Thursday, January 26, 2023
By Zoom Videoconference
Members Present: G. Harriman (Governmental Co-chair), D. Walters (Community Co-chair), B. Fields (Finance Officer), S. Altaf, R. Babakhanian, K. Banks, A. Betancourt, R. Brown, G. Bruckno, M. Caponi, R. Chestnut, J. Dudley, J. Edwards, R. Fortunato, M. Gilborn, J. Gomez, C. Graham, B. Gross, S. Hemraj, R. Henderson, B. Hribar, E. Kaywin, W. LaRock, M. Lesieur, D. Martin, N. Martin, H. Martinez, L. F. Molano, MD, J. Natt, H. Nguyen, J. Palmer, G. D. Plummer, M. Rifkin, J. Schoepp, M. Sedlacek, C. Simon, M. Soares, T. Troia, S. Wilcox
Members Absent: F. Alvelo, M. Bacon, M. Baney, L. Beal, F. Laraque, L. Sabashvili, M. Thompson
Staff Present: DOHMH: D. Klotz, M. Lawrence, D. Saab, S. Spiegler J. Acosta, S. Macias, G. Novoa, J. Colón-Berdecía, K. Mack, I. Newman, A. Eppinger-Meiering, T. Seabrook, B. Meisel, K. Miller, R. Torres, R. James; Public Health Solutions: B. Silver, G. Ashby-Barclay, R. Santos, A. Shahi
Agenda Item #1: Welcome/Introductions/Minutes/Public Comment
Mr. Harriman and Ms. Walters opened the meeting followed by a roll call and a moment of silence. The minutes from the December 22, 2022 meeting were approved with no changes. Mr. Harriman introduced Ms. Saab, who has joined the Council staff and will support the Needs Assessment Committee.
Agenda Item #2: Program Update: Psychosocial Support for TIGNCNB (PSS)
Mr. Meisel presented an update on the PSS service category, which provides an array of counseling services to help Transgender, Intersex, Gender Non-Conforming, and Non-Binary (TIGNCNB) people with HIV (PWH) cope with their diagnosis and psychosocial stressors. Services include individual, group and family counseling, caregiver support, pastoral care, and biomedical counseling. Clients may be referred to other health and support services and engage community health workers to facilitate access to services. The program goals and objectives were described (e.g., increase retention in HIV care and treatment and VLS, Provide coordinated access to medically appropriate levels of health and support services and continuity of care). Eligibility (aside from general RW eligibility) includes PWH of transgender and/or intersex experience including but not limited to people who identify as women, men, transgender, intersex, non-binary, non-conforming, gender fluid, or gender queer, with an emphasis on Black and Hispanic people.
Service activities include: outreach/targeted case finding, planning and assessment, supportive counseling (group, individual, family, biomedical), treatment adherence (health education, etc.), and service coordination (accompaniment, coordination, reengagement). The recommended staff model is a program director, clinical supervisor, case manager and patient navigator. The program started on September 1, 2021 with a 6-month start-up period. Two programs were funded (one each in Manhattan and the Bronx). Between April 1 and December 7, 2022, there were 42 total enrolled clients, 30 of them active clients. Behavioral Health Specialist in CTP’s Quality Management and Program Implementation (QMPI) Unit provides monthly quality management calls and program implementation consultation. Subrecipients of the PSS TIGNCNB programs report continued increase in client enrollment. A demographic breakdown of clients was provided (most were ages 30-49, 43% were Black and 50% Hispanic, 63% were transgender women).
Challenges implementing the program have included: staff hiring (including funding staff with TIGNCNB lived experience) and retention and client recruitment. Successes have included Support groups well attended by clients (including groups in Spanish), staff training on TIGNCNB issues and engagement with QM staff.
A summary of the discussion follows:
- The expectation for caseload in the first year was 60 per program, which is double the actual number. The hope is that the programs will continue to expand.
- The program is not exclusively for Black and Latino people, but those are the targeted populations.
- Programs are making referrals to usual resources (e.g., HASA), as well as trans-affirming care.
- Programs are paid through a mix of cost-based and performance-based (i.e., deliverable-based) reimbursement.
- There are two providers: Mt. Sinai (Manhattan) and Destination Tomorrow (a trans-led organization in the Bronx), but the Council does not consider contract-level data.
Mr. Harriman concluded by saying that PSRA will review this service category and its allocation after it has had more time to be fully implemented.
Agenda Item #3: Program Update: Oral Health Services (NYC)
Ms. Seabrook presented on the NYC Oral Health service category, which provides comprehensive, coordinated client-centered oral health care to improve the oral function and overall quality of life for PWH and to reduce complications, progression, and mortality due to HIV disease. The list of HRSA-defined allowable activities was presented (e.g., diagnosis and treatment, preventive care). Program goals were described (e.g., promote optimal health and quality of life resulting from the prevention, early detection and treatment of dental decay and periodontal disease, opportunistic infections, and other health-related complications, increase VLS). Service elements were explained (e.g., intake, palliative and restorative care) and the staffing model presented (including a NY State registered dentist and a program coordinator).
Programs started on September 1, 2022 with a 6-month start-up period. Three programs were funded (one each in Manhattan, Staten Island and the Bronx). Between September 1, 2022 and January 18, 2023, there were more than 50 total enrolled clients. Implementation challenges have included staff hiring and retention, data entry and client recruitment. Successes have included increasing enrolment and site visits.
