September 25, 2006 Minutes HIV Health Services Planning Council Meeting

HIV Health Services Planning Council

Milton Marks Conference Center
455 Golden Gate Avenue (Polk & Larkin)
Lower Level, San Diego Rooms
Monday, September 25 th , 2006
4:30 - 7:30 PM

DRAFT MINUTES

I. Call to Order

The meeting was called to order at 4:45 p.m. by CM Allgaier (Co-chair).

II. Roll Call

Quorum was established by roll call (Attachment A).

III. Review and Approval of Agenda

The agenda was reviewed without objection.

IV. Review of August 24 th and 26 th 2006 Minutes

CM Antonetty has requested that future minutes include “Action” or “Outcome” sheets.

August 24 th – approved without objection. (Attachment B)

August 26 th - approved without objection. (Attachment C)

V. General Announcements

CM Thomas announced that Tenderloin Health has received a special project of national significance grant to provide oral health services for people with HIV in partnership with Tom Waddell Health Center. Services will be provided at Tom Waddell and Tenderloin Health Services. Still in the planning and startup process but it will bring additional $2.5 million worth of services over 5 year period.
CM Antonetty announced that Project Homeless Connect #13 is going to meet next Thursday. If anyone has clients that are homeless, please make them aware of this. This will attempt to be one stop shopping for homeless needs. However, please do not promise housing. Anyone that wants to volunteer can contact the PHC website or CM Antonetty. A lot of different agencies are participating, and rapid testing and a variety of other community services will be available.
CM Allgaier welcomed CM Brown back to the Council.
CM Allgaier also discussed leaving his post as Council Co-Chair and the general purpose of participation of Council Membership as roles of empowerment.
CM Pearce asked CM Thomas if the oral hygiene and oral care was only for Tenderloin clients.
CM Brown responded that partner services will be provided by Tom Waddell be the need being so great, can only see six per session and will be oversubscribed. Tenderloin Health will operate a drop in first come/first serve and the need will be greater than what can be provided. However, there will be resources available to provide other dental services than what POP pays for. There is no expected fallout from UOP.
Mr. Newby thanked CM Allgaier for his work during the last two years.
CM Kanios thanked CM Allgaier on behalf of CM Soto as well for leadership and mentor role.

VI. Public Comment

Aimee Crisostomo of Harder+Co in collaboration with San Francisco Department of Public Health (SFDPH) and the HIV Prevention and Planning Council (HPPC) is conducting a needs assessment of people who test HIV-positive for the first time one year or less before they receive and AIDS diagnosis (aka late-testers). Information from this study will be used to improve HIV-related services and to inform local planning. The survey topics include; barriers to testing, the motivations behind getting tested, how to encourage getting tested earlier and how local results conform to national research. The surveys will be conducted one-on-one with 25-30 people and will include 2-3 focus groups. Recruiting for participants will continue through October 2006 and all agencies are requested to assist in recruitment for this survey.
Jacob Moody, BUHPFCI, spoke regarding the recent Macy’s Passport event and felt that the outcome from the firm hired to coordinate the event was less than optimal. If any CARE members or their staff participated in this year’s event, Mr. Moody would like their feedback. He may be reached at 415-822-9743. He felt that overall this was a good event, but felt the event was lacking this year.

VII. Distribute Ballots for Council Co-chair

CM Kleffner has declined the ballot position.

There were no other nominations. The nominations were closed.

The ballots were distributed and will be collected prior to the dinner break.

The nominees were offered an opportunity to speak to the Council regarding their nominations:

CM Herman will seek to maintain the high standards of the position.
CM Newell is honored to be nominated. She will be fully involved and strive to be a valuable co-chair for council and the community.
CM Siron is a PWA and this is second nomination as co-chair and would be honored to serve in the position.

VIII. Council Membership Applicant Recommendations

CM Molnar, on behalf of the Membership Committee, presented application of Billie J. Cooper for Council approval.

Ms. Cooper is presented as an African American consumer of Ryan White care services, and a person of strong character.

VOTE - Ms. Cooper was approved by unanimous vote following a vote by show of hands.

Public Comment on this item.

There was no public comment.

Committee Assignments

CM Molnar discussed the recent committee assignments for Council Members and that this was still a work in progress.

CM Pearce disclosed that this selection process included discussion of committee needs and demographics cross sections for assignments.

