County of Santa Clara HIV Planning Council for Prevention and Care

County of Santa Clara HIV Planning Council for Prevention and Care DATE: TIME: PLACE: November 10, 2015, Regular Meeting 6:00 PM Conference Room A/B, 976 Lenzen Ave, San Jose 976 Lenzen Avenue San Jose, CA 95126 AGENDA In compliance with the Americans with Disabilities Act, those requiring accommodations in this meeting should notify the Clerk of the HIV Planning Council for Prevention and Care no less than 24 hours prior to the meeting at (408) 299-5001, or TDD (408) 993-8272. Please note: To contact the Commission and/or to inspect any disclosable public records related to an open session item on a regular meeting agenda and distributed by the County to all or a majority of the Board of Supervisors (or any other commission, or board or committee) less than 72 hours prior to that meeting, visit our website at http://www.sccgov.org or contact the Clerk at (408) 299-5001 or 70 W. Hedding Street, 10th Floor, San Jose, CA 95110, during normal business hours. COMMUTE ALTERNATIVES: The Board of Supervisors encourages the use of commute alternatives including public transit, bicycles, carpooling, and hybrid vehicles. For public transit trip planning information, contact the VTA Customer Service Department at 408-321-2300 Monday through Friday between the hours of 6:00 a.m. to 7:00 p.m., and on Saturday from 7:30 a.m. to 4:00 p.m. Schedule information is also available on the web at www.vta.org. Bicycle parking racks are available in the James McEntee, Sr., Plaza in front of the County Government Center building. If this Board or Commission does not meet in the County Government Center please contact VTA for related routes. 1. Call to Order/Roll Call. 2. Public Comment. Opening This portion of the meeting is reserved for persons desiring to address the Commission on any matter not on the agenda. Speakers are limited to one minute. The law does not permit Commission action or extended discussion on any items not on the agenda except under special circumstances. Statements that require a response may be placed on the agenda for the next regular meeting of the Commission. Persons wishing to address the Commission on any item on the agenda are requested to complete a request to speak form and give it to the Deputy Clerk so the Chairperson can call on you when the item comes up for discussion. 3. Consent Calendar Consent Calendar 1. Approve minutes of the May 12, 2015 Regular Meeting. 2. Approve minutes of the June 9, 2015 Regular Meeting. 3. Approve minutes of the July 14, 2015 Regular Meeting. Page 1 of 3

Agenda Packet Regular Agenda - Items for Discussion HIV Planning Council for Prevention and Care, County of Santa Clara November 10, 2015 4. Review Statement of Member commitment. (ID# 78931) 5. Discuss possible methods of gathering community input. 6. Discuss and approve Assessment of the Administrative Mechanism Report for Ryan White Fiscal Year 2014-2015. (ID# 78859) 7. Consider recommendations relating to 2016-2017 Grantee Directives. (ID# 78907) Possible action: a. Accept report from the Planning and Resources Committee on the proposed 2016 Grantee Directives. b. Approve the proposed 2016 Grantee Directives. c. Refer the approved 2016 directives to the Grantee for implementation. 8. Ratify Executive Committee action to approve the following applications and forward to the Board of Supervisors: a. Rominda Magnampo - Seat 22, Part C Grantee, District 3. b. Michael Robinson - Seat 8, Non-aligned Consumer, Disctrict 3. c. Donald Spotts - Seat 7, Non-Consumer, District 2. d. Charlie Wasser - Seat 25, Community Based Organization or AIDS Service Organization serving affected population. 9. Approve Standard of Care for Medical Case Management Service Category. (ID# 78906) 10. Receive report relating to November 2015 report on the monthly Health Resource and Services Administration (HRSA) Project Officer Conference Call. (ID# 78864) 11. Discuss and approve proposed Planning Council 2016 meeting schedule. (ID# 78860) Monthly Reports 12. Receive report from the Grantee relating to Ryan White HIV/AIDS Program Allocation November 2015 expenditures. (ID# 78862) 13. Receive verbal report from the Grantee. (McPherson) (ID# 78908) 14. Receive the November 2015 report from the State Office of AIDS. (ID# 78861) Committee Reports 15. Receive November 2015 monthly reports from the HIV Planning Council Committees and Co-Chairpersons: (ID# 78863) a. Council Development Committee (Hepfer) b. Legislative Committee (Vacant) Page 2 of 3

Agenda Packet c. Quality and Standards Committee (Valdez) d. Planning and Resources Committee (Nartker) e. Education and Awareness Committee (Arevalo) f. Executive Committee (Kahwaji, Reed) g. Co-Chairpersons (Kahwaji, Reed) Announcements 16. Announcements and correspondence: a. Holiday dinner scheduled for December 8, 2015. b. Commissioners' Announcements. HIV Planning Council for Prevention and Care, County of Santa Clara November 10, 2015 c. There are currently eight vacancies on the Commission. For Internet access to the vacancies list and applications visit http://www.sccgov.org/sites/bos/bnc/. Adjourn 17. Adjourn to the next regular meeting on Tuesday, January 12, 2016 at 6:30 p.m. in Conference Room A/B, Park Alameda Health Facility, 976 Lenzen Avenue, San Jose. Page 3 of 3

County of Santa Clara HIV Planning Council for Prevention and Care 1 DATE: TIME: PLACE: May 12, 2015, Regular Meeting 6:00 PM Conference Room A/B, 976 Lenzen Ave, San Jose 976 Lenzen Avenue San Jose, CA 95126 MINUTES 1. Call to Order/Roll Call. Opening Meet called to order at 6:09 p.m. by Chairperson Vidt. A quorum was present. Attendee Name Title Status Arrived Timothy Arevalo Member Present Hilary Armstrong Member Absent Winston Ashby Member Absent Christopher Baldwin Member Present Leslie Bannerman Member Present Dena Dickinson Member Present Rodrigo Garcia Member Present Paul Hepfer Co-Chairperson Present David Hernandez Member Present Karim Kahwaji Member Present Claire Nartker Member Present Vince Navarra Member Present Ray Otani Member Present Robert Reed Member Present Phillip Rivera Member Absent Lori Salmiery Member Absent Deborah Styner Member Absent Rigoberto S. Valdez Member Absent Karl Vidt Co-Chairperson Present 2. Public Presentations. No public presentations were presented. Public Issues Minutes Acceptance: Minutes of May 12, 2015 6:00 PM (Consent Calendar) 3. Approve Consent Calendar. Page 1 of 5 Packet Pg. 4

1 Minutes HIV Planning Council for Prevention and Care, County of Santa Clara May 12, 2015 3 RESULT: APPROVED [UNANIMOUS] MOVER: Ray Otani, Member SECONDER: Christopher Baldwin, Member AYES: Baldwin, Bannerman, Dickinson, Garcia, Hepfer, Hernandez, Kahwaji, Nartker, Navarra, Otani, Reed, Vidt ABSENT: Arevalo, Armstrong, Ashby, Rivera, Salmiery, Styner, Valdez 4. Minutes Approval: Consent Items a. Approve minutes of the February 10, 2015 Regular Meeting. b. Approve minutes of the March 10, 2015 Regular Meeting. c. Approve minutes of the April 14, 2015 Regular Meeting. 5. Ratify Executive Committee action to approve membership application for Omar Nunez and forward to Board of Supervisors for Board appointment to Seat 14, Non-elected Community Leader. (Nominated by District 3) 6. Ratify Executive Committee action to reassign membership application for Robert Smart for Board of Supervisors appointment to Seat 18, Affected Community Member/Formerly Incarcerated. (Nominated by District 3) Regular Agenda - Items for Discussion 7. Approve Standard of Care for Case Management Non-Medical Service Category. (ID# 76384) Jim McPherson, Sr. Health Care Program Manager, Santa Clara Valley Health and Hospital System presented a presentation on the changes to the Standards of Care plan. 7 RESULT: HELD ON CONSENSUS Next: 8/11/2015 5:30 PM 8. Discuss and approve Commission Work Plan for Fiscal Year July 1, 2015 through June 30, 2016 (FY2016) and Accomplishments for FY2015, to be submitted to the Clerk of the Board and subsequently forwarded to the Board of Supervisors through the Health and Hospital Committee (HHC). (ID# 75903) Commission approved the 2016 work plan. Minutes Acceptance: Minutes of May 12, 2015 6:00 PM (Consent Calendar) Page 2 of 5 Packet Pg. 5

