MN HIV Services Planning Council
Meeting Minutes for October 12, 2004
Redeemer Missionary Baptist Church

 

 

I.                  Welcome and introductions; lighting of the candle

Paul called the meeting to order at 9:05.  Introductions were made.  Aaron Keith lit the candle in memory of James Bailey, a former Planning Council member, who passed away on Sunday.  James was a great friend and mentor of Aaron Keith’s and will be sorely missed.

 

II.          Review the minutes and proposed agenda

The amended minutes from the September meeting were approved by unanimous consent.

 

III.   Open Forum

Paul shared that since we’re now through the prioritization process Planning Council meetings will now return to their former format and an open forum will be included in each meeting.  There is no one present today to speak during the forum.

 

IV.             Co-chair update

There is some unfinished business from the last meeting – two co-chairs who were not at the September meeting were recognized (Sarah Senseman and Randy Hornstine).

 

          Brief prioritization debrief

Paul shared that the Planning Council has just finished the very difficult processes of prioritization and allocation.  He thanked members for the difficult work that they did during the process.  He then asked members to check in on their thoughts about the process.  Feedback from this meeting and the committees will be used to construct a draft for the next process.

 

Randy said he’s had time to think about the process and has done it before so he has a basis for comparison.  The prioritization process was much improved but he was disappointed in the allocations day process.  The amount of time spent prioritizing compared to the amount of time determining allocations was not balanced. 

 

Bob shared that being on P&P was a long process and he was amazed at how well it came out until it was done.  He was at Camp Benedict for the allocation meeting and was a bit disappointed about some of the decisions made.

 

Lee said that he was astounded by the amount of information and time that folks spent on the process.  He wonders if the allocations step – the prioritization process might have been the right place to stop – letting the allocations be driven from that.  He understands that people feel better about the process this year.  For the next time around, he would consider stopping after prioritization and also figuring out how to streamline it more to reduce the information load. 

 

Dan said it’s an enormous amount of information but was very impressed with the amount of information and genuine attempt to present the content from various stakeholders, consumers, etc.  He suggested using a peer review method that’s been used with another group he works with thinking it might create a more inclusive process.  He was impressed with the energy of staff and this group characterizing it as participant democracy in action. 

 

Jim said he preferred the written information better than the presentations by providers.  He also felt that they weren’t really clear on the original allocations process and hopes that next time that will be clearer to everyone.  He liked the forced choice form as well.

 

Francis wasn’t at the prioritization meeting because he wasn’t a member yet.  He was discouraged from going to the all day allocation meeting but wishes he would have taken it upon himself to show up at that meeting because he feels he would have learned a lot.

 

Roger shared that he still feels like a relative newcomer.  He appreciated the information that was provided to be well informed but also said it was too much to digest.  With respect to the provider presentations he fells we could give the groups a bit a more guidance for preparing them.  He shared that we try to be impartial with respect to agencies but the reality is that it’s the agencies that get the work done.  He wrestled with having outside the facilitators run the allocation meetings but couldn’t imagine a Council member running that meeting.

 

Steven shared that he enjoyed the forced choice model for decision-making.  He didn’t find the provider presentations very useful but thought they might be helpful for some members to hear.

 

Sarah S. liked the forced choice system – it really did reflect the decisions she would have made.  She added that the allocations process should have been longer and felt that an additional meeting the next morning would have been helpful for everyone to have a chance to digest the decisions made.  She still isn’t sure how she likes the lumping of service areas and activities and would like the group to look at prioritizing all services areas and activities together.

 

Ron was impressed with how civil the process was because of the limited amount of funding available.  There was lots of information to make decisions for prioritization but felt there was a lack of information for making allocation decisions so there was more guessing involved which brought emotions into the decision-making. 

 

Jonathan said the Planning Council was very responsive to incorporating new process; committed to making best decisions; would have been helpful to have another half day – very rushed at the end and didn’t support the process well; an improvement over previous years.

