Executive Committee Meeting Minutes June 19, 2019

EXECUTIVE COMMITTEE
Cicatelli Associates, New York, NY
Thursday, June 19, 2019, 3:05 – 5:00PM
MINUTES

Members Present: Fay Barrett (Chair, Rules & Membership Committee), Matthew Baney, Danielle Beiling, Lisa Best, Maria Diaz, Billy Fields, Graham Harriman, Jan Hudis, Amanda Lugg, Marcy Thompson, Dorella Walters 

Members Absent: Joan Edwards, Steve Hemraj, Matthew Lesieur, Jan Carl Park, Saul Reyes, Andrea Straus 

Other Planning Council Members Present: Randall Bruce, Paul Carr

Staff Present: NYC DOHMH:David Klotz,Melanie Lawrence, Karen Miller; Public Health Solutions: Christine Nollen, Bettina Carroll; NYSDOH: Claire Simon (by phone); WCDOH: Julie Lehane, PhD; Joan Corbisiero (Parliamentarian)

Ms. Barrett, facilitating by consent of the Committee, opened the meeting, followed by introductions and a moment of silence.  The minutes from the May 23, 2019 meeting were approved with one change submitted by Ms. Walters. 

Mr. Harriman reported that HRSA hosted a webinar on several policy changes, including: Ryan White Part A (RWPA) Client Eligibility Determinations and Recertification Requirements; Eligible Individuals and Allowable Uses of Funds; Use of RWPA Funds for Health Care Coverage Premium and Cost Sharing Assistance; and RWPA Funds for Core Medical Services and Support Services for People Living with HIV who are Incarcerated and Justice Involved. 

RWPA providers will be receiving a memo on the impending changes that will be made to eSHARE’s intake and reassessment of non-testing RWPA programs.  The changes that will be made will move towards standardizing and simplifying intake as much as possible across the service categories. A list of changes that will take place in the August 2019 deployment for the RWPA Intake Assessment and Reassessment was distributed.  A summary of the changes was described, including adding questions about food insecurity, heptatis C, other medical conditions and quality of life.  Questions removed included sexual behavior and partner-gender questions.  Questions about oral health still need to be finalized. 

On June 5, the Long Term Survivors Wellness Coalition, in partnership with BHIV, hosted their 2nd annual Long Term Survivors Day Event at Baruch College.  The event included a full day of educational and interactive activities, including long-term survivors’ panel discussion, awards presentations, movie screenings, cooking demonstrations, art exhibit, yoga and meditation, raffles, networking, music, and more. 

The Health Department launched “Made Equal,” a new sexual health marketing campaign promoting the evidencebased finding that HIV cannot be passed through sex if the virus is undetectable.  HIV treatment is safe and more effective than ever, and can reduce the amount of virus in the body to an undetectable level.  People who maintain an undetectable viral load for at least six months and who continue HIV treatment cannot transmit HIV through sex. This is known as Undetectable Equals Untransmittable, or U=U.  The campaign encourages New Yorkers to start and continue treatment if they have HIV and emphasizes that treatment is available regardless of their insurance or immigration status.  “Made Equal” 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.  

FY 2020 Application Spending Plans

Ms. Hudis explained that HRSA will likely again cap the amount that an EMA can request in its grant application to a maximum of 5% over its current Base award.  Since the cap was instituted, the Council has asked for the maximum in Base funding.  The application spending request is theoretical, but must be justifiable based on data in the grant application narrative.  PSRA will have the fall and winter to do scenario planning for an actual increase or decrease to the award.  For the application, the EMA is required to submit separate Base and MAI plans.  When we do the final plan for the actual award next year, it is one unified plan.  The MAI funding request, which is completely formula-driven, always remains stable at the current year’s funding (for FY 2020 that is $8,616,680).  

The Tri-County Steering Committee approved an application spending request that also asks for the maximum 5% increase (all TC programs are Base funded).  As the majority of the service portfolio in Tri-County is newly re-bid, there is no data on spending that can be used to make adjustments in the service category allocations.  Thus, the 5% increase is allocated across the portfolio proportionately based on the ranking scores for a total request of $4,722,487.  

The NYC portion of the requested increase in the Base award is distributed in targeted increases to four categories, based on PSRA’s analysis of trends in over-spending and utilization as follows: Food & Nutrition ($1,450,000); Housing ($1,480,833); Supportive Counseling ($450,0000; and Legal ($247,000). 

Ms. Hudis, on behalf of the PSRA, moved that the EC accept the FY 2020 Base NYC, MAI and Tri-County application spending plans as presented.  The motion was adopted 11Y-0N. 