A summary of the discussion follows:
- A behavioral risk assessment is part of the intake for all RWPA programs in order to make holistic referrals.
- There is strict payer of last resort monitoring for this, as for all RWPA programs. People who are not eligible for public assistance programs like Medicaid can enroll in these programs.
- The Council allocated enough for three programs, and all three applicants that applied were funded: H+H Jacobi (Bronx), H+H Gotham Health (Manhattan) and Community Health Center of Richmond (Staten Island).
- Initial site visits focus on staffing, workflow and client recruitment.
- Public Health Solutions and DOHMH work to market the RFP widely to prospective applicants.
- There are no waiting lists for programs and no reports of difficulties getting an appointment.
- Difficulties with eSHARE are known and CTP provides assistance. The Council’s Data Collection Workgroup will be issuing recommendations soon on ways to improve the system.
Mr. Harriman commended the quick ramp-up of these programs, which shows the high demand for these services.
Agenda Item #4: Implementation of the Council’s Disabilities Recommendations
Dr. Acosta presented on the implementation of the Council’s recommendations (approved October 2019) on improving access to RWPA services for PWH with disabilities. The recommendations were created in response to an analysis conducted by CTP that detailed the proportion and demographics of RWPA clients with disabilities. The recommendations covered broad areas (Data Systems, Training, Guidance and Compliance, Provider Resource Guide, and Access to Assistive Technologies). The Recipient described the work to date to implement the guidelines. Highlights include: revised eSHARE intake forms to include applicable questions from a validated screening tools for use by all RWPA providers, guidance distributed to RWPA providers recommending revisions to client records by including accommodation needs, worked with the Mayor’s Office for People with Disabilities to help identify a training for providers, and developed the “Resource Guide for RWPA Programs Serving People with Disabilities”. The Recipient will also work with RWPA programs and the Mayor’s Office for People with Disabilities to identify gaps in access for individual assistive technologies within RWPA programs and determine appropriate mechanisms for assistance.
A summary of the discussion follows:
- RWPA programs do not replace broken wheelchairs, but can make referrals to the needed resources.
- The Council did not ask for a geographic breakdown for the analysis of RWPA clients with disabilities, but that data could be requested.
Mr. Fields stressed how vital it is for people who use wheelchairs to always have a working mobility device, without which they have no independence or access to the outside world.
Mr. Harriman noted that the Recipient will provide an update in the coming months on the implementation of the new Ambulatory Outpatient Care for Aging PWH service category.
Agenda Item #5: Recipient Report
Ms. Macias reported that on January 17th, the CDC and HRSA released a program letter to encourage public health partners and grant recipients to implement status neutral approaches to HIV care and prevention. They expressed support of the use of braided funding to reduce barriers to implementation and to help extend the reach of status neutral services.
In the recently enacted Congressional Omnibus budget bill, MAI funding was increased (including $1.5M for RWPA nationally), and legal language was added to prioritize grants to minority led organizations that have the cultural competence to effectively serve minority communities. On January 19th, the Recipient received the Partial Notice of Award for the GY 2023 RWPA grant in the amount of $15,541,810 (approximately 26% of the current Formula and 16% of MAI awards). Final awards will be processed as soon as HRSA receives the full GY 2023 appropriation amount. HRSA will conduct a 5-day virtual site visit for the RWPA program in the NY EMA from May 15-19, 2023.
The CTP website is in the process of being revamped. The webpage will include: a list of RWPA programs in the NY EMA by borough/county with links to each organization’s website, program descriptions and services offered, an annually updated RWPA Programs Directory with program-specific information for the NY EMA, and links to other programs (e.g., ADAP). Some of this information is already on the Council’s website.
The Recipient is scheduled to conduct a presentation to the Council’s consumer committee on March 7th to obtain consumer input for the Quality Management Plan. A second presentation is scheduled on March 30th for the Recipient to present the final draft of the Quality Management Plan to the full Council.
Mr. Harriman noted that, while there is no guidance from HRSA yet, the shift on MAI funding may require some planning, as the focus had been exclusively on the clients served, not the agency that provides the service.
Agenda Item #6: Planning Council Chairs Update
Mr. Harriman reported that modifications to the usual Council meeting schedule. In February, the Executive Committee will be on the fourth Thursday (Feb. 23rd) and the full Council meeting will be on March 2nd, where there will be vote on the PSRA’s GY 2023 spending scenario plan and an update on the NYC EHE and Project PROSPER programs.
Agenda Item #7: Public Comment
Mr. Palmer and Mr. Lesieur reported that action on the 340b program is expected soon, and that advocates are hoping to come up with a solution that will save funding for HIV service providers. Mr. Martinez added that all the State’s SNP plans have submitted a letter to the Governor in support of extending the program.
Mr. Lesieur explained that the lifting of the public health emergency means that the suspension of recertification for public benefits has ended. All 7.5 million Medicaid recipients in NY State will need to get recertified in the coming months or risk losing their coverage.
Mr. Soares stated that the Recipient needs to ensure that all RWPA providers have client advisory boards to ensure that the consumer voice is amplified.
There being no further business, the meeting was adjourned.