Executive Committee Meeting Minutes June 16, 2022

EXECUTIVE COMMITTEE

Thursday, June 16 2022, 2:35-4:30pm

By Zoom Videoconference

Members Present: Graham Harriman (Governmental Co-chair), Dorella Walters (Community Co-chair), Paul Carr (Finance Officer), Saqib Altaf, Joan Edwards, 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: Leo Ruiz

Staff Present: NYC DOHMH: David Klotz, Melanie Lawrence, Deb Noble, Giovanna Navoa, Gina Gambone, Johanna Acosta, PhD, Frances Silva, Arnelle Vincent, Karen Miller, Ilana Newman, Kimbirly Mack, Patrick Chan; Public Health Solutions: Barbara Silver, Arya Shahi, Rosemarie Santos; 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 April 21, 2022 meeting were approved with no changes.

Agenda Item #2: GY 2022 Planning Council Support Budget

Mr. Harriman introduced the GY 2022 Planning Council Support Budget.  As per the Council/Recipient MOU, the Council leadership negotiates the Council support budget after the final notice of award is received and brings it to the Executive Committee for ratification.  The funds all come out of the 10% of the award set aside for grant administration.  The GY 2022 budget calls for only a modest increase of $17,591 over last year’s budget.  The budget anticipates the costs of face-to-face meetings beginning in October (depending on the state of the pandemic).  Other new costs are a consultant to write the Needs Assessment, and one to conduct an anti-stigma retreat.  There is also money in the budget for the design and purchase of lapel pins for Council members to wear to identify themselves at public events, an initiative that the Consumers Committee is working on.  Other non-personnel costs are comparable to last year.

In response to a question, Mr. Harriman explained that consultants are procured according to City rules through a competitive bidding process, from a potential list of minority- and women-owned vendors. 

A motion was made, seconded and approved 14Y-0N to adopt the Planning Council Support Budget as presented. 

Agenda Item #3: GY 2022 Final Spending Plan

Mr. Klotz explained that for the first time in nine years, the EMA received an increase ($2,662,448) in the Ryan White Part A (RWPA) grant award.  The bulk of the increase was in Base supplemental funds, which is based on the application score.  The application is a three-year application, which means the score remains the same for GY 2023 and 2024.  There was also an increase in formula funds, which are based on the number of PWH reported to the CDC.  This was the area where most of the reductions have been, which means that other EMAs’ HIV incidence is coming more into line with NY.  HRSA announced that every EMA got an increase due to the $10M additional appropriated by Congress plus $20M available nationally from the pool of unspent carryover available due to the waiver of penalties on underspending.  The waiver is in effect again for GY 2021, which means that the award will likely remain stable for at least another year. 

The amount of funds to be allocated includes both the increase in the award, as well as uncommitted funds from savings in carrying costs of programs from GY 2021.  That amount is slightly offset by the allocations that the Council had already agreed to ($250K for the first 6 months of new oral health programs, and $443,500 to fund a full year of PSS TIGNBNC).  This leaves a total of $3.8M in uncommitted funds to allocate. 

Ms. Gilborn presented a plan approved by the Priority Setting & Resource Allocation Committee (PSRA), initially developed by Council and Recipient staff based on need and provider capacity, to allocate the additional funds.  All enhancements are permanent and on-going.  The following are the proposed enhancements:

1. Housing (HOU): $837,136 to address the rise in rent and operations.  Of the total, $515,065 will NYC Short-term Housing, $176,573 to NYC Rental Assistance, $125,276 to NYC Housing Placement Assistance, and $20,222 for Tri-County Short-term Housing.  Ms. Noble added that the amount is based on the HUD increase of 12% in fair market rent as well as ConEd’s estimate that utilities will go up 14% this year.  Part of the new HOU funding will be for on-going staff retention initiatives (e.g., increased salaries and benefits) to address ongoing COVID-related burnout and loss of staff, particularly in congregate facilities.  Short-term rental programs will need more staff to serve additional clients.  The enhancement will cover expenses for leases in existing programs. 
2. Food & Nutrition Services (FNS): $355,801 for NYC programs, $59,975 for TC to provide permanent enhancements to food services, based on the 10% inflation rate since the FNS rates were set in 2019.  
3. Emergency Financial Assistance (EFA): $850,000 to serve the entire EMA.  This program, originally based in TC, has done a phenomenal job extending services to NYC.  The program is currently dramatically overperforming and can benefit from additional funds to cover the increase in demand.  The program spent over $140,000 in March 2022 alone and needs to hire a full-time staff to manage the increase in number of clients requesting EFA services.  The Recipient is also requesting that the Council make permanent the per client annual cap of $5,000 (originally $2000).  It was noted that the Emergency Financial Assistance allocation was moved from the Tri-County plan to the NYC plan.  The program is administered by an agency located in Westchester, but serves the entire EMA and the majority of clients are from NYC.
4. Oral Health Services (OH): The original spending scenario called for funding two programs (to start mid-year) at an annualized allocation of $250,000 each.  There is a third fundable proposal, and programs’ maximum reimbursable amount (MRA) can be increased to $300,000 each.  Thus, an additional $200,000 above what was already pledged is required to fund three programs for 6 months.
5. ADAP: The balance of the uncommitted funds ($1,508,065) would go to ADAP, with the understanding that about $1.3M will be taken back in GY 2023 to fund the new Ambulatory Outpatient Services for Older PWH.  A small amount of ADAP funds was moved from MAI to Base so that the allocations exactly match the respective award amounts.

