Thursday, July 28, 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), F. Alvelo, S. Altaf, M. Bacon, A. Betancourt, G. Bruckno, M. Caponi, R. Chestnut, J. Edwards, B. Fields, R. Fortunato, C. Graham, B. Gross, R. Henderson, E. Kaywin, M. Lesieur, D. Martin, L. F. Molano, MD, C. Moore, J. Palmer, G. Plummer, D. Powell, M. Rifkin, C. Simon, T. Troia, V. Velazquez, S. Wilcox
Members Absent: A. Abdul-Haqq, M. Baney, L. Beal, R. Brown, P. Canady, E. Casey, B. Cockrell, J. Dudley, M. Gilborn, J. Gomez, H. Nguyen, L. Ruiz, J. Natt, M. Thompson, R. Walker
Staff Present: DOHMH: C. Quinn, MD, D. Klotz, M. Lawrence, J. Acosta, D. Noble, J. Colón-Berdecía, K. Mack, I. Newman, A. Eppinger-Meiering, R. James, K. Miller, C. Rodriguez-Hart, Monika Pathak, Conor Reynolds, Grace Mackson; Public Health Solutions: G. Ashby-Barclay, R. Santos, A. Shahi; J. Corbisiero (Parliamentarian)
Guests Present: R. Babakhanian, D. Greene, M. Maia Soares
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 June 23, 2022 meeting were approved with no changes.
Agenda Item #2: Council Officer Elections
Elections were held for Community Co-chair and Finance Officer for terms beginning on September 1, 2022. Mr. Klotz outlined the roles and responsibilities of the officers as described in the Council’s bylaws. There was one nomination for each office: Ms. Walters (for Community Co-chair) and Mr. Fields (for Finance Officer). Ms. Walters and Mr. Fields made brief statements on their candidacies. There being no other nominees, Mr. Harriman declared Ms. Walters and Mr. Fields elected by acclamation.
Agenda Item #3: Monkeypox Update
Dr. Quinn, DOHMH Deputy Commissionerfor Disease Control, gave an update on the monkeypox outbreak, which has seen a sharp rise in cases (1148 in NYC as of today, which is about a third of US cases). She noted that demographic data is posted on https://www1.nyc.gov/site/doh/data/health-tools/monkeypox.page and will be updated every two days. Dr. Quinn discussed vaccine efforts and how DOHMH is addressing the fact that demand far outstrips supply. She also addressed care and expanded post-exposure prophylaxis, which focuses on gay/bi/trans men who have sex with men who have had multiple sexual partners. Additional vaccine allocations will become available next week. DOHMH is holding off on second doses until there is enough supply in order to cover more people with some level of immunity. She also mentioned DOHMH Commissioner Dr. Ashwin Vasan’s letter to the WHO asking that the name of the disease be changed to something less stigmatizing.
A summary of the ensuing discussion follows:
- There is not enough data on the level of protection from one dose, but the data suggests that there is significant antibody protection after the first shot and that the boost from the 2nd dose is significant even if it is delayed.
- DOHMH is leveraging its relationships developed during COVID with agencies that run congregate settings.
- DOHMH should consider non-traditional spaces for vaccine dispensing, as well as community health centers.
- Many people who are not eligible under the current guidelines are trying to get vaccinated and are fearful of skin-to-skin contact. Expansion of eligibility will depend on supply, so right now DOHMH is prioritizing the populations that the epi data show are at highest risk.
- DOHMH has bought ad space on Grindr, Scruff and other apps and will do more.
- When people don’t show up for appointments, the shots go back into the supply for new appointments. Walk-ins will be accepted when supply allows.
- The vaccine is free, and while there is no special insurance coverage for treatment yet, that will require a federal policy change.
Agenda Item #4: GY 2023 Application Spending Plan
Mr. Carr, on behalf of the PSRA co-chairs, explained that the EMA is required to submit Base and MAI spending requests in the GY 2023 grant application. The EMA can request up to 5% above the current year’s award and we traditionally ask for the maximum as a statement of need. In the fall and winter, PSRA will conduct scenario planning for a possible decrease in the award. The MAI award is fully formula-driven, and as in past years, the draft request for the application is identical to this year’s award. For the GY 2023 application, the Tri-County Steering Committee is requesting a 5% proportional across-the-board increase to their Base-funded service categories to address inflation.
