Integration of Care Minutes – December 20, 2023

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Minutes of the Meeting of the

Integration of Care Committee

Veronica Fortunato & Steve Hemraj, IOC Co-Chairs

Wednesday, December 20, 2023

10:00am-11:45pm

Watch the Zoom Meeting Here

Minutes

Committee Members: Ronnie Fortunato (Co-chair); Steve Hemraj (Co-chair); Raffi Babakhanian; Michael Ealy; Dorothy Farley; Deborah Greene; Emma Kaywin; David Klotz; Jeff Natt; John Schoepp, Claire Simon, Brenda Starks-Ross

Staff: Guadalupe Dominguez Plummer; Monika Pathak, Adrianna Eppinger-Meiering; Bryan Meisel; Grace Mackson; Doienne Saab; Cristina Rodriguez-Hart; Cassidy Burt

Agenda Item 1: Welcome, Roll Call & Moment of Silence

Ronnie and Steve opened the meeting followed by a moment of silence and a roll call.  The minutes from the October 18 and November 8 meeting were approved with no changes.

David introduced Monika, who works in the DOHMH BHHS Policy and External Affairs Unit.  Monika is assisting with staffing this Committee until a new community planner is hired.  

Agenda Item 2: Non-Medical Case Management for Incarcerated/Recently Released (NMI)

David reviewed the current NMI directive, approved in 2013.  The directive uses the template that was used for all directives until the Framing and Behavioral Health directives, which used the implementation science logic model (ISLM).  After discussion with the Committee chairs, the staff proposes returning to the former format for the NMI directive.  The purpose of the directive is to provide the Recipient with the information they need to develop an RFP.  The most pertinent information for the purposes of crafting an RFP are the goals and objectives of the service, the service model and service types to be provided, and client and agency eligibility.  The Recipient needs a directive for NMI by early spring, and given the short timeframe, a more streamlined directive would be appropriate. 

Monika presented a summary of the main points of the presentations delivered at the previous two Committee meetings, with a focus on the successes and challenges of the current program.  She also provided information on the anticipated approval of a NYS Medicaid waiver that will allow provision of Medicaid reimbursed services to inmates 30 days prior to release.  Monika then reviewed the proposed update to the column that matches service category goals to the new 2022-26 revised statewide Integrated HIV Prevention and Care Plan (IP).  There was discussion on measurable objectives for the program and it was noted that the IP goals statewide show that the service category goals are aligned, but that program objectives and measures are determined by the Recipient.

The Committee agreed to flip the orientation of the document from vertical columns to horizonal rows.  The Committee discussed getting data from NYC HIV Surveillance specific to health outcomes for PWH in prison, and reviewing literature on the effectiveness of similar programs.  There was discussion on inmates of releasees from State prisons who are returning to the City, and are referred to NYC providers (including the RWPA NMI community provider).  State and Federal prison systems provide all medical services and HRSA does not allow Ryan White funds to be used in those systems.  There was discussion on the pending Medicaid waiver that will allow inmates to be enrolled in Medicaid 30 days prior to release.  There will be text added to the directive to reflect that.  There was also discussion that people need education about using 340b or FQHC pharmacies.  

There was discussion on the social services no longer provided in NYC jails, including job training and placement (which HRSA does not allow RW funds to pay for).  There was a consensus that the directive should be broad to allow for flexibility given the uncertainty of how the NYC jail system will be configured, although H+H Correctional Health Services will provide services in prisons whether they are on Rikers or in smaller, borough-based facilities.  

David reviewed the language of the existing directive and the Committee agreed to the following changes:

  • Additional service category goal to reduce disparities in health outcomes for PWH involved in the correctional system
  • Additional language to anticipate approval of the Medicaid waiver
  • Addition of language that strategies to improve health are evidence-based
  • Additional of oral health and food and nutrition services to the list of services that the program will facilitate access to
  • Deletion of a requirement to participate in the defunct Transitional Care Consortium
  • Deletion of the cultural sensitivity requirement for agencies, as that is included in greater detail in the Framing Directive
  • Clarification that agencies must be accessible to eligible clients from the entire EMA

The revised draft will be circulated and reviewed for final approval at the next IOC meeting, to take place on Wed., January 24th.

There being no further business, the meeting was adjourned.