I. Call to Order
The meeting was called to order at 4:30 P.M.
II. Roll Call
See Attachment
A for the roll call.
III. Review and Approval of Agenda
The agenda was approved by consensus.
IV. Review and Approval of Minutes- November 24, 2003
CM (Council Member) Sanders mentioned he will make non content grammatical
corrections and send them to Council Support. The minutes were approved by
consensus.
V. General Announcements
CM Hume had 2 announcements.
1. A reminder to fill out the FPPC forms and return them to Council Support
2. Reminder that public comment is not a time to ask questions
VI. Public Comment
Patrick Monette-Shaw commented, “As this Council knows, previous press
reports noted Mayor Newsom is considering eliminating the City’s AIDS
Czar position — the HIV/AIDS Policy Advisor to the Mayor — because
its $50,000 salary would pose a so-called “enormous” burden,
given the City’s purported budget deficit. As you may know, there are
2,900 City employees earning in excess of $90,000 costing over $314 million
annually, so this weak excuse the City can’t afford $50K is bogus.
I have taken the initiative to recommend to Mayor Newsom that he retain this
position and fill it immediately. If I can take such initiative, so too can
this Council. If this Council fails to advocate for keeping this position,
San Francisco will become the laughing stock of the nation if we fail to
keep an AIDS Czar and President Bush subsequently follows San Francisco’s
lead by eliminating his own AIDS Czar from the White House.”
Mark Dunlop announced he will be submitting his application to the Council.
A representative from Marin County announced that Allison Clayton will be back in the office soon and wished to thank CM Graham for helping with the cite monitoring in Marin County.
VII. Prevention with Positives Definition- VOTE
Council Co-chairs
The council discussed the Prevention with Positives definition. The Council
voted to adopt the Prevention with Positives definition developed by the joint
working group of the HIV Prevention Planning Council and the HIV Health Services
Planning Council.
Public Comment on this item:
Patrick Monette-Shaw added, “The January 2004 issue of Poz Mazazine currently
available on the Internet has two articles on its Web site, one by San Francisco
psychotherapist Walt Odets and another by Esther Kaplan. Both authors claim
CDC recently sprang the Prevention for Positives concept onto an unsuspecting
AIDS community without forewarning in reaction to the Religious Right, unfairly
targeting gay men. Both authors must not have learned San Francisco has had
a prevention-for-positives demonstration project with the Stop AIDS Project
for the past four years; the CDC’s initiative is hardly new, nor was
San Francisco’s AIDS community unaware of the change at CDC or of this
demonstration project. Conveniently, nobody complained about the Stop AIDS
prevention-for-positives demonstration project. I challenge this Council — as
a formal body and as private individuals — to write Poz in order to set
the record straight that CDC’s initiative is neither new nor picking
on people with HIV/AIDS.”
VIII. Prioritization Recommendations
Randy Allgaier
The Evaluation Committee presented their recommendations for prioritization
2004, following the evaluations of the 2003 prioritization process. Please
refer to the printed slides for more information. The council discussed the
recommendations.
Public Comment on Prioritization Recommendations:
Patrick Monette-Shaw Said, “While Council Member Randy Allgaier just
made an excellent presentation regarding recommendations for the Prioritization
Process, I respectfully disagree with his recommendation the Council consider
hiring meeting facilitators. The San Francisco AIDS Foundation pays facilitators
up to $500 in stipends to “facilitate” events. If this Council
wishes to have any of its meetings conducted by people trained in facilitating
meetings, it should have made that a condition of award in the contract that
provides this Council with administrative support. By requiring organizations
such as Shanti, which holds the current administrative support contract, to
have staff trained in facilitating meetings this Council could kill two birds
with one stone, without having to subsequently hire meeting facilitators in
addition to having a contract to provide administrative support. Then, perhaps
more of San Francisco’s CARE Act award would actually reach people living
with HIV/AIDS, and not have excessive funds spent on meeting facilitators.”
