Executive Committee Meeting Minutes July 21, 2022

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2:35 – 5pm

Members Present: Graham Harriman (Governmental Co-chair), Dorella Walters (Community Co-chair), Paul Carr (Finance Officer), Saqib Altaf, Billy Fields, Ronnie Fortunato, Marya Gilborn, Charmaine Graham, Matthew Lesieur, David Martin, Jeff Natt, Julian Palmer, Scott Spiegler (for Guadalupe Dominguez Plummer), Donald Powell, Claire Simon, Marcy Thompson

Members Absent: Joan Edwards, Leo Ruiz

Guest Present: Deborah Greene (Integration of Care Committee)

Staff Present: NYC DOHMH: David Klotz, Melanie Lawrence, Deb Noble, Giovanna Navoa, Karen Miller, Kimbirly Mack, José Colón-Berdecía, Jenny Fernandez, Patrick Chan; Public Health Solutions: Barbara Silver, Arya Shahi, Gemma Ashby-Barclay, Rosemarie Santos; HRSA/HAB: Axel Reyes; Joan Corbisiero (Parliamentarian)

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 June 16, 2022 meeting were approved with no changes.

Mr. Carr urged DOHMH and other agencies to step up the response to the monkeypox outbreak and to avoid stigmatizing messaging.  Mr. Harriman noted that Deputy Commissioner Celia Quinn, MD will give a brief monkeypox update at the next Council meeting.

Agenda Item #2: HRSA Project Officer Report

Mr. Reyes reported that the Non-competitive Continuing application will be due on October 3rd.  The process is much less cumbersome than a full application.  He also encouraged everyone to register for the National Ryan White Conference, to be held virtually from Aug. 23-26.  Finally, there is a new client-level data dashboard.

Agenda Item #3: GY 2023 Application Spending Plan

Mr. Natt explained that the EMA is required to submit Base and MAI spending requests in the GY 2023 grant application.  The EMA can request up to 5% above the current year’s award and we traditionally ask for the maximum as a statement of need.  In the fall and winter, PSRA will conduct scenario planning for a possible decrease in the award.  The MAI award is fully formula-driven, and as in past years, the draft request for the application is identical to this year’s award.  For the GY 2023 application, the Tri-County Steering Committee is requesting a 5% proportional across-the-board increase to their Base-funded service categories to address inflation. 

The NYC Base award allocates $1,333,800 to Ambulatory Outpatient Services for Older PWH, based on a cost analysis presented to PSRA in June.  This service will be funded starting March 1, 2023.  $450,000 is needed to pay for a full year of Oral Health Services, which begin on Sept. 1, 2022 and is funded for 6 months this year.  In the case of flat funding or a decrease in the 2023 award, PSRA has agreed that funds for these two initiatives can come from the ADAP allocation.  PSRA recommends allocating the remaining $1,690,828 from the 5% increase request to address staff retention and the higher cost of doing business due to inflation.  This increase is not applied to ADAP or to service categories that received targeted increases for this purpose in the current year (Housing, Food & Nutrition), or services that have not begun yet (Oral Health, HIV & Aging).  Mr. Klotz showed the details of the plan on spreadsheets provided to the Committee.

Mr. Natt, on behalf of the PSRA Committee, moved to approve the final GY 2023 Application Spending Plan as presented.  The motion was adopted by a roll call vote of 13Y-0N

Agenda Item #4: Housing Services Directive

Ms. Lawrence introduced Ms. Noble, Ms. Novoa and Ms. Greene, who along with Ms. Fortunato presented the revised Housing Services (HOU) Directive approved by the Integration of Care Committee (IOC).  The HOU portfolio is going to be rebid for GY 2023 and a new directive was needed.  When developing the new directive, IOC considered that housing stability has been severely impacted by the COVID pandemic.  Background on the NYC housing landscape was provided (e.g., the decline in affordable housing, funding for other HIV housing programs like HOPWA, extremely low-income requirements and skyrocketing rents). 

The HRSA definition of HOU was provided.  The revised NYC HOU directive includes the same core services as are currently provided (Rental Assistance, Housing Placement Assistance, Short-term Housing).  The implementation science logic model for the HOU portfolio was explained (intervention source, evidence strength and quality, adaptability).  Implementation strategies were described (e.g., interpretation services, education on client rights, 30% rent cap on client income, rapid response to client inquiries to prevent displacement).  Qualifications for organizations that apply to provide the rebid HOU services were described (e.g., evidence of work to combat stigma and provide trauma-informed care, established linkages, experience with people who are homeless/unstably housed).  Other policies include supporting access to long-term, permanent housing and not housing clients in apartments on the “worst landlord” list.  The DOHMH HIV Housing Services Unit (HSU) should also collaborate to identify clients with extreme housing need, especially those with mental health and/or substance use disorders and co-morbidities.  Training strategies for DOHMH and HOU providers were outlined, including CLAS standards, harm reduction, anti-stigma and racism.  Programs will also implement quality service implementation strategies, such as reporting on common barriers to securing housing among the client population to inform the development of interventions.  Programs must also assist clients in completing all relevant supportive housing applications.    

