Planning Council Meeting Minutes June 23, 2022

Thursday, June 23, 2022

3:30-4:30 PM

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), A. Abdul-Haqq, F. Alvelo, S. Altaf, M. Bacon, A. Betancourt, R. Brown, G. Bruckno, M. Caponi, B. Cockrell, J. Dudley, J. Edwards, B. Fields, M. Gilborn, C. Graham, B. Gross, R. Henderson, E. Kaywin, M. Lesieur, D. Martin, L. F. Molano, MD, J. Natt, H. Nguyen, J. Palmer, G. Plummer, M. Rifkin, C. Simon, T. Troia, V. Velazquez, R. Walker, S. Wilcox

Members Absent: M. Baney, L. Beal, P. Canady, E. Casey, R. Chestnut, R. Fortunato, J. Gomez, C. Moore, D. Powell, L. Ruiz, M. Thompson

Staff Present: DOHMH: C. Quinn, MD, D. Klotz, M. Lawrence, J. Acosta, S. Macias, J. Colón-Berdecía, D. Noble, G. Navoa, D. Ferdinand, K. Mack, R. James, I. Newman, K. Miller, C. Rodriguez-Hart, S. Torho; Public Health Solutions: G. Ashby-Barclay, R. Santos, A. Shahi; J. Corbisiero (Parliamentarian)

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 May 26, 2022 meeting were approved with no changes.  

Agenda Item #2: Monkeypox Update

Dr. Quinn, DOHMH Deputy Commissionerfor Disease Control, gave an update on the monkeypox outbreak.  She described symptoms, modes of transmission, and the scope of the outbreak globally and locally.  She stressed that, while the spread has mostly been in social circles of gay and other men who have sex with men, it is important not to stigmatize this population.  Dr. Quinn outlined ways to protect oneself and one’s sexual partners, what to do if you have symptoms, how to protect others in your household, and who should get the 2-shot vaccine regimen (people with a close contact who has or is suspected of having monkeypox and other people with recent exposure).  DOHMH has opened a vaccine clinic at the Chelsea Sexual Health Clinic.  Gay, bisexual, and other men who have sex with men (cisgender or transgender) age 18 and older who have had multiple or anonymous sex partners in the last 14 days are eligible for the vaccine.  DOHMH is also conducting contact tracing, disseminating information and is planning an educational campaign.  More information and updates are available at nyc.gov/health/monkeypox .

A summary of the ensuing discussion follows:

• The vaccine should ideally be taken within four days of infection, but taking it up to 14 days will lessen severity of disease.  The vaccine is 85% effective.  Also, an infection likely infers a long period of immunity.
• DOHMH will have a presence at Pride events, but is relying on community partners to spread the word widely.  The Department will look at getting the word out to people in supportive housing.
• There is no current data on the interaction between monkeypox and COVID-19.  People with HIV can safely get the monkeypox vaccine. 
• DOHMH labs can test to see if the infection is an orthopox virus, but confirmation of monkeypox needs to be done at the CDC.  However, monkeypox is the only orthopox virus circulating currently.
• Therapy with an investigational oral anti-viral can be prescribed to treat infection.

Agenda Item #3: GY 2022 Final Spending Plan

Mr. Klotz explained that for the first time in nine years, the EMA received an increase ($2,662,448) in the Ryan White Part A (RWPA) grant award.  The bulk of the increase was in Base supplemental funds, which is based on the application score.  The application is a three-year application, which means the score remains the same for GY 2023 and 2024.  There was also an increase in formula funds, which are based on the number of PWH reported to the CDC.  This was the area where most of the reductions have been, which means that other EMAs’ HIV incidence is coming more into line with NY.  HRSA announced that every EMA got an increase due to the $10M additional appropriated by Congress plus $20M available nationally from the pool of unspent carryover available due to the waiver of penalties on underspending.  The waiver is in effect again for GY 2021, which means that the award will likely remain stable for at least another year. 

The amount of funds to be allocated includes both the increase in the award, as well as uncommitted funds from savings in carrying costs of programs from GY 2021.  That amount is slightly offset by the allocations that the Council had already agreed to ($250K for the first 6 months of new oral health programs, and $443,500 to fund a full year of PSS TIGNBNC).  This leaves a total of $3.8M in uncommitted funds to allocate. 

