MN HIV Services Planning Council
Meeting Minutes for May 11, 2004
Redeemer Missionary Baptist Church

 

 

I.       Welcome and introductions; lighting of the candle

Sarah R. called the meeting to order at 6:00 p.m.  Debra lit the candle in memory of all those who’ve passed because of HIV/AIDS.  She was at a meeting the other day where folks were talking about Robert Preston and the contributions he has made to the community.  She lit the candle in memory of him and a reminder of the work he did. 

 

Introductions were made.

 

II.     Review the minutes and proposed agenda

The minutes were passed by unanimous consent.  Ron asked if the ADAP discussion could be moved up in the agenda to accommodate his time constraints.  It was agreed to move the ADAP update to the top of the agenda in an effort to accommodate Ron’s request.

 

III.   Co-chair update

Paul shared that there are lots of changes going on with ADAP and, at this meeting the Planning Council will hear about some of them.  The co-chairs have developed some recommendations for discussion and will present them to the Planning Council after the presentation.

 

Paul also reported that four people attended the HRSA consumer conference in Santa Fe this month.  It was training for consumers to assure that all Planning Council’s are on the same page. Allocations was one area in particular that is timely for this Planning Council. The meetings were structured to be very interactive and gave an opportunity to ask questions as well as offer information to the other EMAs.  They provided much information and there were lots of practical scenarios that were used to reinforce the information being delivered. Questions that came up will be presented to the Executive Committee for discussion and review.  Randy thanked the Council for allowing himself, LaMonte Graham, Paul Tucker and Mary Dwyer to attend.

 

Paul then announced that the Planning Council needs to say good-bye to Meg Hargreaves, the supervisor of Mary Doyle and Jonathan Hanft, who is going on to finish her Ph.D. She will continue to work for the County part time. Paul presented Meg with a certificate of appreciation.  Meg said it’s been a real honor to work with this group – she’s rarely seen such talent and commitment all in one room working on very challenging issues.

 

IV.             Health Education/Risk Reduction Services Area Provider Presentation

This presentation was audio taped for future review.

A.                Data presentation on Health Education/Risk Reduction

Aaron Keith gave an overview of the health education/risk reduction service area in the planning documents.  Judi Marshall reviewed data from the SAR and key points identified by the Needs Assessment & Evaluation Committee.

 

B.                 Provider Presentation

Cathy Vilas from Indigenous Peoples Task Force gave the presentation on behalf of all of the providers.

 

C.                 Discussion

Time was available for members’ questions but there were none.

 

V.                 ADAP changes and discussion

This presentation was audio taped for future review.

 

A.                Presentation on ADAP changes – Dave Rompa

Dave began by reporting that the legislature has not made any definitive decisions yet and will be closing the session next Monday (the 17^th).  Changes that will begin on July 1, 2004 include a residency requirement for eligibility for ADAP and other DHS programs.  Formerly residents from St. Croix and Polk Counties in Wisconsin were eligible for ADAP.  Now they will be required to apply for Wisconsin ADAP.  Eligibility will also be verified every six months, with proof of income being required for a complete application.  Other changes beginning July 1, 2004 will be a copay for drugs ($1 for generic/$3 for non-generic with a $20 limit, only for drugs on the ADAP formulary).  DHS has also negotiated to have Docs be able to write a script for a 90-day supply, with clients only having to pay the copay once for the 90-day supply.  Each pharmacy will be given an option of collecting the copay or writing it off – as long as they don’t advertise that they require no copayment (it’s very pharmacy specific).  Certain environments may continue to require a copay. 

 

Another change starting July 1^st, 2004 will be a cost-sharing premium for Program HH insurance.  Letters to consumers were mailed today. Consumers who range from 100% to 300% above the Federal Poverty Guidelines (FPG) will be subject to the cost share payment.  A formula, based on income and family size, was utilized to determine the amount of the cost share.  FPG of 100% allows income of $9,310 per year for a single individual.  For anyone who falls in the 0% to 99% FPG income range there is no cost sharing but the copay for drugs will still be in effect.  Premiums for cost sharing will need to be received before the end of the month before coverage begins (i.e., July payment needs to be in by June 30^th).  For subsequent months the payment will need to be received by the 15^th of the preceding month.  There will be no coverage for those who miss a payment for 60 days.  DHS is currently in the process of contacting any and all providers who may be working with consumers to be sure they are aware of the changes.

