Tri-County Steering Committee Minutes November 13, 2019


November 13, 2019, 10:05am-11:30pm
Hudson Valley Community Services
40 Saw Mill River Road, Hawthorne, NY


Members Present:   A. Straus (Co-chair), M. Diaz (Co-chair), D. Ahmed, S. Altaf, V. Alvarez, L. Best, L. Bucknor, B. Catena, D. Dominguez, J. Gago, J. Gressel, L. Hakim, G. Harriman, P. Laqueur, K. Mandel, C. Oldi, A. Pizarro, L. Reid, S. Richmond, A. Ruggiero (by phone), A. Simmons, S. Thomas
Members Absent:  M. Acevedo, D. Carney, A. Contreras, M. G. Ferone, A. Hardman, J. Palmer, M. Piazza, D. Scholar, K. Scott, T. Seabrook, C. Watkins
Staff: NYC DOHMH: D. Klotz, P. Farquahar, D. Ferdinand, K. Mack
Agenda Item 1: Opening/Moment of Silence/Minutes  

Ms. Straus and Ms. Diaz opened the meeting followed by introductions and a moment of silence of silence.  The minutes of the October 23, 2019 meeting were approved with one minor change.

Agenda Item #2: Updates  

Consumer Update

Ms. Diaz and Mr. Alvarez reported that new members continue to join.  Also, HRSA policies on reassessment can be onerous.  Mr. Harriman clarified that proof of HIV status is not required for reassessment, only income and residency eligibility.  DOHMH has discussed reassessment requirements with HRSA and they have expressed openness to adjusting them.  Also, the new DOHMH system is making adjustments, but it will take some time.

Ending the Epidemic Report

Mr. Laqueur and Ms. Hakim reported that there will be a meeting with AIDS Institute to plan for a December 10th meeting, where planning will be done for 2020.  Also, the NYS AIDS Advisory Council is looking for more members from Lower Hudson Region.   

Recipient (Grantee) Report

Mr. Harriman reported that HRSA released a Notice of Funding Opportunities (NOFO) for Ending the HIV Epidemic-Primary Care HIV Prevention.  Funding will support the Health Center Program in expanding HIV prevention services that decrease the risk of HIV transmission, focusing on supporting access to and use of pre-exposure prophylaxis (PrEP).  HRSA will invest approximately $50 million in HRSA-funded health centers located in geographic locations identified by the Ending the HIV Epidemic: A Plan for America, which includes 4 counties (boroughs) of NYC.

HRSA’s HIV/AIDS Bureau released its 2019 biennial report highlighting five Ryan White HIV/AIDS Program recipients who implemented successful strategies and models of HIV care and treatment —including practice transformation, public-private partnerships, rapid entry to HIV care and delivery of ART, the use of telehealth/telemedicine, and a jurisdictional approach to providing treatment and care.  Ms. Reid noted that telemedicine can be particularly helpful to older people who are isolated and for PLWH in rural areas. 

The awards under the recent Ryan White Part A Food and Nutrition Services RFP in New York City will be announced soon.

A new staff member is in the hiring process to take Julie Lehane’s position as a program planner for the Tri-County region.  That person will also assist the Steering Committee in its planning responsibilities.

DOHMH submitted the application for the FY2020 Ryan White Part A funding on September 24th.  Key elements of the grant application will be presented to the Planning Council at a future meeting.  As part of the application, the Grantee submitted a waiver application for FY2020 to the Core Medical Services (CMS) requirement, which requires that at least 75% of the services allocation be spent on HRSA-defined Core Medical Services.  The Planning Council’s Application Spending plan necessitates a waiver as only 56% of the service allocation was allocated to the Core Medical Services —such as ADAP, Oral Health Care, Early Intervention Services, Mental Health, Medical Case Management, and Harm Reduction services — and 44% were allocated to Supportive Services — including Housing, Food and Nutrition, Emergency Financial Assistance, and Psychosocial Support Services.

Planning Council Update

Mr. Klotz reported that all the Council sub-committees are meeting.  The Needs Assessment Committee (NAC) is working on recommendations to improve access to care for people with serious mental illness.  The Integration of Care Committee (IOC) is working on standards of care and will then work on a new service directive for a NYC-based Oral Health Services category.  The Priority Setting & Resource Allocation Committee will begin working on scenario planning for the FY 2020 grant award.  The Consumers Committee is working hard on a session to be held at the November 25th Power of Quality Improvement Conference on “Addressing Client Needs for Oral Health Services.”  Ms. Best encouraged Tri-County providers and consumers to attend in order to better understand the oral health needs of consumers and better be able to address them.

Adrian Guzman will attend the January Steering Committee to help get a civic engagement process underway for members who want to work on advocacy issues.

