Executive Committee Meeting Minutes May 20, 2021

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EXECUTIVE COMMITTEE

Monday, May 20, 2021, 3:00 – 4:35PM

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, Danielle Beiling, Randall Bruce, Maria Diaz, Billy Fields, Marya Gilborn, Amanda Lugg, David Martin, Jeff Natt, Guadalupe Dominguez Plummer, Donald Powell, Claire Simon, Marcy Thompson

Members Absent: Lisa Best, Joan Edwards

Staff Present: NYC DOHMH: David Klotz, Melanie Lawrence, Jose Colon-Berdecia, Kimbirly Mack, Karen Miller; Public Health Solutions: Andrea Feduzi; HRSA: Sera Morgan

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 April 15, 2021 meeting were approved with no changes.  

Mr. Fields, Mr. Powell and Mr. Martin thanked the Committee members for their recent expressions of support and caring.

Agenda Item #2: HRSA Project Officer Update

Ms. Morgan reported that, while CARES Act funding has ended, HRSA is preparing upcoming Notices of Funding Opportunity (NOFO) to continue COVID-related work, with a focus on vaccines.  HRSA/HAB has started planning for the next national Ryan White conference, which is expected to be a hybrid of in-person and virtual.  There will be a webinar on June 9th for members of planning councils across the country on the topic of conflict resolution.  Finally, the FY 2020 Part A Annual Progress Report and Expenditures Report, Federal Financial Report (FFR), and Unobligated Funds (Carryover) report are coming due soon. 

Agenda Item #3: Grantee Report

Ms. Plummer reported that the FY2022 Ryan White HIV/AIDS Program (RWHAP) Part C Early Intervention Services Program: Existing Geographic Services Areas NOFO was released on April 2nd. The purpose of the program is to provide comprehensive primary health care and support services in an outpatient setting for low income, uninsured, and underserved people with HIV.  The U.S. Department of Housing and Urban Development’s (HUD) released a NOFO through the Housing Opportunities for Persons with AIDS (HOPWA) program for housing assistance and supportive services for low-income people with HIV and their families.  On May 19, HRSA commemorated National Asian/Pacific Islander HIV/AIDS Awareness Day.

On April 30th, the DOHMH BHIV Care and Treatment Program (CTP) submitted the Coronavirus Aid, Relief, and Economic Security (CARES) Act Progress Report to HRSA.  In 2020, CTP received $1M in CARES Act funding providing critical support to Ryan White Part A (RWPA) Short-term Rental Assistance programs in NYC and Short-term Rental and Utility Assistance programs in the Tri-County region.  The $1M CARES Act funds received from HRSA was fully spent in the grant year.  CTP also will soon submit to HRSA the FY 2020 Part A Annual Progress Report and Expenditures Report, Federal Financial Report (FFR), and Unobligated Funds (Carryover) report.  The FY 2020 carry-over is going to be larger than usual due to COVID.  The Grantee expects around $4M (compared with about $250K from FY 2019).  The PSRA will develop a carry-over plan for review and approval by the Executive Committee and full Council.  HRSA has parameters around the use of carry-over funds.  All carry-over must be spent by the end of the subsequent fiscal year (e.g., FY 2020 carry-over must be spent by February 28, 2022).  All carry-over must be used for existing service categories and must be used for programs (e.g., no administration, Council support or incentives).  Providers can use the funds for direct services, but it needs to be kept in mind any funds used to increase capacity will end in a few months.  Therefore, for example, carry-over used to pay a new client’s rent will end within months.  Funds can be used for program staff training, but given the time it takes to procure training contracts at DOHMH, the providers can receive the funds directly and procure their own training services.  Approval of the EMA’s carry-over request usually comes in the late fall, giving the EMA at most 4 months to spend the funds.  Mr. Harriman noted that the staff is exploring the feasibility of raising the cap on the amount of assistance that clients can receive in the Emergency Financial Assistance (EFA) program.  The cap is now $2000 per year per client.  The Grantee is gathering data on number of clients served, average amount of assistance per client, and overall program spending.  The data will help the Council determine if a higher level of assistance would limit the number of new enrollees.  In most years, most carry-over is allocated to ADAP, which is always able to absorb funding late in the year.  Mr. Carr added that ADAP took a large reduction to cover the cut to the award and new initiatives, and their allocation is running low, with continued expected reductions in the grant award.