FY 2018 Carry-over Plan

Mr. Baney explainedthat the carry-over plan is for the use of unspent funds from the previous year (FY 2018) in the current fiscal year (FY 2019, which ends on Feb. 29, 2020).  Any carry-over funds not expended in this year must be returned to HRSA.  Typically, HRSA approves the carry-over plan in the fall, which leaves relatively little time for it to be spent.  In previous years, due to the constraints on spending carry-over, the plan has called for the funds to be allocated to ADAP.  The amount in the draft plan – $276,373 (a record low amount, all in Base Formula funds) – is preliminary and may be slightly adjusted once close-out is complete. 

The Tri-County Housing programs received a $300,000 enhancement in their allocations in the middle of the previous grant year and have over-enrolled clients due to very active recruitment efforts.  The programs can use $200,000 of the carry-over to maintain services to these clients.  The carry-over funds will ensure that the enrollees continue to receive Housing services through the end of the grant year as the DOHMH HIV Bureau’s Housing Unit works with the programs to assess their ongoing needs and identify areas for client attrition.  If there is a need for on-going additional funding in FY 2020, the PSRA can address that during the scenario planning process through any possible increase to the grant award, or through reallocating funds.  The balance of the carry-over will go to ADAP.

Mr. Baney, on behalf of the PSRA, moved that the EC accept the FY 2018-19 carry-over plan as presented.   The motion was adopted 10Y-0N.

Mr. Carr presented the background on the Needs Assessment Committee’s recommendations for filling the unmet  needs for oral health services in the NYC portion of the EMA (Tri-County already has Part A dental services).  NAC formed an Oral Health Sub-committee, which heard from consumers, received presentations from providers (including ADAP, Part F and the TC Part A providers) and CHAIN.  The Committee found that Medicaid only covers essential services and does not adequately cover the oral health needs of PLWH. It provides low reimbursements, frequently does not cover replacements for lost or broken dentures, uses the cheapest quality material and does not support dental work that preserves the long term oral health of patients.

Dental case management has been shown to reduce anxiety, improve engagement through education and patient preparation for receipt of services.  Dry mouth due to medication is no longer a major issue for PLWH – although it does continue to impact some patients, but issues of candida and thrush due to the use of inhalers is prevalent.  Comorbidities are a major concern – some surgeries cannot be done when a patient has untreated dental problems.  Consideration of oral health is not currently included in RWPA intake/reassessment or screening – and only nominally addressed in Food and Nutrition programs.  Stigma, compounded by fear and anxiety, continues to be a major issue impacting access to oral health services.  Part F– once a safety net, is now described as non-functional and community based providers such as Callen Lorde and Mount Sinai are fully booked.

Ms. Lawrence presented the NAC’s recommendations: 

Fund Part A Oral Health Services in NYC.  Where coverage is available, e.g., Medicaid and ADAP, needed services are not included or easily available, (e.g., gum and bone grafts, crown and bridgework, partials/implants when one tooth is missing, replacements for lost/broken dentures).  Develop a screening tool with validated questions to identify oral health discomfort and issues among consumers, ensure linkage to oral health services, and develop health education modules that incorporate the need for dental services and oral hygiene.  Dental case management within dental programs can afford the opportunity to address social isolation, reduce anxiety and improve consumer engagement and education.  Linkage Agreements to Specialized, Complex and Emergency Services, including Provide coverage for implants and other highly specialized services i.e. crowns, orthodontia, and gum & bone grafting on a case-by-case basis.  Support the Use of Quality Dental Materials, including Allow the use of food vouchers for electric toothbrushes (such as Quip) and other oral hygiene products.  Recommend comprehensive, preventative and recurring dental services and procedures.  Ensure coverage of at least 4 dental cleanings per year.  Develop provider recommendations for common co-morbidities, i.e. Diabetes, Hepatitis C, HPV.  Require trainings that address stigma among dental providers.  Complement Medicaid and ADAP services to ensure a robust system of care.  Provider & consumer guidance on how viral load impacts oral care.  Support data sharing and case conferences to comprehensively treat patients.

Issues raised in the discussion included: 

• Reimbursement rates for current Medicaid and Part F services are so low that it is difficult to attract dentists to provide these services.
• Oral health is one of the least understood but vital services, as oral health affects HIV in many ways, as well as heart health and other issues. 
• The exact dimensions of the service will have to be fleshed out by the Integration of Care Committee, which will have to take into account HRSA policies, payer of last resort issues and coordination with other payers.

Ms. Thompson, on behalf of the NAC, made a motion to accept the Oral Health recommendations as presented.  The motion was approved 11Y=0N.

Mr. Carr was thanked for spearheading this initiative and bringing attention to it at the NAC.  The next step in the process, after final Council approval, will be for IOC to create a service directive that meets Ryan White guidelines, after which PSRA will determine a ranking and allocation.  The timing means that the new service will go into the FY 2021 application for services to begin in early 2021. 

There being no further comment, the meeting was adjourned.