Minutes HIV Planning Council for Prevention and Care, County of Santa Clara 8 RESULT: APPROVED [UNANIMOUS] MOVER: Dena Dickinson, Member SECONDER: Claire Nartker, Member AYES: Baldwin, Bannerman, Dickinson, Garcia, Hepfer, Hernandez, Kahwaji, Nartker, Navarra, Otani, Reed, Vidt ABSENT: Arevalo, Armstrong, Ashby, Rivera, Salmiery, Styner, Valdez 9. Discuss possible methods of gathering community input. Item not discussed. May 12, 2015 10. Nominate HIV Planning Council Members to serve as Co-chairpersons for Fiscal Year July 1, 2015 to June 20, 2016, for election to be held at the June Planning Council Meeting. Commissioner Hepfer nominated Bob Reed as Co-Chairperson. Commissioner Dickinson nominated Karim Kahwaji as Co-Chairperson. Monthly Reports 11. Receive report from the Grantee relating to Ryan White HIV/AIDS Program Allocation expenditures. (ID# 75841) Jim McPherson, Senior Health Care Program Manager, Public health Department presented the Ryan White HIV/AIDS programs expenditure analysis, allocation expenditures for April 2015 and post award allocations for 2014. 12. Consider recommendations relating to Ryan White HIV/AIDS Program Allocation Expenditures. (Roll Call Vote) (ID# 75843) Possible action: a. Receive verbal report from the Grantee. b. Consider revisions to the approved proposed level funding scenario for 2015 Ryan White HIV/AIDS Program Part A, Part A-Minority AIDS Initiative, Part B, and Part B-Minority AIDS Initiative allocations. c. Approve revised proposed Ryan White HIV/AIDS Program Part A and Part A- Minority AIDS Initiative allocation scenario. d. Authorize the Grantee to implement category allocations, consistent with the Planning Council's service prioritization, up to ten percent greater or lesser than the proposed level allocation based on the actual amount of Ryan White funds awarded, and to report to the Planning Council the final allocations implemented. Jim McPherson, Senior Health Care Program Manager, Public health Department presented the proposed modification of grantee revisions. Mr. McPherson explained how the revision will change the way out pocket cost claims until the state takes over in Page 3 of 5 1 Packet Pg. 6 Minutes Acceptance: Minutes of May 12, 2015 6:00 PM (Consent Calendar)

1 Minutes HIV Planning Council for Prevention and Care, County of Santa Clara May 12, 2015 2016, reducing mental health funding and increasing oral health. Commission voted to approve recommended actions to approve revised proposed Ryan White HIV/AIDS Program Part A and Part A-Minority AIDS Initiative allocation scenario. As, well as authorize the Grantee to implement category allocations, consistent with the Planning Council's service prioritization, up to ten percent greater or lesser than the proposed level allocation based on the actual amount of Ryan White funds awarded, and to report to the Planning Council the final allocations implemented. 12 RESULT: APPROVED [UNANIMOUS] MOVER: Dena Dickinson, Member SECONDER: Christopher Baldwin, Member AYES: Baldwin, Bannerman, Dickinson, Garcia, Hepfer, Hernandez, Kahwaji, Nartker, Navarra, Otani, Reed, Vidt ABSENT: Arevalo, Armstrong, Ashby, Rivera, Salmiery, Styner, Valdez 13. Receive verbal report from Grantee. (ID# 75839) Jim McPherson, Senior Health Care Program Manager, Public health Department presented the Grantee Report for the month of April. 14. Receive the March 2015 report from the State Office of AIDS. (ID# 75882) No report received. Committee Reports 15. Receive April 2015 monthly reports from the HIV Planning Council Committees and Co-Chairpersons. (ID# 76312) a. Council Development Committee (Dickinson) b. Legislative Committee (Kahwaji) c. Quality and Standards Committee (Reed) d. Planning and Resources Committee (Nartker) e. Education and Awareness Committee (Arevalo) f. Executive Committee (Hepfer, Vidt) g. Co-Chairpersons (Hepfer, Vidt) Member Dickinson spoke about Council development, and creation of a template for monthly reporting and for PC application and simplify more. Karl and Dena will work offline to make the application more meaningful. Member Kawaji reported on the legislative committee and they called the each of the Board offices, and Supervisors Yager and Wasserman are open to accepting outside of their districts. Member Reed reported on that the Standards of Care guidelines are now the SCCGOV website. Minutes Acceptance: Minutes of May 12, 2015 6:00 PM (Consent Calendar) Page 4 of 5 Packet Pg. 7

1 Minutes HIV Planning Council for Prevention and Care, County of Santa Clara May 12, 2015 Member Nartker reported that the Planning and Care didn't have quorum but had a workshop and are still waiting on guidance for a comprehensive plan. Member Arevalo reported on that the Education and Awareness group met and reviewed what the activities will be for the next year and would like to keep in alignment with the Work plan. Trans gender issues will be the round table discussion in July. Member Dickson, will use Pace funds for training for doctors for trans patients and training for providers in the community. Member Hepfer reported that the Executive Committee, had the first call with the project officer, discussed caring over funds for services and staffing issues, also addressed filling all of the seats in the county. The project officer would like give some advice on planning council budget and as a council they should form a budget every year. 15 RESULT: RECEIVED 16. Announcements and correspondence: a. Commissioners' Announcements. Announcements: Announcements - Dena's retirement dinner, B. Reed announced that there is fund money to help people that would like to go. Pace is having an open house this thursday the 14th from 4-7 pm at PACE clinic, public health department is having a retirement lunch for Mary O. on the 19th. b. There are currently seven vacancies on the Commission. For Internet access to the vacancies list and applications visit http://www.sccgov.org/sites/bos/bnc/. Adjourn 17. Adjourn to the next regular meeting on June 9, 2015 at 6:00 p.m. in Conference Room A/B, Park Alameda Health Facility, 976 Lenzen Avenue, San Jose. Meeting adjourned at 7:37 pm. Respectfully Submitted, Minutes Acceptance: Minutes of May 12, 2015 6:00 PM (Consent Calendar) La'Tria Strother Deputy Clerk Page 5 of 5 Packet Pg. 8

County of Santa Clara HIV Planning Council for Prevention and Care 2 DATE: TIME: PLACE: June 9, 2015, Regular Meeting 6:00 PM Conference Room A/B, 976 Lenzen Ave, San Jose 976 Lenzen Avenue San Jose, CA 95126 1. Call to Order/Roll Call. MINUTES Opening Called to order at 6:35 p.m. by Chairperson Vidt. A quorum was not present, and the members present agreed on consensus to adjourn to a workshop. No action was taken. Attendee Name Title Status Arrived Timothy Arevalo Member Absent Hilary Armstrong Member Absent Winston Ashby Member Absent Christopher Baldwin Member Present Leslie Bannerman Member Absent Dena Dickinson Member Present Rodrigo Garcia Member Absent Paul Hepfer Co-Chairperson Present David Hernandez Member Absent Karim Kahwaji Member Present Claire Nartker Member Absent Vince Navarra Member Absent Ray Otani Member Present Robert Reed Member Present Phillip Rivera Member Present Lori Salmiery Member Absent Deborah Styner Member Present Rigoberto S. Valdez Member Present Karl Vidt Co-Chairperson Present 2. Public Presentations. This portion of the meeting is reserved for persons desiring to address the Commission on any matter not on agenda. Speakers are limited to one minute. The law does not permit Commission action or extended discussion on any items not on the agenda except Page 1 of 3 Packet Pg. 9 Minutes Acceptance: Minutes of Jun 9, 2015 6:00 PM (Consent Calendar)

Minutes HIV Planning Council for Prevention and Care, County of Santa Clara under special circumstances. Statements that require a response may be placed on the agenda for the next regular meeting of the Commission. June 9, 2015 Persons wishing to address the Commission on any item on the agenda are requested to complete a request to speak form and give it to the Deputy Clerk so the Chairperson can call on you when the item comes up for discussion. 2 3. Approve Consent Calendar. There is no separate discussion of consent items, and the recommended actions are voted on in one motion. If you wish to discuss these items please request that they be removed from consent. Regular Agenda - Items for Discussion 4. Receive presentation relating to Planning Council website. (Reed) 5. Discuss Planning Council responsibilities and involvement, committee structure and attendance requirements. 6. Nominate and Elect Planning Council members for two Co-Chairperson positions for a one year term beginning July 1, 2015. 6 RESULT: HELD - LACK OF QUORUM Monthly Reports 7. Consider recommendations relating to 2015 Ryan White HIV/AIDS Program Allocations. (Roll Call Vote) (ID# 76859) Possible action: a. Receive verbal report from the Grantee. b. Consider revisions to the approved proposed level funding scenario for 2015 Ryan White HIV/AIDS Program Part A and Part A-Minority AIDS Initiative allocations. c. Approve final 2015 Ryan White HIV/AIDS Program Part A and Part A-Minority AIDS Initiative allocations. 7 RESULT: HELD ON CONSENSUS Next: 7/14/2015 6:00 PM Minutes Acceptance: Minutes of Jun 9, 2015 6:00 PM (Consent Calendar) 8. Receive the June 2015 report from the State Office of AIDS. (ID# 76867) 9. Receive verbal report from Grantee. (ID# 76857) 10. Receive report from the Grantee relating to Ryan White HIV/AIDS Program Allocation June expenditures. (ID# 76858) 10 RESULT: HELD ON CONSENSUS Next: 7/14/2015 6:00 PM Page 2 of 3 Packet Pg. 10

