MN HIV Services Planning Council
Meeting Minutes for August 9, 2005
Redeemer Missionary Baptist Church

Council Members Present:	Council Members Absent:
Gilbert Achay	Osmam Ahmed – excused
Dan Capouch	Andy Ansell – excused
John Cyzon	Lois Crenshaw – LOA
Megan Ellingson	Bob Hansen – excused
LeMonte Graham	Binta Johnson – unexcused
Dean Halland	Patrick Kramme – excused
Randy Hornstine	Lee Lewis – excused
Andrea Jenkins	Francis Mark – unexcused
Jim Lawser	Gary Novotny – excused
Troy Mangan	Susanne Pfeil – excused
Antonio Marante	Ron Schut – excused
Eric Meininger
Sarah Senseman
Aaron Keith Stewart (co-chair)
Paul Eknes-Tucker (co-chair)
Gwendolyn Velez
Willie Wesley
Consultant:	Becky Kroll – CLEAR
Guests:
Kathleen Clarke Anderson – Congressman Sabo’s office
Tracy Sides – MDH	Girard Griggs - MDH
Debra Riley
G-HAT:
Jonathan Hanft – Hennepin County	Diane Knust - Hennepin County
Julie Hanson Pérez – MDH	Dave Rompa - DHS
Redwan Hamza – DHS	Eduardo Parra - Hennepin County
Staff:
Mary Doyle	Mary Dwyer

I. Welcome and introductions; lighting of the candle

Aaron Keith called the meeting to order at 9:00. Eric lit the candle sharing that his focus of work is with adolescents and he shared Ryan White’s story, which was sent with the meeting materials to all Planning Council members. His hope is that everyone will remember Ryan’s story as they serve on the Planning Council.

II. Review the minutes and proposed agenda

The minutes were approved by unanimous consent with no changes. The agenda stands as proposed.

III. Open Forum

Diane asked for a moment to speak. She lit another candle today because yesterday they received news that one of the wonderful leaders in HIV/AIDS who worked at MATEC in Chicago killed herself over the weekend. This disease not only impacts the people living with the disease but also those who are committed to the work. She then shared some of her thoughts and experiences working with this amazing woman. She asked folks to support Sarah Rybicki during this trying time and encouraged folks to call her if they can. She also spoke about depression – estimates are that 50 to 75% of people living with HIV deal with depression. It’s a cavernous and very deep issue that takes a severe toll on people dealing with it. She asked members to consider that issue in future decision-making.

IV. Co-chair updates

Aaron Keith shared that on July 25^th and 26^th Joan Othieno presented the findings of the CSAD project. It was a very informative session. For those who weren’t there recommendations were developed for work with the African born community. Joan will be at the September Planning Council meeting to present the information as well.

Paul shared that last month members heard about the memorandum of understanding (MOU) being developed with the County. He said one of the biggest impacts the MOU would have on the Planning Council would be the change in supervision for Planning Council staff – Planning Council staff would report to the Grantee. He has some concerns about that. Currently there have been no decisions made and the Executive Committee is continuing to review the documents.

V. Committee written reports; time for questions, discussion

A. Planning and Priorities Committee

ACTION ITEM

· Comprehensive Plan goals, objectives and activities approval

Dan shared that the Comprehensive Plan is a big part of the work of the Planning Council. The intent is to retain the current system of care and ensure that people get into medical care and stay in care. He thanked those who showed up at the Comp Plan committee meetings to participate in the process. He also thanked Kathi Cairns, the consultant, for all of her hard work. The final plan will be presented to the Planning Council in the November Planning Council meeting. The current plan is for Jan. 2006 to Dec. 2008 – three years. Today members will be reviewing the goals and objectives that were developed by the work group.

Dan reviewed the PowerPoint presentation as well as a document that contains all of the goals, objectives, and activities identified by the Committee. He then reviewed specific guidelines that HRSA requires in the Comprehensive Plan. The Plan must ensure the availability and adequacy of core services in the EMA and state. Those core services are: medical care, medications, mental health treatment, substance abuse treatment, oral health, and case management. He reviewed the mission, vision, and values that the group agreed to before they began their work. He then reviewed goal one developed for the plan, which is to increase the percentage of those who are receiving HIV medical care among Minnesotans living with HIV/AIDS. He then reviewed specific objectives developed to accomplish goal one as well as activities identified for how to achieve the objectives.

