MN HIV Services Planning Council
Meeting Minutes for June 14, 2005
Redeemer Missionary Baptist Church

 

 

I.          Welcome and introductions; lighting of the candle

Aaron Keith called the meeting to order at 9:00.  Troy lit the candle saying that this epidemic gives us all a chance to look at our health and access to health care and consider those who work internationally to improve health care.  He expressed thanks to all who are underpaid and under appreciated working in public health around the world.

 

Introductions were made.

 

II.          Review the minutes and proposed agenda

The minutes from the May meeting were approved by unanimous consent.  The proposed agenda stands as written.

 

III.   Open Forum

Jim reminded everyone of the Red Ribbon Ride.  Those who are participating are doing a great service to all, it’s a huge amount of effort and he encouraged all to support the riders and the agencies involved.

 

He also shared that he’s on several listservs that provide much information – if you’re not on those listservs and would like to get the information he can provide information or is willing to send the mailings out to folks directly.  His goal is to provide any kind of assistance to get the information out there.  Jonathan said if it were appropriate for providers he’d like to get copies and will then send the information to providers.

 

Randy shared that Ken Eppich passed away on May 19^th – he loved the community and served it well.  He was a Planning Council member for years and was acting President of the Aliveness Project Board.  Eduardo also shared some of his memories and things he learned from all of the hard work that Ken did over the years.

         

IV.     Co-chair updates

Aaron Keith shared that there was quite a lively discussion in the Planning and Priorities committee meeting about the carryover proposal that will be discussed today.  He encouraged anyone with questions about any of the items to please ask.

 

V.                 Grantee evaluation overview

Mary Doyle shared that one of the main responsibilities of the Planning Council is to assess the administrative mechanism, part of which is the grantee evaluation.  She briefly reviewed other Planning Council responsibilities including: setting up Planning Council operations, conducting a needs assessment, developing the comprehensive plan, setting priorities, allocating funds to priorities, coordinating with other services and Titles (Statewide Coordinated Statement of Need - SCSN), and assessing the efficiency of the administrative mechanism. 

 

The Needs Assessment Committee selected five questions that will be asked of the grantees.  Planning Council members will then be asked to review the measurable objectives for each question and, finally, the grantee responses and decide if the work goal for each question was met or unmet.  Space will be available for comments on each question.  This information will be submitted with the application this fall.  Members were given copies of the questions that will be asked, which Mary Doyle also reviewed.  One question identified that will be primarily for discussion only is:  Are HIV/AIDS medical and support services are reaching the communities intended (underserved and uninsured) by the Ryan White CARE Act?  Members were asked to draft an informal response to this question, which will then be discussed at the July Planning Council meeting.  This question will elicit feedback from members about an important aspect of the Planning Council’s work that has not been discussed as a stand-alone issue. 

 

The questions will be responded to by the grantees.  They will then be sent out to all Planning Council members one week prior to the July meeting.  Columns will be included for members to respond to as to whether or not the objective was met and space to provide additional comments.  Jonathan provided additional information about what the grantees will be including in their response (i.e., what percentage of contracts were awarded within 30 days, etc.).

 

Randy asked if there would be any information coming from providers to help inform Planning Council members in providing their responses.  Mary Doyle shared that we do have the capability to do that.  Jonathan said it might be helpful to survey providers at the end of each funding cycle (the cycle is every two years now), which would be next year.  The grantees did do a contract management survey of providers in which they asked if payments have been received on time, etc. that could be shared with members.

 

VI.     Title I update - Jonathan Hanft

Jonathan gave the update beginning with a spending report from the last fiscal year.  Usually two Planning Council meetings after the end of the quarter a spending report will be given to members.  Currently there is $309,416 (or 8%) in unspent Title I funds that will be requested for carryover.  All Title II funds were spent for last year.  Dental and nutritional services (nutritional supplements) information was not included on this spending report.  This is due in part to not having complete information from DHS about the Title II spending – the Title II year ends a month after the Title I year.

 

Jonathan then reported on the status of technical assistance (TA).  The first part of the TA was health care financing presented by Dan Schriener and a report was submitted so this piece is complete.  Angela Wassuna also came to give TA around ethical decision-making.  She has submitted a report, which is available.  One piece of work that was left undone when Angela was here was to apply the ethical principles that she shared on recent Planning Council decision-making.  Jonathan has submitted a request to complete that part of the TA.  Currently the contract HRSA has with the TA provider, BETAH, is ending

 

The third part of the TA was to look at all of the publicly funded programs in Minnesota to see if there is a way to provide medication and insurance through other sources.  That request has been approved and a list of consultants has been provided.  Jonathan and Dave will be meeting to select that consultant later this week.

