Priority Setting & Resource Allocation Committee Minutes June 10, 2019

Meeting of the
PRIORITY SETTING & RESOURCE ALLOCATION COMMITTEE
Monday, June 10, 2019
Cicatelli Associates, 505 Eighth Ave., NYC
3:10 – 4:50pm
MINUTES

Members Present: Matthew Baney (Co-chair), Jan Hudis (Co-chair), Randall Bruce, Paul Carr, Amber Casey (for Graham Harriman), Broni Cockrell, Joan Edwards (by phone),  Billy Fields, Matthew Lesieur, Oscar Lopez, Jeff Natt, Carmelo Cruz Reyes (by phone), Claire Simon (by phone), Barry Zingman, MD

Members Absent: Steve Hemraj, Jesus Maldonado, L. Freddy Molano, M.D., Jan Carl Park, Saul Reyes

Staff Present: David Klotz (NYC DOHMH); Bettina Carroll, Gucci Kaloo (Public Health Solutions);

Mr. Lesieur opened the meeting, followed by introductions and a moment of silence.  The minutes of the May 13, 2019 meeting were approved with no changes.

Mr. Klotz reviewed discussions and decisions made so far regarding the FY 2020 application spending request.  HRSA will likely again cap the amount that an EMA can request in its grant application to a maximum of 5% over its current Base award.  PSRA already approved the Tri-County Steering Committee’s request for a 5% across-the-board proportionate increase and level funding for the MAI portion of the grant, which is completely formula-driven.  PSRA made small adjustments in the ranking and approved an increase in the FNS allocation in the NYC Base spending plan by $789,480 to increase capacity by 10%.  That leaves $2,838,353 to be allocated in a 5% increase request.  

Mr. Lesieur added that there is a slight chance that there could be an increase to the grant award next year, as the House appropriations bill includes a significant increase for Part A.  The Senate and White House draft budgets have no increase, and the final amount still needs to be worked out.  Also, it is not clear what effect any potential new Federal ETE funds will have, including how much will be available or be distributed (e.g., included in Part A or as a separate funding stream).  Ms. Casey emphasized that the application spending request is theoretical, but must be justifiable based on data in the grant application narrative.  PSRA will have the fall and winter to do scenario planning for an actual increase or decrease to the award.

The following is a summary of the ensuing discussion:

• Any targeted increases should be directed to areas of unmet need.
• Housing is always a pressing need as noted in data from CHAIN, the historically low vacancy rates in the City, and the knowledge that unstable housing is a main barrier to care.  Housing Placement Assistance (HPA) has historically under-spent due to the limited availability of housing units, but the Short-term Housing (STH) and Rental Assistance (RA) programs spend well.  The challenge is that STH and RA do not over-enroll clients if they cannot guarantee them on-going assistance, thus there is no history of over-spending in those areas in spite of the huge unmet need.  Any proposed increase to Housing would be a ball park figure, but is justifiable in the application.
• PSRA allocates funds to the category as a whole, but the Recipient (Grantee) would direct the funds to the areas where there is need (STH, RA). Unspent funds have been moved from HPA to STH and RA.
• Most programs do not keep data on waiting lists for services, as the programs make referrals when they are not able to serve someone. When there are waiting lists, the issue could be either provider capacity or a systemic issue with the program.
• The one area where there is an open RFP and an additional proposal could be funded to broaden geographic coverage is Care Coordination.
• The FY 2018 close-out shows that Supportive Counseling (SCF) over-spent by $265,469 even after the enhancement to their allocation. Also, Legal over-spent about $247,000.  These amounts were capped at 20% as per the reprogramming plan. Taking an average of 4 years over-spending for SCF would only mean about a small increase, and so it is better to use the amount of the most recent year of over-spending.
• Across-the-board increases distributed proportionately by rank can be justified in the application as making up for the years of cuts to the grant award. Some categories should not receive increases due to histories of under-spending and payer of last resort issues (e.g., Mental Health, Early Intervention), or because they are adequately funded (ADAP).
• The Council does not do traditional cost-of-living-adjustments (COLA). Rather, increases in allocations can be used to increase the rates that providers are paid for services.
• The FNS allocation can be increased further to allow for a 15% increase in capacity, which would bring the amount to $1,450,000. Last year, FNS over-performed, and the new service model increases the cap on meals from 14 to 21 per week.
• All the proposed increases are in non-core services, but the EMA has consistently received waivers.  Also, the waiver process is being streamlined.

