Thursday, December 21, 2023
By Zoom Videoconference
Members Present: D. Klotz (Governmental Co-chair), D. Martin (Community Co-chair), B. Fields (Finance Officer), S. Altaf, R. Babakhanian, K. Banks, R. Brown, P. Carr, V. Decamps, J. Dudley, R. Ford, C. Graham, S. Hemraj, B. Hribar, E. Kaywin, M. Lesieur, M. Maia Soares, L. F. Molano, MD, J. Palmer, G. D. Plummer, M. Rodriguez, J. Roman, L. Sabashvili, J. Schoepp, M. Sedlacek, C. Simon, M. Thompson, T. Troia, G. Ty, S. Wilcox
Members Absent: F. Alvelo, M. Bacon, M. Baney, G. Bruckno, M. Caponi, J. Edwards, R. Fortunato, M. Gilborn, J. Goldenbridge, J. Gomez, R. Henderson, J. Henson, F. Laraque, W. LaRock, N. Martin, H. Martinez
Staff Present: DOHMH: C. Quinn, MD, MPH, D. Saab, A. Guzman, M. Pathak, S. Spiegler, J. Acosta, A. Eppinger-Meiering, S. Kramer, K. Mack, D. Bickram, M. Dorsheimer; Public Health Solutions: G. Ashby Barclay, R. Santos
Agenda Item #1: Welcome/Introductions/Minutes
Mr. Klotz and Mr. Martin opened the meeting followed by a roll call and a moment of silence. The minutes from the November 30, 2023 meeting were approved with no changes.
Agenda Item #2: Recipient Report
Ms. Eppinger-Meiering reported news from HRSA and other federal agencies, including World AIDS Day commemorations, the release of the 2022 Ryan White Annual Data Report, and a new Directory of Integrated HIV Prevention and Care Plans. Also, the White House released a National HIV/AIDS Strategy Interim Action Report. DOHMH released the HOPWA Families RFP with proposals due January 8, 2024. RWPA subrecipients are wrapping up their quality improvement (QI) projects for the 2023-2024 contract year and will be submitting final reports. Projects include engaging consumers for feedback on program services and focus areas such as viral load suppression, connections to social support services, and improving documentation of delivered services.
The HIV Care and Treatment Program (CTP) Program Planning and Compliance Unit recently coordinated listening sessions on the development and design for the new Behavioral Health Services category that will launch in 2025. Subrecipients and consumers of RWPA mental health, supportive counseling, and harm reduction services participated in the sessions, where they shared insight on their experiences in both delivering and receiving services, as well as provided pivotal input on how the new category can meet the needs of priority populations. Also, the Mayor announced TeenSpace, the City’s first tele-mental health service for New Yorkers ages 13 to 17 years.
Council members expressed concern about the timeline for responding to the HOPWA RFP. It was explained that CTP is seeking an extension to publicize the RFP better and seek more responders.
Agenda Item #3: HIV Policy Update
Mr. Guzman and Ms. Pathak presented an HIV policy update. On November 17th, the NYC Council held a hearing on older adults with HIV, where DOHMH Commissioner Aswin Vasan, MD and Deputy Commissioner Celia Quinn, MD provided updates on current services and programming. The FDA has approved the first-ever at-home sample collection for chlamydia and gonorrhea.
On December 8, 2023, New York State Office of Addiction Services and Supports issued a letter to the New York State Opioid Settlement Fund Advisory Boardrejecting its recommendation to use the state’s opioid settlement funds to support overdose prevention centers (OPCs). New York City continues to experience an overdose crisis, and DOHMH released a Commissioner’s Advisory, urging action amidst a historically high number of overdose deaths, including authorizing overdose prevention centers. In response to questions, it was clarified that deaths related to methamphetamine use are counted among “overdose” fatalities. It was also mentioned that the US House of Representatives has proposed criminalizing possession of any amount of Xylazine (“tranq”), a non-opioid veterinary sedative that has made its way into the illicit drug supply and has been detected in an increasing number of overdose deaths. On November 30, 2023, Governor Kathy Hochul signed into law legislation establishing the Long-Term Care Facility Residents’ Bill of Rights for LGBTQIA+ New Yorkers and People Living with HIV.
On April 1, 2023, New York State transitioned its Medicaid pharmacy benefit from managed care to fee-for-service, resulting in qualifying safety net providers losing access to millions of dollars in 340B federal drug program savings. To alleviate this, New York State directed reinvestment funds to eligible entities to make them whole and submitted a State Plan Amendment (SPA) proposal to the Centers for Medicare and Medicaid Services (CMS) requesting a federal match in funding. On November 30, 2023, CMS approved the SPA, authorizing federal funds to match state funds. Starting January 1, 2024, undocumented immigrants ages 65 years and older will have a new option for insurance coverage under Medicaid. Previously, this population only qualified for Emergency Medicaid.
Agenda Item #4: Planning Council Subcommittee Reports
Ms. Graham reported that the Consumers Committee held a Town Hall on HIV Stigma on Nov. 14th with 60 Attendees. There were presentations on a conceptual foundation for stigma, the ESCALATE anti-stigma project, and harm reduction. At the last two meetings, Committee members provided feedback on two DOHMH Bureau of Hepatitis, HIV and STI initiatives: the Data 2 Suppression Project, and the Partner Portal Project. The Committee also approved a data request on Client Advisory Boards that will be submitted to the Recipient. The request will provide us with baseline data on CABs at Ryan White Part A agencies. Finally, the Committee approved sending a letter to the Director of the Office of Management and Budget on the difficulties that the Council has had with procurement of expenses that help the Council operate, including food at meetings and support for the Council website. Mr. Maia Soares added that the letter should be addressed to the Mayor (who is cc-ed).
