Priority Setting & Resource Allocation Committee Minutes May 13, 2019

PRIORITY SETTING & RESOURCE ALLOCATION COMMITTEE

Cicatelli Associates, 505 Eighth Ave., NYC
Monday, May 13, 2019 3:10 – 5:00pm
MINUTES

Members Present: Matthew Baney (Co-chair), Paul Carr, Randall Bruce, Amber Casey (for Graham

Harriman), Joan Edwards,  Billy Fields, Matthew Lesieur, Jesus Maldonado, Jeff Natt, Carmelo Cruz Reyes, Barry Zingman, MD (by phone)

Other Council Members Present: John Schoepp 

Members Absent: Broni Cockrell, Steve Hemraj, Jan Hudis, Oscar Lopez, L. Freddy Molano, M.D., Jan Carl Park, Saul Reyes, Claire Simon

Staff Present: David Klotz, Kimbirly Mack (NYC DOHMH); Bettina Carroll, Gucci Kaloo (Public Health Solutions); Julie Lehane, PhD (WCDOH)

Mr. Baney opened the meeting, followed by introductions and a moment of silence.  The minutes of the April 8, 2019 meeting were approved with no changes.

Mr. Klotz reviewed the data summary, which captures by service category the key elements from the Scorecards, Fact Sheets, Payer of Last Resort (POLR) Tool, and the PSRA discussions from the meeting minutes.  He also reviewed the Ranking Tool and definitions of the scoring criteria (POLR, Access/Maintenance in Care, Consumer Priority, Gaps/Needs).  Ranking scores are important because HRSA requires that the EMA submit its allocation plan with the approved service categories in ranked order of priority.  Also, if the PSRA chooses to do an across-the-board increase or decrease, the ranking scores are used to weight those proportionately, with the higher ranked categories receiving a larger relative increase or smaller decrease.  It was emphasized that the ranking scores are independent of the allocations and are based on the relative importance, vis-à-vis the ranking criteria, of the service categories, not on their spending.  For example, if there is a category that PSRA decides should not get any increase in funding in an across-theboard spending scenario, they can hold that category steady and spread the increase proportionately among the other categories.  Given the relative stability of the service system and the fact that PSRA re-ranked the portfolio last year, the Committee focused on several key areas where the data may indicate the possibility for reconsidering the ranking scores.  

A summary of the discussion follows:

• DOHMH is working to provide technical assistance to Mental Health Services providers to increase enrollment.  
• The new Food and Nutrition Services (FNS) model has a focus on medically-tailored meals and nutrition services, which are not covered by the general food programs that are considered when thinking about POLR issues for this service. 
• DOHMH is monitoring POLR issues for Harm Reduction Services (HRM), and with Medicaid, HARPs and OASAS increasing reimbursement and funding for these services, the POLR landscape is changing significantly. 
• DOHMH tries to maximize other resources for all Ryan White Part A services by ensuring that providers and clients get reimbursed through Medicaid and other payers when possible.
• Transitional Care Coordination (TCC) is a sub-section of Medical Case Management (along with the much larger Care Coordination program).  If the Council votes to subsume TCC services within a Housing service, that does not affect the ranking score, as it would be considered part of Housing, but the MCM ranking still applies to the Care Coordination Programs. 
• Legal Services are providing key services that promote access to medical care, e.g., through representing clients in Medicaid recertification, and keeping people from getting evicted (as housing instability is a key cause of falling out of care). 
• Supportive Counseling and Family Stabilization Services (SCF) does not treat people with clinical mental illness, but should be considered for the future around its importance to consumers with psychological issues. 
• The definitions of POLR and Gaps/Needs can be fuzzy and the PSRA should consider looking at how they are defined.  POLR was looked at more tightly this year as large federal payers of “like-tolike” services, rather than the entire constellation of providers.  Ranking can be more of an art than a science.  

A motion was made and seconded to re-rank the POLR score for FNS from 5 to 8.  The motion was adopted 7Y-2N.

