Planning Council Meeting Minutes July 25, 2019

Meeting of the
HIV HEALTH AND HUMAN SERVICES PLANNING COUNCIL OF NEW YORK
Thursday, July 25, 2019
2:05-5:00 PM
LGBT Center, New York, NY
M I N U T E S

Members Present: J. C. Park (Governmental Co-chair), M. Lesieur (Community Co-chair), S. Hemraj (Finance Officer), K. Balovlenkov, F. Barrett, D. Beiling, L. Best, A. Betancourt, R. Bruce, P. Carr, J. Dudley, J. Edwards, G. Harriman, E. Casey, R. Chestnut, B. Cockrell, M. Diaz, M. Domingo, B. Fields, C. Graham, J. Hudis, C. Kunzel, Ph.D., O. Lopez (by phone), A. Lugg, J. Maldonado (by phone), L. F. Molano, M.D., J. Natt, D. Powell (by phone), C. Reyes, S. Reyes, A. Roque, J. Schoepp, C. Simon, M. Singh, A. Straus, B. Zingman, MD 

Members Absent: A. Abdul-Haqq, M. Bacon, M. Baney, B. Fenton, MD, T. Frasca, B. Gross, J. LiGreci, M. Mackey, M. Mañacop, , M. Thompson, D. Walters

Staff Present:DOHMH: D. Klotz, M. Lawrence, A. Casey, J. Colón-Berdecía, A. Azor, C. Rodriguez-Hart, K. Mack, T. Gardet, B. Khan, K. Miller; Public Health Solutions: C. Nollen; WCDOH: J. Lehane, PhD; J. Corbisiero (Parliamentarian)

Mr. Park and Mr. Lesieur opened the meeting followed by introductions and a moment of silence.  The minutes of the June 27, 2019 meeting were approved with no corrections.

Plaques were presented to the following members whose terms are ending on August 31^st: Ms. Balovlenkov, Mr. Baney, Mr. Fields, Ms. Hudis, Dr. Molano and Mr. S. Reyes.  Tributes were paid by the co-chairs, staff and fellow Council members for the retirees’ outstanding contributions to the work of the Council.  Each retiree thanked the Council and staff and relayed how honored they have been to serve this important mission.

Mr. Park announced that he is retiring this fall after 14 years as Governmental Co-chair and Council Director, and after a career of over 30 years fighting for PLWH.  Mr. Lesieur and Mr. Klotz presented a plaque and gift to Mr. Park on the behalf of the Council members and staff and Mr. Harriman presented a tribute and gift on behalf of the Recipient and BHIV.  Mr. Park thanked the Council and staff and spoke movingly about his years living with HIV, watching many friends and colleagues pass away and dedicating his life’s work to the mission of seeing an end to this epidemic.

Mr. Harriman reported the FY2020 Grant Application Funding Opportunity Announcement was released on July 1st.  Recipient staff is starting to prepare and looks forward to the thoughtful edits of Planning Council members.  Council staff will make arrangements for Council members to review and comment on the second draft in mid-August. 

The sixth annual Part A Power of Quality Improvement (QI) Conference will be held on Monday, November 25, 2019 at the Kimmel Center at New York University. The conference theme for this year is “Using Unexpected Results to Improve Performance”.  This is an all-day conference focusing on what has been learned during the process of improving and ways to share those lessons with colleagues.  In June, the quality management program also released the call for abstracts for the Power of QI conference.  This year’s conference theme is “Using Unexpected Results to Improve Performance.”  The NY EMA Quality Management Committee is meeting on July 29^th to finalize priorities for the NY EMA Quality Management Program for this year.  The priorities will include expanding the audience and distribution of a printed guide to RWPA-funded services, making updates to the consumer committee a routine quality management activity, introducing protocols for value-based payment, and other activities. 

On July 1, NYC DOHMH approved renaming the HIV bureau to the “Bureau of HIV” (BHIV).  Before this, the bureau was known as the “Bureau of HIV/AIDS Prevention and Control”.  DOHMH has acknowledged that names can be stigmatizing and not reflective of the times.  As the Bureau of HIV works to eliminate HIV stigma, the bureau has realized that a name change has been long overdue. 

BHIV engaged in a cross-program collaboration, including both the Planning Council and HIV Planning Group, to submit a proposal to support strategic partnerships, communication, peer-to-peer technical assistance, and jurisdictional planning efforts to address emerging needs of targeted jurisdictions through CDC-funded state and local health departments and their ability to end the HIV epidemic in the U.S.  BHIV staff and their grant writing consultant began the process of planning and drafting a proposal and budget.  BHIV outlined in their proposal efforts to enhance the existing jurisdictional epidemiological profile and develop a situational analysis at the beginning of the project and will use this tool to engage existing community bodies, consumers, and providers, and host listening sessions and conduct other engagement activities to solicit feedback to inform the development of a draft plan by June 2020.  The plan will be presented to the Planning Council and HIV Prevention Group and will seek their concurrence with the plan by September 2020, the end of the project

