Tri-County Steering Committee Minutes April 10, 2019



April 10, 2019, 10:05am-11:55pm
Westchester County Department of Social Services 10 County Center Road, White Plains, NY

Members Present:   A. Straus (Co-chair), M. Diaz (Co-chair), M. Acevedo, D. Ahmed, S. Altaf, V. Alvarez, L. Best (by phone), L. Bucknor (by phone), A. Casey (for G. Harriman), B. Catena, A. Contreras, D. Dominguez, M. G. Ferone, J. Gago, J. Gressel, L. Hakim, C. Oldi, J. Palmer, A. Pizarro, S. Richmond, A. Ruggiero, K. Scott (by phone), A. Simmons, S. Thomas  
Members Absent:   A. Hardman, P. Laqueur, J. Page, J.C. Park, M. Piazza, L. Reid, D. Scholar, T. Seabrook, C. Watkins
Staff: NYC DOHMH: D. Klotz, A. Guzman (by phone); WCDOH: J. Lehane, PhD 

Agenda Item 1: Opening/Moment of Silence/Minutes  

Ms. Straus and Ms. Diaz opened the meeting followed by a moment of silence and introductions. The minutes of the March 13, 2019 meeting were approved with no changes. Ms. Hakim announced that the NYS AIDS Advisory Council is recruiting for members from the upper counties of the Lower Hudson    

Agenda Item #2: Updates  

Consumer Update

Ms. Diaz reported that in February, the Council’s Consumers Committee raised its concerns to the Recipient (Grantee) regarding certain questions on the eSHARE Part A Intake Assessment, particularly those questions addressing past and current behavioral risks.  In addition, it was also noted that there are no questions in the current version of the intake assessment regarding Oral Health or Oral Health care services in NYC.  At the April 16th meeting, the Recipient will present its responses to the consumers’ concerns on the intake questions and the CHAIN project will address the committee’s request for additional data analyses/rapid response briefs on the 9 recommendations generated by the quality improvement focus groups conducted in 2017.  At the March meeting, Mr. Guzman presented the NYC Dept. of Health’s responses to US Department of Health & Human Services’ National HIV/AIDS Strategy.  

Mr. Alvarez reported that he has been hearing from consumers about the need for vision care, including eye exams and treatment for conditions such as glaucoma.  This reinforces the need for health care professionals to treat the whole spectrum of health-related issues for PLWH, especially as people age.  Also, a focus of Ryan White programs needs to be on effectiveness of services, particularly when it comes to maintaining undetectable viral loads. 

Ending the Epidemic Report

Ms. Hakim reported that the local EtE committee still working on the presentation that explains the four major areas of focus (testing, PrEP/PEP, stigma, cultural competence).  

Grantee Report

Ms. Casey reported that NYC DOHMH, as part of its focusing on HIV and aging, is co-hosting with the Long-Term Survivors Wellness Coalition its second annual Long Term Survivors summit at Baruch College in Manhattan in June.  The event will be interactive, with a focus on holistic care.  Transportation can be arranged for Tri-County consumers who are interested in attending.   

Planning Council Update

Mr. Klotz will give a Planning Council update at future meetings, so that the Committee feels more closely connected to the work of the full Council.  He reported that the Priority Setting & Resource Allocation Committee approved its annual reprogramming plan, which allows the Recipient (Grantee) to maximize spending in the course of the year.  As in previous years, the plan gives the Recipient the flexibility to enhance over-performing contracts by moving funds between service categories up to 20% of the original spending plan allocation.  This is done after the Recipient and Public Health Solutions (PHS) enhances over-performing programs from funds taken down from programs within the same service category to the maximum extent possible.  One addition to this year’s plan is to make initial enhancements to Tri-County and NYC programs from take-downs of programs in their respective regions, and after initial enhancements are made, to put remaining reprogramming money into one EMA-wide pot.  With newly re-bid Tri-County programs, they are mostly performance-based and able to receive enhancements.  Also, the April 25th meeting of the full Council will take place in at Bronx Borough Hall.  

