Ryan White Planning Council - Regular Meeting

Yes, we have four out of five star members.

And so if I go into a FAP meeting, you'll still have three of five, but I'll still be listening into the meeting in case you lose somebody else and you need me for quorum. But I won't leave for about a half hour yet. I'll be quiet now, I promise.

You're fine. Thank you.

It's too much.

Okay, so since we've reached quorum with four out of five and we're officially starting at 2.31, I suppose, Gwen, can you please do the roll call and have anyone declare their conflicts of interest? Everyone declare.

Thank you, Erica. So I'll be calling the names of everyone on the STAR Committee or any members of our recipient staff who are on the call today to assist with the Service Standards Review. So I'll start with Erica DeCamp.

Erica Teekamp, Star Committee Chair, Conflicts with Medical and Non-Medical Case Management, Referral for Healthcare and Support Services, Medical Transportation, and IPSCA. Randall Furrow.

Planning Council Vice Chair, No Conflict.

Jason Valcruz.

Jason Valcruz. Conflicts include primary medical, substance use, mental health, IPSCA, and referral for healthcare and support services.

Eric Eason.

Have a single conflict vice chair chips.

Jeremy Vernon.

Jeremy have earned in Maricopa County.

Take home and take home in Maricopa County. Very good. I married that I Maricopa County.

Thank you, everyone. And also, we just had Duvia join the call, so that would bring Coram to five out of five, and I'll let Duvia announce her conflicts of interest.

Thank you. Good afternoon, everybody. Duvia Lozano, Chicanos por la Causa. Hey, Randall. Conflict of interest with mental health, substance abuse, psychosocial, medical case management, and non-medical case management. Thank you. Thanks, Duvia.

So we can go back now to the rest of the agenda, Erica. Okay, thank you. So if we can pull up the agenda and we will just review it. We cannot make any adjustments to the agenda, but we can change the order if we need to. We just can't add anything new. That is to comply with open meeting laws and everyone in agreement about the agenda. okay hearing no comments we'll move on to next which will be to review and approve the minutes from the last meeting on march 24th everyone should have received a copy of the minutes so um i'm glad to entertain a motion to accept the minutes whenever anyone's ready so moved Thank you, Jason. Do we have a second?

I'll second.

Thank you, Randall. So with that, Gwen, can you take the vote? Yeah, so I'll just do a roll call vote for today.

Erica, do you care?

Approved. I forgot to ask if there was any discussion before we vote. I'm so sorry. Is there any discussion? Okay. Now. Thanks, Gwen. And yes. Thank you, Erica.

Duvia Lozano. Yes.

Randall Furrow.

Yes.

Jason Val Cruz.

Yes.

Eric Eason.

Yes.

Motion carries. Okay, thank you. So next will be the chair update. I don't have anything in particular other than to say welcome to Jason for his officially official first co-chair or vice chair. Sorry, getting the words wrong for START Committee. So thank you so much. And next we'll move on to the Ryan White Part A recipient update.

Hi, everyone. My apologies. I'm off camera this morning, but I am here. The Gwen sent out a notification to the Planning Council on Thursday. We received our Part A final notice of award. It came in with a total of $11,350,085, which is a just over $300,000 increase from last year's base award, which is exciting. And then also we are waiting on HRSA to approve and correct something in the system before we can submit our carryover request. That should be handled soon. But once we submit, once that's done, we'll be able to submit our Part A and MAI carryover request. It's totaling $421,983 this year, which is an increase of just over $44,000 from last year. request. So that brings us up to an additional 300 and almost $45,000 in funding for this great year compared to what we had last year. So that's exciting. Our team is currently gathering some recipient budgets and reviewing trends so that we can prepare for an allocations workgroup because the council requested us to do a work group before the June meeting. Our hope is that we will be scheduling that later in the week, the week of June 8th, but we should know in the next day or two and be able to get that out to you all. As a reminder for the work group, we cannot exceed quorum of the full council, so it is limited to 11 individuals. will but we'll be reaching out probably starting with the individuals who've participated in the past um and then they'll be bringing recommendations to the full council in on the june 23rd meeting for uh review and approval uh shantae are you able to drop the link in the chat as i'm talking thank you um there is a new hersa interim uh hiv resource hub website that they announced last week as well. It replaces the old target HIV website that was taken down several months ago, quite a while ago. And this is just in place now until they are able to launch their updated website, their full updated website. So That resource is available. There is a lot of information on there. It's not the full exhaustive set of resources that were available before, but it's a good start. Also, we are actively recruiting for new ambassadors for the Positively You campaign. So if you are know anyone ages 18 to 30 who's living with HIV and is a current or former client of Ryan White Services who would like to participate in our campaign refresh, have them reach out to Kate Thomas with a message about why they'd want to be an ambassador. Also, Shante's going to drop her email in the chat as well. We sent out the flyer to providers. If you'd like us to send you a copy of the flyer,

that we're using to recruit, please email Kate and she will send that over.

Finally, I know at the last planning council meeting, we talked about a potential four to 5% drop in viral suppression that we were exploring during my updates for 2025 continuum data. After further review, sorry that we gave you all that scare, but we did do some finalization of the data And there is still a drop, but it's not as significant as we anticipated. So that 89% was actually rounded up from 85.5, which if you've seen our continuum data, it doesn't do decimal points, so it always rounds up. And the actual viral suppression for 2025 is 87%. So it's only a 1.5% decrease. It's still a decrease, and we don't ever want to see that, but it's not as significant as we thought. So we are continuing to review and look at that to see where that impact is coming from. Reagan did inform the CHIPS committee earlier today that it is only about 50 clients. That is the difference between that 87 and 85.5 that we would need to get virally suppressed to get back up there. They're also going to be working with providers during the CQM meetings to explore how we can address that decrease.

