Care and Treatment Committee Meeting United Way Ansin Building 3250 SW 3 rd Avenue, Ryder Conference Room July 5, 2018 Approved September 6, 2018 # Committee Members Present Absent Guests 1 Alcala, Etelvina x Khaleeq Davidson Javier Romero 2 Boyd, Derek x Dr. Luckner Denord Racha Sankar 3 Brini, Carine x Carlos Garcia 4 Gallo, Giselle x Naury Glin 5 Gonzalez, Victor x David Goldberg 6 Grant, Gena x D. Michael Greene 7 Henriquez, Maria x Karen Hilton 8 Iadarola, Dennis x Brad Mestar 9 LaGrome, Arthur x Travis Neff 10 Puente, Miguel x Ashley Richardson 11 Siclari, Rick x Staff 12 Wall, Dan x Meizoso, Marlen Quorum = 5 Ladner, Robert I. Call to Order/Introductions The chair, Dennis Iadarola, called the meeting to order at 10:05 a.m. He welcomed everyone and asked for introductions. II. Resource Persons Mr. Iadarola indicated Behavioral Science Research (BSR) staff as resource individuals. III. Review/Approve Agenda The committee reviewed the agenda. Marlen Meizoso indicated David Goldberg would present the Part B report. Dan Wall indicated that a carryover request would need to be added to the agenda after the sweeps were completed, under New Business. The committee made a motion to approve the agenda with changes noted. Motion to accept the agenda with changes indicated. Moved: Miguel Puente Seconded: Dan Wall Motion: Passed IV. Floor Open to the Public Mr. Iadarola read the following: Pursuant to Florida Sunshine Law, I want to provide the public with a reasonable opportunity to be heard on any items on our agenda today. If there is anyone who wishes to be heard, I invite you to speak now. Each person will be given three minutes to speak. Please begin by stating your name and address for the record before you talk about your concerns. Miami-Dade HIV/AIDS Partnership/Care and Treatment Committee page 1
No comments were made, so the floor was closed. V. Review/Approve Minutes of June 13, 2018 The committee reviewed the minutes of June 13, 2018. Dr. Romero indicated that two corrections needed to be made on page 3. In the second paragraph under the ADAP Report, the statement should read present date 12.8% of 90-day PUSH eligible ADAP clients. And in the fourth paragraph, the sentence should read Phase 2 of the Formulary expansion must be completed by July 1. Motion to accept the June 13, 2018 minutes with the changes noted Moved: Dan Wall Seconded: Miguel Puente Motion: Passed VI. Membership Marlen Meizoso Mrs. Meizoso reviewed the vacancy report (copy on file) which included the requirements of membership and next steps for those interested in membership. She indicated there were several vacancies on the Care and Treatment Committee, and two applications were pending. One of the applicants was present: D. Michael Greene, the applicant, presented himself and expressed his interest. Mr. Greene has worked at various community agencies. The committee voted to make him a member. Motion to recommend D. Michael Greene as a member of the Care and Treatment Committee. Moved: Miguel Puente Second: Dan Wall Motion: Passed New members are required to complete New Member Orientation, Ethics Training, and complete a source of income form. The next orientation will take place August 7, 2018. VII. Reports Ryan White Program Update Dan Wall Dan Wall referenced the Part A/MAI FY 28 expenditure report (print date 7/3/2018: copy on file) which indicated the levels of expenditures may appear to be low. Not all contracts with providers have been executed as of the date of the report, so pending bills have not been paid. The County received the full notice of award, which totaled $26,571,194 of which $23.9 million is Part A and $2.6 is MAI. The Test and Treat program will be restarting July 9 and in reaffirmation of the project, the Part A program has increased the reimbursement rates of Outpatient/Ambulatory Medical Care and Medical Case Management as of July 1, 2018. The rate increase for Outpatient/Ambulatory Medical Care is 2.5 times the base reimbursement rate for evaluation and management codes; Medical Case Management was raised to $1.15 per minute; Peer Educator reimbursement was raised to $.65 per minute. These rates had not been raised since 2009. These increases can allow for additional staff hiring. The Department of Health has signed contracts with six of the seven providers to provide medications for Test and Treat. A notice regarding this item will be sent out tomorrow. The County is working on the program terms report due at the end of the month and will request the Partnership authorize the chair to sign a letter endorsing the priorities and sweeps decisions. Miami-Dade HIV/AIDS Partnership/Care and Treatment Committee page 2
Medicaid Managed Care clients (PAC Waiver) can access out-of network documents on the County website, including referrals and document checklists. Out-of-Network referrals will be need for clients needing to access nutritional supplements (IgG and Ultra Meal). The County has arranged with the Department of Health to use General Revenue funds to have Miami Beach Community Health Center dispense the nutritional products. A contract with a second provider is being worked on. The 2019 Ryan White Program grant application guidance has been released and is due September 21, 2018. The maximum allowable under HRSA guidelines ($27,889,754) will be requested. This is the last year of the current Ryan White Program provider funding cycle and a request for proposal (RFP) for direct services will be released sometime in August/September for another three to four year funding cycle. Part B Program Update David Goldberg David Goldberg reviewed the April 2018 Part B Program Report (copy on file). April is the first month of the grant year. A new category, Emergency Financial Assistance, was funded to pay for the Test and Treat medications. In