Priority Setting & Resource Allocation Committee Minutes July 20, 2020

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Meeting of the

PRIORITY SETTING & RESOURCE ALLOCATION COMMITTEE

Monday, July 20, 2020

By Zoom Videoconference

3:05 – 5:25

M I N U T E S

Members Present: Jeff Natt (Co-chair), Dorella Walters (Co-chair), Randall Bruce, Paul Carr, Broni Cockrell, Joan Edwards, Graham Harriman, David Klotz, Jesus Maldonado, Michael Rifkin, John Schoepp, Terry Troia, Rob Walker

Members Absent: Steve Hemraj, Matthew Lesieur, Oscar Lopez, Carmelo Cruz Reyes, Leo Ruiz, Claire Simon, Barry Zingman, MD  

Staff Present: Melanie Lawrence, Kimbirly Mack, José Colón-Berdecía, Eleanora Jimenez-Levi, Dalveer Panesar (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 July 13, 2020 meeting were approved with no changes.

Agenda Item #2: Oral Health Services: Ranking and Allocation

Ms. Lawrence presented an overview of the Oral Health Service Directive, approved by the Integration of Care Committee (IOC) last week.  Based on CHAIN data, consumer and provider testimony, a Needs Assessment (NAC) subcommittee identified the need (approved by PC in June 2019) for an Oral Health service.  The need for RWPA-funded oral health services was due to the fact that the current service landscape did not meeting the needs of PWH, with gaps in coverage even after Medicaid and Part F programs were taken into account. 

The service directive has many innovating features, including a screening tool to identify oral health discomfort and issues among consumers, screenings for HPV and oral cancers, and timely and appropriate linkage to oral health services.  The core of the service model is: provision of comprehensive preventative dental care, ensuring coverage of four dental cleanings per year; development of  recommendations for common co-morbidities with oral health implications, i.e. Diabetes, Hepatitis C; required trainings to build provider capacity to deliver services in a way that is anti-racist and dismantles stigma; complementing Medicaid, Medicare, ADAP and Part F services to ensure a robust system of care; and development of guidance on how viral load impacts oral care.  There is a cap of 20% of allocated funding that may be used to cover the following high-cost services on a case by case basis: gum and bone grafts, and/or partials/implants when one or more teeth is missing.  The model also supports service delivery through telehealth as appropriate; ensures that dental materials utilized are long lasting and of high quality; and supports replacement of dentures and other apparatus as needed.

The other principle component of the directive is a centralized Dental Case Management service to support: full integration of oral health care into the service system; improved and increased capacity across the service system to improve access and utilization; facilitation of consumer engagement and education; provision of resources to support the more complex dental needs frequently associated with HIV; development of a resource map to support completion of oral health treatment plans; support of coordination of care with client’s care team; ensuring emergency care is funded and available; and provision of coverage for implants and other highly specialized services i.e. crowns, orthodontia, and gum & bone grafting on a case-by-case basis.

A summary of the discussion follows:

  • There was a discussion on whether or not providers funded under this category must also be funded under RW Part F.  Mr. Harriman said that his reading of the spirit of the directive is to ensure coordinated, comprehensive care for clients, rather than expand the system of care.  This would require that RWPA dental providers also be able to bill Part F (in addition to Medicaid, which is a HRSA requirement). 
  • Part F programs (there are 13 in NYC) may not do periodontal work, for example.
  • There was a consensus that Part F providers may be preferred, but contracts should not be limited to only those.  A line will be added to the directive for presentation to the Executive Committee (EC). 
  • Food & Nutrition Services (FNS) already allow purchase of personal hygiene equipment, including oral health related, but a line will be added to the directive for the EC to make it explicit in the directive.
  • FNS nutritional education services should include an oral health module.

Mr. Klotz described the four weighted priority ranking criteria (payer of last resort, access to/maintenance in care, consumer priority, specific gaps/emerging needs) and how the scoring process works.  The Committee discussed the scoring for each criteria.  Ranking is required by HRSA for the application and gives a general sense of how the Council considers the category’s importance relative the rest of the portfolio.  The scores are independent of allocations and do not affect funding levels unless an across-the-board increase or decrease is made.