Discussion moved to goal two, which is to keep PLWH/A adherent to HIV medical care and treatment by sustaining and improving a successful, cost-effective system of care. Dan again reviewed the objectives and activities identified to accomplish this goal. Dan shared the problem statements that have been written for the goals before reviewing the next steps.

The next steps are for the Planning Council to discuss and vote to approve the goals, objectives, and activities proposed. Two consumer forums will be held to hear comments from the community on the goals developed. The Executive Committee will then review any proposed changes and have input on the final product. The completed Plan will then be presented to the Planning Council at the November meeting for final approval. The Plan needs to be submitted by both Titles by January 2006.

Members then asked questions. Randy raised an issue about the use of socio-economic issues in the mission statement. He feels the statement is strong but would like the statement to reflect the part of the community that the CARE Act serves. Jonathan suggested including an overarching statement about eligibility somewhere in the Plan to address this concern. In that same vain, Paul expressed a concern about referring to those who are out of care who may not be eligible for services because of economic reasons. It is challenging to identify those who are out of care and if they would be eligible for Ryan White services (i.e., someone may learn their status but make too much money to be eligible). Eric asked what the Title II Plan would include. Mary Doyle shared that once the Plan is written it will be sent to DHS for review. In the past changes were made to make the Plan inclusive of the whole state and an additional goal was added. Eric also asked about unit cost and was interested in having more information about that. Jonathan said the grantee would be presenting information about unit cost at the October meeting – those costs are still being developed. Dan shared that this Plan seems to be very responsive to the changing environment of the CARE Act. That wasn’t intentional when the process began. Julie asked clarification questions about activities related specifically to work with MDH. The first was working with Partner Notification Services to see if there’s a way for that staff to do follow up referral with newly diagnosed folks. Her other question relates to coordinating with MDH’s counseling, testing and referral program and how that might be accomplished. Julie and Mary Doyle will discuss those activities in more depth to make sure that they are acceptable to MDH. Jonathan reiterated that this is a draft and some wordsmithing still needs to be done.

MOTION: Dan moved Randy seconded approval of the proposed goals, objectives, and activities developed for the Comprehensive Plan. The motion passed unanimously.

B. Community Voice Committee

· Technical Assistance reminder and invitation

Randy shared that the technical assistance follow up with Lennie Green will be on August 30^th at Tubman. This will be an all day session and all members of the Planning Council who are positive are invited to attend.

C. Needs Assessment and Evaluation Committee

Eric shared that they continue to work on various points of the Needs Assessment and outcomes that are being streamlined. He also shared that there was a joint meeting of the co-chairs of Planning & Priorities and Needs Assessment to discuss the future Needs Assessment and outcomes collection and dissemination to the Planning Council.

D. Community Participation Committee – no report

E. Operations Committee

ACTION ITEM

· Election of new members, Planning Council co-chairs and reappointment of four members

LeMonte handed out the ballot for new membership along with information about the proposed candidate. Ballots for reappointment were then handed out. Four members are currently up for reappointment – Dan Capouch, Jim Lawser, Gary Novotny, and Willie Wesley. Ballots for Planning Council co-chairs were also handed out. Debra Riley assisted with ballot tabulation.

Rae Eden Frank was appointed as a new member and all four members were reappointed. Aaron Keith and Andy were voted in as Planning Council co-chairs for September 2005 to September 2006.

· Planning Council member competencies survey

Jonathan gave a bit of background to this survey. The Operations Committee is working to enhance training for Planning Council members. A survey was developed using the Planning Council competencies identified by HRSA that members were asked to fill out. Randy suggested that it might be helpful to know how long members have been involved in the Planning Council to help evaluate the results received. It was agreed to have members put the length of their current service on the form. Members were asked to include that information. The survey will be sent to all members who are not here today.

F. ADAP Ad Hoc Committee

Mary Doyle shared that the ADAP Committee met one last time to develop their roles and responsibilities that could be passed to other committees. The Executive Committee wasn’t able to fully review the recommendations and will continue that discussion at the August meeting.

