Planning Council Meeting Minutes February 28, 2019

HIV HEALTH AND HUMAN SERVICES
CUNY Law School, 2 Court Square West, Long Island City, NY
Thursday, February 28, 2019 3:00-5:00 PM
MINUTES

Members Present: J. C. Park (Governmental Co-chair), M. Lesieur (Community Co-chair), S. Hemraj (Finance

Officer), M. Bacon (by phone), K. Balovlenkov, M. Baney (by phone), F. Barrett, D. Beiling, R. Bruce, P. Carr, R. Chestnut, B. Cockrell (by phone), M. Domingo, B. Fields, T. Frasca, MPH, C. Graham, B. Gross, G. Harriman, J.

Hudis, C. Kunzel, Ph.D. (by phone), O. Lopez (by phone), M. Mackey, J. Maldonado, M. Mañacop, L. F. Molano,

M.D., J. Natt, D. Powell (by phone), S. Reyes, A. Roque, J. Schoepp, C. Simon (by phone), A. Straus, M. Thompson 

Members Absent: A. Abdul-Haqq, L. Best, A. Betancourt, E. Casey, M. Diaz, J. Dudley, J. Edwards, B. Fenton, MD, S. Grant, J. LiGreci, A. Lugg, C. Reyes, R. Rios-Vergara, M. Singh, D. Walters, B. Zingman, MD 

Staff Present: DOHMH: D. Klotz, D. Wong, M. Lawrence, J. Colón-Berdecía, A. Guzman, A. Thomas-Ferraioli, K.

Mack; Public Health Solutions: B. Carroll (by phone), G. Kaloo; WCDOH: J. Lehane, PhD (by phone); J. Corbisiero (Parliamentarian)  

Mr. Park and Mr. Lesieur opened the meeting, followed by introductions and a moment of silence.  The minutes of the January 31, 2018 meeting were approved with no corrections. 

Mr. Harriman reported that pursuant to the Grantee’s federal conditions of award, the following reports are due to HRSA in the coming months: 1) FY2018 Part A Annual Progress Report and Program Expenditure Report, due May 29, 2019; 2) FY2019 Program Terms and Program Submission report, due April 20, 2019. 

Care Coordination Implementation is proceeding, with site visits currently underway to care coordination programs.  Since August 2018, eight new programs have launched and nine programs have transitioned from the previous program model to the new program model.  So far, the Care and Treatment Program (CTP) has held two orientation meetings for care coordination program directors and managers on August 16 (transitioning programs) and October 31 (new programs).  Eight programs are still implementing the previous program model but will transition to the new model in May 2019.  To help Care Coordination programs plan for the transition to the new program model, CTP provided them client-level, surveillancebased client progress reports (CPRs) showing the viral suppression status of all active clients and provided guidance on the use of the reports through webinars. After the distribution of the reports, providers were asked for their feedback on the reports and possible usefulness for other Ryan White-funded programs like mental health and harm reduction.  In March, the program plans to release a full 2018 CPR to re-funded Care Coordination Programs.

Consumers Committee Mr. Fields reported that at the most recent Consumers Committee meeting, members met with Recipient staff to discuss issues with the eShare intake and reassessment forms.  Members expressed concerns that many of the questions – particularly around sexual behavior – were intrusive, traumatizing, duplicative or embarrassing.  Also, many of the questions are redundant and not necessary for a 6-month reassessment.  Also, the Quality Management Sub-Committee reviewed research in the Mental Health and Harm Reduction domains.

Mr. Harriman noted that some of those questions were legacies from past iterations and that the Recipient is working to remove some.  It is a challenging system to change, but DOHMH looks forward to working with the Consumers Committee to improving it.  Other comments on the issue included:

• There are no intake questions about oral health.  This would be an ideal time to assess a client’s needs and make referrals.  
• The master service directive needs to be updated to include referrals to a wider range of services, including those not provided by Part A (e.g., oral health in NYC).
• Open-ended questions can be a more effective and less intrusive way of gleaning information on certain issues.
• Integrated data systems can help reduce burden on both providers and consumers.
• DOHMH should look into pooling resources with the AIDS Institute to train intake staff on motivational interviewing.

