Tri-County Steering Committee Minutes July 14, 2021



July 14, 2021, 10:05-11:35am

By Zoom Videoconference


Members Present:       S. Altaf (Co-chair), M. Diaz (Co-chair), D. Ahmed, V. Alvarez, L. Best, L. Bucknor, A. Contreras, D. Dominguez, M. G. Ferone, J. Gago, L. Hakim, A. Hardman, G. Harriman, K. Mandel, C. Oldi, J. Palmer, M. Piazza, A. Pizarro, G. Plummer, S. Richmond, A. Ruggiero, S. Thomas

Members Absent:        M. Acevedo, L. Reid, D. Scholar, K. Scott, T. Seabrook, A. Simmons

Staff Present:              NYC DOHMH: D. Klotz, J. Acosta, J. Colón-Berdecía, D. Ferdinand, G. Navoa; Public Health Solutions: D. Ortiz; CHAIN: D. Norman

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

Mr. Altaf and Ms. Diaz opened the meeting followed by introductions and a moment of silence.  The minutes of the June 9, 2021 meeting were approved with no changes.  

Mr. Altaf noted that this is Ms. Diaz’s last meeting as co-chair and he and the Committee thanked her for her leadership and collaboration. 

Agenda Item #2: Updates

Consumer Update

Ms. Diaz reported that Living Together is holding its first in-person meeting since the beginning of the pandemic tomorrow.  Members are excited to see each other and continue their work supporting each other and maintaining adherence.

Planning Council Update

Mr. Harriman reported that a Planning Council and Committee member recognition picnic will take place on Friday, August 6th, 2-6pm at Riverside Park at 145th Street in Harlem.  The Council staff can arrange transportation to the event. 

The Executive Committee (July 22) and full Council (7/29) meetings will be 3 ½ hours to allow for review and approval of several initiatives: FY 2022 Application Spending Plans (described below), the Assessment of the Administrative Mechanism, a revised Framing Directive (which applies to all service categories), recommendations for Seriously Mentally Ill PWH, and a new Aging and HIV Service Directive (presented later this meeting).

Mr. Klotz reported that the Priority Setting & Resource Allocation Committee (PSRA) met Monday to approve the spending request for the FY 2022 grant application.  The Tri-County Steering Committee request of a 5% proportionate across-the-board increase was approved.  In addition, PSRA approved a 5% total increase in the Base award, with $500,000 targeted increase to Emergency Financial Assistance (EFA) to continue the one-time enhancement to this program made with carryover funds in 2022 (those funds end on Feb. 28, 2022).  EFA serves the entire EMA, but the category was originally created for the TC region and the provider located there, thus is placed in the TC spending plan.  Other targeted increases for NYC programs are $250,000 for 6 months of Oral Health Services, and a $493,500 to fund a full year of Psychosocial Support for Transgender, Intersex and Gender Non-conforming/Non-binary Individuals.  The balance of the 5% increase is distributed proportionately across all currently funded service categories based on ranking scores.  PSRA and the TCSC will conduct scenario planning for the actual award in the fall/winter.  The expected reduction to the award may be mitigated if Congress approves President Biden’s request for $10M additional funding for RWPA nationally.

Grantee Update (Highlights)

Ms. Plummer reported that the FY 2022 RWHAP Part A Notice of Funding Opportunity (NOFO, or grant application guidance) was released.  The competitive NOFO kicks off the Part A program’s inaugural 3-year period of performance, where Non-Competing Continuation Progress Reports will be submitted in FY23 and FY24, in lieu of a competitive application.  The FY 2022 application scores will be used to determine the Supplemental award amounts in FY 2023 and FY 2024. 

HRSA and the CDC released guidance on the Integrated HIV Prevention and Care Plan, which outlines the planning requirements for Ryan White Parts A and B recipients and all state and local health departments. The Integrated HIV Prevention and Care Plan serves as an HIV strategy guiding all HIV- related resources for the jurisdiction.

Starting July 1, 2021, the Bureau of Public Health Clinics will oversee the Health Department’s clinics, and the Bureau of Hepatitis, HIV, and Sexually Transmitted Infections (BHHS) will oversee the Health Department’s viral hepatitis, HIV, and sexually transmitted infections (STIs).  The creation of BHHS brings together nearly 400 staff members to oversee the City’s response to STIs, including HIV, and viral hepatitis.  The RWPA program will not change and the Council will continue to maintain its independence.

The 8th annual RWPA Power of Quality Improvement Conference will be held virtually in early December.  This year’s conference theme is “Building Resilience, Actualizing Equity, and Ending the Epidemic” which will demonstrate the efforts of RWPA programs to manage services throughout the COVID-19 pandemic by providing continuity of care with resiliency and perseverance.  Ms. Acosta added that she has been working with the Tri-County providers on their quality improvement plans and will be assisting with abstracts for the conference.

Ms. Plummer also announced that the Tri-County RWPA Short-term Housing Assistance contracts will be rebid, with the RFP released September 1st for services starting March 1, 2022.  One or two awards are expected.

Agenda Item #3: FY 2020 Closeout Report

Ms. Plummer reported on the final commitment and expenditure report (closeout) for FY 2020 TC programs.  The Grantee completed the final expenditure report and closeout process for FY 2020.  Total admin expenses for Base and MAI were 92% expended and Quality Management expenses were 86% spent, due to salaries paid by DOHMH’s COVID effort as staff was activated and the City’s hiring freeze.  This year there is larger than usual carryover amount totaling close to $5M (compared to $98,004 in FY 2019).  The substantial carryover amount for FY 2020 is attributed to the COVID-19 pandemic, Governor Cuomo’s NYS on Pause Executive Order lasting over four months (from March to July 2020), RWPA-funded organizations unable to provide many in-person services during this time and adapting to remote work, telehealth, and virtual support services, and DOHMH staff activations lasting for over a year and a half.  Activations at the NYC DOHMH started in February 2020 and are still in effect today, although they are beginning to wind down and most staff will return to RWPA-funded roles soon.  Also, most RWPA funded organizations faced staff turnovers with some staff being laid off, furloughed, or leaving due to burnout.  DOHMH also faced hiring freezes and positions on the RWPA budget that were vacated were not able to be filled for more than 9 months. 

