Tri-County Steering Committee Minutes October 13, 2021



October 13, 2021, 10:05-11:35am

By Zoom Videoconference


Members Present:       S. Altaf (Co-chair), J. Palmer (Co-chair), D. Ahmed, V. Alvarez, L. Beal, L. Best, L. Bucknor, D. Dominguez, J. Gago, L. Hakim, G. Harriman, B. Malloy, K. Mandel, C. Oldi, A. Pizarro, G. Plummer, S. Richmond, L. Reid, A. Ruggiero, A. Simmons, S. Thomas

Members Absent:        M. Acevedo, A. Contreras, M. Diaz, M. G. Ferone, A. Hardman, P. Laqueur, M. Piazza, V. Schneider, D. Scholar, K. Scott, T. Seabrook

Staff Present:              NYC DOHMH: D. Klotz, S. Spiegler, E. Wiewel, D. Ferdinand, R. Torres, G. Navoa, W. Riley, K. Mack; Public Health Solutions: G. Campbell; CHAIN: D. Norman

Guests Present:           C. Cohen (RECAP), L. Cyrus (HVCS/Cornerstone), C. Emestica (PathStone), K. Lynch (Rockland County Office of Community Development)

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.  Mr. Altaf congratulated Mr. Palmer on his appointment to the Council and as co-chair of the Steering Committee.  New Committee members were also introduced: Ms. Beal (also appointed to the full Council), Ms. Malloy and Ms. Schneider (on annual leave this week).  It was noted that meetings will be fully remote until at least the end of the year, after which the possibility of hybrid in-person/remote meetings will be assessed based on the latest public health guidance.

The minutes of the July 14, 2021 meeting were approved with no changes. 

Agenda Item #2: Updates

Consumer Update

Mr. Alvarez thanked the Council staff for the August member appreciation event in Riverside Park.  He reported that many consumers continue to have difficulties with telehealth and the barriers it presents to receiving optimal care.  Also, some members are reporting increases in neurological issues.  The support group is continuing to meet face-to-face and give each other support and discuss issues such as aging and stigma.

Planning Council Update

Mr. Harriman reported that the Council’s Needs Assessment Committee will start work on the first comprehensive needs assessment in 7 years.  The Integration of Care Committee is working to finalize the Framing Directive (a revised version of the old “master directive”).  The Directive will apply to all Ryan White Part A (RWPA) programs in the EMA to ensure that they meet certain standards, particularly around anti-racist and trauma-informed care.  IOC will also be working on Standards of Care for NYC service categories and a Behavioral Health Service Directive combining mental health and harm reductions services.  A new Policy Committee run jointly with the NYC HIV (Prevention) Planning Group will have its first meeting on October 26th.  The Consumers Committee is following up its creation of the first HIV & Aging Service Directive (which will get final approval at the Oct. 28 Council meeting) with a presentation at the December 14th Power of Quality Improvement Conference. 

FY 2022 Grant Application submitted to HRSA.  Twelve new Council members seated, including two from Tri-County.  Orientation 10/22, open to all.  The Executive Committee (10/21) and full Council (10/28) meetings will include final review and approval of a new Aging and HIV Service Directive.  Consumers Committee submitted an abstract to the Power of Quality Improvement Conference on the HIV & Aging Service Directive.

Mr. Klotz reported that the Priority Setting & Resource Allocation Committee (PSRA) meets Monday to continue review of the NYC portfolio with the aim of developing revised allocations for the FY 2022 grant award.   

Recipient Update

Ms. Plummer reported that she has been appointed permanent Director of the HIV Care and Treatment Program.  Core leadership values to be expected from the Director of the HIV Care and Treatment Program are transparency, collaboration, and equity.  These same values are upheld by the Assistant Commissioner of the Bureau of Hepatitis, HIV, and Sexually Transmitted Infections. The Recipient will lead with prioritizing quality services for people with HIV ensuring continuous quality improvement to care and treatment services across the Ryan White Part A portfolio.

On October 1st, the Recipient submitted the FY 2022 Grant Application to HRSA.  This is a three-year application, with only progress reports needed for the subsequent two years of funding, which greatly eases the burden on the program staff.  In response to a question, Ms. Plummer noted that some program staff are still working in activation roles in response to the COVID-19 pandemic but on a part-time basis in order to be responsive to the needs of the Program for Ryan White Part A while addressing the needs of the health department for the COVID public health emergency.