Implementation strategies for the HOU components (the same service types as the current directive) were described.  Short-term Rental Assistance (SRA) will use a payment standard for determining the amount of rental assistance that is in line with HUD fair market rent, and when possible, use the HUD community wide exception rent standard to ensure that PWH are less financially disadvantaged in the housing market.  Housing Placement Assistance (HPA) will Coordinate with and between governmental and intergovernmental actors to compile and share best practices/lessons learned, and to develop and/or strengthen existing policy that increases access to housing for PWH.  HOU outcomes were outlined, including decreasing the number of PWH in unstable housing, increase in coordinated patient-centered care, and increase in timely support and reimbursement to providers. 

A summary of the discussion follows:

  • The 30% of income that can go to rent does not include utilities, which is a US HUD standard used across all federally funded housing subsidy programs.  Utilities should be included as a housing cost (and should include Internet).
  • A new module for collecting data on referral outcomes will need to be developed.  Provider feedback will be elicited for that, and eShare/data collection capacity examined.
  • The DOHMH Housing Unit tracks vacancies through constant monitoring of programs.
  • Household-specific costs for multi-person units can be complicated.
  • The RWPA HOU allocation is very small compared to HOPWA, HASA and other programs, and it would not be practical to use RWPA programs to leverage systems-level changes.  VOCAL-NY does system-wide HIV housing advocacy.  DOHMH also has an HIV Housing Advisory Committee.

Ms. Fortunato, on behalf of the IOC Committee, moved to approve the Housing Services Directive as presented.  The motion was adopted a roll call vote of 12Y-0N. 

Agenda Item #5: Assessment of the Administrative Mechanism

Mr. Carr explained that the Planning Council is required by the Ryan White law to “assess the efficiency of the administrative mechanism in rapidly disbursing Ryan White Part A funds”.  This means that we look at how well the Recipient (the DOHMH HIV Care & Treatment Program) and Master Contractor (Public Health Solutions) are doing to implement the priorities and allocation of the Council, and how fast they are getting the funds out to sub-contractors so that the grant award can be spent and spending maximized.  As in past years, we assessed the administrative mechanism through quarterly expenditure reports received from the Recipient, and through a self-assessment by the Recipient.  This year, in addition to the quarterly reports, we also conducted a survey of providers to get the perspective of Part A sub-contractors.  We asked them about timeliness of contract renewals and payments and gauged their opinion of the quality management and technical assistance provided by DOHMH and PHS.  Mr. Harriman added that the findings were shared in advance of this meeting with the DOHMH and PHS and are meant in a spirit of collaboration to promote a more efficient use of grant funds and to avoid the kind of unexpectedly large carryover that we saw last year.  

Mr. Klotz presented the results of the RWPA provider survey.  Surveys were sent to all 81 agencies that have a RWPA contract and 53 responses were received (a response rate of 65%).  The questions focused on the range of issues related to RWPA contracting, including timeliness of contact execution and payments, reporting requirements, quality management and technical assistance, and helpfulness of Recipient and master contractor staff.  A principal concern of respondents was the lateness of contract execution/renewals.  Thirty-five (66%) respondents reported that contract renewals and executions were not completed in a timely manner.  While some outside forces (e.g., COVID) and internal issues (e.g., difficulty of managing multiple contracts) were cited, most respondents thought that delays were due to issues related to PHS (most commonly late receipt of documents).  Twelve (24%) providers reported that PHS did not make payments within 30 days of submission of required paperwork.  For those who did not receive timely payments, reasons included specific technical reasons as well as more undefined delays.  For the 54% of respondents who received programmatic technical assistance from DOHMH, virtually all received that assistance in a timely manner.  Three quarters of respondents who received fiscal/contractual technical assistance from PHS received that assistance in a timely manner.  In respondent comments section, most respondents praised the timeliness and quality of TA.  80% of respondents reported receiving an enhancement using GY 2020 carryover funds for training/capacity building, but 51% of those recipients did not have enough time to adequately plan to use the funds before the grant year ended.  In the comments, respondents cited gratitude for the opportunity to use funds for organizational development, but often cited the rushed and sometimes haphazard enhancement process.

