Tri-County Steering Committee Minutes May 11, 2022



May 11, 2022, 10:05-11:00am

By Zoom Videoconference

Members Present:       S. Altaf (Co-chair), J. Palmer (Co-chair), D. Ahmed, V. Alvarez, A. Contreras, M. Diaz, J. Gago, G. Harriman, B. Malloy, K. Mandel, C. Oldi, M. Piazza, A. Pizarro, L. Reid, S. Richmond, A. Ruggiero, V. Schneider, K. Scott, S. Spiegler (for G. Plummer), S. Thomas

Members Absent:        M. Acevedo, L. Beal, L. Best, L. Bucknor, L. Hakim, A. Hardman, D. Scholar, A. Simmons

Staff Present:              NYC DOHMH: D. Klotz, J. Acosta, I. Newman, G. Navoa; CHAIN: D. Norman;

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

Mr. Palmer opened the meeting followed by introductions and a moment of silence.  The minutes of the April 13, 2022 meeting were approved with no changes.  Mr. Alvarez noted that former Committee member Victor Martinez recently passed away after a battle with lung cancer.    

Agenda Item #2: Updates

Consumer Update

Ms. Diaz and Mr. Alvarez reported that consumers are expressing dissatisfaction with the food provided at group meetings.  A good quality meal is essential for wellbeing, and also acts as an important incentive to participation (the group’s almost universally suppressed viral load is proof of its effectiveness).  While consumers appreciate the work that agencies do and their needs around budgeting and reporting, this is part of a pattern of providers losing the focus on consumers.  He also noted a high incidence of lung cancer, which is what Victor Martinez died from even though he did not smoke.

Ms. Acosta said that she will reach out to Mr. Alvarez and Ms. Diaz to address the food issue.

Planning Council Update

Mr. Harriman reported that the next full Council meeting will be held on May 26th and will include an update on the EMA’s Quality Management Plan, and the Early Identification of Individuals with HIV/AIDS (EIIHA) plan (a HRSA mandate that accounts for 33% of the score on the annual grant application).  The Priority Setting & Resource Allocation Committee (PSRA) is going to consider raising the cap on the annual amount of assistance per client in the Emergency Financial Assistance program, which covers both NYC and Tri-County. 

The Consumers Committee is working to create a culture of inclusivity and also providing input on the Statewide Integrated HIV Prevention and Care Plan.  The Committee will also sponsor the annual Council and committee member recognition picnic on July 19th.  The Integration of Care Committee is working on both a new Behavioral Health service directive and a revised Housing services directive (timed to a rebid of the program in NYC) this will address stigma and social determinants of health.  The Needs Assessment Committee is continuing its work on a comprehensive needs assessment with the goal to complete it by the end of 2022.  There will be a town hall in the fall where everyone will be able to provide input into the draft needs assessment.

Mr. Klotz reported that the PSRA Committee reviewed a cost analysis for a new service category to be funded in NYC next year for Ambulatory Outpatient Services, part of the Council’s Aging & HIV service directive.  PSRA also began discussion on where to get the funds to allocate to that service, including using data from Recipient payor of last resort site visits this fall.  All RWPA providers were sent a survey to assess the administrative mechanism, a RW legislative requirement that planning councils assess how well the Recipient does spending the grant and implementing the Council’s priorities.  Finally, membership applications for the next round of Council and Steering Committee appointments are due on June 17th.

Recipient Update

Mr. Spiegler reported that HRSA observed National Transgender HIV Testing Day and National Youth HIV Awareness Day this month.  Registration is now open for the virtual 2022 National Ryan White Conference on HIV Care & Treatment, which will take place August 23-26.  The NY EMA will have seven presentations at the conference, including one from the Consumers on the Aging & HIV Service Directive.  In policy news, a federal court struck down a Defense Department ban on PWH serving in the military.

With the federal budget approved, the final Ryan White Part A (RWPA) grant award is expected in mid-May.  The Recipient is now in the GY 2021 subaward closeout period, which is key to fiscal compliance for RWPA subawards.  During closeout, the recipient will ensure that all funds are liquidated within 90 days of the end of the budget period. 

The NY EMA Quality Management Committee met on March 21st with over 20 stakeholders attending, including the Council.  The committee reviewed the Council’s Framing Directive.  They discussed the GY2022-23 priorities for the QM Program and brainstormed strategies to better engage consumers and providers of RWPA services in the QM Program. 

The DOHMH HIV Care and Treatment Program (CTP) co-hosted a webinar with Public Health Solutions (PHS) for all RWPA providers on March 30.  CTP reviewed HRSA Part A policy updates on client eligibility determination and recertification requirements, clinical quality management, 340b monitoring, and payor of last resort policies and monitoring.

Awards under the RWPA RFP for NYC Oral Health Services will be announced on June 15th with funded programs set to start on September 1st.

Agenda Item #3: 2020 GY 2023 Tri-County Application Spending Plan

Mr. Klotz presented a draft spending request for the GY 2023 grant application.  The spending request is not binding and is an expression of the Committee’s needs for the following year.  In the fall and winter, the Committee will review the entire portfolio and plan for the actual award, which likely be another reduction in the formula portion of the award due to the relatively slower increase in HIV cases in the NY EMA compared to other parts of the country.

The application spending plan asks for the maximum increase allowed by HRSA (5%).  As a placeholder, the increase ($267,622) is spread it out across the entire portfolio, weighted based on ranking scores (higher ranked categories are increased at a proportionally higher rate). 

In response to a question from Mr. Altaf, Mr. Klotz explained that the EMA has received modest increases in the one third of the award that is competitive (known as the Supplemental Award), but never near enough to offset the reductions in the formula award. 

A motion was made, seconded and approved 17Y-0N to adopt the GY 2023 application spending plan as presented.

Mr. Altaf and Mr. Palmer noted that the Committee was done for the planning cycle and will begin again in September with the review of the portfolio, which will continue into the winter in preparation for a new set of allocations for the final GY 2023 award.  Mr. Klotz will send periodic updates to the Committee during the recess.

There being no further business, the meeting was adjourned.

There continues to be a lack of mental health resources, particularly due to staff shortages.  Telehealth is not adequate to address many mental health needs.

Agenda Item #4: Planning for GY 2023 Tri-County RWPA Services

Mr. Klotz explained that the Committee will begin a review of the TC RWPA portfolio in the fall.  For the purposes of the GY 2023 grant application, the Committee can request up to the maximum allowed (5% over the current year’s award).  Planning for the actual award will follow a process similar to what the PSRA Committee did for NYC programs.  The Recipient is preparing Service Category Fact Sheets that will be rolled out from September 2022 through January 2023.  The fact sheets contain three years of data on the following measures: Active Enrollment; Client Demographics; Priority Populations as percentage of enrolled clients; Expenditures (compared to original allocation); Service Utilization by service types and service elements.  There will also be a narrative that looks at payer of last resort and systems-level considerations (e.g., how changes in Medicaid coverage or other programs will affect RWPA). 

The TC portfolio has remained at current funding levels for several years, despite continued reductions in the grant award.  This process will need to result in a new set of allocations that right-size programs and address needs within an environment of continued reductions in funding.

There being no further business, the meeting was adjourned.