Priority Setting & Resource Allocation Committee Minutes March 14, 2022


Meeting of the Priority Setting & Resource Allocation Committee

Monday, March 14, 2022

By Zoom Videoconference

3:05 – 4:30

Members Present: Marya Gilborn (Co-chair), Jeff Natt (Co-chair), Matt Baney, Paul Carr, Joan Edwards, Billy Fields, Graham Harriman, Matthew Lesieur, Henry Nguyen, Guadalupe Dominguez Plummer, Michael Rifkin, Leo Ruiz, Claire Simon, Terry Troia, Victor Velazquez, Dorella Walters

Members Absent: Fulvia Alvelo, Eunice Casey, Broni Cockrell

Staff Present: David Klotz, Scott Spiegler, José Colón-Berdecía, Kimbirly Mack, Scarlett Macias, Johanna Acosta, Karen Miller, Renee James, Giovanna Navoa, (NYC DOHMH); Gemma Barclay, Arya Shahi (Public Health Solutions)

Guests Present: Ellie Epstein, Aaron Anderson (Health+Hospitals)

Agenda Item #1: Welcome/Introductions/Minutes

Mr. Natt and Ms. Gilborn opened the meeting, followed by introductions and a moment of silence.  The minutes of the February 14, 2022 meeting were approved with no changes.  

Agenda Item #2: GY 2022 Spending Scenario Plan

Mr. Klotz presented the GY 2022 Spending Scenario Plan, explaining that Congress has approved a budget and the full award should come in within two months.  The review of the portfolio that began last year will be used to develop a new set of allocations for GY 2023.  As in previous years, PSRA will approve a methodology for implementing an expected reduction to the grant award so that the Recipient can implement it immediately upon receipt of the full award.  

The Scenario Plan posits a reduction of 4% in Base funding (no reduction in MAI, as it is completely formula-driven and the award is usually close to the previous year’s) for a total 3.6% reduction (reductions in recent years have ranged from 1.5-3.5%).  After 10% for administration, $3M for Quality Management, and the already approved Tri-County spending plan, that leaves $70.3M for NYC programs (a reduction of $3M).  The actual reduction is likely to be less, given that Congress added $10M nationally to the RWPA appropriation and the NY EMA receives about 10% of national RWPA funds.  

For GY 2022, there is $2.1M in savings in carrying costs in three service categories due to permanent contract takedowns or terminations.  Mr. Spiegler explained that there would be no loss in services to clients.  Ms. Epstein explained that Health+Hospitals (H+H) Correctional Health services (mostly funded through Medicaid and other sources) conducts medical assessments (including HIV tests) for all people admitted to NYC jails.  They also conduct HIV testing on demand for inmates.  Fewer than 10 HIV positive cases have been identified through RWPA EIS funds in the last five years.  H+H staff funded through other sources will continue to connect clients to clinical services.  The Non-Medical Case Management program has seen a significant reduction in the number of clients due to recent criminal justice reforms and the reduction in RWPA funds would right-size the program.  Staff funded through other sources is continuing to provide discharge planning and linkage to care.  In response to questions from Mr. Harriman, Ms. Epstein explained that H+H is moving to provide these services universally regardless of the inmate census.  H+H is also keeping formerly RWPA funded “escort officers” (DOC employees who escorted inmates from the cell to the clinic) through a new sub-contract.  Finally, Correctional Health used to be through a sub-contract with a CBO that provided less than optimal services.  Now that H+H is providing the services directly there are better pathways to address client needs (including for mental health and substance use services).

Ms. Plummer explained that the savings in carrying costs in Mental Health Services is from the end of the Assessment & Referral Team for Populations with Multiple Special Needs.  The program had been both provided by and overseen by PHS staff using 10 HASA staff to engage clients with psychiatric emergencies.  The Integration of Care Committee, as it develops the new behavioral health directive, can determine if the service is still needed as part of the newly configured service category (for implementation in 2024).  Given the ongoing payer of last resort issues among other MH programs, there should be capacity to absorb those clients.

Mr. Klotz continued explaining the spending scenario.  The $2.1M savings in carrying costs is somewhat offset by the need to fund a full year of PSS TINBNC (at $937K, which includes $50K for training) and a half year of the newly bid Oral Health Services (to start Sept. 1, 2022).  In a 3.6% reduction scenario, the remaining deficit ($1,552,233) can be taken from the ADAP allocation, which will be restored (and more) through reprogramming and 2021 carryover.

A motion was made and seconded to approve the spending scenario as presented: In the case of a reduction in the grant award up to 3.6% (or $3,296,674), the deficit (after savings in carrying costs and new allocations) will be taken from the ADAP allocation.  In the event that the reduction in the award is less than $1,249,541 (the savings in carrying cost minus the new allocations), any surplus will be allocated to ADAP.  The motion was adopted 13Y-0N.

Agenda Item #3: Planning for GY 2023

Mr. Klotz presented a data summary that compiles the information presented over the past year through Service Category Fact Sheets, other presentations, and salient discussion points gleaned from meeting minutes.  The data sheet includes current allocations, three years of spending data (ending in 2019 or 2020 depending on the category), number of clients, most frequently used service types, client demographics, and summaries of payer of last resort and systems-level considerations.  It was noted that 2020 spending rates may not be useful as tools for deciding on allocations due to the shift to const-based reimbursement during COVID.  

The goal is for PSRA to use the next months to develop a revised set of allocations for the GY 2023 application spending plan.  The plan will include new allocations for the two HIV & Aging categories to be implemented in 2023 (Outpatient Medical Care, Referrals to Medical and Support Services).  The Recipient will provide a cost analysis to help guide that decision.  The application spending plan will ask for an increase, which is unlikely, and will act as the basis for the final spending plan.  Committee members were encouraged to review the data summary and refamiliarize themselves with the data (some of which was presented a year ago).  

In response to a question from Mr. Natt, it was explained that RWPA can pay for NARCAN, but most programs use Medicaid funds for that, as it is mostly used for non-HIV clients.  Also, there needs to be a road map for long-term funding in light of continued reductions in funding.  Finally, information on whether client numbers are rebounding to pre-COVID levels would be useful.

There being no further business, the meeting was adjourned.