Executive Committee Meeting Minutes June 17, 2021

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EXECUTIVE COMMITTEE

Monday, June 17, 2021, 3:00 – 4:45PM

By Zoom Videoconference

M I N U T E S

Members Present: Graham Harriman (Governmental Co-chair), Dorella Walters (Community Co-chair), Paul Carr (Finance Officer), Saqib Altaf, Randall Bruce, Maria Diaz, Billy Fields, Ronnie Fortunato, Amanda Lugg, David Martin, Jeff Natt, Guadalupe Dominguez Plummer, Donald Powell, Claire Simon, Marcy Thompson

Members Absent: Lisa Best, Joan Edwards, Marya Gilborn

Staff Present: NYC DOHMH: David Klotz, Melanie Lawrence, Jennifer Carmona, Ashley Azor, Scott Spiegler, Jose Colon-Berdecia, Kimbirly Mack, Karen Miller, Giovanna Navoa; Public Health Solutions: Andrea Feduzi, Gemma Ashby-Barclay; HRSA: Sera Morgan; 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 May 20, 2021 meeting were approved with no changes.  

Ms. Simon announced that there will be a virtual memorial for Terri Smith-Caronia on June 28th.

Agenda Item #2: HRSA Project Officer Update

Ms. Morgan reported that the RWPA FY 2022 Notice of Funding Opportunity and Grant Application Guidance has been released.  This year’s application is for a three-year cycle and the score will count towards the supplemental awards for FY 2023 and 2024 (in addition to 2022). 

Agenda Item #3: Grantee Report

Ms. Plummer reported that the White House released President Biden’s FY22 budget request, which proposes $133.7 billion in discretionary funding for the U.S. Department of Health and Human Services (HHS) – an increase of over 23% from FY21.  Of this, $670 million would support continued implementation of the Ending the HIV Epidemic (EHE) initiative. The budget includes over $755 million in CDC HIV prevention funding and $2.5 billion in HRSA Ryan White HIV/AIDS Program (RWHAP) funding (Parts A through F), including an additional $10 million for Part A.  The White House and various agencies also marked the 40th anniversary since the first reports of what would be called AIDS were issued by the CDC. 

HRSA released the RWHAP COVID-19 Data Report for January 20 through December 31, 2020.  As part of HRSA HAB’s Fiscal Year (FY) 2020 Coronavirus Aid, Relief, and Economic Security Act (CARES Act) appropriation, 581 existing RWHAP Parts A, B, C, and D recipients received CARES Act funding.  On June 29 at 2pm HRSA’s HAB You Heard webinar will highlight National HIV Testing Day and HIV Long-Term Survivors Awareness Day.  The CDC published three new reports focused on HIV surveillance data.  HIV prevention partners can use these reports to monitor trends, measure successes, identify gaps in HIV prevention, and help direct prevention efforts and resource allocation.

On May 27th, the BHIV’s Care and Treatment Program (CTP) submitted the FY 2020 Ryan White Part A Progress Report to HRSA.  The report includes the carryover amount that will be presented later in the meeting. 

In response to the RFP for Psychosocial Support Services (PSS) for Transgender, Intersex, Gender Non-Conforming, and Non-Binary Individuals (TIGNCNB), two organizations (Destination Tomorrow, Inc. and Mount Sinai Hospital), were awarded with a proposed annual budget amount of $423,500 each. Contract negotiations are scheduled for the month of July 2021 with contracts executed by late August 2021 and programs starting 9/01/2021. 

The Quality Management and Technical Assistance unit will host a virtual provider meeting for all RWPA-funded programs on July 28, 2021.  On May 25, 2021, Public Health Solutions (PHS), on behalf of DOHMH BHIV released the Routine HIV Testing concept paper for an upcoming Request for Proposals for Routine HIV Testing. 

Agenda Item #4: Planning Council Co-chairs Update

Ms. Walters reported that to improve partnerships between NYC, Long Island and NYS HIV planning bodies, the new NYS HIV Planning Body Coordinating Group will have its first virtual meeting in July.  The 

Coordinating Group will bring together the leadership of statewide and local HIV prevention and care planning bodies and their respective Health Department staff to develop the NYS Integrated HIV Prevention and Care Plan and then to  coordinate planning, discuss data, develop tools to educate planning body members and gauge progress on meeting the goals in the Integrated Plan, the Ending the Epidemic Plan and other guiding documents.  Once the Integrated Plan is submitted, the Coordinating Group will continue with just the planning body co-chairs to coordinate their work.