That's it for me. Any questions? Okay.

Thank you so much, Jeremy. I appreciate it. And good news about the viral suppression. Definitely better numbers. Next up, we have our policy and procedures review. Those of you who were at CHPS, and I guess team worked on it today also, we have started working on this, so we can just do a review, make sure it's all in good shape. So Gwen will take the lead of walking us through it, and then we can comment as we need to.

Thank you very much. Yeah, thank you. So, yeah, if you were on team or CHIPS today, you are familiar with this process. I will just read through it and then I'll kind of stop after every section and pause for questions or any edits that people want to make. So with that, I will just go ahead and start with the overview. So the Greater Phoenix Ryan White HIV Services Planning Council is an entity comprised of individuals appointed by the CEO of the eligible metropolitan area, EMA. for the purpose of planning for the use of Part A funds to support HIV services in the EMA. The Planning Council has established the Standards and Rules Star Committee to develop standards of care, monitor and evaluate standards of care, review and update the bylaws, and provide assistance to the other Planning Council committees on the creation and revision of their policies and procedures. The Star Committee recognizes the value of diversity and voices and representation. To that end, the committee encourages participation that reflects the demographics of the population of people with HIV. STAR committee meetings are conducted in accordance with Ryan White open meeting requirements and the state of Arizona open meeting law. In compliance with HAB expectations, appropriate care must be taken to guard against disclosure of personal information that would constitute an invasion of privacy, including medical or other personnel matters that should not be disclosed. And Jason, go ahead.

So unfortunately, I'm going to have to bring up the same thing that I did with the last third third paragraph. Having the word diversity in there, maybe we can rephrase it as star. You know, seeks to have fair, fair representation of the. impacted population um and that way it's less of a buzzword that might be looked for can you say that again jason so uh fair representation thank you jeremy yeah their fair representation is is the

Or maybe, so like the Star Committee recognizes the value of fair representation and we just take out diversity of voices completely.

How does that look?

That's, that's, it doesn't quite have the same flow, but, you know, I think we need to do as we can, right, to make sure that we're not flagging anything that's going to get us in trouble, so.

Yeah, I will highlight it just so if we have maybe a phrasing that flows a little better, we can come back to that, but I will have it changed to that for now. Okay. Any other questions on that first section?

Just back to the fair representation. I'm comfortable with that, but for somebody that, like a community member or something like that, that's reading this, The first thing that popped into my head is fair representation of what for what.

Yeah, I think Jeremy's second comment in the chat would kind of help with that too. Like if we combine the two sentences and just talk about maybe the committee encourages fair representation and participation that reflects the demographics of the population of people with HIV. That way it's one sentence, it's a little bit more clearly flowing?

Yes, and then I understand what you're looking for.

Yeah, that way it's not kind of this vague, fair representation. I will, I'll come back to this and kind of work on that one day. So annual planning council activity timeline. The STAR Committee shall maintain an annual schedule of activities as noted in the overview section of these policies and procedures. The annual calendar shall be based upon the planning council activity timeline. All right, STAR Committee membership. So all the language in this section is directly from our bylaws or heavily referencing our bylaws. So all members are strongly encouraged to be a voting member of at least one council committee. Planning Council members may join the Star Committee by declaring their intent to join and by attending two consecutive meetings. The member may vote as a member of the committee at the third consecutive meeting. And committee attendance policy. Committee members are expected to attend regular committee meetings. If a committee member is unable to attend a meeting, they should notify the Planning Council support and the committee chair in advance. If a member misses two consecutive committee meetings, the member will be determined to have voluntarily resigned their committee membership. Also, Jason, go ahead.

I would just say just for consistency to have this mirror CHIPS and teams, as Randall said earlier in the CHIPS meeting. Exactly. Yes.

Yes. And thank you for that comment, Jason. And also, Duvia, I know that you are not on the CHIPS committee, but just to kind of fill you in on that discussion, we talked about just ways to make this a little more flexible and like forgiving for folks so that people don't feel like If they had to take a leave of absence or if they missed two meetings, we allow them that flexibility to retroactively explain what happened there. So we're going to just work on making this section a little more flexible for people who are missing meetings.

Thank you for the update, Regan.

Appreciate it.

And Jason, go ahead.

Sorry, I've got one more thing. No, go ahead. So I know that HAB expects... planning council members to be empowered to understand their duties. And in all of the subcommittees, we don't have any type of orientation, but we do have an orientation for the overall planning council. Do we think it's important to mention in terms of membership to the subcommittees that orientation around activities is covered in the main planning council orientation? Or is that just overkill?

I do think that that would be good to mention for sure. There is, yeah, the planning council orientation does have a section describing each of the committees. So I think it would be nice to at least reference that that way, recovering that need. And is there like a specific, wait, which section were you talking about that with Jason?

Just in terms of membership, we're at star committee membership. So when we're talking about the two, how they're at least becoming a voting member, we can say something that new committee members already have completed a planning council orientation, conflict of interest training prior to exercising voting And that way, we're just covered.

That's a really good idea. And I can also go back. I'll add this to the other committees as well, just so we're covering that in all of our policies.

Sorry to cause you so much work, Gwen. I'm a little bit of a governance geek.

