Ryan White Planning Council - Regular Meeting

and good spring to everyone. Uh we'll pretend it's spring. Um it is 2:31 on I don't know what today is Tuesday, March 24th, and we are um starting the standards and rules committee. So um Gwen, if you can kick us off with welcome, introductions and uh declarations of conflict of interest.

Thank you, Erica. So if you are a member a voting member of the star committee or if you are scheduled to speak on today's agenda I will call your name to list any conflicts of interest that you have and I will start with Erica Tamp. Erica Tampar committee chair conflicts of interest with medical and non-medical case management referral for healthcare and support services medical transportation and HIPSA. Randall Furrow. Hi Randall Furrow. Um, planning council vice chair, no conflicts. Jason V Cruz.

Uh, Jason V Cruz. Conflicts include primary medical, substance use, mental health, HIPSA, and referral for healthcare and support services. Eric Gon Jeremy Hiveron. Jeremy Hiver Maropa County. Thank you. That's everyone scheduled to speak or on the committee. So we can go ahead and proceed to the next agenda item.

Okay. Thank you. Um next will be um review and acceptance of the agenda which Gwen, thank you for pulling up. Um we can't make any changes um to what's on the agenda, but we can uh change the order of the agenda. Is everyone in um agreement with the agenda? are pretty standard. Hearing no one saying anything differently, then we'll proceed and go with uh review and approval of the minutes and uh from the previous meeting which was on January 27th. Everyone received a copy uh in their packet. Thank you, Gwen, for always getting that out. And um when ready, I'd be glad to accept a motion to approve the minutes unless there are changes suggested.

Madame chair, I'd make a motion to approve those minutes. Thank you, Randall. I feel like I heard another voice. So, is there a second? Eric second. Thank you, Eric. Any discussion? Okay. Hearing none, can we take a vote, Gwen? Yes. So, we'll just do a quick roll call vote for this one. So, I'll start with Erica Tamp. Approved. Randall Fau. Uh, yes. Jason Val Cruz. I motion carries.

Okay. Thank you. Um, next we'll move on to item number five, chair update. I don't have anything, so we can move right along to number six, Ryan White Part A recipient update. Jeremy,

hi. Yes. Um, couple of uh quickish announcements. So we as we've been talking about we have the national rank white conference coming up this year. It's every other year. It's going to be in August in Washington DC. Um Hersa did request that we participate in a uh panel presentation as part of the planning council track. Um the topics that they've assigned us for our presentation um are the uh collaboration between the planning council and the party program uh as well as our community engagement slashrecruitment efforts. Um and uh Gwen will be leading that presentation. She's working on slides. They are due next Friday. Um uh and then um uh they did request as part of that um present as part of that the panel discussion that Gwen and Randall and possibly myself participate in the in the panel. Um what that means is that uh as you are maybe remember from our last meeting that they said we needed to they had a spot earmarked for planning council chair which is um Michael now and then a and another spot uh for an unaligned consumer member. So Rand and so they requested that Randall fill that spot. Um and so he will be going with us to that uh conference. For other conferences um it is unlikely that we are going to be able to approve other uh to send planning council members to other conferences this year. And the

reason for that is HERSA has increased the scrutiny and reviews of conference uh and travel approvals uh to ensure that conference agendas are in line with the current executive orders. Um what that uh means is if you if you recall um from when we had our conference training and travel policy um we had to go in and update it. The only update we did was we removed the table that said generally approved conferences because almost every conference on there besides the national Ryan White conference is uh likely to not be approved. We've already seen um and heard things like US uh the US conference on HIV and AIDS um synchronicity the lat the national Latin conference are not likely to be approved by with HERSA funding. Um and so what they're doing when they are approving those is they're reviewing the agendas um and sometimes even past agendas um and looking to see if there is even a session on a topic that they uh are that's not in line with executive orders. For instance, if there is a session on diversity, equity, inclusion or a session on um gender affirming care and they are not uh and even if you don't plan to attend that session um they are still not approving uh Ryan White funds to be used for those conferences. But in the meantime, if there are, we are looking at other potential options for um uh covering that outside of uh part A and E funding. But if you do identify a conference that you'd like to go to, we're asking council members to send us uh a link to the conference and a description that way we can review to see if it might pass the muster and pass the Hersa um

approval process. Uh before we move forward, um also a quick reminder, we've been uh sharing this out to the planning council in email and at the last meeting. Um the public health department did launch our uh community health uh needs assessment for 2026. Uh is running through April 30th and it is open to anyone living in uh in Maricopa County, ages 13 and up. If you haven't already, please take 10 to 15 minutes to complete that survey. It is really helpful. I think we're about 40% of our way to our 15,000 um uh goal of having 15,000 residents take the survey. It really does help inform public health uh the department's um priorities uh for funding um um uh programs. Uh we do have an upcoming outreach event on Saturday and Sunday, the uh um annual rainbows festival. Um we are going to be there. And thank you to those planning council members who've signed up. If you haven't yet and you'd like to, that would be really helpful. Please reach out to Gwen and she will let you know what times we have available for slots. Um we are potentially going to be a little short staffed this weekend. Um, so we need all the help we can get if you're interested in AEL. Um, and it's not going to be as hot as it supposed to be. Not supposed to be as hot as it was this past weekend at AIDS, which was a scorcher. Um, uh, but, uh, yes. So, if you are interested, please let us know uh, in terms of allocations um, updates. So, as of March 3rd, we have now received both of our partial awards. So, we got our e partial award um and uh

HERSA has indicated level funding is expected um and we're hoping that the the final awards will be released within the next two months. Um crossing our fingers um but not holding our breath. Um uh usually in years past we got them around end of April, beginning of May. So hopefully that's when it happens this year and not like it did last year um in late June, early August. Um in the meantime, services are continuing at current funding levels until we receive those full and final awards. And then in terms of grantier 25 closeout, we do not have an updated allocations and expenditures report for you today. We are in the process of closing out grantier 25. Final invoices from providers are due by Tuesday, March 31st, and our goal is to have everything processed by April 15th. Um we will provide a full report uh at the April planning council meeting which will include final expenditures by service category. Uh any rapid service reallocations based on your uh rapid reallocations authority that you provided back in December and then uh carryover amounts. We do still anticipate that we'll be uh requesting carryover for almost the entire allowed amount for part A formula funds which is capped at 348,000. Um along with some carryover of of minority AIDS initiative funds. As just a reminder, MAI does not have a carryover limit. So we're able to uh request all of that carried over that's unspent. Any questions for me? I know I kind of ran through that pretty fast.

All right, I'm complete, Erica.

Okay, and I just want to give a plug for the survey. I did it. It was quick and easy, and it did feel good to give input, not just about, you know, our HIV world, but my whole community. So, it really it really does go fast. So, I encourage people to do it just just like Jeremy did. Um, next up, we are moving on to item number seven, which is our new process um for doing an annual service standards review. And Jeremy and Shante are uh going to let us know what that process is going to look like. And we're going to do it today, I believe. Maybe.

