Tri-County Steering Committee Minutes October 19, 2022



October 19, 2022, 3:05-4:40pm

By Zoom Videoconference

Members Present:       S. Altaf (Co-chair), J. Palmer (Co-chair), V. Alvarez, A. Contreras, M. Diaz, J. Gago, G. Harriman, B. Malloy, L. Reid, S. Richmond, A. Ruggiero, S. Spiegler (for G. Plummer), S. Thomas

Members Absent:        M. Acevedo, D. Ahmed, L. Beal, L. Best, L. Bucknor, L. Hakim, A. Hardman, K. Mandel, C. Oldi, M. Piazza, A. Pizarro, D. Scholar, V. Schneider, K. Scott

Staff Present:              NYC DOHMH: D. Klotz, J. Acosta, S. Spiegler, F. Abdelqader, S. Barton, J. Thomas, C. Burt, E. Ramsdall; 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 May 11, 2022 meeting were approved with no changes.  Mr. Alvarez noted the passing of Living Together members Victor Martinez and Thomas Seabrook.

Agenda Item #2: Public Comment

Mr. Palmer reported that the eligibility rules for the new NY State Healthcare Workers Bonus Program for recruitment and retention seems to preclude employees of AIDS service organizations (ASOs).  A group is meeting to advocate for expansion of eligibility.  Also, advocacy efforts are underway by the Save the NY Safety Net Coalition to get the State legislature to extend the 340B program, which provides millions of dollars from Medicaid managed care to ASOs.  

Agenda Item #3: Updates

Consumer Update

Mr. Alvarez urged providers to keep their focus on serving people with HIV (PWH).  He reported that Medicaid-related issues (transportation, medication) that had seemed to be resolved have resurfaced.

Planning Council Update

Mr. Harriman reported that the first full Council meeting of the new session will be held on October 27th and will include a concurrence vote on the draft Statewide Integrated HIV Prevention and Care Plan.  An informational session on the plan was held on Monday.  The Plan will guide HIV services statewide from 2022-26. 

The Consumers Committee met yesterday to review 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.  Mr. Klotz invited any members who want a refresher on the Ryan White program and role of the Planning Council to attend a new member orientation on Friday. 

Recipient Update

Dr. Acosta reported that HRSA recently observed National HIV and Aging Awareness Day.  The CDC issued a health advisory on possible sever manifestations of MOV (monkeypox) in immune compromised people.  The NY EMA’s presentations from the National Ryan White Conference held in August are available, including two from the Planning Council (on the HIV & Aging Directive, and the Framing Directive).

The NY EMA submitted its Non-competing Progress Report to HRSA.  This acts in place of a full application for the 2nd year of the three-year award.  The EMA’s Quality Management Committee reviewed the latest draft of the QM plan.  Also, the WM Program held RWPA service category-specific open forums/provider meetings from June to August.  These meetings create a space for providers to share their experiences, strategies, and coping mechanisms. Providers were very actively engaged and expressed an interest in continuing the open forum format.

Awards under the RWPA RFP for NYC Oral Health Services will be announced on June 15th with funded programs set to start on September 1st.

Agenda Item #4: Service Category Fact Sheets

Mr. Altaf explained that, as discussed during the last planning cycle, the Committee will spend the next few months reviewing all of the service categories in the Tri-County portfolio.  Fact Sheets for each category will be presented to the Committee through December.  The Fact Sheets contain multiple years’ data on client enrolment and demographics, service utilization, spending, plus brief analyses of payer of last resort issues.  After the service category review is complete, the Committee will use the data to make decisions about adjusting service category allocations for the 2023-24 grant year. 

Legal Services (LST)

Mr. Abdelqader presented the goals of LST, which are to provide culturally and linguistically appropriate comprehensive civil, legal and health-related advocacy services that assist clients in removing barriers and gaining access to primary care.  Legal services are limited to those directly necessitated by a person’s HIV status.  The program serves documented and undocumented PWH and its general expertise includes: social security disability, public benefits and entitlement law, eviction prevention and housing rights, foreclosure defense, domestic violence, and areas with specific relevance to PWH and their families, such as living wills and health care proxies, do not resuscitate orders, powers of attorney, legal matters involving health, life and disability insurance, HIV/AIDS discrimination, breach of

confidentiality issues, and permanency planning issues including guardianships.