A summary of the discussion follows:

  • While there are other payers for this service, this program would supplement those existing payers.
  • Oral health care is not considered primary medical care, and while programs would make referrals for people who are not linked to care, it is not their primary purpose to promote access to and maintenance in care.
  • The CHAIN study and consumer testimony at committee meetings and the QM conference have demonstrated that this is a high consumer priority.
  • The program would fill gaps for people who are unable to obtain services from other sources, but it doesn’t target a specific Council-identified special population.

Motions were made, seconded and approved to rank Oral Health Services with the following scores: Payer of Last Resort: 5 (12Y-0N); Access/Maintenance: 5 (12Y-0N); Consumer Priority: 8 (12Y-0N); Gaps/Needs: 8 (7Y-4N).

Mr. Harriman described the proposed allocation recommendation.  For the comprehensive oral health services component, the Grantee recommends $500,000 to fund two Oral Health programs of $250,000 each located in different boroughs with access to transportation to maximize coverage.  Programs must have the capacity to bill Medicaid and to receive funding from RW Part F, services funded under this program will cover gaps in care for most of the clients, and clients with no other payer for services will receive a full array of dental care.

Programs will be able to include the sum of the following staff (approximate): 1.25 full-time employee (FTE) Dentist; 3.75 FTE Dental Assistant/Dental Hygienist; and .47 FTE Administrative office and data support.  Service expectations for programs are that they have the capacity to serve approximately 280 clients, accounting for the increased expense of the higher quality services, procedures, and materials (gum and bone grafts, bridgework, crowns, root canals, partials/implants).  In the directive these services are capped at up to 20% of the funding ($100,000).  The 2 programs will be able to cover approximately: 380 intake/ assessments and reassessments, 280 clients with 100 reassessments in the first year, 36 navigation/education sessions, and 820 Oral health encounters/services.

As per HRSA Monitoring Standards, the dental case management component of the directive will be funded through an allocation in the Medical Case Management line on the spending plan, as these services are not allowable under the Oral Health category.  MCM funds are currently available to fund this service at $200,000.  There are funds already available in MCM, and so no additional allocation is needed.

In response to a question, Mr. Harriman explained that the percentages for FTEs is a pro-rated amount based on the TC program where employees are partially paid through other funds (e.g., Part F, Medicaid) and partially through Part A.

A motion was made, seconded and approved 12Y-0N to fund Oral Health and Dental Case Management Services in the FY 2021 Base application spending plan as presented.

Agenda Item #3: FY 2021 Base Application 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, along with the EFA enhancement.  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).  Another $424,999 is allocated to EFA to serve NYC, but is reflected in the TC plan, where the program is housed.  With the elimination of NMG and the addition of $500,000 for Oral Health, a 5% increase leaves $3,423,557 to allocate in the spending request.  Possible options include targeted increases (e.g., extending the Housing enhancement to address COVID needs), an across-the-board increases weighted by priority ranking score, or a mix of targeted and across-the-board increases.  The Committee may choose to keep certain categories that do not require an increase flat funded (e.g., Mental Health, Hard Reduction).  PSRA will use the plan as a roadmap of priorities when it meets again in the fall to develop a plan for an actual award that is expected to be lower than the current year’s.

A summary of the discussion follows:

  • Housing is a high priority and will remain an ongoing need as the COVID-19 pandemic continues.
  • New FY 2019 close-out data shows that the following categories over-performed and absorbed enhancement through reprogramming: FNS ($945K), Supportive Counseling ($418), Legal ($615K), Mental Health ($400) and Harm Reduction ($600).
  • Mental Health and Harm Reduction had histories of under-performance until 2019.  Also, the large amount of over-performance in FNS came even before COVID-19.
  • There may be a higher need for Legal Services as the threat of evictions increases due to the pandemic.
  • The City’s special food program in response to COVID-19 has abundant resources.
  • Increases should be targeted to areas of highest need, rather than spread across multiple categories.  This better reflects the Council’s priorities and can be justified in the application narrative.

Motions were made and seconded to approve the FY 2021 Base spending plan with the following additions: Housing ($1.5M); FNS ($1M); Legal Services ($600K); Supportive Counseling ($161,779); Mental Health ($161,778). 

The Committee was thanked for their hard work under difficult circumstances.

There being no further business, the meeting was adjourned.