MN HIV Services Planning Council
Meeting Minutes for November 9, 2004
Redeemer Missionary Baptist Church

 

 

I.       Welcome and introductions; lighting of the candle

Aaron Keith called the meeting to order at 9:05.  Introductions were made.  Andrea lit the candle sharing that she attended a historic meeting at the CDC last week.  A number of transgender folks were at the meeting to begin discussing new interventions and to begin identifying the transgender population in the epidemiology.  She also memorialized her best friend who passed away last October due to complications from HIV.

 

II.     Review the minutes and proposed agenda

The agenda was amended as follows:  the action item currently under Operations Committee will be moved to the HIV Positive Committee report. 

 

The minutes were clarified:  ORR (Office of Refuge Resettlement) and FAQ (Frequently Asked Questions) were written out.  Randy also asked that the amended minutes from the October meeting reflect the change that was made.  He asked that in the future that substantive changes made to the minutes be reflected in the next month’s minutes.  The September minutes were amended in the following way, “A group of consumers then staged a silent protest to show that they were very disappointed with the 100% cutting of food shelf funding.”  The minutes from the October meeting were approved by unanimous consent.

 

III.   Open Forum

Aaron Keith asked if there was anything anyone wanted to bring up in the Open Forum.  Randy has some concerns about this meeting space, mainly due to the lack of light in the room.  He feels that it’s important that the meeting atmosphere be more conducive for conducting meetings and suggested that the Planning Council consider looking for another location.  Roger added that the echoes created in the room often make it difficult to hear everything that’s going on.  Staff will research available options again, please contact them with any potential options.  Randy likes the Division of Indian Work and shared that HIV Positive may be changing their meeting time so there may be other options for Planning Council meeting time. 

 

Andrea reiterated the issue of including transgender issues that she shared while lighting of the candle. She encouraged folks, particularly those in state health departments, the county, and service providers to really reach out to this community because the rates in the population are very closely mirroring those in the MSM population early in the epidemic.

 

IV.     Unmet Need update - Luisa Pessoa-Brandao, MDH

Luisa passed out a table that was prepared to be included in the prevention plan regarding unmet need.  She shared that MDH receives lab data from some clinic systems on a regular basis.  The criteria defining “in care” are individuals who have had a CD4 or viral load test in the last twelve months or are on antiretroviral therapy during that same time period.  Currently HCMC, VA Hospital, and Regions do not report their lab tests to MDH.  For 2002 (reported in 2003) the “out of care” was 27%, which she feels may be a result of the Allina Clinics not reporting accurately.  The current (2003 reported in 2004) estimate of those who are out of care is 41%.  Fifty-six percent of males and 67% of females are in care.  Race/ethnicity is more difficult to figure out – MDH is not confident that the care systems are determining that information in a manner consistent with the how the information in the surveillance system is determined.  The information on mode of transmission is also somewhat inconsistently reported. 

 

HARS is the surveillance systems (HIV/AIDS Reporting System) that captures individual lab information.  Andrea asked for clarification of how race is determined and also where transgender individuals were tracked.  Luisa said MDH uses the CDC’s form, which does not track transgender folks separately.  With respect to tracking race Luisa shared that providers fill out those forms and often identify race for the client rather than asking that person how they identify.  This may be creating an inconsistency in how the reporting is done.  This issue may get better because the surveillance system now allows for reporting multiple races but that has just begun recently.  Eric asked what the barrier is in terms of HCMC, VA, and Regions reporting lab tests to MDH.  Luisa said they are not required to report this information but that MDH is hoping to work with them to figure out a way to get that information.  Another challenge is when people move between care systems and MDH’s ability to track those folks.

