Thursday, June 24, 2021
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, S. Altaf, F. Alvelo, M. Baney, L. Best, A. Betancourt, R. Bruce, M. Caponi, E. Casey, B. Cockrell, M. Diaz, J. Edwards, B. Fields, R. Fortunato, T. Frasca, M. Gilborn, C. Graham, A. Lugg, D. Martin, J. Natt, G. Plummer, D. Powell, M. Rifkin, L. Ruiz, J. Schoepp, F. Schubert, C. Simon, M. Singh, R. Walker
Members Absent: M. Bacon, D. Beiling, R. Brown, P. Canady, R. Chestnut, M. Domingo, J. Dudley, B. Fenton, MD, B. Gross, A. Roque, M. Thompson, T. Troia, B. Zingman, MD
Staff Present: DOHMH: D. Klotz, M. Lawrence, J. Thomas, S. Spiegler, A. Azor, J. Carmona, J. Colón-Berdecía, K. Mack, K. Miller, D. Ferdinand, G. Navoa; Public Health Solutions: A. Feduzi, G. Ashby-Barclay, B. Silver; J. Corbisiero (Parliamentarian)
Agenda Item #1: Welcome/Moment of Silence/Introductions/Minutes
Mr. Harriman and Ms. Walters opened the meeting followed by introductions and a moment of silence. The minutes of the May 27, 2021 meeting were approved with no corrections. Mr. Harriman announced that the July meeting will be extended in order to finish the Planning Council’s work for the cycle.
Agenda Item #2: Public Comment, Part II
Ms. Best reported that she has been accepted into the Southern Black Policy and Advocacy Network’s inaugural 3-month training for leadership capacity building.
Mr. Powell announced that Exponents is holding a Town Hall on National HIV Testing Day focused on LGBTQ+ youth of color.
Agenda Item #3: Recipient (Grantee) Update
Ms. Plummer reported that the White House released President Biden’s FY22 budget request, which proposes $133.7 billion in discretionary funding for the U.S. Department of Health and Human Services (HHS) – an increase of over 23% from FY21. Of this, $670 million would support continued implementation of the Ending the HIV Epidemic (EHE) initiative. The budget includes over $755 million in CDC HIV prevention funding and $2.5 billion in HRSA Ryan White HIV/AIDS Program (RWHAP) funding (Parts A through F), including an additional $10 million for Part A. The White House and various agencies also marked the 40th anniversary since the first reports of what would be called AIDS were issued by the CDC.
The RWPA FY 2022 Notice of Funding Opportunity and Grant Application Guidance has been released. This year’s application is for a three-year cycle and the score will count towards the supplemental awards for FY 2023 and 2024 (in addition to 2022). HRSA released the RWHAP COVID-19 Data Report for January 20 through December 31, 2020. As part of HRSA HAB’s Fiscal Year (FY) 2020 Coronavirus Aid, Relief, and Economic Security Act (CARES Act) appropriation, 581 existing RWHAP Parts A, B, C, and D recipients received CARES Act funding. On May 27th, the BHIV’s Care and Treatment Program (CTP) submitted the FY 2020 Ryan White Part A Progress Report to HRSA. The report includes the carryover amount that will be presented later in the meeting.
In response to the RFP for Psychosocial Support Services (PSS) for Transgender, Intersex, Gender Non-Conforming, and Non-Binary Individuals (TIGNCNB), two organizations (Destination Tomorrow, Inc. and Mount Sinai Hospital), were awarded with a proposed annual budget amount of $423,500 each. Contract negotiations are scheduled for the month of July 2021 with contracts executed by late August 2021 and programs starting 9/01/2021. The Quality Management and Technical Assistance unit will host a virtual provider meeting for all RWPA-funded programs on July 28, 2021. On May 25, 2021, Public Health Solutions (PHS), on behalf of DOHMH BHIV released the Routine HIV Testing concept paper for an upcoming Request for Proposals for Routine HIV Testing.