Agenda Item #3: FY 2020 Spending Scenario Planning: Housing Allocation

Mr. Klotz noted that, when planning for a possible cut to the grant award in FY 2020, which begins March 1, 2020, the carrying costs of programs will remain stable as programs are in their start-up year.  In future years, with the advent of performance-based contracting (where agencies are paid for the services delivered based on rates, rather than fixed costs), there will be adjustments as programs find their maximum reimbursement levels.  For FY 2020, the one exception is Housing Services, which will require some ongoing additional funding, as Ms. Farquhar, Director of HIV Housing, will present.

The Priority Setting & Resource Allocation Committee (PSRA) and Council have traditionally been amenable to holding TC programs harmless from cuts to the award, which (along with any additional funds for Housing) can be reallocated from the funds now allocated for ADAP (NYS DOH has informed the Council that they have sufficient funding to help the EMA absorb cuts to the award).

Ms. Farquhar presented an analysis of the program data and resource needs of Tri-County (TC) Housing Services, completed with the assistance of Mr. Ferdinand.  Housing in TC is currently funded (for FY 2019, 3/1/19-2/29/20) at $872,533, which funds two programs.  Both agencies provide short-term rental assistance and utilities assistance in addition to supportive services to PLWHA and eligible household family members.  The programs serve 122 clients for rental and utilities assistance with an average client household rent between $1,114 – $1,460 per month.  On average the program pays $16,041 – $33,847 in rental & utility assistance per month at an average of $642 -$1,058 per client.  The average a client pays towards their rent is approximately $403-$469. 

An enhancement of $300,000 was made in FY 2019, but was implemented late.  Still, additional pockets of individuals and families eligible for Ryan White Part-A funded rental assistance were identified in Rockland, Westchester and Putnam counties.  Higher program costs were attributed to larger bedroom size apartments (i.e. one bedrooms vs 2-4 bedroom apartments) because of high number of families seeking assistance.  Based on the program’s FY2019 year-to-date spending, the rental assistance housing needs of PLWA in the Lower Hudson Valley area is greater than originally anticipated.  Higher rental assistance costs resulted in unanticipated higher RWPA subsidies therefore, additional resources are needed to continue serving newly enrolled households.  Additional needs in FY 2019 were covered through carry-over funds (ends 2/29/20).  Without a permanent enhancement, several family households will lose rental assistance.

Based on the annualized cost of assisting the current client load, the program should receive $175,000 for FY2020.  This will be necessary in order to maintain the current number of individuals/families served through the program.  This would bring the total TC Housing allocation to $1,047,533, allowing the agencies to continue serving 122 clients and potentially enroll additional clients through natural client attrition.  This also addresses the need for RWPA short-term rental assistance in the Tri-County region by sub-populations identified (i.e. Haitian and Latino Communities).   Lack of Section 8 and other social services rental assistance programs like HASA in Tri-County make the enhancement more critical.

A summary of the discussion follows:

  • Disenrolling clients is unlikely, so there will not be much attrition.  HRSA rules state that Ryan White housing is meant to be transitional, thus some attrition would normally occur as the result of programs leveraging additional resources (e.g., HOPWA) and transferring clients to permanent housing.  DOHMH will not ask RWPA programs to stop serving anyone who is receiving housing.
  • There are general challenges around housing (e.g., lack of affordable units, low available stock, competition for Section 8), which requires community advocacy efforts for more resources.  
  • The RWPA TC Housing programs are still conducting outreach efforts, and so there may be need for additional resources beyond the amount recommended. 
  • One provider has seen demand from large families, which is particularly expensive, as the fair market rent is already high and increasing.
  • The percentage of program dollars for the TC region was long tied to the percentage of PLWH in the EMA (now around 4%).  For several years, PSRA and the Council has increased the TC allocation, even in the face of reductions in the overall grant award (currently TC receives 5.4% of program funds).  The proposed amount will cover known needs, and increase the baseline allocation.  Also, there is the possibility of using carry-over funds again to cover additional enrollments, and if there is a documented need for additional resources, then the Steering Committee can request that as an increase to the FY 2021 spending plan.

A motion was made, seconded and approved unanimously to request that PRSA allocate an additional $175,000 for Housing in Tri-County for FY 2020.

A motion was made, seconded and approved unanimously to request that PSRA hold all other service categories at the FY 2019 funding levels into FY 2020.

Agenda Item #4: Public Comment/New Business

In response to a question, it was noted that Westchester DOH has a resource directory, which is on the Council’s website.  Ms. Best added that it should also be available in written form and distributed to all agencies.

Mr. Alvarez thanked Mr. Klotz and Mr. Harriman for the support they provide to the Committee.

There being no further business, the meeting was adjourned.