MN HIV Services Planning Council
Meeting Minutes for January 11, 2005
Redeemer Missionary Baptist Church

 

 

I.          Welcome and introductions; lighting of the candle

Paul called the meeting to order at 9:00 am.  Introductions were made.  Sarah R. lit the candle saying it’s very hard to stay focused on all of the things that we need to do as well as paying attention to other problems around the world – the tsunami has been on all of our minds.  There is also a tsunami of disease that affects us all and it’s easy to forget the impact it has on us all.  Not comparing suffering but allowing us to all pay the time and attention that we need to work on this problem each in our own way.

 

II.          Review the minutes and proposed agenda

The minutes were approved by unanimous consent with no changes.  There is an additional item under the Operations Committee’s action items, which is the grievance policy.

 

III.   Open Forum

Jim L. shared that while looking at the position paper he realized that he’s been working for DHS through three governors and four commissioners.  It took him a while to figure out how government works and thought it might be helpful to illustrate how decisions are made.  From his perspective those who work for the state generally need to be flexible and change gears because the new decision makers who come in with a new government administration often have differing opinions from the old decision makers.  The administration is the group that influences how the laws are implemented.  He then shared that when new legislation is introduced it’s up to constituents to contact legislators to influence their decision-making.  He’s hoping that this information will help inform the Planning Council on how the position paper could be used and that the advocacy should be focused on the legislature at this point. 

 

IV.     Co-chair update

Paul reminded the group that the Planning Council did not meet in December.  Several things have occurred since the last meeting in November.  NAPWA is going to be doing focus groups regarding reauthorization of the CARE Act. The Planning Council sponsored group will be held on January 14^th at Hennepin/Powderhorn Partners from 11:30 a.m. to 1:00 p.m.  There was a grievance presented to the Planning Council re the allocation process – it was not received in the prescribed time so it was not accepted. 

 

The Grievance process has been incorporated into the planned prioritization process.  A copy of the grievance process will be sent to all Planning Council members, providers, and community members (anyone on Mary Dwyer’s meeting posting list) about two weeks before the prioritization is held.

 

V.       Title II and ADAP update, Dave Rompa

Dave shared that DHS is finishing the Title II application, which is due on Friday.  DHS is not in a competitive process – Title II is a formula award based on HRSA’s allocation formula.  Dave gave an update on the status of the technical assistance (TA) requests.  An organizational call is scheduled on the rebate vs. direct purchase analysis.  The grantees are also drafting a joint letter of request for an ethicist who will work with DHS and the Planning Council’s ADAP ad hoc Committee.  The third request is still under negotiation – Dave and Jonathan will be meeting about this tomorrow.

 

Dave also provided and update on the grants that DHS has applied for recently – the faith-based request was denied but they did get good feedback from a couple of the reviewers who recommended that DHS forward the proposal to another funding source.  The alcoholism grant has been submitted but they haven’t heard yet.  This would be an alcoholism and HIV research project with three other programs in the area.  The integrated health grant is reposting any day.  They scored relatively high but funds ran out before DHS was funded.  DHS will be reapplying when a new pool of money is released.  The same goes for the SAMSHA grant. 

 

Within the next ten days DHS should be releasing the new meeting and training schedule for case managers.  Some of the schedule is still tentative because of issues such as Medicare Part D.  CTK, the case management software program, will be launched this month.

 

DHS continues to work with clients about cost-share payments.  Currently there are still no clients who have been terminated from the program for lack of payment and won’t be until those being consulted about the legal ramifications have made a determination.  The cost-share assistance program is up and running at MAP.  Dave added that there are also folks in the community who have been helping with cost-share payments (i.e., doctors donating speaker’s fees, pharmacies, etc.).

 

Currently Dave has no information about the current status of the state budget situation.  There is definitely an ADAP shortfall and we do know that the governor is most interested in containing health care costs and there may be a fight to keep what funding DHS has.