No, no worries. This is good things to add. And it's truly not hard at all to add these little things in. Okay, so for moving on to committee chair and vice chair again same language as the other committees, you must be a voting member of the star committee and you must have been a member of the Council for at least six months immediately prior to the appointment. So now, moving on to a committee specific responsibilities we have first we have the development of standards of care. The STAR Committee will develop specific standards for each individual service category based upon the needs of the EMA, taking into consideration information from the following, comprehensive plan, needs assessments, service category definitions, HRSA recommendations, professional standards, expert advice from individuals in each field, quality management recommendations, current guidelines for HIV AIDS service categories, and other jurisdiction standards of care. And then in terms of monitoring and evaluating standards of care, outcomes evaluation reviews the effectiveness of a service in achieving its intended results. It can help Ryan White programs determine if they are making a difference in the lives of people with HIV. Documentation of outcomes can be used in multiple ways, including ensuring and improving service quality, helping guide program planning, setting priorities and allocating resources, and securing funding from public and private resources.

All right.

The STAR Committee is responsible for overseeing outcome evaluation of the service categories authorized by the Planning Council. The STAR Committee is charged to work with entities that are currently conducting similar activities, including collaborating with the quality management staff on the analysis of the outcome evaluation for each service category in order to better refine standards of care. And Jason, go ahead.

For these, because we're mentioning specific outcomes and responsibilities of the committee, do we want to tie that to like tangible dates, like in terms of reviewing standards of care on an annual or biannual basis, Do we want to have that mentioned in the specific PCAT for this committee? Is there something that we want just to keep us on track around that?

Yeah, so we do have a separate standards of care like review SOP kind of that we had. We had submitted that as part of our corrective action plan from HRSA. So that kind of specifically is like annual basis. We have a schedule like the Part A office does their review every March. So I think in that document, we have like a more kind of like specific outline of dates. But yeah, so that's where that information would be.

All right, thank you.

Yeah. Okay, so moving on from standards of care, now we have the planning council bylaws. Each planning council must have written bylaws which explain how the planning council operates. Bylaws must be clear and exact. They should include mission of the planning council, how members are selected, open nominations process, duties of members, how meetings and committees operate, handling conflicts of interest, grievance procedures, and rules of behavior. And then the star committee will meet and discuss suggested changes to the bylaws received from planning council members, committees, the planning council chair, or members of the public. The committee may decide to continue discussion at a later date, recommend that action be taken, or recommend that no action be taken. The Star Committee understands and fully supports the philosophy that the bylaws should be amended only after periodic review and identified need. In an effort to reduce the amount of paperwork involved, the Star Committee will make formal recommendations on bylaws amendments as necessary and at least annually. The Committee shall exercise reasonable prudence in deciding when a formal recommendation should be made. If there is no immediate need to amend the bylaws, the star committee chair with approval of the star committee shall issue a clarification memorandum, see attachment A, for the approval of the executive committee and the planning council membership at the next regularly scheduled meetings. The sections of the clarification memorandum are as follows. Question, the question outlines the issue being discussed and what sections of the bylaws are being addressed. Background, the background puts the issue being discussed into proper context. And Recommendation, the recommendation is the result of the discussions and vote of the STAR Committee regarding this question. This section gives the Planning Council as a whole the opportunity to address the question. The Use Clarification Memoranda, when approved by the Planning Council, will provide written guidance regarding issues that do not warrant an immediate change to the bylaws and will provide a history of why particular processes take place. Guidance provided through clarification memoranda may be incorporated into the bylaws if needed during the next amendment review. As outlined in Article 19 of the Planning Council Bylaws, the following process shall be followed in order to recommend bylaw amendments to the full Planning Council and the Maricopa County Board of Supervisors. So this is from our bylaws. Unproposed amendments shall be submitted to the STAR Committee for consideration. The Star Committee shall submit proposed amendments in writing to the full council a minimum of two weeks prior to the next scheduled meeting. Any amendments must be consistent with the Ryan White Care Act legislation. So that was all about the Star Committee on bylaws. Was there someone unmuting? Erica, is you?

I unmuted.

That was all a lot. So the clarification memoranda, the purpose is that there's something we have a question about, but it's not going to be in. I'm not following that exactly, I guess.

I don't know if we've ever issued one either. So I know maybe this is kind of just there just in case, but it looks like it's like, There's just a question that people have and would need further clarification on. But yeah, this is not something that we've done frequently, I don't think.

It's almost like putting it in a parking lot to be addressed later.

Yeah, I think it's the essence bylaws. Go ahead, Jeremy.

Gwen's right. We've never, in my recollection, used this. I think it's if we got, like, say we had a provider or a client or a community member, someone submitted a request to review a specific thing in the bylaws, and the committee decided, oh, we're going to consider this for maybe the next full review, but we're not taking an action right now, and here's the reason why and the recommendation, so that there's a pathway for you all to, like, formally address that if there's like a formal request to review something. I think that's where that is stemming from, but we've never used it. But just because we've never used something doesn't mean we don't need a process in place in case it does happen.

So I'm going to be picky. So the first sentence about the star committee understands and fully supports the philosophy that the bylaws should be amended only after periodic review and identified need in an effort to reduce the amount of paperwork involved, the Star Committee will make formal recommendations on bylaws amendments as necessary and at least annually. It just feels kind of like, do we do it whenever we want, but at least annually, but we're trying to limit it. But yeah, I don't know. That all feels a little contradictory, I guess. And then we've got this clarification memorandum. Like if we're going to do amendments as necessary, then why do we need a clarification memorandum? Or are we not going to do amendments as necessary? We're going to do them annually and we have a clarification memorandum in the interim.