Ms. Thomas presented the 2019 RWPA Enrollment Reports that summarize client demographics, HIV risk factor, insurance type and priority populations by enrollment status for each service category. The report is used to assess numbers of clients enrolled and served in RWPA programs, look at changes in enrollment status relative to previous years, and assess the reach of the programs to particular populations. In 2019, the entire EMA’s RWPA program had 13,541 active clients (received at least one service during the time period), and 6,683 newly enrolled clients. Fifty-three percent were over 50, 65% male, and 89% Black of Latinx. The vast majority were enrolled in Medicaid, Medicare or ADAP. RWPA demographics matched somewhat with the EMA’s overall PWH population (the percentage of women and transgender people, heterosexual, Black/Latinx, and people residing in Brooklyn and the Bronx was somewhat higher for RWPA).
In both NYC and Tri-County, Medical Case Management and Food & Nutrition Services were the most heavily used services (also Medical Transportation in TC). Priority populations that were well served in RWPA programs include people over 50, cisgender women of color, Black and Latino cisgender MSM, and people with a disability.
A summary of the ensuing discussion follows:
- Insurance status is self-reported by clients at intake and reassessment.
- Some people may be dually enrolled in Medicaid and Medicare.
- ADAP sometimes only has stopgap coverage, for example during Medicaid spend-down periods.
- Other insurers (e.g., Veterans Administration) are not captured.
- PWH with serious mental illness (SMI) should be considered for inclusion among the priority populations.
Agenda Item #4: FY 2020 4th Quarter Closeout Report and FY 2020 into 2021 Carryover Plan
Mr. Natt introduced the carryover plan explaining that every year, after the Grantee completes its closeout report for the previous year and finalizes the amount of underspending, the PSRA and Planning Council approve a plan to use that carryover amount. The amount of carryover from 2020 is much higher than usual due to the effects of the COVID-19 pandemic. PSRA worked with the Grantee to develop a carryover plan that helps consumers with some of their greatest needs such as Emergency Financial Assistance and Food & Nutrition Services, as well as fund other initiatives and help restore the cut that we made to ADAP at the beginning of this year. The PSRA and Executive Committees discussed the carryover plan extensively and made revisions to adapt to concerns raised by committee members. We believe that the plan presented today fits within HRSA’s allowable uses for carryover and is feasible within the challenging timeframe for spending it. The plan is also flexible, as it will allow for the Grantee to move carryover funds between elements of the plan if there is greater need and capacity of providers. The plan also allows the Grantee to maximize spending at the end of the year, which is vital, as any unspent carryover is returned to HRSA and will never be available again.
Ms. Plummer reported that underspending from FY 2020 is much larger than usual ($4,911,568, compared to $363,720 from FY 2019). This is due to the COVID-19 pandemic and Governor Cuomo’s NYS on Pause Executive Order lasting over four months (from March to July 2020) when RWPA-funded organizations were unable to provide many in-person services and adapted to remote work, telehealth, and virtual services. Also, DOHMH staff activations lasting for over a year meant that Grantee staff salaries were paid through COVID funds and not RWPA. DOHMH also had a hiring freeze that kept some positions open. Many RWPA funded organizations faced staff turnovers with some staff being laid off, furloughed, or leaving due to burnout. All EMAs across the country have faced these same circumstances, and so HRSA has waived penalties and requirements for FY 2020 and FY 2021, including the 5% cap on carryover.
Highlights of the closeout report included:
Ms. Plummer explained that HRSA allows carryover funds to be spent directly on RWPA program services benefiting people with HIV through one-time enhancements to programs late in the grant year, typically around November. In addition, carryover funds can be used to pay for technology devices, such as laptops, tablets, smartphones including connectivity for clients accessing telehealth and virtual support services. All carryover funds must be fully spent by the end of this grant year (February 28, 2022).