2 Minutes Committee Reports HIV Planning Council for Prevention and Care, County of Santa Clara June 9, 2015 11. Receive May 2015 monthly reports from the HIV Planning Council Committees and Co-Chairpersons. (ID# 76752) a. Council Development Committee (Dickinson) b. Legislative Committee (Kahwaji) c. Quality and Standards Committee (Reed) d. Planning and Resources Committee (Nartker) e. Education and Awareness Committee (Arevalo) f. Executive Committee (Hepfer, Vidt) g. Co-Chairpersons (Hepfer, Vidt) 12. Announcements and correspondence: Announcements a. Propose agenda items for next meeting on July 14, 2015. b. Commissioners' Announcements: c. There are currently eight vacancies on the Commission. For Internet access to the vacancies list and applications visit http://www.sccgov.org/sites/bos/bnc/. Adjourn 13. Adjourn to the next regular meeting on Tuesday, July 14, 2015 at 6:00 p.m. in Conference Room A/B, Park Alameda Health Facility, 976 Lenzen Avenue, San Jose. Respectfully Submitted La'Tria Strother Deputy Clerk Minutes Acceptance: Minutes of Jun 9, 2015 6:00 PM (Consent Calendar) Added Items - For Discussion 14. Approve Standard of Care for Case Management Non-Medical Service Category. (ID# 76384) 14 RESULT: HELD ON CONSENSUS Next: 8/11/2015 5:30 PM Page 3 of 3 Packet Pg. 11

County of Santa Clara HIV Planning Council for Prevention and Care 3 DATE: TIME: PLACE: July 14, 2015, Regular Meeting 6:00 PM Conference Room A/B, 976 Lenzen Ave, San Jose 976 Lenzen Avenue San Jose, CA 95126 1. Call to Order/Roll Call. MINUTES Opening Called to order at 5:33 p.m by Chairperson Vidt. A quorum was not present, and the members present agreed on consensus to adjourn to a workshop. No action was taken. Attendee Name Title Status Arrived Timothy Arevalo Member Absent Hilary Armstrong Member Absent Winston Ashby Member Absent Christopher Baldwin Member Absent Leslie Bannerman Member Absent Dena Dickinson Member Absent Rodrigo Garcia Member Absent Paul Hepfer Co-Chairperson Absent David Hernandez Member Absent Karim Kahwaji Member Absent Claire Nartker Member Absent Vince Navarra Member Absent Ray Otani Member Absent Robert Reed Member Absent Phillip Rivera Member Absent Lori Salmiery Member Absent Deborah Styner Member Absent Rigoberto S. Valdez Member Absent Karl Vidt Co-Chairperson Absent 2. Public Presentations. This portion of the meeting is reserved for persons desiring to address the Commission on any matter not on the agenda. Speakers are limited to one minute. The law does not permit Commission action or extended discussion on any items not on the agenda except Page 1 of 3 Packet Pg. 12 Minutes Acceptance: Minutes of Jul 14, 2015 6:00 PM (Consent Calendar)

Minutes HIV Planning Council for Prevention and Care, County of Santa Clara under special circumstances. Statements that require a response may be placed on the agenda for the next regular meeting of the Commission. July 14, 2015 Persons wishing to address the Commission on any item on the agenda are requested to complete a request to speak form and give it to the Deputy Clerk so the Chairperson can call on you when the item comes up for discussion. 3 3. Approve Consent Calendar. 3 RESULT: APPROVED [UNANIMOUS] ABSENT: Arevalo, Armstrong, Ashby, Baldwin, Bannerman, Dickinson, Garcia, Hepfer, Hernandez, Kahwaji, Nartker, Navarra, Otani, Reed, Rivera, Salmiery, Styner, Valdez, Vidt Regular Agenda - Items for Discussion 4. Receive presentation from the Santa Clara County Public Health Department, Data Management and Epidemiology Unit, relating to HIV epidemiology in Santa Clara County. (ID# 77470) 5. Receive presentation from the Planning and Resources Committee relating to the Priority Setting and Resource Allocation Process. (ID# 77469) 6. Approve Standard of Care for Case Management Non-Medical Service Category. (ID# 76384) 7. Nominate and elect Planning Council Members for two Co-chair positions and one Secretary posititon for Fiscal Year 2015-2016. Monthly Reports 8. Receive the June 2015 report from the State Office of AIDS. (ID# 77468) 9. Receive verbal report from Grantee. (McPherson) (ID# 77471) 10. Receive report from the Grantee relating to Ryan White HIV/AIDS Program Allocation June expenditures. (ID# 76858) Minutes Acceptance: Minutes of Jul 14, 2015 6:00 PM (Consent Calendar) 11. Receive report from the Grantee relating to Ryan White HIV/AIDS Program Allocation July expenditures. (ID# 77472) Committee Reports 12. Receive May 2015 monthly reports from the HIV Planning Council Committees and Co-Chairpersons: (ID# 77467) a. Council Development Committee (Dickinson) Page 2 of 3 Packet Pg. 13

3 Minutes b. Legislative Committee (Kahwaji) c. Quality and Standards Committee (Reed) d. Planning and Resources Committee (Nartker) e. Education and Awareness Committee (Arevalo) f. Executive Committee (Hepfer, Vidt) g. Co-Chairpersons (Hepfer, Vidt) HIV Planning Council for Prevention and Care, County of Santa Clara July 14, 2015 Announcements 13. Announcements and correspondence: a. Commissioners' Announcements: b. There are currently seven vacancies on the Commission. For Internet access to the vacancies list and applications visit http://www.sccgov.org/sites/bos/bnc/. Adjourn 14. Adjourn to the next regular meeting on Tuesday, August 11, 2015 at 6:00 p.m. in Conference Room A/B, Park Alameda Health Facility, 976 Lenzen Avenue, San Jose. Respectfully submitted, La'Tria Strother Deputy Clerk Added Items - For Discussion 15. Consider recommendations relating to 2015 Ryan White HIV/AIDS Program Allocations. (Roll Call Vote) (ID# 76859) Possible action: a. Receive verbal report from the Grantee. b. Consider revisions to the approved proposed level funding scenario for 2015 Ryan White HIV/AIDS Program Part A and Part A-Minority AIDS Initiative allocations. c. Approve final 2015 Ryan White HIV/AIDS Program Part A and Part A-Minority AIDS Initiative allocations. 15 RESULT: MEETING CANCELLED Next: 8/11/2015 5:30 PM Minutes Acceptance: Minutes of Jul 14, 2015 6:00 PM (Consent Calendar) Page 3 of 3 Packet Pg. 14

4 County of Santa Clara HIV Planning Council for Prevention and Care 78931 DATE: November 10, 2015 TO: FROM: HIV Planning Council for Prevention and Care Robert Reed, Co-Chairperson SUBJECT: Review Statement of Member Commitment RECOMMENDED ACTION Review Statement of Member commitment. Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian Packet Page Pg. 1 of 151 County Executive: Jeffrey V. Smith

6 County of Santa Clara HIV Planning Council for Prevention and Care 78859 DATE: November 10, 2015 TO: FROM: HIV Planning Council for Prevention and Care Karim Kahwaji, Robert Reed, Co-Chairperson Karl Vidt, Commissioner SUBJECT: Assessment of the Administrative Mechanism RECOMMENDED ACTION Discuss and approve Assessment of the Administrative Mechanism Report for Ryan White Fiscal Year 2014-2015. FISCAL IMPLICATIONS There is no fiscal impact as a result of this action. REASONS FOR RECOMMENDATION The HIV Planning Council (Planning Council) serves as the local planning council or community input body required for receipt of funding under the Ryan White HIV/AIDS Program. One of the enumerated functions of a local planning council is to annually perform an assessment of the Ryan White HIV/AIDS Program administrative mechanism. Specifically, the HIV Planning Council must assess whether the Grantee Administrative Agent disbursed Ryan White Part A Program funds quickly and efficiently, and closely monitored their use. The Assessment of the Administrative Mechanism Report for Ryan White Fiscal Year 2014-2015 was reviewed by Executive Committee at their September 23, 2014 meeting. Approval of the recommended action will accept (approve) the report from the full HIV Planning Council. CONSEQUENCES OF NEGATIVE ACTION The Planning Council will not have fulfilled its obligation to complete an Assessment of the Administrative Mechanism for Ryan White Fiscal Year 2014-2015. ATTACHMENTS: 2014-2015 Assessment of the Administrative Mechanism (PDF) Planning Council Members Responses - 2015 (PDF) Provider Responses - 2015 (PDF) Assessment of the Administrative Mechanism - Grantee Response (PDF) Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian Packet Page Pg. 1 of 161 County Executive: Jeffrey V. Smith

