Thursday, June 29, 2023
By Zoom Videoconference
Members Present: G. Harriman (Governmental Co-chair), D. Walters (Community Co-chair), B. Fields (Finance Officer), F. Alvelo, R. Babakhanian, M. Baney, K. Banks, A. Betancourt, R. Brown, M. Caponi, 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, L. F. Molano, MD, J. Natt, J. Palmer, G. D. Plummer, L. Sabashvili, J. Schoepp, M. Sedlacek, C. Simon, M. Thompson, S. Wilcox
Members Absent: S. Altaf, M. Bacon, L. Beal, G. Bruckno, R. Chestnut, J. Dudley, J. Edwards, J. Gomez, F. Laraque, N. Martin, H. Martinez, T. Troia
Staff Present: DOHMH: D. Klotz, S. Spiegler, G. Gambone, J. Acosta, I. Newman, F. Silva, B. Meisel, K. Mack, R. Torres, M. Bayene; Public Health Solutions: B. Silva, G. Ashby-Barclay, 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 25, 2023 meeting were approved with no changes.
Agenda Item #2: GY 2022 Closeout Report
Mr. Spiegler presented the GY fourth quarter closeout report. This past year saw great success with the implementation of fixed rate with deliverable reimbursement structures and successful implementation of the Council’s reprogramming plan, bringing the EMA to approximately full spend down with no underspending in program services. Most categories were 100% expended. The exceptions were Non-Medical Case Management (92% spent) and Early Intervention Services (84%) in NYC. There was underspending in grant administration and Quality Management related to DOHMH staff vacancies on the RWPA budget and challenges with filling vacancies quickly due to a long hiring process with the city agency. In summary, Supplemental expenditure is at 100%, Formula is 97% expended and MAI is at 99% for the 4th quarter, with total underspending at $2,889,062, far lower than in GY 2021.
Mr. Spiegler explained that the additional carryover identified since the report to the Executive Committee (EC) comes from administrative funds. The report to the EC included that final reconciliation through DOHMH fiscal might find additional underspending.
There was a discussion about Emergency Financial Assistance (EFA), which Council members noted spent considerably less than its original allocation, considering what an important service this is. It was explained that the EFA program was originally only located in Tri-County, but from 2020-22, the allocation had been increased by a huge amount to respond to COVID. In order to get the funds out quickly, the existing provider was used and the service area expanded to include NYC. There have been barriers to increasing enrollment and spending due to the rapid increase in funding and staffing issues. The Recipient has worked to inform NYC providers about availability of the program. It was noted that more outreach directly to consumers could help, as could having the program place peer workers in the five boroughs. Contracting with a NYC-based provider can be done with the Council’s guidance when the program is reprocured. Paperwork for enrollment in EFA is limited to what HRSA requires to establish eligibility and is less onerous that most other RWPA programs. The Recipient will be exploring more ways to promote the program and increase utilization.
Agenda Item #3: GY 2022 into 2023 Carryover Plan
Mr. Natt explained that every year, the Council approves a plan for the use of funds left unspent after the close of the previous grant year. As you’ll hear in the presentation, the amount of underspending is far lower than the previous two years. PSRA has approved a plan to spend the carryover, based on an analysis of the portfolio conducted by the Recipient. The PSRA Committee is confident that the plan will allow the funds to be spent before the end of this grant year and will enhance services that will directly benefit people with HIV.
Mr. Spiegler explained that, as noted in the closeout report, there is a much smaller amount of underspending ($2.9M) compared to the previous year ($7.68M). HRSA allows carryover to be used for program services and are one-time enhancements that must be used by the end of the year (Feb. 29, 2024) and are generally approved by HRSA in late autumn. The Recipient, based on an analysis of programs, is recommending that carryover be used for the following program enhancements: 1) Food and Nutrition Services for food vouchers and pantry bags ($796,500 in NYC, $103,500 in TC); 2) Value-based payments (VBP) for Care Coordination/Medical Case Management ($398,225 in NYC, $26,775 in TC); 3) Legal Services for increasing client enrollment to expand legal services ($498,720 in NYC, $26,280 in TC); 4) ADAP ($589,062 NYC and TC, plus any additional underspending if the above programs are not able to spend their enhancements. Ms. Gambone provided details on VBP, which incentivizes CCP/MCM providers to find people with unsuppressed viral load and get them into care and suppressed. This would be the third year in a row that the Council authorized these payments.
