Priority Setting & Resource Allocation Committee Minutes November 18, 2019

Meeting of the
PRIORITY SETTING & RESOURCE ALLOCATION COMMITTEE
Monday, November 18, 2019
Cicatelli Associates, 505 Eighth Ave., NYC
3:10 – 4:15pm
MINUTES

Members Present: Jeff Natt (Co-chair), Dorella Walters (Co-chair), Randall Bruce, Broni Cockrell, Graham Harriman, Oscar Lopez, Leo Ruiz, John Schoepp, Terry Troia, Rob Walker

Members Absent: Paul Carr, Joan Edwards, Steve Hemraj, Matthew Lesieur, Jesus Maldonado, Jan Carl Park, Carmelo Cruz Reyes, Claire Simon, Barry Zingman, MD

Staff Present: David Klotz, Melanie Lawrence, X. Pamela Farquhar, Scott Spiegler, Karen Miller (NYC DOHMH); Bettina Carroll, Gucci Kaloo (Public Health Solutions)

Mr. Natt and Ms. Walters opened the meeting, followed by introductions and a moment of silence. The minutes of the June 10, 2019 meeting were approved with no changes.

Billy Fields congratulated the new chairs and wished the committee well. Mr. Natt announced a symposium at NYU about the history of HIV in NYC.

Ms. Lawrence reviewed the decision approved by the Council to eliminate the Transitional Care Coordination (TCC) service category.  The TCC service model was developed in 2011 to address the housing crisis among PLWH in NYC.  The model is based on the Critical Time Intervention and sought to improve the care of PLWH who are homeless and/or unstably housed by facilitating access to care, housing services, and other social support services.  TCC provides linkages to housing services, HIV primary medical care, and case management.  After a rigorous review (including data and provider presentations, meetings with clients and a comparison of service models), the Integration of Care Committee (IOC) determined that the service was duplicative and in competition with Short-Term Housing (STH).  By adding funds to STH, those programs can add the targeted outreach service that TCC currently conducts.  The IOC and PC voted that the TCC service model end, and asked PSRA to consider moving the TCC funding allocation, in whole, to the Housing Services category to increase Short-term Housing.  With additional funding, Housing will enhance and strengthen the current service model to provide additional outreach, housing and care coordination/client stabilization services. 

Ms. Farquhar described the Housing program, which includes three components: 1) Short-term Rental Assistance (SRA) (financial assistance, in the form of rent payments directly to landlords, which is used to secure or maintain stable housing); 2) Housing Placement Assistance (identifying and securing permanent or short-term housing for PLWHA); and 3) STH (provision of housing units – either congregate or scattered-site – to chronically homeless, homeless, or unstably housed PLWHA, including emergency and transitional housing assistance.  The re-allocated TCC funds will be used to enhance SRA, which currently serve 238 households, a reduction from 250 at its maximum (the program costs are high due to increasing rents and larger households necessitating larger apartments).  Additional funding will also be used for STH to increase the number of households served in NYC by approximately 60-65. 

A termination letter was sent to TCC providers by PHS.  A DOHMH Quality Management Specialist provided transition resources for clients to access services at other locations, including all housing, positive life workshop, Medical Case Management, non-MCM, and Care Coordination service providers in the NY EMA.  Program Closure/Non-Renewal letters were sent out by PHS with instructions for completing a “Program Disposition Plan” included with letter.  Programs complete a packet documenting closeout procedure and client transition planning, and follow up is conducted through PHS.

The following is a summary of the ensuing discussion:

• City law requires HASA to provide housing to all income-eligible PLWH in NYC, with certain exclusions, such as the undocumented, which RWPA can serve.
• STH is limited by HRSA policy to 2 years, during which clients are supposed to be transitioned to permanent housing (e.g., HOPWA), but none are disenrolled if they have not yet found appropriate permanent housing.
• The program tries to identify units in 80/20 buildings, but it is a challenge, as many are expensive and there is a lot of competition from other social service programs. 

A motion was made, seconded and approved unanimously to reallocate $1,443,228 from TCC to the Housing category.

Mr. Klotz explained the carry-over process.  HRSA allows up to 5% of formula funds to be left unspent at the end of the year (the actual FY 2018 carry-over into FY 2019 was $241,644, or less than 0.3%).  By December, the Council and EMA must submit an Estimated Unobligated Balance (EUB).  This is notification that the EMA may carry over as much as 5% of formula funds.  This allows the EMA to request to use the actual carry-over later in the fiscal year.  The EUB Request must specify the possible use of the funds and unit cost and ADAP has always been used as a placeholder.  PSRA and the Council are not obligated to allocate the carry-over as specified in the EUB request.  The actual carry-over for FY 2019 (3/1/19-2/29/20) will be known after the final close-out is done in late spring 2020.  When the actual unspent amount is known, the PSRA and Council approve a final carry-over plan for submission to HRSA (typically June).  All carry-over funds must be used in the subsequent fiscal year (i.e., FY 2019 carry-over must be used by 2/28/21).  Any leftover funds are returned to HRSA and the EMA’s formula award is permanently reduced by the unspent amount.

A motion was made, seconded and approved unanimously to accept the FY 2019 estimated carry-over plan as presented.

Mr. Klotz presented the draft 2019-20 PSRA work plan.  Next month, PSRA will begin scenario planning for a possible reduction to the FY 2020 grant award.  This includes review and approval of the Tri-County spending request (an additional $175K is being requested to cover over-enrolment in Housing programs) and determining the allocation for the new service category approved by the Council last summer (Psycho-social Support for TGINBNC People).  The PSS TGINBNC category will be funded in two parts, as per the Council-approved service directive.  A resource directory will be able to be funded in FY 2020 (and going forward at a smaller amount for ongoing revisions).  The service provision portion will be fully funded by FY 2021.  After completing the FY 2020 spending scenario, PSRA will start work on the FY 2021 application spending plan, which will use updated Service Category Fact Sheets.  Other tasks include the FY 2020 Reprogramming and Carry-over Plans.

Any new service categories that the Council approves in the upcoming planning cycle (e.g., oral health) would go into the FY 2021 application spending plan.

There being no further business, the meeting was adjourned.