The Care and Treatment Program’s Quality Management and Technical Assistance program will hold its annual RWPA Provider Meeting (virtually) for all RWPA-funded programs in July 2021.  On April 29th, DOHMH’s HIV Care and Treatment Program and CUNY’s Institute for Implementation Science in Population Health (ISPH) received a notice of award for the collaborative “APPLI” project aimed at optimizing the rollout of long-acting injectable (LAI) antiretroviral therapy (ART) in the Ryan White population. 

Agenda Item #4: Planning Council Co-chairs Update

Mr. Harriman reported that the leadership of the Council and HIV (Prevention) Planning Group are working on a joint Policy Committee to address broader HIV-related issues.  One area under for consideration by a committee is regulation issues around services for seriously mentally ill PWH, which cuts across numerous funding streams and regulatory agencies.  Council and committee meetings will continue virtually through the end of the planning cycle in July, with the expectation that meetings will be a hybrid of in-person and virtual (with full participation for all) starting in October.  An SMI workgroup will be created to continue the Needs Assessment Committee’s work on that issue.  The workgroup will continue the collaboration begun with the NYS AIDS Institute and other NYS and NYC agencies, focusing on an integrated approach to care for this population.

Ms. Walters reported that a New York State AIDS Institute Super Committee is forming to bring together the leadership of New York statewide and local HIV prevention and care planning bodies and their respective health department staffs.  The committee will meet regularly to coordinate planning,  discuss data,  develop tools to educate planning body membership and gauge progress on meeting the goals of the  HIV Prevention and Care Integrated Plan and the Ending the Epidemic  Plan and accompanying guidance documents.  Members will expand understanding of planning bodies efforts and initiatives that impact or influence the work related to HIV and other health issues. Additionally, members will seek to foster alignment of statewide goals and incorporate information learned into the respective planning bodies workplans and priorities.

Agenda Item #5: Assessment of the Administrative Mechanism Survey

Mr. Harriman presented a draft survey of providers to use as part of the “Assessment of the Administrative Mechanism” (AAM).  The AAM, mandated by the Ryan White legislation and HRSA, is an annual evaluation undertaken by the Planning Council to determine how well DOHMH (the Recipient or Grantee) and Public Health Solutions (the Master Contractor) manage RWPA program funds.  The Planning Council is asking all Ryan White Part A Program sub-recipients (contractors) to complete this AAM survey confidentially, with results reported in aggregate form.  The purpose of the survey is to evaluate whether PHS disburses RWPA and MAI funds to sub-recipients in a timely manner; evaluate how DOHMH and PHS manage contracts with sub-recipients; and provide data on these performance areas for inclusion in the annual grant application.

This survey covers the activities of the Recipient and Master Contractor during FY 2020.  FY 2020 was an unusual year due to changes made in the administration of RWPA programs to adapt to the COVID-19 pandemic.  The survey is limited in scope and will include additional questions in future years.  Two questions are specific to new contractors, and only applies to Food & Nutrition providers for FY 2020.  Other questions focused on contract renewals, payments for invoices, programmatic and fiscal technical assistance, policy and reporting requirements, communications, customer service, and overall helpfulness.

Ms. Feduzi raised questions about the administration of the survey, given that agency program staff and fiscal staff may not have knowledge of different aspects of the contracting process.  The agency may need to be instructed to work in a team to complete the survey.  It was also noted that PHS has conducted surveys of contractors on their experiences with the PHS. 

Client satisfactions surveys have been done in the past too, but these would focus on the client’s experience receiving services, rather than the issues assessed in a review of the administrative mechanism (i.e., how well PHS does reimbursing programs).  Ms. Gilborn noted that programs often try to get more in-depth client feedback on programs in ways that allow clients to express themselves freely. 