Public Comment on Agenda ADAP/Medi-Cal Update by Patrick Monette-Shaw:
“
As some of you know, I attended the ADAP demonstration sponsored by the San
Francisco AIDS Foundation at the State building. If you will only read a report
posted on my Web site, www.thelastwatch.com, you will learn SFAF has diverted
$22.4 million in funds to its African affiliate, the Pangaea Global AIDS Foundation,
in just the two-year period ending in June 2003. While a portion of that $22.4
million was from a portion of Pfizer’s three-year $11.5 million grant,
at least $10.9 million, if not more, came from SFAF’s so-called ‘private’ funds.
SFAF could well afford to use some of the millions diverted to African towards
keeping Californians off of an ADAP waiting list. After all, it’s a matter
of priorities, and before we have waiting-list related deaths in California,
as has happened in at least two other states, SFAF could be helping Bay Area
residents with ADAP co-payments, first.”
IX. Membership -VOTE
Mjay Sanders
CM Sanders announced that this year the membership committee will be making
recommendations for new members on a quarterly basis. This will begin in February.
Bringing on new members during prioritization is a challenge. Each new member
will have a mentor to help them understand matters. The Steering Committee
recommended Council Members Margot Antonetty, Charlene Pugh and Norman Tanner
for membership term renewal. These three members were approved by consensus.
X. HOPWA Loan Committee Council Seat- VOTE
Community Outreach & Advocacy Committee
The Community Outreach & Advocacy Committee recommended the appointment
of Council Member Joe McMurray to the Council’s second HOPWA (Housing
Opportunities for People Living with AIDS) Loan Committee seat. This is a second
seat—the first seat is filled by CM Hume. HOPWA gets its funding from
HUD (Housing and Urban Development). These funds are used to support an AIDS
subsidy program and other funds are used for capital projects and operating
expenses for some of the residential care facilities. The Council voted in
favor of Joe McMurray as a representative on the HOPWA Loan Committee.
XI. Community Input Activities
At the next committee meeting, community input activities will be discussed
in further detail, all council members are welcome to attend. The meeting
will be on February 11 from 5:30-7:00 P.M. Any suggestions regarding community
input can also be emailed to CM Durio, Geanuracos, or to Council Support.
The Community Outreach & Advocacy Committee discussed the solicitation of Council Member suggestions for Community input topics/ focuses. CM Sanders encouraged others to recall whether there are other groups or populations, whose needs were insufficiently assessed in the last process. CM Shea mentioned that feedback from the community can be a tool in determining the way that services should be structured. It would be of additional interest to determine the barriers preventing people from participating. The council discussed community input activities.
According to CM Chung, input gathered from clients who are utilizing services helps us prioritize according to services that are needed and desired. She feels that we did not really listen to the community input and for this reason people are discouraged. More people should come together in the planning process. It was also suggested that the meetings should take place in different neighborhoods. However, one must be aware that groups with a specific interest can pack meetings in order to have their needs acted upon and their needs might not reflect the needs of the majority of the community.
XII. AIDS Office Update- VOTE
A monthly update from the HIV Health Services was made; however, the Executive
Director of Health did not attend the council meeting, and discuss the Department
of Public Health’s budget process. Instead, Michelle Long Dixon gave
the presentation. The first item is a report back on the carry-forth project.
Items 1 and 4 are modifications to current contracts – service will
be provided between now and February. Item 2 is contract modification; however,
the vouchers will be saved until the beginning of the next fiscal year and
then they will be available to contractors. Item 3, the planning process
will begin tomorrow. There are a series of three meetings planned. Item number
2 has to do with the un-obligated funds. The council will prioritize how
each fund will be spent. The Health Services HIV stats going back and looking
at proposals that were submitted by contractors to make sure that what was
in question was allowable in the grant and also was in keeping with the time
period in question. We try to make sure that we captured the un-obligated
funds that were possible, as well as some that were already obligated. Please
refer to the hand-outs. Contractors requested a number of supplies, such
as computer equipment. The standards for eight categories have been developed – most
of those have had at least 1training where it says next training Feb. They
only had 1 training session for providers and they are doing a second based
on a survey of staff turnover. In terms of implementation, we refer to standards
of care in the contracts and providers category. The references they are
to appear to the standards of care for their particular category and that
is put into their contract and their contract is monitored to make sure that
they adhere to standards. So, most of the standards will begin to be included
contracts beginning March first for 2004/2005. Integrated services and transportation
are 2 that will spill over into the next fiscal year. As will trainings and
implementations in 2005/2006.
