Minutes of August 12, 2002 HIV Health Services Planning Council meeting

HIV HEALTH SERVICES PLANNING COUNCIL MEETING

Meeting Date: August 12, 2002

Meeting Place: City Hall, Mayor's Conference Room 201

Meeting Time: 4:30pm - 7:30pm

I. Call to Order
4:40pm

II. Roll Call
See Attachment A., a quorum was achieved.

III. Review and Approval of Agenda
There were no changes to the agenda.

IV. Review and Approval of Minutes 7/22/02
The Council postponed approving the minutes.

V. General Announcements
There were no announcements.

VI. Public Comment
Patrick Monette Shaw explained that the summary sheet amounts do not total the complete CARE award for fiscal year '01-'02. Five million dollars of service funding was not included in the summary sheets. Administrative costs were not assigned a summary sheet.
Bill Hirsh spoke for using the Carry Forward funds to back-fill the deficit from this fiscal year.
John Lipp, Interim Executive Director, Positive Resource Center introduced himself.
Attorney, Board member of ALRP, asked the Council to consider how important Housing and Benefits are to People Living with HIV.
Peter Fogal, of Walden House, thanked the Council for their hard work. Substance Use services provides Housing. Cutting Substance Use funding would also cut Housing.
Stephanie Morgan, of Family Support Services, introduced herself. She explained that consumers use her services when they most need a safe place to stay.
Consumer would like to know when the California budget will be signed.

VII. Committee Reports
Steering Committee - Carry Forward Dollars Request Discussion & VOTE
Laura Thomas distributed the Carry Forward breakdown for FY 01-02 by Service Sub-Category (See Attachment B). In order to expedite an approval from HRSA to backfill amounts cut from this fiscal year with Carry Forward dollars, the Steering Committee made a recommendation for use of those funds. After funds to fill the deficit for FY 02-03 are applied, there is a remainder of $210,508 available for new projects.
Marin County asked for $7,500 of Carry Forward funds for Prioritization resources for the Marin AIDS Commission and Case Management assessment.
Planning Council support asked for $47,500 for projects that were not allocated funding at the last prioritization, that are mandated by HRSA: Needs Assessment activities (additional focus Groups); Grantee Assessment activities; advertising/print media; website.
Housing Committee proposed to provide the remaining amount for Direct Emergency Financial Assistance. As it would be difficult for any agency to use $70,000 within only a couple of months, this subcategory could apply the money easily. The recommendation included a proposed $65,500 to be used for REGGIE data entry. $20,000 would go to food vouchers.
Ken Pearce suggested that the group consider using monies for technical assistance for agencies to learn how to bill MediCal to the maximum. Toni Butler explained that MediCal does supply technical support for agencies.
Sam Kaplan requested that if monies are going to be used for Needs Assessment focus groups, the amount should be applied to looking at homebound populations and those not-in-care.
Patrick Monette Shaw, member of the public, explained the numbers do not add up. He suggested the Council not use the money for REGGIE, as the system should be scrapped. He added that the Council does not need a website, as PRC and DPH have existing websites.
The group expressed interest in receiving a breakdown of the Council support proposed amounts. Norman Tanner explained that the monies should be applied to direct services, not administrative costs. Bill Hirsh encouraged the group to put as much money back into client services, not spending money on REGGIE to justify spending money later in prioritizations.
Susan Shea spoke against the proposal. The Council has an unfunds policy to send these proposals through the I & E Committee. She asked for the AIDS Office to explain why so much money left on the table last year. This would assist with prioritization. She explained that her agency received its award on the last day of the fiscal year, and this could be a reason that the money was not used. Susan explained that she must see the breakdown to speak to the Planning Council support. She spoke against spending the money for REGGIE, as the Council previously agreed not to fund the project.
HRSA requires that the total request be submitted at one time, not in pieces. The request is not due until September 30th, but the sooner that the Council submits a request, the sooner the money will be distributed.
John Conley made a motion for the total amount over the back fill amounts be applied to Direct Emergency Financial Assistance (DEFA); the motion was seconded. Brad Hume made a friendly amendment to spend half of the $210,000 for Immigration/Legal Assistance and half for DEFA. Susan Shea spoke against the motion and instead proposed that that the total Carry Forward funds be put back into all 31 subcategories equally for COLAs and overhead. John Conley did not except Brad Hume's friendly amendment.
Patrick Monette Shaw, member of the public, explained that the Health Commission has asked that COLAs need to be fundraised, not funded from this group.
Ken Pearce offered that because the Council must spend the money now, they should use the money for food vouchers. Ali Riker spoke for John Conley's motion. Mark Dunlop spoke against all of the motions, as the Council should not make any rash decisions without proper documentation.
Jim Mitulski spoke for the Council Support proposal, to adequately fund the Council infrastructure and be compliant with HRSA's requirements. George Simmons supported Mark Dunlop's suggestion that the Council hold off on making this decision at this meeting.
John Conley withdrew his motion. All agreed. The matter will be moved to I & E, and the Council will vote at the August 26th Retreat.

