INTEGRATION OF CARE COMMITTEE The Center 208 West 13 th St, Room 301 New York, NY November 29 th, 2018 12:30 pm-2:30pm M I N U T E S Members Present: Katrina Balovlenkov, Danielle Beiling (Co-chair), Lauren Benyola, Randall Bruce, Bettina Carroll (non-voting), Michael Ealy (phone), Dorothy Farley (phone), Ronnie Fortunato, Janet Goldberg (phone), Bill Gross, Graham Harriman, Christopher Joseph (Co-chair), Peter Laqueur, Jan Carl Park, Donald Powell, Saul Reyes (consumer-at-large), Annette Roque, John Schoepp, Claire Simon (phone), Brenda Starks-Ross (phone), Joel Zive (phone) Members Absent: Billy Fields, Deborah Greene, Dorella Walters (Co-chair) Other Attendees: Jose Colon-Berdecia, Carlos Cubas, Matthew Lesieur, Scarlett Macias, Monique Mackey, Tye Seabrook, Scott Spiegler, Agenda Item #1: Welcome/Introductions/Moment of Silence/Minutes Ms. Beiling opened the meeting, welcoming everyone and leading a round of introductions with an icebreaker. Mr. Bruce led the committee in a moment of silence. Agenda Item #2: Review of Meeting Minutes, Schedule & Packet Ms. Lawrence introduced the meeting packet and asked if there were any changes to the minutes. The October minutes were accepted. The packet included the Agenda, October minutes, Early Intervention Services Standard of Care (SOC), SOC Update &Transitional Care Coordination grantee presentation, notes on previous TCC presentation and upcoming Calendar. Ms. Lawrence noted that previous presentations on TCC were made available to the committee digitally. Agenda Item #3: Standards of Care Mr. Spiegler reviewed the changes made to the standards of care, as well as what changes could not be made because it is required to be lifted directly from HRSA (Health Resources & Services Administration). All SOCs will follow the following format: Introduction to Services; Purpose of Services; Definition of Services (HRSA); Goals and Objectives of Services (RFP and PC Service Directive); Client Eligibility (HRSA guidance; RFP; and PC Service Directive); Service Activities and Standards (RFP; HRSA guidance; PC Service Directive); 1 P a g e
Quality Indicators (chosen by agencies and not always applicable); Staff Qualifications; Case Closure; Grievance Procedure language will be added. The following changes were/or will be made Summary/Introduction to Services added to each S.o.C; Language (where allowed) has been changed to help with comprehension/understanding; Service Table has introduction paragraph explaining what each section is; Staffing language inserted (lived experience vs. education); Case closure language inserted; Grievance procedure language being developed and inserted; Glossary to be created. The sections of the SOCs that cannot be changed and why, are outlined in the faolloing table from Mr. Spiegler s presentation. Section Definition of Services Goals and Objectives Eligibility Quality Indicators Reason why section cannot be changed Taken directly from HRSA Would require change to service directive Directive from HRSA; would require change to service directive Created by providers As you go through the SOCs please note it is what exists now and is a reflection of the service directive. When you find changes that should be made, please note them and bring them up so they can be put in a parking lot. Quality indicators are developed in provider workgroups for each service category. The committee was then instructed to read through the SOC for Early Intervention Services (EIS). Committee members read through for clarity and for logical progression of services being delivered to a person who presents for testing. The committee worked to understand status neutral services where benefits navigation is a critical element when PEP or PrEP is indicated. HRSA issued a policy notice that allows Ryan White funding can be used to link people to PEP and PrEP. Less people are testing positive for HIV. According to HRSA, Mr. Powell noted there is a 90 day window to work with negative persons. All EIS programs are managed through Prevention and designed to work in consortium. Mr. Park noted there are other funding sources that could be used for these services, and should not be Ryan White funding. Mr. Harriman reminded us that RW money is always payor of last resort. 2 P a g e
Client demographics is different from client information and is the language that should be included in the SOC. Assessing the need for benefit navigation versus benefit navigation: are these significantly different? Mr. Harriman suggested changing the language for clarity. Ms. Mackey noted that conducting a proper assessment in the field is highly challenging and unlikely and does not mesh with what is written in the SOC. The brief intervention is an H-Plus screening which is pretty in depth according to Mr. Powell. Mr. Reyes noted that consistency is needed throughout the document. Ms. Roque highlighted that e-share looks different for different programs. PEP and PrEP are being addressed as if the same service in the SOC, but they require different services. Due to a series of service descriptions that do not make sense, the grantee will take the SOC back to prevention and we will revisit at a later date. PEP access isn t always about rape sometimes it is episodic. Some exposure is clinical. RW money is not used for hospitals and clinics. PEP eligible clients will be quickly linked to a provider. PEP and PrEP education is delivered together, but the description of the services should differ to acknowledge that they have different purposes. SOC chart should flow and not repeat. As it stands the chart doesn t make sense in terms of differentiation of payment points. Mr. Harriman suggested he bring the SOC back to the program to ensure that it is in line with the service directive. The committee agreed to put this SOC on hold until it could be reviewed. The grantee is requested to bring all documents for editing in word format with page and line numbers. Agenda Item #3: Transitional Care Coordination TCC Contracts Summary: Total Service Allocation: $1.46 million with