Tri-County Steering Committee Minutes June 14, 2023



June 14, 2023, 10:05-11:25am

By Zoom Videoconference

Members Present:       S. Altaf (Co-chair), J. Palmer (Co-chair), V. Alvarez, L. Best, L. Bucknor, L. Cyrus, L. Hakim, K. Mandel, M. Piazza, G. Dominguez Plummer (ex-officio), S. Richmond, L. Reid, A. Ruggiero, K. Scott

Members Absent:        M. Acevedo, A. Contreras, A. Desir, M. Diaz, J. Gago, G. Harriman, B. Malloy, A. Pizarro, S. Thomas

Staff Present:              NYC DOHMH: D. Klotz, D. Saab, J. Acosta, Ph.D., M. Beyene; CHAIN: D. Norman

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 May 10, 2023 meeting were approved with no changes.

Mr. Palmer reported that there is progress on getting a contract with the NYS Department of Health to recover revenue lost by Ryan White providers when the 340b program ended.

Agenda Item #2: Updates

Consumer Update

Mr. Alvarez reported that he attended an important meeting at the NYSDOH AIDS Institute where HIV and aging was a focus.  He reported that a number of consumers are having neurological issues for which many medications are ineffective, as they do not penetrate the blood-brain barrier.  He also expressed concern that HIV not be put on the back burner as an issue, as it is still a priority.

Planning Council Update

Mr. Klotz reported that the Council approved the final EMA Needs Assessment, to be presented later in this meeting.  The Priority Setting & Resource Allocation Committee approved a plan to use carryover funds (unspent funds from GY 2022 that must be used in the current grant year).  A portion of the carryover will be used for Food & Nutrition Programs, Legal Services and Medical Case Management in Tri-County.  PSRA also approved the Steering Committee’s GY 2024 application spending request.  The Integration of Care Committee is putting the finishing touches on the new Behavioral Health Directive for NYC, which should be approved by the end of the planning session.

The application period for membership on the Planning Council closes on Friday.  The Rules & Membership Committee will review applications over the next few weeks and develop a slate of candidates by mid-July.  All current Tri-County representatives on the Council will continue their terms next year.

Recipient Report

Dr. Acosta reported on federal updates, including commemorations of Long-term Survivors and Pride and observation of National HIV Testing Day.  HRSA’s Ryan White Part A (RWPA) virtual site visit took place from May 15-19.  As part of the site visit, HRSA met with Recipient administrative, fiscal, and Quality Management staff; consumers who access services at subrecipient sites; the Planning Council and Executive Committee members; and two RWPA subrecipients (Project Hospitality in NYC and Open Door in TC).  The visit concluded with no major findings and an identified success across the EMA’s Quality Management work.  There was one concern raised by HRSA related to late payments to subrecipients and the Recipient’s lack of adherence to payments reconciled within 45 days of invoice submission.  The Recipient has begun to engage in initial discussions internally at the health department including revisiting the contract with Public Health Solutions to ensure we begin to address areas needing to be reconciled to release timely payments to subrecipients.  Additionally, the Recipient administrative and fiscal teams, which include Public Health Solutions, are scheduled to receive fiscal technical assistance from HRSA in June and July.

The Recipient submitted the annual Program Submissions Report to HRSA before the June 10 deadline.  This report is due to HRSA within 60 days after receiving the full Notice of Award.  The report includes a letter of assurance signed by the Council Co-chairs, the Planning Council membership roster and reflectiveness table, an updated HIV Care Continuum services table, and an updated service category plan table.  The NY EMA Quality Management (QM) Committee met on May 30, 2023, to continue discussions on increasing consumer engagement in quality management and quality improvement (QI) work, as well as initiatives to collect consumer feedback on experiences in receiving RWHAP Part A Services.  The QM Program hosted additional QI trainings in June, including a QI Training for Consumers held on June 21 and a QI Peer Learning & Coaching session for subrecipients held on June 27.  Planning for the upcoming Annual RWHAP Part A Subrecipient Provider meeting taking place on July 18, 2023, continues. A recent questionnaire surveyed subrecipients’ interests for breakout sessions and presentations during the meeting.

