HIV Health Services Planning Council
Counties Working Group Draft MINUTES
Wednesday August 17, 2005
25 Van Ness Ave, Room 330B
5:30-7:30 p.m.

Committee Members Present: Ellen Sweetin (co-chair), Will Boemer (co-chair), Charles Siron (co-chair), Randy Allgaier, Will Carter, Wade Flores, Dorothy Kleffner, Elyse Graham
Committee Members Absent: Bill Blum, Sparkie Spaeth
Other Council Members Present: none
Council Support Present: Jack Newby, Skot Jonz
Others Present: none

1. Introductions
Co-Chair Siron called the meeting to order and those present introduced themselves.

2. Review/Approve Agenda
The group reviewed the agenda. The following changes were suggested: Item 9 and 10 removed from the agenda as they have been incorporated into the Relationship Between Counties and the Planning Council document. With those changes, the agenda was approved by consensus.

3. Review and Approval of Minutes-July 20, 2005
The group reviewed the minutes from July 20, 2005. The following changes were requested: CM Sweetin asked for a change to agenda item 6 regarding her comment to change “waste of time” to “unnecessary based on HRSA response.” CM Kleffner requested an addition to her announcement to read “CM Kleffner asked about remaining Needs Assessment data from Marin.”

With those changes, CM Siron moved to approve the minutes. CM Graham seconded. The minutes were approved by consensus.

4. Announcements
Wade Flores announced that the Marin Advisory Council officially adopted their by-laws.
CM Allgaier announced that there is a hearing on September 21 regarding CARE Act reauthorization.

5. Public Comment
There were no public comments.

6. Steering Committee Report
The Co-chairs will present a report back from the Steering Committee activities and discussions.
Co-chair Sweetin provided a report on Steering Committee activities and discussions since she had attended the meeting. She discussed that there was considerable discussion about this working group to wrap up its business. She explained that the completion of the relationships document is the primary task, to be completed next month, with the flexibility to have it completed in October. The task would be in October to create a document that lists other issues that need to be addressed and Steering Committee would determine how to address those supplementary issues. The maximum time to present to full Council at the October meeting is the expectation. CM Allgaier added that the date for ending this group was not arbitrary, but that it was set up based on the end of the Council work year. The group discussed that there was some doubt that an end-date had been established at the beginning, and perhaps in the future it would helpful to have this clarified if the Council expects a working group to complete its work in a set amount of time. CM Kleffner added that she has resigned herself to let go of some issues and will seek other ways to resolve them.
Co-chair Boemer stated that he assumed that the group was to meet for a finite time, but did not recall a defined end-time.
CM Siron agreed that there should be a timeline for completion of tasks and will mention this to Steering Committee.
Will Carter communicated his concern that the function of the document has changed and it has evolved into a policy document.
Group discussed.
Co-chair Sweetin mentioned the other discussions at Steering Committee, primarily the upcoming Prioritization meeting.
CM Graham agreed that now would be a good time to switch responsibility back to Marin County to begin making its own decisions and take up its own issues, if a road-block comes up, now there is an established relationship to reach out for assistance.
CM Allgaier commented that everyone in the room is committed to community planning processes, and encouraged people to write their congress-people to request that planning bodies be voluntary with no authority.
Will Carter asked for a point of information
CM Allgaier agreed to discuss specifics with Mr. Carter after the meeting.

7. Structure of Relationship Between Counties and the Planning Council- VOTE
The group will continue to review and discuss modifications to the document outlining the structure of the relationship between the Counties and the Planning Council and vote to approve the document.
Co-Chair Siron reviewed what was discussed at the last meeting regarding this document, and opened the matter for discussion.
CM Kleffner asked for clarification regarding who will enforce the standards of care, and the process.
Group discussed that it is the grantee’s responsibility since it is in the contract. Marin has not developed its own standards of care and is using the EMA standards.
CM Allgaier discussed that Standards of Care are not enforceable, and are used to decide if someone will receive a contract. CM Allgaier explained how this works.
CM Sweetin explained the process in San Mateo of representatives asked to be contract monitors.
CM Kleffner asked who she would bring something to the attention of if something is not working.
Jack Newby explained that talking about specific contractors is the one clear restriction. If someone is displeased with a service they should go to the County contract monitor. Provider relations and standards of care are solely a grantee responsibility. The Planning Council cannot go to a specific provider since it does not have this information.
CM Spaeth suggested that consumers can go to the Health Department and there is a clear grievance procedure.
CM Allgaier added that if a client has a complaint with a specific provider, there is a process to begin with the grievance of the agency itself, then to the County level, and if necessary proceed to SF DPH.
Wade Flores asked whether there is a conflict of interest between the County and an agency it needs to investigate.
Group agreed that this was not the case, since the County is supposed to ensure that the contractors are doing the job they are paid to do.
CM Kleffner reiterated that standards of care do not belong in the relationship document.
CM Graham added that it is more helpful to bring a complaint as a service category issue rather than a complaint against a specific service provider.
CM Kleffner discussed her concern about the lack of funding for advanced ambulatory care for opportunistic infections.
CM Siron asked if there was additional discussions or questions about the document.
CM Siron moved that this document “Relationship Between Planning Council, Marin and San Mateo Counties” be recommended to the Steering Committee in September for discussion, which will go before the full Planning Council in September.
CM Graham seconded.
Group voted on the motion.
YES: 8
NO: 1
The motion for recommending the document to Steering Committee passed.