 

If the legislature does not fund the additional $2.1 million shortfall more reductions will have to be made.  Further changes could include waiting lists, decrease in the federal poverty guidelines to as low as 140%, ADAP formulary reductions and/or capped enrollment.

 

B.                 Questions and Discussion

Dave then fielded members’ questions.  Ron asked how payments will be billed.  Ron then asked if there was an opportunity for others, like agencies, to find other funding streams to cover the costs of DHS’ medical insurance coverage – for example it may be more economic for providers to help find other sources of funding for premiums rather than let folks lose coverage and have institutions, like HCMC, shoulder the burden of all the costs.  Sarah S. asked about late payments – Dave gave an example to illustrate how late payments could work.  They will be working to try to avoid clients falling off of the program for lack of payment.  Sample packets of information that were sent to clients are also being sent to providers, such as case managers, to be sure they are aware of the changes that their clients may be facing.  More questions were asked with respect to how premiums will be paid, what constitutes a late payment, and how wages will be verified for folks who are undocumented. 

 

Paul asked for clarification of the action going on in the legislature.  Dave recapped what he knows – it was in part to suggest that the Commissioner of Human Services approach the Planning Council to talk about how Planning Council allocations could help the shortfall situation.  Jonathan added that, in his view, the language is much stronger - if it becomes a part of a bill it directs the Commissioner to come to the Planning Council to ask them to redirect some Title I or II funds into the ADAP program. Dave responded by saying that in the current health care crisis if DHS were to call HRSA about a shortfall, HRSA would recommend that DHS come back to the Planning Council for assistance. 

 

C.                 Co-chair recommendations/discussion

Paul shared that the co-chairs have developed recommendations, for discussion by the Planning Council.  Clarification of rebate funding and its use was discussed at length.  Becky offered a suggestion that recommendation #3 be changed to the Minnesota HIV Services Planning Council is very concerned and will continue to monitor state HIV funding and health care financing policies. Debra said that the recommendations don’t represent the Planning Council’s position.  Randy added that he feels the Planning Council needs to develop one, common voice for items like lobbying to the legislature about funding.  Jonathan added that in the past forecasting hasn’t been done by DHS and he feels that it’s important to continue to do that work and help inform decision makers about other funding sources that are available to fund programs.

 

Bob Tracy said that DHS may ask the Planning Council to give something up to ensure adequate funding is available for ADAP, but PLWH/A have already given up a lot – prevention funds and other funding sources, etc.  Ryan White has been providing services, like health education, that the state hasn’t funded. 

 

Dan asked for clarification of who the audience is for these recommendations, when this is determined then the discussion of how clear the recommendations need to be could proceed.  Jonathan reminded members that Planning Council members are jointly appointed by the Commission of DHS and the Chair of the Hennepin County Board of Commissioners and that the Planning Council can ask for time with the Commissioner to help inform him of what the Planning Council’s concerns.  Sarah R. said the recommendations were put together in a short period of time but some plan needs to be finalized so the group can move forward.  Gwen asked why the Planning Council didn’t have this conversation six months ago.  After hearing the presentation twice today, she feels she has a much better understanding of the ADAP situation and, like Bob Tracy, isn’t willing to give up more.  Osmam suggested convening another meeting to continue this discussion and to develop firm recommendations. 

 

MOTION:  Lee moved Roger seconded approval of recommendation #2.  Passed with four abstentions (Graham, Riley, Stewart, and Velez). 

 

Paul asked if the co-chairs could be given permission to act on the Council’s behalf.  Becky suggested also identifying consumers who would be willing to go forward to discuss the impact of these changes with the Commissioner of DHS if necessary.  Mary Doyle asked for clarification – it was determined that the intended audience would be DHS.

