MN HIV Services Planning Council
Meeting Minutes for May 14, 2002
Division of Indian Work

 

Council Members Present:

Council Members Absent:

David Bergquist

Don Anderson

Linda Brandt

Michael Allen Beyer excused

Sheila Brunelle

Frank Guzman

Clarence Charles

Michelle Sims excused

Megan Ellingson

 

Randy Hornstine

 

Efren Tovar Leon

 

Judi Marshall (Co-chair)

 

Mary May

 

Nick Metcalf

 

Steve Moore

 

Jerry Moss (Co-chair)

 

Tim O’Brien - via phone

 

Bob Olander

 

Helen Doris Reed - via phone

 

Roxanne Robinson

 

Dave Rompa

 

Sarah Rybicki

 

Sarah Senseman

 

Debra Smith

 

Paul Tucker

 

John Whalen

 

Norman Wylie

 

 

 

Guests:

 

Ron Barnes – Urban League

Debra Ehret - MDH

Aaron Keith Stewart – Urban League

Jim Huber – DHS

Julia Hidalgo – George Washington University

Darlene Thomas-Fly - DHS

 

 

IGA Present:

 

Julie Hanson – MDH

Tracy Sides - MDH

Eduardo Parra - Hennepin County

Jeff Buckles - DHS

Meg Hargreaves - Hennepin County

Jennifer Thompson - Hennepin County

 

 

 

Staff:

Consultants:

Mary Doyle

Juan Jackson – CLEAR

Wardell Thompson

Becky Kroll – CLEAR

Mary Dwyer (minutes)

 

 

I.          Welcome and introductions; lighting of the candle

Jerry Moss called the meeting at 9:10 a.m.  Paul Tucker lit the candle with a reminder of why we are all here.  Introductions were made.

 

II.          Review of the minutes and proposed agenda

MOTION: The minutes and agenda were approved.

 

III.         Co-chair update, norms for meeting

Judi provided the co-chair update.  She began by reminding members of the conflict resolution process that the Planning Council is undergoing.  The norms for meetings from the retreat were passed out for members to review.  Discussion of specific norms followed and members added several new norms.  A one-page sheet on Robert’s Rules of Order was also passed out as a refresher on motions.  A more extensive training on Robert’s Rules of Order will be conducted in the fall. 

 

IV.             Report from the Linkage & Statewide plan working groups

Debra Ehret from MDH presented a report on both the statewide and linkage working groups.  She began by handing out information from the statewide plan working group.  The advisory group is updating the PC on information that came out of the statewide working group retreat.  They are considering several models for planning, one regional planning model would be comprised of the eight already existing community health services (CHS) areas, the second of the proposed models contains regional hubs, the third model is focused on providing technical assistance, the forth proposes a joint RFP process for both prevention and care, the fifth model is based on using agencies that are already providing services and helping them link together to improve service delivery.  Debra said the next step is another meeting of the core group on June 5th.  Then there will then be another retreat in late June to refine the models and come up with more refined recommendations.   Next, Debra will travel around the state to get feedback from members in outstate Minnesota.  The hope is to come back to both the Planning Council and Task Force with recommendations from the group. 

 

The linkage group is comprised of 25 members.  Co-chairs are Kevin Sitter, Nick Metcalf and Julie Hanson.  They have begun by discussing counseling, testing and referral.  They are looking at better ways to link prevention and services in these areas.  They began by looking at the systems in place and tried to evaluate how well they’re working now.  Debra reminded the PC that the current HRSA reauthorization allows CARE Act money to be used for counseling, testing and referral for high-risk populations.  The goal is to increase access to care.  They are also interested in expanding the relationships between systems of care and points of entry.  Debra conducted an informal telephone survey with 35 points of entry including: emergency rooms, federally qualified health centers, STD clinics/CBO’s, state/county correctional facilities, school based clinics, detox/methadone programs, juvenile corrections/detention, homeless shelters, mental health crisis centers, teen clinics, chemical dependency treatment facilities and college health services.  The linkage group will be recommending that the Planning Council consider prioritizing and funding for testing through points of entry and building capacity of providers to link services to points of entry.  Tim recommended no Planning Council funding of testing without result counseling as a component.  MOTION:  Efren moved referring this discussion to the Planning & Priorities committee to consider and then bring a recommendation back to the full Planning Council for a vote.  Clarence seconded.  Efren also mentioned carryover funding as a potential funding source for counseling, testing and referral.  Judi shared that the Planning & Priorities committee will be discussing a plan for carryover funding when the grantee presents it in June, but if this service was prioritized it would an ongoing service activity, not carryover, (short–term, one time) funding.  Bob Olander asked to amend the motion to say that any discussion in Planning & Priorities make sure that other agencies required to control communicable diseases be held accountable before additional Planning Council funds are prioritized to do so.  Bob then withdrew his amendment.  Motion passed unanimously.