Mr. Klotz reported that the Executive Committee and full Council meetings in July will be extended in order to finish the following Planning Council work: 1) Assessment of the Administrative mechanism; 2) FY 2022 Application Spending Plans; 3) IOC’s Framing Directive; 4) Consumers Committee’s HIV and Aging Directive; and 5) Needs Assessment Committee’s SMI Recommendations.  Also, a brief closed EC meeting will take place on July 20th to review and approve the Rules and Membership Committee’s slate of nominees for appointment to the Council.

Mr. Harriman reported that the Council co-chairs are also meeting with HIV Planning Group Leadership to discuss the scope of work for the upcoming joint HPG and Planning Council policy committee, which should convene in the fall.

The Planning Council’s Annual Member Tribute will be in the form of a picnic on Friday, August 6 from 2-6 pm in Riverside park at 145th and the Hudson river.  Food will be provided we look forward to enjoying the day together. 

Agenda Item #5: FY 2020 Fourth Quarter Closeout Report

Ms. Plummer reported that underspending from FY 2020 is much larger than usual ($4,911,568, compared to $363,720 from FY 2019).  This is due to the COVID-19 pandemic and Governor Cuomo’s NYS on Pause Executive Order lasting over four months (from March to July 2020) when RWPA-funded organizations were unable to provide many in-person services and adapted to remote work, telehealth, and virtual services.  Also, DOHMH staff activations lasting for over a year meant that Grantee staff salaries were paid through COVID funds and not RWPA.  DOHMH also had a hiring freeze that kept some positions open.  Many RWPA funded organizations faced staff turnovers with some staff being laid off, furloughed, or leaving due to burnout.  All EMAs across the country have faced these same circumstances, and so HRSA has waived penalties and requirements for FY 2020 and FY 2021, including the 5% cap on carryover. 

Highlights of the closeout report included:

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Agenda Item #6: FY 2020 into FY 2021 Carryover Plan

Mr. Natt noted that every year, after the Grantee completes its closeout report for the previous year and finalizes the amount of underspending, the PSRA and Planning Council approve a plan to use that carryover amount.  With the unusually high amount of carryover, PSRA worked with the Grantee to develop a carryover plan that helps consumers with some of their greatest needs but can be spent according to HRSA’s allowable uses and within the challenging timeframe for spending the carryover.

Ms. Plummer explained that HRSA allows carryover funds to be spent directly on RWPA program services benefiting people with HIV through one-time enhancements to programs late in the grant year, typically around November.  In addition, carryover funds can be used to pay for technology devices, such as laptops, tablets, smartphones including connectivity for clients accessing telehealth and virtual support services.  All carryover funds must be fully spent by the end of this grant year (February 28, 2022).

Mr. Natt introduced the elements of the plan: 1) enhancement to Emergency Financial Assistance (EFA) – $500,000;  2) enhancement to Food and Nutrition Services (FNS) – $700,000; 3) Value-based Payments (VBP) for Care Coordination Programs (CCP) – $360,000; 4) Smart phones and data plans for clients accessing RWPA telehealth services – $300,000; 5) Capacity building and training services for Ryan White Part A Programs – $800,000; and 6) Partial Restoration of the reduction to the ADAP program – $2,251,568.

Ms. Plummer described the details and justification of each component of the plan.  EFA was previously limited to the Tri-County region with an original service allocation of $250,000.  In FY 2020, the program services expanded to include the five boroughs of NYC receiving a one-time enhancement of $499,825 from ADAP for COVID-19 response (made permanent for FY 2021).  The actual year-to-date spending rate was 163%.  The carryover plan continues providing EFA services throughout the EMA with an additional funding of $500,000 while also raising per client annual cap on assistance to $5000 from $2000. 

