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, M. Baney, K. Banks, R. Brown, P. Carr, V. Decamps, J. Dudley, J. Edwards, R. Ford, R. Fortunato, M. Gilborn, C. Graham, S. Hemraj, R. Henderson, 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, M. Thompson, T. Troia, G. Ty, S. Wilcox
Members Absent: F. Alvelo, M. Bacon, G. Bruckno, M. Caponi, J. Goldenbridge, J. Gomez, J. Henson, B. Hribar, F. Laraque, W. LaRock, N. Martin, H. Martinez, C. Simon
Staff Present: DOHMH: D. Saab, S. Spiegler, J. Acosta, A. Eppinger-Meiering, S. Kramer, K. Mack, C. Burt, F. Abdelqader, J. Carmona, R. James, M. Dorsheimer
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 December 21, 2023 meeting were approved with no changes.
Agenda Item #2: Public Comment, Part I
Mr. Babakhanian invited Council members to join the Consumers Committee in an effort to expand consumer involvement in the Council by reaching out to members of client advisory boards (CABs) at HIV service agencies as well as other avenues. Ms. Plummer offered the resources of the Recipient to partner in that effort.
Agenda Item #3: Recipient Report
Ms. Eppinger-Meiering reported news from HRSA and other federal agencies, including Notices of Funding Opportunity for workforce development funding under the AIDS Education and Training Centers (AETC), and integration of behavioral health services into primary care settings using telehealth technology. The national RWHAP work was also recognized by the POZ Magazine in their December 2023 edition. HRSA also encouraged all RWHAP stakeholders to subscribe to their listserv.
HRSA issued a partial GY 2024 Part A award. As HRSA is operating under a Congressional continuing resolution, this award provides partial funding (approximately 45% Base Formula and 29% MAI) based on the continuation of GY 2023 funding levels. Final awards will be processed as soon as HRSA HAB receives the full FY 2024 Congressional appropriation amount for this program. The partial award allows the EMA’s RWPA program to continue operating without service disruption.
RWPA subrecipients have wrapped up their quality improvement (QI) projects for the 2023-2024 contract year focused on various areas such as engaging consumers for feedback on program services, viral load suppression, connections to social support services, and improving documentation of delivered services. An all-provider QI meeting is scheduled for July and will include a Consumers Committee workshop on client advisory boards.
The federal government approved the NY State 1115 Medicaid waiver, which includes a series of actions to restructure the state’s Medicaid program to promote health equity and improve health care delivery and outcomes for nearly 7.6 million Medicaid enrollees statewide. More information will be provided to the Council.
Agenda Item #4: GY 2024 Spending Scenario Plans
Mr. Carr and Ms. Gilborn presented the GY 2024 spending scenario plan, which is a methodology for implementing the final award, from a worst-case scenario of a 3.5% reduction to an increase. The plan was approved by the Priority Setting & Resource Allocation Committee last week. The draft federal budget has no change proposed for RWPA nationally, which means that any potential reduction should be much less than worst-case scenario. In any funding scenario, the PSRA Committee recommends:
- Regardless of the grant award amount, flat funding for Tri-County (TC), with $117,982 in uncommitted funds (from the Legal Services category due to a rescinded contract) reallocated to Medical Case Management.
- Regardless of the grant award amount, $931,957 in one-time additional funding for NYC Housing Programs to transition clients in two programs that are ending on February 29 due to the rebid of the NYC RWPA programs.
- Regardless of the grant award amount, funding the Health Education and Risk Reduction (HER) service category for 6 months for a savings of $292,695 (the service model will be incorporated into new Behavioral Health Programs in GY 2025).
There are also uncommitted funds available to offset a reduction in the award from four service categories: Harm Reduction, Supportive Counseling, Legal Services and HER. In a reduction scenario the uncommitted funds will be used to offset a reduction, with ADAP absorbing any reduction beyond the uncommitted funds. In a flat funding scenario, any available uncommitted funds will be used to restore the baseline allocation of the Behavioral Health Categories (Hard Reduction, Mental Health, Supportive Counseling) in anticipation of the rebid of those programs for GY 2025. If there are still uncommitted funds available after restoring the BH categories, it will be allocated to Food & Nutrition Services, as per the application spending plan.
Ms. Gilborn, on behalf of the PSRA Committee, moved that the Planning Council approve the GY 2024 spending scenario plan as presented.
