Tri-County Steering Committee Minutes December 8, 2021



December 8, 2021, 10:05-10:55am

By Zoom Videoconference


Members Present:       S. Altaf (Co-chair), J. Palmer (Co-chair), V. Alvarez, L. Beal, D. Dominguez, J. Gago, G. Harriman, C. Oldi, M. Piazza, G. Plummer, S. Richmond, L. Reid, A. Ruggiero, V. Schneider, K. Scott, S. ThomasMembers Absent:        M. Acevedo, D. Ahmed, L. Best, L. Bucknor, A. Contreras, M. Diaz, M. G. Ferone, L. Hakim, A. Hardman, B. Malloy, K. Mandel, A. Pizarro, D. Scholar, A. Simmons

Staff Present:              NYC DOHMH: D. Klotz, J. Acosta, S. Spiegler, D. Ferdinand, G. Navoa; Public Health Solutions: D. Ortiz; CHAIN: D. Norman, M. Yomogida

Present:       S. Altaf (Co-chair), J. Palmer (Co-chair), D. Ahmed, V. Alvarez, L. Beal, J. Gago, M. G. Ferone, G. Harriman, B. Malloy, K. Mandel, C. Oldi, M. Piazza, G. Plummer, S. Richmond, L. Reid, V. Schneider, K. Scott, S. Thomas

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 December 10, 2021 meeting were approved with no changes. 

Agenda Item #2: Updates

Mr. Alvarez reported that consumers continue to experience difficulties with Medicaid failing to reimburse for medical transportation (note: this is a focus of an ad hoc committee that is examining barriers to care and services in Tri-County).  He criticized the use of resources for provider technical assistance, rather than direct help for clients who need support for treatment adherence (particularly those with other medical conditions).  The Emergency Financial Assistance program has been a lifeline for many, but inflation is making it more difficult for clients to make ends meet, even with assistance.

Mr. Alvarez also reported that the Ryan White Part A (RWPA) Mental Health program run by Westchester Medical Center can now be accessed at an additional location, Hudson Valley Community Services (HVCS) in Hawthorne.  Services currently include individual counseling, but groups will be starting soon.

Planning Council Update

Mr. Harriman reported that the Council’s Needs Assessment Committee has started work on a new comprehensive needs assessment, the Integration of Care Committee has revised the Framing Directive (presented to the Steering Committee last month) and is working on Standards of Care for NYC programs.  The Consumers Committee will present their workshop on the new HIV & Aging Service Directive at the December 14th Power of Quality Improvement Conference. 

The Framing Directive will be voted on at the next Executive Committee.  The Committee will also review the GY 2021 2nd quarter expenditure report, which shows a level of underspending similar to last year’s, which resulted in a larger than usual carry-over.  The full Council on December 16th will vote on the Framing Directive and receive an update on the new NYC HIV surveillance report (Tri-County data will be presented to the Steering Committee in March by Wendy Patterson from the AIDS Institute).

Mr. Klotz reported that the PSRA Committee continues review of the NYC portfolio with Medical Case Management/Care Coordination and Supportive Counseling Services.  The final category, Mental Health, will be reviewed in January, after which they will deliberate on a revised set of allocations for GY 2022, including the spending scenario approved by the Steering Committee today.

Recipient Update

Ms. Plummer encouraged everyone to register for the Power of Quality Improvement Conference, which will include presentations from several Tri-County providers (Open Door, Hudson River Healthcare, HVCS).  She also congratulated HVCS for receiving a World AIDS Day award for their EFA program extending the service to reach the entire EMA during the COVID-19 crisis.  Also, the HVCS presentation for the Power of QI Conference is being submitted for next summer’s National Ryan White Conference.

On December 17th, DOHMH will issue a request for proposals (RFP) for RWPA Housing programs in Tri-County.  Proposals will be due on January 24, 2022, awards announced March 15, 2022 and programs will start June 1, 2022.

Agenda Item #3: GY 2022 Spending Scenario

Mr. Klotz presented a history of the Tri-County Ryan White Part A allocation in comparison to the EMA’s overall award and the percentage of people with HIV (PWH) living in the region.  From 2017 to 2021, the EMA’s total grant award has decreased from $98.9M to $90.7M (and down from a high of over $120M).  The Tri-County region’s percentage of program dollars has grown in that period from 4.7% to 7.3% (if adjusted to not count EFA funds used for NYC clients, the TC 2021 allocation is 6.7%).  The proportion of the EMA’s PWH who live in TC has decreased from over 4% in 2016 to 2.9% in 2019 (year for which most recent data is available).

The EMA expects to continue losing formula funds, which reflects the region’s relative success in preventing new infections.  President Biden has proposed only a $10M increase for the national RWPA appropriation in 2022, which will only partially offset the expected reduction in the award. 

For several years, the Steering Committee has requested level funding, which the PSRA Committee has approved, given that there are fewer local resources in the TC region (e.g., no HASA).  Reductions to NYC programs have been covered by reducing the ADAP allocation and partially restoring it through reprogramming and carry-over.  This strategy should be feasible for GY 2022, but the ADAP allocation has shrunk from over $18M to about $3M, and the Steering Committee will have to start planning for reductions for GY 2023.  The PSRA has made evidence-based reductions and even eliminations of whole service categories (e.g., Non-Medical Case Management) in NYC.  They are currently undertaking a year-long, in-depth review of the NYC portfolio in order to adjust allocations.  The Steering Committee will use a similar methodology over the next year, using service category fact sheets that provide multi-year data on client enrollment, spending rates, priority populations and payer of last resort considerations.

A motion was made, seconded and approved 14Y-0N to adopt the GY 2022 spending scenario as presented for recommendation to the PSRA Committee.

Ms. Reid thanked Mr. Klotz for this thorough explanation of the funding scenario.

Agenda Item #4: Other Business

In response to a question from Ms. Beal, Mr. Norman and Ms. Yamagido explained that interviews with Tri-County recipients will begin in March 2022.  Reports from the CHAIN Tri-County cohort are still being produced, including a recent report on the effects of COVID-19 on PWH.

Mr. Palmer thanked the committee for the sense of community during a difficult time.

The next Committee meeting will be held on January 12th, 10am.

There being no further business, the meeting was adjourned.