Yes. Yes. And Gwen, did you have a your hand up? Yeah. Yeah, I just wanted to give Duvia a chance to unlist her conflict since she joined the meeting. Hi, Duvia. Hi, Duvia Loausano. Conflict of interest with mental health, substance abuse, psychosocial, eh, uh, medical and non-medical. Thank you so much. Thank you. Thank you. And so the updated quorum is 5 by5. Yeah.

Yeah. Okay. All right. I dropped some more stuff in the chat. This is what the policy says um that we um will present uh to you all or review with you all um any updates based on our the part A's internal review of whether or not updates to the standards are required based on any changes in HERSA policy or guidance findings from recent site visits stakeholder feedback and a length of time since the last revision. So uh good newsish I guess um is that there has not been a lot of recent uh changes or guidance from HERSA. they are being very um they are not putting out a lot of new things uh in terms of that except for in terms of uh the standard we're already kind of working on uh with the uh um outpatient amory health standard. So we're we're we're good on that front. um findings from the recent site visit were more actually geared towards the part A program uh and our prep of uh the site visit and the to uh and tools. So, we are working on this year um aligning our tools to better reflect the uh wording and intent of the standards that you all all writtely and working on in some instances for some services aligning it to the clinical practice in terms of how and um the order we're asking the questions. it'll make more sense when we're doing our chart reviews. That was some excellent feedback from our providers during the process this year. Um so we don't have any like standards that we pulled out based on findings from site

visits. That might change next year when we um do the review um ourselves. Um and in terms of stateholder feedback, I we don't have anything that's specific to um any service standards. I believe for HIPSA, we have some things from a uh service category satisfaction survey that we did a couple years ago that we'll be looking to plug in, but that um uh again, that's next up on your list already. So, the main port here is length of time since the last revision. I'm going to pop in so you can see what I had written down for myself. So here I um it's in the chat but I'll I'll tell you what it is. Uh so it has been 6 years since we updated food bank home delivered meals and medical nutrition therapy. So those are definitely need to be on uh the list for you all to take a look at to make sure they're aligned with um the your current expectations and and such. mental health and substance abuse just turned three years old. Um, which means it's a good time to start looking at those again. Um, I know it doesn't it doesn't feel like it's been that long, but it also has uh, right? Um, but, uh, they literally just we just I think they were approved in February 2023, so they literally are just 3 years old. But if we put them on the list for this year, that means by next grant year, they'll be perfect time to implement them. And then we're kind of on a threeyear cycle at least with everything. Um, and then psychosocial uh support would be uh is 2 and a half years old right now. It'll turn three uh at the uh in October. So uh just kind of that's kind of where we were looking at

based on a uh the the age of the things is kind of that order for now. My suggestion is that get through that list and then pause for bylaws. Um you all if you for those of you who've been on standards for a while or been along with the planning council, it used to go on a cycle where we do all the standards like over a year year and a half process and then we take a break from them for 3 years which is why food bank is six years old. Um um but now we're kind of doing more of a rolling schedule which I think is a easier lift for everyone um going forward. So um but if you're okay with that schedule I'm or we we're open to discussions as well. Um my other suggestion is they are currently published but now that we've gotten through the grant year um uh through last grant year emergency financial assistance EIS and housing are not currently funded by part A. We don't want to get rid of the skinner, but my suggestion would be to pull them from the planning council website until that time when we do fund them again, if we them again, and then we can either revisit, publish them while we're revisiting, that kind of thing. So that is now up for you all for discussion or questions.

Thank you, Jeremy. That is very helpful. Could we get a chart like a maybe a little kind of formal kind of like we have a PCAD or we have our meeting schedule some kind of formal chart that lists all the standards and you know kind of the most recent date and maybe it'll have columns we can just update over time or something like that so it kind of shows where we're at and maybe we can even put the ones that

uh like like you just mentioned EIS housing EFA and we can put that they're on hold or you know just something like that. So I think that would be helpful for me and I think it can then show our progress also if like hers is like where are you at or what are you doing for some reason like that would show progress over time definitely and that had been my intent by the way um uh and uh but um yes we can definitely put that together uh we'll put the like most recent an approved date. Yeah.

Um and then like what like maybe a tenative year of what we're planning to review them in. So like these ones would all have 2026. Um and then and we can also then add uh yes the other things you mentioned. Again I'll go back and review the tape but we can definitely work on Yeah. Right. We can definitely work on that and have that out to you all even before the next meeting. Thank you. That would be great. Um, in a three-year cycle, that's I mean, sounds fine by me. That's good by Hersa. We anticipate.

Yeah. As long as they say as long as we show that we've done a review and thankfully the piece is they were very clear at the last site visit that these are a joint responsibility. So, we've done our review, which means now we can go in and Gwen can change the review date on all of them to say this year. Um, uh, so we have an approved date and then we have a reviewed, uh, date. So, the review date, everyone, every standard will have a review date from this year. Um, and then so that's for the policy that you all looked at and and that um, late last year. Uh that is our um our our piece. We present to you what ones we think need to be done based on those things I popped in the chat. Um but uh and then um and then yes, as we actually review and and adjust and make edits and approve them, then we load the current version up there as well. and our meeting notes like from right now is showing we discussed like just like you ran through there are not significant changes in policy there are not you know site uh service specific site visit findings all that means we've fully covered it

nothing that warrants a change right there there might be findings but there you know un unless it's something that warrants a change or we're seeing it like every single provider is having the same issue because this doesn't make sense to them. Um, so we might need to reward it or something like that. That's the things we bring back to you. And do we need to vote on this in any way or approve this in any way or did we put on the agenda that there might be a vote? I know. I don't know. When I brought that up, I was like, maybe I should shouldn't be saying this, but I just don't know how

Yes, this is a a vote may. And I think it would be good for the for the record that you all approved this lineup as your schedule for the year. We should add that obviously outpatient ambulatoratory and hips are first and they are on the schedule for this year too.

Okay. Anyone else have any discussion or things to comments? Thank you Randall. I saw your chat comment. So, just for clarification, Erica and my end, I'm sorry. Um, we're going to have a schedule of how we're going to be reviewing our standards of care for the year. And then Jeremy's going to help us determine what that schedule looks like based on standards of care that are older that need to be prioritized this year. Right.

Oh, Jeremy, you're gonna have to step it up. Well, the schedule I just put I just updated it and popped it in the chat. It is this is the schedule you'd be looking at for this year that you can vote on to approve. We'll create a document that track like a tracking document that we'll share out with you based on what you approve not approve right now. Okay, I see the the schedule. Thank you so much. And we'll add a line in there for bylaws so we can say this that the year we're doing bylaws reviews too

in there so you know when there's a break in between. Well, I would uh be glad to accept an emo uh an a motion an em motion and a motion um uh approving our annual review of the service standards and a uh proposed schedule for the rest of 2026 that will involve the service standards. currently being worked on and uh the ones that are the most out to date as uh explained in the chat. It's a long motion. Who can repeat it? Gosh, no takers. Can we just say I so move to it?

Yes, it's required. I so move for us to review the standards of care as mentioned as listed on the chat. Thank you, Juvia. Of course. And is there a second? Sounds great, Eric. Second. Thank you, Eric. Uh any discussion? Okay. With no discussion, then can we take a vote, Gwen? Sure. We'll just do a roll call vote again. So, I'll start with Erica Tamp.