 

 The out of care information is a requirement for Title I and Title II applications as well as other information that is included in the epi profile.  Jonathan provided additional background on HRSA’s requirement for identifying those who are out of care.  Last year Title I had to demonstrate how they would calculate the number who are out of care.  In 2001 (reported 2002) Becky and Juan conducted a study to help identify those who are out of care, which has helped facilitate the way these numbers are collected.  Within that study, Becky and Juan were also able to talk to folks about some of the reasons that they don’t seek care.  Many feel that if they don’t feel sick they don’t need to be in care.  Randy asked if there is a “standard percentage” of those that would be expected to be in care knowing that not everyone will ever be in care.  Luisa suggested looking at those who have progressed farther into the disease to try to educate that particular group more about the merits of getting into care.  Jonathan suggested 25% with AIDS are not in care.  Megan said – efforts to get more into care would like to see the trend go down rather than go up.  Are these numbers the baseline?  The original study identified about 38% who were out of care.  Megan suggested that the Planning Council look at the factors surrounding the data to help inform them why the trend is moving this way.  Luisa pointed out that changes in coverage and the economy might lead to fewer people being able to be in care.  Becky clarified that there may be info in the needs assessment that this group has not heard.  She also added that the study also addressed those who have lapsed care.  It was also found consistently in the needs assessment that many individuals state that they have a doctor and can call that person when they need to but don’t necessarily go in to see them routinely.  Amy reiterated that a lot of the whys are in the data that’s available.  She added that the quality management advisory committee has been working with Title I to develop indicators, such as if referrals are made and/or followed up on, that might illustrate how current services are playing a role in getting people into care and keeping them in care. 

 

Eric asked where Minnesota ranks in comparison to other states in this area.  Luisa said other states might have rates as high as 60% out of care.  Forty percent seems to be an average number from what she remembers having seen. Eric added that he learned at the training he attended that we (MN) are ahead of the curve in a lot of ways.  Luisa added that there is room for improvement – for example, getting HCMC to report lab results alone would be helpful. 

 

V.       Co-chair update

          Update on meeting with the Assistant Commissioners at DHS

Aaron Keith gave an update on the meeting with the assistant commissioners at DHS (Loren Colman and Brian Osberg).  The group gave the commissioners an update of what the Planning Council has done with respect to allocations that support ADAP.  They stressed the importance of maintaining ADAP and why it was important for the state to support this program.  The Commissioners shared that they are interested in hearing from the Planning Council but the state has authority over the ADAP program.  A current, informal forecast shows a $4.2 million shortfall for 2006-2007 (July 1 is the beginning of the state’s fiscal year).  DHS is interested in seeing the position paper being developed by the ADAP Ad Hoc committee and also provided some ideas for Planning Council advocacy for the position the Planning Council decides to take.  DHS may not agree with the Planning Council’s position at all times, but the Commissioners asked the group to keep in mind that both groups have the same goals; sometimes their perspective may differ.  A Planning Council member also shared his personal perspective in dealing with the ADAP changes and cost sharing.

 

Becky asked if the results of the election have changed the focus that the ADAP subcommittee has with respect to the roles legislators might play in Planning Council advocacy.  Mary Doyle responded that the first step would be to get the money for the shortfall into the Governor’s budget.  The next step is having the Planning Council agree on what it will advocate for at the legislative level.  Mary Doyle reported that the position paper should be distributed to the review committee on December 7^th and on to the Planning Council in the January meeting.  Megan suggested that it might be helpful to meet with new legislators before the session begins and their schedules get busier.  Dan agreed that it would be useful to have champions for this issue while moving forward.  Eric said it would be important to circulate the position paper to all of the legislators. Jonathan added that MAP’s Public Policy Committee has ADAP at the top of its agenda and have folks on that committee who are very connected to the legislature.  They will be meeting again today at 3:00 at MAP.  Dave added that the position paper will help communicate the Planning Council’s intent and suggested that it is important to begin courting those legislators earlier than waiting until the session begins.  Redwan and Dave will distribute information about an upcoming conference at which Linda Berglin will be a keynote speaker, suggesting that it may be a good time to catch her ear.  Amy added that at the last ADAP training folks there brainstormed ideas of others in the community with which the Planning Council could work.

 

Aaron Keith said that nominations for the Grievance Committee should be made and approved in the meeting today.  The composition of the Grievance Committee is the two Planning Council co-chairs and three other members who are nominated by the full Planning Council.  If a grievance is presented to the Planning Council a sixth person with knowledge of the subject who is a current Planning Council member and co-chair of a standing committee will be selected by the other members to finalize that committee.  Randy expressed concern about the by-laws, which does not address consumer involvement on this committee.  Eric suggested amending the by-laws by saying that of the six people one of them should be a consumer.  Aaron Keith said we can certainly consider that but today’s goal is to nominate the three standing members of the Committee.  Andrea added that when the by-laws are amended, the consumer should be a Planning Council member.  Gary suggested soliciting consumer members who would be willing to fill that role.  Francis, Randy, Megan, Andrea, LeMonte, and Bob were nominated.  Votes were tallied – Bob, Andrea, and Megan will serve on the Grievance Committee.

