Ryan White Planning Council - Regular Meeting

Let's go ahead and start, everybody. We have a long day. See if we can get through it. And as people come in, we'll check their conflicts of interest, okay? So we have reached quorum with, Gwendolyn, what was the number again?

18 of 23.

Thank you. We have reached quorum with 18 of 23 council members in attendance. The meeting will now be called into session at 2.32 p.m. I invite Planning Council to support to begin introductions and any declaration of conflicts of interest.

Thank you, Michael. So when I call your name, please state your name and list any conflicts of interest that you have. I'll start with members of the Planning Council, and then I'll go into our recipient staff who are scheduled to speak, and then anyone else who is a guest speaker. Michael Brown.

Michael Brown, no conflicts.

Randall Furrow.

Randall Furrow, vice chair, chair ex officio, no conflicts.

Eva Galindo.

Eva Galindo, CHIPS co-chair, no conflicts.

Eric Eason.

Eason, present, no conflict.

Alan Barnes.

Present, no conflicts.

Erica DeCamp. Erica Teekamp, Star Chair, Conflicts with Medical Case Management, Non-Medical Case Management, Referral for Healthcare and Support Services, Transportation, and HPSCA. Anthony Holscher.

Anthony Holscher, No Conflicts. Bradley Reese.

Bradley Reese, Present, and No Conflicts.

Brian Hagenbart.

Brian Hagenbart, Present, No Conflicts.

Celeste Amaya. Celeste Amaya, no conflicts. Kieran Rahman.

Kieran Rahman, present, no conflicts.

Daniel Iniguez.

Can you guys hear me? Oh, there you go. Yeah, I can hear you now.

Daniel, conflicts with nomenclature. case management, medical case management, nutrition, food bank, and mental health.

Emily Holling?

Sorry, hello. Emily Holling, Prisma Community Care. Concepts of interest are mental health, substance use, medical case management, non-medical case management, nutrition, and food banks. Jason Valcruz?

Hi, Emily.

Jason Bill Cruz, Star Vice Chair. Conflicts include primary medical, substance use, mental health, HPSCA, and referral for health care and support services.

Taylor Kirkman. Present. Conflicts with primary medical, HPSCA, mental health, substance use, and referral for health care and support services. Jimmy Borders.

Jimmy Borders, ADHS, ADAP, conflict, ADAP.

Eduardo Moreira.

Eduardo Morera, ADHS, no conflicts.

Grace Ashu. Hi, good afternoon, everyone. Can community health conflicts are medical case management and medical services?

Benjamin Pearson.

Benjamin Pearson, medical case management.

Stacy J. Cavalier.

Hi, Stacy J. Cavalier, no conflict.

Shantae Coleman. Shantae Coleman, Maricopa County. Alaina Rennie.

Alaina Rennie with the Ryan White program.

Regan Hoy. Regan Hoy, Maricopa County. Rowell Ayala.

I think I saw you unmute, I don't know if I, oh yeah, there you are.

ADHS Ryan White Part A and Ada.

Elena Pittman.

Elena Pittman, ADHS, no conflict.

Thank you. Was there anyone that I missed that happened to enter the meeting while I was doing conflicts? If so, you can just raise your hand and I can call you. Hearing none, we can go on to the next agenda item, Michael.

Thank you, Gwendolyn. Before we move on, I'd just like to remind everybody it's a busy day today on the meeting. And just so everybody can hear, mute your microphones. And just to help the static background, if we have any static background, and help facilitate the meeting, everybody hearing clearly. So moving on to the next item, item three is review and acceptance of agenda. The committee will review the agenda. The chair will not make any adjustments to the agenda. The chair may change the order of the agenda, but not add any new items to comply with open meeting law. Is there anybody today that maybe needs to move up because of time on the agenda or change the agenda? Awesome. I think we're set to go on to the next would be light item number four, which is review and approval of the minutes and action items. The council will review the minutes from the previous meeting. You should have received a packet and a copy of our previous meeting minutes for your review. The council will now review a summary of the minutes, previous minutes. Please share any revisions that you

Uh, maybe then corporate.

Awesome, so I'll go ahead and now accept a motion to approve the minutes from the. April is that the April 20? I'm looking here. Yeah, April 28th, April 28th minutes. Do I hear emotion? Stacey Jay, so moved. Thank you, Stacey Jay. I have a motion made by Stacey Jay.

I'm sorry, go ahead. Celeste Anaya approved.

Thank you, Celeste. I have a motion to approve the minutes by Stacey Jay and a second by Celeste Anaya.

Before we vote, is there any discussion? Seeing none at this time, I'll ask Gwendolyn to do a roll call vote.

Randall Ferrell.

Yes.

Eva Galindo. Yes. Eric Eason.

Yes.

Alan Barnes.

Yes.

Erica Tequia. Yes. Anthony Holsher.

Yes.

Bradley Reese.

Yes.

Brian Hagenbart.

Yes.

Celeste Amaya? Yes. Kieran Rahman?

