Priority Setting & Resource Allocation Committee Minutes June 14, 2021

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Meeting of the Priority Setting & Resource Allocation Committee

Monday, June 14, 2021

By Zoom Videoconference

3:05 – 5:00

Members Present: Jeff Natt (Co-chair), Fulvia Alvelo, Matt Baney, Randall Bruce, Paul Carr, Broni Cockrell, Billy Fields, Graham Harriman, Guadalupe Dominguez Plummer, Michael Rifkin, Leo Ruiz, John Schoepp, Claire Simon, Terry Troia, Dorella Walters

Members Absent: Marya Gilborn, Joan Edwards

Staff Present: David Klotz, Melanie Lawrence, Scott Spiegler, Jennifer Carmona, Clare Biging, Ashley Azor, Johanna Acosta, Eleonora Jimenez-Levi, Yaoyu Zhong, Frances Silva, Kimbirly Mack, Karen Miller, Giovanna Navoa, Dave Ferdinand, Roland Torres, Ellen Wiewel (NYC DOHMH); Andrea Feduzi (Public Health Solutions)

Agenda Item #1: Welcome/Introductions/Minutes

Mr. Natt opened the meeting, followed by introductions and a moment of silence.  The minutes of the May 10, 2021 meeting were approved with no changes.

Ms. Simon reported that an online community memorial for Terri Smith-Caronia will be held on June 26th.  

Agenda Item #2: FY 2020 into FY 2021 Carryover Plan

Ms. Plummer presented a proposed plan for using underspending from FY 2020 in FY 2021 (carryover plan).  Underspending from FY 2020 is much larger than usual ($4,911,568, compared to $363,720 from FY 2019). 

This is due to the COVID-19 pandemic and Governor Cuomo’s NYS on Pause Executive Order lasting over four months (from March to July 2020) when RWPA-funded organizations were unable to provide many in-person services and adapted to remote work, telehealth, and virtual services.  Also, DOHMH staff activations lasting for over a year meant that Grantee staff salaries were paid through COVID funds and not RWPA.  DOHMH also had a hiring freeze that kept some positions open.  Many RWPA funded organizations faced staff turnovers with some staff being laid off, furloughed, or leaving due to burnout.  All EMAs across the country have faced these same circumstances, and so HRSA has waived penalties and requirements for FY 2020 and FY 2021, including the 5% cap on carryover. 

HRSA allows carryover funds to be spent directly on RWPA program services benefiting people with HIV through one-time enhancements to programs late in the grant year, typically around November.  In addition, carryover funds can be used to pay for technology devices, such as laptops, tablets, smartphones including connectivity for clients accessing telehealth and virtual support services.  All carryover funds must be fully spent by the end of this grant year (February 28, 2022).

Based on review of the portfolio and assessment of need, the Grantee is proposing to use the carryover for enhancements to Emergency Financial Assistance (EFA) and Food and Nutrition Services (FNS) programs, Value-based Payments (VBP) for Care Coordination Programs (CCP); Smart phones and data plans for clients accessing RWPA telehealth services; Capacity building and training services for Ryan White Part A Programs; and Partial Restoration of the reduction to the ADAP program made at the beginning of this year. 

Ms. Biging and Ms. Acosta presented a Fact Sheet for the EFA category with data from eShare, PHS and directly from the provider.  She reviewed the goals of the program, client demographics, client numbers, how funds were used and spending.  Most clients were in Tri-County and the Bronx, as the program was expanded into NYC later in the year.  The vast majority were over 50 and Black or Latino.  Cisgender women of color were almost half of all clients, and over a quarter were people with disabilities.  In FY 2020, there were 299 active clients, who received an average of $842 in assistance.  Seventy-eight percent of clients had incomes below the poverty rate and another 16% below 200% of the poverty rate.  By far, the largest amount of assistance was spent on rental arrears, followed by household goods (e.g., cleaning supplies, bedding, etc.), utility arrears and food vouchers.  The program overspent considerably, despite receiving a very large enhancement later in the year.

Ms. Plummer noted that EFA was previously limited to the Tri-County region with an original service allocation of $250,000.  In FY 2020, the program services expanded to include the five boroughs of NYC receiving a one-time enhancement of $499,825 from ADAP for COVID-19 response (made permanent for FY 2021).  The actual year-to-date spending rate was 163%.  The carryover plan continues providing EFA services throughout the EMA with an additional funding of $500,000 while also raising per client annual cap on assistance to $5000 from $2000.  

A summary of the discussion on EFA follows:

  • Little EFA money was spent on transportation because the need for transportation disappeared during the NYS Pause, and because Tri-County has a RWPA Medical Transportation service category.  (Issues have also been raised about Medicaid transportation in Tri-County, which the provider is working with clients to resolve.)
  • As the majority of all PWH are over 50, it makes sense that so are the majority of EFA clients.  Also, the fact that so many clients are women reflects the fact that many have children and have greater financial needs.
  • There is the possibility that average assistance amounts will increase greatly when the eviction moratorium ends.  The program is subject to Payer of Last Resort rules, and the State has a huge new Emergency Rental Assistance Program (ERAP) that pays arrears and is open to the undocumented.  ERAP also pays for utilities arrears.
  • Raising the annual assistance cap per client to $5K will allow the program to keep people housed, address the needs of people who lost jobs and have had trouble finding new employment, but the program does not expect all client to reach the maximum, and funds are needed to support a broad range of needs.  Most clients only need one-time assistance, not on-going.
  • The program works to help people move forward, making referrals to job training and other resources.
  • The addition of $500K is about what the program is able to absorb given time and staffing constraints.  Since carryover is one-time and must be spent quickly, the program is not able to hire permanent staff to bring in more referrals and process clients.  
  • PSRA should consider making this enhancement permanent in the FY 2022 spending plan, so that the program can ramp up on an ongoing basis.

