I. Call to Order
II. Roll Call
Please see attached.
III. Review and Approval of Agenda
The agenda was approved.
IV. Review and Approval of Minutes- January 26, 2003
CM Sanders pointed out that the medical update was listed twice. The agenda
was pre-approved upon CM Sanders’ editorial changes.
V. General Announcements
•
The 2004 Bay Area Adolescent Health Working Group Conference, Whole Body Whole
Health: Innovative Approaches to Building Adolescent Wellness, will take place
Thursday May 6 and Friday, May 7. Registration will begin at 8:00 A.M. and
the conference begins at 9:00 A.M. The location is the First Unitarian Church
(685 14th Street, Oakland, CA 94612). For a detailed agenda and registration,
go to: www.ahwg.net/events/2004.htm. This event happens every two years.
•
Leah Crask announced Donald Frazier’s resignation from the Care Council
on February 12.
•
CM Geanuracos announced that the Community Outreach and Advocacy Committee
have been working on a draft brochure for the Council. This general document
will be used for new member recruitment, distribution at meetings with other
organizations and politicians, and distribution to clients in Care funded agencies.
VI. Public Comment
Hywel Sims of Shanti announced that at a meeting with a foundation official
who is working on a project to discuss what will happen over the next five
years with HIV in California. He is primarily focusing the group on the discrepancy
between emerging cases and decreasing funding. He commended the HIV Services
Planning Council in San Francisco for hiring John Golenski.
VII. Memorandum of Understanding- VOTE
Infrastructure and Policy Committee
The Infrastructure and Policy Committee presented and reviewed the draft Memorandum
of Understanding (MOU) between the Grantee and the Council, including the additions
made to the document.
CM Sanders asked whether the priority setting deadline is the same each year.
Joe McMurray pointed out an acronym that was not spelled out, as well as a
typo in the document. After public comment, the Council voted unanimously to
accept the MOU.
Public Comment on this item:
Partick Monette-Shaw submitted written comment: Item 5 on page 8 of this MOU
discusses unexpended or unobligated funds (the so-called misnomer “un-funds”)
remaining at the end of a fiscal year, indicating the Grantee (SF DPH) will
inform the Council of the amount of unfunds 90-120 days after the end of
the fiscal year. It’s completely ridiculous that it would take DPH
four months into a new fiscal year to admit how much money remained unspent
in the prior fiscal year. As this Council knows, one of the rules imposed
during competitive review of grant applications for competitive CARE funding
is that the application will be judged based on past performance in the EMA.
Other HRSA guidance states that the grantee and the Council must keep track
of how rapidly Title 1 money is, or isn’t being spent. Spending CARE
Act funds rapidly is a HRSA expectation this Council keeps violating, contributing
to reduced funding awards.
VIII. Rebidding Process Report
Infrastructure and Policy Committee
The Infrastructure and Policy Committee gave an update on the rebidding process.
IX. Membership -VOTE
Mjay Sanders/ Jorge Rodriguez
The Membership Committee recommended Council Member Charles Siron for membership
term renewal. The Committee also recommended the following six new Council
Membership Candidates for appointment to the Council: Ayisha Benham, Brian
DeCrocco, Mark Dunlop, Wilfredo Ortiz, Laura Thomas, and Kenneth Valadez. CM
Rodriguez reviewed the backgrounds of the membership candidates.
Public Comment on this item:
Patrick Monette-Shaw: I oppose the nomination of Laura Thomas for membership
on this Council. Mark Cloutier, Continuum’s Executive Director, announced
at the November 2003 Council meeting that Ms. Thomas had resigned from DPH
to accept a position with Continuum, he indicated up to one-third of Ms.
Thomas’ time would be made available to the Council and/or to SF DPH
for CARE-related projects. Since Continuum receives Title 1 CARE funds, appointing
a Continuum employee, Ms. Thomas, to this Council would result in the appearance
of another conflict of interest. HRSA’s requires this body reflect
the demographics of the epidemic, but there are 17 female members, representing
44.7% of the 38 members, but there have only been 987 female AIDS cases in
San Francisco representing a scant 3.85% of all AIDS cases compared to the
88.6% of AIDS cases among gay and bisexual men. Appointing Thomas would not
represent demographics of San Francisco’s epidemic.
The Council voted in favor of the membership renewal and new member candidates.
X. ADAP/Medi-Cal Update
Jeff Byers and Randy Allgaier were not present to give the monthly update on
recent ADAP/Medi-Cal developments. Another CM announced the upcoming ADAP
Rally to Sacramento on March 8, 2004. Buses will be leaving from the San
Francisco AIDS Foundation at 7:30 A.M. (995 Market Street at the corner of
6th and Market). Contact the AIDS Foundation or Project Inform in order to
reserve a seat on the bus.
There are some unknowns about ADAP, such as the total amount of available rebates
from the pharmaceutical companies, which could be part of the financial solution.