And honestly, we've not made changes annually ever unless something has significantly arisen because it is a lengthy process. I think it's probably more that you should review them annually. And if there's no changes needed, then you don't make any changes rather than it saying that you're going to issue an amendment every year. Time and we rarely actually in this issue amendments anymore. We do the full process and send them forward. And which is what we did the last time we only had a few minor changes from the cap. And so we didn't do an amendment. We just did a full bylaws.

Approval are we required to do a full? Like reauthorization on a rate on a certain schedule.

I think the only thing that our PCAT says, there's no requirement for how often.

Like from HRSA, there's no requirement.

There was no, they have not, I've not seen that, no. I've only ever seen that they're like, I think a review, similar to standards. They don't require you to update them every year. They require you to review them every year and then make changes as necessary. And so we could, and I mean, it may be that that clarification memoranda is not even needed. And you could just adjust that.

Adjust that whole section.

It's just so much. And I mean, I agree that you need You need the guidelines because you don't know what will happen. Kind of like Jason was saying, I think in the prior meeting or someone was, I can't remember which Jason, but like you need these things for when, you know, none of us are here, but someone now remembers how to do things. So it's important, but I don't know. I just feel like this needs a lot of tidying.

I'm glad to take a shot at it.

I mean, do we think we're approving this today? Are we going to have to come back to it anyway because of the absences and that clarification?

Yeah, I do think we will have to revisit policies at least for one more meeting since we also have to approve team and chips as well. So this could probably be added again to July to kind of like finally clean it up, but we can I can try and make as many edits as possible, like today maybe, and then also leave time for the HPSCA standard too. Yeah.

Erica, if you want to take a shot, I'll take a shot with you.

Okay. So maybe we can, Jason, I can work on it, run it by Gwen and Jeremy too, just to make sure we are representing what needs to be represented. And then we can bring it back in July rather than wordsmithing ad nauseum right now on it. Okay, thank you. We can keep moving.

Perfect. So I believe this is the last section and then there's just like a layout for what the clarification memorandum is, but this last page should be quick. So policies and procedures. The executive committee has charged the star committee with the responsibility of providing assistance to all other planning council committees in the creation and revision of their respective policies and procedures. To that end, the STAR Committee has created a Policies and Procedures template for all committees, which outlines the responsibilities of the committees and how those responsibilities are carried out. In accordance with the Executive Committee directives, all committees are to present their policies and procedures to the STAR Committee for comment and or approval before being presented to the Executive and the Planning Council for final approval. The STAR committee has determined that the following elements must be included in each of the planning council policies and procedures. So it's overview, committee membership, which includes requirements, attendance policy, and chair and vice chair eligibility, and then committee responsibilities.

And that's it for the primary parts of this procedure.

Okay, I don't have anything more there. Does anyone else?

Okay, well, great. Thank you so much, Gwen, for going through that. We will put it on our July agenda. And Jason, I'll talk to you later about it. Okay, let's jump in then with our service standards. So Jeremy, are you starting us off with some things with TIPSCA or? Your name is there along with mine. Are we like I always forget where we left off.

Sure, we finished the first section there on the page except for the categories. Are you comfortable with the category names that we drafted?

We need to correct the spelling of adequacy, but let's see. Insurance adequacy cost.

I believe so.

I'm having a brain blank moment. How do you spell it? You're OK. Spelling in front of everyone and typing.

Oh, yeah.

Oh, and then we had, um. Oh, Jeremy, that's for the cost-sharing one. Okay, your other comment.

Okay.

So is that a new comment, Jeremy? Should this state or is that the old?

Let's go for a second.

I can't see it on my screen. Yeah, the process timeframe. I do think it should be phrased differently because like you're saying, it's often not just the person processing the request is not necessarily the person processing the check. And so on that process can take time.

Yes.

Yes.

So can we change that, Gwen, to what Jeremy said? Does everyone agree with that?

Yes, that's fine.

Under processing timeframe for the first for HIP.

So rather than HIPCA staff pays it, it's like premium payment process within 10 business days of receipt of commission. And the reason this one is kind of quick is because it is for health insurance premiums, which have generally timeframes within which they need to be paid or either the insurance is put on hold and or canceled altogether. So it does really require timeliness of processing.

Okay, are we good to move on? Okay, thanks for the nods. Okay, so we've got HIV relatedness.

Let's see, I need the outcome measure.

I believe, again, we already discussed this standard for the HIV-relatedness. It was just the category name that we didn't have in there, but open to changing that.

I would say I don't know if I agree with the first documentation of referral from an HIV clinician, because an HIV clinician can give a referral for all number of things that may not be HIV-related.

You get my...

Differentiation there.

It feels like that's offering three different options of how HIV relatedness is documented, and I don't think the first one. It would be accurate. I saw someone's thumbs up. So do we want to just keep it with a note from the HIV clinician? And or does it have to be from the HIV provider? Could it be from the specialist? So can a cardiologist say why something is a heart condition is HIV related? Or does it only have to be from the HIV clinician?

Any thoughts from anyone?

Erica, you think it'd be better to word this according to the forms you guys have, which I think are awesome, by the way. Because you have the two different forms.

Yeah. I just, I think it, wait, I, what are you comfortable with, Jeremy? I wasn't sure what you meant. With either type of provider?

I was going to say, like, use the titles of your forms.

Yeah.

Receive those forms you guys have that are awesome.