Yes. Emily Holling?

Yes.

Jason Val Cruz?

Aye.

Taylor Kirkman?

Yes.

Jimmy Borders?

Yes.

Eduardo Moreira?

Yes.

Grace Ashu? Yes. Benjamin Pearson?

Yes.

Stacy J. Cavalier?

Yes.

Motion carries.

Awesome. Thank you, Gwendolyn. Next, I'll move on to light item number five, which is the chair update. I just have a few updates. Number one is I, yesterday at the executive council meeting, we appointed Tanika Drake for the team's chair, committee chair. And I'm excited to have her on board as a chair of the team's committee and to serving and her dedication to the council. I don't know if Chanika is present. Is she like to say anything or?

I don't see her yet, but she might be joining the call later so I can let you know.

OK, awesome. And then also I would like to say thank you for the allocation support group that met. I think it was last week. I'd like to thank you for your time, your commitment, and your dedication. This was my first allocations work group. I was real impressed by the conversations we had, the detailed conversations, the knowledge, and coming to consensus on the decisions we had to make. Sometimes they're not easy to go forward, but I was really impressed with the committee and the allocations work group. And thank you guys for your time and commitment. The other thing I would like to say is if you're interested in joining a committee or would like more information about opportunities to join, please let me know. Reach out to me or support staff so we can get you in contact with a committee that matches your interest and skills. We're always looking for people to join committees and would like your input and feedback would be awesome. And that's all I have for chair updates. So we will move on to item number six, the Ryan White HIV AIDS Part A recipient. I think you're going to be presenting this information.

Yes. So good afternoon, everyone. First, I'd like to provide a brief overview of our grant year 2026 and a notice of award. I'm going to share my screen real briefly so you guys can follow along with me while I'm Spatting these numbers out to you all. Okay. So for Part A funding, we received a total award of $11,350,085, which represents an increase of $300,622 in our formula and supplemental awards, including Minority AIDS Initiative or MAI funding. In addition to the Part A award, we have $421,983 in carryover funding and approximately $150,000 in Part B rebate funding, bringing the total funding available for services just under $12 million. Then I'm going to move on to the EHE funding for our EHE or ending the HIV epidemic funding, we received $2,768,896, which is an increase of $336,942 compared to last year. So we will discuss these funding amounts and the proposed allocations in more detail later during the allocation sections of today's meeting, but I just wanted to briefly go over it real quickly. Moving on. HRSA has launched a new HIV Resource Hub, which is currently serving as the interim replacement for the Target HIV website. The new website contains many of the resources, tools, and training materials that were previously available through Target HIV. So the website address is hivresourcehub.org. I'm going to drop that in the chat here now for you all. And there are some planning council resources listed on their website. Moving on to my next update, the Positively You campaign is seeking new ambassadors as part of our campaign refresh for our project, our refresh project for this grant year. The campaign is looking for individuals between the ages of 18 and 30 who are living with HIV and are current or former Ryan White service clients. Ambassadors will have an opportunity to share their experiences and help shape future campaign messaging and outreach efforts. If you know someone who might be interested, please have them contact Kate Thomas at kate.thomas.maricopa.gov and include a brief message explaining why they would like to serve as an ambassador. I will also drop that information for you all in the chat. That concludes my program updates.

Thank you, Santeri.

Next, we will move over to integrated plan, line item number seven, integrated plan concurrence. And I think, Raul, are you going to be presenting today on the integrated plan?