The NYC Base award allocates $1,333,800 to Ambulatory Outpatient Services for Older PWH, based on a cost analysis presented to PSRA in June. This service will be funded starting March 1, 2023. $450,000 is needed to pay for a full year of Oral Health Services, which begin on Sept. 1, 2022 and is funded for 6 months this year. In the case of flat funding or a decrease in the 2023 award, PSRA has agreed that funds for these two initiatives can come from the ADAP allocation. PSRA recommends allocating the remaining $1,690,828 from the 5% increase request to address staff retention and the higher cost of doing business due to inflation. This increase is not applied to ADAP or to service categories that received targeted increases for this purpose in the current year (Housing, Food & Nutrition), or services that have not begun yet (Oral Health, HIV & Aging). Mr. Klotz showed the details of the plan on spreadsheets provided to the Committee.
Mr. Carr, on behalf of the PSRA Committee, moved to approve the final GY 2023 Application Spending Plan as presented. The motion was adopted by a roll call vote of 21Y-0N.
Agenda Item #5: Housing Directive
Ms. Lawrence introduced Ms. Noble, Mr. Babakhanian, Mr. Maia Soares and Ms. Greene, who along with Ms. Fortunato presented the revised Housing Services (HOU) Directive approved by the Integration of Care Committee (IOC). The HOU portfolio is going to be rebid for GY 2023 and a new directive was needed. When developing the new directive, IOC considered that housing stability has been severely impacted by the COVID pandemic. Mr. Maia Soares provided a personal anecdote on the importance of housing to support the health and mental health of PWH. Background on the NYC housing landscape was provided (e.g., the decline in affordable housing, funding for other HIV housing programs like HOPWA, extremely low-income requirements and skyrocketing rents).
The HRSA definition of HOU was provided. The revised NYC HOU directive includes the same core services as are currently provided (Rental Assistance, Housing Placement Assistance, Short-term Housing). The implementation science logic model for the HOU portfolio was explained (intervention source, evidence strength and quality, adaptability). Implementation strategies were described (e.g., interpretation services, education on client rights, 30% rent cap on client income, rapid response to client inquiries to prevent displacement). Qualifications for organizations that apply to provide the rebid HOU services were described (e.g., evidence of work to combat stigma and provide trauma-informed care, established linkages, experience with people who are homeless/unstably housed). Other policies include supporting access to long-term, permanent housing and not housing clients in apartments on the “worst landlord” list. The DOHMH HIV Housing Services Unit (HSU) should also collaborate to identify clients with extreme housing need, especially those with mental health and/or substance use disorders and co-morbidities. Training strategies for DOHMH and HOU providers were outlined, including CLAS standards, harm reduction, anti-stigma and racism. Programs will also implement quality service implementation strategies, such as reporting on common barriers to securing housing among the client population to inform the development of interventions. Programs must also assist clients in completing all relevant supportive housing applications.
Implementation strategies for the HOU components (the same service types as the current directive) were described. Short-term Rental Assistance (SRA) will use a payment standard for determining the amount of rental assistance that is in line with HUD fair market rent, and when possible, use the HUD community wide exception rent standard to ensure that PWH are less financially disadvantaged in the housing market. Housing Placement Assistance (HPA) will Coordinate with and between governmental and intergovernmental actors to compile and share best practices/lessons learned, and to develop and/or strengthen existing policy that increases access to housing for PWH. HOU outcomes were outlined, including decreasing the number of PWH in unstable housing, increase in coordinated patient-centered care, and increase in timely support and reimbursement to providers.
Ms. Plummer added that the Recipient strongly supports the directive. Mr. Fields noted that systemic issues in the housing market must be addressed by US HUD and other policy makers (national HIV housing advocacy groups are working on these issues).
Ms. Fortunato, on behalf of the IOC Committee, moved to approve the Housing Services Directive as presented. The motion was adopted a roll call vote of 24Y-0N.