6.a ASSESSMENT OF THE ADMINISTRATIVE MECHANISM REPORT FOR RYAN WHITE FISCAL YEAR 2014-2015 DRAFT Sept. 24, 2015 SAN JOSE, TRANSITIONAL GRANT AREA RYAN WHITE PART A PROGRAM Purpose of the Assessment The HIV/AIDS Bureau (HAB) / Department of Service Systems (DSS) expect that the chief elected official (the Board of Supervisors in Santa Clara County) will disburse Ryan White Part A Program funds quickly and efficiently and will closely monitor their use. Meeting these expectations involves effectively implementing the request for proposal (RFP) process, reviewing applications, awarding and execution of provider subcontracts, disbursement of funds, and programmatic and fiscal monitoring of subcontractors. References: Ryan White CARE Act Title 1 Manual, Section VI: Planning Council Operations, Chapter 1: Planning Council Duties Ryan White HIV/AIDS Program Part A Manual, Section VI: Planning Council Operations, Part C Ryan White Part A Planning Council Primer Assessment of the Administrative Mechanism, Final Report, Fiscal Year 2007, Denver Transitional Grant Area, Ryan White Part A Program San Antonio Area HIV/AIDS Health Services Planning Council, 2008/2009, Assessment of the Administration Agency Mechanism Assessment of the Administrative Mechanism, Final Report, Fiscal Year 2009, Las Vegas Transitional Grant Area, Ryan White Part A Program Scope of Work The Executive Committee of the Planning Council is charged with the Assessment of the Administrative Mechanism. We elected to keep the Assessment simple and consistent from year to year as it is done primarily with volunteer Planning Council members. The main questions to be answered include: Did the Grantee disperse Ryan White Part A funds according to the priorities and allocations set by the Planning Council at the annual PS&RA Process and subsequent reallocations? Was there adequate participation by the community in the planning process? Were service contracts issued in a timely manner and were subcontractors reimbursed in a timely manner? Report 2014-15 Assessment of the Administrative Mechanism DRAFT v21 AugOct. 236, 2015 Page 1 of 4 Co-Chairs: Paul Hepfer Karl J Vidt 976 Lenzen Avenue, Suite 1800 San Jose CA 95126 p- 408-792-5210 f 408-792-5031 www.scchivplanningcouncil.org Packet Pg. 17 Attachment: 2014-2015 Assessment of the Administrative Mechanism (78859 : Assessment of the Administrative Mechanism)

6.a Was the RFP Process for FY 2014-15 fair and effective? Are services funded by the Ryan White Program successfully reaching the community? Note: A full RFP Process was conducted for the 2011-12 RW fiscal year. Assessment results and comments were included in the Assessment for that year. The San Jose TGA conducts a full RFP process every three years. No RFP process was conducted for FY 2014-2015. Elements of the Assessment Information for this Assessment of the Administrative Mechanism was obtained from: An online survey directed to Planning Council Members and Service Providers (both PC members and nonmembers). A review of the initial priority and allocation figures as well as subsequent reallocations leading to the final year end fiscal data report. Data Collection Process Information for the Assessment of the Administrative Mechanism was gathered in the following ways: With the help of Dr. Wen Lin from Epidemiology and Data Management Unit, Santa Clara County Public Health Department, an online survey was conducted for three weeks in July 2015. The raw data was gathered by Dr. Wen Lin and then reviewed by the ad hoc committee. (See Attachments A & B for responses, results, and individual comments) o Survey questions were obtained from the Ryan White CARE Act Title 1 Manual, Section VI: Planning Council Operations, Chapter 1: Planning Council Duties o Participants included 13 Planning Council Members, 2 who also identified as a Service Provider, and 5 service providers, 1 who also identified as a Planning Council member, for a total of 18 responses. Service Provider respondents included Program Directors and fiscal employees. o There were no Ryan White Part A questions regarding the RFP process in this year s survey as there was not an RFP process conducted for the year assessed.. Financial data was reviewed monthly by the full Planning Council and at our June and July 2015 meetings. This data included a review of the initial Part A and B priorities and allocations, subsequent reallocations, and the final year end expenditure reports. Attachment: 2014-2015 Assessment of the Administrative Mechanism (78859 : Assessment of the Administrative Mechanism) Report 2014-15 Assessment of the Administrative Mechanism DRAFT v21 AugOct. 236, 2015 Page 2 of 4 Packet Pg. 18

6.a Summary of Findings: Satisfaction with 2014-15 Priority Setting & Resource Allocation Process. Generally, the Planning Council members were satisfied (3.55 of 4.0) with the PS&RA process, although 1 respondent said they didn t know, due to being new. One respondent was unclear about the process, but is now clearer. A recommendation to provide a readers guide prior to the PSRA including information on service categories and current needs of RW clients so Council members can study ahead of the PSRA. Did priorities and funding amounts allocated to the service categories meet the planning council allocation levels set at the annual Priority Setting and Resource Allocation Process? There was overall agreement that the Ryan White priorities and funding amounts met the priorities and funding allocations set by the Planning Council. (3.92 of 4.0) Is the level of PLWHA, special populations, and general community participation in all planning activities adequate? The majority of those surveyed felt that the level of PLWHA was generally average. (2.92 of 4.0) General community involvement in the planning process was perceived as average. (2.92 of 4.0) This is an area that still needs work. Comments recognized the valuable input from PLWH/A on the council but mentioned the need for getting input from PLWHA not on the Planning Council. Respondents recognized the difficulty in reaching and gathering input from the general public, many who don t see themselves as affected by HIV. Populations needing to be more involved continue to be African Americans, undocumented Latino immigrants and women. Over the course of the 2014-15 cycle, the number of non-aligned consumers serving on the Council has decreased. Was all data that was requested provided? Was the data reliable and accurate? Planning Council members felt that requests for data were reliable and timely. (3.73 of 4.0) A request was made to include how quality improvement activities being implemented by service providers are being directly linked to the HIV continuum of care. Are services successfully reaching the community funded by the Ryan White Program? According to survey results, funded services are successfully reaching those for whom they are intended. (3.91 of 4.0) Overall and fiscal administration of Ryan White Funds. Service providers who responded were very satisfied with the fiscal administration (3.75 of 4.0) and overall administration of the RW funds. (3.40 of 4.0). One respondent felt that they would benefit from better State and HRSA auditing guidelines. Contracting process, completion, and subcontractor reimbursement. Service providers responded that they were somewhat satisfied with the contracting process (2.80 of 4.0) and subcontractors were reimbursed in a timely manner and in compliance with their contracts. (3.50 of 4.0). Providers who responded were generally satisfied with the overall contracting process. Comments indicated that for some, more time was needed to adequately process new contracts and that more advance notice and realistic deadlines would be appreciated. Monitoring of service contracts during FY 20143-154. The results indicate that all service providers indicated their contracts were sufficiently monitored (3.67 of 4.0). Technical Assistance from Grantee. Providers who needed and requested technical assistance (2) indicated they received he assistance they needed and that it helped them. (3.00 of 4.00). Other Comments: Some service providers would like to see more advance notices and reminders to facilitate timely reporting. Others felt that due to Administrative limitations, clear direct communication and guidance from the SHAP office would be helpful. Specific Comments. Comments may be found in attachments A and B. Attachment: 2014-2015 Assessment of the Administrative Mechanism (78859 : Assessment of the Administrative Mechanism) Report 2014-15 Assessment of the Administrative Mechanism DRAFT v21 AugOct. 236, 2015 Page 3 of 4 Packet Pg. 19