Steering Committee -- Multiple Cut Scenarios Discussion & VOTE
The vote was tabled to the Retreat. The Retreat will be held at the Multi-Services facility of Walden House on 1885 Mission Street at 15th Street.

Three-Year Plan Working Group -- Draft of Goals & Objectives
Catherine distributed the Three Year Plan Goals & Objectives for the Council review (See Attachment C). The Council has never prioritized at the sub-category level, so a work sheet was distributed (See Attachment D) that the Council members will use to rank their vision of the priorities. Charlene Pugh put together a Decision Matrix (See Attachment E) that the Council can use as a tool for prioritization. Each Council member is to submit his or her prioritization sheet to Tricia before the Retreat.
Sam Kaplan explained the Needs Assessment information should be clarified. He will forward his comments to the Council via email.

VIII. Presentation - SFDPH -Report on Integrated Service Provider Survey & Assessment
Joel Ginsberg, of Compass Point, reviewed the scope of the report on Integrated Service Providers. ISPs have increased the number of people receiving primary care. Substance use and mental health coordination coupled with an interdisciplinary team and the public health system are needed for a successful ISP. Housing is continually a barrier to care.
Needs outlined include a shortage of psychiatric and mental health services, especially a lack of appropriate staff to handle complex needs of severe mental illness and substance dependent clients. Monolingual clients face service barriers, as there is an overall lack of Spanish speaking Detox staff, and Asian therapy services.
Cultural competence is critical for successful service intervention, especially providing Spanish-speaking staff. There are structural challenges: sharing client data; clarify MOUs, funding technical assistance for collaborative work; regular provider meetings; increased coordination and sharing of resources among DPH branches.
The presenter explained that there must be a close interface between Mental Health and Substance Use service providers who are part of the clinical team. Clients would like staff on site available for a drop-in basis, with great harm reduction skills, but with sensitivity to abstinence. The staff should be shared between ISPs, but must be on-site and participating in teams.

IX. Presentation - MediCal Update
Herman Levias, Benefits and Resource Manager at the AIDS Office, distributed A Guide to Health Care Programs in San Francisco (See Attachment F). MediCal is a need-based health program. MediCal is an insurance program that a finite amount of money to cover services for HIV consumers. In order for a provider to be successful in capturing MediCal reimbursement, they must meet the following characteristics:
1. Having an eligible patient
2. The service must be covered by MediCal program
3. The healthcare provider must be registered and certified by MediCal
There are providers who are not billing MediCal because of a number of reasons. Mr. Levias distributed a MediCal provider application to become a certified provider (See Attachment G). The patient must be income eligible or disabled, or part of a family unit that includes one of these requirements. MediCal covers "standard medical services", widely recognized treatment. Mental Health is a little different, because counties are responsible for assessing those services. There are restrictions on what MediCal will cover, i.e. pharmaceuticals, podiatry, etc. Often MediCal will place a visit restriction on a patient. CARE funded services are the funding source of last resort. MediCal, too, is for last resort, but is required to pay for services before CARE is required to pay.
Detox and Substance Use services are not billed to MediCal. Sam Kaplan made some corrections to the presentation. Because CARE does not have the same strict restrictions as MediCal, the billing process is different. Mr. Levias claims that turnaround time for payment is 15-30 days, unless there is a problem with the bill.
Charlotte Bobek explained that CARE money is not set up as insurance money, and cannot be used as such.
Patrick Monette Shaw, a member of the public, explained that the reason that the providers may not bill MediCal because it is labor intensive. MediCal will not solve CARE dollar problems.

X. Presentation - SFDPH - Report, Mental Health Sub-category Summary Sheets

XI. Presentation - SFDPH - Report, Substance Use Sub-category Summary Sheets

XII. Presentation - SFDPH - Report, Case Management Sub-category Summary Sheets

XIII. Presentation - SFDPH - Report, Day/Respite Care Sub-category Summary Sheets

XIV. Committee Reports
Membership Committee
Membership Committee made a recommendation to re-appoint Brad Hume. There was a unanimous vote to forward Brad's name to the Mayor for re-appointment.

PLWH Advisory Committee
Brad Hume explained that the committee held a successful community forum; about 35 people participated in a prioritization activity. Common themes focused on the need for integrated services, "one-stop shopping". Brad thanked the group for their participation.
Norman Tanner requested the committee supply additional outreach.

I & E Committee
Catherine Geanuracus urged Council members to forward their thoughts/proposal to Sam Kaplan or Charlene Pugh if they are unable to attend tomorrow's meeting.

Housing Committee
The group will meet one more time before Prioritization on Thursday, August 16 from 10am-11:30am at 240 Golden Gate, 3rd Floor.

XV. New Business
There was no new business.

XV. Adjourn
7:22pm.

Approved 8/26/02