Thursday, February 25, 2021
By Zoom Videoconference
Members Present: G. Harriman (Governmental Co-chair), D. Walters (Community Co-chair), P. Carr (Finance Officer), A. Abdul-Haqq, S. Altaf, F. Alvelo, D. Beiling, L. Best, A. Betancourt, R. Brown, R. Bruce, P. Canady, M. Caponi, E. Casey, R. Chestnut, B. Cockrell, M. Diaz, M. Domingo, B. Fields, R. Fortunato, T. Frasca, M. Gilborn, C. Graham, B. Gross, A. Lugg, D. Martin, J. Natt, G. Plummer, D. Powell, J. Reveil, M. Rifkin, A. Roque, L. Ruiz, J. Schoepp, F. Schubert, C. Simon, M. Singh, A. Straus, M. Thompson, T. Troia, R. Walker
Members Absent: M. Bacon, M. Baney, J. Edwards, J. Dudley, B. Fenton, MD, S. Sanchez, B. Zingman, MD
Staff Present: DOHMH: D. Klotz, M. Lawrence, A. Gandhi, PhD, J. Colón-Berdecía, K. Mack, J. Carmona, , S. Hubbard K. Miller, C. Rodriguez-Hart, E. Jimenez-Levi, D. Ferdinand, M. B. Khan; Public Health Solutions: A. Feduzi; J. Corbisiero (Parliamentarian)
Guests Present: S. Torho, V. Schubert (Consultants)
Agenda Item #1: Welcome/Moment of Silence/Introductions/Minutes
Mr. Harriman and Ms. Walters opened the meeting followed by introductions and a moment of silence. The minutes of the January 28, 2021 meeting were approved with no corrections.
The Committee paid tribute to Ms. Straus, who is retiring and ending her term on the Council. She was thanked for her service to the Council and her leadership in the Tri-County community. It was announced that Mr. Altaf will become the new co-chair of the Tri-County Steering Committee.
Agenda Item #2: Public Comment
Mr. Ruiz announced an upcoming forum on telehealth, and also that he will be offering assistance with scheduling COVID-19 vaccines at Ryan-Chelsea Health Center.
Ms. Fortunato reminded the Council that the issue of consent for data sharing still needs to be addressed. Mr. Harriman said that this issue will be addressed at the May meeting in a presentation on eShare and other data collection.
Ms. Alvelo announced that the Alliance for Positive Change is now offering COVID testing in Washington Heights.
Mr. Carr highlighted the excellent forum on Serious Mental Illness recently held by the Needs Assessment Committee, noting that this issue has struck close to home with two residents dying due to untreated mental health issues.
Agenda Item #3: Recipient (Grantee) Update
Ms. Plummer reported that the RFP for Psychosocial Support Services for TIGNCNB Individuals has been released. The RFP will fund two programs with an anticipated start date of September 1, 2021. BHIV/Care & Treatment Program is holding two virtual capacity building trainings facilitated by the NYS AIDS Institute. The goal of the trainings is to build organizational capacity to implement comprehensive quality management programs and promote continuous improvement of services. The BHIV Quality Management and Technical Assistance Unit has also developed a Program Navigation Guide to navigating services for PWH with co-occurring mental health conditions. Also, Governor Cuomo has expanded COVID-19 vaccine eligibility to include all people with a list of co-occurring conditions, including HIV.
Ms. Plummer introduced Andrea Feduzi, Deputy Director of Programs at Public Health Solutions, who is now the PHS liaison to the Council.
Agenda Item #4: FY 2021 Spending Scenario Plan
Ms. Gilborn and Mr. Natt presented the FY 2021 spending scenario plan developed and approved by the Priority Setting & Resource Allocation Committee (PSRA). The application spending plan approved last summer was a request for an increase to the grant award. The last time the EMA received an increase was seven years ago. Every year, prior to the receipt of the actual award, PSRA plans for a possible reduction. A spending scenario is developed that determines how to implement a cut up to a certain percentage of the award. This is a methodology that allows the Grantee to apply the actual award amount as soon as we receive it from HRSA and to implement the spending plan without delay. For many years, the EMA has received reductions in the range of 1.5 – 2.5%. This is because Ryan White has been flat funded nationally, and the NY EMA has received reductions in the formula portion of our award due to our successful prevention efforts, which have resulted in the EMA having a smaller proportion of HIV cases relative to other EMAs.