This process resulted in the following assignments:

Community Outreach and Advocacy

Aimee Barnes
Billie J. Cooper
Darnell Durio
Wade Flores
Walter Miller
Catherine Newell

Evaluation Infrastructure and Policy

Ayisha Benham
Tracy Brown
Robert Oropeza
Charles Siron
Donald Soto
Sparkie Spaeth

Points of Integration

William Blum
Ken Pearce
Susan Philip

Membership

Raymond Banks
Stephen Herman
Mary Lawrence Hicks
Dorothy Kleffner
Mark Molnar
Kandi Patterson

Planning

Randy Allgaier
Margot Antonetty
Billie-Jean Kanios
George Simmons
Ellen Sweetin
Laura Thomas

IX. Department of Public Health, HIV Health Services Quarterly Report

Ms. Michelle Long, Department of Public Health, HIV Health Services, discussed four areas (Attachment D):

Conditions of award met July 2006 – August 2006
Quality Management
Contract Status Report
New Staff

Conditions of Award - Ms. Long discussed that CARE Title I applications will be mailed out on Thursday, September 28 th and anyone wanting an advance copy may request it through Mr. Newby at the HIV Council Support office. These applications will be due on October 2 nd, 2007. The amount being requested is $33,837,485 which represents a 21% increase over the current budget. This request, if funded, would put San Francisco at the 2003 award amount prior to the large budget cuts maintained since that time.

Quality Management – Ms. Long discussed the 2 training programs being conducted during the next quarter by the Quality Management Program (QMP) and other provider trainings sponsored by HIV Health Services (HHS).

These trainings include:

9/17/06 Medi-Cal Billing Training (QMP) – this training is primarily targeted to the COE’s but training is open to others interested in fact finding.

9/19/06 Recruiting the Right People (HHS)

Contract Status – reflects the 23 contracts that are CARE I and II being processed and MOU’s with the DPH. She also gave the breakdown of the contract status.

Contractors were waiting on the COLA that they were promised and did not turn in CARE documents to create a CARE contract because they thought that they would have GF $ to add to that. This was by their choice and not a direction of the grantee. Also subs got additional GF$ that they wanted to incorporate into a contract. General fund and COLA monies were not available until within the month of August when most contractors got a contract extension and have been paid.

New Staff – Ms. Long concluded her presentation by announcing the hiring of a new part-time secretary to the HIV Health Services staff.

CM Pearce questioned whether, with respect to Medi-Cal billing, there are programs that can be maximized by billing Medi-Cal?

Ms. Long responded that there are programs that can maximize how they are billing with everyone who can bill Medi-Cal is setup to bill Medi-Cal. The issue with the COE is to be pro active and what they found out dealing with HRSA and their audit in the program design that they had what they had what the insurance companies understand. Calling them in early is to explain to them the configurations of the COE’s will hopefully avoid dis-allowment of payment and maximize payments.

Public Comment on this item.

There was no public comment.

X. Centers of Excellence Presentations

There are seven (7) Centers of Excellence (COE) in the San Francisco EMA, with five (5) being funded by CARE.

The five CARE funded COE’s include:

Mission Neighborhood Health Center of Excellence (Attachment E)
CChamp/ Women’s Center of Excellence(Attachment F)
Tenderloin Care Center of Excellence
Forensic AIDS Project Center of Excellence
Southeast Center of Excellence (Attachment G)

Mission Neighborhood Health Center of Excellence – Fernando Gomez-Benitez, HIV Services Director, presented powerpoint information regarding this COE. The general topics covered included:

Goal discussion
Mission COE Flowchart
Funding breakdown between MNHC
Staffing breakdown by agency
Positive Aspects summary.
Staffing Breakdown.
Negative and challenging aspects.
COE funding Impact on Services MNHC / Clinica Esperanza

In viewing the impact summary, pre-COE data was compared with March-August 2006. It was noted that a 31% increase in Title I cases and a 51% increase in referrals and linkages occurred. This data was taken from the SFDPH database.

Chronic Care HIV/AIDS Multidisciplinary Program (CCHAMP) - Richard Bargetto presented information regarding this COE to include:

Successes
Start-up Challenges
Interesting Observations

Women’s COE – Mr. Bargetto also presented information regarding this COE to include:

Successes
Start-up Challenges
Interesting Observations

Mr. Bargetto noted that despite the challenge of Reggie connectivity issues, there appeared to be a seamless service to clients. As an observation, with five (5) partners when partner has and issue it affects the entire COE. This is due to the MOU and other contractual obligations.

