Priority Setting & Resource Allocation Committee Minutes July 13, 2020


Meeting of the
Monday, July 13, 2019
By Zoom Videoconference 3:05 – 4:45pm

Members Present: Jeff Natt (Co-chair), Dorella Walters (Co-chair), Paul Carr, Broni Cockrell, Graham Harriman, David Klotz, Oscar Lopez, Jesus Maldonado, Carmelo Cruz Reyes, Michael Rifkin, John Schoepp, Claire Simon, Terry Troia, Rob Walker

Members Absent: Randall Bruce, Joan Edwards, Steve Hemraj, Matthew Lesieur, Leo Ruiz, Barry Zingman, MD

Staff Present: Melanie Lawrence, Kimbirly Mack, Johanna Acosta, Eleanora Jimenez-Levi, Dave Ferdinand, Karen Miller, May Wong (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 a roll call and a moment of silence.  The minutes of the June 29, 2020 meeting were approved with one change to reflect accurate attendance.

Agenda Item #2: FY 2021 MAI Application Spending Plan

Mr. Klotz presented the draft MAI (Minority AIDS Initiative) FY 2021 application spending request.  HRSA requires the EMA to submit separate Base and MAI plans in the applications.  The MAI award is 100% formula-driven, based on the number of non-white PLWH in the EMA.  The EMA traditionally requests level funding for MAI, and asks for the maximum allowable increase in the Base award (5% over the current year). 

A motion was made, seconded and approved 12Y-0N to accept the FY 2021 MAI application spending plan as presented.

Agenda Item #3: FY 2021 Base Application Spending Plan

Non-Medical Case Management (General Population)

Mr. Klotz summarized the discussion to date on Non-Medical Case Management (NMG), which provides coordination and assistance providing access to and retention in medical and support services.  The allocation is $1.228,931, with four contracts (all NMG providers have contracts in other RWPA categories) serving 621 clients in 2019 (number adjusted to reflect full year).  All NMG service types (outreach, accompaniment, coordination, assistance) are provided across numerous RWPA categories (HRR, MH, MCM, PSS, EIS).  Almost half of active NMG clients were actively enrolled in at least one other service category.  HASA, Medicaid Health Homes, Special Needs Plans, and Ryan White Part B, RWPA Care Coordination, and Supportive Counseling all provide similar case management services.  NMG has consistently under-performed (11.2% in 2015; 0.01% in 2016; 9.2% is 2017, nearly 20% for 2018).

Given NMG services’ duplication of RWPA and other funded case management services, where does the model fit in the Planning Council’s funding priorities?  With the prospect of continued decreases in the RWPA grant award, should the PC use this service allocation to offset future reductions and/or for additional funding to higher priority service categories and new needs (e.g., Oral Health, COVID response)?

A summary of the discussion follows:

  • NMG Clients at Project Hospitality on Staten Island may not be able to be enrolled in Harm Reduction if they do not meet the program criteria of being an active substance user or in need of substance use-related services.  Many are also more disconnected from the care system.  Once stabilized, about half move into Health Homes.
  • Programs are required to ensure that there is continuity of services.  DOHMH project officers provide programs with resources and check in to ensure that any clients in a discontinued program receive seamless care.
  • 127 of the 621 NMG clients are uninsured.  Of those, about a quarter are already enrolled in Care Coordination, and others in Harm Reduction and other programs.  Uninsured clients can enroll in programs funded by RW Parts B, C and D.  All parts of NYC have programs under these parts.
  • NMG is a low threshold service, often “one-off” – to meet an emergency need (e.g., housing, enrollment in Medicaid), who then leave the program.   
  • All RW programs are payer of last resort and all can be found elsewhere, but the Council funds them because they fill a gap, such as Food & Nutrition.  The case for defunding NMG is that there is an abundance of other sources, and other categories have a higher priority in a time of increased need and diminishing resources.
  • The NMG program for inmates and releases operates under the same service directive, but has its own allocation in the spending plan and would continue if NMG is no longer funded.

Mr. Carr moved that the NMG category be eliminated from the FY 2021 Base spending plan.  The motion was seconded and approved 13Y-0N.

Mr. Klotz and Mr. Natt noted that it is difficult to vote to end a program, and thanked the Committee for having a thoughtful discussion of the proposal.  Programs have been eliminated many times in the past as the epidemic evolved and resources diminished (e.g., buddy services, home health care, transitional care coordination), and the Council always tries to act to improve the overall system of care.

Base Spending Plan

Mr. Klotz presented the FY 2021 Base Application Spending Plan showing the current allocations (including the COVID-19 enhancements).  The EFA enhancement is reflected in the total Tri-County amount.  The one-time Housing enhancement which was taken from ADAP is shown as restored to that category.  The EMA traditionally requests the maximum allowed by HRSA (5% over the current award, or $4,205,840).  $434,000 is accounted for to fund the Psychosocial Support for TINBMC PWH ($10,000 for the resource guide update, the rest for half a year of programs).  With the elimination of NMG, a 5% increase leaves $3,923,557 to allocate in the spending request.  Possible options include targeted increases (e.g., extending the Housing enhancement to address COVID needs), and an across-the-board increases weighted by priority ranking score.  The Council may choose to keep certain categories that do not require an increase flat funded.  PSRA will use the plan when they meet again in the fall to develop a plan for an actual award that is expected to be lower than the current year’s.

There being no further business, the meeting was adjourned.