 

VI.     Title I update - Jonathan Hanft

Jonathan reported that the 2005 Title I application is going out to HRSA today.  Copies will be available for those who would like one.  All of the letters of intent for the RFP were due a week ago, full proposals are due on the 19^th (next Friday).  The review committees will meet the second week on December and all providers should be selected and announced by January 10^th. 

 

Jonathan then stated that $14,175 couldn’t be spent in the health education service area.  He would like to suggest a reallocation of this funding to nutrition (food shelf and congregate meals).  Jonathan shared that the service system lost a health education provider last year which resulted in the under spending of funds.  The nutrition service area is being fully utilized and can utilize more funding. 

 

MOTION:  Randy moved Lois seconded reallocating $14,175 from health education to nutritional services.  The motion passed unanimously.

 

Jonathan added that Michelle is no longer on the Title I grantee staff; she has accepted a position in the Hennepin County Public Defender’s Office.

 

VII.   Title II and ADAP update - Dave Rompa

DHS did not get the integrated health care grant but it is reopening January 3^rd (due March 17^th).  DHS scored 85, which is normally very good, but it was so competitive that they didn’t get selected.  They are going to tweak the application based on feedback they got and will resubmit it.  The faith based grant information has not come in yet so they don’t know the status of that application.  They are working on another proposal for alcoholism and HIV, which would be a research project to look at what kinds of chemical health treatment would be more effective in reaching those with HIV/AIDS.  Direct service will not be provided under this grant.

 

 The Title II application guidance has not been received yet so it’s holding up progress on the application.  The application is currently due January 3^rd.  Redwan’s role is shifting a bit because of not getting the ORR grant.  He is currently involved with finding ADAP clients that can’t be located, assisting with activities of the formulary committee, and preparing to cover for Amy while she’s on maternity leave. 

 

The Access to Care Project is progressing.  The management team is meeting on November 19^th and will generate recommendations.

 

The ADAP Ad hoc Committee will review the ADAP data report from DHS at it’s next meeting.  With respect to the 2006/07 forecast for ADAP Dave added it’s very important to remember that the Medicare Part D is not included as a component of the forecast. 

 

With the election results last week DHS is not anticipating a windfall in funding from the federal government.  He added that as HRSA is requiring Title I and II to meet unmet need and funding is not increasing it’s difficult to try to meet current needs.  The Planning Council and the community need to continue to challenge HRSA and the CDC to look realistically at expectations vs. capacity. 

 

Two TA requests have been made by Title II – one for an ethicist to assist the formulary committee and one for an independent consultant to analyze whether Minnesota should be a rebate or direct purchase state.  Amy will forward a recent email regarding the rebate issue to staff for distribution to the full Planning Council.

 

VIII.HRSA planning process, questions and discussion

Aaron Keith presented a PowerPoint presentation shared by Lennie Green who is providing technical assistance to the HIV Positive Committee.  The presentation illustrates an overview of the Planning Council’s process.  This presentation is an attempt to show how each phase of the Planning Council’s work feeds into subsequent phases of work.  It also helps demonstrate the impact of information contained in the Comprehensive Plan and how that aids in decision-making.  Mary Doyle and Amy provided additional background of the procurement, measuring/evaluation, and outcomes portions of the process. 

 

Randy gave a bit more background from the discussion in the HIV+ Committee.  One area he pointed out was the need for information about other services (both HIV and non-HIV specific) that are available to serve the needs of those living with HIV/AIDS.  Eric shared that the Planning Council is hoping to have information from the Care Systems Assessment part of the CSAD Project to help provide information on those services.  Megan added that this was discussed in the early planning phases of the prioritization process but it feel off the radar and asked whose radar it should be on.

