Minutes of the Meeting of the
Integration of Care Committee
Veronica Fortunato & Steve Hemraj, IOC Co-Chairs
Wednesday, October 16, 2024
10:05am-12:00pm
Minutes
Steve Hemraj (Co-chair), Ronnie Fortunato (Co-chair), Raffi Babakhanian, Michael Ealy, Dorothy Farley, Billy Fields, Christopher Joseph, David Klotz, Marcelo Maia, Karen McKinnon, Jeff Natt, Cesar Nuñez, Guadalupe Dominguez Plummer (ex-officio), Leah Richberg, John Schoepp, Brenda Starks-Ross, Gretchen Ty
Other Council Members Present: Paul Carr
Staff Present: NYC DOHMH: Michael Navejas, Doienne Saab, Kimbirly Mack, Grace Herndon, Scott Spiegler, Adrianna Eppinger-Meiering, Gina Gambone, Johanna Acosta, Jacqueline Graham, Ho Ki Mok, Nicki Harris
Agenda Item #1: Welcome/Introductions/Minutes/Public Comment
Mr. Hemraj opened the meeting followed by introductions, including new Council Deputy Director Michael Navejas and new committee members. A moment of silence in memory of Claire Simon was observed. The draft minutes from the June 26th meeting were approved with no changes.
Mr. Maia discussed reports that people are selling their HIV medications to earn money and that some pharmacies are buying them back and reselling them.
Agenda Item #2: Emergency Financial Assistance (EFA) Service Directive
Mr. Klotz explainedthat when the Executive Committee reviewed the IOC’s approved EFA directive in July, they wanted the IOC to consider two additions to the service model and reconsider the decision to mandate programs in both NYC and Tri-County.
The Committee discussed a proposal to have programs use people with lived experience (peers) to educate consumers about the program and assist with enrollment. Mr. Carr outlined the benefits of using peers who can reach fellow consumers at other agencies, in supportive housing or in their social circles. A summary of the ensuing discussion follows:
The Framing Directive already includes language about using peers when possible, making the proposed addition redundant.
There may be a need to add language specifically for this directive to ensure that it is reflected in the RFP. (All RFPs since the Framing Directive was approved have included provisions for utilizing peers.)
Programs pay the vendor who needs reimbursement (landlord, utility company, etc.). HRSA only allows EFA providers to use program funds for those payments and not for outreach activities.
There is the possibility of using soon-to-be available funding from Ending the HIV Epidemic (EHE) grants to incentivize outreach and linkage to ERA and other services through employment of peers.
It is important to address the underutilization of the service, which persists in spite of the TA that the Recipient has provided. Programs should not just rely on referrals from case managers, many of whom still are unaware of the program in spite of the efforts undertaken to inform them of its availability.
There was a consensus to leave the draft language out of the directive but to add a footnote that the Recipient will investigate incentivizing outreach and linkage to EFA services in other RWPA services.
The Committee then discussed proposed language to require that EFA programs have an online portal for consumers to apply directly for services. A summary of the ensuing discussion follows:
- This requirement would have to be paid out of administrative funds. An online portal can be very expensive and can not be mandated.
- Public Health Solutions is working on an initiative funded through the Social Care Networks under the Medicaid 1115 waiver that could be leveraged for this.
- The need to streamline data collection at intake was the focus of a report generated by the Council’s ad hoc Data Workgroup. An update on the recommendations will be presented to the full Council soon.
- There is the possibility of using EHE funding for this.
There was a consensus to leave the draft language out of the directive but to add a footnote that the Recipient will investigate ways to leverage other funding to create a streamlined, confidential application process, including through an online portal, for submitting applications and necessary documentation.
The Committee affirmed the requirement to have distinct programs in NYC and Tri-County. The revised directive will be brought for final approval to the Executive Committee in November.
Agenda Item #3: Medical Case Management/Care Coordination (CCR) Service Category
The Committee began the process of reviewing the CCR service category for revision of the directive in advance of a rebid of the program. CCR is the largest and most complex service category in the EMA’s portfolio, using about one third of the allocation of program dollars.
Ms. Herndon presented an overview of CCR, which provides client-centered medical case management services to help improve health outcomes for people with HIV. The HRSA definition of CCR (which they call Medical Case Management) was provided. Activities provided under this service category may be provided by an interdisciplinary team that includes other specialty care providers and includes all types of case management encounters (e.g., face-to-face, phone contact, and any other forms of communication). Key activities of CCR include: initial assessment of service needs, individualized care plans, coordination of services, client monitoring, reevaluation, treatment adherence counseling and advocacy, and benefits/insurance counseling and enrollment assistance.
The program goals and objectives from the Council’s current directive (approved in 2017) were outlined, along with the directive’s client eligibility criteria. Specific service activities were listing, ranging from case finding and intake assessment and care planning to case conferencing, accompaniment and modified directly observed therapy (mDOT). mDOT can include home or office visits as well as video calls. The service’s staffing model was explained (director, care coordinator, navigator, medical and clinical staff and data entry). Mr. Babakhanian recommended adding language to revised program goals concerning addressing co-morbidities.
Ms. Herndon explained the implementation history of the current program (24 programs since 2018 in hospitals, community health centers and CBOs). Seventeen of those programs had CCR programs previously. Implementation challenges, especially since COVID, include high staff turnover, documentation burden and data reporting issues. Implementation successes include high client engagement, tailored services specific to client needs, QI projects that focus on VLS and a CCR-specific training model.
At the November IOC meeting, there will be an updated fact sheet with data on client demographics, service utilization and expenditures. Also, data will be presented from the PROMISE study, which is an outcome evaluation of CCR. In December, providers and clients of current programs will discuss their successes and challenges. The staff will also prepare a literature review with information about other programs nationally.
Agenda Item #4: Other Business
Mr. Joseph sent the link to the PHS initiative that seeks input from Medicaid recipients in Manhattan, Brooklyn and Queens on the four services that will be funded under the Medicaid 1115 waiver (food, housing, transportation and care navigation). Mr. Klotz will send the IOC members a presentation that was delivered to the full Council by the NYS DOH earlier this year with an overview of the program.
Mr. Hemraj reported that the deadline for people to submit claims that they did not receive their full SNAP benefits.
The next IOC meeting will be held on Friday, November 22nd, 10-am-12pm. In December, the Committee will resume its regular 3rd Wednesday schedule.
There being no further comment, the meeting was adjourned.