Yes, ready for whenever you all the same, good to go for the same presentation. Hello everyone. For all those that you do not know me, my name is Roel Ayala. I work for part of the Plan B team supervised by Deborah. And a couple of the stuff I do is a training program for the Office of HIV and Hepatitis Services, the integrated plan, SWAG, and other of those things. So a lot of you all have seen this presentation, so I'm going to try to go through it as quickly as possible. anyone has any questions or anything feel free to rise your raise your hand on here the chat feature okay so here is the 2027 to 2031 arizona hiv sti and hepatitis c integrated plan like We're going to hyper drive this. So here, the biggest part here is ADHS leading with coordination from obviously you all, the Vegas TGA is now down there, SWAG, HEP3AZ. And the intention and approach with this new iteration of the plan is to build on the existing 22 to 2026 plan, make it more condensed, improve monitoring, more streamlined as well. Here's kind of the timeline. We're now here down here in the late spring. So we have done the community webinar, we have finalized a plan, and now we're just getting concurrence from everyone. A couple of things that were accomplished was a comprehensive needs assessment, oversight committee work groups, a lunch and learn for community input, two other community engagement webinars, meeting with the planning bodies. And the strategies that we took are we would work on the plan, get kind of like a draft version, then get feedback, and then overall we did four drafts. So we're now right now in stage four. So getting concurrence and letter of support. Then we are done with SWAG. we are done with the Vegas TGA, and we are done with Fast Track City. So now Vegas TGA, I'm pretty sure they did concurrence. Fast Track City did a letter of support, and Hep C I think is going to do a letter of support. For all of you that do not know, for you all, we are asking for concurrence. And so concurrence is when the planning body is in support. of the plan. There's also concurrent with reservation, which is the planning body is generally in support, but they have reservations or requests to change. Then there is the nodding concurrence. So as a planning body does not support major changes when you be added and letter of supporter for like some organizations get the option of concurrence or letter of support. And since we've all been working on this for a really long time, I'm gonna just So the integrated plan is divided into four pillars. The first pillar is diagnose with our goal to improve and expand testing. And I'll go over kind of more of big themes that working on this and working with you all that I saw was big focus on syndemic, big focus on increasing availability, such as like things with like after hours, a big focus on new partners, innovation. So objective one is to increase availability of testing. Number one is to improve the access, increase awareness. And number four is about partner services. Number two is the prevent pillar. This one just takes up a little bit more space and the goal is to reduce new transmission of our mobilities. So number one is to expand PrEP coverage. Number two is about the overdose and disease prevention programs and harm reduction services. This one is a more Hep C, HIV focused one and expand us sexual health prevention mechanisms. So this is where we include our PEP and our DoxyPEP, our U equals U work and Last is to reduce preventable cases of perinatal hep C and syphilis among pregnant persons, which has been a problem for Arizona. We're pretty high up there and there's been like a trend upward. And then we have the treat pillar. So this one is improved linkage. improve navigation, specifically to achieve care for Hep C, and increase retention, people with living with HIV. And lastly is the RESPOND, which the goal is to strengthen statewide HIV, Hep C prevention and systems. Number one is probably the most wonky one, which is Cluster detection response, surveillance, and outbreak response.

Yep, we got a question. Randall?

You can finish and then I'll have my question. Sorry about that.

No, you're good. Again, focusing on on syndemic, newer partnerships, and then lastly is the workforce one. And so we've done all of This, yeah, I think we're just waiting on a couple letters and then we've typed everything up, did all the narrative portions, sent to Maricopa and Jeremy for them to have a look through and then sending it to our higher ups to be able and then we're submitting it June 30th, I believe, maybe earlier to CDC and HRSA. And so, yeah.

Okay, Raul, great presentation. My question is, I just want to confirm, you're looking for concurrence from the planning council today. Once you have that concurrence, hopefully today, then it's going to move over to the letter of concurrence, which Michael will be signing, and then that's presented to you guys. What happens after that?

So let's say Michael signs it to us, and then it gets added to the application, to the submission to the CDC and HRSA.

Okay.

It's part of the, would it be fair to say the grant submission or grants, like a grant deliverable? And so we'll put it in there.

Great. Thank you. And then you have another question.

Hello, I had a question this may I should be more for Gwen, but I know we discussed a couple of weeks ago that, like, the plan would need to be kind of concurred upon or signed off on by. A miracle account is like science director or something like that. Do you know if we've gotten approval from all the folks that we need to America county?

The, so what what that is, is the whole submission that's what needs to get approved and that was sent last week. So we haven't gotten that, but that's like, it's like a bigger, that's like a bigger document. That's like, like I think ours is.

So we can still concur without all those reviews being done. Correct. Okay. There's one. I'll double check. Thank you.

And Bradley, to answer your question. Yes, we, we have received those letters in our office is approving those. We are, we are just finalizing that through our leaderships at the County, but it is, It has been approved. We're just waiting for those final signatures to send to because we as well has to submit that same integrated plan to about the 30th as well.

Okay, awesome. That's good to know. Thank you.

No problem.

Is there any other questions or comments about to roll out the plan? Awesome.

Thank you, Raul, for your time today and the plan and presenting the plan and your work. So at this time, I will now accept a motion to vote on concurrence on the final statewide integrated plan. Do I hear a motion? This is Jason. Awesome, Jason. I hear that you motion to approve the plan. Do I hear a second?

Eric Eason, second.

Thank you, Eric. I have a motion to approve concurrence on the final statewide integrated plan motion made by Jason Val Cruz, second by Eric Eason.

Is there any discussion before we vote?

Congratulations on everyone's hard work on this. I know many of us were involved.

Yeah, so many, so thank you all so much.

Thank you. So Gwendolyn, would you like to do a roll call vote on this for me, please?

Randall Ferrell?

Yes.

Eva Galindo? Yes. Eric Eason?

Yes.

Alan Barnes?

Yes.

Erica Teacamp? Yes. Anthony Holscher?

Yes.

Bradley Reese.

Yes.

Brian Hagenbart.

Yes.

Celeste Amaya. Yes. Kieran Rahman. Yes. Emily Holling. Yes. Jason Val Cruz.

Yes.

Taylor Kirkman. Yes. Jimmy Borders.

Abstain.

Eduardo Marrera.

Abstain.

Grace Ashu. Yes. Benjamin Pearson.

Yes.

Stacy J. Cavaliere?

Yes.

Motion carries.

