Thursday, January 27, 2022
By Zoom Videoconference
M I N U T E S
Members Present: G. Harriman (Governmental Co-chair), D. Walters (Community Co-chair), P. Carr (Finance Officer), S. Altaf, F. Alvelo, M. Baney, L. Beal, R. Brown, P. Canady, M. Caponi, B. Cockrell, J. Dudley, J. Edwards, B. Fields, R. Fortunato, M. Gilborn, J. Gomez, C. Graham, B. Gross, R. Henderson, E. Kaywin, M. Lesieur, L. F. Molano, MD, C. Moore, J. Natt, H. Nguyen, J. Palmer, G. Plummer, M. Rifkin, L. Ruiz, F. Schubert, M. Thompson, T. Troia, V. Velazquez, R. Walker, S. Wilcox
Members Absent: A. Abdul-Haqq, M. Bacon, D. Beiling, A. Betancourt, G. Bruckno, E. Casey, R. Chestnut, B. Fenton, MD, A. Lugg, D. Martin, D. Powell, C. Simon
Staff Present: DOHMH: D. Klotz, M. Lawrence, S. Spiegler, G. Gambone, S. Torho, C. Rodriguez-Hart, J. Colón-Berdecía, J. Lawrence, K. Miller, R. Torres, M. Pathak; Public Health Solutions: B. Silver, A. Shahi, G. Ashby-Barclay, R. Santos
Agenda Item #1: Welcome/Introductions/Minutes/Public Comment
Ms. Walters and Mr. Harriman opened the meeting followed by a roll call and a moment of silence. The minutes from the December 16, 2021 meeting were approved with no changes.
Mr. Natt announced that NYU is conducting a 6-session self-management workshop and encouraged members to spread the word about it.
Agenda Item #2: GY 2020 into GY 2021 Carryover Expenditure Report
Ms. Plummer reported that as of the end of November 2021 (end of the third quarter), $47.7M (60%) of the total GY 2021 award is spent, which is lower than the expected 75%, largely due to the use of cost-based reimbursement. About $1.8M will be reprogrammed to ADAP. Actual carryover amount from GY 2021 into GY 2022 may be lower as funds are spent between December 2021 through end of the grant year on February 28, 2022. Mr. Shahi explained that with a cost-based reimbursement structure (in place for two years), a large portion of funding is spent in the final months of the contract year. Ms. Plummer reviewed the Council’s GY 2020 into GY 2021 carryover plan. Of the $4.9M in carryover, from HRSA approval of the carryover plan to this meeting, 63% has been spent. A breakdown by line item was provided: $204K for Care Coordination Value-based Payments, $492K to Emergency Financial Assistance, $2.5M to ADAP. Mr. Shahi explained that there is no data available yet for expenditure on Food & Nutrition, staff development and training, or technological devices because PHS is currently in the process of finalizing amended budgets to allow for these expenditures. Ms. Plummer added that she and her staff are working with PHS to address issues that have presented problems around contractor payments and expenditure reporting. Also, the program is moving back to performance-based (aka fee-for-service) reimbursement in GY 2022. Ms. Silver added that other EMAs and other federal grants across the country are experiencing the same issues. Mr. Harriman added that HRSA has waived the 5% cap on underspending of formula funds again this year, which will help. Most importantly, it is essential to spend all the carryover in the subsequent year, otherwise those funds are returned to HRSA and the unspent amount deducted from future grant awards.
A summary of the discussion follows:
- There needs to be a plan for involving consumers and providers in discussions on reimbursement issues, as it affects service delivery.
- The staffing issues that have affected providers (and thus spending levels) have been seen nationally, and the response from the federal bureaucracy has been slow.
- The funds for phones and data plans for access to telehealth are targeted to those who are not eligible for other federal programs that pay. Funds can be used to upgrade existing technology.
- It is vital for programs to offer in-person services again. For some clients, remote services are not accessibly, even with proper technology. Also, many services are not optimal unless delivered in-person. It is possible to safely reopen and DOHMH should consider mandating at least partial reopening within public health guidelines.
- The Recipient cannot legally require agencies to reopen (State regulations apply to congregate care/nursing facilities) but will inquire further.
- Even services that can be delivered well remotely should have an in-person option for those who may not be able to access telehealth (including for reasons of privacy).
- Agencies that stayed open during the lockdown lost money when they were forced to accept cost-based reimbursement, and the Recipient should consider deliverables for in-person services.
Agenda Item #3: Payer of Last Resort Compliance and Monitoring
Mr. Shahi presented on the RWHAP payer of last resort requirement and how that is implemented in the EMA’s Part A portfolio. RWHAP is considered funds that may not be used for any item or service “to the extent that payment has been made, or can reasonably be expected to be made under…any State compensation program, under an insurance policy, or under any Federal or State health benefits program… or by an entity that provides health services on a pre-paid basis.” HRSA guidance requires that recipients and subrecipients must ensure that reasonable efforts are made to use non-RWHAP resources (e.g., Medicaid, Medicare, state and local programs, private insurance) whenever possible, including establishing, implementing, and monitoring policies and procedures to identify any other possible payers to extend finite RWHAP funds. Public Health Solutions (PHS) requires subrecipients to track Medicaid and other sources of third-party reimbursement generated by back billing for all reimbursable services for contract clients. Any third-party reimbursement is to be reported to PHS as program income. This income must be used to support the Ryan White-funded program, and aggregate cumulative program income information is submitted with contract closeout documents at the time of closeout.