Needs Assessment Committee (NAC)

Ms. Thompson reported that NAC is continuing is work on disabilities, including the challenges of aging, and how to ensure that all services are completely accessible and meet consumer needs.  The Committee is planning for a town hall in May, which will be used along with the findings from the committee meetings to develop a set of recommendations by the end of the planning cycle. 

Mr. Carr reported that the NAC’s Oral Health Sub-committee has met twice.  At one meeting, there a Part F provider called in to talk about preventative care, what Medicaid covers, and how oral health can affect nutritional health.  The sub-committee also examined the Tri-County Oral Health Service Directive.  The sub-committee is looking at where the gaps in services are with an aim towards making recommendations to the full committee. 

Integration of Care Committee (IOC)

Ms. Beiling reported that IOC recently heard from consumers and providers on the housing resources landscape as part of their work on revising the service directive for Transitional Care Coordination.  Ms. Lawrence reported that a TGNB Sub-committee is drafting recommendations for inclusion in the Master Directive based on last year’s NAC work. 

Tri-County Steering Committee (TCSC)

Ms. Straus reported that the TCSC is almost complete with their review and approval of the Standards of Care for services that are unique to Tri-county.  In January, TCSC completed Medical Transportation, Oral Health, Psycho-social Support, and Emergency Financial Assistance.  The Committee did not meet in February, but at its March 13^th meeting, they will complete the final two SOCs: Housing and Medical Case Management (which are different models than those categories in the NYC portion of the EMA).  At the March meeting, there will also be a Tri-county-specific epidemiology and surveillance update from the NY State AIDS Institute.  That information will be made available to the full Council, as it is important for the Council to understand the picture of the epidemic throughout the EMA.

Priority Setting & Resource Allocation Committee (PSRA)

Ms. Hudis reported that PSRA met two weeks ago and had a presentation from Ms. A. Casey on an updated Payer of Last Resort (POLR) tool.  The new tool is more tightly focused on core medical services and government payers of those services, such as Medicaid, Medicare, other Ryan White parts, etc.  The presentation gave the committee a good understanding of services and populations that are not covered by other payers, as well as how Part A services are coordinated with other payers.  This will be an important tool to use as we look at areas in the Part A portfolio where PSRA might want to make adjustments to allocations for the FY 2020 application spending plan.  Next month, the Committee will be reviewing new service category Fact Sheets, which provide both service category data (e.g., on spending rates), as well as analysis of systems-level changes that may impact the delivery of services.

In response to a question from Mr. Lesieur, Ms. Hudis noted that changes in POLR issues stemming from decisions by the State Medicaid Redesign Team were discussed, and that the PSRA intends to keep updated on these, such as to reimbursement for behavioral health services.  It was also noted that CBOs that provide counseling and therapy services may need assistance to be able to develop the systems they need to become providers that can bill Medicaid.

Rules & Membership Committee (RMC)

Mr. Klotz, on behalf of Ms. Barrett, reported that, after a year of painstaking work, RMC, in cooperation with the Recipient staff, completed its work on the revision of the Council-Recipient Memorandum of Understanding.  The MOU describes the two parties’ roles and responsibilities and governs communications and other aspects of our relationship.  After their site visit last March, HRSA advised the EMA, that we needed to revise the MOU, which was originally adopted in 2011.  The revised MOU brings the document up to date with changes in the Ryan White legislation and HRSA policies, as well as with changes in titles and the reporting structure at DOHMH.  The tone of the document is more positive and collaborative, with realistic time frames for things like requesting data and issuing reports.  The revised MOU was presented to the Executive Committee last week, which approved it, with the exception of one outstanding issue regarding the process for deciding the Planning Council support budget.  We expect this issue to be resolved by the next EC meeting in March.  The revised MOU is also being reviewed by HRSA Project Officer Sera Morgan, as well as the DOHMH Legal Department.  After RMC receives their feedback, they and the Recipient will draft a final version, which will be presented to the EC and the full Council for ratification.  Details of the MOU will be presented to the full Council at that time.  At its next meeting, RMC will begin revising the Council’s Grievance Procedures, which is another task that HRSA has asked us to complete based on last year’s site visit.