FY 2018 Fourth Quarter Close-out Report

Ms. A. Casey presented the FY 2018 fourth quarter close-out report, which showed final spending data for the fiscal year ending February 28, 2019. Noting that the award was received in three parts, the master contractor, Public Health Solutions, worked to ensure that contractors did not over-spend during the period before the final award was received. The final amounts left unspent at the end of the fiscal year were: $167,102 in NYC Base programs, $4 in MAI, $12 in Tri-County, $29,809 in grant administration and $44,718 in Quality Management. The grand total unspent for the EMA was $241,645 (0.3%), a record low amount. All unspent funds were from the formula portion of the award (100% of the supplemental award was spent due to the accounting work of DOHMH fiscal staff). Line-item details were described, including modifications from the approved spending plan due to take-downs and enhancements as per the Council’s reprogramming plan. Some notable details included: under-spending in Care Coordination due to the start-up period for newly re-solicited contracts, the on-going difficulty in spending in Housing Placement Assistance due to lack of available affordable units, and under-spending in Non-Medical Case Management (General Population) resulting from a contract termination (the allocation amount was adjusted by PSRA to the new carrying cost in FY 2019).

FY 2018 Assessment of the Administrative Mechanism

Mr. Klotz presented the annual table summarizing the elements of the assessment of the administrative mechanism. Concerning executed contract and renewals, the Recipient received the award from HRSA in three parts. The first Notification of Award included funding approximately equal to approximately 31.5% of our FY2017 formula award and 20.5% of MAI, the second was for an additional 37% of the FY2017 formula and 24% of MAI, and the third NOA was for the balance of the award. Subcontracts were executed and renewed on a timely basis using the partial award. Insofar as it is within the Master Contractor’s control, all contracts were executed within six weeks of receipt of a complete and accurate contract package and necessary approval from DOHMH. The NY EMA received a slight decrease to its award in FY2018. Contracts were adjusted and executed on a timely basis. Uncommitted funds resulting from contract negotiations and/or contract terminations were reprogrammed on a one-time basis as per the PC’s Reprogramming Plan. It is a tremendous challenge for program planning and executing contracts without a full award as City of New York oversight agencies do not allow the program to make commitments without a full award.
Regarding procurement, in order to procure new services in line with the Planning Council’s EIS service directive, an RFP was released June 27, 2017. Successful applicants and new awards were distributed to the PC in the Recipient Report in January 2018. Regarding subcontractor payments, Subcontractors were paid in a timely manner (within 30-60 days) of receipt of a complete and accurate expenditure report/invoice, as confirmed during site visits by BHIV Administration staff monitoring the master contractor.
Regarding spending, as described above, FY 2018 expenditures by service category were reported to the EC and PC as requested and scheduled. Spending rates continued at high rates. Preliminary close-out reports show virtually no carryover in MAI and approximately $241K in formula funding as unobligated. Modifications to the spending plan were reported by service category to the EC and PC and matched the PC’s reprogramming plan. The Recipient and Master Contractor were commended for their excellent stewardship of the grant. Mr. Hemraj noted that the EMA had come a long way from when he first because involved in the Council in FY 2004, when there was $14M in underspending and a great deal of mistrust between the Council and Recipient.
Mr. Hemraj made a motion, which was seconded and approved 32Y-0N, to accept the FY 2018 assessment of the administrative mechanism as presented.

Ms. Beiling presented the IOC’s recommendations concerning eliminating the TCC model, currently funded at $1,443,228.  After extensive review by multiple committees, IOC reviewed the directive in light of new presentations from the Recipient, clients and providers.  The model, developed in 2011, provides care coordination for homeless and unstably housed individuals and provides linkages to housing services, HIV primary medical care and case management.  The model is time limited to one year and lacks flexibility.  The majority of enrolled clients already have a primary care physician/case manager and some clients do not need case management at all.  Clients expressed both appreciation and frustration with the program.  It was found that Care Coordination requires significantly more time than the program model acknowledges, and that TCC is sometimes in competition with Short Term Housing (STH), which is an unintended consequence of the model, due to duplicative services.  IOC recommends that the TCC service model be discontinued and that PSRA to consider moving the TCC funding allocation, in whole, to the Housing service category to increase STH.  With additional funding, Housing will enhance and strengthen the current service model to provide additional outreach, housing and care coordination/client stabilization services.  A summary of the discussion follows:

• Ryan White, by law, can only provide STH, which is defined as less than two years, but clients are never asked to leave housing.  Providers work to move them onto permanent housing funded through other sources, such as HASA and HOPWA.
• TCC does not provide any actual housing, which is its biggest disadvantage.  By giving the funding to STH providers to do the linkages and case management that TCC provides, there will be less duplication and more seamless service provision.
• Four of the five TCC contracts are held by agencies that already provide STH, and there are providers in the geographic area that is covered by the fifth contract.
• The high spending rates by the current TCC programs is due to the way they are reimbursed and not reflective of the need for the service.
• Ryan White housing is bound by federal fair market rent regulations.