Thank you, Gwendolyn. And thank you, everybody. Next, we'll move on to light item number eight, which is the grant year 2026-27 allocation recommendation. And I have Shantae Coleman and Elena presenting today.

And we are back. So I'm going to share my screen again. Okay, so as part of the recipient update, I briefly reviewed the funding we received through our notice of award. I now like to walk through the allocation recommendations developed by the allocations work group. So, starting with the worksheet, the rankings reflected in the first columns here are the priorities established by planning council during last year's priority setting and resource allocation process. Column E, shows the final expenditures of grant year 2025 by service category. This provides a picture of where funds were ultimately spent and helps explain how we ended the year with carryover funding. Column F reflects the allocations that Planning Council proposed and approved during last year's PSLRA process. These allocations were based on the projections available at the time and included decisions to reduce or discontinue certain service categories such as EFA and EIS. And then column G represents the projection if everything remains relatively unchanged. In other words, it shows where we would likely end up if current spending trends continue based on provider budget requests, year-end utilization trends from last year, and the trends we've seen so far this year. Now Column H is where we want to focus on today. So Column H presents the proposed grant year 2026 Part A allocation. So under this proposal, 50,000 of the Part B rebate funding would be allocated to Health Insurance Premium and Cost Sharing, or HPSCA. As a result, the Part A allocations for HPSCA would be reduced by the same amount. The remaining $100,000 in Part B rebate funding would be reserved to address potential coverages or overages in both HPSCA and OHS or outpatient ambulatory health services, providing some flexibility should utilization exceed projection during the year. We are also seeing some client need in both transportation and food bank services. To respond to those needs, additional funding has been proposed for both service categories, as you see a slight increase. In addition, it's proposed that beginning August 1st, the Ryan White Program increased food voucher assistance from $40 per month to $100 per month for eligible clients based on current program protocols and available funding. So that concludes my review of the proposed 26-27 allocations recommendations. At this time, I'm going to turn it over to Gwen and Michael for any discussion or next steps.

Awesome. Thank you, Chante, and thank you for your hard work putting the report together. I'd also ask maybe if anybody from the allocations workgroup who attended the workgroup would like to add anything or or any discussion about anything that the work group came up with or add your voice at this time?

I'm glad we increased the full voucher to 100 again temporarily, I guess. Because that's going to help a lot of our clients out a lot.

And I appreciate a clarification that we had during the allocation work group as to those food vouchers worth for versus thinking of them as like gift certificates for groceries. It's not that. It's tied to nutrition and stuff like that. So I'm glad that we had that clarification. And I also just want to thank Staff or their thoughtfulness in terms of presenting the information so that we were able to come to the proposal. I think it was a smooth process that you said and Michael and. It was a, it was a good experience overall.

Thank you.

And to clarify, it's not a gift like you just mentioned. Because you have to show that you're buying healthy food with the receipts and so it's a process, but it's great.

It's also, this is Emily and our organization receives the food voucher program and it, like Eric said, it's supposed to supplement. It's not supposed to cover somebody's groceries completely. and it's supposed to work in conjunction with the patient's care plan that they've created with Peggy and work towards their, whatever their nutritional goals are.

Emily, this is Randall. If I could ask a question, because I know a lot of people get confused about the program. Um, does, do the clients have to go through like an evaluation process and they kind of look at, um, things like comorbidities and things like. Absolutely. Okay.

Yes. And they have to also, um, they'll sit with Peggy, they'll do an intake. They'll, they have to see Peggy, I believe every six months, um, to also make sure they're on track with their care plan. people with comorbidities, excuse me, are more than likely going to be put on the food voucher program because of the comorbidities. But yeah, they have to check in with Peggy at least, if it's not three months, it's six months to make sure that everything is going well. And then also, like Eric said, you have to present your receipts. We're not trying to have the, I think Peggy uses the example of like crab legs. Don't do that.

How often are the receipts sent down?

Monthly. So they have to, we have to have the receipts in hand for them to be eligible for the next month's food voucher card.

Okay. That's all I had as far as questions, but from what I hear, the program is very beneficial to our clients, especially those that do have increased comorbidities and physical concerns.

Yeah. If anybody has questions about nutrition or food vouchers or anything like that, y'all can email me or Peggy or whatever. We'll gladly answer any questions at any time.

Thank you.

Thank you. Thank you, everybody. Thank you, the allocations workgroup again for your time and dedication and the council as well.

Is there any more discussion on the allocations?

Okay, seeing no more discussion, I guess we will now accept a motion to accept the allocations as presented by Part A office and issue a directive to Part A office to raise the monthly food voucher amounts to reflect the increase in allocated funding for the food home-baked delivery meal service category. And I think also was in there was transportation was increased as well.

So do I hear a motion? One quick question.

It might not be in accordance with our meeting, but transportation right now, it's like one trip per week to see your doctor. Is that going to change or remain?

Maybe is Erica on the line?

No, I don't think she's on here. Yeah, she is.