Mr. Guzman presented briefly on the following policy issues:

On Feb. 6, 2019, the U.S. Attorney for the Eastern District of Pennsylvania filed a civil suit to prevent the establishment of a safe injection facility (SIF) in Philadelphia. The suit, which names Safehouse, the nonprofit planning to open the SIF, seeks a judicial decree that establishing a SIF would violate federal law. 

On Feb. 25, 2019, community advocates held a press conference and rally in Foley Square in Lower Manhattan to launch Decrim NY, a coalition that “advocates and organizes to shape New York City and State policy and public opinion around people in the sex trades. We seek to improve the lives of people who perform sexual labor by choice, circumstance, or coercion, people profiled as such, and communities impacted by the criminalization of sex work and sexual exchange.”  The goals are: decriminalize sex trade related offenses in New York, decarcerate people who have been arrested on sex trade-related offenses, and destigmatize the sex trade so that workers have access to housing, education, employment, health care, and other basic needs without restriction. 

On Feb. 5, 2019, the president delivered his 2019 State of the Union (SOTU) address, during which he announced his Administration’s plan to end the HIV epidemic by 2030.  Following the SOTU, HHS announced “Ending the Epidemic: A Plan for America”, a set of strategies to reduce new HIV infections by 75% in five years, and by 90% in 10 years by targeting states and counties with the highest burden of HIV.  The initiative will target 48 counties, Washington, DC, San Juan, Puerto Rico, and seven states that have a substantial rural HIV burden with additional expertise, technology, and resources.  The 48 counties include four in New York State: Bronx, Kings (Brooklyn), New York (Manhattan), and Queens Counties.  Funding will be used to increase investment in these areas through existing, effective programs, such as the Ryan White HIV/AIDS Program, as well as new programs through community health centers that will provide medicine to protect persons at highest risk from getting HIV.  Data will be used to identify where HIV is spreading most rapidly and guide decision-making to address prevention, care, and treatment at the local level.  Key strategies to achieving its targets are: 1) Diagnose: Implement routine testing during key healthcare encounters and increase access to and options for HIV testing; 2) Treat: Implement programs to increase adherence to HIV medication, help people get back into HIV medical care and research innovative products that will make it easier for patients to access HIV medication; 3) Protect: Implement extensive provider training, patient awareness and efforts to expand access to PrEP; and 4) Respond: Ensure that states and communities have the technological and personnel resources to investigate all related HIV cases to stop chains of transmission.  The U.S. Department of Health and Human Services (HHS) released a blog, “Ending the HIV Epidemic: A Plan for America”, launched a new page on its HIV.gov website, “What is ‘Ending the HIV Epidemic: A Plan for America’?” and a fact sheet.  New York City Health Commissioner Dr. Oxiris Barbot released a statement in response noting that HIV cannot be combatted while other administration policies try to restrict access to insurance and target LGBTQ and other communities most affected by HIV.

So far, the amount proposed for this initiative is very small, but there will be more information next month about whether Ryan White Part A will be one of the mechanisms that will be used to implement the initiative and what that may mean for the EMA’s funding.  There were also concerns that under the current administration, investigation of clusters of infections may be dangerous for people, particularly those who live in states with HIV criminalization laws.

In the Feb. 8, 2019 issue of the Federal Register, HHS published a notice soliciting public comments on the next iteration of the National HIV/AIDS Strategy (NHAS), due Mar. 11, 2019. The notice calls for input on ways to improve efficiency, effectiveness, coordination, and accountability of HIV prevention, care, treatment, and cure policies, services, and programs. The current NHAS: Updated to 2020 is organized around four goals: 1) Reducing new HIV infections; 2) Improving access to care and health outcomes; 3) Reducing HIV-related health disparities; and 4) Achieving a more coordinated national response.  Ms. Balovlenkov urged people to offer comments about the harmful effect of restrictions on use of federal funds for syringe exchange.  