The standards of care are done through a community process. The consultant that organizes the meetings and actually does the writing, he contacts, all of the providers in those particular categories, and also gets those providers involved in a community-wide process. The participants work to develop a draft – the draft is circulated for comment the results are a community component where we convene the community with HIV and explain the processes and go through to come up with the draft, explain the draft with their comment and do that. A client must know what their responsibility is and then the standards become finalized, and then we train the consultant who develops a curriculum.
Russ Zellers reviewed the final budget for 2003/2004 Please refer to the handouts.
It is important to note that here have been some changes to this budget since
the original one that was submitted 6 months ago. In addition to the carry
forward 1 time balance there have been instances in which contracts were reclassified
based on program manager’s recommendations or providers requests. Also
there have been occasions in which contract structures were changed. For example,
case management or primary care exhibits have been combined to become primary
care, so money moves depending on the structure of the contract. Clearly, there
are variations between this budget and the one received earlier.
The HRSA budget for 2003/2004 was approved.
The second item reviewed was a spreadsheet about the cost of care, which resulted from a cost of care analysis project.
XIII. ADAP/Medi-Cal Update
Jeff Byers and Randy Allgaier presented a monthly update on recent ADAP/Medi-Cal
developments. CM Byers announced his intention to keep ADAP without capping
it. Last year there was a discussion about co-payments. Co-payments did not
become a reality -- instead, money was taken from vouchers to help compensate
for funds taken in co-payments. The CARE HIP Program (the Health Insurance
Premium Payment Program) pays for an individual’s COBRA payment if
an individual is too sick to work. The program has become very popular. ARIES
is an ongoing program that is similar to Reggie, but not Reggie. ARIES is
a partnership between the state of California, the San Diego VMA, the San
Bernidino Riverside VMA, and the state of Texas all working together to develop
this system that will be available in the future. CM Allgaier developed a
presentation outlining Title II funding. He will provide this presentation
to the Council at a future date.
Public Comment on this item
Laura Thomas thanked the people who attended the rally in front of the state building. Over 250 people attended including advocates living with HIV, speakers discussing what the program has meant to them, anger at the proposed cap, and energy towards opposing it. As she gets dates for future demonstrations, she will post them on the Council’s Yahoo list.
Patrick Monette-Shaw commented regarding ADAP. “As some of you know,
I attended the ADAP demonstration sponsored by the San Francisco AIDS Foundation
at the State building. If you will only read a report posted on my Web site,
www.thelastwatch.com, you will learn SFAF has diverted $22.4 million in funds
to its African affiliate, the Pangaea Global AIDS Foundation, in just the two-year
period ending in June 2003. While a portion of that $22.4 million was from
a portion of Pfizer’s three-year $11.5 million grant, at least $10.9
million, if not more, came from SFAF’s so-called “private” funds.
SFAF could well afford to use some of the millions diverted to African towards
keeping Californians off of an ADAP waiting list. After all, it’s a matter
of priorities, and before we have waiting-list related deaths in California,
as has happened in at least two other states, SFAF could be helping Bay Area
residents with ADAP co-payments, first.”
XIV. Dinner Break
Following dinner was a quick announcement from Hywel Sims (Shanti) regarding the email announcing Joe Fera’s resignation. As a result in the change of staffing, the structure of Council Support is being evaluated. Further information will be available in the coming week
XV. Proposal for Prioritization Consultant- VOTE
*Planning Committee Prioritization Topic
The Planning Committee presented a motion to adopt the prioritization development
proposal from John Golenski. The Council unanimously voted in favor of adopting
the proposal from John Golenski (Institute for Ethics and Health Policy)
to work with the Council on developing the prioritization process. Please
see
the proposal for project details.
Public Comment on this item
Patrick Monette-Shaw commented on the proposal for a prioritization consultant.
