Thursday, March 2, 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, M. Caponi, J. Edwards, R. Fortunato, B. Gross, S. Hemraj, R. Henderson, B. Hribar, E. Kaywin, M. Lesieur, D. Martin, H. Martinez, L. F. Molano, MD, J. Natt, J. Palmer, G. D. Plummer, L. Sabashvili, J. Schoepp, M. Sedlacek, C. Simon, M. Soares, M. Thompson, T. Troia, S. Wilcox
Members Absent: S. Altaf, M. Bacon, L. Beal, R. Brown, G. Bruckno, R. Chestnut, J. Dudley, M. Gilborn, J. Gomez, C. Graham, F. Laraque, N. Martin, W. LaRock, H. Nguyen, M. Rifkin
Staff Present: DOHMH: D. Klotz, M. Lawrence, D. Saab, S. Spiegler J. Acosta, S. Macias, A. Raker, J. Colón-Berdecía, K. Mack, D. Bickram, I. Newman, A. Eppinger-Meiering, R. James, S. Torho, J. Jaramillo, D. Noble, M. Beyene, M. Pathak; Public Health Solutions: G. Ashby-Barclay, A. Shahi
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 in honor of Black History Month and the many people of African descent who contributed to the fight against HIV. The minutes from the January 26, 2023 meeting were approved with no changes.
Agenda Item #2: Public Comment, Part I
Mr. Schoepp reported that MetroPlus insurance will no longer provide prescription coverage and will move beneficiaries to a Medicaid program
Mr. Gross announced two open positions at SAGE, which serves LGBT+ seniors.
Dr. Sedlacek announced a job opening at Montefiore Medical Center. Also, the Governor’s budget contains a proposal that may result in disruption to mental health care by disenrolling thousands of people with chronic conditions (including HIV and mental illness) from Health Homes, and she encouraged people to sign an advocacy letter opposing this.
Mr. Natt announced that his program’s capable AIRS data specialist was let go from NYU Medical Center due to budget cuts and is available for hire.
Agenda Item #3: HIV (Prevention) Planning Group Update
Ms. Torho reported that the HPG held its annual Strategic Planning Retreat last month with the theme “Transformation and Recommitment”, which focuses on assessing the HPG’s and its workgroups’ goals and activities. They will also look towards strengthening the collaboration with the Planning Council beyond the Joint Policy Committee.
Agenda Item #4: GY 2023 Spending Scenario Plan
Mr. Natt presented the GY 2023 spending scenario plan approved by the PSRA and Executive Committees. The plan is a methodology for implementing the final award when the EMA received it from HRSA, allowing the Recipient to immediately execute sub-recipient contracts. The scenario plans for up to a 3.5% reduction to the Base award. Even with a flat funding scenario, there will be a deficit of $1,783,000 in order to pay for Council-approved initiatives (a full year of Oral Health Services, and the new Ambulatory Outpatient Care for Aging PWH). There is a savings of $233,000 in the cost of Tri-County programs through a Tri-County Steering Committee-approved budget that has a targeted reduction to Medical Case Management and a proportionate across-the-board reduction weighted by ranking score. PSRA’s spending scenario addresses a potential deficit by starting with a $2M targeted reduction to ADAP. If there is still a deficit, there will be a proportionate across-the-board reduction to other categories weighted by ranking score. Mr. Klotz reviewed the plan on the NYC and TC spreadsheets. The final notice of award is expected in the next month.
Mr. Natt, on behalf of PSRA, moved to accept the GY 2023 spending scenario plan as presented. The motion was adopted 27Y-0N.
Agenda Item #5: GY 2022 3rd Quarter Expenditure Report
Mr. Fields prefaced the 3rd quarter expenditure report by noting that there continues to be higher than usual underspending due to systematic issues, and the Recipient is committed to working with the Council to address this long term.
