Thursday, July 29, 2023
By Zoom Videoconference
Members Present: G. Harriman (Governmental Co-chair), D. Walters (Community Co-chair), B. Fields (Finance Officer), S. Altaf, R. Babakhanian, M. Baney, K. Banks, A. Betancourt, R. Brown, J. Dudley, J. Edwards, R. Fortunato, M. Gilborn, C. Graham, B. Gross, S. Hemraj, R. Henderson, B. Hribar, E. Kaywin, W. LaRock, M. Lesieur, M. Maia Soares, D. Martin, N. Martin, H. Martinez, L. F. Molano, MD, J. Natt, J. Palmer, G. D. Plummer, L. Sabashvili, J. Schoepp, M. Sedlacek, C. Simon, M. Thompson, T. Troia, S. Wilcox
Members Absent: F. Alvelo, M. Bacon, G. Bruckno, M. Caponi, R. Chestnut, J. Gomez, F. Laraque
Staff Present: DOHMH: C. Quinn, MD, S. Braunstein, PhD, D. Klotz, M. Lawrence, D. Saab, J. Acosta, J. Carmona, J. Fernandez, M. Pathak, D. Bickram; Public Health Solutions: A. Shahi, R. Santos; J. Corbisiero (Parliamentarian)
Agenda Item #1: Welcome/Introductions/Minutes/Public Comment
Mr. Harriman and Ms. Walters opened the meeting followed by a roll call. Mr. Brown let a moment of silence in memory of Council member Linda Beal, who passed away recently. Ms. Beal was a long-time advocate who had served on the board of VOCAL-NY and was a fierce advocate for the needs of people with HIV, particularly in her native Westchester County. The minutes from the June 29, 2023 meeting were approved with no changes.
Agenda Item #2: Remarks from Deputy Commissioner Celia Quinn, MD
Dr. Quinn thanked the Council members for their exemplary service and reiterated DOHMH’s support for the Council’s work and the centering of consumer voices in developing and implementing effective programs to improve health outcomes for PWH. She recommitted herself and her leadership team to consistently fostering an environment where community voices can be heard and improving the working relationship between the Council and DOHMH to ensuring the success of the Ryan White Part A Program. A consultant is working to help identify and address some internal issues that are impacting the Council and Recipient relationship, and she expressed her confidence that the Recipient and Planning Council staff are approaching this effort with seriousness and a commitment to improve the relationship. One concrete product will be a final draft of the Council-Recipient Memorandum of Agreement describing the roles/responsibilities and relationship between the parties so that it can be finalized through the Council processes as a first order of business when the Council reconvenes in the fall.
Council members thanked Dr. Quinn for her support and provided additional feedback, including the following points related to the importance of mutual respect, which includes full participation for the entirety of Council meetings. Member stressed the importance of a harmonious relationship to fulfill the mutual goals and mission of the program, and the need to respond to and value consumer input. Mr. Hemraj asked for a response from the Recipient.
Agenda Item #3: Public Comment, Part I
Jules Levin (Executive Director, NATAP) stated that all aging PWH require specialized geriatric care, including bone density and cognitive tests. This type of care is sorely lacking across the major clinics. Government must work together to ensure that the complex and unmet medical needs of aging PWH are addressed.
Agenda Item #4: Election for Community Co-chair
Mr. Harriman explained that an election is being held for a two-year term as community co-chair, with the term beginning on September 1, 2023. The duties of the community co-chair were described as outlined in the Council bylaws. Two candidates, Mr. Hemraj and Mr. Martin, have accepted nominations for the position. A final call for nominations was made and no other Council members accepted.
Mr. Hemraj and Mr. Martin made statements about their candidacies and votes were cast through an online ballot. Mr. Klotz and Ms. Corbisiero were appointed as inspectors of elections. Later in the meeting, Mr. Harriman announced that Mr. Martin had been elected by majority vote of Council members present and voting.