“
Last February this Council increased its administrative support contract by
$91,600. You just unanimously voted, approving another $200 per hour contract,
for $28,920 in total, to have an ethicist teach you how to choose among equitable “decision-making” models
for priority-setting spending of next year’s CARE funds. Last year you
didn’t shoehorn a decision-making model onto priority-setting; why this
expense has suddenly become crucial is unknown. Last fall, Council Member Susan
Shea researched various decision-making models, presumably at the library.
Her research stymied, Shea brought in Ethicist John Golenski on November 24
for a presentation on decision-making models. This Council failed to choose
a model independently and now want to spend nearly $30K, or almost $1,000 per
Council member, to learn this skill, which will need to be repeated annually,
given the high rate of Council member turnover. This money could be better
spent on direct emergency financial assistance to PLWH/A.”
XVI. Overall structure of HIV Care in SF
*Planning Committee Prioritization Topic
CAEAR Coalition Board Member, Laura Thomas, provided an explanation of the
overall system of Care in San Francisco, including where Title I and Title
II dollars fit in. She reviewed a pie chart of Federal HIV/ AIDS spending for
care and assistance by program (including State share of Medicaid). Please
refer to the handout. Title I is 16% of the total. When people are diagnosed
with AIDS, about 40% of people are on private insurance, such as Kaiser, BlueCross,
and HealthNet. About 40% are uninsured, and 20% are publicly insured – in
other words, they have Medi-Cal. For many people, an AIDS diagnosis enables
them to get a disability status, which enables them to get Medi-Cal, even if
their income disqualifies them. One’s insurance status often changes
after their health status changes. When they can no longer work due to illness,
their private health insurance is often discontinued. The number of people
with private insurance decreases and the number of people eligible for Medicaid
increased. That leaves 40% of people on private insurance and 60% relying on
public funds. Of the 60% relying on public funds, the Ryan White funds are
about 16% of that. Title 1 is paying for about 10% of the cost of people living
with AIDS. In the Ryan White Care Act,
Title I is the money that comes to eligible urban areas to pay for HIV services.
Title II goes to the state and California gets the largest portion of it. The
rest of it goes to the county. (Please refer to the pink handouts.)
Title III is a program that pays for direct medical care services (Community
Based Programs).
Title IV is children, youth, women, and families.
Medi-Cal is the main provider for the city’s disabled and low income
and provides medical care and optional benefits. The disease is impoverishing.
Medi-Cal does not cover the population diagnosed with HIV, but not considered
to have AIDS, as well as undocumented immigrants.
The Council discussed the various funding streame for HIV services. CM Antonetty
briefly discussed funding for the housing of people with HIV. Title 1 funds
are not used to help those in prisons.
XVII. HRSA Program Guidance
Susan Shea
*Planning Committee Prioritization Topic
Council Member Shea reviewed the HRSA program guidance for prioritization.
Since a consultant has been hired to help with the prioritization process,
it is important for council members to read the HRSA guidance and figure out
what is most essential for prioritization. Refer to the prioritization chapter
in the Title I manual or download the information from the following Website:
http://hab.hrsa.gov/tools/title1/t1SecVIIChap2.html
ftp://ftp.hrsa.gov/hab/t1SecVIIChap2.pdf
Public Comment on this item:
Patrick Monette-Shaw again said, “Since tonight’s meeting ran overtime,
rather than presenting any new or meaningful summary of HRSA’s Program
Guidance, Council Member Susan Shea just indicated that the Council’s
vote to approve the $28,920 contract with Ethicist John Golenski from the Institute
for Ethics and Health Policy, is ‘That’s what we’re paying
him to do.’ This is outrageous; this Council is mandated to know what
HRSA’s program guidance is, and you should not need either a meeting
facilitator nor an ethicist to teach you what your roles are, nor how to use
a decision-making model. From my understanding of the CARE Act, there is no
provision that permits you to substitute hiring an ethicist for knowing HRSA’s
program guidance stipulations. For an expenditure of $28,920, you might just
as well have gone to Needless Markup — err, Neiman Marcus — and
bought yourselves new Gucci handbags to pack your priority-setting into Gucci’s
newest decision-making purse strings.”
XVIII. New Business/ Next Agenda
Obtain more information about the contracting process from the AIDS Office
XIX. Adjourned
The meeting was adjourned at 7:30 P.M.
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