HIV Health Services Planning Council
Milton Marks Conference Center
The State Building
455 Golden Gate Ave. (Between Larkin & Polk St.)
Lower Level, Benicia Room
July 11, 2005
4:30 PM - 7:30 PM
DRAFT MINUTES


I. Call to Order
CM Siron called the meeting to order.

II. Roll Call
Council Support called the roll and quorum was met. See Attachment A, Column 1.

III. Review and Approval of Agenda
Council Members reviewed the agenda. CM Siron made a motion to approve the agenda and it was seconded. The agenda was approved by consensus.

IV. Review and Approval of Minutes- June 27, 2005
Council Members reviewed the minutes from June 27, 2005.

CM Sallee requested changes to the minutes regarding Title III representation, and will submit her changes in writing to Council Support. Her changes affected her announcement regarding her representation of Title II, should be Title III. Additionally, the phrase “provider at the clinic” was corrected to read “provider from one of the Title III clinics. The final change from CM Sallee pertains to the final portion of her announcement to read as follows: “…continue her term on the Council as a Community Advisory Board Member of SF Needle Exchange Program.”
CM Allgaier made a change regarding Item VIII to change the words “he was misquoted” to “he misstated”. Additionally, CM Allgaier corrected the spelling of Mr. Petralis’name.
CM Siron made a motion to approve the minutes. With those changes, the minutes were approved.

V. General Announcements
CM Banks made an announcement that he is stepping down as co-chair of COA Committee.
CM Ortiz co-chair of COA committee announced the Community Meeting on August 10 at Walden House and encouraged other CMs to attend.
No other announcements.

VI. Public Comment
• Michael Petralis addressed the Council regarding AIDS cases and AIDS deaths in San Francisco and cited an 81-page epi-report. He discussed an 11% decrease in the AIDS caseload in San Francisco.
• Dana Van Gorder of San Francisco AIDS Foundation discussed collaborating with Project Inform and implementation of Medicare Part D program and the associated out-of-pocket expenses. He discussed briefly how this can affect people who receive medication from ADAP and must pay co-pays.
• Patrick Monette Shaw expressed disappointment with Council Director Mr. Newby and Co-Chair Allgaier regarding their recent article in the B.A.R. and implied that the inflated statistics reported by the SF CARE Council are affecting people negatively.
• Bill Barnes discussed the City budget, and the proposed cuts of some $15 million. He emphasized that if some of the people who spoke earlier have their way, the cuts could be more. He added that it would be helpful to send a letter or email to the Board of Supervisors expressing support.

VII. Alternative Funding Streams Presentation
Jeff Byers, California Department of AIDS, CARE Section
CM Byers presented on alternative funding streams, including Title II, ADAP, CARE-HIPP, and other state funds. (Copy of PowerPoint presentation on file at Council Support Offices). Council discussed and asked questions of Mr. Byers who provided informative answers.

Public Comment on this item
• Tracy Brown from TARC, asked a question regarding MAI funds and Mr. Byers indicated he would address the question during the break.
• Patrick Monette-Shaw made a comment to encourage Mr. Byers to work to increase in the HIPP program.
• Bill Barnes commented on the usage of ADAP in other states, and suggested that the HIPP program has more value for the money.
• Michael Petralis – discussed the possibility of some errors in Mr. Byers presentation that reinforce his opinion regarding the negative effect of inflated numbers.
• Patrick Monette-Shaw commented “dump Reggie”

VIII. HIV/AIDS Provider Network Presentation
Mike Smith, HAPN
Council Members will be presented with an update from HAPN, and have an opportunity for discussion and to ask questions.
Mike Smith presented an update on the HIV/AIDS Provider Network and their recommendations to the Council regarding this year’s prioritization and allocation process, service categories, and other matters. (Copy of PowerPoint presentation on file at Council Support Offices). Council Members directed comments to and asked questions of Mr. Smith who provided informative feedback.

Public Comment on this item
• Michael Petralis commented that the epi data points to the number of people infected with HIV/AIDS has decreased and out of 55 agencies none of the Executive Staff have taken a salary cut. His suggestion of agencies merging and collaborating is not happening.
• Patrick Monette-Shaw requested more transparency with the HAPN process, and suggested a facilitator. He added that there has been defunding of Adult Day Health Centers and suggested that the Director of Council Support position be eliminated to pay for research.
• Bill Barnes clarified Title I funding for Bayview had been funded in the past with general funds.
• An unidentified member of the public discussed the last time CARE money was provided to the Bayview and expressed offense that in 2005 there is suddenly concern for African Americans, and stated that there seems to be a disparity in services.