Erica Kaurudar, i'm on the request for transportation keeps things status quo, which is five rides in a month. Erica Kaurudar, it's not really an increase that's just based on what we've been doing and. Erica Kaurudar, So it's keeping things status quo.

Paul Minehart, Okay, sorry about that I thought it was. Paul Minehart, Thank you for explaining that Erica.

Thank you Erica.

Okay, so do I hear a motion to approve the allocations for Part A office?

Ms. Tamaya, I'll approve those notes.

Thank you, Celeste. Do I hear a second? I have Benjamin's second. Thank you. I have a motion on the floor to accept the Part A Office issued directive for the party to raise a monthly food voucher to reflect the increase in allocated funding and a second.

Is there any more discussion? At this time, I'll ask Gwendolyn if she can do a roll call vote.

Randall Farrell?

Randall says yes.

Eva Galindo? Yes. Eric Eason?

Eric Eason, yes.

Alan Barnes.

Yes.

Erica Tecan. Abstain. Anthony Holsher.

Yes.

Bradley Reese.

Yes.

Brian Hagenbart.

Yes.

Celeste Amaya. Yes. Kieran Rahman. Yes.

Emily Holling.

Abstain. Excuse me.

Jason Val Cruz?

Abstain.

Taylor Kirkman?

Yes.

Jimmy Borders?

Abstain.

Eduardo Marrera?

Abstain.

Grace Ashu? Yes. Benjamin Pearson?

Yes.

Stacy J. Cavalier?

Yes.

Motion carries.

Thank you, Gwendolyn, and thank you, everybody, for coming to vote on that and your feedback and your input. Next, we'll move on to light item number nine, the AEAM results, and Gwendolyn will be presenting that today.

Thank you, Michael. So I'll just get my screen shared and then we'll get started. So today I will be presenting the results of the assessment of the efficiency of the administrative mechanism, also known as the AEAM. And this is one of the annual responsibilities of the planning council where the Ryan White Part A office is evaluated for how quickly Part A funding is moving into the community and being made available for care. And this involves ensuring that funds are being moved into the community quickly through an open process and that providers are being paid in a timely manner. And that also means reviewing whether the funding is being used to pay only for services that were identified as priorities by the Planning Council during the PSRA process. And there are six questions in this survey. These were reviewed and approved by the Executive Committee and Planning Council earlier this spring, and today we're just looking at the results. So starting off with question one, our first question looks to see if the providers are being paid within 30 days of receiving a completed invoice. And this is important because we're measuring, again, how quickly that funding is being moved into the community and being made available for care. And as you can see at the bottom, the total average number of days was 10.36, which is well within the 30-day requirements. So question two, so where contracts with Part A subrecipients signed and executed in a timely manner. So the partial notice of award was issued by HRSA on January 14th, 2025, and the email notice to providers was sent out 57 days later on March 12th, 2025. I do want to point out though that guidance on level funding was given to providers during contractor calls from February 3rd to 14th. So there was some guidance given Before the final email notice and then the final notice of award was issued on July 29 with task orders to providers being sent on September 2 2025. So our next question is question number three at the end of the grant year did the part a grant have 5% or less in unspent formula funds that were eligible for carry over. So HRSA only allows us to carry over up to 5% of formula, of the formula funding. And the formula portion of the award is based on the number of people with HIV and the number of new diagnoses. And the goal is to move as much money as possible into the community for client services. Otherwise that money gets returned to HRSA. So these charts show the budget year award information. So that top table right there is for non-services. So this includes clinical quality management administration, and that includes planning council costs. And then the second table is for core and support medical services. But for the purposes of this question, we're going to focus on that small table at the bottom, which I'm going to zoom in on on this slide. So as you can see right there, we had a total of 4.77% of unspent funds, which is below the 5% carryover cap. And then you'll see a 9.91% there. That's for Minority AIDS Initiative funding, and there's no 5% cap on that. So we're good right there with 9.91%. So moving on now to question four. Next, we look at how the funding was spent and did the recipient's office follow the guidance of the council regarding which service categories they paid for. So this chart looks at core medical services and compares the PSRA report to the final allocation reports. So just walking through the table here, that first column in light blue is the initial allocations from the PSRA report. The gray column is final allocations. The green column is final expenditures. And then we have two columns there for variance and the explanation of variance. And this table is just looking at core medical services. We'll look at support on the next slide. And I'm going to leave this on the screen just for a few moments for people to read through the explanations. And then moving on to the second part of this question, and we're still on question four, but now this is looking at support services. So same columns here. And again, I'll leave this on the screen for a few moments for folks to read through. Okay, moving on to question number five. Were Part A resources reallocated in a timely manner to ensure the needs of the community are met? And so this is just looking if Part A resources were reallocated in a timely manner. So here we have the date of the reallocation, the narrative of the reallocation, where funding was moved from, and where it was moved to. So we just have two narratives here. And again, I'll let you read through those. And then our final question is question number six. So this is looking at if the Part A office notified clients of any applicable planning council decisions that directly impacted services and eligibility in a timely manner. So last year, the planning council issued a directive on June 6, 2025, and that directive included a number of service category decisions. As you can see down there, the last two rows for early intervention services and psychosocial support, it says not applicable for notifications. And that's because for early intervention services, clients were closed out of services individually and transitioned to case management services. So there wasn't like one email that went out since people were notified on an individual basis. And then finally for psychosocial support, that reduction did not impact service delivery because costs were moved to another funding source. So there was no impact on clients. And then that's our last question, so I'll stop here for questions or comments. And if you want me to go back and look at another slide again, I can also do that. But I'm going to take my screen down for now so I can see if there's hands being raised.