The Scenario plan covers up to a 2.5% cut to the award. The plan also accounts for the fact that the one million dollars in coronavirus stimulus CARES Act funds will not be renewed. PSRA reviewed the enhancements made last spring to respond to needs that arose from the COVID pandemic: $1,900,000 to Housing; and half a million dollars to enable the Emergency Financial Assistance program to expand from Tri-County to include NYC residents. The Housing enhancement was funded with all of the CARES money, plus additional funds taken from the EMA’s ADAP allocation. Funds from the ADAP allocation were also used for the EFA expansion. The Council also committed to fund a new initiative: Psycho-social Support for Transgender, Intersex, Gender Non-binary and Non-conforming individuals.
PSRA reviewed the performance of and the expected needs of the Housing and EFA categories. The Committee also received data from the NYS Uninsured Care Program on the ability of the ADAP program to sustain a reduction in their Part A allocation without having any effect on services or enrollment. We will be able to restore a portion of the ADAP allocation through the use of 2020 carry-over and 2021 reprogramming funds, but PSRA is aware that the ADAP allocation has shrunk considerably. That pot of money will not always be available to help absorb reductions to the award and fund new initiatives. PSRA will be looking at the entire portfolio over the next planning sessions to continue exploring areas where we can streamline services and provide the maximum benefit in a challenging funding environment with new needs arising.
For 2021, the amount that the Council would have to take from ADAP to balance the budget in a reduction scenario is offset by a savings of $1.7 million. This savings is from the elimination of the category of Non-medical Case Management (approved by the PC last summer) and reductions in the carrying costs of programs in three categories (EIS, Legal, MCM) due to permanent take-downs from lower than expected performance or terminated contracts. The Scenario Plan that PSRA has developed allows us to maintain service levels, continue enhancements to Housing and EFA, and pay for PSS. The total reduction to ADAP in a 2.5% Base reduction scenario is $2,590,884.
Mr. Klotz reviewed the details of the spreadsheets, pointing out where all of the elements described above are shown. A summary of the discussion follows:
- The EMA will have the ability to carry over more funds than usual from FY 2020 into 2021. The exact amount will be known in early summer after close-out.
- The change to cost-base reimbursement in response to the pandemic means that it will be difficult to do enhancements based on performance. Thus more reprogramming money will be available to restore any cuts to ADAP.
- The pandemic made it difficult for sub-contractors to submit for payments based on service units delivered. The switch to cost-based reimbursement allowed providers to continue paying for staff and overhead while conducting outreach and delivering telehealth and other virtual services. This reimbursement modality will continue indefinitely into FY 2021, although there is a possibility that there will be a return to fee-for-service (performance-based) reimbursement later in the year.
- Mr. Carr explained that he voted no to register his concern that the ADAP allocation has dwindled and will not be available much longer to cover further reductions to the award and future new initiatives (e.g., Oral Health, recommendations around older PWH). PSRA needs to find savings and efficiencies in the service portfolio.
- Ms. Gilborn and Mr. Natt thanked Mr. Carr for keeping this issue at the forefront, and that PSRA will be looking at a strategic, long-term approach to allocations that protects ADAP, prioritizes the most effective and needed services, and allows for new needs.
- Mr. Klotz added that PSRA and the Council have been examining and amending the portfolio in response to the changing epidemic and fluctuating awards for many years (e.g., eliminating Home Care, Transitional Care Coordination and Non-medical Case Management in recent years). Through collaboration with the State, ADAP has been used to cover reductions in the award since the very beginning of the program. Also, ADAP has been the top ranked service category for many years and has also been used to balance the Base and MAI allocation amounts.
- Ms. Simon added that ADAP has the resources meet its needs, but is also able to spend all the funds it gets through carry-over and reprogramming late in the year.
Ms. Gilborn made a motion on behalf of the PSRA Committee to accept the FY 2021 spending scenario plan as presented. The motion was restated and adopted by a roll call vote 38Y-1N.
Agenda Item #5: Ending the HIV Epidemic Plan: Concurrence
Ms. Torho gave an overview of the updates made to the draft NYC Ending the HIV Epidemic (EHE) plan, based on the feedback gathered from the Planning Council and HIV (Prevention) Planning Group in meetings and through online feedback. As presented previously, the plan’s activities fall into four “pillars”: Diagnose; Treat; Prevent; and Respond. The major changes to the draft plan are:
- Language Shifts: less stigmatizing language, less use of “risk” language, ensure appropriate and consistent language with respect to priority populations and HIV-related vulnerabilities.
