Meeting of the Priority Setting & Resource Allocation Committee
Monday, January 9, 2023
By Zoom Videoconference
3:05 – 4:15
Members Present: Marya Gilborn (Co-chair), Jeff Natt (Co-chair), Fulvia Alvelo, Matt Baney, Kyron Banks, Billy Fields, Graham Harriman, Steve Hemraj, Matthew Lesieur, Guadalupe Dominguez Plummer, John Schoepp, Dorella Walters
Members Absent: Joan Edwards, Henry Nguyen, Claire Simon, Terry Troia
Staff Present: David Klotz, Scott Spiegler, Johanna Acosta, PhD, Scarlett Macias, Doienne Saab, Karen Miller, Deb Noble, Giovanna Navoa, Renee James, Ilana Newman, Patrick Chan (NYC DOHMH); Arya Shahi, Gemma Barclay (Public Health Solutions)
Agenda Item #1: Welcome/Introductions/Minutes
Ms. Gilborn and Mr. Natt opened the meeting, followed by introductions with conflicts of interest noted, and a moment of silence. The minutes of the December 12, 2022 meeting were approved with no changes.
Agenda Item #2: GY 2023 Spending Scenario Planning
Mr. Klotz reviewed the spreadsheet showing the baseline for discussion of a spending scenario plan for the actual GY 2023 award. As agreed by PSRA at the previous meeting, the spreadsheet shows a scenario with a 3.5% reduction to the Base award. Any deficit from a reduction would also include the obligations for two new allocations approved in the Council’s GY 2023 application spending plan: 1) a full year of Oral Health Services (which started mid-year this year and is currently funded for 6 months), and 2) the new Ambulatory Outpatient Services for Aging PWH (AOS), which will begin on March 1, 2023. These two new allocations total $1,733,800 in new funding, and a 3.5% reduction in the Base award would mean a deficit of about $4.5M. Such a drastic reduction is not likely, but the PSRA must plan for all contingencies.
Mr. Harriman reported that Congress approved a flat-funded appropriation for Part A nationally, and a modest increase to MAI programs, which are spread across all Ryan White parts. The long-time trend of the NY EMA seeing a smaller percentage of PWH across all EMAs due to higher investment in prevention is expected to continue, affecting our formula award, which is two thirds of the total. HRSA has announced that there will be a small partial award this year to keep programs running, but the full award is expected in March, and PSRA and the Council must have a methodology in place by the end of February, so that the Recipient can get the funds out to providers as soon as the award comes in.
Mr. Shahi explained that in February he will present the amount of savings in the carrying costs of programs from GY 2022 into GY 2023 due to contract terminations and other permanent takedowns. In GY 2021, there was about $700K in savings in Mental Health and Early Intervention Services. Programs were cost-based that year, but have returned to performance-based in GY 2022, but the savings analysis has not taken place yet. The savings in carrying costs will offset the amount that PSRA will have to find to cover the deficit from a flat funding or reduction scenario. In addition, the Tri-County Steering Committee is considering changes to their portfolio which likely result in a reduction of about $233K in programs in that region. PSRA will need to decide how to make up any additional deficit.
There was a discussion on the possibility of eliminating Health Education and Risk Reduction (HERR) as a stand-alone category and incorporating it into the new Behavioral Health (BH) Directive. Mr. Harriman explained that the peer-led self-management course has reported good outcomes, and that the evidence-based intervention (EBI) it uses (Positive Life Workshop) can be folded into the BH programs as an option for an EBI. The BH directive will include a number of EBIs for self-management. With the much larger scale of the programs that will be folded into BH (over $14M for Mental Health, Harm Reduction and Supportive Counseling), there will be far more opportunities to engage a wider range and greater number of clients. Mr. Spiegler reviewed client enrollment data for HERR for GY 2020 and 2021, which showed 606 and 547 active clients respectively, although it was noted that not all completed the 7-session program. Some clients who graduate attend “alumni workshops”, which helps reduce social isolation. Ms. Dominguez Plummer added that the BH programs will be implemented in GY 2025, which means that if HERR ended this year, there would be a two-year gap in services. The current HERR contracts end in Feb. 2024 and can be extended for a year. Mr. Harriman added that the program’s original intent was to enroll newly diagnosed people, but that was untenable, and when the program was re-bid in 2015, the eligibility criteria were expanded. There was a consensus that HERR should continue until it can be incorporated into the BH program in GY 2025.
Mr. Klotz explained that in previous years, PSRA’s methodology has been to make as many targeted reductions as possible, then apply an across-the-board proportional reduction weighted by service category ranking score. In discussions before the meeting, Council and Recipient staff and the PSRA chairs discussed a $2M upfront reduction to ADAP, which would cover the entire deficit in a flat funding scenario. Also, much of those funds would be restored through reprogramming and carryover. In a more drastic reduction scenario, the remainder of the deficit would be made up through the across-the-board reduction (offset by the savings in carrying costs and Tri-County programs).
A motion was made and seconded to use the methodology of a $2M targeted reduction to ADAP and a proportionate across-the-board reduction. The motion was adopted 9Y-0N. At the February 6th meeting, the exact amounts for Tri-County and savings in carrying cost will be applied to the plan.
At the February meeting, there will also be a presentation from the Recipient on their payer of last resort site visits, which was requested by PSRA when discussing the Medical Case Management/Care Coordination category last year. The data should help the committee understand the overlap with Medicaid Health Homes.
There being no further business, the meeting was adjourned.