There are currently two contracts in the Tri-County region.  Among the Council’s priority populations, 80% of LST clients are over the age of 50 and 68% have a disability.  The overwhelming majority of clients were Black and Hispanic and were about evenly divided between Westchester and Rockland residents.  The vast majority of service units provided were direct legal advocacy.  The number of clients dropped from 48 in 2019 to 34 in 2020 (due to COVID) but continued to drop to 25 in 2019.  Programs spent less than their allocations in 2021 (programs are cost-based). 

In response to a question from Ms. Malloy, Mr. Abdelqader explained that the absence of any documented clients of trans experience could be related to data collection.

Oral Health Services (OHT)

This service provides comprehensive oral health services in the Tri-County region, including preventative, palliative, and restorative dental care, as well as procedures not covered by Medicaid or ADAP, such as prosthodontics, scaling and rot planning, periodontal maintenance, and root canal treatment.  Oral Health Services are fully integrated with the client’s primary care to ensure prompt communication to the client’s medical provider/care team. There is one contractor.  Seventy-one percent of clients are over 50, 80% people of color, and three quarters from Westchester.  The most common service units delivered were client engagement followed by preventive services.  The number of clients dipped considerably during the COVID year but started to rebound in 2021.  The program spent close to its full amount every year. 

Dr. Acosta explained that some services could be provided virtually during the pandemic, such as assessment, enabling the program to spend down their allocation.  Actual dental procedures require in person visits.

Medical Transportation (TRT)

This service provides transportation directly necessitated by an individual’s HIV status in order to engage and retain people with HIV (PWH) in treatment and care to attend medical appointments and other qualifying supportive services appointment.  Services include direct transportation via taxi, van, and ambulette vehicles through contracted transportation providers, gas/mileage and bridge/tunnel/road toll vouchers, metro cards, and bus/train vouchers.  There is one contractor.  Two thirds of clients are over 50 and over half are women.  Close to half have a disability.  Most were from Westchester, but a quarter were from Rockland.  The number of clients dipped considerably during the COVID year but started to rebound in 2021 as people returned to in person services.  The program considerably underspent in 2021.

Dr. Acosta clarified that while arranging for trips can only be made during regular business hours, trips can be done on evenings and weekends.

Early Intervention Services (EIT)

Ms. Barton presented the goals of EIT, which are to build capacity for organizations to provide HIV testing in non-clinical settings and provide HIV prevention and care navigation and linkage services for priority populations.  As payer of last resort, either the person to whom the service is provided is ineligible for coverage by other payers (e.g., does not qualify for Medicaid) or the services provided are not eligible for reimbursement by other payers (e.g., services performed off-site as applicable).  There were 195 tests conducted in 2021 (up four times from the previous, COVID affected year), with 3 positive tests, of which two were linked to treatment.  Thirty-four of those who tested negative were linked to PrEP and other prevention services.  Clients were spread out among age groups and most were men and Hispanic and Black MSM.

There is one program in this category, and the contract was executed December 2019; thus, GY2019 was only from 12/2/2019 – 2/28/2020.  During this time, the contract was in the process of hiring staff, so no services were provided in GY2019.  Due to the COVID-19 pandemic, this program was unable to implement community-based testing until August 2022.  Instead, this program has been providing services out of a local clinic 1-2 days a week.  From 2019 – 2021 the program was cost-based but has switched to a hybrid cost-based/deliverable-based payment structure for 2022.  The program underspent considerably in 2021. 

Ms. Barton, in response to questions, explained that while tests during the pandemic were performed in a clinic, payer of last resort requirements were still followed and many of the tests were done for people with no insurance (e.g., undocumented immigrants).  The program has struggled with timely data entry, which may account for the one person who tested positive that was not reported linked to care.  She also noted that the underspending in 2021 was in mostly fringe benefits and indirect costs.

Mr. Harriman clarified that there has been a disinvestment in Tri-County testing as well as NYC.  The Council’s reduction to EIS in NYC that was done several years ago used a positivity benchmark of 1% (EIT’s rate is about 1.5%).  Also, EIT is designed to reach priority populations who may not be tested in clinical settings.  Dr. Acosta noted that the program goes to needle exchange programs, jails, shelters and other areas where people at elevated risk may congregate. 

Agenda Item #5: Other Business

Ms. Contreras announced that the Putnam County Health Department is holding a migrant health clinic with free vaccines and other services for the undocumented.

The next meeting will be held on Wed., Nov. 2nd, 3-5pm with a review of Mental Health, Psychosocial Support and Food & Nutrition.  Starting in December, the Committee will return to its usual 2nd Wednesday 10am schedule.

There being no further business, the meeting was adjourned.