Mr. Natt introduced the elements of the plan: 1) enhancement to Emergency Financial Assistance (EFA) – $500,000; 2) enhancement to Food and Nutrition Services (FNS) – $700,000; 3) Value-based Payments (VBP) for Care Coordination Programs (CCP) – $360,000; 4) Smart phones and data plans for clients accessing RWPA telehealth services – $300,000; 5) Capacity building and training services for Ryan White Part A Programs – $800,000; and 6) Partial Restoration of the reduction to the ADAP program – $2,251,568.
Ms. Plummer described the details and justification of each component of the plan. EFA was previously limited to the Tri-County region with an original service allocation of $250,000. In FY 2020, the program services expanded to include the five boroughs of NYC receiving a one-time enhancement of $499,825 from ADAP for COVID-19 response (made permanent for FY 2021). The actual year-to-date spending rate was 163%. The carryover plan continues providing EFA services throughout the EMA with an additional funding of $500,000 while also raising per client annual cap on assistance to $5000 from $2000.
The FNS allocation in FY 2020 was $7,462,131 and included a one-time enhancement from ADAP for COVID-19 response. The allocation for FNS in the Tri-County region was $968,807 and the actual yea- to-date spending rate was close to100%. The Grantee is proposing an additional $210,000 for food and nutrition services across the NY EMA for larger/more pantry bags, food vouchers, etc.
Value-based payments (VBP), which is part of the Care Coordination Program (CCP) contracts, is an initiative to align incentives with service quality. It was supposed to start in March 2020 but was derailed by COVID. Programs receive payments if they meet certain benchmarks that demonstrate improved client-level outcomes. The system rewards programs when they improve their own performance over time. The benchmarks include: percentage of clients with at least one community-based patient navigation service (coordination, accompaniment, linkage, etc.); percentage of clients with at least one case conference service per quarter; and percentage of clients who have achieved viral load suppression within the first 6 months of program participation. The carryover gives the Grantee an opportunity to pilot VBP in a low-risk way for programs allocating $15K/benchmark for 24 programs at a total of $360K. Not all programs will spend the maximum, so any unspent carryover will be rolled into ADAP (as with all other carryover left unspent near the end of the year).
The allocation for smartphones and data plans is based on an estimate of $300 per client for a total of 1,000 clients ($300,000), distributed across service categories (Health Education and Risk Reduction, Harm Reduction, Mental Health, and Supportive Counseling/Psychosocial Support Services) that may make use of this technology to carry out program activities. There is also a federal program (SafeLink) that pays for this to access telehealth, but SafeLink plans have data limits (although it will subsidize phone bills). While there is no way to prevent a client from using the equipment for personal use, the main objective is to allow them to access telehealth and remote services.
The enhancement for capacity building and training ($800,000) would allow programs to use the funds for developing plans for Health Equity, Racial Equity, Anti-Stigma, Trauma Informed Care and trauma informed supervision, and Professional Development, including conferences/webinars, certifications, licenses to enhance scope of practice. The remaining balance ($2,251,568) will go to ADAP.
Mr. Natt concluded by noting that due to the short amount of time to spend the money and limitations on the capacity of providers to spend it, maximum flexibility will be needed. As the year ends, the Grantee will assess spending, reallocate funds to areas of the plan that demonstrate need and ability to spend, and will roll any unexpended carryover funds into ADAP, which is the one program that can absorb last-minute funding (as well as being the Council’s highest priority service category, which directly provides medications to clients).
A summary of the ensuing discussion follows:
- The Grantee will develop a roster of provider trainings based on the Council’s and DOHMH’s priorities, particularly around racial equity and trauma-informed care.
- During COVID, providers experienced high burdens of trauma, both personally and through their jobs.
- The federal Lifeline Program will expire when the government declares that the national emergency is over, but the need to help consumers access telehealth will continue. The Council should consider looking into how to extend the assistance.
