Priority Setting & Resource Allocation Committee Minutes February 8, 2020

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Meeting of the Priority Setting & Resource Allocation Committee

Monday, February 8, 2021

By Zoom Videoconference

3:05 – 4:30

M I N U T E S

Members Present: Marya Gilborn (Co-chair), Jeff Natt (Co-chair), Fulvia Alvelo, Matt Baney, Paul Carr, Broni Cockrell, Joan Edwards, Billy Fields, Graham Harriman, Guadalupe Dominguez Plummer, Leo Ruiz, John Schoepp, Claire Simon, Dorella Walters

Members Absent: Randall Bruce, Michael Rifkin, Terry Troia, Rob Walker

Staff Present: David Klotz, Melanie Lawrence, Scott Spiegler, Eleonora Jimenez-Levi, Kimbirly Mack, Karen Miller, José Colón-Berdecía, Giovanna Navoa, Dave Ferdinand  (NYC DOHMH); Gucci Kaloo, Bettina Carroll, Rosemarie Santos (Public Health Solutions)

Agenda Item #1: Welcome/Introductions/Minutes

Mr. Natt and Ms. Gilborn opened the meeting, followed by introductions and a moment of silence.  The minutes of the January 11, 2021 meeting were approved with no changes.

Agenda Item #2: FY 2021 Spending Scenario Planning

Mr. Klotz reviewed that the PSRA Committee needs to finalize a methodology for implementing an expected reduction in the FY 2021 grant award.  The methodology allows the Grantee to execute contract renewals as soon as the award is received.  Outstanding items for the Committee to decide on are: 1) how much to fund Housing and Emergency Financial Assistance (EFA), the categories that received enhancements in FY 2020 to respond to COVID-19; 2) funding for new the initiative of Psychosocial Support for TIGNBNC (PSS).  The NYSDOH Uninsured Care Program presented at the previous meeting and assured the Committee that they are able to cover the enhancements and new initiatives through a reduction in the ADAP allocation without affecting the clients enrolled in that program.  The Committee was reminded that the CARES Act (Coronavirus stimulus) funds will not be renewed and it is unknown if the proposed new stimulus will include any funding for Ryan White programs, this the assumptions is that there will be no stimulus money this year.  Also, nationally, Ryan White is flat funded for 2021, which means that the expected reduction in the EMA’s formula funding should be in line with the previous several years.  Any national increase to Ryan White appropriations would come in 2022 if President Biden and Congress negotiate an increase.

Tri-County Spending Plan

In January, the Tri-County Steering Committee received an analysis of their Housing programs, similar to what PSRA received last month for NYC Housing programs.  In FY 2020, the TC region received a $45,000 enhancement to Housing, which was the region’s prorated amount of the CARES Act money based on their percentage of the overall award.  In FY 2021, it would require $90,000 above the original base allocation to support the currently enrolled households with increased rental costs due to impact of COVID-19 and loss of household income, increased consumer utility expenses, costs of PPE/cleaning supplies, and increased costs of program operations (i.e., office rent/utilities, finance, staff salaries/fringe, teleworking, etc.).  For FY 2021, an additional $70,000 would support serving an additional 10 eligible households with housing/short-term assistance needs to prevent homelessness among PLWHA affected by COVID.  This means enhancing the program above its original FY 2020 allocation by $160,000.

Based on the presentation given by Johanna Acosta at last month’s PSRA meeting, the EFA program is expected to spend the full $499,825 that was allocated to serve NYC residents.  (The EFA line item appears in the TC plan because the sole provider of the services is located in the region.)  The program started spending the enhancement slowly because they received the funds mid-year and needed to hire additional staff and ramp up to start serving clients in NYC. 

Ms. Lawrence noted that the Los Angeles EMA allows EFA clients to receive up to $5000 in assistance per year, compared to the NY EMA’s $2000 cap.  The Council’s service category directive decided on the cap in order to ensure that a larger number of clients could be served with the limited allocation available.  An analysis would have to be done to determine the cost and the effect of a higher cap on the number of clients that could be served.