Also noted was that clients come to COE even when not seeing their provider and they are accessing mental health services as well as primary medical care.

Tenderloin Area - Naomi Prochovnick, Director, Tenderloin Care Forensics, discussed the merger of Tenderloin Health

This is actually two (2) COE’s that function within one agency and same neighborhood. Goal is seamless presentation of services. The bulk of challenges are administrative. It was noted that services are Tenderloin based are not CCHAMP based. CCHAMP determined that funding was not sufficient to provide primary onsite medical care within the Tenderloin. FT nurse still but no clinic by ward 86 and now clients must go to ward 86. Tom Waddell has agreed to provide 2 separate half day medical clinics at 255. Good results with attendance. Last week there was a 102% show rate.

There is greater flexibility with the merging of the two agencies, since clients can flow back and forth between 255 and Tom Waddell. Also noted was the electronic charting system that is inclusive across all categories and makes information available to everyone within the COE.

They have attempted to remain creative in providing seamless service to a highly chaotic population.

Forensic AIDS Project (FAP) - Kate Monico Klein, Executive Director spoke of the services provided to the incarcerated. The goal of FAP is to return people into the community in as smooth a transition as possible. The breakdown of the approximate 700 clients they see a year include:

88% male
12% female
5% transgendered
44% African American
11% Latino
40% Caucasian
5% Asian/Pacific Islander
<1% Native American
59% have mental health diagnosis
62% report themselves as substance abusers

FAP works in three (3) jails at the Hall of Justice, on two (2) jail wards at San Francisco General Hospital and in two (2) jails in San Bruno.

Basic challenges and barriers revolve around funding for health education groups and to coordinate transgender services.

Southeast Partnership for Health (SPH) Center of Excellence – Charlotte Smith, Director, spoke of the overall COE partnership they are involved with including the partnerships, vision and purpose.

The purpose of SPH is to address the widening gap between morbidity and mortality among African Americans living with HIV/AIDS in the Southeast region of San Francisco.

Ms. Smith’s general presentation included:

Overview
Partners
Vision and Purpose
Challenges

Case finding
Establishing systems of care at 3 sites
Community organizational infrastructure.
Low community literacy

Services

Primary care
Case management
Treatment adherence
Mental health services
Substance abuse assessment and referral
Nutritional services
Pharmacological services

Success
Program Statistics

Conclusion

This COE strives to support the individual and community in generating a broader perspective for defining themselves as African Americans in the AIDS epidemic.

Questions

CM Allgaier reminded Council that questions are to be service category related only.

CM Pearce – Considering the very large number of clients that are being seen at ward 86 and not being able to serve all of them at the COE, are some of those clients being seen at other COE’s or is this a group of people not being served?

CM Allgaier restated the question. For clients that were being served prior to the COE inception who are now maybe not being seen or there has been a change or a shift in the continuum of care, how has that been managed?

Richard Bargetto - Every client is assigned to only one COE. If a client comes to ward 86 and they believe they should be eligible for the COE they are added immediately. It takes great time and energy to determine whether eligible and possibly graduated from COE. Clients are not turned away if not eligible for COE and they would be.

Fernando Gomez-Benitez agreed that this is an administrative issue. They use a formula and it would only cover 50% of clients they serve. If they find out that a client is receiving service at another COE, the client is encouraged to make a decision as to where service is received.

CM Molnar – What is the UDC contract for Tenderloin area?

Naomi Prochovnick – TLH has seen 236 and the contract is approximately 400.

For FAP?

Kate Monico-Klein - 400 contract and FAP sees 700 clients annually.

For SEH?

Charlotte Smith - 100 SE infected and 200 for affected.

CM Molnar – each COE is serving various populations and curious about those that have 2 COE’s and what criteria is used to determine where the client goes.

Naomi Prochovnick - Client choice as well as capacity dictates where the clients go in this case.

Charlotte Smith membership is defined by the association of case management and there is a significant amount of case management that occurs away from the primary medical care site.

CM Allgaier – What is the difference between proposal and what is operational? How has the cultural issues been addressed between non-profit and governmental entities?

Charlotte Smith – A blending of cultural differences, a marriage of culture has occurred.