A motion was made, seconded and approved unanimously to accept a Base application spending request for the FY 2020 application with a 5% increase allocated to: FNS ($1,450,000), Housing ($1,480,833), Supportive Counseling ($450,000), and Legal ($247,000).

A draft FY 2018 carry-over plan was presented.  The carry-over plan is for the use of unspent funds from the previous year (FY 2018) in the current fiscal year (FY 2019).  Funds must be used in the current year, which ends on Feb. 29, 2020.  Typically, HRSA approves the carry-over plan in the fall, which leaves relatively little time for it to be spent.  Any carry-over from last year that is not spent in the current year is returned permanently to HRSA.  In previous years, due to the constraints on spending carry-over, the plan has called for the funds to be allocated to ADAP.  The amount in the draft – $276,373 (a record low amount, all in Base Formula funds) – is preliminary and may be slightly adjusted once close-out is complete.  Ms. Casey explained that the Tri-County Housing programs received a $300,000 enhancement in their allocations in the middle of the previous grant year and have over-enrolled clients due to very active recruitment efforts.  The programs can use $200,000 of the carry-over to maintain services to these clients.  The carry-over funds will ensure that the enrollees continue to receive Housing services through the end of the grant year as the Housing Unit works with the programs to assess their ongoing needs and identify areas for client attrition.  If there is a need for on-going additional funding in FY 2020, the PSRA can address that through any possible increase to the grant award, or through reallocating funds.  It was also noted that there is an on-going need for Housing services in Tri-County, where HASA does not exist. 

A motion was made, seconded and approved unanimously to accept the FY 2018 carry-over plan as follows: allocate $200,000 to Tri-County Housing, and the balance to ADAP.

Mr. Natt and Ms. Casey presented a mockup of a consolidated version of the Scorecards and Fact Sheets, based on the work of a sub-committee.  Mr. Natt explained the proposed data tool.  From the Scorecards, the new tool will keep the top box (“Expenditures/Allocation”), minus data on modifications and give a brief narrative on the reasons for any over-/under-spending (e.g., contracts re-bid).  The box on “Expenditure/ Modified Spending Plan” was eliminated as redundant.  The box showing the Expenditure Trend line would be kept for those who like visuals. Primary Care Status Measures are eliminated, as they have never been used for planning.  PSRA can do a special request for HIV status data for EIS, which serves many HIV-negative/status unknowns.

The version of Units of Service data from the Fact Sheets will be used, as it spells this out in more detail with service types, but the new version will keep three years of data.  Clients by special population will be kept and updated based on the Needs Assessment Committee revisiting it and focusing on key populations with major disparities.

Client demographics will have data for the most current year for active clients, based on DOHMH enrollment reports for data on: Age (with older populations broken up into 50-64 and 65+, rather than just over 50), Race/Ethnicity, Borough, Gender, Insurance Status (a proxy for income).  The box with the Units of Service line is eliminated (which is like the spark lines on the old fact sheets that weren’t useful). From the Fact Sheets, current rank, allocation and number of contracts will be put in the banner on top.  The bar chart will be eliminated (it has the same data in more detail in the top box of the Scorecards).  The new tool combines POLR and Systems-Level Consideration narratives into one broader narrative on “Systems-Level Considerations, including POLR, Funding and Policy Landscape”.

Outgoing chairs Mr. Baney and Ms. Hudis were thanked for their outstanding leadership of the Committee over the last few years.  Mr. Baney and Ms. Hudis thanked the committee members and staff for their hard work, saying it was an honor to serve as chairs.

There being no further business, the meeting was adjourned