Mr. Natt presented a plan approved by the Priority Setting & Resource Allocation (PSRA) and Executive Committees, initially developed by Council and Recipient staff based on need and provider capacity, to allocate the additional funds.  All enhancements are permanent and on-going.  The following are the proposed enhancements:

1. Housing (HOU): $837,136 to address the rise in rent and operations.  Of the total, $515,065 will NYC Short-term Housing, $176,573 to NYC Rental Assistance, $125,276 to NYC Housing Placement Assistance, and $20,222 for Tri-County Short-term Housing.  Ms. Noble added that the amount is based on the HUD increase of 12% in fair market rent as well as ConEd’s estimate that utilities will go up 14% this year.  Part of the new HOU funding will be for on-going staff retention initiatives (e.g., increased salaries and benefits) to address ongoing COVID-related burnout and loss of staff, particularly in congregate facilities.  Short-term rental programs will need more staff to serve additional clients.  The enhancement will cover expenses for leases in existing programs. 
2. Food & Nutrition Services (FNS): $355,801 for NYC programs, $59,975 for TC to provide permanent enhancements to food services, based on the 10% inflation rate since the FNS rates were set in 2019.  
3. Emergency Financial Assistance (EFA): $850,000 to serve the entire EMA.  This program, originally based in TC, has done a phenomenal job extending services to NYC.  Mr. Spiegler and Dr. Acosta explained that the program is currently dramatically overperforming and can benefit from additional funds to cover the increase in demand.  The program spent over $140,000 in March 2022 alone and needs to hire a full-time staff to manage the increase in number of clients requesting EFA services.  The Recipient is also requesting that the Council make permanent the per client annual cap of $5,000 (originally $2000).  It was noted that the Emergency Financial Assistance allocation was moved from the Tri-County plan to the NYC plan.  The program is administered by an agency located in Westchester but serves the entire EMA and the majority of clients are from NYC.
4. Oral Health Services (OH): The original spending scenario called for funding two programs (to start mid-year) at an annualized allocation of $250,000 each.  There is a third fundable proposal, and programs’ maximum reimbursable amount (MRA) can be increased to $300,000 each.  Thus, an additional $200,000 above what was already pledged is required to fund three programs for 6 months.
5. ADAP: The balance of the uncommitted funds ($1,508,065) would go to ADAP, with the understanding that about $1.3M will be taken back in GY 2023 to fund the new Ambulatory Outpatient Services for Older PWH.  A small amount of ADAP funds was moved from MAI to Base so that the allocations exactly match the respective award amounts.

A summary of the ensuing discussion follows:

• Most EFA clients use close to the cap of $5000/year.  Housing costs and utility bills are the most common uses of the funds.
• EFA clients are accepted first come, first serve.  Clients are referred by case managers from across the EMA.  Programs must ensure that all funds are payer of last resort (e.g., if they can use another program to pay their back utilities, they must avail themselves of that before using the RWPA EFA program).
• Oral Health services are also payer of last resort and enhance services paid by Medicaid and other sources.  Those programs pay for limited services and the RWPA program will allow for more preventative, restorative and other dental services (e.g., additional deep cleaning, bone grafts, implants).
• Programs across the portfolio may be able to use more money for staff retention enhancements, particularly medical case management, where clients build long-term relationships with providers.  There are limitations to the ability of some providers to do pay increases (e.g., agency policy, union rules).  PSRA will consider this in the GY 2023 application spending plan.

A motion was made, seconded and approved 26Y-0N to adopt the final GY 2022 Spending Plan as presented. 

Agenda Item #4: GY 2021 4^th Quarter Closeout Report

Mr. Carr introduced the GY 2021 fourth quarter commitment and expenditure report, noting that EMAs across the country have had challenges spending their full awards during the pandemic.  In a pre-meeting with the Recipient and Council leadership, there was a commitment to address spending issues so that carryover is minimized in future years.