Needs Assessment Committee
Ms. Thompson reported that the NAC is exploring the emerging topic from the Comprehensive Needs Assessment of immigrant/asylum seeker/migrant health. There have been presentations from subject matter experts on current immigrant health issues impacting new New Yorkers, including speakers on the City’s response to the influx of newly arrived/asylum seeker/migrants/undocumented communities of NYC. NAC will use these to develop a set of recommendations to address gaps in HIV care for this population.
Integration of Care Committee
Mr. Hemraj reported that IOC is revising the service category directive for Non-Medical Case Management for Inmates/Recently Released (NMI). There have been two months of presentations on current program (program data, successes & challenges, client and provider perspectives), and service delivery issues for incarcerated/recently released PWH. IOC is using the old service directive template, which describes goals & objectives, alignment to the Integrated Plan, service model and types, client and agency eligibility. The Committee has made draft revisions to directive, including revised goals, and tweaks to service model and client eligibility requirements.
Priority Setting & Resource Allocation Committee
Mr. Carr reported that PSRA has begun its Spending Scenario Planning process for the 2024 grant year. PSRA will develop a methodology to implement a possible reduction to the grant award so that it can be implemented immediately upon receipt of the notice of grant award from HRSA. Considerations for this year’s planning process include: 1) a savings of $1.4 million in the carrying costs of programs; a need for an additional one-time allocation of $930,000 to pay to transition clients of Housing programs that are not being funded in 2024; 2) if there is a large reduction in the award, PSRA will consider possible targeted reductions, and has been looking into the Health Education & Risk Reduction category as a possibility; and 4) in a flat funding scenario, there would be a need to reallocate uncommitted funds, with possibilities being considered for the Behavioral Health categories and Food & Nutrition Services.
Tri-County Steering Committee
Mr. Palmer reported that TCSC completed its GY 2024 Spending Scenario Plan for TC program services, recommending level funding for GY 2024 (after reduction in GY 2023), and a reallocation of $117K in uncommitted funds to Medical Case Management.
Rules & Membership Committee
Dr. Molano reported that in the winter and spring, RMC will review member attendance, followed by the annual new member recruitment and appointment process.
PC/HPG Joint Policy Committee
Mr. Lesieur reported that the JPC discussed federal budget updates, including Congressional appropriations. The US House is proposing major cuts to a number of HIV programs, including EHE and Ryan White Part F. Proposed Part A allocations are flat funded. There is a small increase proposed for HOPWA. The Committee has ongoing workgroups to address disabilities and sexual health education. This winter, JPC will address: HIV and sexual health services for asylum seekers; crystal meth use among PWH; Medicaid “unwinding” data for PWH (State redetermining enrollees); and Doxy-PEP.
Agenda Item #5: Executive Committee/Recipient Strategic Planning Retreat Report
Dr. Quinn expressed her feeling that the November 15th Executive Committee-Recipient Strategic Planning Retreat was a successful and powerful event that reaffirmed the commitment of the Council and Recipient to working collaboratively and centered the participants in the work ahead.
Mr. Martin presented the shared values that were developed in the retreat. These values characterize how we will conduct ourselves in our efforts to yield meaningful results for people impacted by and living with HIV. The Recipient and the HIV Planning Council will seek to live into these values in everything we do, including in our work uplifting the needs and experiences of people impacted by and living with HIV. The shared values are: 1) Authenticity: honor, community, respect our differences and expertise, think of each other’s needs; 2) Collaboration:willingness, shared decision-making, include stakeholder input; 3) Accountability: stewardship, excellence, trust; and 4) Grace:Treat others as you would wish to be treated yourself, empathy, human kindness in our interactions, make space for emotions, assume best intentions, a habit of mind that you can’t fake, centering grace promotes healing.
Ms. Plummer presented how the retreat participants discussed the impact of the recently approved Council/Recipient Memorandum of Agreement (MoA). What will remain the same is: Our commitment to this work; our colleagues, that we all wear multiple hats and share the same goals, and that we will still be dealing with the same competing issues. What we hope will be different is: having a tool to lean on, clear shared expectations, a renewed commitment to our partnership, more opportunities for Council and Recipient staff to get to know each other and interact to build trust and transparency, more well defined goals, and a greater shared focus on empathy, humility, and communication.
Mr. Klotz presented what the retreat found that is needed beyond the MoA to improve the Council/Recipient relationship, including: using the HRSA Primer, greater transparency, elevating sensitivity and compassion, embracing humility and respect and checking in on people’s feelings, ensuring early involvement of the Recipient in developing service directives, ensuring that people with lived experience are involved in monitoring the implementation of services, reassessing hiring practices to value lived experiences, more in-person meetings so we can get to know each other, extending grace to each other, and the recipient being more visible in community events.
A series of recommended next steps was developed by the retreat facilitator, and there was a call for volunteers to form a small group to prioritize them in rank order. The following members volunteered: Mr. Martin, Mr. Maia, Mr. Brown, Mr. Babakhanian, Dr. Molano, Mr. Fields, Ms. Kramer, Mr. Wilcox, Ms. Acosta, Ms. Mack and Ms. Sedlacek.
Agenda Item #6: Public Comment, Part II
Dr. Quinn announced that she is in the final stages of the process of naming a new Council director.
Mr. Maia Soares reported that a number of PWH he knows have stopped treatment and expressed his alarm and the need for more support to prevent treatment fatigue.
Mr. Babakhanian related a story about the sub-par care a friend received at several facilities where there was a lack of basic knowledge around HIV care.