Yeah, I mean, we will take a note. Like, they don't have to use our form, so I guess they don't want to hem someone in. Other providers of HPSCA might have other forms or ways that they document it. So, but Jeremy, were you saying you were comfortable with an HIV clinician or the provider of the specialty care? Yeah, and I think you could actually...

and just say documentation from an HIV clinician or provider explaining how the condition is HIV related. Then you're taking out a note or referral because you could just say documentation of documentation from an HIV clinician or however you said that, Erica, explaining how the condition is HIV related or an invoice showing an HIV ICD-10 code.

I think from an HIV clinician or.

Medical specialist, I don't know. Uh, Jason, what would be a?

I would say, uh, um, like phrasing HIV.

Um? Medical provider and that way you get the APP's and the MD's.

Well, we also want, though, to allow like the cardiologist, the pulmonologist. So we want it to be broader than just HIV clinicians or medical. I feel like medical provider sounds like an HIV clinician or an HIV medical provider.

So I would say one or the other, right? Like I would say, or you could just do medical provider and take out the HIV.

Maybe we just say that.

And then it's from anyone that's doing the work, right? Because a cardiologist, for example, would know if the damage was caused by HIV. Like they could specifically diagnose it without being an HIV specialist. So just a medical provider.

Yeah. Do we have, like from OHS, a term we use for a medical provider? Like, for example, like, is an RN okay? You know, does... that clarifies kind of that grouping of.

If we if it's involving the.

I can we do clinical from a clinical medical provider. From a clinic, which that even making sense.

I I think that's duplicative like a nurse couldn't do a ICD code. It has to be a. It's a diagnosis code and only medical providers can diagnose. Like a nurse practitioner could, but not a nurse, yeah?

I didn't know if there was a term we can use just so again, like if we're not going to accept a note from a nurse, that needs to be clear. And will someone think a nurse is a medical provider? I mean, I would.

Not if they're doing ICD codes. That's my perspective.

Yeah, no, I agree with you. But does this...

It's written in OR right now. We don't necessarily require the code on the documentation, like on a note. That's why she's saying how do we. I got you.

Yeah, the note doesn't have to have the code, so I get what you're saying.

If it did.

Do we have something in OHS that clarifies what type of providers we mean when we're saying who can do things? I can't remember.

If not, you could do.

Put it all. And like put MD, DO, APP.

And that would be good. Well, let's do that.

And APP again, Advanced Practice Practitioner.

Yeah.

Okay. And that's your RN, PA. That's not an RN, but it's.

Oh, not an RN. NP. An NPE. Right, PA.

Okay, thank you.

So, Gwen, can we put there in parentheses MD, DO, APP? Was that it?

Yeah. Just so you guys are aware, for the OHS, we use licensed medical provider, and then we put in a parentheses MD slash DO or advanced practice provider. I can drop it in the chat for you.

Cool.

Perfect. Thank you, Shante.

You're welcome.

And thank you for getting, I know we've kind of got over it, but that really was important to clarify as people are very particular sometimes about what they would like covered or not. OK, so these again documentation requirements documentation supporting the cost sharing requested on file, including explanation. So this Jeremy was your. Oh no, that was your yeah.

Yeah, and I added that I didn't finish it because I was like that comment in there in the side.

I was like, do we need all the things?

So I didn't include it in the text on the table.

I mean, I think that it's what the specialist should be screening in terms of the documentation received. It is just the EOB and the invoice.

Yeah. So I think it just can be period after error.

Yeah.

Explanation of benefits and provider invoice.

Yeah.

Period.

And then you can update the next line item as well. Yeah.

For the next box. OK.

Thanks and then next up. Yeah, I like the same language used above for. The requests are processed.

Because it's multiple staff usually involved in that.

And just for everyone, while like 60 days might might feel like a long time, but again, this is services have already been provided. It's you know it's a financial assistance request. It's paying a bill after the fact for someone. And so of course you know we want to process that timely, but it does take time to get things. There's multiple pieces that the client needs to get turned in. Sometimes they have an invoice, but it can take a while to get all the rest of the pieces. And then even so, just the processing timeframe, that just gave a good window there.

Anything further there?

Okay, let's move on.

Dental insurance focused standards. Oh, lots of notes from Jeremy here.

Yeah, so that we had a couple of things. One, I was going to request if we could add in dental insurance, in the title, dental insurance administration standards. focused standard because this is just really about the administration of it. It's a great idea. And the periodontal screen, we really have no control over. We like it as an internal thing that we look at to see that people are getting it done, but it is a tricky thing. It's also why it's always been kind of a lower 75% of that done. So that's just for people who've had a service in the year or are enrolled. Sorry. And then the dental insurance predetermination. So these are the two that were currently on the standard. We don't we're not doing pre we're not doing additional funds and we haven't been doing them for what, two years now, Shante, or at least a year and a half. And so I would like it can be on there in the event of. But if we're not doing it, do we want to take it out? So why don't we start with those first two and give your feedback on whether we should keep or lose those two, and then we can talk about the other options.

I'm in favor of losing periodontal screen. This is Dental Insurance Administration. That's not what that is. And like you said, we have no control and.

It can still be a measure we look at in QM to monitor, but we don't have to do it as part of the audit.

People in agreement with that. It's not great. So removing the entire row, right, Erica? Yes. Okay.

If I delete the whole, I don't know why my track changes aren't showing. So I'm just going to make a little note that this will delete it. That way we're not just erasing it.

You can also do a strike through, Gwen.