Agenda Item #3: 2021-22 Committee Workplan

Mr. Klotz presented a draft workplan for the committee for the new planning cycle.  Tasks include Scenario Planning for a possible reduction in the FY 2022 grant award, a TC epi update from the AIDS Institute, the FY 2023 application spending request, and an FY 2021 expenditure report.  Additional items will be added as the year proceeds, such as a presentation on the new Framing Directive.   

Agenda Item #4: Tri-County Housing Services

Mr. Ferdinand presented an overview of HIV housing services in the Tri-County region.  RWPA funds two Short-Term Rental Assistance (SRA) contracts (cost-based line-item budget reimbursement) serving Westchester, Rockland, and Putnam counties.  HOPWA funds four cost-based contracts for Long-Term Rental Assistance serving Westchester, Rockland, and Orange counties.  RWPA programs are funded at $1,207,533 as per the Committee’s and Council’s allocations.  HOPWA programs receive $1,465,900.  In the 2020-21 fiscal year, RWPA programs spent 99.8% and HOPWA programs spent 92% of their awards. 

The RWPA SRA program provides financial assistance in the form of payments directly to landlords and/or utility providers for rent, utilities, telephone service, and moving expenses to secure or maintain stable housing for Persons With HIV (PWH) in the Tri-County region.  RWPA is payer of last resort and allows for short-term (2 years) services.  Clients are required to obtain their own apartments and leases and a 30% resident rent payment is required (if income other than public assistance).  Rent subsidies designed to help persons establish and/or maintain permanent, stable housing, which is associated with better adherence to HIV treatment, viral suppression based on lower HIV viral loads, higher CD4 T-cell counts, better mental health status, and reduced HIV risk behaviors.

RWPA has three areas of client eligibility: HIV Status (services only for those documented HIV positive, with limited exceptions for dependents), Residency (living in the EMA), and Income (up to 500% of federal poverty level). 

Contract monitoring was described, including: 1) monitoring compliance with contract terms, 2) site visits (fiscal and program), 3) fiscal audits, 4) monitoring reports, 5) housing quality and habitability visits, 6) payments and contract renewals/modifications.  There is also daily communication and technical assistance and trainings. 

The program service types include: 1) Intake Assessment (assessment of health, psychosocial status and service needs of new clients to facilitate plan development completed within 30 days of enrollment into the program); 2) Service Plan Development (development of a client-centered plan in response to the initial comprehensive assessment, listing client’s goals for participation in the program); 3) Reassessment (Follow up assessment to re-evaluate and record client eligibility, engagement in care and services, emerging health and service needs, progress towards achieving plan goals); 4) Service Plan Update (evaluate progress toward achieving goals); 5) Apartment Inspection (initial and annual apartment/housing inspection using the HUD Housing Quality Standards to assess the habitability of the apartment/housing unit); 6) Client Assistance (helping client gain access to health care, supportive services, housing, entitlements and benefits, and other needed services, coordination with service providers, etc.); 7) Rental/Utility Payments (incl. brokers’ fees and moving expenses); 8) Eligibility Verification.  The programs also ensure that housing units meet any regional building and fire codes, and assess clients’ medical conditions and/or disabilities when determining appropriateness of housing.  The data reporting requirements for programs were reviewed (eShare for RWPA, eCompas for HOPWA).  Provider and stakeholder meetings and training were also outlined.

A summary of the discussion on the Aging and HIV Service Directive follows:

  • The housing stock in TC is limited and sometimes units are not in great conditions, but it can be necessary to house people at least temporarily in sub-standard units to avoid homelessness.
  • The program would never tell a client who is housed to vacate a unit that does not meet federal habitability standards.  They will work with the landlord to improve conditions.  Withholding of rental payments to landlords is an option if the conditions are not remedied.
  • There are specific barriers to optimal housing for many.  For example, if a PWH is in supportive housing based on age or mental health status, they may not receive HIV-specific care. 
  • Other funding is needed to leverage RWPA and HOPWA funds.  Advocacy is needed to increase the federal appropriations for RWPA and HOPWA.
  • The programs try to balance the burden of documentation with client stability.  Income eligibility is checked four times a year, rather than twice along with reassessment, so that the programs can ensure that payments are being made and also check habitability standards.
  • NYC provides incentives for staying undetectable.  TC should look into a similar program.
  • An analysis of what’s available in TC compared to NYC (which has HASA), would be useful to take actions that will help level up TC programs.
  • There is a general affordability issue, with housing costs particularly high in Westchester.  The federal Fair Market Rent level does not take into account high cost markets like the NYC area. 

The presenters were thanked, and the Committee will continue to follow up on the issues raised in this presentation.

The next Committee meeting will be held on November 10th, 10am.

There being no further business, the meeting was adjourned.