Thursday, March 24, 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), A. Abdul-Haqq, F. Alvelo, M. Bacon, A. Betancourt, S. Altaf, M. Baney, R. Brown, G. Bruckno, M. Caponi, R. Chestnut, B. Cockrell, J. Edwards, B. Fields, R. Fortunato, M. Gilborn, C. Graham, B. Gross, R. Henderson, E. Kaywin, M. Lesieur, A. Lugg, D. Martin, L. F. Molano, MD, J. Natt, H. Nguyen, J. Palmer, D. Powell, M. Rifkin, L. Ruiz, C. Simon, M. Thompson, T. Troia, R. Walker, S. Wilcox
Members Absent: L. Beal, D. Beiling, P. Canady, E. Casey, J. Dudley, J. Gomez, C. Moore, G. Plummer, F. Schubert, V. Velazquez
Staff Present: DOHMH: D. Klotz, M. Lawrence, C. Rodriguez-Hart, PhD, S. Torho, J. Colón-Berdecía, K. Mack, D. Noble, G. Navoa, D. Ferdinand, M. Pathak; Public Health Solutions: A. Shahi, R. Santos; NYS AIDS Institute: W. Patterson; J. Corbisiero (Parliamentarian)
Agenda Item #1: Welcome/Introductions/Minutes/Public Comment
Ms. Walters and Mr. Harriman opened the meeting followed by a roll call and a moment of silence. The minutes from the February 24, 2022 meeting were approved with no changes.
Agenda Item #2: GY 2022 Spending Scenario Plan
Mr. Natt introduced the GY 2022 Spending Scenario Plan. Congress has approved a budget and the full award should come in within two months. The review of the portfolio that began last year will be used by PSRA to develop a new set of allocations for GY 2023. For 2022, as in previous years, PSRA has approved a methodology for implementing an expected reduction to the grant award so that the Recipient can implement it immediately upon receipt of the full award. The Spending Scenario Plan posits a reduction of up to 3.6% in the total award (reductions in recent years have ranged from 1.5-3.5%). The EMA is likely to continue seeing a decrease in our formula award (based on the number of HIV cases in the EMA compared to the other 51 EMAs). The cut will be offset somewhat by a modest increase in the national Part A appropriation in the budget just passed by Congress.
Mr. Klotz described the details of the plan. The EMA is likely to continue seeing a decrease in our formula award (based on the number of HIV cases in the EMA compared to the other 51 EMAs). The cut will be offset somewhat by a modest increase in the national Part A appropriation in the budget just passed by Congress. After 10% for administration, $3M for Quality Management, and the already approved Tri-County spending plan, that leaves $70.3M for NYC programs (a reduction of $3M). The actual reduction is likely to be less, given that Congress added $10M nationally to the RWPA appropriation and the NY EMA receives about 10% of national RWPA funds.
For GY 2022, there is $2.1M in savings in carrying costs in three service categories due to permanent contract takedowns or terminations. Health+Hospitals (H+H) Correctional Health services (mostly funded through Medicaid and other sources) has seen a significant reduction in the number of clients due to recent criminal justice reforms and the reduction in RWPA funds would right-size the program. In addition, H+H staff funded through other sources are continuing to serve those clients. The $2.1M savings in carrying costs is somewhat offset by the need to fund a full year of PSS TINBNC (at $937K, which includes $50K for training) and a half year of the newly bid Oral Health Services (to start Sept. 1, 2022). In a 3.6% reduction scenario, the remaining deficit ($1,552,233) can be taken from the ADAP allocation, which will be restored (and more) through reprogramming and 2021 carryover.
Mr. Natt, on behalf of PSRA, moved to approve the spending scenario as presented: In the case of a reduction in the grant award up to 3.6% (or $3,296,674), the deficit (after savings in carrying costs and new allocations) will be taken from the ADAP allocation. In the event that the reduction in the award is less than $1,249,541 (the savings in carrying cost minus the new allocations), any surplus will be allocated to ADAP. The motion was adopted 31Y-0N.
Agenda Item #3: HIV Prevention Group (HPG) Update
Ms. Torho reported that there was a presentation at the recent HPG meeting to the Status-Neutral Workgroup on reducing stigma in HIV prevention activities. The HPG is also working on updates to its website with a focus on integrating community voices. The HPG is also participating in the development of the Integrated HIV Prevention and Care Plan in a process parallel to that of the Planning Council.
Agenda Item #4: Statewide Integrated HIV Prevention and Care Plan
Ms. Simon and Mr. Harriman presented on the 2022-26 Integration HIV Prevention and Care Plan, for which CDC and HRSA have released their guidance. The Plan builds on the first (2016-21) plan and allows each jurisdiction (state, territory) to use portions of existing initiatives such as federally funded Ending the HIV Epidemic (EHE) and State Ending the Epidemic plans. The three main points highlighted in the plan are: 1) Identify persons with HIV who remain undiagnosed and get them linked to care; 2) Link and retain persons diagnosed with HIV in health care to maximize viral suppression; and 3) Increase access to PrEP for persons who are HIV negative.