Ms. Beiling, on behalf of the IOC, made a motion to accept the elimination of the TCC model as presented.  The motion was approved 32Y-0N.

Mr. Domingo introduced the IOC’s recommendation for a new service directive to provide Psycho-social Support Services for people of Transgender, Intersex, Non-Binary and Non-conforming (TGINBNC) experience.  The development of the directive was led by members of the TGINBNC community who provided input throughout the process.  There was a strong emphasis throughout the planning for the directive that these services be provided as much as possible by people from the TGINBNC community.  The goals of the service model are: 1) Provide individualized supportive counseling services that aim to overcome barriers to access and facilitate continued engagement in medical care for PLWHA; 2) Provide family-focused services that reduce stressors in the lives of PLWHA in order to remove barriers to engagement in HIV care and adherence to treatment; 3) Increase the proportion of newly diagnosed individuals who enter into primary care within 30 days of HIV diagnosis; 4) Increase retention in HIV care and treatment; 5) Increase the proportion of clients who have an optimal level of antiretroviral therapy (ART) adherence; 6) Increase the proportion of clients with an undetectable viral load and to improve immunological health; 7) Support comprehensive, coordinated patient-centered care for people with HIV, including addressing HIV related co-occurring conditions and challenges in meeting basic needs, such as housing; 8) Reduce mortality; and 9) Reduce (and then maintain below significance) socio-demographic differences in: prompt linkage to HIV/AIDS care following HIV diagnosis, retention in primary medical care, and undetectable viral load and HIV related mortality. 

The service model elements are: 1) Conduct an initial client intake assessment and periodic reassessments, in a gender affirming manner that appropriately and sensitively identifies a patient’s unmet medical and social needs, and to appropriately support client’s capacity for self- management; 2) Coordinate all levels of medical and behavioral health, as needed; 3) Ensure access to consistent and sustainable use of ART using motivational interviewing techniques and other adherence tools; 4) Provide individual and group support services that promote engagement and maintenance in care, adherence to primary medical care, inpatient/residential treatment (as necessary) and modes of healthy living; 5) Provide linkage/referrals to clients for programs and services that facilitate client stabilization, including but not limited to credit repair, financial literacy, estate planning, end of life planning, job readiness, housing readiness, housing starter kits, legal services and representation, basic and continuing educational opportunities; 6) Implement broad based education, prevention, intervention and remediation programming to address stigma and discrimination such as intimate partner violence, hate based crimes and state/institutional violence; and 7) Agencies should engage in outreach, recruitment and employment practices that attract TGINBNC staff with life experience and expertise that is shared by the agency’s target population in order to improve access to and ensure optimal utilization of health care services.

Client and agency eligibility were described, including for non-profit organizations with expertise in delivering gender affirming care and experience with people of TGINBNC experience living with HIV and preference for agencies run and staffed by persons that identify as being of TGINBNC experience and who are able to provide gender affirming environments.  All staff (including staff such as administration, maintenance and security) should be trained in gender affirmation, TGINBNC sensitivity, health education, harm reduction, and motivational interviewing techniques.  

A summary of the discussion follows:

• The clarity of the format of the Council’s service directives can be improved. 
• Mr. S. Reyes expressed concern that the bigger picture was not adequately explained.  It was reiterated that this directive, which spells out the service model and elements and client and agency eligibility, if approved today, will be the basis for the request for proposals (RFP) developed by the Recipient.  PSRA will determine a dollar allocation in the course of its scenario planning for the FY 2020 award, after which this will become a new service category under the HRSA-defined category of psychosocial support (the EMA already has PSS in Tri-County and in NYC, where it is called Supportive Counseling and Family Stabilization).
• Organizations that provide this service should ideally be led by the target population.  There is always the possibility that large providers will win the contracts due to their institutional muscle, but even they must have competency to serve the TGINBNC population.  DOHMH provides technical assistance to build capacity among small grass-roots organizations so that they can compete for Ryan White Part A contracts.

Ms. Beiling, on behalf of the IOC, made a motion to accept the TBINBNC PSS service directive as presented.  The motion was approved 32Y=0N.  The full directive can be found at: https://www.nyhiv.org/pdfs/service_directives/TGNB%20PSS%20Directive_7-25-19_PC%20Approved.pdf

Mark Misrok distributed flyers for “Career Power Source” a day-long event promoting employment opportunities for PLWH on September 18^th at Baruch College.  The day will include a range of trainings and workshops, including resume writing, wardrobe, headshots, benefits counseling and legal rights.

Ms. Best announced that the Consumers Committee is working on a workshop for the Power of Quality Improvement Conference on promoting access to oral health care for PLWH.  Mr. Carr is leading the sub-committee that is writing the abstract and planning for the workshop.

Ms. Edwards reminded the Council of the August 8^th memorial for Humberto Cruz at the Schomburg Center.  Community members are invited to submit a personal message, sentiment or tribute in his honor.  Messages received will be featured in a slideshow and displayed on video screens throughout the program.

There being no further business the meeting was adjourned.