Planning Council Meeting Minutes February 29, 2024

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Thursday, February 29, 2024

3:05-5:00 PM

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, P. Carr, J. Edwards, R. Ford, R. Fortunato, M. Gilborn, C. Graham, S. Hemraj, R. Henderson, J. Henson, 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. Thompson, T. Troia, S. Wilcox

Members Absent: F. Alvelo, M. Bacon, M. Baney, R. Brown, G. Bruckno, M. Caponi, V. Decamps, J. Dudley, J. Goldenbridge, J. Gomez, B. Hribar, F. Laraque, W. LaRock, N. Martin, H. Martinez, M. Sedlacek, C. Simon, G. Ty

Staff Present: DOHMH: D. Saab, S. Spiegler, J. Acosta, A. Eppinger-Meiering, S. Kramer, G. Gambone, I. Grant, B. Meisel, K. Mack, F. Abdelqader, M. Dorsheimer, P. Chan, J. Jaramillo, A. Prince; Public Health Solutions: A. Shahi, 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 January 25, 2024 meeting were approved with no changes.  In honor of Black History Month, Ms. Saab presented on Black history makers in the fight against HIV.

Agenda Item #2: Public Comment, Part I

Mr. Carr reported on a recent HRA/HASA policy change that mandates check-in visits to clients in congregate and scattered site housing as often as twice a month, which can be intrusive for many clients.  

Mr. Fields promoted a new AARP Blueprint for Action for Older Adults.

Agenda Item #3: Recipient Report

Ms. Eppinger-Meiering reported news from HRSA and other federal agencies, including commemorating National Black HIV/AIDS Awareness Day, a new infographic summarizing data on clients served by and health outcomes among people getting HIV-related medical care from the Ryan White Program, and a new tool to better understand the basics of Medicare-Medicaid dual eligibility.    Registration for the 2024 National Ryan White Conference on HIV Care & Treatment (NRWC) is opening in the month of February.  The 2024 conference will be a hybrid event with unlimited attendance for virtual participation.

A concept paper for the forthcoming RFPs for Behavioral Health and Non-medical Case Management/ Inmates & Releasees will be released on March 14th.  A timeline of the RFP was reported, with programs to start March 1, 2025.  Ms. Plummer added that the Recipient is limited in what can be said publicly about the upcoming RFP, but she encouraged potential applicants to submit strong proposals, as it will be a competitive bid.  The Quality Management (QM) Committee for the NY EMA met to discuss updates and feedback on subrecipient quality management trainings.  The QM Program is also collaborating with the Consumer Committee to address concerns about Consumer Advisory Boards (CABs). After a productive dialogue between committee members, the CTP QMPI Unit, and AIDS Institute partners at the Consumer Committee meeting in January, three concrete projects have been identified: 1) survey to RWHAP Part A subrecipients on the current status of CABs; 2) updated version of the Consumer Committee’s existing recommendations and best practices for CABs; and 3) development and delivery of a Consumer Committee-led session at the 2024 RWHAP A Provider Meeting in July. 

There were updates on federal hepatitis policy and the CDC’s new state profiles on sexual health policy and data landscapes among schools in select states, including New York.

Agenda Item #4: Revised Directive: Non-Medical Case Management/Inmates & Releasees (NMI)

Ms. Fortunato presentedthe revised service directive for NMI, approved by the Integration of Care Committee (IOC) on January 24th.  NMI) is a program to support RWPA eligible clients who are being held by the NYC jail system and those who have been recently released from NYC or NYS jails and returned to the EMA.  There are two unique components to this program.  One delivered on Riker’s Island by Correctional Health Services (CHS) which is part of NYC Health and Hospitals Corporation (H+H).  CHS is the only entity who can provide these services to clients held by NYC’s jail system.  The second component, delivered by a non-profit community-based organization, works with clients once they’ve been discharged to support re-entry and link clients to care. This is bid through a competitive request for proposal.  (New RFP out soon for services beginning March 1, 2025).  The goals of the program are to provide support services to soon-to-be released and recently released innates living with HIV to ensure engagement in ongoing HIV medical care and support services, and provide advice and assistance to PWH in obtaining medical, social, community, legal, financial, and other needed services to improve their physical and mental health status.  IOC added a new goal to reduce disparities in health outcomes for PWH involved with the correctional system.  The goals from the new Integrated Plan that align with the program goals were revised.

Key activities of the program were described (e.g., initial assessment, client advocacy, reevaluation).  Details of the service model were given: Provide HIV-specific discharge planning to incarcerated individuals living with HIV in New York City correctional facilities to ensure linkage to medical care through referral to medical case management, oral health services, mental health services, alcohol and substance use services, and housing services post-release.  Provide time-limited (pre-release and 90 days post-release) assistance with benefits and entitlements, including enrollment in/restoration of Medicaid and ADAP resources, treatment education, risk reduction counseling, linkage, referral and follow-up for recently released individuals living with HIV. 

These programs have access to some of the most vulnerable and hardest to engage clients across the city.  This is a vital program for engaging PWH and linking them to care.  IOC received data and reports from the Recipient, providers and clients that attest to the success of the service model.  No substantive changes were made to the service model.  Minor tweaks included: post-1115 Medicaid Waiver allows enrollment in Medicaid prior to release, and the addition of oral health to list of referrable services.  There are no changes to Client or Agency Eligibility Criteria.