Hi. Dia Lozano. Yes. Randle Fo. Yes. Jason Val Cruz. I Eric Een. Yes. The motion carries.

Thank you. Okay. Well, let's next jump into the service standard that we hope we can finish today. Um, so the one we are so close on is outpatient ambulatory health services and we have a document Jeremy, did you want me to share it from my screen or did you want to facilitate that? Okay, I'll try to zoom in some more. There's Jeremy left some comments on the side, too. So, I want to make sure that those are visible. Oh, that's too much. Do we want to start at a certain section or where would we like to begin?

Um I mean I think Jeremy can we tell the dates of your notes that I mean just had a couple things we were when if you go there's a format change. If you accept the format change then it should adjust. There's one format change. Sorry, I should have fixed that. You can Yeah, if you scroll up Oh, this one. That one. Accept that. It should get rid of that. There you go. It's a little bit better. Yeah.

Yes. Um, this comment that I added here was just updated to match the the preferred language that you already put in the is it the first? Yeah, the first uh standard in the table below. Thank you. We keep scrolling. I think we were mainly as I recall it was just getting that feedback from um Valley Wise providers, right? Okay.

Yeah. Everything else should be I think there are some changes in language but very minimally on that was only because uh uh and that was from reviewing the tape but it was very minimal. So all the blue that you're seeing is really just some we did most of that stuff while you're in there. I just confirmed it through going back through the watching the video and reading the transcript.

Mostly it's just the comments

other very small comments. Let you zoom in on the comments. Do you want to start with the comments and do those? Yeah. Would it help if I put the comment in the chat, too? I got it. I'll grab it. So, this, as I recall, I think our issue was, you know, are are these the only OIS? Are there other OIS? Are these old OIS that we don't worry so much about? Can you scroll just a little, Gwen? So um we can see like the next page

page five because I think they both like there was PCP MAC and so I'm I'm taking from the medical provider comment that maybe to be um rather than calling out specific ones maybe we can find some phrasing over all about you know referring to current clinical guidelines something like that. I don't know that we have to say specific OIS. Is that what other people Jason can can you help make sure I'm interpreting?

Yeah, I think I because there's I mean there's more than just a couple, right? OIS and and so I think just saying OIS would be appropriate. That's just my take. Yeah. and just saying current clinical guidelines because obviously we're not going to put all that other language in there but and that could because that can change as well. That's right. So really could just be ongoing opportunistic infection prevention. Should we do So the next one says eval like the second the next category says evaluation. Should we do prevention and evaluation or prevent or should we do ongoing

maybe evaluation? I don't know. What do you think Jason? And do you have a like is one word is it evaluation and treatment is that the title then too because the the actual standard then talks about prescribing right and treating. Yeah. Yeah. I would say evaluation and treatment. Okay.

So just opportunistic infection evaluation and treatment. We don't need to call out any specific ones. And then uh it would really be all I'm not sure how we've said it, but I guess clients will be screened for opportunistic will be evaluated and treated for opportunistic infections based on current clinical guidelines. I would almost say evaluated for vulnerability to opportunistic infections because it's it's I mean the entire point is prophylaxis around it.

Right. That's why I didn't love leaving prevention out. I have to say on the I mean is evaluation broad enough that it would lead to like cover kind of prevention and treatment or do we need to say all three words? Do we put preventative in the language of the standard of care? So like CL what what did you say Jason? clients are screen

I I would say that they're evaluated for vulnerability, right? Because we're looking at viral load, you know, there may be environmental stuff like if they've got cats, you know, there's lots of lots of stuff to kind of evaluate uh when you're when you're looking at that.

Yeah. I mean really prevention is what our real priority is obviously treatment if that oh sorry if that becomes necessary but um people feel evaluation covers prevention. So would it be Clients are evaluated for vulnerability for opportunistic infections and are prescribed preventative prophyl preventative medications. Um yeah I would say

document

treatment prophylaxis right I'm not being sure what I want to say. So I there's prevention and there's treatment. treatment if they indeed do have an OI. So, are we trying to combine it all in one? Is our standard really more about prevention versus treatment? Um, I feel like it's getting jumbled up and not like we're saying evaluation and treatment, which for me means treating an OI. um

versus but then yet our language is about prevention and prescribing prophylaxis. Yeah, I I think and I I'm there's two lines and then one like the MAC prophylaxis that is medication to stop MAC, right?

But I think we're trying to just get one row that's covering all OIS, isn't is I thought that was our goal. So then it would have to be all-incclusive because it would be prevention ahead of time for certain opportunistic infections and then should an an opportunistic infection show up treatment to relieve the symptoms as well until um the body is able to deal with it essentially. So I wonder if we and don't write this exactly but some kind of a like Jason was saying evaluation and then you know appropriate uh treatment which you know we can preventative or treatment I don't know some kind of words like that just that cover both

kind of like you know you're positive we're gonna or not positive we're going to get you in the right path. We can still do it under one sub like one header like we do for uh like this the labs and screening like they have a header. So we could do the first one being that they're evaluated for vulnerability for opportunistic in in infections and then we could do a separate sentence that says if clinically indicated um um or if you know based on current clinical guidelines whatever are offered uh treatment to treat or you have to keep them separate.

Yeah. So, I'm just going to throw out there um our current standards are only about prophylaxis. Do we care about treatment? I mean, obviously we treatment is very important, but is that a standard that we want to in essence now create? And and here's the other thing, Erica, would that not already be included in other treatment standards?

Yeah. Yeah. So if if we're looking just at prophylaxis, then that makes more sense to me a as as being we we're looking to prevent opportunistic infections, not just through medication availability access, but also like if someone has reached a point where they need additional medication aside from the their art to prevent an OI, then that would be a category. But if they have developed an OI then I feel like that would um be included on any other kind of medical treatment that's being provided. Right. Rather than creating additional

right because we there are lots of things that could be discovered we assume are going to be treat treated. Right. Exactly. So I feel this is about prevention the importance that that is being evaluated and attended to and prescribed for.

Yeah. So, I'm going to suggest that we completely remove one of the rows for PCP or MAC, which I mean maybe P PCP1 just since we started working on the MAC one. And um then I think it should be evaluation and treatment. I mean prevention or op yeah opportunistic infection evaluation and prevention and then MAC should be crossed out. And then it was I think Jason said clients will be evaluated. Can you say it again, Jason?

I just popped in the chat I think. Okay, great. And will that entire sentence replace the whole box that we have currently? We um let me see. I'm sorry. I need to Or do we want to keep Do we want to keep anything about CL current clinical guidelines? I do think it don't you think it should say something based on current clinical guidelines? Yeah. So maybe just add that to the last clients are evaluated based on current clinical guidelines for vulnerability for opportunistic infections and our prescribed treatment prophylaxis as indicated

when I'm updating my thing because we write it in a specific way. Okay, I'll wait for you to have that written just so I we because we in other places we're saying in accordance with whatever language you want. And and Jeremy, can I ask a question without it being too you can Yes. inflammatory, let's say.