IX. Dinner Break 6:15 PM

CM Simmons indicated that it has been since the early 1990s that Title I money has been spent in Bayview, and wanted to clarify his earlier comments.

X. Service Categories PresentationDiscussion - VOTE
Laura Thomas and Don Soto, Planning Committee Co-Chairs
Proposal from Planning Committee regarding Service Category definitions.
CM Thomas presented a proposal for changing the way service categories are used to make decisions. The Planning Committee and several other committees have looked at it to make a final recommendation, it was sent to Steering Committee where there were some concerns. There was no time for a Planning Committee meeting prior to this Council Meeting. At the direction of the co-chairs, Don Soto and Laura Thomas, as Planning Committee co-chairs took into account the Steering Committee concerns. Essentially, this recommendation is coming from CM Soto and CM Thomas and not the full committee, but represents the full conversation at Planning and Steering, and coming to Full Council for a final decision.
One issue at Steering was a concern about the existing status quo and what that looks like. CM Thomas reviewed the impact of changing the service categories. The federal agency, HRSA, provides a list of service categories allowed. CM Thomas provided additional information regarding the history of the SF EMA that has created its own categories, or used different terminology, to reflect the epidemic in San Francisco, similar to HRSA categories but not identical. She mentioned that this has become more problematic over time. Reggie, Needs Assessment, Priority Setting, reporting to HRSA and others use different lists. The effort here has been to come up with a consistent list.

She walked the Council through the proposal and passed out two documents (on file at Council Support Offices). The Council and the AIDS Office will use HRSA categories for prioritization, and continue to use local subcategories for allocation. Reports that come to Planning Council from the grantee will also contain subcategories. The AIDS Office cannot move money from one service category to another, and cannot move it into a category that has not been prioritized by the Council.

CM Molnar asked if the AIDS Office will have the ability to move funds within a service category.
CM DiCrocco asked about Complementary Therapies appearing on the chart. CM Thomas added that HRSA does not represent Complementary Therapy as a service category. She indicated that it falls under Other Support Services within the local subcategories.
CM Byers asked about Agenda Item X, and whether any adjustments could be made. He added two additions to Agenda Item X. To the first bulleted item: add “and the state” and to the third bulleted item add “and Title II”.
CM Allgaier indicated that directives to the AIDS Office must be provided in order to be clear about the language and intent of how money is spent.
CM Thomas directed Council to the chart on the back of the handout providing examples of current categories, for example the subcategories of housing would all be collapsed into one category of Housing.
CM Thomas indicated that Planning Committee will come up with a list of categories to work with, but it is up to the Council to decide whether subcategories need to be moved up or down.
CM Banks asked about the process of this item coming to Council. CM Thomas clarified. CM Banks explained that it is setting a dangerous precedent and seems unfair to the public who may not have been aware of it. CM Thomas explained that several committees over several months have looked at this item all of which were noticed properly.
CM Durio asked if there was a motion on the table.

CM Thomas moved that the Council move to accept the three bullet points with the additions that CM Byers suggested.
CM Simmons seconded.