 

Amy then passed out the current ADAP report, which includes an analysis of the chart audit DHS conducted.  There are some limitations to the data due to the timing of the analysis.  She feels that once the program changes implemented have been in place for a year there will be better information available.  She then recapped the information from the chart audit including how many folks are enrolled in the program, needed action taken (i.e., income verified, signed application, etc.) and how many were closed due to lack of information needed for renewal.  Amy further reported that no one is being referred to the MN limited benefit (MNLB) program because the benefits are not adequate for an entire year and once the person goes onto the program it is difficult to find the individual in the system when the MNLB run out and transfer them to ADAP.  If they are lost in the system and don’t receive treatment for a period of time this can result in increased drug resistance – a major problem with HIV treatment.

 

Amy then reviewed the cost share payment information collected.  This data runs through the end of September so it covers the first four months of the program changes.  Eighty percent of clients on Program HH are under 200% above federal poverty level.  Currently 30 people have opted out of Program HH, the majority of which being folks whose coverage was too cost prohibitive based on other coverage they for which were eligible.  She further reviewed information about those who have not submitted one or more payments to the program.  As of November 31^st there are 109 clients who are subject to case closure for lack of payment (this policy is not currently being enforced).  This doesn’t include folks who’ve applied for cost share payment assistance from MAP, to date there are close to 50 people who have applied for assistance.  Amy added that the MAP program will only pay for missed payments (need to have an overdue invoice to apply) and it is not automatic that they will receive this help in an ongoing way; they must reapply each month.  The key is to get consumers to apply to MAP for the program, which has been a challenge, but they are continuing to work out the kinks.  It’s not clear if the folks missing many payments are case managed or not. 

 

Members raised concern about those who are not able to make the first cost share payment. If they can’t make that first payment, they are ineligible for aid form MAP, because they need an unpaid invoice to receive assistance.  Jonathan asked if that information can be tracked as well, Dave said they would.  Randy expressed concern about those folks who are delinquent in payments who are not being sought out – his question is why premiums aren’t paid for those folks.  Dave shared that there are challenges that individuals face but that there are also challenges faced with tracking utilization partly due to the fact that the state allows pharmacies 18 months to bill.  There has clearly been a wide range of reaction to implementation of cost share payments.  Jonathan shared that he just received an updated ADAP report that has lots of good information about the current state of ADAP programs throughout the country.  He will be sure a copy goes out to all Planning Council members. 

 

VI.     Title I update, Jonathan Hanft

Jonathan reported that the application is currently being reviewed by an external review board (not HRSA) and they will finish their process by January 15^th.  He is not hopeful that we’ll have the award by the end of the month and plans to begin executing contracts.

 

The RFP process is essentially complete and providers for the next two years have been selected.  Letters were sent to the selected providers last week.  There was one grievance filed by an agency that submitted their proposal late (the process is very similar to the Planning Council’s grievance process).  A grievance committee was put together and decided that it was not grievable.

 

Jonathan handed out the spending report for the first six months of the year and pointed out that spending is pretty much on track. 

 

BREAK

         

VII.        Committee written reports;time for questions, discussion

 

Planning and Priorities Committee

Update on Comprehensive Plan process

Bob gave the update.  The committee will begin to plan the process for the Comprehensive Plan at tomorrow’s meeting.  Anyone who is interested in participating is welcome to attend the meeting.

 

HIV Positive Committee

Update on Technical Assistance

Randy reported that Lennie will be coming back to continue working with the committee (probably in February or March).

 

Needs Assessment and Evaluation Committee

No report – the Needs Assessment and Evaluation Committee meeting was not held in December.

 

Community Participation Committee

Update on hiatus

Bob shared that he’s been on a leave of absence.  The committee will not be meeting until February.

 

Operations Committee

                            Update on recruitment needs

          LeMonte shared that the committee is currently seeking four to five new members who will begin their term in March.  He asked members to think about folks who would be good candidates and get their information to him for the Operations Committee consideration.  We are currently seeking applicants who are HIV positive (four), non-aligned (three), people of color (three) and from greater Minnesota (one or two).  Mary Doyle will forward the email again to those interested.  Debra Riley and David Bergquist’s term limits are up.  Neri Diaz has moved and Steven McIver is not seeking reappointment. Dewey Stuve is on a LOA and is requesting an extension.  Potential members will be interviewed in January and February with new terms beginning in March.  He further reported that Lee has requested a leave of absence while his work project finishes.