For TC programs, the Mental Health Services category had an expenditure of 48% due to under-performance resulting from staffing vacancies and client recruitment challenges.  The Grantee continues to provide ongoing TA to the organization.  Food and Nutrition Services is at 89% due to one program underspending because they faced staff vacancies.  Medical Case Management is at 86% due to the NYS shutdown in response to the COVID-19 pandemic and certain service types (such as Accompaniment and DOT) unable to be provided remotely/virtually.  Essential services in the Tri-County region such as Housing, Legal, and Emergency Financial Assistance were fully spent at 100%.  EFA expanded client services throughout the entire NY EMA to address the unmet needs of PWH in both the five boroughs of NYC and the Tri-County region.  The total expenditure for Tri-County Part A (Base) services are at 84 percent, which was very good for such a challenging year.

The Planning Council approved a plan to use the carryover in the current year.  The plan includes (all funds for both NYC and TC, except where noted): 1) $500k for the EFA; 2) $700k for the Food and Nutrition Services Program; 3) $360k for value-based payments for the Care Coordination Program (NYC only); 4) $300k for smart phones and data plans for clients accessing telehealth and virtual support services; 5) $800k for capacity building and training services allocated to all service categories providing direct services to clients to build competency in trauma informed care, racial and health equity, etc. across the Ryan White Part A portfolio and throughout the NY EMA; 6) The remaining balance of $2,041,568 to ADAP. 

In response to a question, Ms. Plummer explained that the transition of all contracts to cost-based reimbursement will take some time, as many will not be transitioned until they are rebid.  Ms. Best pointed out that in Tr-County, there continues to be an issue of gaps in insurance coverage, particularly during the Medicaid spend down period. 

Agenda Item #4: Aging & HIV Service Directive

Mr. Harriman presented on the new Aging & HIV Service Directive approved by the Consumers Committee and to be reviewed and approved by the Executive Committee and full Council later this month.  PWH over 50 represent a majority of the total PWH population (59% of PWH in NYC in 2019) and yet their intersectional needs are often unaddressed by HIV service organizations.  PWH over 50 have achieved the highest proportions of sustained viral suppression of any age group and yet care for their comorbid health conditions remains suboptimal and they have shorter life expectancies than those not living with HIV with two thirds of deaths among PWH due to non-HIV-related causes.  Much data shows the need for improved resources for PWH over 50, including services to address social isolation, coordination between programs, benefits navigation, services offered in Spanish, and to address medical conditions of women with HIV over 50.  The services included in the Outpatient Medical Care (OMC) component include: 1) Increase capacity to treat the complex needs of PWH over 50 mirroring  aspects of the Golden Compass model  through use of clinical staff(MD, RN, Pharmacist, Medical Assistant) to address comorbidities and to provide health education; 2) Geriatric, Psychiatric, and Cardiology consultation, and referrals to ongoing specialty care; 3) Resources provided by RWPA to address gaps in current care provided at clinical sites; and 4) support improved self-advocacy/ self-management so that PWH over 50 can talk to their medical providers about broader health concerns.

The services in the Referrals component are: 1) Increase the knowledge of resources available to support PWH over 50 among RWPA funded providers; 2) Improve referral tracking to ensure PWH over 50 are engaged in needed services; 3) Adapt referral practices from the ARTAS model (i.e. the development of referral partnerships),  communication/outreach/education, navigation and transportation if neededThe programs will strengthen PWH networksand fund organizations that provide social support services for older people living with HIV, Fund social support for exercise (e.g., set up buddy systems, making contracts with others to complete specified levels of physical activity, orset up walking groupsand other groups to facilitate  friendship and support), fund navigation,  structured health education and practical and emotional peer support services  to increase engagement in care and promote self-care; and identify how toleverage technology for social support and overcome barriers that older people living with HIV face.  There will also be funds for provider training to ensure that they are able to effectively support PWH over 50 through increased ability toidentify comorbidities, and link PWH over 50 to needed resources.

A summary of the discussion on the Aging and HIV Service Directive follows:

  • The expertise of benefits navigators is different than what case managers can offer and is necessary to ensure that PWH get connected to and do not lose access to benefits. 
  •  An addition can be made to the directive for the Executive Committee to include benefits navigation.
  • The new programs will be implemented in FY 2023 (March 1, 2023-Feb. 29, 2024), but elements that affect existing RWPA providers can be implemented sooner.
  • There are no enough primary care physicians in general who have expertise in treating HIV. 
  • MOUs have to be enforced and not just signed and put in a drawer.
  • Transitioning to cost-based reimbursement will help providers not just concentrate on reaching their contractual numbers to get paid. 
  • The HRSA requirement for 6-month proof of HIV status needs to be scrapped, as it is a burden to clients and providers.  DOHMH has relayed this to HRSA.
  • There should be a conference or workshop on HIV and aging in Tri-County.

Agenda Item #4: Public Comment, Part II

The Committee thanked Ms. Best and Ms. Diaz for their powerful advocacy on behalf of the Tri-County region on the full Council. 

The next Committee meeting will be held on October 13th, 10am.

There being no further business, the meeting was adjourned.