Ms. Plummer continued with the carryover plan.  The FNS allocation in FY 2020 was $7,462,131 and included a one-time enhancement from ADAP for COVID-19 response.  The allocation for FNS in the Tri-County region was $968,807 and the actual yea- to-date spending rate was close to100%.  The Grantee is proposing an additional $210,000 for food and nutrition services across the NY EMA for larger/more pantry bags, food vouchers, etc.

A summary of the ensuing discussion on FNS follows:

  • TOUCH, a food provider in Rockland County, spent more than $40K last year over its RWPA allocation and continues to see increased need for services.  There were also additional costs to adapt to contactless delivery.  Nutritional education programs shifted to online, and the program would like to expand that.  As the State opens up and clients start coming back to receive in-person services, there will be a need to continue a hybrid of in-person and virtual programming.
  • A $210K enhancement would average out to only $16K per program.  The FNS category can undoubtedly absorb more, even if the funds come in late in the year and the programs have to spend them expeditiously.
  • The amount that any single program gets would be determined by the Grantee, based on an assessment of performance, keeping in mind that many programs were in a start-up phase for part of last year due to the rebid of the programs.
  • Congregate meals were cancelled during the pandemic, but might return in the fall.

Ms. Carmona explained the proposed enhancement for value-based payments (VBP) to Care Coordination Programs (CCPs).  VPB, which is part of the CCPs contracts, is an initiative to align incentives with service quality.  It was supposed to start in March 2020, but was derailed by COVID.  Programs receive payments if they meet certain benchmarks that demonstrate improved client-level outcomes.  The system rewards programs when they improve their own performance over time.  The benchmarks include: percentage of clients with at least one community-based patient navigation service (coordination, accompaniment, linkage, etc.); percentage of clients with at least one case conference service per quarter; and percentage of clients who have achieved viral load suppression within the first 6 months of program participation.  The carryover gives the Grantee an opportunity to pilot VBP in a low-risk way for programs allocating $15K/benchmark for 24 programs at a total of $360K.  Not all programs will spend the maximum, so any unspent carryover will be rolled into ADAP (as with all other carryover left unspent near the end of the year).

Ms. Plummer continued, noting that the allocation for smartphones and data plans is based on an estimate of $1,000 per client for a total of 1,000 clients ($1M).  It was noted by several Committee members that smartphones can be bought for under $300, and that data plans can cost as little as $50.  There is also a federal program (SafeLink) that pays for this to access telehealth, but SafeLink plans have data limits (although it will subsidize phone bills).  While there is no way to prevent a client from using the equipment for personal use, the main objective is to allow them to access telehealth and remote services.  

The enhancement for capacity building and training would allow programs to use the funds for developing plans for Health Equity, Racial Equity, Anti-Stigma, Trauma Informed Care and trauma informed supervision, and Professional Development, including conferences/webinars, certifications, licenses to enhance scope of practice.

Mr. Bruce made a motion, which was seconded, to approve the Carryover Plan as presented, with the following modifications: 1) the Grantee will develop a revised increased FNS enhancement; and 2) the Grantee will lower the amount for Smartphones/Data Plans based on a more realistic and economical cost.  The revised plan will be reviewed at the Executive Committee meeting on Thursday.

A summary of the ensuing discussion follows:

  • Housing on Staten Island continues to be a need, with HOPWA funding in the area reduced and overall fewer resources than in other areas.
  • All enhancements, like all allocations, are subject to payer of last resort requirements.  For example, if a client can access financial assistance for housing arrears through ERAP, the program will work with them to ensure that they receive ERAP benefits.  Only if ERAP is inaccessible, will the client be eligible for the RWPA EFA program.
  • The process of approving the carryover plan is rushed and the Committee should take more time to assess it.
  • The amount of carryover is not known until June (normal timing – three months to do closeout after the end of the fiscal year), and the request to HRSA must be submitted in a timely manner.  Also, the EC and full Council do not have the bandwidth to consider this in July.  They will already have extended meetings to review and approve spending plans, the assessment of the administrative mechanism, the Framing Directive, a directive for Services for Older PWH, and Seriously Mentally Ill recommendations.

The motion was restated and adopted by a roll call vote of 8Y-1N, with 4 not voting.

Mr. Klotz noted that the July 12th meeting agenda will include the approval of a spending plan for the FY 2022 grant application.  HRSA is again allowing EMAs to request up to 5% above the current year’s award.  The spending request is not binding and PSRA will develop an actual spending plan for a likely reduced award in the fall and winter after completing the review of the service category portfolio.  As a placeholder for the application, any increase can be spread out across the entire portfolio, weighted based on ranking scores, with targeted increases to certain areas such as Oral Health that the Council has previously pledged to fund.

The July meeting will also continue the review of the portfolio with the presentation on Housing that was scheduled for today, and a presentation on FNS.  Mr. Klotz thanked Ms. Jimenez-Levi and Ms. Zhong for their patience, and thanked Ms. Plummer, Mr. Spiegler, Ms. Biging and the Grantee team for their extraordinary time and effort developing a feasible and effective carryover plan.

There being no further business, the meeting was adjourned.