Oh, thank you. That's right.

Oh, right there. Okay. Thanks, Jeremy.

Where Jeremy's notes go?

Oh, there they are.

They're important. I think personally, before we get into the predetermined dental insurance predetermination, I do think that eligibility processing timeframe would be like, if we think of the process for administration focused standards, like that would be one to start with, right?

Yeah, I think so too.

So what time frame?

I mean, do we basically want to use the idea that people are enrolled by like the first of the following month? I know the goal and often people do get enrolled quicker, but in general, most insurance starts the first of the following month when one kind of applies or gets approved. So to keep a kind of realistic.

It's okay to think about it in terms of like how, like even if they don't, even if their enrollment doesn't start until the first, like how quick are we, are we processing? So I'm, I'm okay with even like seven days or within five business days.

Yeah, I think five business days is kind of the standard. Isn't that kind of the standard for almost all services?

Yeah, it's seven, yes. So. Yeah, kind of, but no. Yeah.

Yes, but dental should be faster.

Why should it be faster?

Oh, I mean, it's just, it's easy. It's an easy process to enroll someone, I think. Juvia's got her hand up.

Whoops, you're muted, Juvia.

I just had a quick question. Sorry about that. On the periodontal screen, did we decide to take that out? And then you said you're going to revisit it later? Is that what I heard Jeremy say?

No, I just said it's something that we can still continue to track on the QM side, just for like a performance measure type thing. How many clients who are actually getting services are actually getting a periodontal screen.

But not part of the standard.

Not part of like annual review process because it would be like basically what we're doing is this standard is directing us how we're reviewing the folks who are administering the dental insurance program, which is really just enrolling people and processing stuff and monitoring the enrollment pieces.

Oh, that makes sense, Jeremy. I just thought that for some reason, like they weren't going to get the periodontal screening anymore, but no, this is like the report card basically. So that makes sense.

Yeah.

Because the screening is part of the screening process.

Yeah. It made sense more when we had direct dental. Remember when we had direct dental? And so when we were monitoring actual client charts at direct dental providers, it made sense for it to do it there. It doesn't really do much for us now on the standard.

Is there a standard for people using the service at least once a year for them to remain part of services for dental?

That's

in the comments as one we could add in.

So about more about like, again, how we're administering it about how we're reviewing for use, doing our use analysis and disenrolling individuals who are not using the thing to cost save on the admin costs.

Yeah, because I think for like, for what we're doing now, like, in this day and age, that would be like more of an appropriate service standard than tracking the screenings.

I agree.

I agree with that. All right. Thanks for the clarification.

So Gwen, can we add a add a couple of rows of boxes?

would the first one be what what do we call it above can you scroll back up gwen at the other ones like oh those are just related ones one more up okay that's just that so um this would just be uh enrollment would that be the right header

Feel good for everyone.

Hearing enrollment or is it referral referral processing referral timeline?

Well, it's referral timeline.

Do we want and enrollment or does that not really matter? Because the enrollments the enrollment. Like regardless, maybe that's sufficient then. So whatever language we've used in the past about, you know, referrals for dental insurance will be processed within five business days or working days. I'm not sure which we got business days above.

Mary just threw a wrench at me. Mary, can you can you come off mute so we can talk about. So we do this right now. If they if they get a referral in within the first through the 15th, they process it right away, and the enrollment starts the beginning of the month that they, so like, what's today? If we got a referral on May 5th, they would be enrolled as of May 1st. If we got it after the 15th, they are enrolled as of June 1st. Mary, do we wait to process the referral and get their enrollment started until the beginning of the month, or do we do that right away so they're ready to go at the beginning of the month?

We enroll the clients, but with the effective date of the filing.

Okay. So I would say five days is still fine to process the referral. And then I don't think we need to worry about, because the enrollment piece is just, we can't pre-enroll them after the 15th. That's a dental, that's a Delta requirement.

Just to clear them. from the referral from CAREWare, right?

Yeah.

Okay.

So referrals or requests for enrollment, I would say, because we could get requests for enrollment that are not through CAREWare, are processed within five business days.

Yeah, that should work.

Do you think someone would take that, meaning they are enrolled in insurance within five business days?

That's what I thought when I heard you guys talk about it.

That's why I was like, whoa, whoa, whoa. Yeah. Just someone who doesn't, you know, I mean, it's just parsing the terms and the words, but...

Not sure the, you know, just, and without going into all the details. And that's what I was kind of saying before about, I know that we do this thing about if it's before the 15th, then dah, dah, dah. But, you know, again, if we had fewer clients, more clients, different things, is it a kind of broader standard to say the first of the following month? And if you get it earlier, yay. So I wonder if I thought here could be referrals or requests for enrollment or process within five business days with an insurance start date effective the 1st of the following month.

Perfect.

You know, I know in practice we can get it done earlier for people depending, but this is. That feel OK, Mary? Yeah, that sounds good. Thank you. And then then just for the expectations for, you know, a client reading this like OK, and if we get them done faster, that's great. Happy day for them. Like if it they happen to do it on the 13th and they'll be so happy they got in retroactively.

OK, so the outcome measure is.

Like the referral processing or documentation of referral. I always call it, what do I use? Resolution or?

Referral. I would just say completed. Completed within five business days.

Well, some are rejected. Very rare. But if you want to just say completion, that's fine. We need another word there, Gwen, after referral. We'll say completion.

Within the five business days.

Within five business days?

Yes. What shall our benchmark be? At least 90%. yeah do we want it higher we could be 295 yeah right yeah they're they're checking lisa

So would that just be 95% of referrals are completed within five business days?