A summary of the discussion follows:

• HOU funding will be distributed to programs based on proposals they have submitted for the use of funds.  The bulk of the increase will go directly to benefit clients (e.g., paying rents, brokers’ fees, buying ACs or furniture).  DOHMH will be able to track how many clients benefit (e.g., an estimated 10 people on the waiting list for short-term housing will be enrolled).
• Programs beyond HOU are dealing with staff retention issues and can benefit from enhancements to address that.
• Purchased equipment (e.g., ACs, furniture) should be good quality and durable.  Also, the Framing Directive asks providers to collaborate to save money on buying equipment.

A motion was made, seconded and approved 15Y-0N to adopt the final GY 2022 Spending Plan as presented. 

Agenda Item #4: GY 2021 Fourth Quarter Closeout Report

Mr. Spiegler presented the GY 2021 fourth quarter commitment and expenditure report reported that the carryover from previous year is unusually high for the second year in a row.  HRSA issued a waiver again from any penalties for carrying over more than 5% of the award.  The past two grant years were unpreceded due to the COVID-19 pandemic and under normal circumstances we would not be managing such a large carryover amount.  This is largely attributed to the cost-based reimbursement structure across the RWPA portfolio implemented in the past two years due to the pandemic. Also, most RWPA funded organizations faced staff turnovers with some staff leaving due to burnout and for higher paying jobs offering telework/full remote work.  This great resignation has also been experienced at DOHMH for staff supported on the RWPA budget, and the city is moving very slowly on job postings and start dates for new hires.  Highlights of the report are:

• Non-Medical Case management service category expenditure is 81%.  This is due to close-out expenses related to the program ending on 02/28/2021.
• Housing and FNS both spent close to 100% of their allocations, demonstrating the demand for these essential services.
• Mental Health Services in both NYC and Tri-County have historically underspent because of payor of last resort issues.
• MAI funds were almost fully spent.
• Tri-County PSS has an expenditure of 79% due to underperformance resulting from staffing vacancies and challenges with hiring new staff.  The Recipient is actively providing ongoing support and assistance to the program.
• TC Medical Transportation services category has an expenditure of 81% due to services slowing returning to in-person from virtual and people with HIV accessing more transportation services.
• EFA had an expenditure of 58% due to receiving carryover funds late in the fiscal year making it challenging to spend down, however, as explained earlier, this year the program is overperforming dramatically. 
• There is major underspending in administration and Quality Management due to DOHMH staff vacancies and challenges filling vacancies quickly due to a long hiring process.

The total carryover of $7,627,207 is the largest in many years due to the unprecedented time challenges of the pandemic and the resulting staff turnover.  The Recipient is working to improve grant administration and DOHMH/PHS monitoring of spending to proactively identify funds for reprogramming and minimize underspending.  Additionally, the Recipient is working with the Quality Management team and PHS to communicate and prepare subrecipients in advance of carryover funds so programs are set up successfully to spend down.  In response to a question, it was explained that Base and MAI programs are considered one pool of funds for planning purposes, as all Base programs meet MAI eligibility.  The Recipient assigns contracts to the MAI funds and can switch them to Base to match the grant awards.

Mr. Harriman noted that at this point the Committee reviews the Assessment of the Administrative Mechanism.  This year, the Council has conducted a survey of RWPA providers, which resulted in findings around timeliness of contract documents and payments to contractors.  We have conveyed the results of the survey to the Recipient and master contractor (PHS) as well as to Ms. Walters and Mr. Carr.  The Council leadership will present the findings to the Executive Committee and Council at the July meetings in order to give the Recipient time to develop a sound and actionable response to the findings.