 

 MOTION:  Lee moved Sarah R. seconded approval of recommendation #1.  Passed with three abstentions (Graham, Riley, and Stewart).  Mary Doyle asked if members were willing to add another meeting to the schedule to continue some of these critical discussions.  It was decided to convene a special meeting to continue this discussion.  It was agreed to hold the meeting on Tuesday, May 18^th from 9:00 a.m. to 12:00 noon.  Amy offered the Ladyslipper Room at DHS for the meeting.  Dave asked that DHS be duly noted about recommendations 1 and 2 and where they are.  Jim Lawser shared that he was quiet because members just got the recommendations today at the meeting – if they were available earlier more informed discussion could have happened.  Unfortunately they were developed after the Executive Committee meeting and weren’t ready in time.

 

BREAK

 

VI.     Consumer Forum Summary and questions

Written information regarding the consumer forums conducted over the last couple of months.  Mary Doyle reported the major themes, which included health care and ease in getting and keeping care or accessing and maintaining care.  There are both benefits and drawbacks.  Transportation was mentioned in all forums as the hardest service to access.  Housing was another area that was tough to access.  Case management was considered valuable but wasn’t always easy to access when needed.  Anecdotally, stigma in accessing services was another theme that was raised.  As an example, posting an HIV forum in a clinic might not be the best way to encourage folks to participate in that forum.  David reiterated the need for easier access to transportation throughout the state and encouraged more discussion about this issue in particular.  Mary Doyle encouraged folks to prepare data driven arguments for the allocation portion of the prioritization process.  During that time there will be opportunities for members to advocate for services and allocations, such as transportation.

 

VII.   Title II update – Dave Rompa

Dave reported that the integrated health care grant proposal was submitted.  If granted, funds will be available in September.  DHS is also waiting to hear about the ORR grant.  Amy encouraged folks to attend the upcoming ADAP forums and pass the information on to others.  She also reported that she and Michelle attended a quality management training in Washington DC this month.  Dave also reported that DHS has contacted the agencies selected from the case management RFP with a request to reduce their budgets by 6.5%.  DHS is waiting to hear back from agencies to see if they will be choosing to move forward with the reduced budget.

 

VIII.    Title III update – Linda Brandt

Linda gave the update.  The RAAN board proceeded with $100,000 in budget cuts.  Because of the cuts, and the fact that RAAN hires quality staff, Roger Ernst had to be laid off.  She then handed out information for members to review about Title III funding and let members know that she is available to answer questions.  At least 80% of Title III funding needs to fund physicians who provide primary care.  She further reported that many of their clients would suffer if their premiums can’t be paid by DHS.  Her plea was to have Planning Council members keep in mind that all persons in Minnesota need to have access to case management. All of the Titles need to work cooperatively to ensure equal service to all living with HIV/AIDS in the state.  Transportation is another huge issue that needs to be addressed – whether it’s someone to provide a ride or as a service area.

 

IX.            Committee written; reporttime for questions,

·        Planning and Priorities Committee

·        HIV Positive Committee

·        Needs Assessment and Evaluation Committee

·        Community Participation Committee

·        Operations Committee Action Item Member reimbursement caps

LeMonte reported that the Operations Committee has proposed caps to member reimbursement rates and a wage verification form to be used as documentation of lost wages.  David expressed some concerns about a member having to divulge a member’s participation in Planning Council meetings in the workplace. Dan said his department reimburses for lost wages and uses a pay stub to verify lost wages.  Debra suggested adding a bullet offering pay stub verification as an option.  Consensus is that the caps and lost wage verification, with changes noted, and was approved.

 

X.      Announcements, next agenda, meeting evaluation

Julie announced that the Task Force has been renamed to the Community Cooperative on HIV/AIDS Prevention (CCHAP).

 

Andy announced that the AIDS Walk is on Sunday.  If you haven’t already given, please do – he is accepting donations tonight.

 

Documents distributed at or before the meeting:

·        Agenda and April 13, 2004 meeting minutes

·        Health Education/Risk Reduction SAR and SAR summary

·        Service provider information regarding Health Education/Risk Reduction

·        Proposed letter to employers to support wage reimbursement

·        Proposed caps to reimbursement policy

·        Program HH payment schedule

·        Written committee reports (summaries)

 

MOTION:   Sarah S. moved David seconded adjournment of the meeting.  Passed unanimously.

 

Adjourned at 9:10 pm