Yep.

Okay. Then our next one, Jeremy, are you offering either or for one and two? Yeah.

Either or. Either an annual process where we just do like the non-use analysis and just enroll. Yeah. Or we do a biannual process where we look at, which would include a, so there's like, so the proof of that would be that we've done the review and that we've done the communication reminders for individuals to schedule preventative or slash annual dental appointment at the six-year mark of non-use.

So right now is it just number one?

Yeah, yeah, we're doing it now.

Me number choose a great idea.

Do we want great ideas in the standards? Are they manageable great ideas? How many people are currently? Well, I guess how many? Marie, do you have, like, an idea of how many people drop off? Because it's a fair amount that drop off for, well, I guess more for not eligible versus non-use, right?

Yeah, yeah. For not eligible, between 70 and 100 each month. Non-usage, I did not get to do that yet. Jackie and Adrian were doing that, so I couldn't tell you.

Yeah, the annual process is probably more, there's probably a lot. I think the six-month process is pretty easy, actually, because we can run the report, and then we're just going to be doing a standard generic newsletter or mail link to them, so it'll take less time, because you don't have to do the disenrollment pieces of it and all of that stuff.

It would just be doing a

kind of canned email reminder or a mail reminder to folks, which would be relatively simple.

Well, what does everyone think?

Do we want, I mean, it's a highly enrolled in service and a lot of funds are committed to it. It would be interesting to know a little more of how many people is that dropping off for non-use. I mean, people definitely want dental, but I think there is a significant chunk that then don't use it, unfortunately. So do we want to be monitoring that more?

Based on last enrollment date, I think it was around 150 people that we disenrolled based on they had been enrolled for more than a year since their last enrollment date in it that had not used.

It was around that number that we disenrolled the last time we did it, which was early last year. I mean, it's fine to start with just the annual 12-month piece as well.

I guess part of me is thinking, is this a standard?

I guess it's the quality of the administration.

Yeah, it was an idea because I was like, we have one. other idea, which was the thing. So it doesn't need to be included. It can just be something that we do. And we told you all about it.

Yeah, I like the idea.

I'm just wondering if it's more of a program process rather than a statement.

Yeah. I agree.

I kind of feel like it might be a process, more of a process as well.

Yeah. I mean, I almost kind of feel like that with number one also. I mean, I like them both and I think they're important to have good utilization of the service and not be spending money that doesn't need to be spent. It's just hard because the standard is about like administration versus.

Yeah, this is a that's why this one is a tricky one. Yeah, I was like, OK. I mean, we do have some other things and other standards that are process-based. We can always leave the dental insurance predetermination to have it there just in case we ever do bring that back if we have additional funds to use.

I think it's worth keeping. I mean, yeah, it's already written.

If you want to do that one and leave the referral timeline and that's it for now, that's totally fine, too. We need something to review.

Yes. Yeah, I was going to add that what happened last year when we had the referrals, when we had a waiting list. So if we had to go back to something like, you know, where there's a lot of demand and there's not enough funds for everyone, it might not get us to the 95% of referrals completed within the five business days because I know it was taking longer. So if something like that were to happen, I know that for a period of time, we might not be able to reach the 95% of referrals completed within five business days if there's a wait for services. So that could create a little bit of difficulty.

And I also want to mention for the determination, just so you guys keep in mind that that's also... been very difficult for our office to retrieve that information. We really rely on the client to get that documentation because we can't get that from Delta directly anymore. So that's also something I want to make sure that we keep in mind when we're talking about the documentation for the predetermination as well.

Yeah, but the 10 days is fine because that's a completed request. That means we have all the documentation in order to complete it. So now we're doing a review after that within 10 days. So I think that that's 10 days is still fine there. I do the, I hear what you're saying, but we've also made, whenever like we've made changes like that, like we've had things where we've made changes to like the like brief changes to the food vouchers. We've opened them up a wire. We didn't go in and change the standard for that. And we're hopeful that we won't need it until this year. So I think we should be okay there. But we would always take that into consideration and the planning council would be like fully aware if we had to do that. So I think we're okay to not plan around that possibility if that happens.

Does that make sense? You could even have the referral be opened and a note added, you know, so it's still pending.

No, I was going to say, if you're counting pending, then that's still like completing the referral. like whatever category you move it to, like whether that's completed, fully enrolled, or these people are pending, but we've already, you know, we already have them on the list. That could be considered completed.

Yeah, I think that that would, between what Jeremy said and... And they track all this stuff separately from CareWear. So it's like, it's very clear. You can see when things are updated and when things are processed and when things are on hold, because I'll wait for us. And so it's pretty, I think it,

would be it would be reviewed against that rather than the care where referral anyway i know what we could add here is what about disenrollments not just of non-usage but um you know that's something that needs to be done on in a timely manner like disenrollments you know, generally it's due to not being eligible.

Those are done the very first of the month. We run a report and all these clients that are not eligible, that's the first thing we do on the first to get them through. So that's done. That's a for sure thing that needs to be completed. We like to ensure that before a client sees a dentist.

I guess the standard that it's like wouldn't be a standard just because it's like.

Has to be done or yeah, yeah, we we have to do it. That's that. That's the priority of the day. As soon as you come in, that's the first thing gets done.

OK, well, then maybe this is what we are. I'd like to see dental insurance predetermination be the second one. So it starts with referral timeline. Gwen, you can change that later, but just FYI.

Okay.