 

Sarah R. would echo many of the things that were said.  She’s not certain what the changes to provider presentations would be but thinks there could be a more level playing field.  She also agreed with Sarah S.’s comments about needing more time to process and reflect on the allocations process but for sure making it a longer meeting.  She also said that the Planning & Priorities Committee did a fabulous job, taking feedback from the previous prioritization and making productive changes.  She also thinks everyone got a raw deal, but we knew there would be cuts and it was regretful that the Council had to allocate when resources are very low.

 

Andrea didn’t have a lot to provide because she was on a leave of absence during the process.  What she does think about the process from the early stages that it was an amazing process that was laid out with much work by all members.  She appreciated having the opportunity to hear the provider presentations.  They helped give her a broader respect for the work they are doing – hearing what they’re doing takes on a different level of understanding about how services are provided.  Early on in the process it was very evident that some groups were better prepared than others.

 

Mary Doyle shared that Planning & Priorities is carefully looking at the input from the council and the committees to draft plan for the next prioritization and allocation process.  She felt very impressed with the careful, thought out work that P & P brought to this prioritization and allocation.  Hopefully the next will also be a great leap forward in terms of member satisfaction.

 

Aaron Keith said it was like giving birth, the work done in committee and to have the process used was very exciting.  He wasn’t able to be at the allocation day meeting so can’t speak to that.  The committee did lots of work and he was glad to be involved.

 

Amy said DHS appreciates the thoughtfulness that the Planning Council put in to making decisions for Title II.  She also appreciates the paradigm shift that everyone had to deal with, having done it in the last year.  She suggested – good job of setting up how data should be used but then somehow it falls short when putting it in to practice.

 

Linda shared that this was a vast improvement from the last process.  The RAAN Board discussed the value of – more visionary about the big map or picture but not on the driving process of the detail.  If we had a core services deal much of the work to be done would be reduced.  She added that the provider presentations were modeled after Houston forums that are conducted – where providers have the ability to come together to discuss.  The forums have shaped too much of the community forums and the Council needs to get outside of the circle more and hear form those that aren’t funded by Ryan White. 

 

Becky commended the group for spending time reflecting on the process.  In the daylong session there was no discussion about money until after lunch so she feels that the day could be collapsed in a different way that wouldn’t take additional hours of meeting. 

 

Julie echoed many of the same views.  One idea that came up with respect to the provider presentations is to have the grantees present on services with providers filling in information about emerging need and other trends they’ve seen.  Allocations daytime needs to be adjusted.  P&P spent a lot of time developing the budget criteria prior to the allocation meeting but then strayed away from them without discussing it.

 

Paul further reported that there was one challenge made to the vote.  A small group of people met to review the tape from the allocation day, the minutes and notes that were taken that day.  The group felt that the process for that vote was consistent with the process used for the other votes taken that day.

 

V.                 Title I update, Jonathan Hanft

Jonathan reported that carryover has been released so contracts will be going out soon.  EFA, EHA, med adherence, home health care and capacity development will be given carryover funding to use by either February 28^th or March 31^st 2005 depending on whether they received Title I or Title II funding.

 

The Title I team is working on the application that is due on November 10^th.  It’s challenging because the application is limited to 80 pages total.  Over the last couple of years there have been lots of changes made.  This year HRSA is continuing it’s push to get folks into care and has developed six core areas (primary care, medications, oral health, mental health, CD treatment, and case management).  Covering these core areas in the application can be challenging because some areas have consistently not needed additional Ryan White funding in the EMA because other funding sources have been available.

 

The request for proposal (RFP) cycle has begun.  Most services are being RFP’d but there are a few for which single source contracts will be awarded.  They have sent RFP’s out to service providers, including the MDH list and the DHS list.  There will be technical assistance sessions available for providers who would like additional information.  They are also requiring that agencies that are applying for funds submit a letter of intent, which is due on October 28^th.  Proposals are due on November 19^th and award announcements are expected on January 1, 2005.

 

Jonathan further reported that they are piloting a joint project with MDH for the outreach service area to help link prevention and care.  Providers will have one contract that covers both prevention and care outreach.

