRR, MH, MCM, PSS, EIS). HASA, Medicaid Health Homes, Special Needs Plans, and Ryan White Part B, RWPA Care Coordination and Supportive Counseling all provide similar case management services. Almost half of active NMG clients were actively enrolled in at least one other service category. NMG has historically under-performed (11.2% in 2015; 0.01% in 2016; 9.2% is 2017, nearly 20% for 2018). Given NMG services’ duplication of RWPA and other funded case management services, clients can be served through other programs. DOHMH will ensure that closing programs transition clients to new programs. With the prospect of continued decreases in the RWPA grant award, the EMA should use this service allocation to offset future reductions in the award and for additional funding to higher priority service categories and new needs (e.g., Oral Health, COVID response).
Mr. Natt, on behalf of the PSRA Committee, made a motion to approve the FY 2021 Tri-County, MAI and NYC Base application spending plans as presented. The motion was adopted 17Y=0N.
Agenda Item #6: Assessment of the Administrative Mechanism
FY 2019 Close-out Report
Mr. Hemraj introduced the FY 2019 close-out report and assessment of the administrative mechanism, noting that spending rates in the last fiscal year continued at historically high levels.
Ms. Dominguez Plummer and Ms. Miller reported on the FY 2019 fourth quarter close-out. A total of $128,115 in program dollars were unspent (all but $11 in NYC Base). NYC service categories that had higher than usual under-spending include MCM and FNS. MCM was under-spent due to community health clinics having to adapt to changes in reimbursement and to one contract termination. The Tri-County Mental Health category under-spent due to the start-up year and the switch to performance-based contracting. All underspending was reallocated to over-performing categories per the Council’s reprogramming plan. Administrative dollars were over spent by $235,605 due to larger than expected union raises for many staff. Unspent administrative dollars were reprogrammed to services over the course of the year. This includes savings from Council staff vacancies.
While more Harm Reduction services will be Medicaid reimbursable, this is only true of those provided by Syringe Exchange Programs, and not all RWPA Harm Reduction programs are housed in an SEP. There was a discussion on how the depreciation of computer equipment may affect the Council budget.
Assessment of the Administrative Mechanism
Mr. Klotz explained that the Council is required to assess the administrative mechanism (i.e., determine if the Recipient is implementing the Council’s funding priorities and getting RWPA funds out quickly). The formal assessment looks at four metrics. Below is a summary of the draft assessment for FY 2019.
Executed Contracts/Renewals (how quickly funding has been committed and contracts executed/renewed. The Recipient received the award from HRSA in multiple parts – one partial and a final. The first NOA we received funding equal to approximately 31% of our FY2018 formula award and 20% of MAI and the final 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 final award was a 1.4% reduction from the total FY2018 and contracts were adjusted and executed on a timely basis. Uncommitted funds resulting from contract negotiations and/or contract terminations were reprogrammed on a one-time 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.
Procurement (has the Grantee communicated the results of all RFPs to the Council). The food and Nutrition RFP process that began in FY2018 was completed in FY2019. The successful applicants and the Planning Council (via the Recipient Report) were both notified in January 2020 with an updated list of awardees in February 2021. The Master Contract for Public Health Solutions was also procured resulting in an only recently announced award to Public Health Solutions. Contract is expected to begin September 2020. 2) Planning Council were fully informed of release of RFP and awards in a timely manner via the Grantee Report.
Subcontractor Payments (are subcontractors paid in a timely manner). 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.
Spending. FY 2019 expenditures by service category were reported to the EC and PC as requested and scheduled. Spending continued at historically high rates. Close-out reports show carryover of $128,104 in NYC Base funding, $10 in MAI, and $1 in Tri-County programs. Modifications to the spending plan were reported by service category to the EC and PC and matched the PC’s reprogramming plan.
Mr. Hemraj made amotion, which was seconded, to approve the Assessment of the Administrative Mechanism as presented. The motion was adopted 17Y=0N.
The Committee thanked retiring EC members Mr. Lesieur, Ms. Barrett and Mr. Hemraj for their outstanding contributions to the Council.
There being no further comment, the meeting was adjourned.