Tri-County Steering Committee Minutes April 13, 2022



April 14, 2022, 10:05-11:15am

By Zoom Videoconference


Members Present:       J. Palmer (Co-chair), D. Ahmed, L. Bucknor, M. Diaz, J. Gago, L. Hakim, G. Harriman, B. Malloy, K. Mandel, M. Piazza, A. Pizarro, L. Reid, S. Richmond, K. Scott, S. Spiegler (for G. Plummer), S. Thomas

Members Absent:        S. Altaf, M. Acevedo, V. Alvarez, L. Beal, L. Best, A. Contreras, M. G. Ferone, A. Hardman, C. Oldi, A. Ruggiero, V. Schneider, D. Scholar, A. Simmons

Staff Present:              NYC DOHMH: D. Klotz, J. Acosta, F. Abdelqader, J. Colon-Berdecia, G. Navoa, D. Ferdinand; CHAIN: D. Norman;

Agenda Item 1: Opening/Moment of Silence/Minutes/Announcements/Public Comment

Mr. Palmer opened the meeting followed by introductions and a moment of silence.  The minutes of the March 9, 2022 meeting were approved with no changes. 

Mr. Colón-Berdecía announced that applications for the Council and Steering Committee are open and encouraged people to spread the word.  Consumer representation on the Steering Committee is a particular focus.  Two representatives from Acme Pharmacy introduced themselves.  Acme operates in the Tri-County region and provides PEP and PrEP.  

Agenda Item #2: Updates

Consumer Update

Ms. Diaz reported that some consumers in Tri-County are experiencing a bone-related issues, probably related to aging or long-term use of medication.  The community continues to reach out and support each other.

Planning Council Update

Mr. Harriman and Mr. Klotz reported that the next full Council meeting will be held on April 28th and will include a report on Women and HIV from the CHAIN Study.  There will also be a vote on the annual reprogramming plan, which allows the Recipient to maximize spending by shifting funds between service categories (up to 20% of the original allocation) to enhance over-performing service categories.  There will also be a vote on a bylaws revision to formalize the long-standing practice that all full members of the Council are expected to serve on at least one sub-committee.

The Consumers Committee is working to create a culture of inclusivity as they address the needs of youth and young adults with HIV in the EMA.  The Integration of Care Committee is working on both a new Behavioral Health service directive and a revised Housing services directive (timed to a rebid of the program in NYC).  The Needs Assessment Committee is continuing its work on a comprehensive needs assessment with the goal to complete it by the end of 2022.  Staff member Cristina Rodriguez-Hart is moving to a new role in the Research and Evaluation Unit, and Mr. Klotz will staff NAC until a replacement is found.

The next Policy Committee meeting will focus on overdose prevention sites (the first one will open in NYC soon).  The Data Collection Workgroup had its second meeting to address data collection challenges of the RWPA program.  

Ms. Acosta reported that there will be one more meeting in May of the ad-hoc Tri-County Services Workgroup, which was created to address concerns raised in the Steering Committee on Medicaid and other issues facing TC consumers.  After that meeting, there will be a report back to the Steering Committee on the findings. 

Recipient Update

Mr. Spiegler reported that on March 10th, the HRSA HIV/AIDS Bureau (HAB) observed National Women and Girls HIV/AIDS Awareness Day.  The 2022 National Ryan White Conference on HIV Care & Treatment will take place August 23-26, with unlimited virtual attendance.  The NIH released revised guidelines on COVID-19 for people with HIV.  Congress passed a final budget that includes a national $10M increased for Ryan White Part A (RWPA). 

The DOHMH HIV Quality Management Program has a new name: “Quality Management and Program Implementation Unit” to convey the scope of its work with programs across the NY EMA.  The program provided multiple trainings on quality improvement (QI) to RWPA subrecipients in February 2022, including introductory-level and advanced-level QI capacity building trainings.

Two contracts were awarded under the recent re-bid of RWPA Tri-County Housing Programs: Lifting Up Westchester ($873,004), and Cornerstone Family Healthcare ($401,878).  These are the same organizations that were providing the service before, so there will be continuity.  There is also an RFP out for Oral Health Services in NYC. 

Agenda Item #3: 2020 The Impact of COVID-19 on Tri-County RWPA Services

Mr. Abdelqader presented on how COVID affected RWPA services in the Tri-County region.  Ryan White Part A (RWPA) programs and service providers faced challenges in enrolling new clients and delivering services during the COVID-19 pandemic.  To assess the impact of COVID-19 on client access to RWPA programs and services, we analyzed new enrollments and service utilization data for Tri-County RWPA programs.  Grant recipient put in place changes to minimize the effect of COVID-19 restrictions on access to services (e.g.  permitting telephone/videoconferencing for broader array of reportable services, reimbursing for costs instead of fee-for-service).  The DOHMH HIV Program’s Research and Evaluation Unit compared eShare data from March-Sept. 2020 to the same period in 2019, looking at New Enrollments, Service Utilization (the number of clientswho received a service and the number of service units delivered).  Service categories looked at were: Housing Services, Food and Nutrition Services (FNS), Psychosocial Services (PSS), Oral Healthcare Services (OH), and Emergency Financial Assistance (EFA).  Mental Health services were not included due to the agency funded for this program under-performing in 2019 and 2020.