It is possible that the legislature will not go along with the Governor’s
request. The Board of Supervisors of Los Angeles County recently voted on a
resolution strongly supporting ADAP, demanding full funding for the program
and rejecting any changes in the eligibility criteria.
No mention was made regarding co-payment. It should be fully funded without
co-payments.
There is a national effort to pass an emergency appropriation to put additional
dollars into part of the Ryan White title that funds ADAP, Title II.
XI. Dinner Break
XII. Integrated Service Model (Brad Hume, Susan Shea & Catherine
Geanuracos)
The goals of the ISM were presented to the Council and the Co-Chairs facilitated
the discussion in connection with the Prioritization Process. Susan Shea
gave a thorough history of how the ISM philosophy came to the Council.
Points made by CM Shea: In 1997, a group of Council members, community members,
and consumers were trying to make the functioning of the care system more effective
and efficient for clients from a consumer’s viewpoint. One idea that
came up was having some organizations that were placed in different geographic
areas start networking together. A group of Council members got together and
decided to put 25% of primary care dollars into integrated service providers.
This was a big deal at HHS because it meant that in a short amount of time,
they had to “put out to bid” pieces of the CARE system that for
years had not had to interact with one another. Some MOU’s worked better
than others. There was nothing in an MOU that required case conferencing or
integration. It meant a change for the entire system. The system was in an
uproar for two years. The people that need the services most are the most difficult
to get into CARE. People that need the services most may need housing, mental
health services, substance abuse services, and case management. All of these
issues would need to be addressed BEFORE the client can see a primary care
provider and get medication. A year ago, there was a Planning Council discussion
about having an integrated service model instead of an integrated services
provider. When money went into integrated service providers, it was not realized
how much money was required. In order for the care to be better, more money
is needed. HHS is not to blame. Last year, the CARE Council decided to move
from ISP’s to ISM’s. Clients or patients should get their care
in a network, where the providers are encouraged, paid for, reimbursed, forced
to communicate with one another. Please refer to the integrated service model
handout.
The goal of prioritization this year is to:
•
To clarify the definition of integrated services model
•
Determine the percentage of our total budget going to concept
•
Determine the infrastructure of the concept to keep HHS informed as to the
parts of the ISM that need proper funding
Are there geographic areas of the city that we want to consider?
Are there certain populations that we want to identify as to first going into
ISM’s?
Does everyone need an ISM? Some think yes and some think no.
These conversations are necessary between now and July
People must be aware of the process on how the ISM will be discussed. The I& P
Committee requested the AIDS office to set up a task force that will be made
up of consumers, providers, Council members, and AIDS office experts. This
collaboration will lead up to a request for a proposal (RFP) in the fall that
will have everyone’s input. While that advisory group is in progress,
John Golenski will be looking at this model closely and assisting.
A third process that is going on in the city is a think tank. This “think tank” is comprised of people from USCF, consumers, Black Coalition on AIDS, Asian and Pacific Islanders, etc. that are coming together to discuss how the HIV healthcare system should look in the future. Hopefully, all the information from this will be included in our Prioritization process, which will be assisted by John Golenski. John Golenski will present to the next Planning Committee the documents that will be used, the information, along with the outcome. That will be discussed by the Planning Committee, the Steering Committee, and the Full Council to validate matters, and then we will begin. The Council spent forty-five minute discussing about the ISM.
CM Geanuracos mentioned the importance for the council of getting feedback from the clients who utilize the services. She discussed ways of obtaining consumer input at the forum, scheduled for the spring. What do you want to know from the people who have been in the ISPs? Do you want to know their positive and negative experiences in the ISPs? Some of those things will transfer into the ISMs and some of them will hopefully, be addressed by the Council. John Golenski is going to assist in structuring the forum so that meaningful feedback is obtained. CM Geanuracos expressed her opinion that one can have a comprehensive model and still have within it, individualized care planning. It is possible to have eight services available in a given model. Perhaps 30% of the clients will use eight services at some point, but 40% will use six and will not need the other two. There is a steadily increasing level of need in the clients served. As the funding gets tighter, those clients are the people that we want to concentrate on serving.
According to CM Shea, HRSA’s main concern is that primary care be at the hub of case management services. ISM’s will be more expensive, but more effective. Not every ISM will look the same for every population and every geographic area. An ISM for African American women is going to look different from an ISM for another group. Some ISM’s will be vertical, where everything is done in one building, by one provider. The principles of ISM and the support of the structure can be the same for every ISM; however, every ISM can have its own personality. According to Reggie, 50% of everyone in the CARE system gets their HIV care from the privates. A challenge is to make sure that the people who are getting primary care outside of our structures are getting good primary care. It is important to look at the centers where we are providing care to the neediest populations. The Department of Public Health is the provider of last resort. The centers must be healthy and the satellites must be healthy.