Oh boy. When we're talking about current clinical guidelines, that's not referring to any set of national or federal standards so much as it is to the clinical best practices seen throughout the industry. Is that correct? Yes. Okay, good. Just in case just have to in a couple years things, but only in the event that they have not digressed, right? Evolved. Evolved.

Evolved. Evolved. That's a better word for me to say. Yes. Thank you. Thank you, Jason. Yes. So, How's that? I just updated my comment in the chat. Look.

Yes. Is it our prescribed pro treatment for as needed? As appropriate.

As appropriate. So just add as appropriate to the end of that statement. Great. You can translate that into an outcome measure, the appropriate outcome measure. Client chart documents evaluation for opportunistic infections.

Um I feel like it's kind of two things. I mean there's the evaluation and there's then the prescribing. Yeah. Do we want to say the evaluation and then appropriate clinical steps to be followed? Something like that. I like that

because even like even if they're not at risk for an OI, then we could follow up with um adherence counseling. Like there's lots of stuff, right? Mhm. So, client chart documents evaluation for opportunistic infections. And what did you say was the last part? She said appropriate

uh appropriate um clinical steps uh followed or something something to that effect and that provider followed appropriate clinical steps as followup. Once I say it, Jeremy, I instantly forget. So I know. Can we just say an appropriate clinical followup or do you like steps?

No, I think an appropriate clinical follow-up is great. I guess my question is still are those technically two different things or I mean they should go together but uh what if someone is found to be vulnerable and then yet there's not followup. Uh I know that would never happen but they would fail they would fail the outcome measure at that point then okay because they got to do both. Yeah, I think it's I think it's a it's a it's a it's a pass fail both way because that's

something that really needs to be addressed, right? Okay, perfect. Thank you. No point in doing the first if you're not doing the second. That's right. I think we can do this in terms of the the measure that Oh, sorry. It has a x an extra. And the reason why is because that is much easier for us to see um as the as the measure. Um yeah, that works for me. Yeah.

And then you just want to put a line through or remember to line out the one ahead, the PCP one. Just removing the whole thing. And aren't we glad that we do not have to name PCP and MAC anymore, right? Like that's that is progress, folks. That is great. I mean, I feel like hopefully there's barely anyone this is ever even going to apply to anymore, you know? I mean, in terms of Yes. Yeah.

Hopefully, it's a very small number of clients in the next site visit. I've just been training some new staff and it's always wonderful to be it's a great opportunity to be remembering how far uh we have come. Okay. Are we happy here? I think we appropriately incorporated our provider comments and thumbs up from everyone to keep moving. Okay.

Oh, let me pop this. This is the note on this section says reviewers should know the actual clinical criteria for each of the different annual preventative lab and screenings. Also, renal screening should be added to lipid screening, which we did. Um, it might be on the next page, Gwen. Right there, you added renal screening in there. Um, I don't think this comment requires any change to the language that you already did, though, right?

That's more for us to be sure we're telling our reviewers to use the appropriate clinical guidelines to review. Well, I mean, honestly, I did kind of think about that myself in terms of I I don't know, a little just like this is so clinical and it was like is I don't know. I was just getting my head in a twist about standards of care in terms of maybe policy and procedure versus clinical guidelines. Is it is it appropriate that the part A office is like doing a clinical review? Do we know all of that? Do we know what we're looking for? You know, the people who are doing the reviewing. Um, is there another body that does clinical reviews? I don't know.

So, of course, we want to know good care is provided and that we only know that from clinical. Erica, when these when these reviews are being done, there it is typically with a clinical person from from the provider side

to help that yes, that if there's a question or if it looks gray um then they can speak to the clinician or whoever is representing the medical provider um to say, you know, what's why didn't you do you know, STI screening. Well, see right here in the notes, it says that this person is celibate right now. And generally speaking, the notes are there. So, it's really like uh that is usually there's usually a justification and that's why the we write it that way that there's some sort of justification for these if it's not.

Um but other than that, most of the things are timing right on these. So, those are pretty standard to have with you. um we just had to make sure that we're uh using the appropriate ones and that was something we had said we would do a little bit more not that we haven't but a little bit more clearly this year and going forward about these are the ones we want you to be reviewing against in terms of clinical standards

great okay yeah I think that comment was like you said just about the review process so further Scrolling that was complete then about the various immunizations. Okay. Did we then did you incorporate Jeremy are you saying?

Yeah it's on the next page here. Yeah that yeah so you all asked for the bullet bulleted list at the last meeting. So we did that in between and then the clinical provider note was uh add MOX and RSV which we added and then again it was the same thing like no the OI uh guideline. Yeah. Recommendations. So that's again nothing needed to change. Okay. I think that's great then. Could we be done?

I think we might be. Oh, I I had a question on the on the immunizations, ongoing immunizations. And do we also include um Oh, we do have it on there. I'm sorry. I see it right there. HPV. Thank you. Right. Yeah, it's a good good list. Big list. Yeah. Are you getting ready for a vote? I I just want to see. It looks like there was one last comment. Is that

That was I just added the the what you all preferred based on the conversation last time. So, that was that's pretty that's done. So, you're good with the language that's currently on there. Uh, scroll all the way down. Make sure we got nothing else. Um, I mean, I feel I'm ready to accept a motion to approve the outpatient ambulatory health services standards. Um, I'll make that motion.

Thank you so much, Randall. Thank you. There a second.

Looks great. A second. Thank you, Eric. Any discussion? Okay. Hearing none, can we call for the vote, Gwen? Yes. Thank you, Erica. Um, I'll start with you, Erica. I Dubia Lozano Dia. Oh, thank you Dia. I'm so sorry. Like I was getting a call in the middle of this. Sorry. No worries. Thank you, Dubia. Randall Fau. It's my pleasure to say yes. Jason Vel Cruz, I. Eric E.

Yes. Motion carries. Hooray everyone. Great work. This was a lot to push through. It's like the most important service obviously. So great that we were able to really modernize it. Uh kind of like Jason referred to um you know like great great progress has been made. So how nice to remove some things that really are from like the 90s. So Erica, how many meetings did it take to approve the standard

three. Yeah, I was thinking three. So maybe that's not We've talked about other things a lot too, but I feel like we did a really a good lot of good discussion on this and it was like three full meetings almost. So it's good information to share with our project officer that so much time was spent Yes. making wise decisions. Yes. I know. I think we put a lot of thought into all the standards. Everyone really gives good um input which is so appreciated. You guys are an amazing team.

Yes. Um okay then that lets us move into our next standard which is HIPSA. And um I think what we'll work on today is probably just do a nice quick review. Uh we can make sure all the uh standard language is going to get updated and we will we may have some questions that we'll we'll have to come back to. So and do just kind of a general overview. We may have some questions we're going to need to get answered. Especially this one is challenging as it is um two distinct uh kind of services within the service category. So, first off, uh because I know I still think about HIPSA just as the premium cost sharing assistance, but we have to remember the the dental insurance um program being in here, too. So, this is all our standard. Is there anything we really need to look at here? Is this pretty stand like uh hersa language that we don't alter? Yes, Jeremy is nodding. Okay. So, kind of three things. I mean, in essence, health insurance premiums, standalone dental insurance premiums, and then um cost sharing. Okay. Okay. So, I guess we can kind of keep scrolling.