Between 2019 and 2020, new enrollments increased for food and nutrition and emergency financial assistance; and decreased for housing, psychosocial, and oral healthcare services.  We expected that oral healthcare services will have reduced enrollments (and services) under social-distancing restrictions during the pandemic months, due to the unavoidably in-person nature of oral healthcare services.  EFA was a new service category that started on 3/1/2019.  In June 2020, EFS was expanded to NYC clients in order to cover the entire EMA (all under one provider in Westchester).  Between 2019 and 2020, the number of clients served decreased for Housing, FNS, and OH (only slightly for the first two); increased for EFA (likely because the program was expanded to service NYC clients); and remained roughly the same for PSS.  Between 2019 and 2020, the number of service units delivered increased for all programs, except for OH services, like palliative, restorative, and preventative services, which are mainly performed in-person, so it is not unexpected that service units under this service category decreased during the pandemic months.  The increase was greatest for FNS and least for Housing services and EFA.

Compared to 2019, the decrease in new client enrollments in 2020 may have been due to difficulties in conducting work remotely and conducting in-person outreach to enroll new clients.  From 2019 to 2020, while the number of clients served decreased, service unit increases in programs like Housing, PSS, FNS, suggesting a higher need for those services.  The decrease in clients served may reflect lower access to programs in the pandemic, however, the increase in service units suggests a greater demand among clients already accessing services in those programs.  RWPA providers faced numerous obstacles during the COVID-19 pandemic, and the extent of these obstacles will never be fully detailed by the numbers provided from this analysis.  Those obstacles include: lack of technology (access to phone/internet to conduct and receive remote services); loss of clients and employees due to COVID-related morbidities/mortalities; loss of staff due to extensive, pandemic-related turnover; and lack of privacy in terms of delivering services to clients in shared living spaces.  The RWPA NY EMA encompasses a very large area and COVID-19 effects have varied by geographical location, and so clients might be more or less inclined to seek services depending on how they were affected.  Data entry may also have been depressed by the COVID-19 pandemic. 

Provider feedback reported that the use of telehealth and client telephone calls facilitated the delivery of services during the pandemic with staff working from home, especially with clients who are worried about contracting COVID-19.  More referrals were made during the pandemic primarily for food programs and pantries, unemployment assistance, Department of Social Services assistance (e.g., Medicaid), EFA, teletherapy, and legal services.  Follow-ups were conducted with existing clients more frequently to ensure referrals were addressing essential needs, which might explain the increases observed in the number of service units delivered.  Capacity limits and budget constraints prevented Tri-County Housing providers from enrolling new clients during the pandemic, and allocated CARES Act funding (~$45K) was directed towards ensuring housing stability and security for existing clients who were economically impacted.

DOHMH has put in place provisions to address the evolving challenges of enrolling new clients and delivering services during the pandemic:1)  Continue to provide RWPA service providers with programmatic support and technical assistance that is specific to the challenges presented by the COVID-19 pandemic; 2) Ensure that most service modifications that were made allowable during the pandemic (e.g. virtual delivery and remote options) become permanent to accommodate different methods for client outreach and service delivery; 3) Resolved eSHARE issues related to entering new services data for Tri-County Housing providers; 4) Developed fillable eSHARE forms for electronic data collection outside of eSHARE, as an alternative to entirely paper-based data collection and live data entry to eSHARE.

A summary of the ensuing discussion follows:

  • The adaptations made in response to the pandemic were vital to clients, as for many of them the services were a lifeline, even if they were delivered with little or no personal contact.
  • It will be interesting to see how patterns from the pandemic years play out in 2021.  By September 2020, enrollments were picking up again, and that trend was expected to continue.  NYC and TC trends followed similar patterns.
  • Access to equipment and Internet service was and remains a barrier for some consumers.  EFA funds can pay for initial Internet access, but HRSA does not allow for ongoing reimbursement.  A client and/or case manager needs to look for alternative resources.
  • During the pandemic, applications for social services did not decrease, and were facilitated by waivers allowing for online applications.  Need for and referrals to food bank services increased markedly and were often addressed by drive-through and other contactless services.
  • There continues to be a lack of mental health resources, particularly due to staff shortages.  Telehealth is not adequate to address many mental health needs.

Agenda Item #4: Planning for GY 2023 Tri-County RWPA Services

Mr. Klotz explained that the Committee will begin a review of the TC RWPA portfolio in the fall.  For the purposes of the GY 2023 grant application, the Committee can request up to the maximum allowed (5% over the current year’s award).  Planning for the actual award will follow a process similar to what the PSRA Committee did for NYC programs.  The Recipient is preparing Service Category Fact Sheets that will be rolled out from September 2022 through January 2023.  The fact sheets contain three years of data on the following measures: Active Enrollment; Client Demographics; Priority Populations as percentage of enrolled clients; Expenditures (compared to original allocation); Service Utilization by service types and service elements.  There will also be a narrative that looks at payer of last resort and systems-level considerations (e.g., how changes in Medicaid coverage or other programs will affect RWPA). 

The TC portfolio has remained at current funding levels for several years, despite continued reductions in the grant award.  This process will need to result in a new set of allocations that right-size programs and address needs within an environment of continued reductions in funding.

The next Committee meeting will be held on May 11th, 10am.

There being no further business, the meeting was adjourned.