 

Jonathan then provided a brief training update.  The next series is based on the capacity building needs assessment done with providers and will focus on human resources.  The next two sessions will focus on cross-cultural communication and effective evaluation.  The series will be on August 4^th (at Tubman Alliance) and 25^th (at Children’s Home Society) and all Planning Council members are welcome to attend these trainings.

 

VII.   Title II and ADAP update – Redwan Hamza

Redwan shared that if the legislature does not agree on budget issues all state operations will shut down on July 1^st.  It is unclear what will happen with current contracts but contingency plans are being developed and the HIV/AIDS staff will let us know as soon as they do. 

 

DHS has applied for grant funding with Blue Cross/Blue Shield to work with new communities.  They were not invited to submit a proposal.  The HCAP grant was submitted yesterday – to provide services for uninsured and underinsured folks in collaboration with clinic based providers.

 

With respect to Medicare Part D, a proposal was submitted to DHS to provide wrap around services for those on Medicare Part D.  If that proposal is approved rebate funding will be able to be used to pay the doughnut hole.  Currently they have identified 173 clients who will be impacted by these changes.  The details are currently being worked out and they will be able to report in more detail at the July meeting (pending a state shutdown).

 

Training for Medicare Part D will be conducted tomorrow, Wednesday, June 15^th in the Roseville office from 9 am to 12 noon.  Everyone is welcome to attend.

 

The Planning Council will be considering using carryover funds to partially fund a benefits counselor position focusing on Medicare Part D that will be housed at DHS.  DHS is considering using state funds to partially fund that position and a decision should be made soon.

 

This year is a reauthorization year for the CARE Act.  Proposals have been sent to HRSA by many national organizations (NASTAD, NAPWA, and CAEAR).  Redwan is pulling them together and will send them to Mary Doyle for distribution.  DHS has internally supported the current NASTAD proposal.  Jonathan asked if he could summarize the data so folks can see the similarities, etc.

 

There are new brochures (available online) because DHS will be moving at the end of September and they are not doing any new printing.

 

BREAK

                            

VIII.Epi update - Luisa Pessoa-Brandão – MDH

Luisa began her presentation by describing the surveillance system in Minnesota.  The information she is presenting is compiled from the two reports that are on MDH’s website.  The current overall rate of AIDS in the United States is 15 per 100,000.  Minnesota’s current rate of incidence is 3.6 cases of AIDS per 100,000 people (not all states report HIV, which is why AIDS rates are used).  As of December 31, 2004 there are 5,002 people in Minnesota who are assumed alive and living with HIV/AIDS.  This year Minnesota participated in a study with the CDC to reduce duplication of counts (details of this piece of data are included in the technical notes section of the report on MDH’s website).  Because of this the total number of those living with AIDS doesn’t appear as large as may have been anticipated given the number of new cases.  In 2004 there were 307 new cases of HIV reported, 37% (115) were AIDS at first diagnosis.  Folks who are foreign born continue to have higher rates of AIDS at first diagnosis than the general population. 

 

The largest increase in diagnosis remains in Minneapolis.  Rates in the suburbs continue to increase as well.  Currently there are only ten counties (out of 87) in the state that have not reported any cases.  There was a greater increase in rates in females than in males, with women of color still having a large disparity compared to white women, but men are still experiencing higher rates of infection.  Fortunately rates among those 19 and under are still relatively low. 

 

Eighty-seven percent of cases live in the seven county metro area.  Minneapolis accounts for about 40% of new infections.  Currently 50% of all living cases are white men.  Women of color currently account for 70% of all cases among women. 

 

Currently, in terms of age, there is still low incidence in younger populations.  It is unclear if this is due to lack of testing because there are consistently higher rates in other STDs.  Information about mode of exposure is estimated because of the uncertainty of mode of transmission, especially within the African born population.  Information about how the estimates were arrived at is included in the technical notes on the reports contained on the website.  Perinatal transmission rates remain low; unfortunately those numbers are increasing in foreign-born populations.  Among foreign-born folks 52% are AIDS at first report (for Hispanic males it’s closer to 60%) and overall (removing foreign born) rates of AIDS at first diagnosis are about 37%.  This presents challenges for folks having treatment options and getting prevention messages in the early states of the disease.  New infections counted in MN are those who have first tested in Minnesota.  In terms of mortality our numbers are low.  Deaths listed include death by any cause, not necessarily caused by HIV/AIDS.

 

Members then asked questions.  Randy was curious how many of those living with HIV/AIDS are living at 300% of federal poverty guidelines or below.  There is some information through utilization data – 3383 are currently receiving services but all of these folks may not be in the surveillance system.  Luisa did an estimate in 2002 based on information from census data in the past, but that too has its limits.  Luther asked if there is demographic information about those who are not currently in care.  Luisa shared that an estimate was done last year, which was about 40% but there is not specific information about their demographics.