6.a Recommendations Involving the Community in the planning process. Gathering input from the community at large and people living with HIV/AIDS continues to be a significant problem. Services are being delivered in a very successful continuum which is indicated in data about transition to care, retention in care and viral load suppression in the San Jose TGA. Grantee and Planning Council continue to work together to develop and implement a plan to increase participation among PLWHA and special populations as well as the general community in the planning process. It is important to have current and accurate information for the Planning Council to make decisions setting the priorities and allocations for the San Jose TGA. A lack of funding for Planning Council Support and activities has heightened the administrative burden, especially on Planning Council members. We encourage the Grantee to assist the Planning Council in resolving membership recruitment, appointment and retention issues facing the Council. We also recommend the Grantee pursue innovative ways to gather the input needed to inform the PC in setting priorities and allocations for the San Jose TGA. We look forward to seeing how new information gathering methods currently under development by the Grantee will inform this process. Underspending. The Planning Council realizes the limitations of a very small TGA in reallocating unspent funds to areas of need. We encourage the Grantee to continue to be vigilant for underspent funds that could be spent I other service categories with identified needs. Contract Processing, Monitoring and Support. We recommend the Grantee continue to assist Service Providers with their contract needs and simplify the process where possible within the HRSA requirements. Look into how to best assist Service Providers with reporting, invoicing and billing technical assistance and reminders as needed to streamline the administrative burden on service providers, especially those with small contracts. Conclusions In general, the Administrative Agency of the San Jose, CA TGA is successful in rapidly allocating funds to the areas of greatest need within the grant area and delivering delivering Ryan White services to many who need them through a network of service providers. Health statistics of those in care support this conclusion. A concern of the Planning Council continues to be the unspent balance of the grant award at the end of the grant cycle. Expenditure reporting was greatly improved over previous years and the effects of the Affordable Care Act have settled in. We recommend the Grantee continue to work closely with service providers to ensure the maximum expenditure of available RW funds. Doing so will help prevent the loss of available funding for services and deliver services better and more effectively in the San Jose TGA. The Planning Council is also very concerned about finding new and economically feasible ways to gather quality community input to inform us of gaps in services and meet the needs of those in the San Jose TGA. PC member recruitment, appointment and retention are areas of primary importance where we could use the Grantee s influence to resolve and streamline membership issues. The PC and Grantee are working well together to implement the goals of the Ryan White Program. We recognize the economic and regulatory challenges that we all must work with. The Planning Council looks forward to working with the Grantee to meet these challenges. Attachments: A. AttA_Planning_Council_Members_Results_2015 B. AttB_Providers_Results_2015 Attachment: 2014-2015 Assessment of the Administrative Mechanism (78859 : Assessment of the Administrative Mechanism) Report 2014-15 Assessment of the Administrative Mechanism DRAFT v21 AugOct. 236, 2015 Page 4 of 4 Packet Pg. 20

Assessment of the Administrative Mechanism 2015 - Council Commissioner Survey 6.b Q1 What is your relationship to the Planning Council? Answered: 13 Skipped: 0 Answer Choices Planning Council Member Total Respondents: 13 Planning Council Member Planning Council Memb... Planning Council Member and Service Provider 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Responses 84.62% 11 15.38% 2 Attachment: Planning Council Members Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 1 / 8 Packet Pg. 21

Assessment of the Administrative Mechanism 2015 - Council Commissioner Survey 6.b Rate on a 1-4 scale Rate on a 1-4 scale 1 (Strongly Disagree) Q2 The Planning Council received sufficient data and information in the planning process regarding the needs of the HIVpositive community in the San Jose Transitional Grant Area (TGA). 0.00% 0 Answered: 13 Skipped: 0 0 1 2 3 4 5 6 7 8 9 10 2 (Somewhat Disagree) 0.00% 0 3 (Somewhat Agree) 23.08% 3 4 (Strongly Agree) 61.54% 8 15.38% # Comments: Date 2 13 3.73 1 I am been a planning council member for three months and do not feel adequately informed to answer this question. 7/16/2015 3:34 PM 2 I would like to see how any quality improvement activities being implemented by the service providers are being directly linked to the HIV continuum. I would also like to see the treatment cascade for Santa Clara County. I don't know Total Weighted Average 7/7/2015 9:19 AM Attachment: Planning Council Members Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 2 / 8 Packet Pg. 22

Assessment of the Administrative Mechanism 2015 - Council Commissioner Survey 6.b Q3 The level of participation in the planning process by people living with HIV/AIDS (PLWHA) was adequate. Answered: 13 Skipped: 0 Rate on a 1-4 scale Rate on a 1-4 scale 1 (Strongly Disagree) 7.69% 0 1 2 3 4 5 6 7 8 9 10 1 2 (Somewhat Disagree) 15.38% 2 3 (Somewhat Agree) 46.15% 6 4 (Strongly Agree) 23.08% # Comments: Date 3 7.69% 1 13 2.92 1 I would like to see greater involvement by consumers of the RW funds 7/7/2015 9:19 AM I don't know Total Weighted Average Attachment: Planning Council Members Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 3 / 8 Packet Pg. 23

Assessment of the Administrative Mechanism 2015 - Council Commissioner Survey 6.b Q4 The level of participation in the planning process by the general community was adequate. Answered: 13 Skipped: 0 Rate on a 1-4 scale Rate on a 1-4 scale 1 (Strongly Disagree) 0.00% 0 1 2 3 4 5 6 7 8 9 10 0 2 (Somewhat Disagree) 30.77% 4 3 (Somewhat Agree) 38.46% 5 23.08% # Comments: Date 1 The grantee does a great job of providing financial analysis and financial planning for the planning council however I would like to see greater involvement in decision making on the council's part. I would also like to see the general community more involved in the decision making regarding where funds are allocated. 4 (Strongly Agree) 3 I don't know 7.69% Total Weighted Average 1 13 2.92 7/7/2015 9:19 AM Attachment: Planning Council Members Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 4 / 8 Packet Pg. 24

Assessment of the Administrative Mechanism 2015 - Council Commissioner Survey 6.b Q5 I was satisfied with the 2014-15 Priority Setting and Resource Allocation (PS&RA) process. (conducted in August 2013) Answered: 13 Skipped: 0 Rate on a 1-4 scale Rate on a 1-4 scale 1 (Strongly Disagree) 0.00% 0 1 2 3 4 5 6 7 8 9 10 0 2 (Somewhat Disagree) 0.00% 0 3 (Somewhat Agree) 38.46% 5 4 (Strongly Agree) 46.15% 6 15.38% # Comments: Date 2 13 3.55 1 I am been a planning council member for three months and do not feel adequately informed to answer this question. 7/16/2015 3:34 PM 2 I was unclear of what the process would look like but am more clear now 7/7/2015 9:19 AM I don't know Total Weighted Average Attachment: Planning Council Members Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 5 / 8 Packet Pg. 25

Assessment of the Administrative Mechanism 2015 - Council Commissioner Survey 6.b Rate on a 1-4 scale Rate on a 1-4 scale 1 (Strongly Disagree) Q6 Funding amounts allocated to service categories met the planning council priority setting and resource allocation levels set through the PS&RA process for the Ryan White Fiscal year 2014-15. 0.00% 0 Answered: 13 Skipped: 0 0 1 2 3 4 5 6 7 8 9 10 2 (Somewhat Disagree) 0.00% 0 3 (Somewhat Agree) 7.69% 1 4 (Strongly Agree) 84.62% # Comments: Date 11 7.69% 1 13 3.92 1 I am been a planning council member for three months and do not feel adequately informed to answer this question. 7/16/2015 3:34 PM I don't know Total Weighted Average Attachment: Planning Council Members Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 6 / 8 Packet Pg. 26

Assessment of the Administrative Mechanism 2015 - Council Commissioner Survey 6.b Q7 Services are reaching the communities funded by the Ryan White Program. Answered: 13 Skipped: 0 Rate on a 1-4 scale Rate on a 1-4 scale 1 (Strongly Disagree) 0.00% 0 0.00% 0 7.69% 1 76.92% 10 15.38% # Comments: Date There are no responses. 0 1 2 3 4 5 6 7 8 9 10 2 (Somewhat Disagree) 3 (Somewhat Agree) 4 (Strongly Agree) I don't know Total Weighted Average 2 13 3.91 Attachment: Planning Council Members Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 7 / 8 Packet Pg. 27

Assessment of the Administrative Mechanism 2015 - Council Commissioner Survey 6.b Q8 Do you have any recommendations to improve the timely planning process and disbursement of Ryan White funds? Answered: 2 Skipped: 11 # Responses Date 1 Its a HERSA issue 7/14/2015 2:51 PM 2 A reading guide could be provided before the PSRA for all commissioners so we all can study up on the service categories and current needs of Ryan White clients so that we're better informed coming into the PSRA. 7/14/2015 11:51 AM Attachment: Planning Council Members Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 8 / 8 Packet Pg. 28

Assessment of the Administrative Mechanism 2015 - Service Provider Survey 6.c Q1 Which of the following best represents your level of involvement in delivering services at your agency? Answered: 5 Skipped: 0 a. Executive (i.e. Execut... Answer Choices Total Respondents: 5 b. Program Director c. Program Level (i.e... d. Fiscal (i.e. CFO,... e. I am also a Planning... a. Executive (i.e. Executive Director, CEO, Associate Director) b. Program Director c. Program Level (i.e. Nurse, Caseworker, Medical Assistant) d. Fiscal (i.e. CFO, Bookkeeper) e. I am also a Planning Council Member 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Responses 0.00% 0 80.00% 4 0.00% 0 20.00% 1 20.00% 1 Attachment: Provider Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 1 / 10 Packet Pg. 29

Assessment of the Administrative Mechanism 2015 - Service Provider Survey 6.c Q2 Payments were received in a manner consistent with the payment schedule included in contracts for Ryan White services for the RW Grant Year 2014-15. Answered: 5 Skipped: 0 Rate on a 1-4 scale Rate on a 1-4 scale 1 (Strongly Disagree) 0.00% 0 0.00% 0 20.00% 1 20.00% 1 60.00% # Suggested methods to improve the Grantee's payment process: Date There are no responses. 0 1 2 3 4 5 6 7 8 9 10 2 (Somewhat Disagree) 3 (Somewhat Agree) 4 (Strongly Agree) I don't know Total Weighted Average 3 5 3.50 Attachment: Provider Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 2 / 10 Packet Pg. 30