A summary of the ensuing discussion follows:
- Consumers could be more involved in developing VBP benchmarks. There is a sense in the Consumers Committee that their feedback into quality management generally needs to be more valued.
- The benchmarks were developed in 2019 and can be adjusted moving forward, incorporating client feedback.
- Benchmarks should be more focused on outcome measures, rather than process measures.
- The BHHS research and Evaluation Unit does an analysis of which agencies met their benchmarks and the amount of each VBT is recalculated so that the allocation is maximized. Providers can use the VBP for any RWPA activity.
- While HRSA does not require programs to have client advisory boards (CABs), it can be a local requirement, as it once was in the EMA.
- All RWPA programs in the EMA are currently required to have a method in place for getting client feedback, which could be a CAB. The QM plan is a living document and there can be ongoing discussions on consumer engagement.
- In the past two years, VBP has been the part of the carryover plan that has spent down the most quickly.
- After the Council approves the carryover plan, it was to be submitted to HRSA, which generally approves it in the fall, after which providers can be notified that the funding is available.
A motion was made and seconded and to accept the Carryover Plan as presented, noting that the amounts have been adjusted since the plan was presented to PSRA and EC to account for the additional amount of available carryover.
There was a discussion on whether the plan as presented needed to be reviewed again by the PSRA or EC. Mr. Harriman noted that it is normal for the final carryover amount to change as DOHMH does its final reconciliation. Also, all the additional underspending comes from grant administration and would be repurposed for programs that directly benefit PWH.
A subsidiary motion was made and seconded to refer the Carryover Plan back to the Executive Committee.
It was noted that all PSRA and EC members are part of the full Council. Also, the bylaws give the full Council the authority and final say over items that come from any sub-committee. Ms. Silver also noted that delaying approval by another month would give the providers less time to apply for and spend the funds, meaning delays in delivering the services to PWH.
The motion to refer the Carryover Plan back to the Executive Committee was defeated 13Y-15N
The motion to accept the Carryover Plan as presented was approved 16Y-13N
Agenda Item #4: Planning Council Chairs Update
Mr. Harriman announced that nominations are being accepted for community co-chair. Elections for a two-year term will take place by online ballot at the July meeting. Any full voting member who is not a representative of a governmental agency is eligible to run for election to the position. The roles and responsibilities of the co-chair were described as per the Council bylaws.
The annual member recognition event will take place on Friday, August 4th, 12:30-4pm at Riverbank State Park.
Agenda Item #5: Public Comment, Part II
Mr. Fields stated his concern that the Recipient is not respecting the Council’s legislatively mandated role. He expressed his desire to work cooperatively to improve health outcomes for PWH. He also suggested reconstituting the Finance Committee. Mr. Klotz explained that this would require a change to the bylaws and would need to be referred to the Rules & Membership Committee for consideration. Mr. Harriman added that the issues with the spending report can be resolved by being more diligent about briefing the Finance Officer and other Council members in advance of the meeting.
Mr. Schoepp announced that a EtE Health Fair will take place in Jackson Heights on September 30th and is seeking volunteers.
Mr. Maia Soares stated that the Council and Recipient can work together more effectively, but that everyone must keep the needs of PWH as their primary focus.
Mr. Hemraj and Mr. Martin expressed his concern about any staff person disrespecting PWH or being dismissive of consumer concerns or the community planning process.
Dr. Molano and Ms. Walters urged everyone to engage respectfully and work together to build trust, work through disagreements and move forward to provide the best services possible to PWH.
The Behavioral Health Directive will be postponed until the July meeting.
There being no further business, the meeting was adjourned.