8. Working Group Next Steps
The group will continue the discussion to define its scope of work, and next steps to complete it.
CM Graham suggested that deciding an end-date would be a good next step.

CM Siron asked if this working group was willing to go on until October.
Group discussed.

CM Kleffner asked about the calendar year budget year item, being in synch with the prioritization process of San Francisco. Group discussed that this should be resolved within Marin, since San Mateo is already in synch.
Another issue identified includes deciding on Council Support for the Counties.
CM Siron asked if anyone had other issues.
Jack added that some of it could be addressed within the document, and he pointed to the presentation scheduled for the prioritization process. Implicit in that is for the counties to decide on a date that they do that.

9. Determine Planning Council Reporting Responsibilities
The group will discuss Planning Council Reporting Responsibilities.
[This item removed from the agenda as the details are incorporated into the document.]

10. Determine Grantee Reporting Responsibilities
The group will discuss Grantee Reporting Responsibilities.
[This item removed from the agenda as the details are incorporated into the document.]

11. Council Support for the Counties
The group will discuss Council support for the Counties.
Group discussed. Primarily, CM Spaeth asked for this to be included on the agenda because Marin does not have any funding to support the council, for food, outreach, community forums, and so on. The County will provide support administratively, and there will be a health planner provided. But additional support is needed for Marin County.
CM Allgaier requested to inject a dose of reality into the conversation by reminding the group regarding limited funds and perhaps money used this year for needs assessment could be used for Marin County support. He added that the amounts being spent on council support is being scrutinized on a federal level. However, the SF EMA is among the lowest in the country spent on council support. He reviewed the ongoing scrutiny of the allocations for SF Council Support. If this decision regarding Council Support for the counties is made, it needs to be done next week at Prioritization. He suggested an additional $5-10,000 to support the work of the counties.
Jack Newby suggested that the lower figure could be folded into the budget and would not make a huge impact. The goal to solicit consumer input in the Counties is justifiable.
Jack discussed the mechanism to make this happen.
CM Siron asked whether a recommendation to Steering could include that the SF Planning Council should and will support budgetary supplies and expenses for forums for both counties, Marin and San Mateo.
CM Allgaier stated that this is unnecessary if there is a specific line-item in the budget discussed next week.
Jack Newby suggested there would not be a specific item, but rather the amount would be folded into an already existing category.
CM Sweetin asked if something should be stated and written somewhere regarding the mechanism of how the requests are made and how they are carried out and/or approved.
Jack responded by directing ad hoc members to Item V2 on the relationships document, that could have vebiage added specifying this agreement.
CM Allgaier suggested coming up with the language and make an amendment.
CM Kleffner asked for clarification about what these expenses would include.
CM Spaeth listed postage, room rental, business cards, and food for meetings as examples.
Jack added that the language could include an annual cap.

Group discussed.
The specific language of the amendment to Section V.2. shall read:

Council Support shall also provide reasonable financial assistance to the Counties for consumer-related and general advisory group activities.

There was a unanimous agreement to the amendment.

12. Working Group Member Agenda Requests
• Calendars update - Presentation of the next few years calendars for the counties

CM Spaeth explained the changes with the fiscal year in Marin County, which this year included 18 months. Contracts extended to get everyone on the CARE Council calendar year.
CM Allgaier explained that Marin County is a contractor for the SF grantee, rather than a grantee itself. This explains the use of funds that may seem like rollover or unspent funds.
CM Kleffner asked about the Marin fiscal year that is twenty months.
Group discussed that this might be a question more appropriately addressed to Michelle at HIV Health Services.

13. Next Meeting Date & Agenda Items
The next Counties working group is scheduled to meet September 21st after the monthly Steering Committee meeting. The primary suggested item on the agenda is to discuss the response of the Steering Committee regarding the recommendation of the Relationship document. It was agreed that if the Steering Committee passes the document intact, the September Counties Working Group meeting will be cancelled. It was noted that September 21st is the same night as the briefing on the CARE Act reauthorization.

CM Siron adjourned the meeting at 6:50 pm.

 

Meeting minutes are considered to be in DRAFT form until reviewed and approved by Council attendees.

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