Assessment of the Administrative Mechanism 2015 - Service Provider Survey 6.c Q3 I was satisfied with the Grantee's fiscal administration for the RW Grant Year 2014-15. Answered: 5 Skipped: 0 Rate on a 1-4 scale Rate on a 1-4 scale 1 (Strongly Disagree) 0.00% 0 0.00% 0 20.00% 1 60.00% # Please provide any comments or suggestions you may have on how to improve the Grantee's fiscal administration for RW FY 2014-15 (i.e. reimbursement process, payment schedule, unity of cost support, etc.) There are no responses. 0 1 2 3 4 5 6 7 8 9 10 2 (Somewhat Disagree) 3 (Somewhat Agree) 4 (Strongly Agree) 3 I don't know 20.00% 1 5 3.75 Date Total Weighted Average Attachment: Provider Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 3 / 10 Packet Pg. 31

Assessment of the Administrative Mechanism 2015 - Service Provider Survey 6.c Q4 You required technical assistance from the Grantee during the RW FY 2014-15. Answered: 4 Skipped: 1 Yes Answer Choices Yes No I don't know No I don't know 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Responses 50.00% 2 50.00% 2 0.00% 0 Total 4 # Comments: Date 1 TA for ARIES assistance 7/20/2015 2:12 PM Attachment: Provider Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 4 / 10 Packet Pg. 32

Assessment of the Administrative Mechanism 2015 - Service Provider Survey 6.c Q5 If you required technical assistance during the RW FY 2014-15, the Grantee provided information or technical assistance that helped you. Answered: 5 Skipped: 0 Answer Choices Yes No Not applicable I don't know Yes No Not applicable I don't know 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Responses 60.00% 3 0.00% 0 40.00% 2 0.00% 0 Total 5 # Comments: Date There are no responses. Attachment: Provider Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 5 / 10 Packet Pg. 33

Assessment of the Administrative Mechanism 2015 - Service Provider Survey 6.c Q6 I was satisfied with the overall quality of information and/or technical assistance I received from the Grantee. Answered: 5 Skipped: 0 Rate on a 1-4 scale 0.00% 0 20.00% 1 60.00% 3 20.00% # Comments: Date 1 Quality of information or technical information received from Grantee was usually broad. Rationale behind decisions would be helpful. Rate on a 1-4 scale 1 (Strongly Disagree) 0 1 2 3 4 5 6 7 8 9 10 2 (Somewhat Disagree) 3 (Somewhat Agree) 4 (Strongly Agree) 1 0.00% 0 5 3.00 7/20/2015 2:12 PM 2 It is under our impression that the Grantee simply passes along nearly all the reporting burdens to the providers. 7/14/2015 9:51 AM I don't know Total Weighted Average Attachment: Provider Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 6 / 10 Packet Pg. 34

Assessment of the Administrative Mechanism 2015 - Service Provider Survey 6.c Q7 Service contracts were sufficiently monitored by the SHAP office during the RW FY 2014-15. Answered: 5 Skipped: 0 Rate on a 1-4 scale Rate on a 1-4 scale 1 (Strongly Disagree) 0.00% 0 0.00% 0 20.00% 1 40.00% 2 40.00% # Comments: Date 1 This seems to be a question for the SHAP office. Once we submit reports and invoices, we cannot access whether the contracts were monitored. 0 1 2 3 4 5 6 7 8 9 10 2 (Somewhat Disagree) 3 (Somewhat Agree) 4 (Strongly Agree) I don't know Total Weighted Average 2 5 3.67 7/20/2015 2:12 PM Attachment: Provider Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 7 / 10 Packet Pg. 35

Assessment of the Administrative Mechanism 2015 - Service Provider Survey 6.c Q8 I was satisfied with the contracting process for the RWP services during the RW FY 2014-15. Answered: 5 Skipped: 0 Rate on a 1-4 scale Rate on a 1-4 scale 1 (Strongly Disagree) 0.00% 0 1 2 3 4 5 6 7 8 9 10 0 2 (Somewhat Disagree) 40.00% 2 3 (Somewhat Agree) 40.00% 2 4 (Strongly Agree) 20.00% # Comments: Date 1 0.00% 0 5 2.80 1 It would be beneficial if there was adequate time to process new contract in a timely fashion. 7/20/2015 11:12 PM 2 More advance notice with realistic deadlines would be appreciated. 7/20/2015 2:12 PM I don't know Total Weighted Average Attachment: Provider Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 8 / 10 Packet Pg. 36

Assessment of the Administrative Mechanism 2015 - Service Provider Survey 6.c Q9 I was satisfied with the Grantee's overall administration of the Ryan White funds. Answered: 5 Skipped: 0 Rate on a 1-4 scale Rate on a 1-4 scale 1 (Strongly Disagree) 0.00% 0 1 2 3 4 5 6 7 8 9 10 0 2 (Somewhat Disagree) 0.00% 0 60.00% 3 40.00% # Please provide us with any other comments or suggestions you may have on the administration of Ryan White funds 1 The auditing process and finding could greatly benefit from having the state and HRSA provide some guidance on their methods of auditing to help improve the counties process. 3 (Somewhat Agree) 4 (Strongly Agree) 2 I don't know 0.00% 0 5 3.40 Date Total Weighted Average 7/20/2015 11:12 PM Attachment: Provider Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 9 / 10 Packet Pg. 37

Assessment of the Administrative Mechanism 2015 - Service Provider Survey 6.c Q10 What do you think is the single most important system-wide change that would improve the contracting process for Ryan White funds? Answered: 4 Skipped: 1 # Responses Date 1 Becoming efficient with our limited Administrative time. Much of the time spent, could be resolved with clear direct 7/20/2015 11:12 PM communication/guidance from HAP. 2 I would like to see advance notices and reminders of when grant budgets and the various paperwork are due. The 7/20/2015 2:12 PM system is very confusing with the grant and fiscal years. 3 Strong administration support from the Grantee 7/14/2015 9:51 AM 4 Not sure. 7/6/2015 11:58 AM Attachment: Provider Responses - 2015 (78859 : Assessment of the Administrative Mechanism) 10 / 10 Packet Pg. 38

County of Santa Clara Public Health Department 6.d STD/HIV Prevention & Control 976 Lenzen Avenue, Suite 1800 San José, California 95126 (408) 792-5030 FAX 792-5031 www.sccphd.org October 1, 2015 Karim Kahwaji, Co-chair Robert Reed, Co-chair HIV Planning Council for Prevention and Care 976 Lenzen Avenue, 2 nd Floor San Jose, CA 95126 Re: Response to 2015 Assessment of Administrative Mechanism Dear Co-chairs Kahwaji and Reed and Members of the HIV Planning Council: On behalf of STD/HIV Prevention & Control, acting as the Ryan White HIV/AIDS Program Administrative Agent for the San Jose, CA TGA, I would like to express our thanks to the HIV Planning Council for its efforts to conduct a thorough and meaningful assessment of the efficiency of the administrative mechanism in rapidly allocating funds to the areas of greatest need within the eligible area pursuant to Title XXVI, Part A, Sec. 2602(b)(4)(E) of the Public Health Service Act. In that the administrative mechanism involves both the HIV Planning Council and the Administrative Agent on behalf of the Grantee to rapidly allocate funds, we understand this assessment and its findings and recommendations to be reflective of the mechanism, rather than an assessment of the staff or members of the Administrative Agent, Grantee, or HIV Planning Council as individuals or entities. We have reviewed the draft report dated August 26, 2015, and offer the following comments and responses: Scope of Work On page 2 of the report there is a notation stating that A full RFP Process was conducted for the 2011-2012 fiscal year. Assessment results and comments were included in the Assessment for that year. The San Jose TGA conducts a full RFP process every three years. No RFP process was conducted for FY 2014 2015. This notation is factually inaccurate. Pursuant to Board of Supervisors policy, requests for proposal (RFP) are conducted at least every five (5) years unless specifically authorized by the Board to extend the time between RFPs beyond five (5) years. A bid (RFP) process was conducted for all Ryan White HIV/AIDS Program funded service categories in 2011 for agreements beginning July 1, 2011. A bid process was conducted in 2014 for Oral Health, Early Intervention Services, Legal Services, and Food Bank agreements starting July 1, 2014; and a bid process was conducted in 2015 for Case Management, Emergency Financial Assistance, Home- and Community-Based Health Services, and Outreach services agreements starting July 1, 2015. Attachment: Assessment of the Administrative Mechanism - Grantee Response (78859 : Assessment of the Administrative Mechanism) Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian County Executive: Jeffrey V. Smith Packet Pg. 39

