Executive Committee Meeting Minutes May 23, 2019


NYCDOHMH, Long Island City, NY
Thursday, May 23, 2019, 3:05 – 4:15PM

Members Present: Matthew Lesieur (Community Co-Chair), Jan Carl Park (Governmental Co-Chair), Matthew

Baney, Fay Barrett, Lisa Best, Maria Diaz, Joan Edwards, Billy Fields, Graham Harriman, Steve Hemraj, Andrea Straus, Marcy Thompson, Dorella Walters (by phone)

Members Absent: Danielle Beiling, Jan Hudis, Amanda Lugg, Saul Reyes

Staff Present: NYC DOHMH:David Klotz,Amber Casey, Melanie Lawrence, Merline Jean-Casimir, Kimbirly Mack; Public Health Solutions: Christine Nollen, Bettina Carroll; NYSDOH: Claire Simon (by phone); WCDOH: Julie Lehane, PhD; Joan Corbisiero (Parliamentarian)

HRSA: Sera Morgan(NY EMA Project Officer, by phone)                                                                                        

Agenda Item #1: Welcome/Introductions/Minutes  

Mr. Park and Mr. Lesieur opened the meeting, followed by introductions.  A moment of silence was held in memory of Andy Velez, a long-time HIV advocate and founding member of ACT-UP.  The minutes from the April 18, 2019 conference call were approved with no changes.

Agenda Item #2: HRSA Project Officer Update  

Ms. Morgan expressed her admiration for the extremely low level of under-spending in the FY 2018 grant year, saying that this was a notable achievement for such a large EMA. She also noted the changes to the Ryan White RSR reporting system.

Agenda Item #3: Rules & Membership

Memorandum of Understanding (MOU)

Mr. Klotz presented three minor revisions to the MOU in response to comments from HRSA.  Two set exact dates

(rather than just the month) for two Council products (June 1 for the Reprogramming Plan, July 31 for the Assessment of the Administrative Mechanism).  The final revision clarifies that the Council uses the Recipient’s service effectiveness data for planning purposes. 

Ms. Barret, on behalf of the Rules & Membership Committee (RMC), moved that the EC accept the MOU edits as presented.  The motion was adopted 11Y-0N. 

Planning Council Grievance Procedures

Mr. Klotz presented the revised Planning Council Grievance Procedures.  The Ryan White legislation requires planning councils to develop procedures for addressing grievances with respect to funding under Part A and for resolution of grievances through progressive steps that lead up to binding arbitration when grievances cannot otherwise be resolved.  These relate only to Council decisions, and not to issues that consumers may have around services at an agency (the Recipient and Public Health Solutions have procedures for those issues). 

The current Grievance Procedures were approved in 1997.  After HRSA’s site visit in March 2018, the EMA was informed that revised procedures were needed.  The RMC met from February-April 2019 (after completing work on the MOU), and draft based on model procedures in the HRSA Part A Manual, and best practices from other EMAs.  A draft was approved by RMC and submitted to HRSA and DOHMH Legal in March 2019, and their comments incorporated into the final draft by RMC April 29, 2019.The first item in the procedures addresses “Standing” (who may bring a grievance): Providers eligible to receive Ryan White funds; Consumer groups/people living with HIV (PLWH) coalitions and caucuses; the Planning Council itself or individual Council members; and Individual PLWH who are eligible to receive Ryan White services. The next item is “Basis” (who may bring a grievance): Deviations from the Council’s established, written prioritysetting or resource-allocation process (e.g., failure to follow established conflict of interest procedures); Deviations from an established, written process for any subsequent changes to priorities or allocations; Membership and appointment process. 

Step 1 in the Grievance Procedure is Filing a grievance, which requires the grievant to complete a form and submit it to Council staff (within 20 business days of the disputed action).  The grievance is then referred to the Community Co-chair who meets with grievant (5 days), determines standing and basis (10 days).  It was noted that if the Community Co-chair is unavailable, the Finance Officer (as per the Council Bylaws) acts in his/her stead.  The Executive Committee agreed to add to the draft procedures that if neither office is available, the clock will start when one becomes available.

