Priority Setting & Resource Allocation Committee Minutes December 9, 2019


Meeting of the
Monday, December 9, 2019
Cicatelli Associates, 505 Eighth Ave., NYC
3:10 – 4:50pm

Members Present: Jeff Natt (Co-chair), Dorella Walters (Co-chair), Randall Bruce, Paul Carr, Broni Cockrell, Graham Harriman, Steve Hemraj, Matthew Lesieur, Oscar Lopez (by phone), Carmelo Cruz Reyes, Michael Rifkin, John Schoepp (by phone), Claire Simon (by phone), Barry Zingman, MD   

Members Absent: Joan Edwards, Jesus Maldonado, Leo Ruiz, Terry Troia, Rob Walker

Staff Present: David Klotz, Melanie Lawrence, Scott Spiegler, X. Pamela Farquhar (NYC DOHMH); Bettina Carroll, Gucci Kaloo (Public Health Solutions)

Agenda Item #1: Welcome/Introductions/Minutes  

Mr. Natt and Ms. Walters opened the meeting, followed by introductions and a moment of silence.  The minutes of the November 18, 2019 meeting were approved with no changes.

Agenda Item #2: FY 2020 Spending Scenario Planning

Tri-County Allocation

Mr. Klotz presented the draft FY 2020 spending plan for Tri-County (TC) programs as approved by the TC Steering Committee.  Since the TC portfolio was rebid last year and programs are in their startup year, there is no change to the carrying cost of programs.  The one exception is the Housing Services Category.  In FY 2019, TC Housing programs enrolled more clients than the program was budgeted for.  Also, there was an increase in the number of family units in contrast to single individuals, thus the programs’ rental assistance share was higher than anticipated.  The shortfall was covered in FY 2019 through the use of carry-over funds left over from FY 2018.  Those carry-over funds run out on February 29, 2020.  In order to keep those extra clients housed in FY 2020, the TC Steering Committee is requesting an increase to the baseline Housing allocation of $175,000.  If there is any natural attrition in the program, additional clients can be enrolled.  It was noted that the Tri-County region lacks a HASA program, Section 8 Housing or other rental assistance programs for PLWH (aside from some HOPWA funds).  In the event of a reduction in the overall FY 2020 grant award, the additional funds will be taken out of the ADAP allocation.  Julie Vara, the director of the AIDS Institute, has confirmed that the State can absorb the reduction to ADAP without losing any services through other funding streams (Part B, State funds, drug rebates).

In response to a concern raised by Mr. Lesieur, Ms. Farquhar explained that the over-enrollment in the first year was related to the late enhancement to the contracts and that the DOHMH HIV Housing Unit will be providing close oversight to ensure that the programs do not spend beyond their contract amounts.

A motion was made, seconded and approved unanimously to approve the FY 2020 Tri-County spending plan as presented.

Psycho-social Support for Transgender, Intersex, Non-binary, and Non-conforming (PSS TGINBNC) Individuals

Ms. Lawrence gave an overview of the service model that was approved by the full Council in July to fund PSS TGINBNC services, which will provide individualized supportive counseling services that aim to overcome barriers to access and facilitate continued engagement in medical care for PLWHA.  The gender-affirming service model includes: assessment and re-assessment, coordination of all levels of medical and behavioral health (as needed), treatment adherence services, individual and group support services, linkage/referrals, health education, and outreach.  The directive also calls for a resource directory and training curriculum.

Mr. Spiegler presented on the number of Transgender individuals living with HIV in NYC and who are currently enrolled in Ryan White Part A (RWPA) programs (excluding HIV testing), followed by a cost estimate for the service category.  According to the recently released HIV surveillance report, in 2018, 59 transgender people were diagnosed with HIV and 25 with AIDS (a marker of late entry into care).  About half were Black or Hispanic and ages 20-29.  There are a total of 1873 transgender women and 31 transgender men living with HIV in NYC as of Dec. 2018.  Ninety percent were Black or Hispanic.  In FY 2018, there were 458 transgender women and 53 transgender men enrolled in PWRA programs who received at least one service at any time during the grant year.  There is no data on intersex, non-binary or non-conforming people.