A motion was made to re-rank the POLR score for HRM from 5 to 3.  The motion was adopted 9Y-0N. A motion was made to re-rank the Access/Maintenance score for Legal from 3 to 5.  The motion was adopted 9Y-0N.

A motion was made to re-rank the Consumer Priority score for SCF from 5 to 8.  The motion failed 3Y-5N.

Mr. Klotz explained that 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.  Since the cap was instituted, the Council has asked for the maximum in Base funding with targeted and proportional increases that can be supported by the data reviewed during the planning cycle.  The MAI funding request, which is completely formula-driven, always remains stable at the current year’s funding.  It was noted that $258,596 was moved between ADAP Base and ADAP MAI to balance the award amounts (this has no effect on the other service category allocations).  PSRA will be able to plan for the actual award when its conducts scenario planning in the winter.

There was a discussion on the possibility of new funds to be appropriated by Congress under the federal Ending the Epidemic initiative.  The funds are fairly minimal (the president’s budget called for $250M nationally, and the House Appropriations Committee is proposing about double that), but that is spread across research, prevention, care and treatment and PrEP initiatives across all 48 high incidence counties across the country (4 of which are in NYC).  Also, any funds for care and treatment that go through HRSA will likely not be part of the Ryan White awards, but be done through a separate Notice of Funding

Opportunity, which means that eligible localities will have to apply for the funds and they will not be subject to Ryan White restrictions.  NYC DOHMH is already meeting to plan for how they would want to apply for

Priority Setting & Resource Allocation Committee Meeting Minutes May 13, 2019

the funds, and there are many unknowns at this point, but for the purposes of planning for the Part A grant, the PSRA should not factor this into the spending plans. 

Last week, the Tri-County Steering Committee approved an application spending request that also asks for the maximum 5% increase (all TC programs are Base funded).  As the majority of the service portfolio in Tri-County is newly re-bid, there is no data on spending that can be used to make adjustments in the service category allocations.  Thus, the 5% increase is allocated across the portfolio proportionately based on the ranking scores.  With a 5% increase to the Base award, after QM, administration and Tri-County, the amount that would need to be allocated for NYC Base programs is $3,627,833.

A motion was made, seconded and approved unanimously to approve the Tri-County and NYC MAI spending plans as presented.

The PSRA considered revisions to the NYC Base spending plan.  Last year, PSRA voted to increase FNS by $1.8M, which was used to increase rates to improve food quality.  A recommendation to increase the category by an additional $789,480 to increase capacity by 10% was put on hold while the service model was revised and programs re-bid.  Legal and Supportive Counseling are the other two categories that consistently over-spend.  Also, there is an open RFP for MCM/Care Coordination, which would allow additional funding to expand the service to a geographic area that is not currently being served.  

There was discussion that, with the re-bid of FNS, there will be the opportunity for the Recipient to ensure that the new higher quality standards are implemented, including having the right kind of staff to ensure medically and culturally appropriate meals and to nutritional assessments.  Methods for ensuring improved quality may include site visits, client satisfaction surveys and “secret shopper” visits.  

It was noted that MCM is already the highest funded service, and it is not clear that more funding is necessary for this service.  The Council can increase this allocation to ensure greater geographic coverage, which the Recipient would implement either through expansion of an existing program or through funding a proposals that was did not receive funding in the RFP process.

A motion was made, seconded and approved unanimously to increase the FNS allocation in the NYC Base spending plan by $789,480.

The Committee will continue consideration of the NYC Base spending plan at the June 10^th meeting. 

Mr. Natt reported that they met last week to discuss how to consolidate the Scorecards and Fact Sheets, which have a lot of overlapping data, as well as some data that has not been useful for PSRA’s planning purposes.  DOHMH staff is working on mock-up to bring to the PSRA’s June meeting.   

There being no further business, the meeting was adjourned. 

Priority Setting & Resource Allocation Committee Meeting Minutes May 13, 2019