If no standing and basis found, grievant can appeal (5 days) to an RMC Panel (5 days).  If Standing and Basis is found, the process goes to Step 2: Informal dispute resolution: Referral of the matter to the appropriate Council entity, e.g., PSRA for allocations issues (30 days to address with grievant).  If it is still not resolved, it proceeds to Step 3: Mediation.  The grievant can request mediation (5 days), upon which a non-conflicted third party is engaged (20 days) and the mediation meeting takes place (10 days).  If there is no resolution from mediation within 3 business days, the parties proceed to Step 4: Binding Arbitration (grievant must request within 5 business days).  The American Arbitration Association (AAA) will be engaged.  AAA has a filing fee (currently $200) payable by the grievant (consumers are exempt and their fees covered through the Council’s administrative budget).  An AAA representative sets a meeting of parties and renders a decision (21 days), which is final and must be accepted by all parties. 

Actions taken in resolution of grievances shall be applied prospectively, with regard to funding issues, and thus will not include reversals of previously established priorities or allocations.  There are also Confidentiality and Nonretaliation Protections in the procedures.  Ms. Best noted that, while it is important to have these protections written down, it may not completely protect someone from negative consequences of filing a grievance. 

Ms. Barret, on behalf of the Rules & Membership Committee, moved that the EC accept the revised Grievance Procedures as presented with revisions.  The motion was adopted 11Y-0N.  

Agenda Item #4: Recipient (Grantee) Report

Mr. Harriman reported that on May 2nd, HRSA released revised language in the Policy Clarification Notice (PCN) on Clarifications on Ryan White Program Client Eligibility Determination and Recertification’s Requirements.  The revised language provides clarification that for both initial/annual and six-month recertification procedures, eligibility determinations may be performed simultaneously with testing and treatment.  Recipients and subrecipients assume the risk of recouping any HRSA Ryan White HIV/AIDS Program funds utilized for clients ultimately determined to be ineligible, and instead charge an alternate payment source, or otherwise ensure that funds are returned to the RWHPA program.  This means almost no change for the New York Ryan White Part A Program as many of these elements where already put in place after the original PCN in 2013. The only change is programs may presumptively serve clients before confirming eligibility, however, would run the risk of recoupment for services paid for in that period if that person is found ineligible.

On May 14th, the Grantee submitted the Program Terms Report to HRSA through the Electronic Handbook (EHB), as part of HRSA’s Conditions of Awards requirement.  The Program Terms Report, report Grantee Report identifies direct and indirect service contracts that are being funded for the current grant year and ensures allocations for core medical and support services meet the 75/25 requirement unless a waiver has been submitted and approved, and the report also ensures the 10% Administrative and 5% CQM (or $3,000,000, whichever is less) caps are not exceeded.  The remaining conditions of awards, is the FY2018 Progress Report and Expenditures, due on May 29, 2019.  This annual report identifies recipient’s program activities, successes and challenges to implementation reported for this past grant year.  The report also includes the program’s expenditures report to serve as a reference to determine how recipients allocate and subsequently expend funds for the budget period.

On Thursday, May 16, Ryan White Part A (RWPA)-funded programs from across New York City came together for the 2nd annual RWPA provider meeting.  BHIV Care and Treatment program staff and Housing program staff from the Division of Disease Control joined to organize and facilitate the meeting for over 170 staff from RWPAfunded programs.  The meeting was held at Baruch College and started with updates about the Care and Treatment program and BHIV from Mr. Harriman and Dr. Oni Blackstock, Assistant Commissioner, BHIV, respectively.  Allison Jordan, Senior Director for Reentry and Continuity Services, NYC Health + Hospitals Correctional Health Services, addressed the plenary about continuity of care for people living with HIV after incarceration.  Throughout the day, participants attended sessions about telephone counseling, housing, stigma, and young people living with HIV, quality management and improvement, and using data to assess program performance.  Participants in the meeting engaged with one another in the spirit of improving the quality of services provided to PLWH. 

The grantee will be making changes to the Intake Assessment and Reassessment for non-testing Ryan White Part A programs later this year to move towards standardizing and simplifying as much as possible across service categories. We will be asking questions about food insecurity, hepatitis C, McGill Quality of Life question (a measure of quality of life appropriate for people with advanced conditions), and expanding the selection of other medical conditions for those service categories that don’t already do so.  We will be simplifying the pregnancy related questions for our Medical Case Management Tri-County (MCM-W), Transitional Care Coordination (TCC) and Non-Medical Case Management for Incarcerated or Released Individuals with HIV (NMI) service categories to only ask if the client is pregnant, and if so are they enrolled in prenatal care.  We will also be removing several questions, specifically the method of use for all substances and the set of sex and health questions across all programs.  We will, however, be asking Harm Reduction Recovery Readiness Relapse Prevention (HRM) and NYC Mental Health (MHV) clients if they had any sex to ensure that we facilitate discussions around pre-exposure prophylaxis (PrEP).  We hope to implement these changes in both the Intake Assessment and Reassessment by the end of August 2019.