Programs would be cost-based.  Based on average salaries plus fringe and other than personnel services (OTPS), the following cost analyses were presented:

Scenario one: $255,646-$335,775 for one program that would have a caseload of between 50-60 clients (55-90 unique clients).  The anticipated staffing includes a program director (at half Full-Time-Employee rate), a clinical supervisor (.15 FTE), 2 full-time case managers and a peer navigator.

Scenario two: $324,327-$423,500 to serve 75-90 clients (80-120 unique clients).  The anticipated staffing is the same as above, but with an additional case manager.

Funding for the resource manual and curriculum would require $50,000 in FY 2020 to create, and $10,000/year for updates in subsequent years.  The resource guide and curriculum can be accomplished in FY 2020, but program services will require a request for proposals (RFP), which is a lengthier process, thus the allocation for program services would be earmarked for FY 2021.  This amount would be put into the application spending plan next spring and in the actual FY 2021 spending scenario next winter.  A summary of the discussion follows:

  • Any solicitation or RFP can say that an organization with TGINBNC staff is preferred, but by law cannot be restricted to that.
  • The currently funded psycho-social support services (called Supportive Counseling and Family Stabilization in our EMA) use a different service model and do not provide the specialized services in the PSS TGINBNC directive and use a different payment structure, thus just expanding those programs’ capacity is not feasible.
  • New programs funded under this directive can provide employment opportunities for people from the target population.
  • The service model was developed through a lengthy process that involved the Needs Assessment and Integration of Care Committees and has been approved by the full Council.  PSRA’s role is not to revisit the service model, but to determine the allocation based on how many programs to fund and the cost of the services.
  • The demand for this service is unknown.  These will be cost-based contracts (not performance-based), which means programs will be paid based on staffing levels, not on how many units of service they provide.  If there is a low demand, then it will be impossible for the master contractor to adjust the contract amount and staff will be under-worked.  If there is higher than expected demand, then the PSRA and Council have the opportunity to increase the allocation in future grant years.  Thus it might be wiser to start conservatively with a smaller allocation.
  • The Council does not get involved in procurement, but provides as much guidance about the program model as possible so that the program can be successfully implemented.
  • The difficulty in having a larger number small programs is that infrastructure costs (overhead, office space, etc.) can be large, making it unfeasible.
  • Information about the geographic distribution of transgender PLWH in NYC and who are enrolled in RWPA programs would help determine how many programs there should be and where they could be located.
  • All programs will have to be available to eligible clients in the entire EMA, and the recipient will work to ensure geographic distribution of services, but it will also depend on the proposals that are received through the RFP process.
  • Start-up costs are always built into new programs.  It might be good to start small and look at enrollment numbers and see if the service warrants growth in future years.
  • The scenarios presented are based on current supportive counseling models, but staffing needs may change as the program is implemented.  The staffing model might be too top-heavy (e.g., additional peer navigators might be called for).
  • Feedback on program implementation will be solicited from the community as part of the procurement process after a concept paper is released, but before the final RFP goes out.
  • The gap between the numbers of transgender people with open and active enrollment in RWPA programs might signify that some clients did not feel comfortable with the programs they initially encountered.
  • Programs should not just be serving people already enrolled in other RWPA programs, but doing outreach to find those who are not connected to the system of care.

A motion was made and seconded to fund the resource directory and training curriculum in FY 2020 at $50,000 (with $10,000 to be allocated in future years for regular updates).

In response to a question, Mr. Spiegler explained that the amount was derived based on the time and effort that has been required for similar projects.

The motion was adopted unanimously.

Additional data will be presented at the January 13th meeting, along with a draft FY 2020 spending plan showing the additions approved today, changes to the carrying costs of programs, and a possible 3.5% reduction to the Base award.

There being no further business, the meeting was adjourned.