Is this program guidance? We can just move on there. I think intake. Go ahead. Sorry, Erica. Uh quick question. Uh this is reviewed by Hersa. Yes, kind of. Kind of. They look at them. Yeah, they really Yes. But this is okay. Let me We missing some something wrong here. Is this all No, if you're looking at language.

I am. Um, the issue is going to be that this should be language that's on their PC. So, if they haven't updated it, then um Okay, that's a thing that I did not peek at really fast, but I can do that really quickly. I I I just see the eword and uh I know in other places that's been flagged. So, which one? Equity. Yeah. Where was that at? Equitable enrollment.

Uh, I'm looking at um Six seconds. Can we find a paragraph where it says that? You scroll up when the equity part. Yeah. Where is equity?

It's right there on the second sentence in program guidance. An equitable enrollment policy. Did you see it anywhere else, Jason? No, I'm looking though. No, it still says that an equitable enrollment policy. I mean, we can take that word out just to be on the safe side. Um, we've been utilizing fairness instead.

Comparable comparable. I mean, because I think here they are talking about comparable, right? Um, is it comparable there? I mean because it's saying if part C D has the resource to proide the serviceable basically we have. Yeah, I would say a comparable. Yeah.

Gwen, can you make that change? Instead of inequitable, write a comparable. I don't know what's going on with the spacing there, but I will adjust that. Good catch, Jason. We can come back to it, Gwen. Next one.

Yeah, I made a Yeah, sorry about the spacing. Um are should I move on to Yeah. Um B Yes. Um, now this category has two different FPLs. So, do we need to clarify that? Some services may have lower income level thresholds as outlined in the Yeah, read the whole That way we don't have to like adjust that for every single service every time.

Okay. So, this is all our standard. But did we change anything about HIV labs or has that been being in all the answers? I am looking to confirm that in a recent as we just approved OHS. Yeah. And I it's I mean it's our standard eligibility language, but I mean we don't disenroll anyone any longer if they don't have labs from the past six months. or viral load from the last.

What is the last standard that we did? OS. Yeah. Before that one, didn't we do one recently? Hold on. I have the other folder open. We did um food bank home delivered meals I think. Or was that earlier? Oh my gosh, we did do that one. It's not Gwen. That's the thing. I was looking at our I was looking at the website. No, it's not. We did not do that one. Sorry. That was um Did you nutrition?

No, those are the ones that are on the schedule coming forward. So, I don't think we changed any of them for the six months. Okay. They all still say 6 months. I think it's okay to leave it for now until we come until we it's matching with everything else.

Yeah. Okay. Okay. So moving on to key service components and activities. Is this what your guys are using now, Jeremy, or what? Yes, we do look at that and we also look at viral suppression for hip. Okay.

So, we'll need to clarify for both for the I mean I know it was spelled out above as three bullet points about hip cost sharing and then let's just call it dental but I feel like hip and cost sharing in general go together and then dental is this, you know. So can we kind of think in general in terms of two service categories within the service category

is looking at how we do it for Yeah. because we do like in the referral for healthcare we did it separately kind of um in there uh just depending on the on the type right so yeah I think we could do something specifically for those who use I would say co-pay and deductible assistance um to shorten that um and then well it should be copay and premium assist well I mean the CASA is deductible, co-ay, co- insurance. The HIP is health insurance premium. Yeah.

Maybe we say premium and cost sharing. Do we want to just call it that? Sure. Okay. Or call it just call it cost sharing assistance. I mean, that's really we're not doing a lot of premium anyway, so we kind of bundle it under the same thing. Um and then the second one would then we could do one about uh dental insurance. I think technically premium is not cost sharing and my only reason I'm being picky is just because above there are three bullet points and cost sharing is its own and premium is its own. So I think it's best to call it premium and cost sharing. Okay,

just to be just clear. And then the second um dental insurance program or So Gwen, can you we need to adjust the program outcome? It's premium or cost sharing, right? Premium or cost sharing assistance. And then we'll have another bullet point for dental insurance program. Is that the or dental insurance assistance or dental I

dental I just call it the dental insurance program. Yeah. Okay. How we refer to it. I mean, this can help us just get kind of the formatting going and then we can fill in numbers and stuff next time. So, this be 90% of clients who use the dental insurance program. Yeah, you can just replace that. I would just copy and and paste and then just change the thing to instead of premium and or cost sharing, just do dental insurance program and we can come back to the numbers. As Erica said, we can flush all that the details out of the next one. We're just getting kind of set up here.

Do we have Jeremy a dental uh dental standards of care from when it was dental? Because that could be helpful. Yep. We We don't even have to pull it up today, but maybe that could be helpful. Yeah, we can locate it. Yeah, for specifics. I mean, there is already like we have it built into this already. Oh, okay.

So, we we we had we already combined them back in 2020. It's been a while since it's been under HIPS. I don't I don't know where time has gone. Okay, great. Well, then great. Sorry, my my my question is moot. I'm going to tell you the language on the on the on some of these standards are not fun to look at. So, I apologize. There's some language coming in a little bit that it's not ideal. Okay. So, then on to indicators. We'll probably have two indicators, right? Yeah.

Okay. Would you want to just copy that, Gwen? And then know one is premium or cost sharing, one is dental insurance program.

Yeah. And I think we simplified the language on the first one anyway to be Yeah. Great. And then service units will be the same. I mean two It's really just

Yeah, I know. Can I ask a thing? Can I ask a thing? And I maybe we should have done this sooner than later, but like do you all see a benefit for having the service units there? Because the service unit doesn't really like for outpatient aatory, it's the number of clients retained in OS and the number of clients demonstrating vital suppression is the service unit. I don't think that is a service unit. Exactly. And I don't think we use them. I don't think we I don't think we you I we missed this.

I'm wondering if we can just I think we could just get rid of service units and if you all want to get through this and before the end of the day want to tell us we would like you to remove service units from all the standards. We'll go and do that as part of our annual review. That's great. We can reopen that. You'll need to vote that. Yes. Okay. You can do that as part of working on standards of care because that's a standard adjustment. Yes.

Well, and it's part of our annual service standards review that we're going to reopen that line item or that agenda item. Um, okay. Well, let's um continue scrolling through here. Oh, why does the header say medical case management? where Oh, that's weird. Yeah. Yeah, that's strange. This is Sorry. It's just like the on the second page going forward, it says medical case management. We use the template. We use the template. That's why you can fix it later.

I'll I'll fix that later. We're already confused. We don't need more. Okay. Okay, that's just the standard language.

Yeah. Okay. So, health insurance premium focus standards. So, here we do have it broken out. Do we want to get into this today? This nitty-gritty right now of because it looks like Can you scroll just a little further, Gwen? Next page. Next page. Okay. So, we do have it broken out into three things. I just feel like we need to be three consistently or two consistently unless there is a way to combine premium and cost sharing. But I mean they are a little different.