6.d Data Collection Process On page 2 the report states that there were no Ryan White Part A questions regarding the RFP process in this year s survey as there was not an RFP process conducted for the year assessed. We understand that the 2015 Assessment did not ask questions or solicit feedback related to the RFP process; however, as previously noted, bid processes were conducted in both FY2014 and FY2015. We ask that the report be corrected. Summary of Findings-Satisfaction with 2014-15 Priority Setting & Resource Allocation Process Included in this finding was that one respondent was new and didn t know, due to being new, and that one respondent was unclear about the PSRA process but is now clearer. HIV Planning Council member orientation, including orientation to the priority setting and allocation process is an HIV Planning Council responsibility. Therefore, we acknowledge the finding as it relates to the HIV Planning Council s processes. Additionally, a recommendation was made to provide a readers guide prior to the PSRA including information on service categories and current needs of RW clients so Council members can study ahead of the PSRA. All information and supporting materials related to the Priority Setting & Resource Allocation process, including service categories and client needs assessments, are distributed to all HIV Planning Council members in advance of the HIV Planning Council s PSRA workshop and meeting, and are also made available to the public prior to the workshop and meeting in accordance with Section 54950 et seq. of the California Government Code (the Ralph M. Brown Act). Further, the data provided was consistent with what had been requested by the Planning & Resources Committee to be a part of the priority setting and resource allocation workshop and meeting. Absent additional clarification, we consider this recommendation to have already been met. Summary of Findings-Is the level of PLWHA, special populations, and general community participation in all planning activities adequate The findings appear to be reflective of community participation on and input to the HIV Planning Council s planning and assessment processes, which may or may not be related to the efficiency of the administrative mechanism in rapidly allocating funds. We therefore acknowledge this finding and recommendation as it relates to the HIV Planning Council s level of community involvement in its planning process and obligations pursuant to Title XXVI, Part A, Sec. 2602(b)(4)(D) and (G) of the Public Health Service Act, which stipulates that the HIV Planning Council shall develop a comprehensive plan for the organization and delivery of health and support services and establish methods for obtaining input on community needs and priorities which may include public meetings, conducting focus groups, and convening ad-hoc panels. Summary of Findings-Was all data that was requested provided? Was the data reliable and accurate? We were unable to identify survey questions related to the perceived accuracy and/or reliability of the data provided or whether all data requested had been provided that support the findings. The survey question asked of HIV Planning Council members was The Planning Council received sufficient data and information in the planning process regarding the needs of the HIV-positive community in the San Jose Transitional Grant Area (TGA). Of the 13 respondents, 11 (84.62%) somewhat or strongly agreed with that statement; and 2 (15.38%) didn t know if they had received sufficient data and information. One individual commented that they did not feel adequately informed to answer the question. This would seem to be reflective of a need Attachment: Assessment of the Administrative Mechanism - Grantee Response (78859 : Assessment of the Administrative Mechanism) Packet Pg. 40

6.d for the HIV Planning Council to orient its members to its planning process, rather than the effectiveness of the administrative mechanism. With respect to the individual who commented they would like to see the treatment cascade for Santa Clara County, both treatment cascade and continuum of care data for Santa Clara County has been provided to the HIV Planning Council and made a part of the public record. With regard to the recommendation to include how quality improvement activities being implemented by service providers are being directly linked to the HIV continuum of care, we assume include means to report to the HIV Planning Council on the linkage and relationship of quality improvement activities to the continuum of care; and we look forward to working with the HIV Planning Council s Quality & Standards Committee in such an effort. Summary of Findings-Overall and fiscal administration of Ryan White Funds; Contracting process, completion, and subcontractor reimbursement; Monitoring of service contracts during FY 2013-14; Technical Assistance from Grantee; and Other Comments We were deeply concerned to learn that only two (2) provider agencies are represented in the responses, and that potentially 80% of responses are from a single agency. While the limited number of responses does not negate the perceptions of those who responded, whether positive or negative, it cannot be considered representative. Further, there were several questions where 20-60% of the respondents didn t answer or answered don t know. We also note that the survey question was related to our monitoring of service contracts during FY 2014-15, not 2013-14 as stated in the report. We ask that the report be corrected. We are pleased that the limited number of responses indicated some degree of satisfaction with our administration of the service contracts, and we take seriously the comments provided asking that we provide clearer direction, reasonable timelines, and effective communication. We would, however, ask that future assessments draw a clearer linkage between satisfaction with our monitoring and other business processes and the efficiency in rapidly allocating funds. With respect to the recommendations made and conclusions reached, we offer the following: Recommendations-Involving the Community in the planning process The recommendation includes both findings and recommendations. With regard to the recommendations, we concur with the recommendation that the HIV Planning Council and Grantee (which we take to mean both the Board of Supervisors and its President (the Chief Elected Official) and the Administrative Agent) continue to work together to develop and implement a plan to increase participation of people living with HIV, special populations and the general community in the planning process, as we believe such action would improve the efficiency of the administrative mechanism in rapidly allocating funds. We also agree with the recommendation that we pursue innovative ways to gather input needed to inform the HIV Planning Council in setting priorities and allocations and meet its obligation to develop a comprehensive plan for the organization and delivery of health and support services and establish methods for obtaining input on community needs and priorities which may include public meetings, conducting focus groups, and convening ad-hoc panels. And, we also acknowledge the HIV Planning Council s request for assistance in resolving its member recruitment, appointment and retention issues. Recommendations-Underspending We concur with this recommendation. Attachment: Assessment of the Administrative Mechanism - Grantee Response (78859 : Assessment of the Administrative Mechanism) Packet Pg. 41

6.d Recommendations-Contract Processing, Monitoring and Support We partially concur with this recommendation. We agree and continue to make efforts to limit the administrative burden on service providers, streamline those processes within our control, provide technical assistance, and provide additional resources to support the administrative cost to providers. However, transferring administrative burden from service providers to the administrative agent is not a viable alternative, may be inappropriate or a conflict of interest, and could have a detrimental impact on the efficiency of the administrative mechanism. Conclusions The conclusions includes both findings and recommendations. We are pleased by the HIV Planning Council s conclusion that we, as the Administrative Agent, have been successful in delivering the services to those in need; and agree that continued effort is needed to ensure that service providers are timely and appropriately spending the resources appropriated to them. We share the HIV Planning Council s concern regarding the level of community input into its planning processes, and agree that member recruitment, appointment and retention is an issue of concern. With regard to the recommendation to [use] the Grantee s influence to resolve and streamline the membership issues, such action on the part of the Administrative Agent could be considered as usurping the relationship between the Board of Supervisors and its President (Chief Elected Official) and the HIV Planning Council. We were, however, unable to identify a clear statement or finding regarding the efficiency of the administrative mechanism in rapidly allocating funds to the areas of greatest need within the grant area, and would ask that a clear, unambiguous finding regarding the efficiency of administrative mechanism be included. We are gratified that the HIV Planning Council feels that we are working well together, despite the many shared challenges and resource limitations; and we share that opinion of our relationship with the HIV Planning Council and its Committees. We remain committed to preserving and improving that relationship, and look forward to our continued work together to meet the needs of all persons living with or at risk for HIV in Santa Clara County. Respectfully, Jim McPherson Program Manger Attachment: Assessment of the Administrative Mechanism - Grantee Response (78859 : Assessment of the Administrative Mechanism) Packet Pg. 42

7 County of Santa Clara HIV Planning Council for Prevention and Care 78907 DATE: November 10, 2015 TO: FROM: HIV Planning Council for Prevention and Care Karim Kahwaji, Robert Reed, Co-Chairperson Claire Nartker, Member SUBJECT: 2016 Grantee Directives RECOMMENDED ACTION Consider recommendations relating to 2016-2017 Grantee Directives. Possible action: a. Accept report from the Planning and Resources Committee on the proposed 2016 Grantee Directives. b. Approve the proposed 2016 Grantee Directives. c. Refer the approved 2016 directives to the Grantee for implementation. FISCAL IMPLICATIONS There is no anticipated fiscal impact resulting from the proposed revised directives. REASONS FOR RECOMMENDATION The final Grantee Directives approved by the HIV Planning Council are used by the Grantee to implement and/or revise the system of care consistent with those directives and the Comprehensive Plan. Approval of the recommended actions is needed in order to approve and submit the Grantee Directives to the Grantee for implementation. The Planning & Resources Committee recommends approval of the proposed directives. The Grantee concurs with the Committee recommendation. BACKGROUND Pursuant to the Ryan White HIV/AIDS Treatment Extension Act of 2009, the HIV Health Services Planning Council may establish directives to the Grantee in order to promote an Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian Packet Page Pg. 1 of 432 County Executive: Jeffrey V. Smith

effective coordinated system of care consistent with the HIV Planning Council's Comprehensive Plan. The HIV Planning Council's directives are reviewed by the Grantee to determine if the directive is possible or appropriate to implement. In the event the Grantee determines that a directive is not possible or appropriate, the directive is referred back to the HIV Planning Council for further discussion and resolution by both the HIV Planning Council and Grantee. The proposed 2016 Grantee Directives were approved by the Planning & Resources Committee Planning Council, and being referred to the full Planning Council for consideration and approval. CONSEQUENCES OF NEGATIVE ACTION The HIV Planning Council will not provide directives to the Grantee. ATTACHMENTS: Proposed 2016 Grantee Directives (PDF) 7 Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian Page 2 of 2 County Executive: Jeffrey V. Smith Agenda Date: November 10, 2015 Packet Pg. 44