 

ACTION ITEMS

·        Attendance policy approval

          Members reviewed the revised attendance policy.  Randy asked if there was a limit on the number of leaves of absence granted with respect to reflectiveness.  Mary Doyle reported that the policy was developed to be flexible to the needs of people living with a chronic illness.  The LOA policy encourages retention of positive members.  There is a limit on the length of an LOA and the number of extensions on an LOA that a member can request.  MOTION:  LeMonte moved Debra seconded approval of the proposed attendance policy.  FRIENDLY AMENDMENT by Jim and accepted by LeMonte and Debra is to substitute the word criteria for other meetings attended to criterion for other meetings attended.  Passed unanimously.

 

·        Grievance process approval

Members reviewed the proposed process.  MOTION:  LeMonte moved Debra seconded approval of the change to the proposed grievance process which is to specify that at least one HIV positive Planning Council member be one of the three members elected to the Grievance committee in addition to the Planning Council co-chairs.  Jim asked for clarification of simple majority and if that’s the definition of majority.  It was determined that in this case simple and 2/3 majority are one in the same.  Passed unanimously.

 

Randy raised a question about Paul’s co-chair update with respect to the five-day time limit on grievable actions and asked if members were interested in looking at a more user-friendly timeframe in today’s world for filing a grievance.  Mary Doyle said that should be brought to the Operations Committee to decide if they want to make a change to the grievance policy, which would then have to be taken to the Executive Committee then on to the full Planning Council for a vote.  Mary Doyle suggested Randy consider what a reasonable time period would be and propose it to the Committee for consideration.  There is a new process that has been developed that will help inform the community, Planning Council members, etc. of the grievance process in advance of the next prioritization process.  A copy of the grievance policy will be distributed to all Planning Council members, service providers and those on the meeting posting mail list.

 

          Executive Committee

          There was no report from the Executive committee.  All the items the Executive Committee approved for forwarding to the Planning Council were presented by the Committee in which they originated.

 

          ADAP Ad Hoc Committee

          Sarah R. thanked those who have reviewed the position paper to date and those who have provided feedback.  The audience for this paper is intended to be a tool for many (Planning Council, other decision making groups, etc.) to use in their advocacy efforts.  Sarah R. then briefly reviewed the process used when developing the paper.  Francis, Diane Knust, Amanda Tatro and Sarah R. were the authors.  The ADAP ad hoc Committee reviewed the paper last week and changes were made within 24 hours and distributed to Planning Council members.  She has received comments and suggestions from some since that revision, but has not incorporated any of those comments into the draft, which is not to say those comments won’t be incorporated.  Dan mentioned that a two-page position paper is very difficult to achieve and Sarah R. reported that they will be pulling out key points or messages that members can use to deliver specific points when they are advocating for the Planning Council.

 

The process will be to review the paper section by section and approve each section as it’s reviewed.  Eric asked when it would be best to bring up general points about the paper. His example is that there is only one citation throughout the whole paper and feels that adding more specific references to the information would be appropriate.  Sarah R. reported that this was a conscience decision because the writing group was trying to limit the information to key themes.  Linda said it has no title and one needs to be added.  Amy added that further clarifying which division of DHS needs to be included as well.  Aaron Keith asked about incorporating recommendations from the IOM report (the report suggesting an entitlement program be established) and if the Committee had discussed that issue.  Sarah R. reported that they discussed that suggestion in great length and collectively decided it wasn’t feasible to include those recommendations – they needed to edit a lot of information to maintain a shorter page length.  She further shared that MAP is sponsoring a local forum with David Holtgrave, one of the IOM Report authors, who is also willing to meet with Planning Council members to discuss specific questions about health care funding.

 

ACTION ITEMS

·        Position paper discussion/approval

Ron mentioned that in the medical community HIV is still considered a fatal disease and he would not like to see the paper lose any emphasis by saying it is most likely fatal.

 

Discussion moved to specific sections’ recommendations.  Our Public Health Responsibility – Eric said “requires a greater level of responsibility and commitment” is too vague.  Troy added that this recommendation is not asking legislators to do anything and suggested adding it to the background section.  Linda asked if this paper should be asking for prevention money as well as ADAP funding.  Sarah R. said she will take that back to the committee – removing the recommendation from the public health responsibility as a recommendation and including it in the background section.  Eric suggested adding “since HIV can be spread it’s important to recognize that our public health responsibility be to fully fund prevention programs, including the AIDS Drug Assistance Program.”