A motion was made and seconded to approve the FY 2021 Tri-County spending scenario plan as presented, with all categories held at the same level as the original FY 2021 allocation with the exception of Housing (to be enhanced by $160,000) and EFA (enhanced by $499,825 in order to serve clients in the entire EMA).  The motion was adopted 14Y-0N.

NYC Spending Plan

As presented last month, the BHIV Housing Unit recommends that PSRA enhance the Housing category by $1,205,000 above the original FY 2020 allocation, which will keep current households (including those newly enrolled with the FY 2020 enhancement) stably housed. 

The PSS category included $50,000 in FY 2020 for the first phase – a resource directory and training curriculum.  During the year, a community-based organization independently created an online directory of trans-affirming services (Callen-Lorde’s TransAtlas).  Mr. Spiegler reported that for FY 2021, the Grantee can do a micro-purchase to enhance the TransAtlas, and will have to conduct a solicitation for the training curriculum and trainings.  Her noted that all consulting contracts now have to go through the DOHMH contracts office, which is currently not reviewing any proposals that are not directly COVID-related.  Also, contract executions generally take about 7-9 months.  A total of $70,000 will cover the update of TransAtlas and the training component.  In addition, the RFP for PSS programs is currently out for programs to start on September 1, 2021.  To fund two programs at a half year amount, the allocation would be $425,500.  Thus, the proposed total PSS allocation for FY 2021 is $495,000.

Paying for new initiatives and covering a cut to the award can be offset by savings in the carrying cost of programs (i.e., how much is costs to continue programs at their FY 2020 levels).  The Committee was reminded that there is a savings of $1,228,931 from the Council’s decision in the summer to eliminate Non-medical Case Management/General Population (NMG).  In addition, there are the following savings from permanent take-downs of programs due to performance issues or terminated contracts: Medical Case Management ($122,577), Legal Services ($154,445) and Early Intervention Services ($206,836).  This is a total savings of $1,712,789.

In a scenario of a 2.5% cut to the Base award plus the elimination of the CARES Act funds, this means that we would have to reduce the ADAP allocation by $2,570.884 to cover the enhancement, new initiatives and the cut to the award.  If the cut to the award is less, then the ADAP reduction would be lower.

Mr. Harriman noted that in past years the Council has used the previous year’s carry-over to help restore the ADAP reduction.  In recent years, there has been very little carry-over, but the Council should recommend that the Grantee allow for a larger carry-over than usual to that it can be used to restore ADAP.  There will be expected higher than usual carry-over from FY 2020 due to COVID.  Mr. Kaloo added that the Council can consider using its reprogramming plan next year to restore ADAP. 

A summary of the ensuing discussion follows:

  • The savings in Legal Services are not specific to COVID, but to longer-term performance issues.
  • Due to COVID, all reimbursements have reverted to cost-based, rather than performance-based, and so there are no permanent take-downs due to lower levels of service provision during the pandemic.
  • The ADAP allocation has dwindled considerably and there are maybe only two more years where it will be available to cover reductions to the award and new initiatives (e.g., oral health).  The Council needs to do long-range planning so that the portfolio is flexible and can be adjusted to meet the needs.
  • The EMA’s award has fallen about $25M from its peak and the Council has made many adjustments, including eliminating whole categories that were redundant or no longer needed (in recent years, NMG, Transitional Care Coordination, Home Care).  The strategy of using the ADAP allocation to preserve needed programs goes back to the beginning of the Ryan White program.  It’s only in recent years that the Council has not been able to restore ADAP to its original allocation due to high spending rates.  Without the flexibility that ADAP allows, the savings in the portfolio would have to come from other programs (e.g., Housing, Food, MCM, Mental Health, Harm Reduction, etc.).
  • The PSRA and Council have the option of making proportionate reductions across the entire portfolio, weighted by priority rank score.  The Council has only used this option when there have been draconian cuts to the award and the savings through targeted reductions were not enough to cover the entire deficit.

A motion was made and seconded to approve the FY 2021 spending scenario plan as presented: $1,205,000 enhancement to NYC Housing, $493,500 for PSS, a maximum reduction to ADAP of $2,570,884 should there be a 2.5% cut to the Base grant award and no stimulus funds).  The motion was adopted 13Y-1N.

There being no further business, the meeting was adjourned.