Agenda Item #6: GY 2021 Assessment of the Administrative Mechanism
Mr. Carr explained that the Planning Council is required by the Ryan White law to “assess the efficiency of the administrative mechanism in rapidly disbursing Ryan White Part A funds”. This means that we look at how well the Recipient (the DOHMH HIV Care & Treatment Program) and Master Contractor (Public Health Solutions) are doing to implement the priorities and allocation of the Council, and how fast they are getting the funds out to sub-contractors so that the grant award can be spent and spending maximized. As in past years, we assessed the administrative mechanism through quarterly expenditure reports received from the Recipient, and through a self-assessment by the Recipient. This year, in addition to the quarterly reports, we also conducted a survey of providers to get the perspective of Part A sub-contractors. We asked them about timeliness of contract renewals and payments and gauged their opinion of the quality management and technical assistance provided by DOHMH and PHS. Mr. Harriman added that the findings were shared in advance of this meeting with the DOHMH and PHS and are meant in a spirit of collaboration to promote a more efficient use of grant funds and to avoid the kind of unexpectedly large carryover that we saw last year.
Mr. Klotz presented the results of the RWPA provider survey. Surveys were sent to all 81 agencies that have a RWPA contract and 53 responses were received (a response rate of 65%). The questions focused on the range of issues related to RWPA contracting, including timeliness of contact execution and payments, reporting requirements, quality management and technical assistance, and helpfulness of Recipient and master contractor staff. A principal concern of respondents was the lateness of contract execution/renewals. Thirty-five (66%) respondents reported that contract renewals and executions were not completed in a timely manner. While some outside forces (e.g., COVID) and internal issues (e.g., difficulty of managing multiple contracts) were cited, most respondents thought that delays were due to issues related to PHS (most commonly late receipt of documents). Twelve (24%) providers reported that PHS did not make payments within 30 days of submission of required paperwork. For those who did not receive timely payments, reasons included specific technical reasons as well as more undefined delays. For the 54% of respondents who received programmatic technical assistance from DOHMH, virtually all received that assistance in a timely manner. Three quarters of respondents who received fiscal/ contractual technical assistance from PHS received that assistance in a timely manner. In respondent comments section, most respondents praised the timeliness and quality of TA. 80% of respondents reported receiving an enhancement using GY 2020 carryover funds for training/capacity building, but 51% of those recipients did not have enough time to adequately plan to use the funds before the grant year ended. In the comments, respondents cited gratitude for the opportunity to use funds for organizational development, but often cited the rushed and sometimes haphazard enhancement process.
Respondents overwhelmingly agreed that DOHMH and PHS provide clarity on program reporting requirements, policies and procedures, and HRSA updates that impact programs. Respondents were also satisfied with personal interactions with PHS and DOHMH staff. Comments often cited the helpfulness and responsiveness of staff. Several instances were cited where communication could be clearer and errors in documentation avoided. In general comments respondents overall praised the helpfulness of DOHMH and PHS staff, particularly in the challenging environment of a pandemic. Areas cited where DOHMH and PHS can provide better service include communication and response time, setting reasonable deadlines, more training, and the need for additional formal check-ins.
Mr. Harriman summarized the findings of the Assessment of the Administrative Mechanism. Underspending remains high for the 2nd year and the 3rd Quarter expenditure report was inaccurate with the amount of unspent funding. With the expected end of HRSA waiver of carryover penalties for GY22-23, DOHMH/PHS must improve spenddown of grant funds or the NY EMA will be penalized with a reduced award in future years. PHS must ensure that contract documents are sent to sub-recipients in a timely manner so that contractors are in a status to be paid once the contract term starts and the service expectations are clear. DOHMH/PHS must ensure that sub-recipient payments are made in a timely manner to ensure continued service delivery and to avoid hardship of strapped agency budgets. Carryover enhancements should be proactively managed so that providers can spend their funding in the last four months of the year (notify providers of the possibility of receiving carryover and the plans for carryover approved by the Council months in advance, ensure timely processing of enhancements once carryover is approved).
Ms. Plummer and Mr. Shahi presented the Recipient’s response to the findings of the assessment. The Recipient acknowledges the past two years as being unprecedented given the COVID-19 pandemic, leadership changes at DOHMH and PHS, and other administrative changes. Additionally, the leadership of PHS experienced a number of staffing transitions resulting in a loss of institutional knowledge. The Recipient is taking measures to ensure these findings are an opportunity for quality improvement and is providing a number of corrective action steps to address the findings, including:
Late Payments: BHHS and PHS finance and administrative teams continue to meet regularly to review and reconcile financial expenditure reports from PHS to BHHS and to monitor transfer of funds. BHHS Administration is also allocating staff and resources to implement a systems-improvement process.
Delayed Contract Executions: PHS began working with the subrecipients to collect scopes of work, service target grids, budgets, etc. for FY 2022, beginning 03/01/2022. The majority of the subrecipients will receive amendments to their existing agreements for FY 2022. Amendments now require less paperwork and should not necessitate the same type of legal review on the part of the subrecipients.