Mary Doyle reported that they may be, in part, the role of the group working on the Comprehensive Plan, the Planning and Priorities Committee has also been very interested in having that information available and has been discussing how it could be collected; barriers to this include time and data availability.  Sarah S. added that the Needs Assessment and Evaluation Committee has also discussed needing additional information on provider capacity, and how SARs may be modified to be more useful.  Becky added that she’s never seen a resource inventory come up before and added that the two statewide planning groups also have grappled with this issue and began to do some of the work.  Amy said a starting point could be to identify the services provided then contacting First Call for Help for a listing of other providers of those services.

 

 Roger expressed some concern about the close co-administration of Title I and II.  Title II funds are intended to be used for statewide services but when speaking to Title I and Title II providers they often can’t identify which Title is the source of the funding.  Amy will raise this concern at the next all vendor meeting and added that a vendor manual was developed to help clarify those funding questions.  Roger added that he doesn’t know if metro based agencies extend themselves to the outer boundaries of the EMA, which is part of the issue.  Amy and staff provided more information relating to the composition of the EMA and how it relates to metro vs. suburban vs. rural considerations.  Mary Doyle added that there have been many questions about service needs, etc. in the whole state, especially in regard to the epi increase in the suburban areas.  The Needs Assessment and Evaluation Committee has asked that the in-depth analysis of the needs assessment be geographical.

 

IX.     Committee written reports;time for questions, discussion  

·        Planning and Priorities Committee –refer to written report

·        HIV Positive Committee

ACTION ITEM

·        Incentive plan approval

Randy gave a brief history of the incentive plan being proposed by the HIV Positive Committee.  MOTION:  Francis moved Sarah S. seconded approval of the proposed incentive plan, as written, for consumer members.  Passed unanimously.

Update on Technical Assistance

Lois and Randy gave an update of the technical assistance conducted at last month’s HIV Positive Committee meeting and shared that a report is available for review.  A follow call is scheduled for Monday, November 15^th.  Lennie is a very dynamic person and Randy encouraged anyone interested to attend the next meeting that he is here for.

·        Needs Assessment and Evaluation Committee – refer to written repot

·        Community Participation Committee – refer to written report

·        Operations Committee – refer to written report

·        ADAP Ad Hoc Committee

·        Position paper discussion schedule

Francis reported that the position paper is being worked on committee members have split up sections of the paper to work on individually.  The ADAP committee is requesting two representatives from each committee to review and give feedback on the paper.  Preliminary discussion will happen at the December 13^th ADAP meeting.  The final paper will be presented to the Planning Council at it’s January meeting.  The intent is to prepare the paper for wider distribution after approval by the Planning Council.  Troy asked if there was coordination with MAP on the positions being presented with the goal being to prevent developing competing ideas.  Sarah R. and Francis have been in contact with folks at MAP in an effort to coordinate those efforts.  Eric shared that he’d like the Planning Council to have a draft of the paper in advance of it being distributed to others, including collaborating partners.  Amy added that a report from the chart audit and cost share update is being prepared for a December 22^nd meeting and will be presented to the Planning Council in January

·        Executive Committee

Eric shared that a component of the grant application that Jonathan referred to is an evaluation of the grantee.  A subcommittee of the Needs Assessment Committee identified questions to be asked of the grantee and providers for the grantee evaluation.  The Executive Committee has also reviewed the feedback and is sharing that information with the whole Planning Council. 

 

X.                Announcements, next agenda      

Amy encouraged everyone to pick up cards for DHS’ website, which has DHS meetings and trainings listed on it.  If there are other topics that folks are interested in adding please contact Amy to let her know.

 

Documents distributed at or before the meeting:

·        Agenda and minutes from October 12^th meeting

·        Table 11: Out of Care Study Results from the 2003-2005 Prevention Plan

·        Statewide Coordinated Statement of Need 2001

·        Statewide Coordinated Statement of Need Progress Report 2002

·        Proposed HIV Positive Committee Incentive Plan

·        ADAP ad hoc Committee workplan

·        Evaluation of Grantee October 2005

·        Planning Council Responsibilities and Grantee Duties from Title I Planning Council Primer

·        Planning Council vision, values, goals and objectives

·        Grievance Committee roles (from by-laws dated 9/23/03)

·        Technical assistance report from Lennie Green

·        Written committee reports

 

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

 

Adjourned at 12:00 pm