Priority Setting & Resource Allocation Committee Minutes June 10, 2024

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Meeting of the Priority Setting & Resource Allocation Committee

Monday, June 10, 2024

By Zoom Videoconference

3:05 – 4:50

Members Present: Paul Carr (Co-chair), Marya Gilborn (Co-chair), Matt Baney, Raffi Babakhanian, Kyron Banks, Joan Edwards,Billy Fields, David Klotz, Steve Hemraj, Matthew Lesieur, Guadalupe Dominguez Plummer (ex-officio), John Schoepp, Claire Simon

Other Council Member Present: David Martin

Member Absent: Terry Troia

Staff Present: Doienne Saab, Jeff Klein, Johanna Acosta, PhD, Gina Gambone, Bryan Meisel, Isidra Grant, Emma Ramsdell, Adrianna Eppinger-Meiering, Kimbirly Mack, Patrick Chan, Jimmy Jaramillo (DOHMH); Barbara Silver, Arya Shahi

Agenda Item #1: Welcome/Introductions/Minutes

Mr. Carr and Ms. Gilborn opened the meeting, followed by introductions and a moment of silence. The minutes of the April 13, 2024 meeting were approved with no changes.  

Agenda Item #2: GY 2023 into 2024 Carryover Plan

Mr. Klotz explained that the PSRA Committee must develop a carryover plan for the unexpended funds from the previous year (GY 2023) for use in the current year. HRSA usually does not approve the plan until the fall, leaving a short time frame for providers to spend the funds. Any unspent carryover is deducted from the following year’s award as a penalty.

Ms. Plummer explained that all carryover must be used for program services benefiting PWH (i.e., no grant administration or quality management activities). As presented at the last Council meeting, there is $2,294,4212 available for carryover (about $600,000 less than the previous year). Based on the Recipient’s analysis of need and the ability of programs to spend the money, the recommendation is to use the funds for Housing and Food & Nutrition Services (both NYC and Tri-County). The proposed breakdown is:

  • Short-term rental assistance (NYC) = $798,216
  • Short-term housing (NYC) = $816,264
  • Short-term rental assistance (Tri-Co) = $205,896
  • Food and Nutrition Services (NYC) = $401,115
  • Food and Nutrition Services (Tri-Co) = $72,930

Any funds that can not be spent in those categories would be allocated to the ADAP Program.

In response to a question, Ms. Plummer explained that the amounts were based on an analysis of the cost of current leases with the increased fair market rents factored in. There was also discussion about the need for an ongoing increase in the baseline allocation for Housing. This will be considered in the context of the GY 2025 spending plans.

A motion was made, seconded and adopted 12Y-0N to approve the GY 2023 into 2024 carryover plan.

Agenda Item #2: GY 2025 Application Spending Plan

Analysis of NYC Oral Health Services (OHS)

Mr. Klotz reminded the Committee that the Recipient identified two service categories that have faced challenges with spending and/or enrollment.  Data on the first category, Psychosocial Support services for TIGNBNC populations (PSS) was presented last month.

Ms. Ramsdell explained that data is from GY 2022-23 (programs began on September 1, 2022) and looks at clients who had an open enrollment and received at least one service. Service types provided were: intake assessment and reassessment, care/service plan development, client assistance, and dental visit (preventative/hygienist, restorative, and palliative). In GY 2022 (when there was half a year of program and start up time), 21 clients were enrolled and received services. In GY 2023, there were 168 unique clients. In GY 2023, there were 144 intake assessments, 135 preventative units of service, 175 restorative treatments, and 120 palliative treatments. Spending in GY 2023 was $770,308 compared to an allocation of $900,000. At the end of GY 2023, one of the three programs rescinded their contract. All programs have reported payor of last resort (POLR) issues due to Medicaid covering a wide range of services.

A summary of the discussion follows:

  • It is not possible to tie specific service types (e.g., restorative services like bridges and implants) to expenditures. Programs are cost-based and are reimbursed based on fixed costs (e.g., salaries), and do no bill for different types of services provided. Also, eSHARE does not collect data beyond the broad service types.
  • The programs did not have enrollment targets, as they were newly created programs and there was no baseline. They were expected to have a minimum of 60 clients each, and two of the programs met that goal.
  • While all three programs faced payor of last resort issues, one was unable to reach their goal and after a difficult startup period (including a 6-month delay in their contract start date), decided to rescind their contract.
  • Court-ordered Medicaid expansion of coverage for dental procedures took effect in NY State in February 2024. While ADAP has not yet followed suit, they are in discussions about adding the same level of coverage. ADAP usually aligns their coverage with Medicaid.
  • One possibility is for clients to use EFA to pay for uncovered dental.
  • All three proposals in the original RFP were funded and obtaining a new provider would entail a new year-long procurement process.

Ms. Gambone reported that one of the two remaining programs has a waiting list and would be able to absorb some of the uncommitted funds in this category to increase capacity. She is waiting to hear back from the other program. There was also a consensus to revisit this category in spring 2025 in order to assess the impact of Medicaid expansion.

Mr. Klotz noted that the application spending request is a blueprint for an increase scenario for the actual award. In the winter, the Committee will plan for flat funding and decrease scenarios. Hesummarized that the Committee must make decisions on the following items:

  • Allocation for PSS TIGNBNC
  • Allocation for OHS
  • Possible reallocation of Health Education and Risk Reduction (HERR) funds to a Behavioral Health category
  • Possible targeted increases in a 5% increase spending request
  • Possible proportional increases to service categories in a 5% increase spending request

PSS Allocation

Mr. Meisel reported that an analysis by the Recipient shows that the program can be reduced by 20% ($193,800) and allow these cost-based programs to continue serving clients at their current levels (accounting for some uptick in enrollment) and not have a negative effect on service provision. A summary of the discussion follows:

  • CTP and QMPI worked intensively with the programs providing technical assistance on outreach and recruitment, but the program serves a niche population, many of whom were already receiving similar services at other providers with whom they were satisfied.
  • All RWPA programs should be TIGMBNC affirming, and this will presumably be true of newly procured Behavioral Health services, which begs the question of a need for a stand-along service for this population.
  • The program is expensive for the number of clients served. Given the continued decrease in the Part A award and the need for higher prioritized services, the Council must make difficult choices about allocations. Also, the Part A ADAP allocation has shrunk considerably and will not be able to indefinitely absorb award reductions.

A motion was made, seconded and approved 10Y-0N to reduce the allocation to PSS by $193,800 (20%) and put those funds into the pool of money available for allocation in a 5% increase spending request.

HERR Allocation

There was a consensus to not reallocate uncommitted funds from HERR but to put those funds into the pool of money available for allocation in a 5% increase spending request.

The Committee agreed to hold the next meeting on Monday, July 8th, 3-5pm. There being no further business, the meeting was adjourned.