Mr. Spiegler reported that the carryover from previous year is unusually high for the second year in a row.  HRSA issued a waiver again from any penalties for carrying over more than 5% of the award.  The past two grant years were unpreceded due to the COVID-19 pandemic and under normal circumstances we would not be managing such a large carryover amount.  This is largely attributed to the cost-based reimbursement structure across the RWPA portfolio implemented in the past two years due to the pandemic. Also, most RWPA funded organizations faced staff turnovers with some staff leaving due to burnout and for higher paying jobs offering telework/full remote work.  This great resignation has also been experienced at DOHMH for staff supported on the RWPA budget, and the city is moving very slowly on job postings and start dates for new hires.  Highlights of the report are:

• Non-Medical Case management service category expenditure is 81%.  This is due to close-out expenses related to the program ending on 02/28/2021.
• Housing and FNS both spent close to 100% of their allocations, demonstrating the demand for these essential services.
• Mental Health Services in both NYC and Tri-County have historically underspent because of payor of last resort issues.
• MAI funds were almost fully spent.
• Tri-County PSS has an expenditure of 79% due to underperformance resulting from staffing vacancies and challenges with hiring new staff.  The Recipient is actively providing ongoing support and assistance to the program.
• TC Medical Transportation services category has an expenditure of 81% due to services slowing returning to in-person from virtual and people with HIV accessing more transportation services.
• EFA had an expenditure of 58% due to receiving carryover funds late in the fiscal year making it challenging to spend down, however, as explained earlier, this year the program is overperforming dramatically. 
• There is major underspending in administration and Quality Management due to DOHMH staff vacancies and challenges filling vacancies quickly due to a long hiring process.

The total carryover of $7,627,207 is the largest in many years due to the unprecedented time challenges of the pandemic and the resulting staff turnover.  The Recipient is working to improve grant administration and DOHMH/PHS monitoring of spending to proactively identify funds for reprogramming and minimize underspending.  Additionally, the Recipient is working with the Quality Management team and PHS to communicate and prepare subrecipients in advance of carryover funds so programs are set up successfully to spend down.  In response to a question, it was explained that Base and MAI programs are considered one pool of funds for planning purposes, as all Base programs meet MAI eligibility.  The Recipient assigns contracts to the MAI funds and can switch them to Base to match the grant awards.

Mr. Harriman noted that at this point the Committee reviews the Assessment of the Administrative Mechanism.  This year, the Council has conducted a survey of RWPA providers, which resulted in findings around timeliness of contract documents and payments to contractors.  We have conveyed the results of the survey to the Recipient and master contractor (PHS) as well as to Ms. Walters and Mr. Carr.  The Council leadership will present the findings to the Executive Committee and Council at the July meetings in order to give the Recipient time to develop a sound and actionable response to the findings.

Agenda Item #5: GY 2021 Carryover Plan

Mr. Natt explained that the PSRA and Executive Committees, after extensive deliberations, approved a plan for allocating the carryover funds based on a set of recommendations developed by the Recipient.

Mr. Spiegler noted that, as reported earlier, the final carryover from GY 2021 available to allocate in GY 2022 is $7,627,207.  The HRSA rules for use of carryover funds were explained (one-time program funds that typically arrive late in the grant year and must be fully spent by February 28, 2023).  The Recipient surveyed provides and looked at capacity, spending trends and needs to develop a draft carryover plan, which was presented to PSRA, which modified the plan to what is being presented today.  The proposed uses of the funds (all for both NYC and TC), as approved by PSRA are:

1. FNS: $1,000,000 to provide additional food vouchers and pantry bags.
2. Value-based payments for Medical Case Management (VBP): $1,200,000.  VBP was implemented successfully in GY 2021 using GY 2020 carryover.  Payments are made on four measures using benchmarks for enrolling virally unsuppressed clients, case conferencing, health education sessions, and achieving VLS. 
3. Culturally and Linguistically Appropriate Services (CLAS) Standards: $2,106,000 to allow every sub-recipient (RWPA provider) to complete a federally-mandated CLAS Standards assessment tool and work plan, as outlined in the Council’s Framing Directive.  This will help improve quality of services, address inequities, and reach PWH who may need translation and interpretation services at $26,000 per provider across a total of 81 unique agencies.  The amount is based on an estimate of how much time will be required for each agency to complete the assessment.
4. 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 28^th Council meeting for 2-year terms beginning September 1^st.   Also, the annual member recognition event is scheduled to take place on July 19^th 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.