Need Assessment Committee Meeting Minutes March 14th, 2019


Marcy Thompson & Amanda Lugg, Co-Chairs
March 14 th, 2019, 10:00AM -12:00PM

LGBT Center, 208 West 13th Street, Room 301, New York, NY By Conference Call – 1-866-213-1863, Access Code 3587454#

Members Present: Amanda Lugg (co-chair), Marcy Thompson (co-chair) Jan Carl Park, Fay Barrett

(phone), Randall Bruce, Paul Carr, Micah Domingo, Billy Fields, Timothy Frasca, Graham Harriman, Jennifer Irwin, John Schoepp, Mytri Singh

Members Absent: Marcy Thompson (co-chair), Maria Diaz, Guillermo Garcia-Goldwyn, Ron Joyner, Carol

Kunzel,  Ruben Rios-Vergara, Saul Reyes, Janie Simmons, Robert Steptoe, Maiko Yomogida

NYC DOHMH/PHS Staff Present: Nadine Alexander, Ashley Azor, Jose Colon-Berdecia, Rong Gao, Julie Lehane, Darryl Wong

Materials Distributed

  • Meeting Agenda
  • Presentation: Providing Reasonable Accommodation for People with Disabilities
  • Presentation: New York City Human Rights Law: Disability Discrimination Legal Enforcement Guidance
  • Calendar
Welcome/Introductions/Moment of Silence/Public Comment/ Review of the Meeting Packet/Review of the Minutes:

Paul Carr volunteered to temporarily chair the meeting with staff liaison Melanie Lawrence, due to CoChair Amanda Lugg’s car trouble. Mr. Schoepp led us in a moment of silence and Ms. Lawrence reviewed the meeting packet.

Please note that these meetings only reflect the conversations, questions and answers around the presentations given, not the actual presentations. The slides are available by request. 

Update on the Oral Health Subcommittee  

Mr. Carr updated the committee on the work of the Oral Health Subcommittee: Next meeting, March 15th at Cicatelli, from 2-4pm. 

  • Committee has met twice
  • Finding a great deal of stigma that clients experience from oral care providers.
  • Sopke with Dr. Moy, who has worked at Mt. Sinai with RWPA population for the past 12 years o Emphasis on prevention o Bone grafts are not always appropriate – but can be necessary to anchor lower dentures. 
    • Medicaid reimbursement is extremely low
  • Spoke with ADAP
    • Cover 12 visits /year
    • Won’t tell providers exactly what is covered: providers are required on the day of service to ensure the service is covered and the client is covered by ADAP
  • Large consumer presence on the subcommittee, would be good to see more PC members 
  • RWPA money cannot top up on other payers – so how would we address the low reimbursement rates
  • Subcommittee is looking at what ADAP covers, what Medicaid covers
  • Looking at case management to help with paperwork and council clients. 
  • A few years ago the council required that all agencies be able to bill Medicaid, which helps ensure that we are the payer of last resort. Still in discovery stage. How many dentists are providing Medicaid covered services? 
  • There is a disincentive to provide this care – and have to refer out for many more complex services. For Mount Sinai, the part F money has been critical to continuing offering the services. 
New York City Human Rights Law: Disability Discrimination Legal Enforcement

Presented by Dana Sussman of the NYC Commission on Human Rights.  NYC Human Rights Law Statute of Limitations Mr. Schoepp: If a patient goes to a patient advocate about the issue, are they required to inform the commission.No.   But those people are welcome to come to the commission Mr. Fields: There are still many organizations with examination rooms that are unable to accommodate wheelchairs and people’s needs The ADA is much more specific about the technical aspects of accessibility. The commission does not have those, but it allows us to be more flexible. And if these are new buildings it’s a huge concern. And should be brought the commission Mr. Park: The DOH has no accommodations for people with hearing disabilities. I went to my EEO officer, and filed a request for an accommodation, I was asked how much it would cost to put an induction loop system. He made it clear that I was responsible for hiring an acoustic architect to survey the space and estimate the cost. Our dialogue broke down at that point. As a major training space, this seems like an injustice. What is the obligation of people doing RWPA work to ensure accommodations?

There should be a way to insert language that lists all of the obligations for those who are contracted by the city, including the human rights law.

This committee hopes to identify a set of recommendations to meet the requirements – we know that tech is far ahead of the law. It seems like cost is always the biggest barrier. But sometimes these costs are minimal. Our funding stream does not pay for capital improvements, so installations actually are a cost issue – we cannot hold them responsible for things we cannot pay for. 

To the extent that the commission can be useful  is that we do a lot of agency to agency work – we have a small policy team. But if there is the capacity to accommodate – then the burden isn’t on the funder, it is on the provider. Our office is happy to help. We enforce anti-discrimination law, and crafting best practices and training to providers, CCHR can help provide, around scheduling changes, terminology, vendors. While this is a massive undertaking, we can chip away at some of these issues. We highlight model LGBTQ providers – can do this for accessibility. 