awards ranging from $160,000-$450,000 Number of Contracts: 5 4 Base 1 MAI TCC was first created in 2011 to address a specific need in New York City at the time Between 2001-2003, 4% of PLWHA in New York City used the homeless shelter system Prevalence of HIV/AIDS among users of the single adult shelter system was 2x as high as the prevalence in the NYC adult population TCC provides referrals and linkages to housing services, HIV primary medical care, and transition to a case management program An adaptation of Critical Time Intervention (CTI), TCC seeks to improve the care of HIVpositive individuals who are homeless and/or unstably housed by facilitating access to care, housing services, and other social support services Targets homeless and unstably housed individuals who are HIV-positive, including newly diagnosed Are not stably engaged in HIV primary care Transitional Care Coordination Services include: 3 P a g e
1. Targeted Case finding and outreach; 2. Screening and referral for social service needs such as housing, Medicaid, HASA; 3. Screening and referral for medical case management/care coordination; 4. Development and implementation of a service/care plan, with a focus on housing, client stabilization, and linkage to care; 5. Health Education; 6. Linkage to an HIV primary medical care provider and/or outpatient medical bridge program; 7. Transition to a case management program (between 3-12 months after enrollment); and 8. Follow-up by the transitional care coordination program with mainstream care coordination and/or primary care program to verify engagement in care via a kept primary care visit Forty (40) % of the population served are living in SROs. Yr26, March 1,2016-February 28, 2017 Housing status (a) at intake Number Percent Homeless (b) 467 65.3% Unstably 101 14.1% housed (c) Stably housed 147 20.6% (d) TOTAL (e) 715 100.0% Living Situation at Intake N = 716 % Single Room Occupancy (SRO) hotel 48.5% Staying or living in someone else's (family's or friend's) room, apartment, or 18.6% house Room, apartment, or house that you rent (not affiliated with a supportive housing 14.1% program) Emergency shelter (non-sro) 7.1% Homeless/Placenot meant for human habitation (such as a vehicle, abandoned 6.3% building, or outside) Supportive Housing Program 3.6% 4 P a g e
Hospital, institution, long-term care facility or substance abuse treatment/detox center; apartment or house that you own; other hotel or motel (paid for without emergency shelter voucher or rental subsidy); other; missing 0%-1.4% each Transitional Care Coordination (TCC) services are funded through the Ryan White Part A (RWPA) Medical Case Management service category (which includes treatment adherence services). Programs funded in the New York EMA seek to address HIV/AIDS healthcare and clinical outcome disparities among homeless and unstably housed people living with HIV (PLWH) by facilitating access to care, housing services, and other support services through the TCC Critical Time Intervention (CTI) program. The Model: Medical Case Management Services (including treatment adherence) to ensure timely and coordinated access to medically appropriate levels of health and support services and continuity of care, provided by trained professionals, including both medically credentialed and other health care staff who are part of the clinical care team, through all types of encounters including face-to-face, phone contact, and any other form of communication Activities that include at least the following: Initial assessment of service needs Development of a comprehensive, individualized care plan Coordination of services required to implement the plan Continuous client monitoring to assess the efficacy of the plan Periodic re-evaluation and adaptation of the plan at least every 6 months, as necessary. Coordination of services required to implement the plan Continuous client monitoring to assess the efficacy of the plan Periodic re-evaluation and adaptation of the plan at least every 6 months, as necessary. Service components that may include: A range of client-centered services that link clients with health care, psychosocial, and other services, including benefits/ entitlement counseling and referral activities assisting them to access other public and private programs for which they may be eligible (e.g., Medicaid, Medicare Part D, State Pharmacy Assistance Programs, Pharmaceutical Manufacturers Patient Assistance Programs, and other State or local health care and supportive services) Coordination and follow up of medical treatments Ongoing assessment of the client s and other key family members needs and personal support systems Treatment adherence counseling to ensure readiness for, and adherence to, complex HIV/AIDS treatments Client-specific advocacy and/or review of utilization of services Critical Time Intervention was originally meant to quickly move people from shelters to stable housing. The short term nature of the intervention may not serve clients well. It was initially a mental health intervention. TCC has really focused on connecting clients to strong networks, developing a plan and social support system. There is a 3 month phased stage system which is based on research evidence. Medical Case Management: The majority of clients enrolled in TCC already have a primary care physician and/or case manager. (anecdotal evidence from conversations with providers) 5 P a g e
Housing Services: Clients at enrollment are mainly homeless and/or unstably housed and enroll specifically for housing services (referral and linkage), however the model does not provide housing assistance directly. This intervention precedes HASA for all. Doesn t seem to make sense currently. The model sounds just like Care Coordination. Grantee is asking if TCC should move out of Medical Case Management and into Non-Medical Case Management (nmcm) or Psychosocial Support Services (PSS). People are going to TCC for housing, but that is not the primary focus of the model. TCC providers will attend the December meeting. 6 P a g e