PHS requires subrecipients to maintain documentation in each client file that demonstrates that each client was screened for insurance coverage and eligibility for any other available programs that are reimbursable by other payers. The subrecipients are required to carry out internal reviews of client files and its billing system to ensure that Ryan White Part A funding is used for eligible services only in the absence of other third-party payers. Details of the service types delivered under the Care Coordination Program (e.g., client engagement, case conferencing), were described. During every new budget period, all CCP sub-awardees are required to complete a POLR payability assessment to ensure compliance with the POLR guidelines. Questions are asked such as “Was the client enrolled in Medicaid on the date of service?” and “Did a staff person eligible to provide Medicaid-payable services deliver the service?” If the answer to any of the questions is “no,” then RWPA is the appropriate payor. If the answer to all these questions is “yes”, then Medicaid should be billed for the service.
Contractors are subject to verification of reported services at a POLR site visit, should there be services billable to Medicaid or any third-party payor. During a site visit, any services that were reimbursed by PHS and have been verified as Medicaid/third-party payor eligible are subject to recoupment. In 2020/2021, HRSA waived site visit requirements due to pandemic, but the POLR payability assessments were still required during the subaward extension process to ensure subrecipients complied with the POLR guidelines.
A summary of the discussion follows:
- POLR site visits have not occurred since 2019. The services assessed in a site visit rotate, and is organizational, not for each client.
- All programs should have the capacity to bill Medicaid for eligible services. Care Coordination does have some services that are not reimbursable by Medicaid.
- With over 4000 clients, CCP programs must have many clients who can receive the same services through Health Homes. PSRA needs more data on duplication of services so that they can make an informed decision about the allocation for this category and pay only for those who cannot receive the services through Health Homes.
- Some CCP services (e.g., patient navigation) are also provided through Part C- and D- funded programs.
- Some small agencies are not able to bill Medicaid.
Agenda Item #4: Recipient Update
Ms. Plummer reported that the White House Releases the National HIV/AIDS Strategy for 2022-2025 on December 1st. The Strategy will accelerate the nation’s work to end the HIV epidemic in the U.S. by 2030, re-energizing and strengthening a whole-of-society response to the epidemic. The Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau (HAB) announced that the 2022 National Ryan White Conference on HIV Care & Treatment will take place August 23-26, 2022 with the theme “The Time Is Now: Harnessing the Power of Innovation, Health Equity, and Community to End the HIV Epidemic.”
On 01/12/2022, the Recipient received the Partial Notice of Award for the FY 2022 Ryan White HIV/AIDS Program (RWHAP) Part A grant in the amount of $29,005,692 (approximately 49% of Formula and 32% of MAI). HRSA continues to operate under a Congressional Continuing Resolution and the award provides partial funding based on the continuation of GY 2021 funding levels. Final awards will be processed as soon as HRSA/HAB receives the full GY 2022 appropriation amount for this program.
HAB released a Policy Clarification Notice on Determining Client Eligibility and Payor of Last Resort in the RWHAP. The updated guidance eliminates the six-month client eligibility recertification requirement for RWHAP programs, instead allowing recipients and subrecipients to conduct timely eligibility confirmation in accordance with their policies and procedures. The notice also states affirmatively that immigration status is irrelevant for the purposes of eligibility for RWHAP services.
Ms. Gambone has been named as the Acting Director of the HIV Care & Treatment Program’s Quality Management (QM) unit. Ms. Gambone introduced herself, saying that she looks forward to working with the Council.
In December, Public Health Solutions (PHS), on behalf of DOHMH, released the Ryan White Part A Services in the Tri-County Region Rental Assistance Program RFP, with programs starting June 1, 2022. PHS will soon release the Oral Health Care Services in New York City concept paper, with the RFP set to be released on February 2, 2022 for programs starting September 1, 2022. Public Health Solutions also released the Ending the Epidemic in New York City: The Undetectables Viral Load Suppression Program and Crystal Methamphetamine Harm Reduction Services RFP, with programs starting July 1, 2022.
Agenda Item #5: HIV Prevention Update
Ms. Torho reported that the HIV Prevention Group (HPG) just concluded their new member orientation. Mr. Fields is one of 11 new members. The planning will start in February with a strategic planning retreat to review the agenda for the year, including a focus on stigma, 90-90-90 goals, inequities, and new prevention technologies (e.g., injectable PrEP). Mr. Harriman added that he will be giving updates to the HPG and that Ms. M. Lawrence will present to that body on the Framing Directive.
Agenda Item #6: Planning Council Chairs Update
Mr. Harriman thanked recently retired long-time Council member Randall Bruce for his many years of dedicated services. Council members expressed their appreciation for his work.
Mr. Harriman noted that the RWPA program has had numerous data collection challenges over the years, including but not limited to; barriers to provider data access, inefficient data entry including double data entry and inefficient data entry processes, inability to import or export data to/from other data bases, and significant data collection burden on consumers and providers. The Planning Council is initiating a time-limited ad hoc workgroup to develop recommendations that will be shared with the Recipient, colleagues in DOHMH, and HRSA to improve data collection through improved database technology that will increase user access to data for quality improvement, reduce required data collection, and increase capacity to share information across programs so that consumer and provider data collection burden will be reduced.
It was noted that the Data Workgroup’s task is a huge, complex undertaking. The workgroup should also address lags that make data less than optimal for planning purposes. All stakeholders should be represented, including consumers, and a concrete timeline should be developed. Other considerations include using a platform that works across multiple funding streams and using the data platform to get consumer input on service delivery and quality.
There being no further business, the meeting was adjourned.
Minutes approved by the HIV Planning Council on February 24, 2022
Graham Harriman, MA