CM Hume feels that there needs to be a definition of vicinity.
Care dollars are designated for the underinsured. Hopefully services that do not fit into this model will be looked at. There are a number of people who are not covered within the CARE system, but who utilize the “wrap around” services.
CM Siron feels that last year the effectiveness of the ISPs was not evaluated.
Now we want to launch a new definition of service model. It is expected to
cost more. CM Siron hopes that the committee is going to look at ways to
integrate this ISM into DPH funding and DHS funding so that it is effective.
It is not going to be an effective model with CARE Title I money only. It
is important to know who our partners will be in this endeavor.
Public Comment:
Jim Eliott of Project Open Hand: I want to comment on the providers’ perspective.
We had an extensive discussion about this after the January 28, 2004 meeting,
which, was organized by the Council and the AIDS office. The problem that comes
up is the different perspectives that we have.
Patrick Monette-Shaw: Your perspective is just about Care money and CARE funded services. There are a whole range of community-based service providers, like myself, who have a blend of funding streams and serve a wide population of people—people with HIV. We have mental health money, substance abuse money, senior money, and we are all trying to serve our clients. Your money is very restricted and it is more restricted over time to this severe need population and we buy into that. What you are defining is a service system using not all the parts, but just for that severe need group. This idea that fifty percent of the people in Reggie do not get their primary care through Care through CARE funded primary care. I bet that it is a lot more than that. The whole point is they should be getting their primary care paid for by MediCAL, or insurance, or other kinds of services. CARE is the funding of last resort. If you make your CARE funded primary care clinics the lynch pin of the Integrated Services Model, you are going to restrict it down to a small number of people. It should be a small number of people. We want to cooperate with this, we will. As Naomi pointed out to us, it is not if and how, but when. We know this is coming and we know you have the power to determine the priorities for your funding. You have to recognize that we serve a wide variety of people, like Mjay, who do not access CARE funded primary care necessarily, but who do need outpatient substance abuse treatment paid for by CARE funds that they will not get. If all of the money for outpatient substance abuse treatment goes into this ISM, it’s over.
Naomi Prochovnick, Director of Tenderloin Care Continuum: When we are talking about people who are getting their primary medical care outside of CARE funds. These clients are still high need and are getting their “wrap around” services through CARE funded services because MediCAL does not pay for case management and very little psychiatric and/or mental health, and food and transportation, etc. The case manager needs to coordinate the provision of whether the care is provided by a CARE funded medical provider or a MediCAL funded care provider. Our goal is to get all CARE or MediCAL eligible clients to get benefits, including “wrap around” services. In the future, the coordination will rely on the provider coming to meet with the client rather than have the client “run around.”
Sherry Thomas: Be careful when you speak of the vicinity because II work with a specific targeted population and they have boundaries and they have areas that they just will not go into. They would rather die and they will die because they will not go across town to get medical care or mental health care. When I hear you guys pushing around and moving around vicinity and someone says that it is not important, it is important to a certain population that I work with. I am new to this process, but it is very interesting because I do not see my population represented around this table and my staff is young, so I’ll have to be that voice. I want you to be a bit more open-minded so we can all be represented at the table.
XIII. Severe Need Definition
Infrastructure & Policy Committee
*Planning Committee Prioritization Topic
The Infrastructure and Policy Committee presented the Severe Need Definition
and the Co-Chairs facilitated a discussion of the Council’s Severe Need
Definition. Refer your handout with the definition of severe need.
CM Shea feels that the severe need document needs to have a phrase stating that people who are out of care are perhaps in the severe need population. It is not going to be true for all, because some are out of care and fine. However, others are out of care because they are homeless, substance abusing, or mentally ill.
It appears that access to services and access to medication has only gotten worse in the Bay View/Hunters Point area. This population is primarily African American. Last year in prioritization $35,000 in rollover funds was allocated to do a community planning process. That community is an example that having this definition is not helping one of the most severely needy populations.
Public Comments on this item:
Member of the Public: Providers work it into their proposals that they are
serving these people. This is meaningless until you realize that care funds
are like insurance. Until you tell Reggie, to tag the people in Reggie who
should be CARE funded, this is meaningless and it will not be possible to
track whether Reggie is actually targeting the people that you want them
to target. Why does Reggie not identify the low income, uninsured, under
insured? When I search the Reggie records and my clients, I can say, “This
one’s funded by CARE.”
Naomi Prochovnick: I wanted to piggy-back on something that Susan Shea was talking about, which is remembering that HRSA is mandating a certain percentage of CARE funding be set aside for bring “out-of-CARE” clients into CARE. It is important to look at who is out of CARE and why they are out of CARE.
Sherry Thomas expressed that more needs to be done to help the severe need African American population.
XIV. New Business/ Next Agenda
Complete the evaluation forms by the door
XV. Adjourned
The meeting adjourned at 7:30 P.M.
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