Questions were raised from the Committee about the purpose of the pregnancy questions (e.g., to be able to assess for prevention of peri-natal transmission).  Also, there was concern expressed on why the question on sexual activity was limited to just MHV and HRM programs.  Mr. Harriman explained that there were the only programs with a reimbursable service for education around PrEP.  RWPA pays only for referral to PrEP (e.g., to a negative partner of the client), since the program is not allowed to serve HIV-negative clients.  It was stressed that all RWPA clients should have a conversation about PrEP for their negative partners.  Also, BHIV has City Tax Level funds for status-neutral care coordination to help the HIV-negative access PrEP and adhere to it. 

The Long Term Survivors Wellness Coalition, in partnership with BHIV, will be hosting their 2nd annual Long Term Survivors Day Event on June 5th at Baruch College.  The event will include a full day of educational and interactive activities to facilitate building connections and celebrating Long Term Survivors in New York City. A flyer for the event is included in your packet.  

On May 15th, BHIV held a bureau-wide meeting to share progress on the implementation of innovative programs created as part of the New York City Ending the Epidemic (ETE) initiative.  The half-day meeting included presentations by BHIV staff who work directly with ETE-funded funded agencies across NYC on six programs:

PrEP for Adolescents, PEP Centers of Excellence, Transgender Organization Capacity-Building Support, Crystal Meth Harm Reduction Services, The Undetectables Viral Load Suppression Program, and Status Neutral Care Coordination.  Each presentation included an overview of the program model, priority populations, implementation, evaluation measures, and lessons learned.  A round-robin discussion was facilitated after the presentations to identify strengths and challenging aspects of the ETE initiative and generate ideas about next steps.  The content of the group discussion was shared with all BHIV staff and will be used to critically assess the initiative, guide programmatic changes, and inform program evaluation.

Agenda Item #5: Committee Reports

Priority Setting & Resource Allocation (PSRA)

Mr. Baney reported that PSRA is almost finished with its planning for the FY 2020 application spending plan.  After spending several months looking at several data sets. Including the Service Category Scorecards, Fact Sheets and a Payer of Last Resort analysis, the Committee made some minor adjustments to the ranking scores of several categories.  We are also developing an application spending plan that targets increases to areas of highest need.  The rankings and spending plan will be presented at the June EC and Council meetings.  A small group of PSRA members met with DOHMH and PHS staff to look at combining the Scorecards and Fact Sheets into one unified document.  The two data sets have a lot of overlapping data and some items that were not useful for planning purposes.  The draft combined data tool will be presented to the PSRA at the June meeting.

Needs Assessment Committee (NAC)

Ms. Thompson reported that the NAC is conducting a Forum on Disabilities on June 20th in Brooklyn as part of its work to develop recommendations for addressing the needs of people with disabilities in the Ryan White Part A service system.  NAC also has two sub-committees meeting, to address Oral Health and Seriously Mentally Ill.  

Integration of Care Committee (IOC)

Ms. Walters reported that the IOC is close to completing work on recommending that the Transitional Care Coordination programs become part of the Housing Services category.  At the June meeting, the Committee hopes to complete work on the final standards of care. 

Mr. Park also noted that US HUD has recently issued new rules that deny transgender people equal access to shelter services, part of their on-going assault on the rights of LGBT people.  In NYC, transgender people will still be protected under local human rights laws. 

Consumers Committee

Mr. Fields reported that at yesterday’s Consumers Committee meeting, the Committee members participated in a webinar on client engagement in care and the social determinants of health.  Ms. Best reported that she and Darryl Wong met with the Medical Monitoring Project (MMP) advisory committee last week on delays in initiating HAART.  They expressed their concerns that the data was old (from 2009-14), and that there are concerns around privacy, particularly around enrollees who report having unsafe sex and who may be subject to criminal prosecution in states with draconian HIV laws. 

Tri-County Steering Committee (TCSC)

Ms. Diaz reported that the TCSC has wrapped up its planning for the current cycle.  At its last meeting, the Committee approved a spending request for the FY 2020 grant application.  Given that most of the portfolio has just been rebid, the Committee voted to request an increase of 5% spread proportionately across all service categories based on rank.  In subsequent years, the Committee will have more robust data on spending trends and service effectiveness that we can use to make targeted adjustments in allocations. 

There being no further comment, the meeting was adjourned.