Yeah. I will for just as an example for referral for healthcare the indicators above the table um have like the needs focused and the peer support as one indicator but they have separate boxes below and are separated out. I'm okay. It's all under one how we frame it under one service thing. Even though there are separate services, the same kind of thing. I think it's okay to do it in here like that. Um, and have those because they're still going to fall under the same we're still going to shoot for the same percentages for those things and they're at least more aligned than say the dental insurance program which is a

different. Okay. Okay. Um, is this where we were thinking of waiting of getting into? No, I think you can go ahead and start looking into this like most like if you have questions for us to go back to review and provide feedback on we can work on the category stuff later. I think here you look at the the language of what this is and then we can come back.

Okay. So for health insurance premium focused standards um HIPSA staff paid request for I'd almost like to say premium payment but uh it's paid request for payment is unusual within 10 10 business days of receipt of completed application. Anyone have any thoughts on that?

That seem a reasonable timeline. How I mean my question is to you since you run that program. How often do you guys see clients submitting and then not technically being completed applications? Um we get very few requests for premiums. Um people do have to and I almost kind of feel like the order of these three should change because I I think first we need to say what needs to be provided which is the insurance policy, the formulary. So people sometimes might request something but then not end up providing all the documentation. Um I mean most of the time they do. Um but it can sometimes take a while for them to get that which is why the 10 business days of a completed application was important not just 10 days from when they requested the service. that kind of answer that Daniel.

Yeah, because you're thinking of like this is generally like people who are maybe on COBRA or something where we've determined that it's the the cost benefit is better than having them be on part A medical care,

right? And then so I almost feel like the you know the the second tube should be first and then it ends with paying the premium but just in terms of I guess if I'm thinking of the flow of the service maybe it doesn't matter but the the goal is to like Jeremy said the costbenefit analysis of making sure that it makes sense to pay for this um and you know versus and I don't know if I mean within that is also basically other payer screening. So for example if the person can get access that that might be something that a road that's gone down um instead of paying a premium. Um, so I don't know if that could kind of be considered to be covered under costbenefit analysis or if we need to clarify that more.

Could you add uh um costbenefit analysis of uh what is it? is that premium coverage really is completed to it and then and including uh uh eligibility for other payers. Maybe that's how you do it. Does that make sense? Mhm. And Erica, I do think that you're on the right track in terms of it should be arranged by flow just because you know from an auditing perspective that makes more logical sense as well,

right? So I think really the first one is the first thing that's needed. I don't know that it needs to say where premiums are covered. I mean that's what this is. Um, so maybe it's just there's proof that the insurance policy provides comprehensive primary care and a formulary with full range of HIV medications. That should be the first row. Gwen, just put for now, just put in the category, put number one in that line. We can move it around.

I don't even want to try and change the formatting with all of us watching. And can we are do people agree we could remove that first where premiums are covered? Yep. So just um take this out like that.

Are you all comfortable with us just like kind of gathering and jotting down your feedback and then reviewing the It's really easy to do this while reviewing like make the edits and move things around while we're reviewing the the the tape and stuff. So, we'll we can do that to um uh rather than like going in and like rewarding everything right now, just talk about how you want it. We'll get some notes down in there. Um and then we can plug it in and have it ready for you to review at the next one.

That's fine by me if everyone else agrees. Seeing I'm nodding. Okay. Um costbenefit analysis of insurance is completed including um other pair screening something like that or pair of last resort screening or whatever language Hersa likes. It's payer with an e, right? Or is it o r? I've seen it both ways so I don't I'm just going to put payer like that. That's number two. And then number three is the just for for the tape paid request for premium payment. ready to move on to cost sharing assistance. So again, I think the order is there. Can you scroll down to the next page? Yeah.

Oh, okay. That's a separate Yeah. Um, can you keep scrolling? Okay. Oh, that's incidental. On a side note, I think payers just use for formal documents. I think that's the only difference. PE the the O one. Yeah, the O is Yeah, for more like legal or official healthcare documents. Thank you.

You can go back up, Gwen. Yeah, go back up. I was seeing if there were more. Um, so the second one should be number one. And I don't think it needs to say we're covering co-pays for appointments or services. So I think you can take out you can take the whole first part out up to there is Um there also another just other than saying infection is

related to diagnosis with HIV I not sure what HIV related Anyone have thoughts on the best way to phrase that? I think HIV uh and I think it's kind of that the service um maybe more so than the condition.

The service. Yeah. But the service uh is H is HIV related. I think that's fine. It's the language we use all the time and we can reword that a little bit to be a little bit cleaner and align up with how we say it in other things. We also status instead of infection.

We'll do HIV related uh like we that's how we talk about it anyway. Um, that's why I was like, you all are not gonna love some of the language on here because it's not these are all these are old. Um, yeah. So, there are other things that we also um just pull up I mean we also need like I mean there's other and I don't know if this more is policy like in the when you do the policies Jeremy but like the data service has to be in the fiscal year the um you know we have to have the EOB in the Um also the invoice uh we screen for other payer like are there is that like stuff that's a standard or that is policy? So we could actually include that in do you want that in number one that there is documentation uh and then put it that is HIV related that they're they've been screened for other payers and that and uh um the explanation of benefits.

Yeah. They have to have a the invoice from the medical provider and an explanation of benefits from the insurance. Um, so those things have to be on file. Although it does give a whole the outcome measure for that one is a little bit more. We can add something about uh so add a standard well and not all services are covered even though it's related to HIV. So again like that's a lot to Excuse me. Sorry about that. Um I don't know if there's a succinct way to put that.

Quick question. So when it is HIV related and not covered, what typical like situation is that common? Well, for example, someone can be in the hospital for HIV, but we don't cover inatient. Okay. Um emergency room visits are not covered even if it's for HIV. Um, is there a document, Erica, that has like all of the the details that we Ryan White Part has a flyer that they've put out over the years that

sometimes people ask us that like what is and what isn't covered like that'd be really great to review um in one of our educational classes. Yeah, there's a fire part A. I'm grabbing the link to it actually. It's on positively. Thank you, Jeremy. Um, Gwen, I just dropped a comment in the chat. If you can add just a comment on there, we can add a line that talks about documentation of EOB medical provider invoice allowable services and screening for other payers. We'll work out that in a language for you all to take a look at and

edit. lots of rules. So, yeah, just whatever the best way to whether that's bullet points like we've done for other things. Um maybe you guys can play around with that and and I guess again what is a standard versus policy and procedure. I think that's okay. That's pretty we can we can work on like there has to be I think some of that could be okay to be in a standard. We might spell it out a little bit more clearly in the policy, but I think having some of that is is still really helpful because it is a requirement. I dropped both links for the English and the Spanish version on there just so you know. These are they they literally just expired this month because they were about last grant year. Um uh so we are we are working to get the the updated versions. um out. But yeah, that's

yeah, I think you did like three years ahead. So you we did like the three years is over, but all the bulk of the information is correct. It's just the dates. Yeah. Yeah. And I think maybe as we are thinking of how to say this kind of like we referenced, you know, clinical standards, it's like these are HERSA prescribed what's covered and what's not really. I mean, most of that is all. So, I don't know if there's a way to reference that or anyway. Yeah.