The NYS ETE Blueprint and Beyond 2020 addendum were developed after a comprehensive community engagement effort. Those reports addressed health disparities and equity, trauma-informed care and the impact of COVID-19. The goals were to prevent new HIV infections, improve HIV-related health outcomes for people with HIV, reduce HIV-related disparities and health inequities, and achieve integrated, coordinated efforts that address the HIV epidemic among all partners and stakeholders. COVID-19 remains an emerging issue for NYS residents due to mental health issues, job loss, lack of technology proficiency and capability (i.e., telehealth), poor medication adherence, increased isolation, lack of routine HIV, hepatitis C and STI testing, etc. In February 2019, the U.S. Department of Health and Human Services (HHS) announced Ending the HIV Epidemic: A Plan for America (EHE) which aims to reduce new HIV infections by 75% in five years (by 2025), and by 90% in 10 years (by 2030). EHE focuses on four pillars: 1) Diagnose, 2) Treat, 3) Prevent, and 4) Respond.
A timeline for the new Plan was presented, starting from coordination group meetings, data gathering and community input, through developing a draft, public comment and feedback, concurrence votes by planning bodies (including the Council) and final submission by December 9, 2022.
A review of the previously presented NYC EHE plan was given. Of the 48 counties identified by HHS for funding, 4 are in New York State (Bronx, Manhattan, Brooklyn, Queens). The Council and HPG voted to concur with the plans in January 2021 after an extensive public input process. The EHE plan includes a Situational Analysis that identifies social determinants of health and how they intersect with the HIV service system. Priority populations are identified (e.g., Black MSM, PWH over 50) along with activities to address health inequities (e.g., address stigma, use a status-neutral approach to care). Key EHE activities were outlined (e.g., value-based payments for Care Coordination, capacity building, expand Sexual Health Clinics, employ peers). Activities for each EHE pillar were explained (e.g., Diagnose/improve detection of acute HIV infection, Treat/meet behavioral health needs of PWH). The EHE plan also includes key activities to address social and structural determinants of HIV-related health inequities (e.g., PSS TIGNCNB and Aging service directives).
Opportunities for input into the Integrated Plan will include the April Consumers Committee meeting, a summer NYS Town Hall, and a special pre-concurrence session for the Council in September.
A summary of the discussion follows:
- The CDC and HRSA require this plan even though it overlaps with existing plans. They want to ensure coordination across jurisdictions. Also, the Integrated Plan offers an opportunity to develop new goals and objectives and have parts of the State that are not part of the EHE plan to learn best practices.
- The counties chosen for EHE funding were decided by the federal government based on prevalence data. EHE funding might expand in the second five-year time frame for the program.
- The Plan fulfills the RW legislative mandate that requires that all states complete a “statewide coordinated statement of need”.
- Mapping the lessons from existing plans would allow for concentration on new areas of focus (e.g., health equity).
The presentation was followed by a breakout session where participants provided feedback on priority populations. Highlights of the feedback from the breakout rooms were:
- Perinatally infected people may fall under the youth priority population but be facing the issues of older PWH.
- There needs to be a way to track the prevalence of disabilities among PWH or RWPA clients.
- There are intersections between priority populations and populations that are not specifically mentioned (e.g., substance users).
- There is a need to address how provider burnout affects care for priority populations and how workforce development can address that.
This was followed by a second breakout session where participants provided feedback on potential goals and objectives for each pillar of the plan. Highlights of the feedback from the breakout rooms were:
- Address co-occurring conditions across health issues.
- Address issues arising from the COVID pandemic (e.g., social isolation).
- Be inclusive of those not named as priority populations.
- Focus on social determinants of health, including employment, housing, education.
- Ensure that everyone feels safe accessing health care.
- Discuss how to leverage resources beyond Ryan White funding.
Agenda Item #5: Co-chairs Report
Mr. Harriman reported that the Executive Committee approved a provider survey to enhance the Council’s Assessment of the Administrative Mechanism. The survey will obtain input from RWPA contractors on payments, technical assistance and other aspects of their relationship with the Recipient.
In-person meetings are expected to resume in the fall. Time will be needed for the procurement process to pay for meeting space, food, audio and other expenses.
Agenda Item #6: Public Comment
Ms. Chestnut asked members to keep her sister in their thoughts during her health challenge.
Mr. Fields encouraged everyone to be mindful of the accommodations needed for people who use wheelchairs.
In a response to a question from Ms. Gilborn, Mr. Harriman reported that Recipient data shows that all RWPA providers are offering in-person services. Many still allow a virtual option for clients who request or need it. Also, as of March 1st, the recipient has reverted to fee-for-service reimbursement for RWPA providers.
Mr. Carr encouraged providers to move towards normalcy in the provision of services. He asked for support for his participation in the California AIDS Life Cycle Ride.
There being no further business, the meeting was adjourned.