BREAK

VI. Title II and ADAP update - Dave Rompa

Dave shared that they are now beginning to impose the closure policy regarding cost share for premiums on Program HH. In the first phase of closures 17 people will be impacted. They have already found that people are responding to make sure their cost shares are covered. DHS, in conjunction with MAP and Title I has taken steps to assure that those with cost shares going back to last year will be able to access six months of assistance for the last grant year and six for this grant year, which means that clients will be able to get assistance for twelve months. Case managers have also been contacted with a list of their clients who are in jeopardy of losing their coverage. All of these clients will have to make a case for good cause (a payment system) then arrangements for amounts still unpaid can be made. Unpaid files for the drug program will close on August 31 and those for insurance will close on September 30. At another meeting, Jonathan raised a question about those who may have been employed during a portion of the time – Dave said those clients would be adjusted appropriately. The next phase are those who are 60 to 120 days past due and the third phase will be those who are more recently delinquent. Dave was resistant to estimating the number of folks who would be impacted during phase two and three because those numbers can change dramatically until all the details are known. He estimated 150 clients total, right now, could be impacted through all three phases.

Medicare Part D – a bulletin developed by DHS was sent out to all case managers, physicians, Pharm Ds, etc. It explained that enrollment in and Medicare Part D enforcement has to go through the Healthcare Division at DHS. Subsidy rules, etc. are still being determined and will be released when the information is complete. Currently there are approximately 152 individuals in the state that may be impacted by Medicare Part D. He further shared a story of a Planning Council member who had some problems getting on Medical Assistance for Employed persons Partially Disabled (MAEPD) program. That information gave DHS an opportunity to further explore the situation. They found that Hennepin County was enforcing the rules too rigidly and they’ve since been able to get that person on MAEPD.

With respect to reauthorization Redwan collected a lot of documents illustrating the positions of various national advocacy groups in response to the Administration’s position on reauthorization of the CARE Act. These were forwarded to Planning Council members. President Bush’s proposal would have a significant impact on Title II funding because the base award could potentially be reduced by 60% after reauthorization. Dave mentioned that here are sign on letters being generated by the State of California, which have been agreed upon by all states similarly impacted. Currently there is no time frame indicated for potential changes. Paul is forwarding efforts to work with our Governor on this effort.

The Integrated Health Care (HCAP) Grant is currently being reviewed by HRSA. DHS should know by early September if DHS is selected to receive that grant.

The Formulary Committee is in the process of reviewing the proposed waitlist criteria. There is a community forum scheduled for August 17^th, which will give community members an opportunity to weigh in to the decisions being made. Information about client closures for lack of payment of cost share and Medicare Part D will also be available at that forum. There is also a provider forum scheduled this Friday at MAP at 10:00 am. Currently the model being proposed for the wait list is a medical model as opposed to a first come first served model. There are many recommendations included in the ADAP waitlist document and he encouraged folks to attend one of the forums.

The policy position remains vacant. There are five applicants who have been invited for a second interview; a decision will hopefully be made in the next week or so.

Dave then announced a couple of conferences that are coming up. There will be a disability conference in Duluth at the end of the month at which DHS will present. The International AIDS conference will be in Toronto next August and applications for scholarships will be available soon. It is very rare to have this conference in North America because of more restrictive immigration laws. He encouraged all interested to get updated information.

VII. Title I update - Jonathan Hanft

Jonathan handed out the outline for his update, a current spending report for the first quarter, and a letter from HRSA regarding implementing changes that will come with Medicare Part D. He briefly reviewed the spending report highlighting areas that are currently under spent. Currently amounts for carryover are not included in the spending report because the proposal has not yet been approved by HRSA.

The last condition of award for this year was submitted. Guidance for the 2006 Title I grant application has been received and the proposal is due on September 30^th. HRSA is looking for more discussion on quality management and information about other health care programs that are available in the state. They are also looking for more information about funding of the six core areas defined. If other services are funded, HRSA is requiring that those services demonstrate how folks get into care and stay in care.

Jonathan will be having a conference call with our project officers about the carryover request because there are some questions regarding the health education events proposed. He hopes to have approval soon after the call.

HRSA sent the grantees and co-chairs a letter about Medicare Part D. They are planning to release some guidance regarding Medicare Part D based on the changes coming up. Until that guidance has come out HRSA is saying that allocation decisions should not be made.

Mary Vienna, a Medicare expert at HRSA, will be coming on September 8^th for a technical assistance conference. The goal of the conference is to ensure that all providers know how to work with their clients on Medicare Part D. Times are 11:30 to 4:30 and the location is yet to be determined. He encouraged all providers who have front line staff working to get folks into care to be sure to attend. Diane added that HRSA is paying for this –Minnesota is part of a pilot project focusing on how communities respond to Medicare Part D and she encouraged any provider who has any contact with HIV positive clients to attend this session.