Monitoring of Spending: Quarterly meetings with Recipient and BHHS Admin at NYC DOHMH will be scheduled starting in August. Most service categories are returning to fixed rate reimbursement. PHS will work with the Recipient to engage in in-depth spend down reviews and budget modifications to avoid large carryover amounts. The Recipient, BHHS Admin, and PHS meet monthly to coordinate the programmatic, contractual, and fiscal management of the Ryan White Part A program. PHS will be more proactive with cash flow, streamlining contract executions and amendments, and have done cash advances to ensure that providers have cash flow.
Mr. Harriman thanked the Recipient for taking the assessment’s finding seriously and developing a corrective action plan. The assessment was made in a spirit of cooperation and collaboration to improve spending, particularly as the waiver of penalties for underspending will not be in place for this year.
Mr. Carr made a motion, which was seconded, to accept the GY 2021 Assessment of the Administrative Mechanism as presented. The motion was adopted a roll call vote of 22Y-0N.
Agenda Item #7: Planning Council Chairs Update
Mr. Harriman and Ms. Walters acknowledged the retiring members of the Council: Mr. Abul-Haqq, Mr. Canady, Mr. Carr, Ms. Cockrell, Mr. Powell, Mr. Ruiz, Mr. Schubert, and Mr. Walker. They were thanked for their contributions to the Council.
Mr. Harriman thanked everyone who attended the annual member recognition event is scheduled to take place on July 19th in Riverbank State Park. He noted that the Data, Policy and SMI Committees will continue to meet during the recess.
Ms. Simon announced that there will be a special session in October for Council members to provide input into the draft Statewide Integrated HIV Prevention and Care Plan, which is the next step in the process of moving toward a Council vote on concurrence with the Plan.
Agenda Item #8: Public Comment
Mr. Fields gave a report on the recent Abilities Expo, an annual event that brings together people of diverse abilities to address issues and network on advocacy for the disabled. He highlighted some issues raised at the Expo, including accessibility, dating and relationships, technology and disability products, and the need for wheelchair assistance at all hours. He encouraged RWPA providers to attend next year’s Expo.
There being no further business, the meeting was adjourned.
ADAP: The remaining $3,321,207 would be absorbed by ADAP, which has taken severe reductions every year to absorb cuts to the award and pay for new initiatives. ADAP Director Julie Vara has affirmed that they are able to absorb and spend the additional funds.
Any of the funds for the above initiatives that are still unspent near the end of the grant year would be absorbed by ADAP. The Recipient will begin working with agencies early to prepare them to spend any enhancements.
A motion was made, seconded and approved 27Y-0N to adopt the final GY 2021 Carryover Plan as presented.
Agenda Item #6: Planning Council Chairs Update
Mr. Harriman announced that the election for community co-chair and finance officer will take place at the July 28th Council meeting for 2-year terms beginning September 1st. Also, the annual member recognition event is scheduled to take place on July 19th in Riverbank State Park.
Ms. Simon thanked everyone who completed the Integrated Plan survey. Results will be shared next month.
There being no further business, the meeting was adjourned.
There is an emphasis on using peers to promote testing, as well professional development for those peers so that they can move up in their organizations.
Agenda Item #5: Planning Council Co-chairs Report
Mr. Harriman reported that a new chair for the Data Workgroup will be needed. Mr. Lesieur reported that a letter in support of the Safer Consumption Services Act, which would expand overdose prevention sites, was sent to the NYS legislature. The letter was developed by the Joint Policy Committee, written by Adrian Guzman and approved by the Executive Committees of the Planning Council and HPG.
Ms. Simon reported on the Integrated HIV Prevention and Care Plan. Proposed strategies were received through various feedback mechanisms (including the Council and Consumers Committee) for the four areas of focus (Prevent, Diagnose, Respond, Treat). The process for prioritizing those strategies was explained, based on magnitude of impact, alignment with the ETE plan, sustainability and ease of implementation. Council. Members will be provided with an online tool to prioritize proposed strategies. In addition, two “community convenings” will be held in June to get additional feedback.
Ms. Simon also announced a new NYSDOH AIDS Institute request for applications to support innovative program models that address barriers and needs of older adults living with HIV.
There being no further business, the meeting was adjourned.