Agenda Item #5: Behavioral Health Directive
Ms. Fortunato, Mr. Hemraj and Ms. Lawrence presented the draft Behavioral Health Directive, approved by the Integration of Care and Executive Committees last month. An integrated behavioral health model is meant to remove roadblocks to accessing behavioral health services: patients can receive all/most of the care they need from one location and one team at the same time. This intervention seeks to provide integrated mental health, substance use, and psychosocial support care for PWH with behavioral health needs. The new service will provide rapid linkages, navigation and enhanced peer support are some of the evidence-based strategies shown to mitigate barriers to care, increase client engagement, and help improve behavioral health and other health-related outcomes. The new service combines the current service categories of Mental Health, Harm Reduction and Supportive Counseling (psychosocial support), which are funded for a total of $14,119,145.
The Directive requires all programs to have the capacity to charge Medicaid for billable services (does not apply to non-SEP Harm Reduction service sites), and have a full deployment of all available funding and resources to improve training, clinical care practices, service access, and reach of BH programs. It calls for increased peer experienced, PWH-led wrap around services to support behavioral health services for people with serious mental illness (SMI); timely linkage to mental health, physical health, and substance use services; and service sites available in all five boroughs with consideration for disproportionately impacted neighborhoods/UHF/zip codes, sites must serve clients from throughout the EMA.
Justification for the new model was given, based on social determinants of health and a pyramid of needs and costs from self-care to intensive treatment. The model leverages wrap-around psychosocial supportservices to meet clients where they are, provide the support needed to facilitate client readiness for mental health and harm reduction interventions (if needed), and increase and leverage peer support. Service models and types from the original three categories are supplemented by new guidance that includes: 1) services for PWH with complex behavioral health needs or SMI leverage peer experience and persons with lived experience to manage a cadre of PWH who provide support, navigation and accompaniment; 2) implementation strategies to support client centered care; 3) All behavioral health screenings must appropriately assess and obtain a diagnosis for all clients who may have SMI using a two-stage process, to support accurate identification of all clients who may benefit from more intensive behavioral health services, including support for serious mental illness; 4) Agencies must have access to real time client data and population data to provide on time and tailored interventions; and 5) Pending HRSA review, movement and social activities strengthen client connection and wellness outcomes.
Outcomes that the Directive seeks are: improvement in behavioral health measures; increase in treatment adherence (medical and behavioral health); and increase in continuity of care and resulting HIV outcomes among PWH accessing behavioral health services; increase in PWH aware of their status, retained in care, and virally suppressed; increase in PWH reported quality of life; increase in PWH reported satisfaction with RWPA BH services; decrease in anticipated, internalized, and enacted stigma reported by clients; and increase in client knowledge of rights to and options to access behavioral health.
Mr. Natt said that the Directive must balance the need for services in underserved communities and the fact that many people from those communities prefer to travel for services outside of their neighborhoods. Many providers, especially large hospitals, are located in ZIP codes with low prevalence, but serve many people from disproportionately affected areas.
There was a consensus to amend language in the Directive to address the above concern. The new language reads: “Distribution of sites should align with UHF/zip code distributions of geographic prevalence of HIV and service need, and with providers whose population served comes from disproportionately affected communities.”
There were also comments regarding peer training and using harm reduction approaches, which are included in the Directive. Concerns about wages for peer workers can be addressed by the Recipient encouraging a living wage, but they are unable to mandate specific pay structures.
A motion was made and seconded and to accept the Behavioral Health Directive as presented with the above change. The motion was adopted 35Y-0N.
Agenda Item #6: GY 2024 Application Spending Plan
Mr. Natt explained that the Council must approve a spending request for submission to HRSA with the GY 2024 non-competitive continuation application. EMAs are allowed to ask for up to 5% more than that previous year’s award. PSRA traditionally requests the increase in the Base award, as the MAI award is completely formula-driven. The request can be a road map to plan for an unlikely increase in the FY 2024 grant award. Planning for the likely scenario of a decrease will take place in the fall-winter. PSRA used the FY 2022 close-out report presented to the Council last month as the best available proxy for which service categories can absorb additional funds. Food & Nutrition was the one service category that spent more than 105% of its original allocation and the Committee recommends a targeted increase equal to the amount of funds reprogrammed to that category last year. The rest of the increase is allocated across the portfolio through an across-the-board weighted increase with the exception of ADAP and all categories that less than 95% of their original allocations (Non-Medical Case Management, Early Intervention, Oral Health, Emergency Financial Assistance).