Agenda Item #6: Planning Council and Committee Updates

Consumers Committee

Mr. Bruce reported that the Committee is reviewing a draft service directive for Older People with HIV (OPWH), using an Implementation Science format for the first time.  The directive has four major program components: 1) Outpatient medical care (increase the capacity of outpatient medical care to treat the complex needs of OPLWH); 2) Referral for Healthcare and Supportive Services (increase the knowledge of resources available to support PWH over 50 among the RWPA funded providers); 3) Prevention and Wellness (provide social support for exercise by setting up a buddy system, making contracts with others to complete specified levels of physical activity); and 4) Training (increase training of RWPA providers to ensure they are able to effectively support).  The public will have a chance to comment on the draft at the June 4th virtual OPWH Forum.  Mr. Martin added that, given the accelerated aging process for PWH, preparing for optimal care for aging with HIV needs to start earlier (e.g., in someone’s 40s), for example with screening for prostate cancer, particularly for African-American men.    

Needs Assessment Committee

Ms. Lugg reported that NAC is working to finalize its recommendations on SMI, incorporating the feedback from the two virtual forums that were held.  There is a hope that the work will dovetail with the proposed Policy Committee.

Integration of Care Committee

Ms. Beiling reported that IOC continues its work to update the Framing (formerly Master) Directive, using the Implementation Science format.  The directive will better reflect the Council’s values, particularly around ensuring services are provided through an anti-racist and anti-stigma and equity lens, including pay equity for provider staff.

Ms. Beiling announced that she will be going on maternity leave soon, and the Committee congratulated her on the coming bundle of joy.

Priority Setting & Resource Allocation Committee

Ms. Gilborn reported that PSRA met last week to continue its year-long review of the service portfolio with presentations on Harm Reduction from Matt Feldman of the DOHMH Research and Evaluation Unit (REU), and Angela Aidala from the CHAIN study.  With data from enrollments, intake assessments, reassessments, and services that were entered into eSHARE, the Committee got a clearer picture of who is enrolled, and the reported substances among Harm Reduction clients in terms of lifetime and recent use.  PSRA also reviewed data on crystal meth use and HIV health outcomes among MSM in Part A programs, where the data showed an independent association between recent crystal meth use and unsuppressed viral load.  Additional data showed that hard drug use (most commonly cocaine/crack) among Part A clients had a significant, independent relationship with unsuppressed viral load.  CHAIN data showed that problem drinking and substance use is widespread among PWH (more than half of study participants have a history of problem drinking and/or hard drug use), and is more consistently associated with worse engagement in care and health outcomes.

Given Medicaid reimbursement for harm reduction services and the focus of the service on support for those with current substance use, PSRA has asked the REU to provide additional data for the fall as the Committee deliberates on the appropriate allocation for this service.

Tri-County Steering Committee

Mr. Altaf reported that the TCSC met last week and received a presentation on the Tri-County Ryan White Part A enrollment report.  This was the first time that the Committee reviewed detailed data on who is being served in the Ryan White Part A program in Tri-County.  Jacinthe Thomas of the DOHMH Research and Evaluation Unit presented data as of February 2020 on Client Demographics, HIV Risk Factor, Insurance Type by Enrollment Status, and Priority Populations.  A couple of key takeaways from the data are that most Tri-County clients were 50 years or older, male, Black or Latinx, and reported to have heterosexual  HIV transmission risk; and that the most common new enrollments were under medical case management and emergency financial services.  The Committee will be using this and other data inputs as we review service priorities for the future.  In addition, some TCSC members and others held a brainstorming session on how to engage more Tri-County consumers in the Committee and Council,  

Rules & Membership Committee

Mr. Fields reported that RMC is in full swing with the annual PC membership recruitment process.  We reviewed the current membership and have set goals for increasing applications from under-represented communities, including Latinx/Hispanic; people who live in the Bronx, Queens and Tri-County; and transgender women.  As always, RMC is also looking to boost consumer participation.  Applications are due on June 18th.  With retirements, RMC expects that they will be able to recommend for appointment as many as 13 new members for terms beginning in September.  Mr. Colón-Berdecía is conducting outreach through multiple virtual events, with a focus on consumers.  The RMC will review applications in late June, conduct interviews in early July, and present a final slate of candidates for review and approval by the EC on July 22nd

There being no further comment, the meeting was adjourned.