 

V.                 Consumer Satisfaction Survey report

Juan will pass out copies of the report at the break.  Members were asked to put the data into their Prioritization notebooks.  This discussion will be deferred until the next PC meeting.

 

VI.             Epi update

Tracy presented her Epi update that was made available on MDH’s website in April.  Her presentation focuses on new infections, new patterns of infection and prevalence (those who are living with HIV/AIDS).  Tracy provided a brief background of the areas of interest to Planning Council members regarding those who will need services.  In Minnesota, HIV became a name-based infection in 1985.  Currently 33 states have the same degree of reporting.  Currently we use both active and passive forms of data collection.  They also try to interview all new cases.  Steve asked about the possibility of duplication.  Tracy stated that because we are a name-based testing state there is little risk of duplication. Tracy then provided some information on those living with HIV/AIDS throughout the nation.  Because of new therapies available AIDS diagnoses and deaths have gone down but the number of those living with HIV/AIDS continues to increase.  Tracy then moved her presentation to cases of individuals living in Minnesota.  As of December 31, 2001 there are 4,331 persons that are assumed alive and living with HIV/AIDS in Minnesota.  Currently, approximately 3,800 people living with HIV/AIDS reside in the metro area (Anoka, Washington, Ramsey, Dakota, Scott, Carver and Hennepin – which has the largest population of those living with HIV/AIDS).  Minneapolis currently has 49% of those living with HIV/AIDS, 30% are in suburban areas and greater Minnesota has 11% of those affected.  The majority of those currently living with HIV/AIDS are white males.  Currently our younger population has smaller numbers than those over 25.  Tracy cautioned that the younger groups are more likely to be underestimated and the younger the person is at the time of infection the more likely they are to spread the infection.  Approximately 56% of those living with HIV/AIDS in Minnesota are MSM.  Tracy is seeing an emerging trend of those living with HIV/AIDS in the foreign born population (primarily African countries).  To summarize the data: we have had just under 300 new HIV diagnoses each year for the past five years, mortality continues to remain low, men account for approximately 80%, 90% of live cases in the seven county metro area and the population of those living with HIV/AIDS in the metro area is becoming more diverse.  This is an important because language and cultural differences may present barriers to prevention and care.

 

VII.        Title I update

Jennifer gave her last Title I update. They mailed out copies of the grant application evaluation to all members.  Please let Jennifer or Eduardo know if you did not receive a copy.  We will also be discussing the Planning Council’s budget at the next Executive Committee meeting.  Areas that are increasing are Council member reimbursement, technology costs and some one-time expenses that were incurred that were a little higher than anticipated.  It is time for the Planning Council to evaluate the Grantee.  Our Title I project officer, Francis Hodge, will be attending the June Planning Council and HIV Positive Committee meetings.  The rest of the day has been set aside to allow Frances time to meet with Planning Council members. The grantee also conducted a vendor fair to do training and discuss new contract requirements.  Jennifer hopes that this will lead to doing more vendor fairs because this was a successful event.  There will not be a final spending report today because there are still outstanding invoices.  Jennifer estimates that there may be $250,000 (approximately 5%) in Title I and Title II that may be unspent for this year.  The goal is to limit carryover to no more than 5%-10% each year.

 

VIII.    Title II update

There is little to report – a full report will be presented at next month’s meeting.

 

IX.            Task Force Report

Julie Hanson provided the update.  The Task Force is meeting on Friday.  Becky Kroll is developing a plan for new member training that will be presented.  Also, the linkage group has been working with the Continuum of Care and has added some pieces that relate to prevention.  The Task Force will be reviewing the revised document at that meeting and will bring the results back to the full Planning Council.