Agenda Item #5: GY 2021 Carryover Plan

Mr. Spiegler noted that, as reported earlier, the final carryover from GY 2021 available to allocate in GY 2022 is $7,627,207.  The HRSA rules for use of carryover funds were explained (one-time program funds that typically arrive late in the grant year and must be fully spent by February 28, 2023).  The Recipient surveyed provides and looked at capacity, spending trends and needs to develop a draft carryover plan, which was presented to PSRA, which modified the plan to what is being presented today.  The proposed uses of the funds (all for both NYC and TC), as approved by PSRA are:

1. FNS: $1,000,000 to provide additional food vouchers and pantry bags.
2. Value-based payments for Medical Case Management (VBP): $1,200,000.  Ms. Gambone explained that VBP was implemented successfully in GY 2021 using GY 2020 carryover.  Payments are made on four measures using benchmarks for enrolling virally unsuppressed clients, case conferencing, health education sessions, and achieving VLS. 
3. Culturally and Linguistically Appropriate Services (CLAS) Standards: $2,106,000 to allow every sub-recipient (RWPA provider) to complete a federally-mandated CLAS Standards assessment tool and work plan, as outlined in the Council’s Framing Directive.  This will help improve quality of services, address inequities, and reach PWH who may need translation and interpretation services at $26,000 per provider across a total of 81 unique agencies.
4. ADAP: The remaining $3,321,207 would be absorbed by ADAP, which has taken severe reductions every year to absorb cuts to the award and pay for new initiatives.  ADAP Director Julie Vara has affirmed that they are able to absorb and spend the additional funds.

Any of the funds for the above initiatives that are still unspent near the end of the grant year would be absorbed by ADAP.  The Recipient will begin working with agencies early to prepare them to spend any enhancements.

Mr. Lesieur stated that VBP should move towards a focus on only the fourth measure, as the first three should be part of the programs’ basic expectations.  Ms. Gambone responded that many programs enroll clients who are virally suppressed by need additional Care Coordination to maintain that in the face of challenges such as mental health issues.

A motion was made, seconded and approved 13Y-0N to adopt the final GY 2021 Carryover Plan as presented. 

Agenda Item #6: Planning Council Co-chairs Report

Ms. Simon encouraged all Council members to complete the Integrated Plan prioritization survey.

Mr. Harriman announced that the annual member recognition event is scheduled to take place on July 19^th in Riverbank State Park. 

There being no further comment, the meeting was adjourned.

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

Members Absent: Graham Harriman, Finn Schubert

Staff Present: NYC DOHMH: David Klotz, Melanie Lawrence, Scott Spiegler, Scarlet Macias, Renee James, Giovanna Navoa; Public Health Solutions: Barbara Silver, Gemma Barclay, Arya Shahi, Rosemarie Santos; Joan Corbisiero (Parliamentarian)

Agenda Item #1: Welcome/Introductions/Minutes/Public Comment

Mr. Carr opened the meeting followed by introductions and a moment of silence.  The minutes from the March 17, 2022 meeting were approved with one typo corrected.

In response to a question from Mr. Martin, Mr. Klotz clarified that the Ryan White legislation caps funding for the quality management program at either 5% of the total award or $3M, whichever is less.

Agenda Item #2: GY 2022 Reprogramming Plan

Mr. Natt introduced the GY 2022 Reprogramming Plan approved last week by the Priority Setting & Resource Allocation (PSRA) Committee.  The Council develops a reprogramming plan each year to spend funds that become uncommitted during the course of the year.  We traditionally give the Recipient the latitude to shift funds between service categories in order to enhance overperforming contracts.  No service category will be enhanced by more than 20% of its original allocation in the spending plan without Council approval.  ADAP will be included as a category for enhancement after all other service categories have been considered, but will not be subject to the 20% cap.  With programs reverting to fee-for-service reimbursement, the plan will allow the EMA to maximize spending during the year and reduce the levels of carryover seen during the two pandemic years.

Mr. Natt, on behalf of PSRA, moved to approve the Reprogramming Plan as presented.  The motion was adopted 14Y-0N.

Agenda Item #3: Committee Reports

Consumers Committee (CC)

Ms. Graham reported that the CC had a lively meeting this month focused on respectful engagement and conflict resolution as well as feedback for the Integrated Plan.  Compiling feedback and ensuring that everyone’s concerns are heard will continue to be the focus of CC meetings, in addition to planning an end of year picnic for the Council hosted by the Consumers, tentatively slated for the date of the July CC meeting.  The CC also continues working on designing a lapel pin for consumers on the committee and is re-configuring our approach to hosting a youth forum by partnering with agencies that serve youth.