Respondents overwhelmingly agreed that DOHMH and PHS provide clarity on program reporting requirements, policies and procedures, and HRSA updates that impact programs.  Respondents were also satisfied with personal interactions with PHS and DOHMH staff.  Comments often cited the helpfulness and responsiveness of staff.  Several instances were cited where communication could be clearer and errors in documentation avoided. In general comments respondents overall praised the helpfulness of DOHMH and PHS staff, particularly in the challenging environment of a pandemic.  Areas cited where DOHMH and PHS can provide better service include communication and response time, setting reasonable deadlines, more training, and the need for additional formal check-ins.

Mr. Harriman summarized the findings of the Assessment of the Administrative Mechanism.  Underspending remains high for the 2nd year and the 3rd Quarter expenditure report was inaccurate with the amount of unspent funding.  With the expected end of HRSA waiver of carryover penalties for GY22-23, DOHMH/PHS must improve spenddown of grant funds or the NY EMA will be penalized with a reduced award in future years.  PHS must ensure that contract documents are sent to sub-recipients in a timely manner so that contractors are in a status to be paid once the contract term starts and the service expectations are clear.  DOHMH/PHS must ensure that sub-recipient payments are made in a timely manner to ensure continued service delivery and to avoid hardship of strapped agency budgets.  Carryover enhancements should be proactively managed so that providers can spend their funding in the last four months of the year (notify providers of the possibility of receiving carryover and the plans for carryover approved by the Council months in advance, ensure timely processing of enhancements once carryover is approved).

Mr. Spiegler presented the Recipient’s response to the findings of the assessment.  The Recipient acknowledges the past two years as being unprecedented given the COVID-19 pandemic, leadership changes at DOHMH and PHS, and other administrative changes.  Additionally, the leadership of PHS experienced a number of staffing transitions resulting in a loss of institutional knowledge.  The Recipient is taking measures to ensure these findings are an opportunity for quality improvement and is providing a number of corrective action steps to address the findings, including:

Late Payments: BHHS and PHS finance and administrative teams continue to meet regularly to review and reconcile financial expenditure reports from PHS to BHHS and to monitor transfer of funds. BHHS Administration is also allocating staff and resources to implement a systems-improvement process.

Delayed Contract Executions: PHS began working with the subrecipients to collect scopes of work, service target grids, budgets, etc. for FY 2022, beginning 03/01/2022. The majority of the subrecipients will receive amendments to their existing agreements for FY 2022. Amendments now require less paperwork and should not necessitate the same type of legal review on the part of the subrecipients.

Monitoring of Spending: Quarterly meetings with Recipient and BHHS Admin at NYC DOHMH will be scheduled starting in August.  Most service categories are returning to fixed rate reimbursement.   PHS will work with the Recipient to engage in in-depth spend down reviews and budget modifications to avoid large carryover amounts.  The Recipient, BHHS Admin, and PHS meet monthly to coordinate the programmatic, contractual, and fiscal management of the Ryan White Part A program.

Mr. Shahi added that PHS will be more proactive with cash flow, streamlining contract executions and amendments, and have done cash advances to ensure that providers have cash flow. 

A summary of the discussion follows:

  • Sub-contractors should be required to complete the survey.  It was noted that this would need to be an element of the providers’ sub-contracts.
  • Sub-contractors needed clarification on whether the actual deliverables paid for by the carryover funds for training needed to completed by the end of the grant year, or if the only the funds had to be spent but the trainings could be delivered after the year ended.
  • While GY 2021 was still an unusual year with the ongoing pandemic, staff changes and vacancies at providers, the Recipient can still do a better job at anticipating underspending and proactively taking steps to reallocate that money using the Council’s reprogramming plan.

Mr. Carr reiterated that if the funds are not spent, it hurts consumers in the end.  It is important for the Council to have accurate information.  The GY 2021 3rd quarter expenditure report to the EC stated that spending was on track, only for the Committee to learn that the carryover would be over $7M.  It is important to rebuild institutional memory at PHS and to strengthen relationships.  DOHMH and PHS should be commended to committing to improving after the major changes over the last two years.

Mr. Carr made a motion, which was seconded, to accept the GY 2021 Assessment of the Administrative Mechanism as presented.  A motion was made, seconded and approved by unanimous consent to amend the main motion to include the Recipient response in the Assessment.  The amended motion was adopted a roll call vote of 11Y-0N. 

Agenda Item #6: Planning Council Co-chairs Report

Mr. Harriman thanked everyone who attended the annual member recognition event on Tuesday.  Hopefully hybrid in-person meetings with a virtual option will begin with the new session in October.

There being no further comment, the meeting was adjourned.