Tri-County Steering Committee Minutes November 6, 2020

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TRI-COUNTY STEERING COMMITTEE MEETING

November 6, 2020, 10:05-11:20am

By Zoom Videoconference

M I N U T E S

Members Present:        M. Diaz (Co-chair), A. Straus (Co-chair), D. Ahmed, S. Altaf, V. Alvarez, L. Best, L. Bucknor, D. Dominguez, J. Gago, D. Klotz, K. Mandel, C. Oldi, J. Palmer, M. Piazza, A. Pizarro, G. Plummer, S. Richmond, A. Ruggiero, S. Sanchez, S. Thomas

Members Absent:         M. Acevedo, A. Contreras, M. G. Ferone, L. Hakim, A. Hardman, P. Laqueur, L. Reid, D. Scholar, K. Scott, T. Seabrook A. Simmons, D. Smith

Staff:                               NYC DOHMH: J. Acosta, M. Lawrence

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 October 14, 2020 meeting were approved with no changes.  

Ms. Ruggiero announced that Open Door is providing rapid drive-through COVID testing in Ossining on Nov. 11th.

Ms. Lawrence encouraged everyone to attend a special film screening and panel discussion of the documentary “Nothing Without Us: The Women Who Will End AIDS” on November 17th.

Mr. Palmer reported that the Governor’s Medicaid Redesign Team has proposed diverting the drug cost savings from the 340B program away from Ryan White service providers, community health centers, and others serving people with HIV (PWH).  This will hurt many vulnerable people at a particularly difficult time with the pandemic and economic downturn.  He encouraged people to join the Save NY Safety Net Coalition (www.savenysafetynet.com).

Agenda Item #2: Updates

Consumer Update

Mr. Alvarez reported that many consumers in Tri-County are having challenges with telehealth.  Some feel intimidated with the technology or miss the personal connection of in-person services.  He commended service providers who continue to support clients virtually. 

Mr. Klotz and Ms. Best added that the Consumers Committee’s workshop at the Dec. 8th Power of Quality Improvement Conference will address the challenges that consumers face accessing telehealth.  All are encouraged to attend (conference registration will be required – details to follow).

Planning Council Update

Mr. Klotz thanked the Committee for their support during his time as the Council’s acting governmental co-chair.  He will continue as deputy director and staff support of this committee.  The first meeting of the Council was held on October 29th with a presentation on the FY 2021 Ryan White Part A grant application.  A copy of the PowerPoint will be sent out to the Committee.  The next Council meeting will be on November 19th and will feature an update on the Recipient’s implementation of the Council’s recommendations for enhancing access to services for people with disabilities.

Recipient (Grantee) Report

Ms. Plummer reported that, as Graham Harriman transitions next week to his new post as Planning Council Director, she will serve as Acting Director of the Care & Treatment Program.  The Power of Quality Improvement Conference theme this year is “Redesigning Systems to Address Social Justice and COVID-19”.  Along with the Consumers Committee workshop, two Tri-County programs will be presenting.  Registration information will be available soon.

Ms. Acosta encouraged referrals to Tri-county’s Part A Mental Health and Emergency Financial Assistance (EFA) Programs.  

Mr. Klotz reported that in 2019, the federal government announced “Ending the HIV Epidemic (EHE): A Plan for America”, which targets 48 high incidence counties around the country.  While in the NY area only Bronx, Manhattan, Brooklyn and Queens are eligible for funding, the local EHE plan will serve as a guide for the entire EMA in approaches for services that support the plan’s goals.  More details will be presented over the course of the winter.

Agenda Item #3: FY 2021 (March 1, 2021-Feb. 28, 2022) Spending Scenario Planning

Mr. Klotz explained that every fall/winter, the Steering Committee plans for a possible reduction in the grant award.  The Council’s Priority Setting & Resource Allocation (PSRA) Committee does the same for the NYC portion of the award and for the overall award.  The national RWPA appropriation is unchanged, but given the continued reductions in new cases in the New York EMA compared to other regions of the country, we are likely to continue seeing gradual reductions in our formula award.  For several years, the Steering Committee has asked the PSRA to maintain Tri-County funding at the current level even if there’s a cut to the award.  A preliminary plan was presented for discussion with the following elements:

  1. Level funding for most categories.
  2. Continuation of the $45K enhancement to Housing that was done in 2020 to address COVID-related needs.  The FY 2020 enhancement came from the federal CARES (Coronavirus Relief) Act, which is one-time money (the amount is Tri-County’s pro-rated amount of the CARES money, which was all allocated to Housing). 
  3. The FY 2020 enhancement to EFA was done by drawing down funds that had been allocated to ADAP.  For the FY 2021 application spending plan, the Planning Council allocated $846K for the new Transgender/Intersex/Gender Non-binary/Non-conforming (TINBNC) Psychosocial Support category in NYC.  That category is being bid out and won’t be funded until half way through the year, so we can use half the allocation ($423K) to continue the EFA enhancement in FY 2021. 

The EMA has been able to use its ADAP allocation as a cushion against cuts to the award and to fund emergency needs with the cooperation of the AIDS Institute, which has far greater resources for ADAP (Part B, State funds, drug rebates) and can reduce the Part A contribution without any effect on ADAP clients.  The EMA still wants to retain some ADAP allocation as a cushion against future cuts and because only ADAP can absorb under-spending late in the year, thus avoiding penalties for any carry-over above 5% of formula funds.  The Part A ADAP allocation has fallen from a high of around $17M to $5.1M.

There will be additional information from the Recipient on the carrying costs of programs.  In most years with performance-based programs (reimbursed based on the number of units of service provided), there are adjustments to allocations due to permanent take-downs due to chronic under-spending.  This year, due to the difficulty of meeting service targets due to COVID, many programs reverted to cost-based reimbursement.  There may be higher than usual under-spending, and the PSRA will develop a carry-over plan to use those funds in FY 2021.  For FY 2020, the carry-over from last year will be allocated to Housing.  Carry-over funds are usually approved by HRSA in the late fall and must be spent by the end of the fiscal year (Feb. 28).  A summary of the discussion follows:

  • The CARES Act funds end in February and it is unknown if there will be another federal stimulus, and if there is, if any of it will be allocated to Ryan White programs.
  • Food insecurity has increased due to the economic impact of COVID, driving up demand for this food services.
  • Tri-County Housing programs are set to use all of the current enhancement and more, as COVID has driven up demand for short-term housing and rental assistance.
  • The PSRA can prioritize Food and Housing for its annual reprogramming plan, which reallocates funds freed up in the course of the same fiscal year.
  • EFA funds can be used by clients to buy personal protective equipment (PPE) and cleaning supplies.  In addition, providers are using Ryan White funds to buy these items.

A motion was made and seconded to approve the spending scenario as presented as a baseline, with the understanding that a final plan will be approved as more data (e.g., on carrying costs) become available.  The motion was approved unanimously.

Ms. Straus acknowledged the PSRA’s generosity holding the Tri-County portfolio’s allocations harmless in years when there have been reductions to the grant award.

Agenda Item #4: Other Business

In response to a question, it was confirmed that undocumented people are eligible for all Ryan White services.

Ms. Best encouraged people from Tri-County to Zoom into the Council’s meeting, as there is no travel required now.

There being no further business, the meeting was adjourned.