Mr. Harriman presented highlights of the presentations given by representatives of the New York EMA at the 2018 National Ryan White Conference, which is the largest national conference for comprehensive HIV care and treatment providers, Ryan White HIV/AIDS Program recipients, and stakeholders.  Sponsored by HRSA, the conference’s theme was “Catalyzing Success: Advancing Innovation. Leveraging Data. Ending the HIV Epidemic”.  The conference provides a forum to share best practices and strategies to assist with the facilitation of a coordinated response to the HIV Epidemic.  The following is a summary of the presentations:

The Undetectables Framework: Using Quality Improvement to Achieve 90-90-90 Targets (G. Harriman, M. Feldman, et. al.).  Translating a data-to-care model to an effective systems-level intervention to achieve and sustain viral suppression through the distribution of treatment status reports on individual clients who do not appear virally suppressed; and HIV surveillance-based reports comparing the proportion of an agency’s  RWPA clients with viral suppression to the proportion of all NYC RWPA clients with viral suppression Successful Hepatitis C (HCV) Strategies within the Ryan White HIV/AIDS Program (A. Casey, et. al.).  Explained the importance of treating HCV in PLWH and to identify potential RW eligible individuals who are not able to access affordable treatment, and create a streamlined application process to improving their access to medication.

The Consumer-led QI Project: Integrating PLWHA’s Lived Experiences into Recommendations for HIV Care Quality Improvement (D. Wong, B. Fields, C. Rodriguez-Hart).  Through the use of participatory research methods, evaluates how to establish positive consumer-provider relationships from the perspectives of PLWH.

The Power of QI: Promoting Peer Learning and Engagement for Quality Improvement (J. Carmona, T. Hatton, G. Harriman, et. al.).  Describes the process and strategy to promote peer learning in quality management and improvement, and demonstrates the utility of participatory research methods in QI, and the importance of capacity building for consumers to carry out QI activities.

Leveraging the Ryan White System to Improve Access to PrEP and other Services (K. Belfon, J. Carmona, et. al.).  Leveraging the RWHAP system to support access to PrEP services, and other medical and support services. 

Leveraging Ryan White Resources to Promote Status-Neutral Approaches for Sex Workers and Crystal Meth Users (F. Silva, et. al.).  Addresses crystal meth use among MSM and sex workers to reduce the risk of HIV infection and improving HIV treatment outcomes through a status-neutral care coordination approach.

Translation of a RWHAP-Funded, Evidence Informed Intervention for Broad Scale-Up & Sustainability (K. Penrose, et. al.).  Translates a Ryan White-funded intervention for dissemination through an online toolkit.

Other NY EMA presentations and posters included: Integrating HCV Cure into HIV Care; Data Communities of Practice: Use, Quality, and Action; Breaking down silos: Data sharing and integration to assess and strengthen the HIV Care Continuum; Ending the Epidemic: Maximizing Communication Between Program and Evaluation to Strengthen the Care Continuum; Data to Care Initiatives within Ryan White HIV/AIDS Program Part A Jurisdictions; Getting to Zero: Improving the Quality of Ryan White Services Report Data: The New York City Experience; Support services use and unmet need among Ryan White medical case management program clients in NYC.  HRSA also sponsored panels on topics like the Core Medical Services Waiver, and how to build meaningful involvement (which Mr. Fields participated in as a panelist).

In addition, the CAEAR Coalition held a town hall in collaboration with NASTAD, AIDS Institute (FL), HIV Dental Alliance, RW Medical Providers Coalition, AIDS Alliance for Women, Infants, Children, Youth and Families, and NE/Carribean AETC to inform policy discussions with Congress and the Administration regarding any future reauthorization of the Ryan White HIV/AIDS Program.

Full presentations can be found on the Target HIV website:

https://targethiv.org/library/2018-national-ryan-white-conference-presentation-slides

There being no further business the meeting was adjourned.