The FNS allocation in FY 2020 was $7,462,131 and included a one-time enhancement from ADAP for COVID-19 response.  The allocation for FNS in the Tri-County region was $968,807 and the actual yea- to-date spending rate was close to100%.  The Grantee is proposing an additional $210,000 for food and nutrition services across the NY EMA for larger/more pantry bags, food vouchers, etc.

Ms. Carmona explained the proposed enhancement for value-based payments (VBP) to Care Coordination Programs (CCPs).  VPB, which is part of the CCPs contracts, is an initiative to align incentives with service quality.  It was supposed to start in March 2020 but was derailed by COVID.  Programs receive payments if they meet certain benchmarks that demonstrate improved client-level outcomes.  The system rewards programs when they improve their own performance over time.  The benchmarks include: percentage of clients with at least one community-based patient navigation service (coordination, accompaniment, linkage, etc.); percentage of clients with at least one case conference service per quarter; and percentage of clients who have achieved viral load suppression within the first 6 months of program participation.  The carryover gives the Grantee an opportunity to pilot VBP in a low-risk way for programs allocating $15K/benchmark for 24 programs at a total of $360K.  Not all programs will spend the maximum, so any unspent carryover will be rolled into ADAP (as with all other carryover left unspent near the end of the year).

Ms. Plummer continued, noting that the allocation for smartphones and data plans is based on an estimate of $1,000 per client for a total of 1,000 clients ($1M).  It was noted by several Committee members that smartphones can be bought for under $300, and that data plans can cost as little as $50.  There is also a federal program (SafeLink) that pays for this to access telehealth, but SafeLink plans have data limits (although it will subsidize phone bills).  While there is no way to prevent a client from using the equipment for personal use, the main objective is to allow them to access telehealth and remote services. 

The enhancement for capacity building and training would allow programs to use the funds for developing plans for Health Equity, Racial Equity, Anti-Stigma, Trauma Informed Care and trauma informed supervision, and Professional Development, including conferences/webinars, certifications, licenses to enhance scope of practice.

A summary of the ensuing discussion follows:

  • EFA has spent most of its money on rent arrears, but also includes utilities, transportation, household goods.  As with any program, expenditures are subject to payer of last resort requirements. 
  • The State’s new Emergency Rental Assistance Program (ERAP), generously funded with federal COVID stimulus money, covers both rental and utility arrears, is open to the undocumented, and has a cap of 125% of fair market value of rent and can be tapped twice per year per client.  Even with the looming end of the eviction moratorium, most clients will be able to access ERAP before RWPA. 
  • Carryover cannot be used to reimburse a provider for any overspending from the previous year, as that year has been closed out.  All funds must be used for programs in the current year.
  • The Grantee would need to assess spending under the carryover plan about one month before the end of the fiscal year in order to move funds into ADAP.
  • The Grantee and PHS can give sub-contractors advance notice to prepare for a possible enhancement in advance of HRSA approval, but the funds cannot be committed until HRSA approval is final.
  • The Council gives the Grantee authorization during the year to move accruals (uncommitted funds freed up in the course of a year) between service categories up to 20% of the original allocation.  This is generally also done around the same time as distribution of the previous year’s carryover (December).  While the Grantee must follow the Council’s carryover plan, there could be a blanket authorization to make adjustments as needed. 
  • The EFA and FNS enhancement amounts are based on an assessment of what the programs are able to absorb and feasibly spend, given staff resources and time limitations.  The EFA program especially depends on referrals and it will require substantially more work to bring in additional clients making it challenging to spend a large enhancement.
  • Ms. Morgan will inform HRSA’s fiscal division how important it is this year to expedite the carryover approval process.
  • There is a need to allocate the Capacity Building and Phone/Data Plan to specific service categories for the official request to HRSA.

Mr. Natt, on behalf of PSRA, moved that the Committee adopt the carryover plan as presented with the addition that the Grantee will assess spending near the end of the year and reallocate funds to ADAP as necessary to spend down the carryover.  The motion was adopted 14Y-1N.

Mr. Harriman noted that the 2nd and 3rd quarter commitment and expenditure reports given to the Council by the Grantee were inaccurate.  If they had been accurate, the PSRA could have started planning earlier for a higher than expected carryover.  This will be reflected in the assessment of the administrative mechanism.

There being no further comment, the meeting was adjourned.