Meeting of the Priority Setting & Resource Allocation Committee
Monday, December 9, 2024
By Zoom Videoconference
3:00 – 4:30
Members Present: Paul Carr (Co-chair), Marya Gilborn (Co-chair), Raffi Babakhanian, Kyron Banks, Billy Fields, David Klotz, Marcelo Maia, Guadalupe Dominguez Plummer (ex-officio), Stella Safo, MD, Terry Troia
Member Absent: Matt Baney, Joan Edwards, Steve Hemraj, John Schoepp
Staff Present: Adrianna Eppinger-Meiering, Gina Gambone, Johanna Acosta, PhD, Jimmy Jaramillo (DOHMH); Arya Shahi, Gemma Barclay, Rosemarie Santos (Public Health Solutions)
Agenda Item #1: Welcome/Introductions/Minutes
Mr. Carr and Ms. Gilborn opened the meeting, followed by a roll call. Mr. Carr led a moment of silence in memory of Jeff Forrest, a long-time ally of the HIV community. The minutes of the November 4, 2024 meeting were approved with no changes.
Agenda Item #2: Behavioral Health Category Cost Analysis
Ms. Eppinger-Meiering presented a cost analysis of the three behavioral health categories (Mental Health, Harm Reduction and Supportive Counseling). The Behavioral Health Directive, approved by the PC in July 2023, seeks to provide integrated Ryan White Part A mental health, substance use, and psychosocial support care for people with HIV (PWH) with behavioral health needs. HRSA does not have a “behavioral health” category and so allocations must be reported by their separate line items, as well as other HRSA reporting requirements. HRSA definitions of the three categories were provided. Challenges in funding were described, including staff retention issues, payor of last resort and increased costs common across social services.
Service elements for each category were provided, with many common elements (e.g., intake assessment, overdose prevention trainings, evidence-based interventions or EBIs for health education, referrals and linkages). Some are unique to certain categories (e.g., psychiatric evaluation for Mental Health, auricular acupuncture for Harm Reduction). The staffing plans for each category were described, e.g., 2 full time employee (FTE) patient navigators for Mental Health, 0.2 FTE pastoral counselor for Supportive Counseling. Proposed costs for each category were described (e.g., for Mental Health, $660,447 for one program, of which $421,562 is personnel costs.)
Total estimated BH costs were broken out with $3.3M for Mental Health, $5.3M for Supportive Counseling and $4.6M for Harm Reduction. The total adds up to the same existing allocation for all three categories in the Council’s GY 2024 spending plan. The Recipient encouraged agencies to apply for more than one model and is undertaking other efforts to integrate them as per the spirit of the Council’s directive, such as having a unified Quality Management team for all programs, creating linkage agreements, etc. HRSA monitoring and reporting requirements do necessitate separate reporting for each category.
A summary of the discussion follows:
- Programs have options for filling partial FTEs, including using existing staff from other programs.
- Recommended staffing costs were based on extensive research into similar programs. The Recipient has strongly encouraged awardees to pay competitive salaries. Recipient staff will use contract negotiations to drive home the message that salaries must enable staff to live in NYC.
- Some salaries will be influenced by NYS or federal requirements (e.g., clinical mental health providers) as well as union rules.
- The Recipient should get input from programs that have client advisory boards.
- All programs are including a health education EBI, mostly “Seeking Safety”, but four are proving the Positive Life Workshop (PLW), which is double what had been provided under the stand-along service category. All services are evidence-based, including ear acupuncture. Programs will have the option to add additional EBIs later.
- CTP can discuss with awardees about reaching out to peers who have already been trained to deliver the PLW.
- CTP undertakes many efforts to ensure that consumers know about the availability of services. They also work closely with providers on outreach and in-reach efforts. The new Google maps, the RWPA Referral Directory and other resources are available.
Agenda Item #3: GY 2025 Spending Scenario Planning
Mr. Klotz explained that there is an estimated additional $1,193,512 in savings in the carrying costs of programs. The exact amount and breakout by service category will be known by the January meeting. This means that there is a potential total of $2,611,986 to absorb a reduction to the award or reallocate if there is a smaller cut or flat funding. The savings in carrying costs will cover virtually all of a 3.5% reduction to Base funding. Any reallocation of uncommitted funds would be guided by the GY 2025 application spending plan approved by the Council in July which allocated targeted increases to Housing and Food & Nutrition.
There was discussion on the possibility of severe cuts due to a drastic reduction or even elimination of the Congressional appropriation for the Ryan White program. The DOHMH Policy and External Affairs Unit and community groups are monitoring the situation, although it was noted that Ryan White has traditionally had bipartisan support. The PSRA Committee will consider a drastic reduction scenario and one possibility is to implement an across-the-board reduction weighted by ranking score. Ms. Gilborn noted that the BH categories might need to be re-ranked given changes in the service model.
Ms. Plummer and Mr. Shahi reported that there is difficulty spending down the portion of GY 2023 carryover funds allocated to Housing due to the one-time nature of the funding (e.g., funds can not be used to enroll new clients as the funding for rental assistance will run out at the end of February). Carryover funds can be rolled into the ADAP program, and more details will be presented to the Executive Committee with the 3rd quarter expenditure report. The Recipient can also look into adding additional funds to the carryover allocation for Food & Nutrition Programs.
Agenda Item #4: Public Comment
Mr. Carr asked about the income eligibility for ADAP (500% of federal poverty level, or $75,300 for an individual).
Mr. Maia invited people to attend a webinar on Ibogaine to treat substance use issues. There being no further business, the meeting was adjourned.