 

Jonathan then updated members on the County’s reorganization process.  Title I is now part of the Human Services Department in the public health protection division.  As part of the reorganization contract managers all got shifted around.  There is a programmatic contract manager (EP) and a contract analyst.  The contract division has gone through a process for determining how the County should administer contracts.  There will be changes to that system but most of them will have the largest impact on contracts that are funded with county dollars.  Contracting may also move to a two-year cycle as opposed to a three-year cycle to be more in line with the Planning Council’s prioritization.

 

Jonathan then said that they would like to request a reallocation of $11,900 from primary care to EFA and EHA.  Primary care is being under spent and both EFA and EHA are in need of additional funding.  MOTION: Lee moved Roger seconded approval of the reallocation of $11,900 from Primary Care to EFA and EHA.  The motion passed.

 

VI.     Title II and ADAP update, Amy Moser

Amy said that DHS did not receive any of the three grants applied for but scored very high.  The $20M in additional funding for ADAP was taken from one of the proposal funding sources.  The Office of Refugee Resettlement (ORR) proposal was to try to provide additional care for African refugees for people from three African countries.

 

The DHS staff is currently researching a project to look at how organizations currently and in the future could provide HIV services for African immigrant populations through religious organizations.

 

What does the ADAP budget look like?   See Handouts.  The new forecast will be coming out at the end of this month.

 

Linda Atlas will become the third DHS eligibility specialist.  Redwan will be more visible in communities to try to pick up some of the visibility Linda had in the community. 

 

Mental Health (MH) service areas changes in access – the Planning Council has heard several previous discussions about the plans for both Title I and II to move funds to a centralized fund available to practitioners who currently can charge Medicare for the provision of mental health services. Certain providers from this pool, who express interest in working with PLWH/A, would receive extra training and be eligible to charge the fund for their services.  This would create more access to MH services around the state and more choice on the part of service users. They are on track for starting this in February-March 2005.

 

Event announcement: Training for PC regarding ADAP; next training coming up October 28 from 1:00 to 3:00 at HPP.

 

No one has been discontinued for not paying cost-share.  Review is at Attorney General’s office prior to implementing any actions.  Frequently Asked Questions (FAQ) brochure has been made and printed, it is going out with all applications.

 

Budget report: Amy walked the Council through the ADAP budgets for 2000 to 2004.  She handed out summary document to bring all separate elements together.  Also included 2000 data per request to budget data previously given.  Amy reviewed rebate spending year by year.  In 2002 rebates monies were spent more often for projects.  In 2003 the legislature forced DHS to use rebate account monies, resulting in overspending and reducing the reserve; the same occurred in 2004.  2004 was also the first year that ADAP monies came from rebates. 75% of rebate account was spent by the end of FY04.

 

Amy reviewed HIV/AIDS Division staff as there have been many questions about the structure.

 

Slides are included in the handout of the last ADAP training.  Includes an overview of Title II, the consortia, ADAP in MN, state insurance appropriation, who is enrolled, background of changes and actions taken.

 

Last page is Ryan White CARE Act Key for Titles I and II to show where to find key areas of those titles.  Amy answered a question about HIV drugs by that state insurance appropriation cannot be used to purchase drugs; only federal finds can be used.  NASTAD helps negotiate reimbursement programs with drug companies.  Dave Rompa wrote the cover memo.  States who buy drugs directly get discount off the top instead of rebate.  MN is not eligible for federal wait list funds.

 

VII.   Staff update

Mary updated the members on flu shots and encouraged those with compromised immune systems to get flu shots as there will be a general lack of prevention for others with flu this year.

 

CSAD – Joan will call members for interviews in the near future.

 

GHAT met about the Statewide Plan.  Mary Dwyer has been meeting people in various regions of the state and shortly will begin the planning process.  Mary Dwyer updated members about Statewide Plan.  There are four regions outside the EMA: NW, SW, NE, and SE regions.  It is unsure in which region Stearns and Benton counties will be located at this point.  Mary looked at the current CHS divisions and used it as a basis for planning.  She considered service delivery systems as well. 