Mr. Klotz reviewed a spreadsheet showing that a 5% increase would mean an additional $4,268,232. After administration, quality management and a weighted across-the-board 5% increase to Tri-County programs (approved by the Tri-County Steering Committee and PSRA last month), that would leave $3,618,919 for NYC Base programs. There is an additional $292,704 in uncommitted funding available due to a contract termination in Health Education and Risk Reduction. The distribution of the increase was shown as described above.
A motion was made, seconded and approved 33Y-0N to approve the GY 2024 application spending plan as presented.
Agenda Item #7: Assessment of the Administrative Mechanism
Mr. Fields introduced the annual assessment of the administrative mechanism, explaining that the assessment is a legislative requirement that planning councils assess whether Ryan White Part A grant funds are being expended according to the Council’s priorities and allocations, and whether funds are being rapidly disbursed to the community. The assessment is for the 2022-23 grant year and contains findings related to four areas: 1) Executed Contracts/Renewals, 2) Procurement, 3) Subcontractor Payments, and 4) Spending. The draft assessment is based on information presented to the EC and PC through quarterly spending reports and monthly Recipient reports. There was also fiscal information provided from the Recipient, as well as preliminary findings from HRSA’s site visit in May. Overall, the findings are positive, particularly in the area of spending and procurement. Mr. Klotz reviewed the text of the draft assessment’s findings, which was amended by the Executive Committee last week to include a statement concerning the high underspending in Emergency Financial Assistance and the need for the Recipient to notify the Council as early as possible in the grant year when a service category has high underspending.
Ms. Plummer suggested adding language regarding the Council’s reprogramming plan. There was a consensus to add the sentences “The Council will review its reprogramming plan to clarify the parameters of service category takedowns. The Recipient will partner with the Planning Council to adhere to new guidelines for reprogramming.”
In response to a question from Ms. Hribar, Mr. Shahi and Ms. Plummer explained that for annual subrecipient amendments, Public Health Solutions (PHS) allows up to a 25% advance to ensure cash flow for the providers. Executing a newly procured contract can take 45 days, possibly more depending on the administrative requirements. Payment after receipt of invoices can be delayed due to the need to obtain required documentation. DOHMH is looking at how documentation can be streamlined to lessen the burden on providers. DOHMH is working with HRSA to review processes to ensure that funds are distributed expeditiously, and is working in conjunction with the NYS DOH to move to a web-based system to make the process more efficient.
In response to questions related to the difficulty of procuring services for Planning Council administration, Ms. Fernandez explained that all non-services must now be procured through the NYC agencies and cannot go through PHS, but that BHHS is working with the Division of Disease Control to improve the process.
Ms. Betancourt stated that when in-person meetings resume, it is critical to provide a car service for PWH who are unable to take public transportation.
A motion was made and seconded to approve the assessment of the administrative mechanism as presented with the above change. The motion was adopted 30Y-0N.
Agenda Item #8: Recognition of Retiring Members
Mr. Harriman paid tribute to five members who are completing their 2nd term and retiring from the Council: Ms. Betancourt, Ms. Chestnut, Mr. Gross, Mr. Natt and Ms. Walters. Inscribed plaques are being made to honor their service. Council members and staff thanked the retirees for the years of commendable and dedicated service on the Council.
Agenda Item #9: Public Comment, Part II
Mr. Harriman reminded the Council of the annual member recognition event on Friday, August 4th, 12:30-4pm at Riverbank State Park.
Ms. Walters reminded members to stay informed on the Medicaid 1115 waiver, which will affect service delivery. (A presentation to the Council on this topic is scheduled for the autumn.)
Mr. Harriman outlined items that will be on the Council’s agenda in the next session, including value-based payments, the emergency financial assistance service category, and updates on the implementation of the Framing Directive, Oral Health and Ambulatory Outpatient/Older PWH programs.
Mr. Harriman announced that the job posting for Director of the HIV Planning Council has been posted on nyc.gov/jobs. He expressed his confidence that the Council will be able to manage the challenges it faces, keep the focus on the community and consumers, and maintain the legacy of the Ryan White program. Council members thanked Mr. Harriman for his leadership and guidance and his focus on centering the consumer experience. There being no further business, the meeting was adjourned.