The second part of the supervisor training series will be held on August 25^th at Children’s Home Society. Please contact Diane if you’re interested in attending.

VIII. Variant Atypical Resistant HIV Surveillance (VARHS) Program Introduction - Tracy Sides, MDH

While waiting for Tracy to arrive, Girard gave information about the Community Cooperative Council on HIV/AIDS Prevention (CCCHAP) that he staffs with Julie Hanson Perez. He shared that they are currently accepting applications for membership and encouraged all who may be interested to apply.

Tracy handed out copies of her presentation and a client information sheet about HIV drug resistance and subtype testing. She began by reviewing the goals of the program. The program will monitor the prevalence of HIV drug resistance in Minnesota among the newly diagnosed. They will also monitor the prevalence of non-B HIV-1 among the newly diagnosed. This will be done using genotypic drug resistance testing and HIV subtype determination.

Currently guidelines suggest that if there is prevalence of 5% or more of drug resistant strains of HIV in a community that drug resistance testing be done with the initial assessment. LeMonte asked about the costs for testing because they are so high. Tracy said those tests will be covered through the CDC grant funding this program.

An annual report will be developed with prevalence of drug resistance and drug types and associated demographics. Because this is a public health activity, and not research, specimens will be collected during routine exams. Patient confidentiality is of paramount importance and MDH is committed to maintaining its excellent record of maintaining private data.

The program is funded by the CDC and will begin on September 1, 2005. The focus will be on diagnostic laboratories and provider/client education. The program will probably expand to greater Minnesota early next year. With respect to client education a fact sheet will be developed (and translated into other languages) and made available to clients. A copy of the fact sheet was handed out and she encouraged anyone with feedback to send it to her directly.

Those eligible for this program will be folks whose first diagnosis with HIV has been within the past 12 month with no previous exposure to HIV drugs. Participants can be any age but must be a resident of Minnesota. Specimens will be sent to MDH, participants will be checked for eligibility, and then tested for HIV subtype and drug resistance. Results will then be sent back to the health care provider and the surveillance program at MDH. Results will be available to the patient or provider at any time.

Members then asked questions, many of which were specifically about confidentiality. Tracy described the process used for releasing results to providers and patients in this program. Jonathan suggested adding information to the fact sheet that encourages folks who are recently diagnosed to contact the MAP AIDSLine or another resource that will facilitate them getting into care. Debra asked if there are other similar programs. Tracy reported that there are other sites that are successfully implementing this program. The current grant runs for five years. Debra asked how the word would be getting out to providers who aren’t HIV specific. Tracy shared that they have a disease control newsletter that will have an article about this program in it. They also have a letter that will be going out to physicians that will share information about the program. The Twin Cities AIDS Clinicians meeting will include information on the study, as well as the MDH website. Randy asked how this data would improve prevention efforts as mentioned on the fact sheet. Tracy shared that one of the ideas may be to incorporate information about different strains in prevention messages; there will also be implications on medical care. Diane suggested including the MN-Tel (physician consultation) phone number on the provider fact sheet for those who may not work with HIV specific providers directly.

IX. Announcements, evaluation, next agenda

Mary Doyle shared that Don Sikkink, a consultant who has previously done training on parliamentary procedure with the Planning Council, will provide another training on PP. He will conduct the training on Thursday, August 25^th from 9:00 am to 12:00 p.m. (location to be confirmed).

Mary Dwyer announced that the greater Minnesota training team will be conducting training in Anoka on September 16^th and encouraged all to pass information on to providers who may be interested in attending.

Documents distributed at or before the meeting:

· Agenda and minutes from the July 12^th meeting

· Written committee reports

· Comprehensive Plan PowerPoint presentation

· Draft critical issues, goals, and objectives (dated August 3, 2005)

· Action Item – member election, member reappointment, and Planning Council co-chair election

· Action Item – Comprehensive Plan 2006 to 2008 goals, objectives, and activities

· Planning Council member competency survey

· Reappointment ballot

· Planning Council co-chairs ballot

· Appointment ballot and candidate information

· All Vendor Fair invitation

· Community Cooperative Council on HIV/AIDS Prevention (CCCHAP) application for membership

· Variant, Atypical and Resistant HIV Surveillance (VARHS) PowerPoint presentation

· HIV Drug Resistance and Subtype Testing Information for Clients

MOTION: Randy moved Jim seconded adjournment of the meeting. The motion

passed unanimously.

Meeting adjourned at 11:55 a.m.