Updates were provided on the Medicaid continuous enrollment period, the NY State budget, and the US Department of Health and Human Service’s new STI National Strategic Plan. 

Ms. Plummer presented the GY 2022 4th quarter closeout report for Tri-County programs.  All programs were 100% spent at the end of the year.  This was due to several factors, including the change from fixed-rate reimbursement to a mix of deliverables-based payments.  Also, effective reprogramming meant that unspent funds from some programs (mostly due to staff vacancies, which is a national problem) were moved to programs that performed above their original allocations.  

Agenda Item #3: NY EMA Needs Assessment

Ms. Saab presented the EMA Needs Assessment (NA), approved last month by the Planning Council.  She reviewed the HRSA definition and requirements and noted that the previous NA was done in 2014, and like this one, was a collaboration between the NAC and DOHMH.  The 2023 NA has four main sections: 1) Epi Profile, 2) Resource Inventory, 3) Profile of Provider Capacity, and 4) Assessment of Service Needs/gaps.  The timeline and process for development of the NA was also presented. 

The Epi Profile highlights key HIV epidemiological data from the EMA and examines the HIV-related inequities experienced by PWH and populations disproportionately impacted by HIV.  Details of the profile were presented, along with key takeaways, such as that poverty is linked to higher proportions of people being newly diagnosed with HIV and poor HIV-related outcomes.  Four recommendations from this section were presented, such as capturing relevant data for all priority populations and explore the social and structural determinants of health. 

The Resource Inventory section highlights the RWHAP-funded and other care providers delivering and promoting core medical and support services to address gaps in the HIV care continuum and helps PWH address barriers to viral suppression.  The NA found that there is an increasing need for health education, risk reduction, housing services, and medical case management services in the Bronx and Queens.  Recommendations include increased support for recipients to offer comprehensive and integrated services, and interventions to support providers in adopting and expanding anti-racism and anti-stigma practices. 

The Provider Capacity section, based on a comprehensive AETC survey, identifies areas for improvements in workforce capacity, gain knowledge of the workforce (e.g., clinical competency, service efficiency) and defines needed resources.  One finding is that respondents who have worked in the HIV field for less than 10 years reported their level of expertise as fair or adequate.  Recommendations include that employers should enhance recruitment and retention strategies to increase the representation of communities that are disproportionately impacted by HIV, and that the RWPA program should provide engaging, innovative, and interactive training methodologies to increase provider HIV knowledge and strengthen care delivery.

The Assessment of Service Needs and Gapssection highlights the identified service needs and barriers, provider capacity and capability, and other data such as service utilization, to determine gaps in care by service category and location among specific populations.  Recommendations include increased staffing to expand the number of case managers to assist clients in accessing services and streamlined referral services.

The NA identified a number of “parking lot” items to be addressed in the future, such as HIV outcomes data, a list of RW Part B providers, and additional workforce data. 

In response to a question from Mr. Piazza, Ms. Saab explained that data concerning increased demand for mental health services during the COVID-19 pandemic and barriers to receiving care can be taken back to the Needs Assessment Committee as one of the future action items.  In response to a question from Mr. Palmer, Mr. Klotz explained that the Needs Assessment will be used as a planning tool to inform the work of the Council and its committees over the next several years. 

Ms. Saab was commended for her efforts guiding the Needs Assessment. 

Agenda Item #4: Public Comment

Ms. Best expressed concern about Tri-County consumer representation on the full Council.

Mr. Klotz and the committee thanked Mr. Piazza, who is retiring, for his many years of service representing Putnam County on the Steering Committee.

The next meeting will be in October, date TBD. 

There being no further business, the meeting was adjourned.