Tri-County Steering Committee Minutes June 10, 2020


June 10, 2020, 10:10am-11:45am
By Zoom Videoconference


Members Present:        M. Diaz (Co-chair), A. Straus (Co-chair), D. Ahmed, S. Altaf, L. Best, L. Bucknor, D. Dominguez, L. Hakim, G. Harriman, D. Klotz, P. Laqueur, J. Palmer, L. Reid, A. Ruggiero, K. Scott, S. Thomas  

Members Absent:         M. Acevedo, V. Alvarez, A. Contreras, M. G. Ferone, J. Gago, A. Hardman, K. Mandel, C. Oldi, M. Piazza, A. Pizarro, S. Richmond, D. Scholar, T. Seabrook, A. Simmons

Staff:                               NYC DOHMH: J. Acosta, A. Guzman, M. Lawrence, K. Mack; PHS: J. Hegarty; CHAIN: D. Norman, M. Yamagido

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

Ms. Diaz and Ms. Straus opened the meeting followed by introductions and a moment of silence.  The minutes of the May 13, 2020 meeting were approved with no changes.  

Agenda Item #2: Updates

Consumer Update

Ms. Diaz reported that consumers in Tri-County are keeping in touch despite the technical challenges.  Living Together members are maintaining their treatment adherence and generally staying well.   

Planning Council Update

Mr. Klotz reported that the third Consumers Committee virtual Town Hall on COVID-19 and HIV will take place on June 16th.  Dr. Oni Blackstock (who leaves her position as NYC DOHMH Assistant Commissioner for HIV) will provide a medical update and answer questions.

Other Council committees are continuing their work.  Needs Assessment is still developing recommendations to improve service for seriously mentally ill PLWH.  Integration of Care is working on a draft directive for oral heath in the NYC portion of the EMA. 

The Council’s Executive Committee approved a support budget for the Council, which comes out of the grant’s administrative funds and pays for Council operations.  There will be over $100K in savings from last year’s budget.

Membership applications for the next round of Council appointments are due on June 19th for terms beginning September 1st

Recipient (Grantee) Report

Mr. Harriman reported that on April 30, HRSA/HAB (HIV/AIDS Bureau) announced greater flexibilities for the FY 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act funding as it pertains to Ryan White HIV/AIDS Program (RWHAP) provision and funding limitations.  The announcement includes HRSA’s response to award implementation, which including waiving the requirements for Planning Council approval, WICY expenditures, unobligated balances penalty, core medical services 75% allocation requirement, and maintenance of effort, among other requirements relevant to Part B and C programs.  

Additionally, for COVID-19 testing and provision of Personal Protective Equipment for Household Members of People with HIV (Parts A, B, and C), the requirement to serve only people with HIV is waived for the COVID-19 CARES Act funding only in the extremely limited instances of household members living Ryan White HIV/AIDS Program clients, and only for funds for this purpose in the absence of a waiver.  Also, HRSA/HAB has requested approval from OMB to create a new monthly, aggregate data report to collect information on CARES Act funded activities. This module will be required for all providers (regardless of whether they are recipients or sub-recipient) who receive FY 2020 CARES Act funding.

In light of the COVID-19 pandemic, the 2020 National Ryan White Conference on HIV Care and Treatment scheduled for August 11–14 will be held virtually.  The virtual format will allow for everyone to participate (registration information will be sent to the Steering Committee).

The EMA received a score of 98% on the FY2020 RWHAP Part A Grant Application from HRSA/HAB’s Objective Review Committee.  The Part A Progress and Expenditures Reports and 2020 RWHAP Part A Program Terms Report deadlines have been extended in response to COVID-19. 

The NY EMA’s annual Ryan White Part A Provider meeting will occur as scheduled on June 10 as an abbreviated, web-based video conference.  There will be a Tri-County specific provider meeting in the near future. 

Finally, Guadalupe Dominguez Plummer is the new Director of Program Planning and Operations in the Care and Treatment Program and will serve as alternate to Mr. Harriman in his role as Grantee representative on the Planning Council. 

In response to a question from Mr. Palmer, Mr. Harriman explained that the monthly 1/12 of MRA payments will revert to performance-based (fee-for-service) at some point, and accommodations will be made for programs with difficulties.

Agenda Item #3: Tri-County Program Data

Ms. Acosta presented on enrollment and expenditures in the TC Ryan White Part A portfolio.  This is the first time that the Steering Committee reviews enrollment and expenditure data, a process used by the Council’s Priority Setting & Resource Allocation Committee (PSRA) to set funding levels for the NYC portion of the award.  Enrollment and expenditure data for FY 2019-20 (the first year of the new portfolio’s contracts) will not be available until the fall.  Also, even this data will have only limited utility in assessing program performance, as the first year is a startup year for Tri-County programs. 