Mr. Spiegler reported that as of the end of the 3rd quarter (Nov. 30, 2022), the grant was 64% spent (the same as the end of the 3rd quarter in GY 2021, and less than the 72% reported at that point in GY 2020). Carryover funds (ADAP, value-based payments for Medical Case Management, Food & Nutrition Services, CLAS standards) were only 29% spent. Some overarching issues explain underspending across all service categories: staff recruitment and retention, stagnant or uncompetitive salaries, administrative caps on sub-recipients, difficulties conducting outreach, and continued struggles with in-person services and hesitation to gather in groups as COVID-19 lingers. Problems with underspending are being seen in EMAs across the country, as well as the NYS Part B program.
Several reasons for underspending unique to specific service categories were given, such as late execution of Housing contracts, the large enhancement to Emergency Financial Assistance that came several months into the year, and continued lower usage of Tri-County Medical Transportation as in-person services continue to rebound.
In order to increase the expenditure rate, the Recipient will reprogram unspent funds to ADAP. Longer-term, they will revisit reimbursement structures to address underspending and collaborate in addressing systemic barriers to service delivery.
A summary of the discussion follows:
- The portion of reimbursable expenses that are deliverable based includes quality management activities, data entry, CLAS standards, emergency preparedness and other contract requirements.
- The changes at Rikers Island that are affecting the Non-Medical Case Management program there include staffing issues and larger numbers of releases.
- The Families First Coronavirus Act added billions, particularly for food services, which might have impacted the RWPA FNS providers with payer of last resort issues.
- COVID SNAP benefits are ending, which may drive higher demand for RWPA FNS.
- HRSA did not approve expending funds to buy cell phones for clients to access telehealth.
- While the Recipient is trying to address the issue of staff shortages, many of the issues are out of its control. The Recipient cannot mandate salaries, and many salaries are determined by unions.
- The increase in the allocation for FNS was able to cover the added expenses due to inflation.
Mr. Harriman stated that future presentations of expenditure reports should include the narrative up front to provide greater context and understanding.
Agenda Item #6: DOHMH BHHS Training and Technical Assistance (T-TAP):
Provider Training to Support Older PWH
Ms. Raker, Content Tailoring Specialist at T-TAP, presented on a new initiative to tailor provider trainings to support aging PWH. T-TAP provides comprehensive, culturally appropriate training and technical assistance to support NYC service providers in their HIV, Hepatitis, and STI-related work. Among the many trainings offered are: HIV 101, Benefits Navigation, Enhanced Outreach, Linkage to Medical Care, HIV Stigma, Enhancing Health Outcomes for Older PWH. Additional trainings are in development (e.g., Trauma-informed Care, Racial Equity). Background for this initiative was explained (e.g., 60% of PWH over age 50, many long-term survivors on ART over 10 years). A timeline of development was given, starting with focus groups in 2018 through training of trainers (TOT) in 2021 (delayed and mostly virtual due to COVID-19). Content included: frailty, isolation, multi-morbidity, stigma, mental health, cognitive issues. Revisions to the curriculum will include social determinants, intersectionality and making the training more interactive. Details of those components were described.
Successes were described, especially the development of a strengths-based, affirmative training for providers who work with OPWH, called “Enhancing Health Outcomes for Older People Living with HIV”. Challenges include adapting to COVID-19 and developing initial TOT experience. Lessons learned include adopting a strength-based approach that values the experience of older PWH and developing best practices for adapting a training for older PWH providers. Next steps include: learning management software, resource manual, group-specific trainings (e.g., Older Women with HIV).
In response to questions, Ms. Raker noted that addressing transgender and other populations is on the radar for new trainings. Also, while a high proportion of new infections are among younger people, this training is specifically for older PWH, most of whom have been living with HIV for some time.
Agenda Item #7: Planning Council Chairs Update
Ms. Walters encouraged everyone to fill out an AIDS Institute survey on participation in the development of the Integrated HIV Prevention and Care Plan. Mr. Harriman gave brief updates on the work of the Council’s sub-committees.
Agenda Item #8: Public Comment
Mr. Palmer reported that a bill to preserve the 340b program has been introduced in the NYS legislature. He encouraged people to mobilize before the program sunsets on April 1st.
In response to a question from Mr. Schoepp, Mr. Harriman said that the purchase of tablets is working its way through the DOHMH procurement process. There being no further business, the meeting was adjourned.