 

X.                MHSPC Staff updates

Our next meeting will be at DHS in Roseville and will have an extra hour attached to it.  Maps are available.  Becky Kroll, Juan Jackson, Tracy Sides and Meg Hargreaves will do data analysis training.  Lunch will be served and DHS staff will provide breakfast.  Mary Doyle and Mary Dwyer will be available to drive those interested to the meeting.

 

All members received their notebooks with prioritization documentation.  We will be adding data when possible over the next couple of months.  Mary Doyle also reminded people that we still need Conflict of Interest forms filled out by everyone before prioritization.

 

The Operations Committee has discussed having the prioritization meeting on August 6th (as opposed to August 13th – which is the regularly scheduled date).  Julie Hanson stated that would conflict with Task Force.  It was decided to keep the August meeting as it stands on the 13th.  Mary Doyle also discussed canceling some August committee meetings – the individual committees will make that decision.

 

XI.            Uncompensated Care final report

Jennifer introduced Julia Hidalgo, from George Washington University, who has been working on the uncompensated care report.  A two-page summary of the study methods, findings and recommendations was handed out.  Julia works with a group that does CARE Act policy and assessment.  She is a former Planning Council member in the Maryland/Washington D.C. and has worked with Title II and Title IV, as well as many other areas related to HIV/AIDS.  Julia then shared some background on the report she is preparing.  They have been working with Hennepin County, MDH and DHS to get information to help better understand the system of care in Minnesota and related policy areas.  They were looking specifically at medically related services that are not funded in any way – services that are not reimbursable under any system.  Services that are not fully covered are considered to be a short fall as opposed to uncompensated.  Key findings that were found are: Minnesota has one of the highest rates of insurance coverage of any State in the Country.  HIV providers, however, do not get any operational funding to support their services from insurance.  Often HIV related medical appointments are much longer than the norm, 5 to 15 minutes, and carriers do not take this into consideration when reimbursing for these visits.  These clinics rely on other institutional funding sources.  Because the institutions are under financial stress, administrative positions have been lost; pharmacists, dieticians and other professionals have been moved out of HIV clinics to profitable areas and most, if not all, service providers are losing money.  Standards of care that have been established for patients with HIV/AIDS include several areas that are not currently funded.  Many clinicians have reported doing much of their work on their own time (i.e., phone calls with other doctors, etc.).  Minnesota has been very good about providing insurance coverage for many people, the problem here is that many HIV/AIDS related services are still not covered.  Julia also shared problems such as the six-month waiting period for pre-existing conditions, which is problematic because that is a period of time where other funding services need to kick in.  For Title I in Minnesota is 45th out of 51 for the proportion of money allocated to primary care.  For Title II we are rated 45 out of 45 for primary care (i.e., insurance premiums). 

 

Another area of observation is that we have a small number of folks affected relative to the number of organizations that are available to provide services.  The weight of this system is going to get heavier and heavier.  Many service providers that her group looked at are not managed very efficiently and Julia’s group has made recommendations for improvements to those services.  Julia’s thought is not to shut them down, based on the Epi data Tracy shared, because those who are not in service but should be will fill the capacity of providers who currently have “empty seats”.  Julia also mentioned that there are areas that can be funded in other ways, rather than CARE Act money.  Specifically Julia mentioned that many states have Case Management that is covered under Medicare, which is something we currently don’t have.  She suggested that a change in that system here could open up more funding sources for other agencies here.

 

Recommendations that they’ve developed include tightening up finances, maximizing existing HIV clinical capacity by increasing outreach to those newly infected and not in care – this would require more collaboration between providers.  As for insurance, strategies need to be developed with insurance carriers to begin recognizing the need for increased reimbursement.

 

XII.          Committee reports – in the interest of time committee reports were not presented.  There were no action items to be discussed.

 

XIII.   Announcements, next agenda

Judi said a few words to express our thanks to Jennifer for all of her hard work.  This will be her last meeting and we will miss her greatly.

 

Linda announced that RAAN is accepting donations for a fundraiser garage sale that they are holding it on June 1st.

 

Debra passed out a flyer for the Everyday People’s Health Fair.  Please ask her for more if you need them.

 

Adjourned at 12:15 p.m.