Some service categories are “Performance-based” (also known as “fee for service”) with payment based on a recognized quantity of each type of service reported in eShare by individual rates per service type.  These categories are: Legal Services, Food & Nutrition, Medical Case Management (MCT), Mental Health, and Psychosocial Support (PST).

“Cost-based” services are reimbursed based on cost incurred, as reported in monthly expenditure report, in alignment with approved budget.  The cost-based categories are: Emergency Financial Assistance, (EFA) Early Intervention Services, Housing, Oral Health, and Medical Transportation (TRT).

As of February 2019, the category with the highest enrollment was MCT with 916 unique clients, followed by TRT with 543.  The lowest number enrolled was PST with 34.  Most of the clients enrolled are between the age of 30-64, Latinx or Black, live in Westchester and Rockland Counties, and report MSM or Heterosexual as their risk factor.  Of the priority populations outlined in the EMA’s Integrated Plan, the largest one served is Older PLWH (585), followed by cisgender women of color (408).  The numbers clients enrolled was broken down into those newly enrolled (first time clients), closed, reopened (clients previously closed), and active (who received some service during the reporting year). 

Expenditure data from 2016-19 shows that the total Tri-County allocation was almost always fully expended.  This held true for each individual service category. 

A summary of the discussion follows:

  • The total number of unique clients enrolled across all programs in 2018 is 1085.  Some of those may be enrolled in more than one programs.  The total enrollment is a substantial proportion of all PLWH in the Tri-County region.
  • The charts showing the original service category allocations should be based on the spending plan that the Committee and Council approved, not the adjusted MRA reported by Public Health Solutions.  A revised slide set will reflect that.
  • Information on dual enrollment is programs can be provided in the fall.

Agenda Item #4: Planning for the FY 2021 Grant Application

Mr. Klotz explained that the Committee must approve a spending request for the FY 2021 grant application.  The spending request is not binding and is an expression of the Committee’s needs for the following year.  In the winter, the Committee plans for the actual award, which for many years has seen small reductions.

A draft application spending plan was presented for discussion that asks for the maximum increase allowed by HRSA (5%).  As a placeholder, the increase ($233,630) is spread it out across the entire portfolio, weighted based on ranking scores (higher ranked categories are increased at a proportionally higher rate).  The increase is based on 5% over the FY 2020 plan without the one-time COVID-19 enhancements to Housing and Emergency Financial Assistance (EFA).  It was noted that EFA is expected to receive another one-time enhancement in FY 2021 of $423K.  This will be taken from the new NYC program of Psychosocial Support for TGNB clients (pending PSRA approval).  Since PSS TGNB will be funded for the first time in 2021 and won’t start until mid-year, we can use half the allocation to continue funding EFA at close to the 2020 enhanced amount.

In response to a question from Mr. Palmer, it was explained that all funds must be allocated to a specific service category and cannot be allocated across the portfolio to address COVID-related expenses, but each program can use funds from its own budget for PPE, disinfecting supplies, telehealth and other expenses.

A motion was made, seconded and approved 14-0 to accept the FY 2021 application spending plan as presented.

Agenda Item #5: Policy Update

Mr. Guzman presented on current topics in law and policy.  In response to the protests (including by City employees) over police brutality, NYC Mayor de Blasio has pledged to reduce the NYPD budget.  On Jun. 1st, Westchester County Executive Latimer announced that he is assembling a work group to review training guidelines for new recruits at the county police academy and for ongoing police trainings.  Also, Yonkers City Council President Khader stated that he is working on comprehensive police reform legislation, including a pilot program mandating body cameras for Yonkers police officers and a civilian complaint review board. 

The New York State legislature has also announced a policing reform legislative package advanced that includes banning chokeholds and releasing information about police disciplinary records.

All ten regions of the State have met the COVID-19 metrics for reopening, with new infections and deaths declining substantially and hospital capacity at appropriate levels.  The Mid-Hudson Region (including Tri-County) has entered Phase II of reopening, including offices, in-store retail and hair salons.  Gyms, theaters and malls remain closed.   

The US House of Representatives has passed another COVID-19 relief package that includes aid to states and additional economic stimulus, but it is being blocked in the US Senate.

The next meeting will be held on Wednesday, July 8th by Zoom videoconference.

There being no further business, the meeting was adjourned.