TRI-COUNTY STEERING COMMITTEE MEETING
November 2, 2022, 3:05-4:25pm
By Zoom Videoconference
Members Present: S. Altaf (Co-chair), J. Palmer (Co-chair), J. Acosta (for G. Plummer), V. Alvarez, L. Best, L. Bucknor, J. Gago, G. Harriman, B. Malloy, K. Mandel, C. Oldi, M. Piazza, A. Pizarro, L. Reid, S. Richmond, V. Schneider, K. Scott, S. Thomas
Members Absent: M. Acevedo, D. Ahmed, L. Beal, A. Contreras, M. Diaz, L. Hakim, A. Hardman, A. Ruggiero, D. Scholar
Staff Present: NYC DOHMH: D. Klotz, K. Mack, F. Abdelqader, J. Thomas, E. Ramsdall, K. Familara; 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 October 19, 2022 meeting were approved with no changes.
Agenda Item #2: Updates
Mr. Alvarez reported that PWH who receive Medicaid are being required to enroll is managed care plans, but that many of their long-time primary care doctors are not on those plans. People need specialized benefits counselors to help navigate this process and ensure continuity of care. He also reported that Medicaid-related issues (transportation, medication) that had seemed to be resolved have resurfaced. Mr. Piazza offered to connect Mr. Alvarez with a new Medicaid coordinator for Putnam County. Ms. Best added that old issues with Medicaid transportation are continuing, creating barriers to care.
Planning Council Update
Mr. Harriman reported that the NYC Commissioner of Health attended the first full Council meeting of the new session last week, where he commended the Council for its work and noted its alignment with DOHMH strategic priorities such as racial equity and addressing behavioral health. The Council also voted to concur with the Statewide Integrated HIV Prevention and Care Plan.
The Consumers Committee is reviewing the draft Quality Management plan for the EMA, which will be submitted to HRSA in December. The Integration of Care Committee began drafting a new Behavioral Health service directive. The Needs Assessment Committee will soon begin reviewing a draft of the comprehensive Needs Assessment for the EMA. The Policy Committee is working on three key issues: 1) overdose prevention centers, comprehensive sex education, the 340b program. The Committee hopes to contribute to educating policy makers on these issues. Mr. Harriman invited anyone from Tri-County who is interested in these issues to get involved.
Mr. Klotz invited any members who want to learn more about the priority setting and resource allocation process to attend an orientation on November 14th.
Dr. Acosta reported that the DOHMH HIV Care and Treatment Program is preparing for a HRSA site visit in May 2023 and working with programs to align with HRSA’s priorities.
Agenda Item #3: Service Category Fact Sheets
Mental Health Services (MNT)
Mr. Abdelqader presented the goals of MNT, which are to provide mental health services directly necessitated by an individual’s HIV status to engage and retain people with HIV (PWH) in treatment and care. There is currently one contract in the Tri-County region. Among the Council’s priority populations, 62% of MNT clients are over the age of 50 and 59% report heterosexual contact as their transmission category. The overwhelming majority of clients were Black and Hispanic and were mostly from Westchester. In 2019 and 2020, the number of clients was very small (3 or under). The number increased in 2021 to 26. All received intake assessments, and most received coordination with service providers. Twelve received mental health counseling. The program was mostly fully expended in 2021 after two years of severe underspending (and almost no expenditure at all in 2020). The program was understaffed in both GY2019 and GY2020, and they did not have a provider with the credentials needed to provide client services. The program also had a poor understanding of the service category mapping and eSHARE reportable services. Public Health Solutions and DOHMH worked very closely with the program providing intensive technical assistance to address all the issues to get the program back on track.
Mental health services are offered by other payers (e.g., NYS Office of Mental Health, NYSDOH AIDS Institute, and ADAP Plus. An eligibility requirement for mental health programs is to be Article 28 or 31 certified, so they can bill allowable services to Medicaid and ensure RWPA services are truly utilized as payer of last resort.