And then the rest, are we good with the personnel qualifications? hear no one saying no.

And then assessments related to cost benefit analysis for HIP and dental insurance are addressed.

So do we do a cost benefit analysis for dental insurance?

I don't think so. I mean, that's the only one. Jeremy's throwing daggers my way as I say this, but the only other standard potentially for dental is payer of last resort. which is so challenging and complex. But if we're not doing that, I don't know that we should have something saying cost benefit analysis for dental insurance.

Can we leave it?

Okay. And the reason being is we could, we may, if we are alerted to an other insurance, we will review what their insurance covers. And we've done that for access plans where we've not, but that's probably, that's something that we're probably going to have to address sooner than later. So I would prefer to leave it.

And a question, is that also what we do as far as like when we go out for RFP and review the different dental plans? Is that also part of that cost benefit?

No, it's not. no it's more about it's more about so like we do for hip where we would look to see is it a benefit for someone to be enrolled in a like a cobra coverage or other payer that we're paying for your coverage employer coverage yeah medicare advantage plans sometimes have great coverage and thank you for the clarification jimmy about the ffm that was a challenging year

Okay. Service plans are not required for HBSCA.

Okay.

Transition and discharge. That's just our standard language. I don't feel like that really applies to this service category, but do we just keep that in there for all of it, every, all of them? And case closure protocol, the same thing, and I think all the rest are all standard.

You can still refer to cultural and linguistic competency in class.

Are they still holding folks to a class standard, Jeremy?

My apologies, sorry, I couldn't unmute myself and my screen went all wonky. That's the thing.

It's in all of our stuff.

Are they still?

Can we come back to that one too?

Yes, I say we should move past it.

Yeah, it's on all the other standards. We can do a blanket. update if we need to later for them. Glenn, can you add that to our list of things we need to take a look at and see if it needs to be removed from all the standards?

Yeah. OK, so scroll down. We've got a recertification and we're done. Yay.

So are we good? Are we, I don't think there was anything we needed to come back to. Was there other than formatting? Yeah.

Yeah. Everything prior to the tables, we got, we finished that review at our last meeting. So it's really just that it's today. Yeah.

Okay. So. I think we're in a situation to, I'd be glad to accept a motion to approve the HPSCA standards. Do we have enough people to vote? I just realized where are we at? Cause Eric left and Randall left or Randall's. Do we need three or four?

We need at least three, but I'm going to message Randall just in case, because he did say that he would still be kind of on. So let me just see if he's available.

I know Eric left.

If we're ready to go, I'll move the motion forward.

Yeah, and I'll second. Thank you, Jason. Thank you, Juvia.

Is there any discussion?

Okay, hearing none. uh given that gwendolyn said we have enough to vote let's uh call for a vote erica t camp yes duvia lozano yes jason velcruz yes motion carries okay great hooray one more done um I think we are then moving on to our next item, which is to review and resolve any parking lot items, of which we have none. So we can move to next. Well, and I guess we're putting in the parking lot our service standard things, correct, Gwen, to keep working on?

Yes.

And then so I guess that goes to the next one. Determination of agenda items for the next meeting, which will add that on. What is our next service standard were set for and then we'll do our cat also.

I believe it will be the nutrition standards.

OK. And so can you invite someone wait? Didn't we say we figured that out that we had done those? I think we'll. Because it was food-based and home-delivered meals that we finished.

Is nutrition a separate standard? Or is that under... Let me go check.

Just get them confused. Of whether it's like one whole standard. I know we had this discussion last time. Because we were all like, we've done this, but yet we couldn't see where we had done it.

Yes, yeah, that was the one where we were kind of confused on. Let me go pull up And also while I'm looking for those notes, just a quick look at the PCAT for May and July. I just wanted to share that on the screen with everybody.

So I do have medical nutrition is the next one. Yeah. Okay. So it is a separate one. So that'll be medical nutrition. And then so for today, then for our PCAT, took care of parking lot, we're reviewing our PCAT. We reviewed HPSCA and we are working on the planning council. Is this meaning the committee's policy and procedures? Yes, yeah, the committee's. Okay, great, which we have started on.

Okay, anything for the PCAT? Anyone have?

Okay, then. We go back to our agenda.

We are then at, whoops, sorry, I lost my page. There we go. I have on the screen too. OK, thank you. Next up then will be 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 voiced during this time. Jason, did you want to share what you shared in the chips?

Oh yes, thank you. So just a reminder that Aunt Rita's is having our bake sale and drag show this coming Friday. I can give you the exact address. Let me just look it up real quickly on the calendar.

Like 56th Street and Osborne.

Yeah, essentially it's at the church there. So it's 3641 North 56th Street. It is in a church. And it'll be a lot of fun. We have Rita Bain as the drag performer, I believe. And we're also doing bingo and the food is going to be delicious. So come out and support Aunt Rita's so that they can support all the different partner agencies across the state. Thank you.

And an 80s theme, correct?

It is indeed an 80s theme. I have no idea how I'm going to dress because I got rid of all my 80s clothes. But it is an 80s theme. If you want to dress 80s, there will be a costume contest.

I think goodwill is in your future, Jason. You can go find something. Does anyone have anything else for current event summaries? Okay, then call to the public. This is the time for the public to comment. Members of the committee cannot propose, discuss, deliberate, or take legal action on any matter voiced during this time. Okay, well, hearing nothing, then our next star committee will be held on July 28th at 2.30 p.m. And with that, we will adjourn today at 3.52 p.m. Thank you, everyone. Thank you.