Um, so do we really have to call out eyewear? I mean, there's a lot of things. I know. Um, believe me, I know vision care uh is such a thing. Everyone wants their glasses and contacts covered. I wish we could. I totally get it. Um, so if it is that big of an issue that it needs to be a standard, um, I don't think I cannot think of anyone that we that this has ever happened for.

I don't think we was needed because have we covered eye related medical care? Yes. for OIS, things like that. But we've never had to get prescription eyewear because of that kind of situation. So, if it's really putting it in there because we want I mean, I don't know that the clients are really looking at the standards, you know. I I don't know. I just It seems like I think this makes it seem like it's more of an opportunity than it actually is.

Yes. Um, and we don't I can't recall that we've ever seen this in an actual chart review. I cannot remember ever having done it. We could call this out in the policy.

Yeah. And because like I and it is written in um the flyer, it says eyeglass prescriptions without medical approval is not covered. Because certainly gets asked all the time and I totally understand why. It's I mean vision care, routine vision care is needed by I don't know what percent of the population but a lot and I get that and it's expensive and I get it but it's not HIPSA her hersa I mean Hersa really is called this out years and years ago.

Yeah. So, I think in favor of removing this one,

I mean, if you're not seeing it documented, like why are we, you know, if we're not seeing any examples of it? Um, I don't see a need to keep it in there. I like that. Here's your reminder. Hit the main. And then if we can we scroll back up. So the first one Oops. Other you know that'll the first one will be number two. Um and we had 60 days here I believe from the past because just the time frame of checks being written um I mean it's also unlike premiums where there it's very time sensitive cost sharing not so timesensitive. Um, you know, not that we don't want to have it processed certainly, but um, again, it's after the fact. It's not, uh, paid in order to get someone the service. So, they've had their service, they've had their care, they have a bill, they're requesting uh, to get their bill paid. And I think too it also has to do with uh timelines of when things are cut and also when things hit some other system. So

right I don't I would say more often than not this is happening much faster than this. Yes. Um but I don't I don't I would not recommend changing this one. Okay. Is everyone okay with that? saw knots. Great. So, let's scroll down to dental. Glenn, you had to highlight that, didn't you? I did make sure that we're changing that.

Wow. HIV infected dental insurance. I mean, I I don't even know what that is. So, clients enrolled in the dental insurance program or clients um you know insurance could be going to be rude HIV infected. That's so confusing. I'm assuming the same change will be made here to like clients enrolled in the program. Will have will have.

I said will have. Yeah, I should say will. Yeah, it's it the the language in this one was not all the way. Clients enrolled in the dental insurance program will have a periodontal screening or examination at least once in the grant year. Okay.

And then I would just say 75% of uh dental insurance clients. Yeah. Gwen. And I will tell you this one is really really hard. Like we have no real This is really just a tracking measure because it's one of Hersa's tracking measures. Um one of the things one of their uh performance measures for this, but it's really really hard because we don't contract directly with any of the dentists. So we can't tell them to do more of these. Um,

but that's why it's lower percentage. Shantae, Shante still on except isn't that an expectation to stay enrolled in the program? I mean,

they need a service. Um, it doesn't necessarily mean that it would need uh would be an exam or a periodontal screen. Um, they may just come in because they have a toothache and that would be So really this I think what we need to do one because the next standard is not we're not doing additional funds right now. Um, and so I don't think that uh I think we should probably come back to you all with some suggestions on this one about more of the administrative process rather than

this about the ins. We want Yes, we want them to um have this um but I think we we're pretty close to meeting the measure when we look at it when we run data on it. Um but uh it's not something that we can see in the

something that we would say you're the the program is missing the mark because they didn't do this because they're not the ones seeing the clients, right? So I think we can come back with more of like a how quickly these are processed um like requests for enrollment are processed or what have you. Yeah, like the time frame because that's often important to clients is how quickly

um you know they're enrolled. So I think that timeliness is good. Um I think there should be something about the service you know having a service if hers is so specific about periodonal screen or exam. I mean like you said then that makes sense to maybe keep that a little lower since we can't um control that. But I think there should be then something else about required to have a service a service however we want to phrase that and then whatever other administrative kind of things. Okay. Okay.

Yeah. We can do like percent of clients who uh had a service and that could be higher than 75% because we should be um we've also set in parameters like we're just enrolling people they haven't used it in a year. So okay okay

okay we just scroll down through the rest which should be fairly quick. Um, so do we just need to or just clarif do we need to clarify like the position? Obviously dentists have different I mean under personnel qualifications like

yeah we're not we're not funding dental providers anymore. So I think this is okay. Okay. And then service plans are not required. Transition and discharge. That's usually all our regular language. Correct.

Section C. I think that's Can we see the HIPSA money now in I know we did at one point. Can we see it in um Careware? What do you mean? Well, the point about um you know, let's say someone was uh seeing a community medical provider and then transferred to Valley Wise. That's two different HIPSKA providers. Um I guess really right now we

I think that's more related to it's only related really to dental, but there's a cap. Okay. We're not imposing. We've had HIPSKA caps over time. I suppose we don't really have one now my face but um car we are working on that for dental to show that across so people that it obvious that would refer to one program um in F though uh

I think that's it's not section C it was the one about costbenefit analysis Oh, but it also says dental insurance. Oh, yeah. What is section C? Section C was the key service components and activities. And I think the table we always lived underneath there. And then we added a section D about following policies. And so the table doesn't really have its own section. It's just a thing. So I I think it would be addressed in the service category standard table.

Yeah, I Yeah, I think so. And I guess that is one about dental insurance, Jeremy, as you're putting the dental insurance stuff together. I know it's the worst topic. Oh, that other payer screening for dental. Sorry, not saying anything on on on the recording for that. It's very important to do and it can be challenging. Yes, very challenging. Okay.

When on F, can you actually cross out in section C uh so that I know to edit that or we know to edit that when we're looking at it? Okay. And then transition and discharge that'll get that does seem do we actually reference something else usually in there? No, that's a that's okay. So that'll get cleaned up. Uh case closure protocol, that's just the standard. Rights and responsibilities is a standard. Grievance standard. I think all the rest is we just need to make sure it's our most recent

standards there every 12 months for reertification. Okay. Is that the that the end? That's the end.

Okay. So we will uh put this on our agenda for next week or not next week next meeting. Um I would like to uh just go back to item number seven about annual service standard reviews. And um I would like to propose since this came up in our discussion about service units that um as part of our annual service standards review that we remove service units from um all of the standards as part of our annual update. Would anyone um like to make a motion about that?

So moved. Thank you, Jason. Do we have a second? I'll second. Thank you, Juvia. So, Jason with the um motion, Juvia with the second. Any discussion? Okay. Hearing none. Can we take a vote, Gwen? Yes, we can. I will start with Erica Tamp. I Dia Lozano. Yes. Randle Faux. Yes. Jason Vruz. I Eric Een. Yes.

Motion carries. Okay. Thank you. And so our uh Ryan White um staff will get that all updated. So, thank you so much Next, we will then move on to item number nine, review and resolve parking lot items, of which there are no items currently. So, next, let's look at item 10, review, scope of work, and PECAT. And here we are in March. We took care of our parking lot. We are doing we completed our first annual service standards review and scheduling of updates. Uh review planning council policies and procedures and we can so we have it on there for both March and May. So if we can add that to the agenda for May for the committee to take a look at.