DRAFT Co-Chairs Robert Reed, Karim Kahwaji Santa Clara County HIV Planning Council 976 Lenzen Avenue, Suite 1800 San Jose, CA 95126 (408) 792-5210 7.a Planning and Resources Committee FY 16-17 Part A Grantee Directives & Part B Recommendations Approved at P&R 09-15-2015 EC reviewed 09-23-2015 Overall Part A Directives and Part B Recommendations 1. In the event the Ryan White Grant Award is not received by the time contracts are awarded, the Grantee is directed to use the level PC approved funding scenarios based on the available information about the grant award at the time in establishing the funding levels of the service contracts. 2. The Grantee is directed to review and consult with the P&R Committee and the PC regarding proposed allocations in the event the RW Grant Award is significantly outside the range of the approved funding scenarios. 3. The Grantee is directed to closely monitor how the implementation of the Health Care Reform Act policies affect expenditures in service categories affected by these changes, propose reallocations as necessary to facilitate maximum expenditure of RW funds, and inform the P&R Committee and the PC on a regular basis. 4. The Grantee is directed to facilitate active communication and collaboration within the local HIV continuum of care. 5. The Grantee is directed to continuously develop and implement procedures with all Ryan White service providers in the San José, CA TGA to simplify the ongoing eligibility process for clients. 6. The Grantee is directed to develop and implement procedures with all Ryan White service providers in the San José, CA TGA to verify that clients are receiving health care and facilitate reconnecting out of care clients into care. Attachment: Proposed 2016 Grantee Directives (78907 : 2016 Grantee Directives) 7. The Grantee is directed to work with Ryan White service providers to expedite the enrollment of eligible individuals into the AIDS Drug Assistance Program (ADAP). 8. The Grantee is directed to ensure RW clients in the San Jose, CA TGA are informed in a timely manner of major changes in the delivery of RW services in the local TGA by appropriate means P&R Approved 09-15-2015, EC Reviewed 9-23-2015 1 of 2 Packet Pg. 45

such as public forum(s) or written notice. DRAFT 7.a Directives for specific Service Categories Home & Community Based Health Services 9. The Grantee will ensure that Personal Care Services (PCS) are provided only to individuals who need assistance with one or more Activities of Daily Living (ADLs) according to a standard assessment scale approved by the Grantee; and that services are provided only for the ADL(s) requiring assistance, as identified by a medical case manager. Local AIDS Pharmaceutical Assistance 10. The Grantee is directed to advise the Public Health Officer and appropriate Ambulatory Care and Local AIDS Pharmaceutical Assistance Providers to implement prescription medication cost saving measures in this service category. Health Insurance Premium and Cost Sharing Assistance 11. The Grantee is directed to increase funding in this service category as needed throughout the FY 15-16 funding cycle to meet the actual demand (such increases to be covered by any under spending in other service categories). Attachment: Proposed 2016 Grantee Directives (78907 : 2016 Grantee Directives) P&R Approved 09-15-2015, EC Reviewed 9-23-2015 2 of 2 Packet Pg. 46

9 County of Santa Clara HIV Planning Council for Prevention and Care 78906 DATE: November 10, 2015 TO: FROM: HIV Planning Council for Prevention and Care Karim Kahwaji, Robert Reed, Co-Chairperson SUBJECT: Standards of Care RECOMMENDED ACTION Approve Standard of Care for Medical Case Management Service Category. ATTACHMENTS: Service Standards HRSA HAB Guidance 12_14 (PDF) Proposed Medical Case Management Standard of Care (PDF) Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian Packet Page Pg. 1 of 471 County Executive: Jeffrey V. Smith

9.a SERVICE STANDARDS RYAN WHITE HIV/AIDS PROGRAMS WHAT ARE SERVICE STANDARDS? Service standards 1 outline the elements and expectations a RWHAP Service provider follows when implementing a specific service category. The purpose of service standards are to ensure that all RWHAP service providers offer the same fundamental components of the given service category across a service area. Service standards establish the minimal level of service or care that a RWHAP funded agency or provider may offer within a state, territory or jurisdiction. Service standards must be consistent with applicable clinical and/or professional guidelines, state and local regulations and licensure requirements. The variability in state/local regulations and requirements prevents the adoption of national service standards for the RWHAP, and thus they must be set at the grantee level. Medical care service standards must be consistent with U.S. Department of Health and Human Services care and treatment guidelines as well as other clinical and professional standards. For non-clinical services, service standards may be developed using evidence-based best practices, the Part A and B National Monitoring Standards, and guidelines developed by the state and local government. As a result, service standards are essential in defining and ensuring that consistent quality care is offered to all clients. Service standards set a benchmark by which services are monitored, and sub-grantee contracts are developed. Each funded service category must have a unique set of service standards. There may be some overlap of service standards among two or more service categories (ex. medical case management and non-medical case management may both assist with enrolling clients in insurance assistance programs). 1 Service Standards applies to standards of care in RWHAP Parts A and B manuals. Outside of RWHAP services, standard of care has been used to refer to acceptable levels of medical care and treatment rendered. Therefore, the term service standards is used to encompass services offered through RWHAP funding. What should be addressed in Service Standards? Each categorical specific service standard should include: Service Category Definition Intake and Eligibility Key Services Components and Activities Personnel Qualifications (including licensure) Assessment and Service Plan* Transition and Discharge Case Closure Protocol Client Rights and Responsibilities Grievance Process Cultural and Linguistic Competency Privacy and Confidentiality (including securing records) Recertification Requirements* * Where Applicable Attachment: Service Standards HRSA HAB Guidance 12_14 (78906 : Standards of Care) Packet Pg. 48

Ryan White HIV/AIDS Programs 9.a HOW ARE SERVICE STANDARDS DEVELOPED? It is ultimately the responsibility of the grantee to ensure that service standards are in place for all funded service categories. For RWHAP Part A grantees, developing service standards is a shared responsibility, typically led by the Planning Council. For Part B grantees, advisory committees and grantees are encouraged to obtain public input in the development of the service standards. Often this is done through a committee or workgroup body. For Part A and B grantees, the development of service standards is a shared responsibility of the grantee and the planning body. Grantees and planning bodies may determine the order in which they are developed based on various criteria including: funding allocation level, service category prioritization, service utilization and changes in the national and local health service delivery systems. In addition, grantees and planning bodies should obtain input from providers, consumers and experts when developing standards to provide technical input and recommendations for service delivery, and to ensure that full consideration and diverse perspectives are included in service specific service standards. The roles and development process may vary for each jurisdiction. For Parts A and B, service standards should, at minimum, also follow the programmatic and fiscal management requirements outlined in the Part A and B National Monitoring Standards. For Parts C and D, medical care standards should be based on the latest HHS HIV guidelines. For Part C and D grantees, the development of service standards are done on the organizational or agency level and are often referred to as Policies and Procedures. Each Part C and D grantee is expected to have policies and procedures in place on patient eligibility, enrollment, available services, as well as a patient grievance and discharge procedure. In addition, clinics and healthcare agencies are further guided by accrediting organizations (e.g. The Joint Commission) and regulations and guidance (e.g. Medicare Fee-For- Service Payment Regulations). All applicable standards and policies should be vetted by the legally responsible authority of the agency, usually the Board of Directors. Part C and D grantees are encouraged to refer to the most recent funding opportunity announcement for additional guidance on recommended policies and procedures. WHY ARE SERVICE STANDARDS IMPORTANT? Service standards are important to various stakeholders, with the goal to improve client and public health outcomes. Consumers - Service standards ensure the minimal expectation for consumers accessing or receiving RWHAP funded services within a state, territory or jurisdiction. Service Providers - Service standards define the core components of a service category to be included in the model of service delivery for each funded service category. Attachment: Service Standards HRSA HAB Guidance 12_14 (78906 : Standards of Care) Grantee - Grantees are responsible for ensuring the development, distribution, and use of the service standards. Service standards are important to ensure that services are provided to clients in a consistent manner across service providers. Quality Managers - Service standards are the foundation for the clinical quality management program, and provide the framework and service provision from which processes and outcomes are measured. Planning Bodies - Service standards assist planning bodies with understanding what activities are being provided 2 Packet Pg. 49