Mr. Schoepp: What is the cost?

Completely free, no income threshold. 

Mr. Harriman: I’m the grantee for Part A services. Wondering about the slide on keys to reasonable accommodations – how are these assessments conducted?

Our use of the term assessment, is not in the public health sense, more like what are the job functions that need to be performed. Trying to avoid this idea of ‘I say disability” and you get axed. Disabilities are incredibly individualized. Different for different people – adjusting light in the waiting room, not having to wait, etc.

Thinking about a standardized rights document that every client would need to sign to ensure they are aware of their rights – are there templates for this?

We have something, can check to see if we have a model policy. A lot of these are employment based. These should also be considered for pregnancy, etc.

Mr. Wong: Question about collaborating with other entities, ie. Dept of Buildings, which issues a certificate of occupancy for existing and new building, fire, etc. So when a building is retrofitted to become a care facility, doesn’t the Dept of Buildings have to issue those certificates? What do we have to do to get disabilities to be addressed on that level? And with the state, can you work with the state commission on human rights, article 28s and 31s, they are very specific about physical structural pieces, with regard to privacy and security; how do we bring in the issue of accessibility. 

We do work with the Department of Buildings, it often will come up – I believe its built into the retrofitting – can check on that, Our law can butt up against their mandate – has to do with the differing requirements – such as a ramp that’s approved, but would be too steep, but wouldn’t encroach on the sidewalk. We do work with the state.

Mr. Carr: Currently there are oral health care providers requiring blood work for HIV patients and refuse to work on you unless you provide it. When I ask for a written policy, they have nothing to show. What kind of action would work for that?

Depending on what you prefer – if you are willing to share the name of the provider, we would do an investigation – we can send out “secret shopper” like investigation. Someone can come forward, but has to be within the last year. 

Providing Reasonable Accommodation for People with Disabilities

How can RWPA funds be used to support accessibility for people with disabilities. The federal government places limits on the amount of money that may be spent on things like salaries and equipment. Costs must be reasonable, and sometimes there is a federal ceiling on things like salaries. If an agency is funded my multiple sources, the cost put out must be charged to all of the grants who that resource is serving.

Mr. Harriman: This material is dense ad thick and involves details on how to administer your grant. The challenge for working on this is that at the program level, they are working with multiple funding sources – and so they must charge purchases to those funding sources. That doesn’t let people off the hook, but should be thinking about how we pay for things and what we expect of providers. 

Mr. Fields: People need to understand that they must comply to the federal requirements around disabilities. 

Ms. Lawrence: As long as something is not a capital purchase, is less than $5,000 and will serve the client – it’s allowable.

If only RWPA clients are accessing the service for which the equipment is purchased, the entire purchase can be charged to RWPA.

All agencies in NYC must comply with all laws. But do they all know how to comply with the law? That’s a good question.

For institutions where clinics are embedded with larger institutions, these conversations need to be happening at higher levels – because that is where a lot of the change is going to come from. 

That is something the grantee can be directed to do. That’s part of the process. If these things are not in place, a contract will not be awarded.

ASL is available on your smartphone. The Mayor’s Office for Disabilities provides this service for free.

Only 3% of people who have hearing disabilities are deaf, of which an even smaller number use ASL. But with real time captioning, much of this can be addressed in larger settings. Technology helps assist even more on an individual level. 

If a staff member is fluent in ASL a portion of their salary can be charged to Ryan White. 

Ryan White cannot be used for capital improvements, but can purchase portable equipment. Providers can provide accessible materials as long as the appropriate portion is charged to the grant. These are programming costs and do not come out of the admin budget. 

Ms. Lawrence will make a flow chart to help assist visualizing this issue. 

Collection of Disability Videos (Rethinking Disabilities: Disrupt the Narrative)

We need more data and research to understand who is coming into our agencies. (Disabilities Videos: Historical Overview) (Disability Videos: Overview to ADA)

We should be thinking about how to work with organizations that serve people with disabilities.  The center of this must be the environment in which we conduct and deliver services. For people not impacted by disabilities – no one else can speak for them.

We are just beginning the conversation – stigma is so embedded against people with disabilities – we should be doing this work through our youth. Many groups are focused on this – and on anti-bullying. 

Can’t be satisfied with having a ramp installed.

Two prong – legal aspect of what he have to follow. And then the struggle to hold providers accountable.

Even though HIV testing is the law, it still does not happen.

A lot of our clinics, or anywhere that people are accessing health services – those staff should be trained. You must train everyone. That’s also the work that we can do in our agencies – working with compliance, to ensure the legal aspects are addressed.  

New Business

A subcommittee on the SMI is being convened. This is not just about mental health, that’s very broad. We want to complete this work in this cycle. Three aspects, diagnostic, RWPA funding to assist with the need, and how to manage this without adding an undue burden to providers. Can go to social service agencies that service SMI which will help us to frame the issue. Subcommittee formed.