That would be great. I feel like we literally just did that also. Like that's all the different or am I confusing the different bylaws for the different committees? That is what that's referring to by the way. Okay. Um, so does it need to let me look because I don't think we have any we've identified anything that really needs to change. Yeah, if it's for the committees too, the committees themselves would review it first and then it would move to STAR I believe for like the other two subcommittees, right, Jeremy?

Yeah. Do you all think like the Jeremy for the executive positions is does that cover executive positions as well? the executive committee policy. I think so. Gwen, I'm trying to find them. I can I That's the I agree with Eric. I think I feel like we just finished reviewing them. Um, but since we're reviewing policy, I mean, not policies, but standards of care again, we might have to go back to bylaws and make some changes like to language or, you know, just like minor little edits here and there. Um, but I feel that's going to be like more towards the end of us reviewing standards of care and then, you know, aligning it back to the bylaws. Well, and there is one for review of bylaws and glossery. So, this is a different thing. Planning council policies and procedures.

I see that. I mean, I was asking Jeremy because you're right, J. Totally agree agree with you, but I just Jeremy I thought you had said you were saying it kind of was the bylaws, but now I'm seeing there's a separate bylaws. Oh, no. It was the No, I was saying it's the you that is you're talking it's talking about the all the committees policies. What it's talking about, not the B. Sorry, my my apologies if I was confusing about that. So, it looks like you all did the committee policies

in 2024. So, oh like around so they're just about two years old. I don't know that we I don't we can have the committees start that process and review, but I don't there's nothing that's coming to mind right now that we've heard that needs to be updated at this point from the committees so far. But we can take a look at them. The executive one, um I'm going to have to do we're going to do a little research because I don't see an updated one there. I see a draft of an update, but that one might not have been done. But again, that should start generally does start at the executive at the committee that's doing the policies. Executive usually lives out of the bylaws though or should even in terms of positions and voting um I'm just thinking governance you know positions and voting are gener are should be covered in the bylaws but we can go back that's something the executive committee could could take a look for sure. But there is an a draft version in there from 2023. That's what it doesn't I don't see a final version of Gwen and I can do some research to see if we can find a final version. Um but yeah, we can definitely if you all want to take a look and have the policies and procedures on your radar or look at your stars policies and procedures. That's where we could uh we could start with that.

So, is this like a full thing to happen every year or is it just almost like that annual review kind of like we're doing with service standards. It seems a lot to do every year,

right? I think it's more to be on make sure it's on your radar because if we lose it off of there and we do a granty year timeline, I think it's more to have it on your radar and and earmarked for when you want to do it. I don't think we put it on your agenda because we didn't have any specific updates that we needed to do. We did do some specific process uh policies uh recently um but they weren't like from the committee policy. So you can I would say we should probably Gwen put this on all the committees for next for next month for them to review their committee policy and that would include executive

to look at the the policy. Hi. Can you guys hear me? Yeah. Yes.

Okay. Um I'm driving so I'm kind of in and out on the discussion but what is it that we're looking for um on executive did the uh the final uh policy for the executive committee. I only see I can only find drafts in my thing except for one from 2022 but still looks like a draft. We should, if my memory is serving me at all, we should have completed that by 2024. I thought so. We'll go back and look and see if it's just not where I'm looking. I'll see if I can find it, but I think every we can have every committee at their next meeting at least take a look at to see if there's updates that need to happen. Um, and then uh and then go from there. Yeah, I'm trying to remember if we did it before the other subcommittees or after the subcommittees, but um yeah, however you research it, but um one tool you can use is maybe just look at the agendas.

Yeah, that's what I figured we'd go back and look at all the meeting all the meeting attachments and such. We would have it there. Okay. And I'm sorry that my memory doesn't serve me better. We had some ch if it was all done in the early 2024, we had some transition around that time. So that might be why it's not where we would have put it, right? It might it just might just might be in a different folder. Yeah. Yeah. We'll take a look.

Sorry, guys. I appreciate the input, Randall. That helped us all get our minds back on the track with it. Right track with it. Um, okay. Now that we have that attention to, last one is we are reviewing our PCAT. So, we are good there. And last then determination of agenda items for next me meeting. So uh standards or I mean not standards um the policies and procedures for the committee and then um we will add HIPSA. Do we want to get started on add another uh standard? Whatever the next one up was the six. Was that a six-year-old one, Jeremy?

Was it food bank or nutrition one? The food bank. That was food bank or medical nutrition. Medical nutrition. Doesn't it seem like we just did nutrition, too? Like it seems like we just did this. I really feel like Were you saying to because didn't we have like Emily from Prisma? We did. We had Emily and and seemed like six years ago. I don't think it was I think like maybe three at the most. I feel even more recent.

I know. It was I think it was at two meetings ago when we because I had asked if we could get Peggy on on these approvals, but you guys were like I still say, you know, I would still want her two sentence and she is the one the director of the nutrition program even though you know she does great every year. I did bring it up to her. She's never been in the conversation any of these meetings. Um but I mean if we just No, she has she has I have minutes. I have minutes. She's been to standards. I mean that's we just did a we just talked about this two two meetings ago I think but yeah

I think theoretically the whole idea from HERSA is as long as we have all of these things scheduled and we're at least putting our eyes over the top of everything in one grant year. um that the issues and the changes and all of that are are going to be growing smaller and so it won't take you know two to three meetings to complete something that it could be done quicker so I think that's theory I don't know if it can be done but

like policies and procedures those I can't see changing that much bylaws now that we've done a complete go through and we've had the attorney sit with us. Um it's going to be little little changes or little tweaks or things that we missed. So hopefully it will become easier. I mean, if we do, if we're not clear on exactly what our next standard is, um, I mean, we could just not add another one,

figure it out for next time. If our next meeting is briefer, that's okay. We've put in many phone meeting lately and um because we definitely do want to invite people um you know who we uh want to participate uh who have some good input to provide. So should we just leave off um imagine there'll be some discussion about dental anyway. So should we just stop there for for our May meeting? Why not? I like it, Randall. You know, it's gonna be the day after Memorial Day. We're going to be

Yeah.

You know, so let's um stick with that then as our agenda. Is there anything else we need to add to the agenda? Okay. So, finally, current event summaries. This is the time for planning council members to share a brief summary of current events. Members of the committee cannot propose, discuss, deliberate or take legal action on any matter match or voice during this time. Do any members have anything to share? We already know about rainbows coming up and on rainbows. Um, I realize a lot of people won't have the ability or capability or whatever to like work a whole 2our shift in the booth, but maybe if you're down at Rainbows, if you could at least stop by the booth for 10 or 15 minutes and say hello and uh see what kind of interaction goes on and stuff like that, that would be cool.

Thank you, Randall. And next then we will move on to call to the public. This is time for the public to comment. Members of the committee cannot propose, discuss, deliberate or take legal action on any matter voice during this time. Anyone from the public? Okay. Hearing nothing then we are adjourned at 4:26 p.m. Thank you everyone for the great discussion and feedback. And