- Additions to Priority Populations: People experiencing homelessness or housing instability; People with serious mental illness; People who use drugs and/or have a substance use disorder; People who exchange sex for money, drugs, housing, or other resources; People born outside the United States, especially persons without a settled or “adjusted” immigration status; People who live in medium-, high- and very high-poverty NYC neighborhoods; People with limited access to ongoing, high-quality primary health care; People who have experienced intimate partner violence; People with a history of incarceration and other justice-involved people. NYC HD also recognizes that people may have multiple, intersecting identities and that the seven categories listed above may not reflect all members of additional populations that are disparately impacted by HIV and/or face unique barriers to HIV prevention and care, including the following.
- Addressing Cross-Cutting Themes among Pillars.
- Considerations for Behavioral Health and History of Incarceration: More attention to people with a history of incarceration; trauma-informed care; Support policies and interventions that aim to combat mass incarceration of Black and/or Latino/Hispanic communities; Collaborate with behavioral health leaders to improve HIV prevention and care among people with serious mental illness; Provider training; Expand access to behavioral health services for people who use drugs.
- Provider Accountability: Disseminate community-informed language guide among NYC HD staff and BHIV-contracted providers to increase knowledge and support use of affirming and non-stigmatizing language; Increase awareness of the LGBTQ Health Care Bill of Rights; Provider training; Develop and implement scientifically rigorous and community-informed evaluations of BHIV-contracted programs and initiatives; Employ quality-based financing mechanisms for BHIV-contracted programs; Support and monitor inclusive hiring practices.
- Multi-sectoral Partnerships: Develop strategies to promote increased cross-sector engagement of local, state, and federal government agencies.
Ms. Torho also presented a series of cross-cutting issues that need to be addressed (Social and Structural Determinants of HIV-Related Health Inequities; The HIV service delivery System) and pillar-specific amendments, such as removing barriers to treatment for people with mobility issues, and increasing uptake of PrEP/PEP among young MSM of color. Additional points include: technology and the need to teach people how to use technology; tracking progress to determine our timeline and adjust work plans as needed, and defining “priority-led” organizations.
A summary of the discussion follows:
- Language around anti-racism is embedded throughout the plan.
- The language around training is kept intentionally broad to not limit it and can include mental health and substance use issues for first responders.
- More inclusive language can be used to describe faith-based and non-traditional venues.
- Molecular surveillance can be misused, but the plan’s language on this is broad. This method is already used by DOHMH/HIV Surveillance and is a key tool to optimizing the use of genotyping for drug-resistant HIV for all PWH. Also, New York State has strong legal privacy protections in place, unlike other states.
- There needs to be advocacy around lifting regulatory burdens to integrating medical and behavioral health care. The plan talks about integration of care generally.
- The plan needs to address burnout and self-care for staff.
A motion was made and seconded to accept the EHE plan as presented with the recommendations described above. The motion was restated and adopted by a roll call vote 36Y-0N.
Agenda Item #6: Third Quarter Commitment and Expenditure Report
Ms. Plummer presented highlights of the 3rd quarter commitment and expenditure report, pointing out the areas with higher than expected under-spending. Overall, as of the end of the third quarter (Nov. 30, 2020) programs are spending close to the expected 75 percent. Short-term Rental Assistance was 55% spent as of the end of the 3rd quarter. During the NYS Pause last spring, consumers were afraid to seek housing assistance/leave home, landlords were unwilling to show apartments, and staffing vacancies posed challenges to scaling up services. The eviction moratorium also prevented hundreds of evictions which would have resulted in increased costs to service category but never materialized. The full allocation is expected to be spent by the end of the year. Early Intervention Services and Non-Medical Case Management/Rikers also have higher underspending, the latter due to restrictions on visits to jails due to COVID-19. The Tri-County Mental Health program is severely under-spent despite ongoing technical assistance from BHIV. Steps will be taken to ensure that a provider is capable of providing the service in the region. Tri-County Medical Transportation is also under-spent due to the halt in in-person services due to COVID-19.
Cost-based reimbursement will continue indefinitely due to the pandemic. Contractors have been successful rearranging their reporting to accommodate this change and maximize spending.
There being no further business the meeting was adjourned.
Minutes approved by the HIV Planning Council on March 22, 2021
Graham Harriman, MA