Tri-County Steering Committee Minutes December 14, 2022



November 2, 2022, 10:05-11:10am

By Zoom Videoconference

Members Present:       S. Altaf (Co-chair), J. Palmer (Co-chair), D. Ahmed, V. Alvarez, L. Best, M. Diaz, K. Mandel, C. Oldi, M. Piazza, L. Reid, S. Richmond, V. Schneider, S. Spiegler (for G. Plummer), S. Thomas  

Members Absent:        M. Acevedo, L. Beal, L. Bucknor, A. Contreras, J. Gago, L. Hakim, G. Harriman, B. Malloy, A. Hardman, A. Pizarro, A. Ruggiero, D. Scholar, K. Scott

Staff Present:              NYC DOHMH: D. Klotz, J. Acosta, F. Abdelqader, M. Beyene, J. Colon-Berdecia

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

Mr. Altaf and Mr. Palmer opened the meeting followed by introductions and a moment of silence.  The minutes of the November 2, 2022 meeting were approved with no changes. 

Agenda Item #2: Updates

Consumer Update

Ms. Diaz and Mr. Alvarez reported that four consumers have just had their SNAP recertifications delayed, causing unneeded hardship during the holidays.  This is a systemic problem with the Westchester Department of Social Services.  Ms. Schneider and Mr. Oldi offered resources to assist clients with this issue.  Ryan White Part A-funded pantry bags helped cover the gap in services.

Planning Council Update

Mr. Klotz reported that the Statewide Integrated HIV Prevention and Care Plan has been submitted to HRSA and the CDC and has been posted on the Planning Council website.  At the December Council meeting, there will be a presentation on the 2021 NYC HIV surveillance report, which shows continued progress in reducing new infections and linking people to care and treatment.  Tri-County data is collected by the NY State DOH and will be presented to the Steering Committee in March. 

The Consumers Committee had an informative presentation on benefits navigation for Medicaid and Medicare and other programs.  The Integration of Care Committee is reviewing a draft of the new Behavioral Health service directive, which combines Mental Health, Psychosocial Support and Harm Reduction services in NYC.  The Priority Setting & Resource Allocation Committee has begun the process of planning for a possible reduction in the GY 2023 grant award. 

Recipient Update

Mr. Spiegler reported that both HRSA and NYC DOHMH commemorated World AIDS Day with ceremonies.  The 30th anniversary of the HOPWA program was also celebrated.  The Recipient is preparing for a virtual site visit from HRSA scheduled for May 2023.  There will be additional opportunities for input on the EMA’s draft Quality Management (QM) plan, which has been delayed due to staffing issues.  The QM Committee will resume meeting in January.

Agenda Item #3: Service Category Fact Sheets

Medical Case Management (MCT)

Mr. Abdelqader presented the goals of MCT, which are to address HIV healthcare disparities by facilitating access to care and other support services.  In additional to standard RWPA eligibility, priority is given to clients who are newly diagnosed, out of care, virally unsuppressed, or living with hepatitis C.  There are five contracts in the Tri-County region.  Among the Council’s priority populations, 51% of MCT clients are over the age of 50 and 56% report heterosexual contact as their transmission category.  Eighty-nine percent of clients were Black and Hispanic.  Fifty-nine percent were from Westchester and 25% from Rockland.  From 2019 and 2021, the number of clients remained stable at around 415.  The most commonly offered types of service were Client Assistance (9692 units in 2021) and Health Education (1901).  Spending in 2020 and 2021 was close to $200K below the service category allocation.  The number of service units stayed consistent except for intake/assessment, which indicates that due to COVID-10 few new clients were enrolled, but the existing clients still had a high level of service utilization. 

With expanding Medicaid coverage offering Medical Case Management services to those covered, MCT services should continue to be monitored to ensure the utilization of MCT as wrap-around services for clients dually enrolled. Some program services may be eligible for reimbursement by third party payer.  Individuals who are Medicaid/Medicare eligible may receive select services provided under MCT from those programs.  Services that may be paid by another payer include self-management assessment, case conference, health promotion, modified directly observed therapy, and immediate initiation of ART.  There are a variety of payer for the above-mentioned services, including Ryan White parts C and D, NYS AIDS Institute, and NYS Medicaid/Medicare programs.  Clients may be dually enrolled in a MCT program and a Medicaid Health Home program. For these clients, services that are eligible for reimbursement under Health Home are not eligible for reimbursement under MCT. Clients who are not eligible for Medicaid or are not enrolled in Medicaid Health Home may receive the full range of services from MCT.  MCT services not reimbursed by Medicaid/Medicare should be provided to eligible clients are a wrap-around service.

A summary of the ensuing discussion follows:

  • The low number of units of client engagement in 2019 was due to programs waiting for guidance on implementing this service type.
  • County/borough of residence is based on self-reported ZIP codes of clients.  Tri-county residents who receive services in NYC are counted in NYC programs.  Most of the NYC clients who seek services in Tri-County likely are from the Bronx (and vice versa).
  • Accompaniment during the pandemic was available, but there was little demand as providers of specialty services had mostly closed their offices.
  • With the switch to telehealth, demand for engagement was high, as clients sought to maintain a connection with their MCT provider.
  • If clients with serious mental illness are already enrolled in a RWPA service, then MCT programs can engage them with more intensive services.
  • There is broad overlap in service types between MCT and Health Homes and other case management payers, but MCT is tailored for HIV-related services. 
  • Most underspending in this category was due to staff vacancies.

Housing (HOT)

Ms. Beyene and Mr. Abdelqader presented the goals of HOT, which are to provide housing services directly necessitated by an individual’s HIV status to engage and retain persons with HIV (PWH) in treatment and care.  In additional to standard RWPA eligibility, priority is given to clients who are homeless or unstably housed or of risk of becoming so.  There are two providers in Tri-County.   

Sixty-three percent of HOT clients are over the age of 50 and 62% report heterosexual contact as their transmission category.  Forty-five percent report having a disability.  The overwhelming majority of clients were Black and Hispanic.  The vast majority of clients (78%) were Westchester residents.  The number of active clients dropped from 144 in 2020 to 114 in 2021, with little rebound in 2021 despite an increase in the allocation.  The most commonly provided service type is Rental Assistance Payment, with 835 units of service provided in 2021.  The category spent all or close to its full allocation in 2019 and 2020 but underspent by 16% in 2021.    

Housing program should ensure that housing is limited to short-term or emergency housing assistance with a recommended duration limit of up to 24 months.  Housing programs are required to develop mechanisms that will allow new clients access to housing services. 

A summary of the ensuing discussion follows:

  • The reported absence of Reassessment and Service Plan Development/Update in 2019 is due to eShare issues, but the work was done.
  • The service category allocation was permanently enhanced in 2021, and programs generally need time to get spending up to the new amounts.
  • The program shifted from providing both Rental Assistance (RA) and Utilities payments to being mostly RA.  This necessitated additional Apartment Inspections, and many units require repairs to bring them into compliance with appropriate housing standards.  This means both delays in assistance and higher spending per client.

Mr. Klotz explained that he will compile data from all of the service category fact sheets, along with points raised in Committee discussions, into a single document for easy reference.  In January, the Committee will begin to deliberate on possible adjustments to service category allocations for GY 2023.

Agenda Item #4: Public Comment

Mr. Palmer reported that advocacy to save the 340b carveout is still ongoing as the State considers eliminating it in the new budget, which would result in the loss of millions for HIV service providers.

There being no further business, the meeting was adjourned.