Discussion of motion:
CM Simmons spoke in favor of the motion and stated that it would make things simpler for the grants.
CM Molnar thanked CM Thomas and CM Soto for work on the proposal, but spoke against the motion. He believes the Council is backing into a corner with this proposal, and provided several specific examples. Because of the inconsistency in explanations about the motion from different Council members he feels the proposal is unsound.
CM Spaeth spoke in favor of the motion, and explained how Marin County has used the HRSA categories, and believes it will make it easier if all counties are using the same categories and same reporting.
CM Allgaier spoke in favor of the motion for three reasons: because the Council has combined Prioritization and Allocation at the same time which can cause some confusion. Because of reporting to HRSA that is different than what Council uses, it helps to keep budget accountable. His issue at the Steering Committee concerned allocations done at the subcategory level, and if directives are provided to AIDS Office this could be done in general. He expressed the need to be able to look at a budget and have it similar to what Council decided.
CM Kanios sees the value of having a standardized prioritization to look across the board. He stated that there is an obligation to the grantee, and spoke in favor of the motion.
CM Geanuracos stated that she is unclear. She asked if the grantee can move money within larger HRSA categories.
Michelle indicated that historically the appropriate committee is consulted if changes need to be made.
CM Hicks asked what is happening now with regard to the grant and the reports being filed to HRSA. She spoke in favor of motion.
CM DiCrocco spoke against the motion and echoed the concerns of CM Molnar. He sees the benefit of using HRSA categories and fears the AIDS Office could move money around in such a broad area without Council approval and could remove the Council from the process.
CM Durio – stated confusion and asked why there needs to be a change.
CM Thomas explained: so that the AIDS Office does not have to combine things from one category to another to make what Council the does fit properly into the HRSA categories. That way the recognizable service categories will appear in reports, provide consistency across the whole system, Reggie reports, budget, grant application, etc. She explained how this is meant to bring more consistency into the process so neither the AIDS Office nor the Council needs to make huge leaps to make everything work.
CM Durio spoke against the motion because he believes some of the smaller subcategories will eventually be lost due to lack of institutional memory.
CM Kleffner directed a question to CM Thomas regarding the use of subcategories in prioritization. CM Thomas explained.
CM Kleffner asked a question regarding directives to AIDS Office regarding subcategories.
CM Callandrillo commented on the value of aligning with HRSA categories, and expressed concern that the first part of the proposal seems reasonable and the other text seems unnecessary.
CM Thomas explained that the additional three paragraphs are background and description and not part of the proposal.
CM Pearce spoke in favor of the motion and reminded Council members that prioritization and allocation should be looked at as two separate issues and processes.
CM Booker called the question.
No objection to calling the question.

Public Comment –
• Patrick Monette-Shaw commented that the proposal abdicates the role of the Council to the AIDS Office.
• Russ Zellers spoke to the issue with regard to moving funds. He stated that the intent of the AIDS Office is to give flexibility, primarily with regard to unspent categories, not to move money willy-nilly. The ability to reallocate within a broader category such as housing, if there is unspent money and sufficient time to reallocate without major effort to obtain permission for changes.
• Bill Barnes commented that by standardizing the process it makes things easier, but if losing budgetary control then it can be problematic.

CM Thomas read the proposal in its entirety, including additions suggested by CM Byers.
Council Support read the roll for Council Members to vote on the proposal:

21 Yes/6 No. The motion passed. See Attachment A, Column 2.

Public Comment on this item No public comment.

XI. Needs Assessment Update
Catherine Geanuracos, Needs Assessment Working Group Co-Chair and Harder + Co.
An update on the Needs Assessment Process
CM Geanuracos provided an update on the Needs Assessment process and referred Council members to the handout entitled 2005 SFEMA Comprehensive Needs Assessment Project Update dated June 27, 2005 (on file at Council Support Offices). She explained how Harder + Co has already exceeded the target for African Americans; the Latino numbers are low because the Spanish survey was late in getting out. She indicated that the numbers were slightly out of date since assessments have been completed since the compilation of this data. She explained that the survey is only part of the needs assessment, and indicated that the focus groups help to provide additional data. She provided an update with regard to the Provider Survey. She also discussed focus groups, and next steps. She explained that open enrollment for survey has closed but they are doing targeted intercept recruitment. Hope to have preliminary data before the two-day August summit. CM Geanuracos and CM Pearce (who both sit on the Needs Assessment subcommittee) informed Council that this is very raw data and more precise data will be available later and distributed to Council Members.

Jack Newby indicated that Harder & Co. will be at COA Committee this week to discuss information that came out of the consumer forums.
CM Banks asked if Council Members could attend focus groups to watch and listen. CM Geanuracos was unsure.
CM Kleffner indicated that it was decided that it was not preferred for her to participate in a Marin County group, as it may be a conflict of interest.
CM Geanuracos’ opinion was that Council Members should not participate in the focus groups.
CM Allgaier suggested that the participation of a Council Member might influence the dynamics of the focus group and suggested that it was best for Council Members not to attend.

Public Comment on this item No public comment.

XII. New Business/ Next Agenda
• The next Council Meeting is scheduled for July 25, 2005.

XIII. Adjourned
CM Siron adjourned the meeting at 7:31pm


 

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

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