 

Discussion moved to the ADAP section.  Troy said there are “concerns about the program structure” but it doesn’t offer what those concerns are or solutions other than to provide more money.  He thinks it makes it tough for legislatures to buy in to what the paper is saying especially where there are no specific recommendations in a time when the Governor is looking at cutting other health care programs.  Troy doesn’t understand how we’ve gotten to the deficit so he’s not certain how to formulate a better way to address that in an effective way.  Eric suggests recommending using resources of the state in order to put pressure on federal government.  Based on the paper, it appears to be a state run program that has mismanaged its funds and finds itself in trouble.  Sarah R says that because of other cuts many consumers have migrated to this program, so there is a funneling effect that creates the deficit – longer life spans, more expensive drugs, etc.  Ron says 90% of the cost is meds, can there be savings created through negotiation with drug companies and/or other channels to access meds.  Amy said a lot of the cost for meds is covered through insurance.  Amy referred back to a paper from an earlier meeting covering the path to the current budget shortfall situation. 

 

Amy reminded the group that the cuts were in Minnesota Care, not ADAP, and that we need to make sure that this is solidly factual to maintain credibility.  Jonathan recommended stating, “Where did problem come from” and then state what “will happen if resources are not provided” and finally, “what public health impact will occur.”  Also, aside from asking for more money, there may be other ways to maximize resources.  There have been other instances in other programs where the legislature has directed the commissioner to explore other methods to address the problem, which may focus efforts and uncover other approaches.  Troy – we may want to have an attachment outlining what other states are doing instead of including this information in the body of the paper.

 

Discussion moved to the 2006-2007 Program Deficit Section

Eric felt that the recommendation was vague regarding funding levels and needs to be more specific.  The projected shortfall is known.  Randy suggested adding “other state legislatures” instead of “state legislatures.”  Jonathan said 35 states contribute to ADAP.  Linda said we need to keep in mind that audience may know nothing specific about ADAP.  Eric – we need a good comparison such as for every $1.00 we spend we get $1.50 benefit.  Paul asked for specific word changes – none were forthcoming besides those discussed.  Sarah is going to find out how other Councils do position papers.  She suspects they have full-time people doing this.  She thinks that the current timeline will not allow us to produce a timely result.  Randy thought we might be able to find a lobbyist.  Troy felt that a lobbyist might be able to pick this up and help craft it into a polished product.  Sarah suggests other agencies involved in this work might be able to help.  MSD suggested we need to conserve our personal time and resources as well because we will be called upon to actively advocate in the future.  Debra knows that we need to tailor this to Minnesota, but sees most issues are global and we might be able to find another position paper and refine it to meet Minnesota specific requirements.  Sarah said that after an extensive search she could not find existing papers. 

 

Sarah recommended that we review the suggestions provided today, define a timeline, and redraft the paper.  Jonathan wanted to revisit what the intent of the paper is.  His understanding is that the purpose of the paper is to inform the audience and arm them with recommended ways to address the issues of the ADAP shortfall.  Troy recommends stating that the recommendation that the “legislature fully fund this program” be placed at the beginning of the paper.  Simplify the reasons for the shortfall, the problems, and the potential solutions.  Make one recommendation.  Randy extended his thanks to those who are doing this work.

 

·        Next steps

 

VIII.          Planning Council member’s legislative information

Mary Dwyer has list of legislature members and committee assignments for distribution.  She will email individual information to all members.  This will allow PC members to contact decision makers directly in addition to the Planning Council’s group voice. 

 

IX.            Announcements, next agenda

Announcements – many handouts.

 

MSD – requested that members fill out the survey on training (purple handout) they want for the next year.  The Operations Committee is sponsoring this survey.

 

Documents distributed at or before the meeting:

·        Agenda and minutes from November 9^th meeting

·        Attendance Policy

·        Grievance Committee structure in the by-laws

·        ADAP ad hoc Committee draft position paper

·        Title I report outline

·        Second quarter spending report

·        Written committee reports

·        DHS cost-share analysis including chart audit synopsis and payment information

·        ADAP position paper draft

·        ADAP position paper approval process

 

Adjourned by unanimous consent.

 

Adjourned at 11:52 pm