Tri-County Steering Committee Minutes May 13, 2020


May 13, 2020, 10:10am-11:45am
By Zoom Videoconference


Members Present:        M. Diaz (Co-chair), A. Straus (Co-chair), M. Acevedo, D. Ahmed, S. Altaf, V. Alvarez, L. Best, L. Bucknor, D. Dominguez, L. Hakim, G. Harriman, D. Klotz, P. Laqueur, K. Mandel, J. Palmer, M. Piazza, A. Pizarro, S. Richmond, A. Ruggiero, T. Seabrook, A. Simmons, S. Thomas  

Members Absent:         A. Contreras, M. G. Ferone, J. Gago, A. Hardman, C. Oldi, L. Reid, D. Scholar, K. Scott

Staff:                               NYC DOHMH: J. Acosta, A. Guzman, M. Lawrence, G. Dominguez-Plummer, K. Mack; 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 March 11, 2020 meeting were approved with no changes.  

Agenda Item #2: Updates

Consumer Update

Mr. Alvarez reported that consumers in Tri-County are coping with the COVID-19 pandemic, on top of the usual stresses of living with HIV.  Mental health issues, in particular are coming to the forefront, in additional to issues around HIV and aging and the heightened threat from COVID-19.  Living Together members are keeping in touch with each other, offering support and helping each other cope with the isolation of quarantine.

Planning Council Update

Mr. Klotz reported that the EMA received its full Ryan White Part A (RWPA) award on April 15th on the same day it received an extra $1,000,000 under the federal Coronavirus Aid, Recovery and Economic Security (CARES) Act.  The Council’s Priority Setting & Resource Allocation Committee (PSRA) swung into action, working with the Grantee to leverage additional available funds and allocate almost $3 million to respond to needs of RWPA clients due to the COVID-19 pandemic.  Some of that funding appears in the Tri-County spending plan, as will be described in the Grantee Report below.

Other Council committees are continuing their work.  Needs Assessment is developing recommendations to improve service for seriously mentally ill PLWH.  Integration of Care is working on a directive for oral heath in the NYC portion of the EMA.  The Consumers Committee is sponsoring a virtual Town Hall on COVID-19 and HIV on March 19th.

Recipient (Grantee) Report

Mr. Harriman reported on the notification of grant award, made on April 15th.  The total Part A award for FY 2020 (3/1/20-2/28/21) is $92,902,442, a reduction of $1,330,082 (1.41%).  The reduction came entirely in the Base award, which was offset slightly by a modest increase in the MAI award.  As noted earlier, the EMA also received $1M in CARES Act funding ($100K for administration, $900K for programs).  The CARES funds must be used for allowable RWPA activities/programs­ and must be used to prevent, prepare, and respond to COVID-19.  The Planning Council had 30 days from the notification to develop an allocation plan.

Mr. Klotz explained that the PSRA and Council approved the plan within a week of the notification.  The Grantee identified additional available funds to add to the CARES money.  There was $177,480 in unobligated funds from a NYC-based Early Intervention Services contract that ended.  Approximately $400,000 will be available later in the year from FY 2019 carry-over (close-out is under way, after which the exact amount will be known).  Finally, the AIDS Institute had agreed that we could use up to $2.46M to cover a reduction in the grant award.  Since the reduction was less than what the Council had planned for, only $960K was needed from ADAP.  The State agreed to let the EMA use the balance ($1.5M) to add to the COVID-19 response.  The Council allocated the funding as follows: Short-term Rental Assistance ($1,900,000 – of which $45,000 goes to Tri-County); Food & Nutrition ($177,480); Short-term Emergency Housing ($400,000); and Emergency Financial Assistance ($499,825).  The EFA funds appear in the TC spending plan, as the only EFA provider in the EMA is located in the region.  The additional funds will allow the provider to expand the program to the entire EMA, including NYC.  In addition, a proportional amount of the Housing enhancement ($45K) is earmarked for Tri-county.  On the spending plan, you will see that amount combined with the permanent $175K in additional funds for TC Housing that was approved earlier this year.  The new enhancements are one-time funds for COVID-19 response in FY 2020-21.  The Council also approved a reprogramming plan for FY 2020 that gives FNS programs first priority for enhancements.

Mr. Harriman continued, reporting that HRSA has a COVID-19 FAQ page on their website that is updated regularly with information and resources for RW program recipients around COVID-19 and HIV Care and client services.  In response to program’s six-month recertification process and limiting exposure and minimize spread of COVID-19, HRSA has implemented the following changes: 1) Allow application forms to be mailed securely to the office; 2) Allow electronic signatures for clients hesitant to come into clinics; and 3) Allow case managers working remotely to use electronic signatures.  HHS is also collaborating with national pharmacies to Expand PrEP access.  HRSA has also extended the deadline for the annual RWPA Progress Report, Ryan White Services Report (RSR), and Program Terms Report.

In response to COVID-19, the Grantee has authorized the following temporary changes to contracts to ensure service continuity for RWPA clients and prioritize the health and safety of program staff, clients and the community including: 1) Programs may substitute in-person client encounters with telehealth services such as videoconferencing and telephone contact, wherever possible; 2) Programs may determine that home visits and patient navigation services provided in the community are not advisable; and 3) Each funded program is expected to contact every enrolled client to check in on their welfare, with follow up contacts as needed.