 

IX.           CCCHAP Update - Julie Hanson Peréz - MDH

Julie gave a report on the Community Cooperative Council on HIV/AIDS Prevention (CCCHAP) that is the sister planning group to the Planning Council.  The CCCHAP recently did their prioritization, which is looking at populations that are most at risk.  They then look at co-factors for each population (i.e., homelessness, survival sex, etc.).  When soliciting proposals each agency will have to address the population they will focus on, as well as, the co-factors to be addressed.  Julie then passed out results of the prioritization for members to review.  The CCCHAP did their prioritization by identifying four main groups:  HIV positive persons, MSM, high-risk heterosexuals, and injecting drug users.  The CDC requires that HIV positive persons be included and ranked as the number one population.  The CCCHAP then prioritized specific populations within each of those subgroups.  The CCCHAP does not allocate funding but does make recommendations to MDH about how funds will be allocated.  The total amount of funding available will be approximately $1.6 million.  Allocation figures are based on 2004 epi data available and funding principles were developed.  It was decided to fund the populations that were rated highest and to fund more comprehensive programs. 

 

Julie also shared that anyone interested in participating in the CCCHAP should contact her for an application.

 

X.          Committee written reports;time for questions, discussion

   A.   Planning and Priorities Committee

·        Comprehensive Plan update

Bob shared that the Comprehensive Plan is progressing.  A work group was formed in March and a retreat was held.  A list of critical issues was identified and they were broken down to two main areas at last week’s meeting.  The main categories are those who are in care and what their needs are and those who are out of care.  There will be a major presentation at next month’s Planning Council meeting.

ACTION ITEM

·        Carryover Approval

Bob further reported that there is currently a proposal for Title I carryover funding.  Jonathan prepared a proposal that was revised slightly by the committee then forwarded to the Executive Committee.  It was intended to have a vote on the approved proposal but there have been some changes in the last couple of days.  Changes include removing the additional allocation to quality management for changing the bubble sheets, it was decided to not make those changes this year; the request may come forward again in the future.  Bob and Dan are recommending moving that amount ($4,500) to home delivered meals. 

 

Debra raised questions about allocations to capacity building – it was previously under spent so why have additional allocation.  Also, conferences were funded, to provide provider training/technical assistance – are those funds adequate to cover a conference type of setting?  Francis shared that similar concerns were raised in the Executive Committee meeting.  Jonathan provided clarification to the rationale used in those decisions.  One idea for conferences is to do smaller, more targeted events or, if a larger conference is organized, adding a provider track that could be funded with some of the provider training allocation.  Randy asked how Planning & Priorities determined that an allocation would be made to a conference type of setting and wondered if there is a specific target group that will be focused on.  His thought is that there are other services that could use that additional funding as opposed to funding a conference.  Randy provided information on what the typical Heroes Conferences have included for those who haven’t attended.  Debra shared that as one of the planners of the Community Advisory Board (CAB) forums, one of the only groups doing community education, has heard feedback from folks that opportunities for further education are welcome.  Troy asked how a conference fits in to the priorities that have previously prioritized by the Planning Council.  In the past conferences have only been funded with carryover funding and it was prioritized higher than some of the other areas funded.  Jonathan shared that one thing discussed when he met with Dave to develop this proposal was that a large majority of those surveyed through the Needs Assessment identified a lack of knowledge of services.  It further added that this is short term funding and there are other specific criteria that carryover needs to adhere to.  Bob reiterated that during prioritization and allocation conferences were specifically not funded with the thought that any carryover funds would be allocated to a conference.  Randy reiterated his concern about seeing many of the same folks at the conferences – he’d like to see an event that reaches those who haven’t attended something like that in the past.

 

Dan suggested changing the wording around conferences to:  money would be dedicated to provide a one-day Heroes style retreat or smaller, targeted events that would be aimed to specific groups.  Troy requested that carryover criteria be added to the carryover proposal.

 

MOTION:  Dan moved Bob seconded that this recommended budget, with the clarification of conferences added and removal of quality management budget be included.  Passed unanimously.

 

Aaron Keith took a moment to recognize Becky’s contribution with the work done on the Needs Assessment, which helps inform these decisions.

 

    B.          HIV Positive Committee

·        Name change

Randy announced that the committee is now officially the Community Voice Committee.

 

·        Regular meeting time, date, location change

The committee has changed its meeting location to Tubman Alliance on the first Tuesday of the month from 10 am to 12 noon.

 

·        Ongoing Technical Assistance, date, time, location

Lennie Green will be returning on Wednesday, June 29^th to finish the technical assistance work begun.  The retreat will be all day at Tubman Alliance.

 

C.          Needs Assessment and Evaluation Committee

·        Process for Evaluation of the Grantee Mechanism

Gary shared that Becky is also this committee’s backbone.  The transportation SAR was reviewed.  The draft of a new combined outcomes form has been developed and was reviewed by the committee.  It will be piloted this year and further reviewed.  The grantee evaluation was discussed as shared previously today in Mary Doyle and Jonathan’s presentation.

