Minutes of the Meeting of the
Integration of Care Committee
Veronica Fortunato & Steve Hemraj, IOC Co-Chairs
Wednesday, January 24, 2024
Committee Members: Ronnie Fortunato (Co-chair), Steve Hemraj (Co-chair), Raffi Babakhanian; Mitchell Caponi, Michael Ealy, Dorothy Farley, Billy Fields, Deborah Greene, David Klotz, Marcelo Maia, Hondo Martinez, Jeff Natt, John Schoepp, Gretchen Ty, Joel Zive
Staff: Guadalupe Dominguez Plummer; Adrianna Eppinger-Meiering; Bryan Meisel; Doienne Saab; Scott Spiegler, Gina Gambone, Johanna Acosta, Kimbirly Mack
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 December 20th meeting were approved with no changes.
Agenda Item 2: Non-Medical Case Management for Incarcerated/Recently Released (NMI)
David reviewed the revisions to the NMI directive agreed on by the Committee at the previous meeting. One service category goal was added, the objectives from the Integrated Plan updated, and the service model stays largely unchanged with an update about the recently approved NYS Medicaid 1115 waiver.
There was discussion on the potential impact of a US Supreme Court case regarding the extent to which federal agencies can issue regulations not specifically stated in legislation.
The directive will be reviewed for final approval by the Executive Committee and full Council in February. Those bodies are empowered to make amendments to the directive, so any further changes suggested by the IOC can be brought for consideration by the EC and Council.
A motion was made, seconded and adopted 11Y-0N to approve the revised NMI directive as presented.
Agenda Item #3: Early Intervention Services (EIS)
David explained that the EIS directive, developed in 2015, needs revision in advance of a rebid of this service category for GY 2025. The testing landscape has changed and there are new considerations for the Committee in a revamped program. The discussion will start with an explanation of HRSA allowable EIS services and a review of the current directive to flag potential areas for review and revision.
Guadalupe presented the HRSA National Monitoring Standards for RWPA EIS services. EIS services must include the following four components: 1) Targeted HIV testing to help the unaware learn of their HIV status and receive referral to HIV care and treatment services if found to be living with HIV (Recipients must coordinate these testing services with other HIV prevention and testing programs to avoid duplication of efforts). HIV testing paid for by EIS cannot supplant testing efforts paid for by other sources. 2) Referral services to improve HIV care and treatment services at key points of entry; 3) Access and linkage to HIV care and treatment services such as HIV Outpatient/Ambulatory Health Services, Medical Case Management, and Substance Abuse Care; 4) Outreach Services and Health Education/Risk Reduction/literacy training related to HIV diagnosis.
Programs must document that: 1) Part A funds are used for HIV testing only where existing federal, state, and local funds are not adequate, and RWHAP funds will supplement and not supplant existing funds for testing; 2) individuals who test positive are referred and linked to healthcare and supportive services; 3) health education and literacy training are provided, enabling clients to navigate the HIV system; 4) EIS is provided at or in coordination with documented key points of entry, and 5) EIS is coordinated with HIV prevention efforts and programs. EIS sub-recipients (service providers) must: 1) establish MOUs with key points of entry into care to facilitate access to care for those who test positive; 2) document provision of all four required EIS components with Part A or other funding; 3) document and report on numbers of HIV tests and positives, as well as where and when Part A-funded HIV testing occurs; 4) document that HIV testing activities and methods meet the Centers for Disease Control and Prevention (CDC) and state requirements; 5) document the number of referrals for healthcare and supportive services; 6) document referrals from key points of entry to EIS programs; 7) document training and education sessions designed to help individuals navigate and understand the HIV system of care; 8) establish linkage agreements with testing sites where Part A is not funding testing but is funding referral and access to care, education, and system navigation services; and 9) obtain written approval from the recipient to provide EIS in points of entry not included in the original scope of work.
For clients who test negative, programs can offer outreach services and health education/risk reduction, and referrals and linkage to PrEP services. Possible navigation services may be included (pending HRSA clarification). For clients who test positive, programs can offer: referral services; linkage to care; health education and literacy training that enable clients to navigate the HIV system of care; and initiation of immediate Anti-Retroviral Therapy (iART).
For several years, RWPA EIS funds have been rolled into the PlaySure Network 2.0 (PSN) program along with City tax levy funds. PSN 2.0 is a navigation services program that has had challenges with program monitoring, overall spend down and performance. Additional data will be presented at the February IOC meeting. David then reviewed the text of the 2015 directive.
A summary of the discussion follows:
- Payor of last resort (POLR) monitoring is done through site visits and documentation review (e.g., intake forms) to ensure that providers are seeking reimbursement from other payors before submitting invoices.
- The proposed cuts to Health Homes in the NYS budget would most likely affect demand for RWPA Care Coordination programs, which provide a similar service.
- The revised directive should include an orientation and resources for navigating the health care system for those newly diagnosed or newly arrived in the EMA and accessing care here for the first time.
- EIS provider staff should have training on delivering HIV test results.
- CDC guidelines are used for timeframes of making linkages after testing.
- Testing needs to be highly targeted to populations and locations where there is a higher prevalence of undiagnosed PWH, such as sex venues.
- There was discussion of access to sex venues and fears that DOHMH would take a punitive approach to them based on old practices.
- The directive can include more detailed guidelines on how health education should be provided.
- POLR requirements would not mean that an EIS provider that did testing in the field would have to refer people to clinical settings to get the test.
- Linkages should be done at the point of connection.
- The IOC should keep discussions focused on the task of revising the directive, which governs RWPA-funded EIS services. Discussions around public policy are beyond the scope of what the IOC can address.
There being no further business, the meeting was adjourned.