NYC DOHMH and PHS will consider the contractual impact COVID-19 has on program’s ability to meeting their targets and pay program costs from March-June.  Programs will receive provisional payment equal to 1/12 of MRA each month through June based on a submitted budget of allowable expenses.  Contract corrective action plans and determination of status has been suspended.  Food and Nutrition Program changes include: 1) Voucher programs are restructured from in-person to mail in vouchers for clients or use vouchers to order food for clients for home delivery; 2) Congregate meal programs are temporarily restructured to provide take-out meals; 3) Caps on meals per client per week have been lifted during this time.  Finally, all programs must report if COVID-19 is affecting service delivery using the electronic Program Narrative Report.

In response to COVID-19, DOHMH, in partnership with New York City Emergency Management, has distributed guidance to all agencies and partners.  The city has implemented cleaning guidance to all city agencies that oversee congregate and community spaces modeled after the Department of Education’s enhanced protocols.  DOHMH has issued guidance on the health department’s website in response to COVID-19 and NYC cases.  The City is also closely monitoring key public health signs to determine when certain social (physical) distancing restrictions will be lifted for people who are not at high risk for serious complications of COVID-19.  Details for the entire State will be described by Mr. Guzmam below.  The Council’s website also has a COVID-19 and HIV resources page, which is updated weekly.

Ms. Acosta reported that she is conducting biweekly check-ins with Tri-County providers, sharing resources on transportation, food distribution, housing, legal services, telehealth, supportive housing programs, mental health services, domestic violence, and how to obtain face mask at no cost.  She is working with the DOHMH BHIV Training and Technical Assistance Unit to create a training curriculum for the Tri-County providers, and will send a survey to providers to determine training/s for the fall and winter.  She is also in the first stages of planning the next Tri-County Providers meeting.

In response to a question from Ms. Best, Mr. Harriman noted that the State is working on protocols to protect patient privacy and security while engaging in telemedicine and that it will be up to programs to ensure that their clients are protected.

Policy Update

Mr. Guzman presented on the current topics in HIV law and policy.  On May 4, 2020, Governor Cuomo extended the special enrollment period allowing eligible individuals to enroll in insurance coverage through NY State of Health through June 15, 2020.New Yorkers eligible for Medicaid, Essential Plan, and Child Health Plus may enroll year-round.  The Trump Administration has refused to reopen Affordable Care Act (ACA) enrollment in the states with markets it manages, and it continues to support a federal suit seeking to invalidate the ACA on the ground that its requirement that most Americans obtain health insurance is unconstitutional.

On April 16, 2020, Governor Cuomo outlined a blueprint to “un-PAUSE New York”, and in May, released ”New York Forward”, a statewide plan to get New Yorkers, region by region, back to work and ease social isolation without triggering renewed spread of COVID-19 or overwhelming the hospital system.  New York State on PAUSE remains in effect until May 15, 2020, at which point the Governor will decide whether to extend the order. Certain low-risk business and recreational activities are expected to reopen statewide at that time.  As part of New York Forward, the state will monitor four core factors to determine whether a region can re-open: New Infections; Health Care Capacity; Diagnostic Testing Capacity; and Contact Tracing Capacity.  A Regional Monitoring Dashboardtracks these metrics across the state’s 10 regions, including the New York City region and Mid-Hudson region (Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester Counties).  Four regions of the State have met the metrics.  NYC and its suburbs are still behind.  It was noted that Westchester and Rockland has a different picture than other parts of the Mid-Hudson region like Duchess, but is currently lumped in with them.

The various federal COVID-19 relief bills (both passed and proposed) were presented.  On May 11, 2020, Rep. Nita Lowey announced that eight hospitals in her district in Rockland and Westchester Counties would receive $246 million in federal CARES Act funding for essential expenses related to treating COVID-19 patients.  In response to a questions from Ms. Diaz, Mr. Guzman said he could find out about any hospitals in Yonkers (outside the Lowey district) had received funding.  Finally, online resources from NYC, Westchester, Rockland and Putnam and the federal government were described.

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

Mr. Klotz reported that program data from FY 2019 will be available for presentation to the Committee at the June meeting.  As most of the portfolio was re-bid and last year was a start-up year, the data will not be useful for planning.  PSRA typically looks at three years of program data aggregated by service category (enrolment, service utilization, client demographics, payer of last resort issues) to make decisions about changes in allocations.  The TC Steering Committee will be presented with options for the application spending request, including asking for the maximum allowable increase (usually 5% over the previous year’s award), spread across all categories, weighted by ranking score.  The likelihood of getting an increase is extremely small, and the Committee will have the fall and winter to plan for a possible reduction, using additional service category data.

Agenda Item #5: New Business

Ms. Best promoted the Consumers Committee’s Virtual Town Hall on COVID-19 and HIV, to take place on May 19th.  Last month’s Town Hall reached people from across the country, who are looking to NY for guidance.  There will be brief updates from Mr. Guzman, and other staff will be available to answer questions, but the main purpose of the event is to hear from PLWH on the challenges they are facing due to the COVID-19 pandemic.

The next meeting will be held by videoconference on Wednesday, June 10th by Zoom videoconference.

There being no further business, the meeting was adjourned.