Executive Committee Meeting Minutes June 22, 2023

By Zoom

3:05 – 5:20pm

Members Present: Graham Harriman (Governmental Co-chair), Dorella Walters (Community Co-chair), Billy Fields (Finance Officer), Saqib Altaf, Ronnie Fortunato, Marya Gilborn, Charmaine Graham, Steve Hemraj, Emma Kaywin, Matthew Lesieur, David Martin, Freddy Molano, MD, Jeff Natt, Julian Palmer, Guadalupe Dominguez Plummer, Claire Simon (for Joan Edwards), Marcelo Maia Soares, Marcy Thompson

Other Planning Council Members Present: Raffi Babakhanian, Reginald Brown, John Schoepp

Staff Present: NYC DOHMH: David Klotz, Melanie Lawrence, Doienne Saab, Scott Spiegler, Johanna Acosta, Deb Noble, Kimbirly Mack, Karen Miller, Patrick Chan, Gina Gambone; Public Health Solutions: Barbara Silver, Arya Shahi; HRSA: Axel Reyes; Joan Corbisiero (Parliamentarian)

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

Mr. Harriman and Mr. Fields opened the meeting followed by a roll call and a moment of silence.  The minutes from the May 18, 2023 meeting were approved with no changes.

Agenda Item #2: Behavioral Health Directive

Mr. Hemraj and Ms. Fortunato introduced the draft Behavioral Health Directive, approved by the Integration of Care Committee this week.  An integrated behavioral health model is meant to remove roadblocks to accessing behavioral health services: patients can receive all/most of the care they need from one location and one team at the same time.  This intervention seeks to provide integrated mental health, substance use, and psychosocial support care for PWH with behavioral health needs.  The new service will provide rapid linkages, navigation and enhanced peer support are some of the evidence-based strategies shown to mitigate barriers to care, increase client engagement, and help improve behavioral health and other health-related outcomes.  The new service combines the current service categories of Mental Health, Harm Reduction and Supportive Counseling (psychosocial support), which are funded for a total of $14,119,145. 

The Directive requires all programs to have the capacity to charge Medicaid for billable services (does not apply to non-SEP Harm Reduction service sites), and have a full deployment of all available funding and resources to improve training, clinical care practices, service access, and reach of BH programs.  It calls for increased peer experienced, PWH-led wrap around services to support behavioral health services for people with serious mental illness (SMI); timely linkage to mental health, physical health, and substance use services; and service sites available in all five boroughs with consideration for disproportionately impacted neighborhoods/UHF/zip codes, sites must serve clients from throughout the EMA. 

Justification for the new model was given, based on social determinants of health and a pyramid of needs and costs from self-care to intensive treatment.  The model leverages wrap-around psychosocial supportservices to meet clients where they are, provide the support needed to facilitate client readiness for mental health and harm reduction interventions (if needed), and increase and leverage peer support.  Service models and types from the original three categories are supplemented by new guidance that includes: 1) services for PWH with complex behavioral health needs or SMI leverage peer experience and persons with lived experience to manage a cadre of PWH who provide support, navigation and accompaniment; 2) implementation strategies to support client centered care; 3) All behavioral health screenings must appropriately assess and obtain a diagnosis for all clients who may have SMI using a two-stage process, to support accurate identification of all clients who may benefit from more intensive behavioral health services, including support for serious mental illness; 4) Agencies must have access to real time client data and population data to provide on time and tailored interventions; and 5) Pending HRSA review, movement and social activities strengthen client connection and wellness outcomes.

Outcomes that the Directive seeks are: improvement in behavioral health measures; increase in treatment adherence (medical and behavioral health); and increase in continuity of care and resulting HIV outcomes among PWH accessing behavioral health services; increase in PWH aware of their status, retained in care, and virally suppressed; increase in PWH reported quality of life; increase in PWH reported satisfaction with RWPA BH services; decrease in anticipated, internalized, and enacted stigma reported by clients; and increase in client knowledge of rights to and options to access behavioral health.

A summary of the ensuing discussion follows:

• The Directive does not prohibit organizations from applying if they are not located in the high priority ZIP codes.  Thus, for example, a major hospital located in a central area that serves the entire City, including people who prefer to receive services outside of their neighborhood, are eligible.  The language was an attempt to balance the need for locally based services in areas of highest need with accessibility.
• The Directive leverages peers and PWH workers to help with services that complement clinical services, such as accompaniment.  Clinical services would still be provided by licensed professionals.
• Harm reduction is often not clinic-based, thus the Directive cannot require them to have clinical services, but they must have linkages and be able to accompany clients and help with all aspects of behavioral health.
• The three categories will still be listed separately in the spending plan as required by HRSA.  Potential providers will apply for a specific category and the Recipient will track funding by service category.
• Agencies will do what they do now, which is bill Medicaid for services that can reimbursed, but then use RWPA funds for anything beyond that.  Language was added so that agencies that bill indirectly, like Health Homes, can be included in the pool of providers eligible for this funding.
• Each provider is limited to using 10% of its contract amount for administration. 
• The final allocation for these services will be determined by PSRA next year based on information from needs assessments, about capacity and other data sources.
• Outcomes listed in the Directive will be used to measure the success of programs.