Fernando Gomez-Benitez – An Even though there are shared visions between two different organizational cultures, differences have been identified.

Naomi Prochovnick – When the concept was designed they had big visions. Unfortunately, funding did not follow the vision. She is a proponent of shared electronic systems. In looking at the model for all people all needs, an expansion of old model of CARE is looked at when anticipating cuts.

CM Herman – Inquired about client surveys and feedback.

Richard Bargetto responded that 200 clients completed and feedback indicated that clients like services and highest point is courtesy, and lowest at CCHAMP and Women’s Services is waiting time.

Charlotte Smith responded that clients their feedback indicates that clients are surprised that comprehensive case management services are once again available.

CM Pearce asked if a meeting has occurred to approach the next step of seamless services for COE’s and are ideas being shared?

Naomi Prochovnick – They met monthly for a year and they do coordinate with other COE’s.

CM Siron – Are we getting outcomes or impacts from CARE funding among all COE’s?

Naomi Prochovnick – Clients at both Tenderloin COE’s represent 50% African American and 70% people of color and they are doing outreach to get these people into CARE.

Charlotte Smith – What is an improved quality of care? Is it that they are meeting their appointments? Or is it that there t-cells are rising, etc.? At SEH, they have a system in place to attempt to track this data.

Public Comment on this item.

Considering the high numbers of African Americans in the system encouraged that the COE committee should encourage those African American clients have a place to go. He works at a drug program and has a large number of clients that would like to switch COE’s and there appears to be a problem with them switching and coming to Bay View and coming to their home.

XI. Dinner Break

Meeting Evaluation Forms were distributed to Council Members during the Dinner Break.

XII. Discussion and Possible Action Regarding Policies and Procedures Manual Attachment (Attachment H)

Meeting Attendance Requirements

CM Kleffner discussed the purpose of the policy change and CM Molnar read the proposed attendance policy.

Following clarification regarding the appeals process and purpose, and matters concerning HIV-positive Council members CM Molnar read the propose bylaw change for attendance. It should be noted that no voting on the bylaw change is being done at this time, however this item is being officially noticed at this meeting.

CM Kleffner discussed the basis and guidelines that were used in this drafting of this amendment following questions regarding its purpose.

CM Simmons called the question without objection.

Vote
This motion passed unanimously. (Attachment A, Item 2)

Committee Motion from Non–Committee Members

Following an objection from CM Kanios, the Work Group and Committee Voting Policy item was tabled for the next meeting with CM Siron opposed to the tabling.

VOTE
Favored – sixteen (16)
Opposed – one (1)
Abstentions – one (1)

This motion passed (Attachment A, item 3)

Policy Regarding Advocacy Project Report

Mr. Newby outlined the purpose of the policy.

Following general discussion this motion from committee was approved by consensus.

Public Comment on this item.

There was no public comment.

XIII. Review of 2006 Prioritization and Allocation Summit

Table for next meeting since CM Antonetty has requested a written report.

Public Comment on this item.

There was no public comment.

XIV. CARE Act Reauthorization Update (Attachment I)

Laura Thomas, Co-Chair, Planning Committee presented this update. Ms Thomas provided a handout outlining the funding proposal for the Ryan White HIV/AIDS Treatment Modernization Act of 2006. Additional correspondence between the lead Congressional staff and community stakeholders as well as a letter of community support from Governor Arnold Schwarzenegger was presented.

The Bill has been passed by the House Committee and is being reviewed by the Senate Committee. At this time, there is no hold harmless provision and this EMA will stand to lose approximately $10.5 million over a 5 year period if this new bill is passed. In addition, if this bill passes by the end of this year’s session, there will be a need for this Council to reconvene and do another Priorities and Allocation Summit in the coming weeks. If the Bill dies in Committee, as anticipated, the EMA would be able to proceed with the grant applications under the current legislated guidelines.

There have been great strides made in lobbying for various changes to the legislation to include, but not limited to, a clearer definition of medical case management.

Of particular concern with the formula for the new allocation process will be the use of new HIV infections over the last five (5) years as a base for funding. This however, does not include those individuals diagnosed prior to that time and are now on CARE.

Ms. Thomas will inform the Council with updates on anything that happens with this reauthorization as quickly as it is learned.

Public Comment on this item.

There was no public comment.

XV. Notice of Proposed By-Law Change: Attendance Requirements/Probation – Article VI. Section I