Minutes of the Meeting of the
Integration of Care Committee
Veronica Fortunato & Steve Hemraj, IOC Co-Chairs
Wednesday, February 26, 2025
10:05am-11:40pm
Minutes
Members Present: Ronnie Fortunato (Co-chair), Steve Hemraj (Co-chair), Raffi Babakhanian, Mitchell Caponi, Dorothy Farley, Billy Fields, Deborah Greene, Christopher Joseph, David Klotz, Marcelo Maia, Jeff Natt, Cesar Nuñez, Guadalupe Dominguez Plummer, Leah Richberg, John Schoepp, Brenda Starks-Ross
Staff Present: NYC DOHMH: Doienne Saab, Michael Navejas, Scott Spiegler, Adrianna Eppinger-Meiering, Johanna Acosta, Gina Gambone, Nicki Harris, Grace Herndon, Marilyn Baculima, Abraham Omeyoma
Agenda Item #1: Welcome/Introductions/Minutes/Public Comment
Ms. Fortunato and Mr. Hemraj opened the meeting followed by a roll call and a moment of silence. The draft minutes from the January 22nd meeting were approved with no changes.
Agenda Item #2: Medical Case Management/Care Coordination (CCR) Service Category
Ms. Saab presented draft revisions to the text of the Program Directive and Service Model section of the Care Coordination services directive, based on the discussions at the previous meetings.
A summary of the revisions include:
- Deletion of the boilerplate language at the beginning, as the themes are covered more extensively in the Council’s Framing Directive.
- Strengthening the language around electronic (virtual) DOT, including suggesting existing interventions that have proven effective, such as “contingency management” through a smartphone-based “PillWatch” app that uses incentive to reward VLS.
- Inclusion of a basic geriatric assessment (BGA) as a standard to screen for multimorbidity, polypharmacy, and cognitive impairments among older PWH, plus referrals to comprehensive services for aging PWH.
- Inclusion of iART as a bridge to regular treatment once clients are fully connected to clinical care.
A summary of the ensuing discussion follows:
- The BGA cited in the footnote is from a specific study that targets men and over 85. A more general BGA will be cited that includes all populations and aligns with the Council’s HIV & Aging directive to target PWH over 50 and address social determinants of health.
- Telehealth is an accepted modality and states set reimbursement rates for Medicaid (federal government for Medicare).
- Incentives provided in contingency management initiatives do not have to be through a digital platform.
- Allowable uses and tracking of incentives is done under HRSA guidance and policy clarification notices. DOHMH already allows incentives for achieving viral load suppression, and is administratively responsible that all guidance is followed by sub-recipients.
- DOHMH promotes documented linkages, but should strengthen tracking through eSHARE (as is being done in the new Behavioral Health contracts) to ensure that there are closed loops in the referral process.
- Client eligibility should include people at risk of developing cognitive issues that may interfere with treatment adherence.
- The citation for gender affirming care was changed to general “current best practices,” rather than citing a specific source from the 2017 directive.
There was a consensus to approved the directive with the changes presented and the additional edits made by the Committee. Mr. Klotz thanked the Committee members and chairs, Ms. Saab and the Recipient staff for their outstanding work improving the service directive for the service category with the largest allocation in the EMA’s RWPA portfolio.
At the next meeting, the Committee will review the HRSA-required service standards, which are brief compilations of existing documents (directives, HRSA monitoring standards, RFPs). The next IOC meeting will be held on Wednesday, March 19th, 10-am-12pm.
There being no further comment, the meeting was adjourned.