It was noted that the program’s performance issues started after the service was re-bid. In response to questions, it was clarified that payer of last resort requirements ensures the program only pays for people who do not have Medicaid or other insurance, or who receive a service that can’t be reimbursed through another payer. Public Health Solutions will be doing payer of last resort site visits to all programs in Tri-County in the coming months. It was also noted that client demographics have followed similar trends across all service categories, with increasing numbers of older clients and cisgender women. This program serves people with a DSM mental health diagnosis, but mental health services are also available in other categories, particularly Psychosocial Support Services, which provides non-clinical counseling and other support.
Psychosocial Support Services (PST)
This service provides psychosocial support services directly necessitated by an individual’s HIV status to engage and retain people with HIV (PWH) in treatment and care through counseling services to individuals experiencing stress and anxiety who do not necessarily have a DSM diagnosis; individual and group supportive counseling services that aim to overcome barriers to access and facilitate continued engagement in medical care and treatment adherence; and family-focused services that reduce stressors in the lives of PWH to remove barriers to HIV care. There is one provider in Tri-County.
78% of MNT clients are over the age of 50 and 55% report heterosexual contact as their transmission category. 78% report having a disability. The overwhelming majority of clients were Black and Hispanic, and 60% were women. Almost all clients were Westchester residents. The number of active clients has stayed stable, with 47 in 2019 and 40 in 2021. The most commonly provided service types were service plan development, client assistance and supportive counseling. The category spent all or close to its full allocation in 2019 and 2021 but underspent by 21% in 2021.
There is no other large, federal payer available for psychosocial support services for PWH. The services are also not funded by Part B and is not Medicaid billable. PST provides outreach to PWH who may require assistance to cope with their HIV diagnosis and other stressors. Program engages participants in self-management skills and acts as a bridge to mental health services for those in need of professional counseling services.
In response to questions, it was clarified that new intakes decreased from 2019, but the program did a good job of maintaining services during COVID by switching to virtual service delivery and maintaining connections with the clients. The program is working on developing new outreach strategies, including ones that target younger people, for all services in Tri-County.
Mr. Alvarez stressed that there is a need to allow someone who is interested in the service to test it out by attending a meeting without going through an extensive and often intrusive intake process. Dr. Acosta explained that due to HRSA regulations, the program cannot bill for providing a service without an intake. There are also confidentiality issues to consider. She stated that she will brainstorm with the program to figure out a workaround that would lower barriers to participation. Mr. Harriman added that the Council’s Data Workgroup is looking at ways to make the intake process less burdensome. Mr. Alvarez added that the clients in the program have achieved a 100% viral suppression rate.
Food & Nutrition Services (FBT)
This service promotes access to and maintenance in HIV medical care by ensuring access to nutritious food through home-delivered meals, congregate meals, grocery/pantry bags, and food vouchers. There are two funded programs in Tri-County. Among the Council’s priority populations, 73% of MNT clients are over the age of 50 and 59% report heterosexual contact as their transmission category. The overwhelming majority of clients were Black and Hispanic, and slightly over half were women. Mostly were Westchester residents, but a third were from Rockland. The number of active clients dipped from 350 in 2019 to 285 in 2021. The most commonly provided service types were food vouchers and nutritional counseling. The category spent all or close to its full allocation in all three years.
Other payers for this service include SNAP, which was expanded under COVID relief bills, and WIC. Proposed changes to SNAP may impact RWPA food services in the future and will be monitored.
During discussion, it was noted that the period when program offices were closed during COVID, the number of food vouchers went up considerably and the programs were effective getting assistance to clients during the lockdown. Questions were raised about allowing programs to give vouchers or arrange for payments for food at farmers markets. Also, it was explained that the program already allows for Ensure or liquid supplements when recommended by a nutritionist. Finally, it was noted that, while demand for food has not decreased, inflation means that the amount of assistance that can be provided with the same funding has decreased.
Agenda Item #4: Public Comment
Ms. Schneider reported that the Emergency Financial Assistance program has received an enhancement and urged those present to make referrals to the program.
The next meeting will be held on Wed., Dec. 2nd, 10am-12pm with a review of Medical Case Management and Housing service category fact sheets.
There being no further business, the meeting was adjourned.