 

D.          Community Participation Committee             

     E.     Operations Committee

                            ACTION ITEM

·        Special election

Francis shared that he has been attending Operations Committee meetings and is taking over for LeMonte today.  Operations discussed options for adding new members in a special election to replace members who have had to leave their term early.  The three members being forwarded have been interviewed and attended orientation.  The normal election cycle is every six months because of the orientation schedule; these three candidates have been forwarded for approval because they attended the last new member orientation.  All three candidates have also been participating on a committee level in the last few months.  All three members were voted in unanimously.

 

     F.     ADAP Ad Hoc Committee

          ACTION ITEM

·        Request for permanent committee status

Francis shared that the committee convened to discuss if, now that the committee has completed its workplan, its work should continue on access to treatment issues.  The committee sees a further need to continue meeting to discuss upcoming issues and is requesting a change in their status to be a permanent committee.  Jim Knappe-Langworthy was elected as co-chair at the last meeting.  The committee is also proposing changing the name to the Treatment Access Committee, which would more accurately reflect the work of the committee.  Paul expressed some concerns about the current structure of committees and the distribution of Planning Council members among all of the committees.  Dan suggested that the work of the committee may fit well into the role of the Planning & Priorities Committee and tasks could be taken on once the Comprehensive Plan is done which might alleviate the burden of an extra meeting.  Francis said that the committee has been able to maintain quorum at every meeting, which has been a challenge for other committees at times.  The committee would be meeting monthly.  Randy suggested reducing the schedule to once every two months.  Mary Doyle added that many of the members of the committee are community members.  Debra asked if the committee has talked about how the fire will keep going if there aren’t critical issues to address into the future.  Mary Doyle further clarified that the committee identified other issues like changes to Minnesota health care programs and Medicare Part D that were considered when making this recommendation.  Megan further suggested that Treatment Access meet every two months at the same meeting time as Planning & Priorities with the idea being that it could be a joint meeting.  She added that it would be beneficial for Planning & Priorities to have this information woven into their agenda, which hasn’t happened in the past.  Dan reiterated those points and added the burden that this committee addition would put on staff.  Gary suggested a standing ad hoc committee that might deal with the issue du jour that would be open to whatever the topic may be at that time.  Jonathan said that’s always a possibility so it wouldn’t necessarily be a change if issues came up.  Debra added that the Planning Council has been batting around the issue of getting involved in advocacy issues for at least the last four years and suggested that this committee could be the policy/advocacy driving force of the Planning Council.  Mary Doyle shared that an advocacy process has been initiated through the Operations Committee, which provides the vehicle for potential advocacy issues.  Debra suggested that the committees look at that particular issue because there have been challenges getting that work done.  Francis suggested taking this issue off the table and taking it back to the committee for discussion at the meeting it has scheduled for tomorrow.  Jonathan suggested referring this discussion back to the Operations Committee for further discussion since a change would require amending the by-laws and they are currently reviewing the advocacy process.  The committee charge in the new committees is the Executive Committee. 

 

MOTION:  Francis moved Jim seconded sending this discussion back to the Executive Committee for further discussion.  Passed unanimously.

 

XI.          Member reimbursement update - Mary Dwyer, PC staff

Mary Dwyer reminded members of the member reimbursement available.  Members can submit reimbursement requests for mileage or other transportation to meetings, childcare, lost wages up to $75 per day, and lodging if coming from greater Minnesota.  We now also have bus tokens and taxi vouchers available at meetings.  Reimbursement is also available for community members.  Expenses must be submitted monthly and all requests need to be received by the end of the fiscal year for Title II, which is March 31^st.  Reimbursement forms are available at all meetings and electronically from Mary Dwyer.

 

XII.          Announcements and next agenda

Francis shared, in light of no evaluation, that it’s important to schedule committee items at the beginning of the meeting; members may be leaving early and will not participate.  It was agreed that all action items will be moved on the agenda to just after the co-chair report.

 

Documents distributed at or before the meeting:

·        Agenda and minutes from May 10^th meeting

·        Written committee reports

·        Planning & Priorities action item – carryover funding

·        Operations action item – special election

·        ADAP ad hoc action item – change in by-laws

·        Final Ethics Executive Summary

·        Planning & Priorities recommendations for carryover

·        2004 final spending report

·        Excerpts from Ryan White CARE Act Title I Manual re: assessment of the administrative mechanism

·        Grantee evaluation questions

·        Overview of the Evaluation of the Grantee Mechanism PowerPoint

·        Special election ballot

·        Title I update outline

·        CCCHAP Target Population prioritization results

·        MDH Epi update PowerPoint presentation

 

Meeting adjourned at 12:00 p.m.