Policy Report

Mr. Guzman reported on the proposed federal Ending the Epidemic 2030 proposal, which may result in a modest amount of additional Ryan White funding in the NY EMA, as four of the 48 counties targeted nationwide are in the EMA (Bronx, Brooklyn, Manhattan, Queens).  There is also the danger that any progress from that initiative might be offset by proposed budget cuts to other federal programs including Medicaid and Medicare.

Mr. Klotz and Ms. Casey reported that ADAP programs (now officially called the Uninsured Care Programs) will have a new income eligibility requirement as of April 24th of 500% of federal poverty level, which is currently calculated at $62,450 (up from 435%).  The Ryan White Part A program will likely synch that program’s eligibility.  Also, documentation on assets will no longer be required.  In addition, there will no longer be a requirement that employers pay 50% of their insurance premiums for the APIC program.  

Agenda Item #3: Medical Case Management Standard of Care  

Ms. Casey reported that DOHMH reviewed the concerns that arose concerning the line on page 1, first paragraph, where it says “In order to enroll in a Medical Case Management program, PLWHA have to be – or become – patients of the clinic with which the program is associated”.  The line can be deleted and clients whoalready have a doctor they like but want MCM services would not need to change providers.   

In the ensuing discussion, the point was made that MCM is a more intensive program – the service directive approved by the Steering Committee responded to consumer concerns that the system needs to move away from the idea of everyone needing a case manager as a “gatekeeper”.  Many people are doing fine with their treatment and may just need occasional assistance (e.g., with paperwork) and a social worker does not need to be the hub of their care.  In addition, there are many case management programs (including Health Homes) that meet a variety of needs.   

A motion was made, seconded and approved unanimously to accept the revised Medical Case Management Standard of Care as presented.

Agenda Item #4: Unobligated EIS Funds  

As reported at the previous meeting, the one provider of Tri-County Ryan White Part A Early Intervention Services (EIS) discontinued their contract, which means that about $134K is now unobligated and must be committed to a service category when the annual allocation plan is submitted to HRSA.  Ms. Casey explained the Steering Committee’s options.  [EIS services include HIV testing, (re)engagement if people lost to care, and linkage for the newly diagnosed.]  The Committee must decide whether to keep the funds in the EIS category or reallocate it to a different category.  If the Committee decides to keep the funds in EIS, the Grantee has a mechanism for quickly obligating the funds through a new provider it has identified.  

Another option is allocating the funds to ADAP (the EMA’s top ranked category) for FY 2019, which would give the Committee time to explore various options for FY 2020 while obligating the funds in the quickest way.  This also gives the Committee a place to take reductions from in FY 2020 if there is a reduction in the grant award.  

The Committee can also allocate the funds to a different service category, which would require more data that might not be available until the new contracts have had a year, or more, of performance.  It was noted that the Council and its committees can designate service categories but not contractors.

A summary of the ensuing discussion follows:

  • EIS is the lowest ranked priority in both Tri-County and NYC and has experienced low positivity rates.  Also, testing is now widespread and part of routine medical care.  The allocation has been dropping steadily over the years in both Tri-County and NYC.
  • In NYC, as well as the Tri-County EIS directive, the emphasis on EIS programs in on linkage and (re)engagement.
  • The mechanism for finding a new provider is possible because one has been identified that is similar in type and in what services would be provided to the terminated program.  If the Committee wanted to fund a new EIS model, that would require a solicitation, which could take 12-18 months.
  • The former provider served a particular hard-to-reach population that may not be reached if the funds are allocated to a different category.  Any new provider should also conduct outreach-based testing, not clinic-based.
  • A Housing program is oversubscribed and has frozen enrollment, and this may be true in other categories.  
  • There are a number of State-funded programs that do community-based testing, and using Part A funds would be a duplication of services.
  • NYC DOHMH is promoting a “status-neutral” approach so that people at risk who test negative can be referred to PrEP.  This requires targeted testing, not broad testing in the general population.
  • There will be some performance data available for the actual FY 2020 and future spending plans, so the Committee can adjust allocations based on information on how the programs are meeting their goals. 

A motion was made and seconded to keep the funds allocated in EIS.  The motion was approved 11Y7N.

There being no further business, the meeting was adjourned.