Thank you, Gwendolyn. Is there any questions for Gwendolyn before we move on to a vote? Awesome. So I will now accept a motion to accept the AEAM results. Do I hear a motion?

This is Erica.

Go ahead. Go ahead, Erica.

This is Erica. I move to accept the results.

Thank you, Erica. And Eva, did you want a second? Yeah, this is Eva. I'll second. Thank you, Eva. I have a motion on the floor by Erica to accept the 8EAM results and a second by Eva.

Is there any discussion before we vote? Seeing no discussion, when will you do a roll call vote?

Randall Furrow?

Yes.

Eva Galindo?

Yes.

Eric Eason?

Yes.

Alan Barnes?

Yes.

Erica Teekamp? Yes. Anthony Holscher?

Yes.

Bradley Reese?

Yes.

Brian Hagenbart?

Yes.

Celeste Amaya? Yes. Karen Raman.

Yes. Emily Holland.

Yes.

Jason Val Cruz.

Yes.

Taylor Kirkman. Yes. Jimmy Borders.

Yes.

Eduardo Marrera.

Yes.

Grace Ashu. Yes. Benjamin Pearson.

yes Stacy J Cavaliere yes motion carries there we go sorry about that thank you Gwendolyn and thank you for your time and doing the report I really appreciate it next line item would be Line item number 10 on the agenda review, the EMA continuum and care of service by category. And that would be Reagan.

Thank you, Michael.

All right, I am going to give a brief overview of our 2025 annual continuum data, which I finished a few weeks ago. It has been sent out to each provider. So if you haven't seen that yet, it will be in your inbox. I do, upon suggestion from our executive committee, want to give a little bit more of a breakdown of what goes into continuum data. I know I tend to really quickly just go, it's our continuum data, and then don't give you guys a lot of detail. But I do want to give you a little bit more during this presentation. So 2025 annual continuum data covers January 1st, 2025 to December 31st, 2025 and our services provided. Something unique about continuum data as opposed to like PSRA data is that there are a couple exclusions we do before we get our final counts and our final outcomes. So one of those exclusions, there's really two major ones. One of them is that we remove ineligible clients, except in the EIS early intervention continuum, which I'll mention a bit later. And then the other major one and is relatively recent is that we remove clients who only had a CE service during the time period, so they didn't have any other service. And that will become relevant as I present later in the presentation. All right, first up, these are our overall major outcomes. The first one here, we served 4,353 clients, which is about 500 less clients than 2024. Again, also, if you were at the executive committee yesterday, I misspoke. Actually, we began the CE removal in spring 2025. So these 2024 numbers do include the CE clients. So that can explain some of the lower amount of clients. But it is a multifaceted thing here, but it's not necessarily cause for alarm when you see that. Our retention and care remained consistent at 94%, and our receipt of care increased by 1%. And then the big thing here, which I've been hinting at for a few weeks, is that our suppression did drop, unfortunately, about 1.5%. So in 2024 annual data, it was showing up as 89%. That's because of rounding. And now it rounds to 87%, which is a 1.5% decrease. And just for some perspective, that means we'd have to have about 50 more clients suppressed to reach that 89% threshold. So that's the concrete number of clients we're looking at here. And again, I did explain that the CE change is relatively recent. And I want to assure you that with these outcomes, I run it both ways each time to see if it's statistically different. And it's not. So even if the CE clients were in here, the suppression would not be statistically different from what I'm presenting to you today. This is just a comparison of the continuums across year. Again, that CE removal is relevant here because the number diagnosed in 2025 is going to be affected with that. The outcomes, again, are not statistically significant, so it's not much of a concern there, but that is just something to keep in mind when you're comparing these years. So again, retention, 94%, which is our highest it's ever been. Receipt of care is 94%, also the highest it's ever been, but our suppression has dropped a little bit. These are our service category goals. There are fewer goals this year because we set them based on service utilization standards now. So basically these are our most utilized services and we only assign these goals to them. So here are the ones that I want to point out are MCM. You can see we're a little bit behind. That is at least partially due to some changes we've made to the standards of care for MCM. So now we're trying to focus clients in MCM that need a little more help, and then clients who don't need as much help, we've been transitioning to the non-medical case management program. So that can explain some of the reason we're a little behind there. But other than that, our HPSCA suppression is on target at 95%. Our OHS suppression and nutrition suppression are a little behind, as well as non-medical case management suppression. This is our viral suppression by demographics. So again, at the top, you can see our overall suppression is 87%. Then there's that vertical line to kind of give you an anchor so you can compare all the different groups to it. The things I wanted to point out here is that the biggest drop we saw actually was in the white non-Hispanic group. So their suppression dropped by 4% from the last time. And that's pretty significant because they're also a very large group. So there were 1,274 white non-Hispanic clients that we served and their suppression dropped by 4%. On the flip side, the Asian and Pacific Islander suppression increased by 2%. So that's great to see. Looking closer at some priority populations, again, the overall is at the top for reference. We then have our EHA groups. EHA stands for early identification of individuals with HIV and AIDS. And then at the very bottom, we have NUIDX, which stands for newly diagnosed. And those are clients who are diagnosed with HIV or AIDS within the continuum time period. That bottom one is also linkage, not suppression. So it's not a direct comparison to our overall suppression rate. but we had 70% of our newly diagnosed clients linked within 30 days. Some things that I want to point out here is that our Black MSM clients had their suppression fall by 4%, as well as our 18 to 24 age group. So their suppression fell by 5%, and we also served significantly fewer young adult clients. So that's something you want to keep an eye out in the future. Finally, we have the early intervention services continuum. As I alluded to earlier, this one has fewer exclusions. So early intervention services are the only services we can provide to ineligible clients. So some of these clients will not appear on the regular continuum because they were ineligible. But overall, we serve 367 early intervention clients. 66% were linked to medical care. 53% were linked to Ryan White. 64% retained. 58% were engaged in care, which is a drop of 6% from last time, and then suppression dropped by 5% to 50%. Keep in mind, early intervention services will always have lower outcomes than our main population just due to the nature of the service. So just be aware that that's why this looks a bit lower than our overall continuum. And that is all I have for you today. I do want to thank the executive committee for giving me feedback on this yesterday. I tend to be very immersed in the data, so if there's ever anything that you guys see and are confused by, feel free to ask me questions as I'm presenting or send me an email and I would love to provide the answers to you. We're always looking for feedback, so thank you very much.