On behalf of the IOC, Ms. Fortunato made a motion to accept the revised service directive as presented.  The motion was adopted 22Y-0N. 

Agenda Item #5: Third Quarter Expenditure Report

Mr. Fields introduced the 3rd quarter expenditure report, noting that as part of the Council’s mandate to assess the efficiency of the administrative mechanism, we receive quarterly expenditure reports from the Recipient.  The report covers the grant year from March 1 to November 31, 2023.  As of the end of the 3rd quarter, overall spending is close to the target of 75%, with the exception of certain categories that will be explained by the Recipient.

Mr. Spiegler presented the details of the report.  Categories in the NYC Base portfolio with higher than expected underspending (<70%) include: NMI (due to staff vacancies and a deliverables-based budget that often is reimbursed in the 4th quarter), Mental Health and Oral Health (due to POLR issues); Supportive Counseling (due to a contract termination); Psychosocial Services for TGINBNC (staff issues and low client enrollment).  In Tri-County (TC), Medical Transportation is rebounding from COVID, but still slightly underspent due to the delivery of some telehealth services.  It was noted that there will always be a demand for in-person appointments.  Also, Legal Services is underspent due to a contract termination.  NYC and TC Base and MAI Mental Health and Early Intervention programs are all experiencing underspending and IOC is reviewing the EIS service directive for an upcoming rebid.

In response to a question from Mr. Carr, it was explained that the time lag required to complete the spending analysis (reconciling all invoices and payments, etc.) means that there is always a delay in reporting.  The timing of the quarterly reports is outlined in the Council/Recipient Memorandum of Agreement.  Also, it was explained that underspending is reprogrammed as per the Council’s reprogramming plan, approved near the beginning of the grant year.  Takedowns are used to enhance overperforming programs within the same service category.  If there are no more available enhancements in that category, the Council authorizes the Recipient to enhance overperforming programs in a different category up to a maximum of 20% over that category’s original allocation.  Any further enhancement above 20% (a rarity) requires Council approval.  The bulk of the reprogramming occurs in the final quarter and is reported in the 4th quarter close-out report.  It was added that the PSRA Committee will review allocations for categories that have chronic spending issues due to POLR and enrollment issues.  

Ms. Plummer added that any contract terminations over the course of the year were due to subrecipients (provider agencies) deciding to end their contracts.  Often, it was due to issues related to staff retention and administrative burden.  The Recipient is working to reduce the burden of data collection and reporting, including by reducing the number of questions required on intake forms.  

Agenda Item #6: NYC RWPA Oral Health Service Implementation Update

Ms. Gambone and Ms. Grant presentedan update on the implementation of the NYC Oral Health Services (OHS) programs.  OHS supports comprehensive, coordinated client-centered oral health care to improve the oral function and overall quality of life.  Clients receive an initial intake assessment and periodic reassessments to develop a comprehensive service plan that includes a scheduled plan of treatment.  Services include outpatient diagnosis, prevention, and therapy provided by dental health care professionals, including general dental practitioners, dental specialists, dental hygienists, and licensed dental assistants.  Ancillary services are also allowed (e.g., behavioral risk assessment and referral).  Program goals were described and eligibility (same as all RWPA programs).  The list of program services was listed, such as preventive care (oral health education, hygiene, sealants), and restorative work (root canals, bridges, dentures and implants).  The program staffing and duties were described (e.g., dental program coordinator).

There are three funded programs, two of which started September 1, 2022 with a six-month start-up (one program start date changed to 03/01/2023 because contract execution was significantly delayed by the subrecipient’s internal legal and administrative processes).  The programs are located in Manhattan, Bronx and Staten Island.  More than 160 clients have been enrolled since the programs started.

Challenges faced in the initial program implementation were in the areas of hiring a program coordinator, understanding the program model, integrating the program into established clinics, documentation and data entry, payor of last resort (POLR), and client recruitment.  Program successes have been in the areas of staffing with dental providers, staff retention, client enrollment steadily increasing, improved understanding of the model and reporting, and quality improvement projects.  

Data on clients and service utilization for the period from January 1, 2023-December 31, 2023 were provided.  There were 167 clients served and 736 units of service provided.  The most commonly provided type of service was restorative treatment.  Hygienist and palliative treatment were also commonly provided.  Clients were 37% over the age of 50 and 43$ between 30-49.  43% of clients were Black and 33% Latino/a.  58% were cisgender male, 37% cisgender female, and 5.4% transgender.  72% were enrolled in Medicaid, 20% in ADAP and 14% in Medicare. 

In response to questions about how consumers can learn about the availability of these services, it was explained that the Care & Treatment Program works to inform the community through the RWPA Referral Directory (also available on the Council website), and through provider networks, who then inform their clients.  DOHMH is also working on a new online Health Map that will include all RWPA services.  It was suggested that the 311 system be utilized.  Also, other RWPA programs should include a question about oral health needs in their intakes so that clients can be referred.  It was noted that there are numerous Part F dental programs, and one was reported to have a waiting list.

Agenda Item #7: Public Comment, Part II

Ms. Thompson reported that she will soon leave the Alliance for Positive Change and relocate, but will continue to serve on the Council and as Needs Assessment Committee co-chair until the end of her term. There being no further business, the meeting was adjourned.