 

VIII.          Access to Care study update, Katherine Cairns - Summit Health Group

Katherine introduced member to this project, which is sponsored by MN DHS.  Covers four service areas: case management, care advocacy, information & referral, and outreach.  Brought together team knowledgeable about DHS funding, primary care,

 

Project is aimed at improving the case management delivery system.  Katherine shared the questions used to elicit input, covered the decision elements for the redesign project, and issues to consider in selecting a model for access.

 

One issue is the lack of a statewide definition for levels of care.  Currently this varies with providers.  Some states have more precise definitions and base compensation on level of care. 

 

Another issue is the role of case management.  Is it integrated?  Does it include Care Advocacy?  Roles and standards of case management will need to be updated in MN.  Issues based on geographic availability are a concern of medical providers.  Quality assurance and evaluation needs to be tied to provision of services.  Connection to health care providers was another major concern among health care providers.

 

Katherine then reviewed issues slide.  There are questions regarding the information in the first bullet regarding numbers of people in case management versus HIV +.  Jonathan pointed out that he believes this is closer to 1 in 5 for case management.  The issue of a person to person match between MDH data and DHS services lists came up and is known to be problematic because of the decision not to use by name reporting at MDH, which does not allow matching of individuals.

Sarah had a question related to intensity of services: how do we know that case management addresses possible underlying issues such as mental health, housing, etc.?  Katherine said that her charge was to consider case management, but that there were certainly other issues that are interrelated to case management.

 

Katherine handed out an Access to Care Redesign questionnaire and asked members to complete it in order to gather more input for the study.

 

Katherine covered geographic availability slide and then asked members to review the questionnaire handout.  Bob pointed out that there are existing county mechanisms for service provision – perhaps using these systems for data collection makes sense.  Linda pointed out that this was considered five years ago and that this would require keeping 87 counties up to date and it is unlikely that social services is ready to take that on. 

 

Sarah R began to discuss the issue of access versus availability and how much are we willing to pay for.  She used the example of limb reattachment to illustrate how someone outside the metro are would be helicoptered in for specialized care.  There are several models that can be used to address this including telemedicine. 

                  

IX.          Committee written reports;time for questions, discussion

·        Planning and Priorities Committee

·        HIV Positive Committee

Technical assistance process beginning

Andy gave an update on HIV+ TA and introduced Lenny Green to the members.  HIV+ committee will meet at 1pm at Aliveness Project and all members are invited to attend.

·        Needs Assessment and Evaluation Committee

·        Community Participation Committee

·        Operations Committee

·        ADAP Ad Hoc Committee 

                                                                                     

X.                Announcements, next agenda

Sarah R updated member regarding the meeting with the commissioner regarding ADAP.  A delegation will meet with Asst. Comm. Loren Colman to follow up on earlier meeting in July to cover ADAP shortages and shortfall.  Issues of transparency, importance of not interrupting treatment for PLWH/A, and looking at other state resources to support/fund ADAP.  If members have inputs or are interested in this issue please contact ADAP committee members.  The meeting is scheduled on Thursday, Oct 21 from 1-2pm.

 

Announcements

- Friday 15^th is Latino HIV awareness day.  An event is on at the El Colegio at 6pm. Some students will present their projects related to HIV in the community.

 

Julie – MDH is getting ready to publish HIV prevention plan.  If you want receive a copy please sign up on the sheet provided.

 

Aaron Keith – looking at having James Bailey’s memorial services at the Basilica on Saturday.  Aaron Keith will ask Mary to email members once service time is finalized.

 

Aaron Keith will no longer be working at Urban League after Friday.  He will be at University of MN working on a CDC grant project called Community Promise and adapting it to the target population.

 

Documents distributed at or before the meeting:

·        Agenda and minutes from September 14^th meeting

·        Title I Update

·        DHS HIV/AIDS Division budgets for Title II, ADAP, rebate and state insurance allocations

·        HIV/AIDS Access to Care Redesign Project: Systems Assessment PowerPoint update and opportunities update

·        Written committee reports

 

MOTION:   Meeting adjourned by unanimous consent.

Adjourned at 11:45 am