Mr. Natt, on behalf of PSRA, moved that the Council adopt the carryover plan as presented. The motion was adopted 27Y-0N.
Agenda Item #5: Committee Updates
Ms. Best and Mr. Bruce reported that the Consumer committee has undergone a seven-month development process for the HIV and Aging Service Directive. The Committee received presentations from a number of Subject Matter Experts including Jules Levin on the state of HIV and Aging research, Moisés Agosto-Rosario on Health inequities for Aging PWH, Dr. Anjali Sharma on Relevant issues for Women with HIV, and Dr. Eugenia Seigler on considerations for the Healthcare system in regards to Aging with HIV. The Committee met several times in May to prepare for the HIV and Aging Community Forum on June 4 where community members provided feedback and edits on the Directive. The Committee is in the process of finalizing those edits in preparation for the July Council meeting.
Needs Assessment Committee
Ms. Lugg reported that NAC held a two-part forum on Serious Mental Illness (SMI) & HIV with state partners (OASAS, OMH, AIDS Institute), and presented findings gathered by the committee. The committee finalized recommendations for PWH with SMI within the RWPA service system and has created a workgroup to collaborate with state and NYC partners to address the needs of PWH with SMI in the larger system of care. Next year, the committee will focus on publishing a comprehensive needs assessment
Integration of Care Committee
Mr. Powell reported that IOC has been working on the Framing Directive, a document that replaces the Master Directive, which will provide foundational guidance for the entire portfolio of services. Using an implementation science logic model, the document provides context and utilizes strategies to improve care.
This process has been difficult but has also been invaluable in forcing conversations about equity and uptake of the implementation science logic model for future directives.
Ms. Gilborn reported that in July, PSRA will approve a spending request for the 2020 grant application. HRSA is allowing us to ask for up to 5% more than what we received in the current year. The application spending plan is not binding, and PSRA will develop a plan for the actual award in the fall and winter. For the application spending plan, there will likely be some targeted increases, including money to fund a full year of the TINBNC Psychosocial Services category, as well as money to implement the Oral Health category. PSRA will also consider earmarking some funds to make the carryover enhancement to Emergency Financial Services permanent. The planning for the actual award, which started earlier this year with a review of each service category, will continue in July with presentations on Housing and Food & Nutrition Services.
Tri-County Steering Committee
Mr. Altaf reported that the TCSC approved the FY 2022 application spending plan for our region’s program. TCSC is requesting the maximum increase allowed by HRSA (5% over the current year’s award), spread proportionally across all service categories weighted by ranking scores. This plan is a placeholder, and the committee will use the fall and winter to plan for the actual award. At the July meeting, they will receive an in-depth report on the Tri-County portion of the FY 2020 fourth quarter closeout report. Mr. Harriman will also present on the work the Consumers Committee has done to develop a service directive for Aging and HIV.
Rules & Membership Committee
Mr. Fields reported that RMC meets tomorrow to review the applications we have received for Council terms beginning September 1st. We have received about 25 applications for new appointment, 13 of them from consumers. Outreach coordinator José Colón-Berdecía did an excellent job recruiting a diverse group of applicants, including a significant number from the Bronx (an area underrepresented on the Council), as well as Tri-County. After the Committee reviews the applications and conducts interview, they will develop a final slate of nominees for review and approval by the Executive Committee before being sent to the Mayor’s Office of Appointments.
Agenda Item #6: Public Comment, Part II
Ms. Best reported that she served as an election worker and that there will be a fresh new crop of elected officials in Westchester.
Ms. Gilborn announced that The Family Center is hiring, including for a Spanish/English bilingual peer outreach worker.
Dr. Lance Keene (NYU School of Social Work) announced recruitment for a new study on LGBTQ+ youth of color and transition to adulthood.
Ms. Simon announced that there will be a virtual memorial for Terri Smith-Caronia on Monday, June 28th.
There being no further business the meeting was adjourned.