Needs Assessment Committee (NAC)

Ms. Thompson reported that the NAC is continuing its work on the full HRSA-mandated Needs Assessment.  Recent NAC meetings have been mostly used for breakout sessions of four workgroups (Epi Profile, Service Needs and Gaps, Resource Inventory, Provider Capacity) that are compiling data and discussion points, identifying key gaps in data and developing recommendations.  A consultant will be hired over the summer to draft the document, which will be reviewed by the NAC and Council for submission to HRSA in December.   

Integration of Care Committee (IOC)

Ms. Fortunato reported that IOC is working on the integrated Behavioral Health directive that will combine Mental Health, Harm Reduction and Supportive Counseling Services.  The Committee had a presentation from CHAIN on behavioral health service needs and utilization and impact of HIV outcomes, and held a panel discussion with two Article 28/31/32 providers.  IOC also has a sub-committee working concurrently on a revised Housing directive.

PSRA Committee

Mr. Natt reported that after a year of in-depth data review In preparation for a revised set of allocations for GY 2023, PSRA is looking at several specific areas.  We will be getting a cost analysis from the Recipient for the two new service categories to be funding under the Aging & HIV directive (Outpatient Medical Care, Referrals to Health and Support Services).  We will also review a proposed methodology for reducing Medical Case Management, which is by far the largest category in the portfolio, and which we have identified as having substantial payer of last resort issues.  A reduction in MCM is the most likely avenue for paying for the Aging services and absorbing future cuts to the award.

A decision about the allocation for the other category with payer of last resort issues, Harm Reduction, will need to be put off until GY 2024 when new programs start under the IOC’s Behavioral Health service directive.  Also, by then will be clearer what POLR issues there will be with Medicaid and harm reduction services.  PSRA will also develop a spending plan for the grant application that asks for the maximum increase allowed (5% over the current award). 

Tri-County Steering Committee

Mr. Palmer reported that at last week’s Tri-County Steering Committee meeting, there was an interesting and thorough presentation from the Recipient on how COVID affected Ryan White Part A services in the Tri-County region.  Service providers faced challenges in enrolling new clients and delivering services during the pandemic.  Overall, new enrollments dropped except for Food & Nutrition and Emergency Financial Assistance.  Even with the decline in new enrollments, however, provision of service units increased in most services (with the exception of those that require in-person services like Oral Health). 

At the meeting, the Committee also got a preview of the service category fact sheets that the Recipient will provide during the next planning session.  The fact sheets contain three years of data on client enrollment, service utilization, expenditures, etc. that the Committee will use to review the Tri-County service portfolio for the 2023 grant year.  

Rules & Membership Committee

Mr. Fields reported that the Rules & Membership Committee is about to undertake its annual membership recruitment drive.  We anticipate that there will be about 8 vacant seats to fill.  Please encourage your contacts to apply.  As always, we are particularly looking to increase representation from consumers.  We also strongly encourage people from under-represented communities to apply.  Applications are available 24/7 through the PC website.  The deadline for this year’s applications process is June 17^th.  Applications will be reviewed by the Rules & Membership Committee in late June.  Candidates will be interviewed in early July, and a slate of nominees will be brought to the July Executive Committee meeting. 

Policy Committee

Mr. Lesieur reported that the Committee meets next week to hear a presentation from the City’s first overdose prevention center.  They are also developing a tracking system for policy issues, with the most likely next topic HIV housing in the rest of NY State (outside of NYC).  The last meeting had a presentation on this subject from Ginny Shubert.

Data Collection Workgroup

Mr. Carr reported that next week’s meeting is cancelled, but that the work will pick up in May as the committee works towards a set of recommendations on data collection for RWPA programs.

Seriously Mentally Ill Workgroup

Ms. Lawrence reported that the SMI Workgroup meets quarterly to continue the work done by NAC last session.  They are looking at an analysis of mental health flags among PWH in NYS and the factors that impact MH functioning among PWH.

Agenda Item #4: Council Chairs Report

Ms. Walters reported that the Council’s contributions to the Integrated Plan discussion from the last meeting have been shared with the State.  The Consumers Committee will continue to provide feedback on the Integrated Plan, which will also be shared with the State.  A draft plan is expected in the fall.

The Assessment of the Administrative Mechanism survey will be sent out to providers in the next several days.  Results of the survey will be shared at the June Executive Committee meeting and by the Full Council the following week.  The chairs are also working with the Consumers Committee on a date for the Annual Council Picnic in July or August.

Mr. Carr announced a new clinical trial for an HPV treatment that is recruiting PWH.  He also thanked everyone who contributed to his participation in the AIDS LifeCycle fundraiser.

In response to a question from Mr. Natt, Mr. Lesieur said that there is no information yet about HIV funding in the Mayor’s proposed City budget.

There being no further comment, the meeting was adjourned.