April, $24,503.78 was expended of the $1.7 million dollar budget. Details on the contract status are included in the report. A typo was noted in the report: "March" should read "April." The May report will be emailed shortly to staff. ADAP Program Update Javier Romero Dr. Romero reviewed the ADAP-Miami Report, dated July 2018 (copy on file). Dr. Romero noted that January re-enrollments are due in July. The pharmacy expenditures for June were $2,500,353.40 for 6,354 prescriptions and 2,850 patients. ADAP indicators and information on Premium Plus/ACA-MP clients are pending. In June, there were 76 new clients. There are 5,095 clients (insured and uninsured) in ADAP. Table 10 detailed the enhancements to the program from 2017-2018. The Q/Flow Patient information is pending. General Revenue Update Marlen Meizoso Marlen Meizoso reviewed the March and April General Revenue Reports (copies on file). In March, 2,474 clients were served at a cost of $626,753 out of a $7.1 million dollar contract. In April, 4,359 clients were served at a cost of $998,244. Partnership Report (reference only) Marlen Meizoso Mr. Iadarola directed committee members to the Partnership report (copy on file). Any questions can be directed to staff. Local Pharmacy Workgroup Report Marlen Meizoso Heard reports from General Revenue and Medicaid. Discussed next steps for the Workgroup's existence. The Local Pharmacy Workgroup was advised that its one year term will conclude at the end of August. Since the workgroup took a while to gather targeted members, the workgroup is requesting an additional six months to complete its tasks and develop recommendations. Miami-Dade HIV/AIDS Partnership/Care and Treatment Committee page 3
Motion to request that the Local Pharmacy Workgroup be extended six months to allow it time to develop recommendations. Moved: Dan Wall Second: Victor Gonzalez Motion: Passed The next workgroup meeting is scheduled for August 15, 2018. VIII. Standing Business None. IX. New Business YR 28 Sweep #1 Part A and MAI All Staff indicated that Needs Assessment data on expenditures were included in the meeting materials (copy on file). Dan Wall reviewed the YR 28 Sweep sheet for Part A and MAI (copy on file). Under Part A, $23,937,248 was awarded and based on provisional awards an unobligated balance of $4,084,524 remained. The County reviewed expenditures and projection shortfalls for all categories and made reductions of totaling $2,594,556. The combined total of available funds was $6,679,080. The combination of requests by providers for additional funding and increases to rates in outpatient medical care ($388,000) and medical case management ($473,282) generated the recommendations totals. In additional, to support wrap-around insurance services, an additional $291,091 was added to the figure. There was a question regarding the food bank allocation of $994,325, since this was lower than last year s expenditures. The final expenditure reflects money placed throughout the year, and there is a carryover amount that can address the shortfall, but this item will be dealt with later in the meeting. The committee voted to accept the allocation recommendations. Motion to reallocate the Part A funding for total funding as follows: $7,438,528 for Outpatient/Ambulatory Health; $ 5,194,357 for Medical Case Management; $971,091 for Health Insurance Services; $287,000 for AIDS Pharmaceutical Assistance; $3,112,128 for Oral Health Care; $235,190 for Mental Health Services; $168,832 for Medical Transportation; $106,000 for Substance Abuse Outpatient Care; $994,325 for Food Bank; $270,073 for Outreach Services; $2,013,000 for Substance Abuse Residential, $194,000 for Other Professional Services (Legal); $559,000 for Quality Management; and $2,393,724 for Administration. Under MAI, $2,633,946 was awarded and based on provisional awards an unobligated balance of $265,802 remained. The County reviewed expenditures and projection shortfalls and no reductions were made. The combination of requests by providers for additional funding and increases to rates in outpatient medical care ($75,802) and medical case management ($100,000) generated the sweeps requests. Miami-Dade HIV/AIDS Partnership/Care and Treatment Committee page 4
Motion to accept the MAI sweeps request of $165,802 to outpatient medical care and $100,000 to medical case management. Carry Over Request All Dan Wall reviewed the carryover request allocation sheet (copy on file). Under Part A, $282,263 remained from the last year s award. The committee decided to place the total in food bank since it was underfunded based on last year s expenditures. Motion to recommend the Part A carryover amount of $282,263 is allocated to food bank. Under MAI, $57,200 remained from last year s award. The committee decided to place the total in substance abuse residential, since it was underfunded based on last year s expenditures. Motion to recommend the MAI carryover amount of $57,200 is allocated to substance abuse residential. Moved: Dan Wall Second: Michael Greene Motion: Passed The County requested that the Committee authorize the Partnership chair to execute a letter to the Health Resources and Services Administration (HRSA) confirming the priorities and sweep reallocation. A draft would be presented at the next Partnership meeting. Motion that the Committee authorize the Partnership chair to execute a letter for the Sweeps 1 reallocation. Moved: Dan Wall Second: Victor Gonzalez Motion: Passed X. Announcements Ms. Meizoso reviewed the July and August calendars (copies on file). XI. Next Meeting The next meeting is on August 2, 2018 at the Ryder Conference Room, United Way Ansin Building. XII. Adjournment Motion to adjourn. Mr. Iadarola adjourned the meeting at 10:57 a.m. Miami-Dade HIV/AIDS Partnership/Care and Treatment Committee page 5