A motion was made, seconded and approved 12Y-0N to accept the Behavioral Health Directive as presented with the change noted above.

Agenda Item #3: GY 2022 4^th Quarter Closeout Report

Ms. Plummer presented the GY fourth quarter closeout report.  This past year saw great success with the implementation of fixed rate with deliverable reimbursement structures and successful implementation of the Council’s reprogramming plan, bringing the EMA to approximately full spend down with no underspending in program services.  Most categories were 100% expended.  The exceptions were Non-Medical Case Management (92% spent) and Early Intervention Services (84%) in NYC.  There was underspending in grant administration and Quality Management related to DOHMH staff vacancies on the RWPA budget and challenges with filling vacancies quickly due to a long hiring process with the city agency.  In summary, Supplemental expenditure is at 100%, Formula is 97% expended and MAI is at 99% for the 4^th quarter, with total underspending at $1,864,030

A summary of the ensuing discussion follows:

• The report includes the $7.6M in carryover from GY 2021, which makes it look like spending is more than 100% of the allocation.  That makes it difficult to get a sense of where spending is for the year.
• Both Base and MAI use a portion of their awards for administration, but it is lumped together for the report.  QM is a separate amount.
• The report shows some categories that spent more than their allocations, but are noted as spending 100%, when it should be more than 100%.  Same with categories that spent less than their allocations.
• The full spreadsheet includes additional columns showing reprogramming.  The PowerPoint version condensed the report with some hidden columns, which made it difficult to see actual spending.
• There was a discrepancy around the allocation for Emergency Financial Assistance (EFA).  The allocation was more than doubled in GY2022.  The actual spending in this category was only about 56% of the Council’s original allocation, but the report shows 100% spending.  There should be discussion about what to do to increase utilization of this needed service.
• There are inaccuracies in the original Council allocations for at least two categories (ADAP, EIS).
• Comments on the report were given by Council staff to the Recipient prior to the meeting, but the Recipient refused to accept them.  The comments were meant to help the Council to get accurate information in order to fulfill its legislative responsibilities to prioritize and allocate resources.  Draft language has been added to the draft Memorandum of Agreement so that hopefully in the future, opportunities for feedback will be incorporated to make the planning process go more smoothly.
• The spending report is also key for the Council to ensure that funds are expended according to the Council’s allocations, as mandated by the Ryan White legislation.
• The only two reprogramming enhancements above the 20% cap (for two Tri-County categories), were taken back to the Council for approval.

There was an agreement that the Recipient will revise the report with accurate numbers, presenting the full spreadsheet with all columns at the June 29^th Council meeting. 

Agenda Item #4: GY 2022 into 2023 Carryover Plan

Mr. Natt explained that every year, the Council approves a plan for the use of funds left unspent after the close of the previous grant year.  As you’ll hear in the presentation, the amount of underspending is far lower than the previous two years.  PSRA has approved a plan to spend the carryover, based on an analysis of the portfolio conducted by the Recipient.  The PSRA Committee is confident that the plan will allow the funds to be spent before the end of this grant year and will enhance services that will directly benefit people with HIV.

Ms. Plummer explained that, as noted in the closeout report, there is a much smaller amount of underspending ($1.85M) compared to the previous year ($7.68M).  HRSA allows carryover to be used for program services and are one-time enhancements that must be used by the end of the year (Feb. 29, 2024) and are generally approved by HRSA in late autumn.  The Recipient, based on an analysis of programs, is recommending that carryover be used for the following program enhancements: 1) Food and Nutrition Services for food vouchers and pantry bags ($796,500 in NYC, $103,500 in TC); 2) Value-based payments (VBP) for Care Coordination/Medical Case Management ($398,225 in NYC, $26,775 in TC); 3) Legal Services for increasing client enrollment to expand legal services ($498,720 in NYC, $26,280 in TC); 4) ADAP – to absorb any additional underspending identified in close-out or if the above programs are not able to spend their enhancements.

In response to questions, Mr. Spiegler and Ms. Gambone explained that VBP incentivizes CCP/MCM providers to find people with unsuppressed viral load and get them into care and suppressed.  This would be the third year in a row that the Council authorized these payments. 

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

Agenda Item #5: Public Comment

In response to a question, Mr. Reyes reported that HRSA is in the process of hiring consultants to work on technical assistance to planning councils, but Planning CHATT resources will continue to be available online. There being no further comment, the meeting was adjourned.