Thank you.

Reagan, thank you for your information and also for getting back with the clarification from yesterday's executive meeting.

Yeah, and I do. I think I saw Jason had his hand up.

Okay. Jason, you had a question? No, I said the fly. Any other questions for Reagan before we move on?

This is Erica. Reagan, when did the not eligible get taken out or was that always the way it was?

That one was always there, at least since I've been here, which is about three years. So I don't know if it was changed before that, but that has always been here.

Great. Thank you for that clarification.

Awesome.

So I think we can move on to the next item on the agenda line item number 11, the HRSA CDC recipient and partner updates. This is a time for representatives from HRSA CDC and recipient office to provide program updates that are deemed pertinent to the work of the council. We will start with access representative Dr. Karim Rahman. Dr. Rahman, do you have any updates that you would like to share with the planning council today?

Yes, I do. I wanted to talk about specifically an update about HR1. As you know, that was passed and it instituted a requirement that eligibility for Medicaid has a specific requirement work requirement addition that is new and that would need to roll out in time for a January 1st start date in 2027. Our team had been working in access, quite a few individuals have been working on this knowing that it was coming with certain guidance that we had previously received. Unfortunately, there was a a new CMS document or 400 page rule that was issued at the very end of May. And that has upended our previous work and has made clear that there are specific steps that they want us to follow in order to be in compliance. So I will tell you that across the country, every state is scrambling to figure out what exactly this means and to be a little bit more specific. So they're requiring that our our expansion population fits a certain medical frailty definition in order to be exempt from the work requirements that would make them eligible to continue their benefits. So we had thought that we could base it off diagnosis code. So in this instance, for example, a patient with HIV who had the diagnosis of HIV perhaps could fit under this medical frailty exemption. What is now clear is that it is requiring us to establish a functional impairment standard and that implement that reliably across our provider community. And so that involves creating a set of evaluation criteria to ascertain not only the diagnosis of severity that would qualify, be a first step of qualifying, but a secondary step to ascertain and to certify that the primary diagnosis is now affecting their ability to work. So that is a much more complicated process. It's incredibly subjective. And so right now there's no official way to do that. And so we're looking at disability processes. We're looking at other systems that are already in place to see if we can kind of glean some pearls from that to see how we can institute this and get our providers up to speed and to train them to make these decisions reliably. And also how do we want our patients to also be empowered to figure out how to go through the steps to get the documentation that they needed to prove that they're medically frail. So it's a lot of moving parts and it will be a completely new business line for access. So this is a big deal considering that we only have

six months for it to go live so that's where we're at right now any questions reese hello um thank you so much for the update i was wondering if we have data right now on how many of our um

clients are like not working or if we should be like concerned in that right if if there will be folks who will be kicked off en masse of access who are in the expansion population yeah i don't have those numbers but i will say that fortunately i mean compared to some other states that they have huge expansion populations the majority of our members would already be eligible due to income stratification and other ways that they're qualifying, whether it's through an SMI designation or other ways that have already kind of kept them away from this increased kind of standard for medical frailty. And so we're looking at, you know, our population of members is, you know, close to 2 million, but we're looking at much, much less that are, you know, in the 100 to 200 to perhaps 300,000 person range who would be affected by this. So we're trying to figure out how best to preserve access for these members. But in terms of impact in our state compared to other states, we're shielded somewhat because of just the way our population metrics have panned out.