Ms. Thompson noted that ending the HER program will leave a 6-month gap in the service and affect the employment of staff and peers, which is a reason to extend the programs until the end of GY 2024 in a flat funding scenario. Also, there is no guarantee that any proposers under the BH RFP will apply to deliver a self-management program. It was explained that the program delivers discrete time-limited trainings and does not require continuous service delivery, like Housing. Also, the BH category allocation is over $13M and will fund about two dozen programs, thus the likelihood is high that there will be multiple applicants to deliver HER services. Finally, multiple evidence-based self-management models will be allowed, not just the Positive Life Workshop curriculum.
A vote was taken and the motion was adopted 31Y-1N.
Mr. Carr encouraged all Council members to participate in the PSRA Committee, as setting priorities and allocations is the core function of the Council and has a big impact.
Agenda Item #5: 2022 Ryan White Part A Enrollment Report
Mr. Abdelqader and Ms. Burt presented the 2022 RWPA enrollment report, which provides data (collected in eShare) on newly enrolled and active clients in the entire EMA’s portfolio of services, broken down by demographics, transmission category, priority population, region and service category. Clients were counted if they Had an open enrollment during the GY of interest in at least one RWPA program and if they received at least one service in RWPA programs during the year.
In general, the number of clients with an open enrollment who received RWPA services was similar in GY 2022 and GY 2021. In 2022, there were 3810 newly enrolled clients (362 of those in TC). There were 11,163 active clients in the EMA (940 of those in TC). The numbers per service category (not including testing contracts) were described, with Care Coordination having the most clients (3840). From 2021 to 2022, the number of active clients in RWPA programs increased slightly for Food and Nutrition, Mental Health, and Housing services; and decreased slightly for Harm Reduction, Health Education, Legal, and Supportive Counseling services. In NYC, bout 53% of clients are over 50 years old, 38% between 30-49 years, and 8.6% 18-29 years. 64% are cisgender men, 29% cisgender women, 5.5% transgender women. 49% are Black, 40% Hispanic/Latino/a. 39% were heterosexual, 44% MSM. For TC, those demographics differ from NYC (i.e., TC clients are more heavily heterosexual). 30% of NYC clients live in the Bronx, 29% Brooklyn, 19%, 15% Queens, 3.5% Staten Island. Of TC clients, 65% live in Westchester, 13% Rockland, 1% Putman and 10% Bronx. Among active clients in NYC, a majority are from at least one priority population (53% over 50, 37% Black or Latino MSM, 28% cisgender women of color, 35% people with a disability). There are similar percentages in TC.
Highlights of the ensuing discussion follows:
- RWPA TC Housing programs are limited in the number of people they can serve due to the size of their contracts. The programs also only provide one type of service (short-term housing), unlike NYC RWPA Housing services, which also provider rental assistance and housing placement assistance.
- The data is for the most recent full year. We are still currently in GY 2023. More current data can be provided for specific planning needs.
- GY 2020 was an anomaly due to the COVID-19 pandemic when there was a steep decline in service delivery, but there has been a general rebound since then.
- Classification as a person with a disability is taken from the intake forms where clients identify if they have one of the listed characteristics.
- There is a far larger proportion of people who identify heterosexual sex as their transmission risk in TC. Data is based on self-reporting, so there might be some cases where people with MSM risk do not report accurately at intake.
- Women and people with heterosexual risk have always been overrepresented as RWPA clients compared to the general population, since RWPA programs target lower income PWH.
- The Emergency Financial Assistance category is listed among the TC programs because the one provider is located there, but the program serves the entire EMA and most clients are from NYC. There will be a fuller report on the EFA program at a future Council meeting.
Agenda Item #6: Council/Recipient Strategic Planning Retreat: Prioritized Next Steps
Mr. Martin presentedthe list of next steps from the Council/Recipient retreat, refined and prioritized by an ad hoc committee of Council members and Recipient staff. The next steps were grouped into categories of “easy”, “moderate” and “difficult”. Mr. Klotz noted that some of the easy steps have already been taken or are in progress, such as sending out the HRSA RWPA Primer, holding briefings before votes on complex issues, providing committee updates, and involving the Recipient in the early stages of planning. Ms. Saab extended an invitation to Council members to plan a quarterly lunch. Mr. Schoepp added that periodic meeting evaluations should be resumed. Mr. Maia added that the list can be prioritized by what can have the biggest impact.
Agenda Item #7: Public Comment, Part II
Mr. Schoepp suggested that the Council monitor the issue around United Health Care and Mt. Sinai, as it might impact RWPA programs.
Mr. Maia urged a great push for health equity. There being no further business, the meeting was adjourned.