Thank you very much.

Thank you.

Erica.

Well, thank you, Dr. Rahman. I know it's always hard to deliver bad news, but thank you, and you really explained it. Can you just clarify, because I feel like I, in my research, always find different answers. When we're saying expansion population, it is those clients with the income greater than 100% of federal poverty up to the 138?

Yes. Okay, great.

So that makes me feel a little happier, at least that it's a smaller amount of people. My second for Bradley is hopefully through part A, we can pull some numbers, they can pull some numbers that at least can show who is on access currently and who is at what income levels that can give us some overall numbers that could help with that. I think they have that. And then my other question is, a lot of our clients have behavioral health issues as well, may not be an SMI designation. Is there gonna be a type of tool Or will whatever tools develop take into account behavioral health symptoms that can affect ability to work?

Yes, absolutely. We'd be looking at behavioral health as well as on our diagnosis list.

Great. Thank you so much.

Of course.

Alan.

Yes, thank you, doctor. I've been hearing about this new rules and it says work requirement. Is there also an option for

volunteer work yes there is or school as well it's just that what we were using the terminology of community engagement and that caused a lot of confusion because what is community engagement um so it's shifted back to using work requirements people understand that but just know it's a broader definition than actual work it also includes school and volunteer as well thank you You're welcome. Jason.

Thank you so much for sharing the information. Again, just to echo what Erica has said, not easy information. So we appreciate you being transparent and coming to speak to us ahead of time. We know that I would say probably the majority of folks utilizing access are working. Has there been any kind of leads in terms of how the reporting for this community engagement would look. I know that there's some concern about if it becomes somewhat onerous, then people may fall off inadvertently, even though they are engaged in the community.

Yeah. So I will say that for those individuals who are working that get a standardized paycheck and have it digitized and, you know, easily traceable, it's going to be much easier for them to prove they're working versus people that are working kind of off the books or, you know, getting paid piecemeal or not on a regular basis or, you know, all of the other kind of setups that sometimes aren't as traceable. We're going to have harder times with that. So we're looking into it. If there is documentation and paper trails, it's going to make it easier. And we'll have to see. Given that it was just less than a month ago that they gave us all this extra information. It's almost like they're building the train as we're riding in it. So we don't have all the answers either. We'll know more as weeks and months progress.

Did that answer your question?

Yeah, I'm sure as things progress, we'll know more about it. I'm thinking specifically like, you know, folks that do gig work or and then for students or those that volunteer, that might be a little bit harder for them. But what I hear you saying is that for folks that have what we back in the day would think of as kind of a more regular job, then it'll be easy because they can submit that pay stub and the hours and everything that the program will be looking for, yes?

Yeah, in terms of proof of being a student or taking classes, I believe CMS is working on a system that it will get automatically transferred over to them. Um, so that's a bright spot in this so that students don't have to. Figure out how to get their information from their schools and send it over. So. That's 1 good piece Jimmy.

Hey, how are you?

Good. How are you? Yeah, good to hear your voice. A couple questions. The first one is I had sent some stuff over to both DES and ACCESS, Susie and a couple other folks. I don't know if you saw Nebraska's implementation plan.

Yeah, yeah, we there's a whole team working on it. Nebraska. Nebraska, some of the states that already kind of published their their list of diagnoses are in a tough space because those, like I said, that just having a diagnosis will not qualify you unless it's like a very, very severe, like for example, quadriplegia, right? So you're paralyzed in all four limbs. Something like that is more of an open and shut case versus a diagnosis that has kind of a span of how it's, progressing in a patient, right? So you can have somebody who's newly diagnosed with something and has, I'll use HIV again, right? And is control well controlled, but has a diagnosis and has not, the disease has not progressed further. Correct. So that person could work, right? Versus somebody who is, and cancer is another one, right? You can in stage one and stage two work with that. But stage four is very different, right? And you're in medical clinics and whatnot, trying to take care of all that. So it's just become a lot more nuanced than looking at just a diagnosis list. And so Nebraska, when they published that list, yes, it was a lot of states, you know, started working off that list as well because it was, you know, refined and seemed like a good starting point. And so we had added additional diagnoses along with that one. However, you know, it's basically starting from scratch where we have to relook at the list to see what will meet the cut. Because the other thing is, is that they have, CMS has made very clear to us that if they don't agree with us, they will audit everything and fine us for those errors.

Yeah, I've heard what you're going through. I've heard I've had the luck, misfortune, or everyone look at it of sitting next to some folks on airplanes that politicians that happen to be doctors go figure that one out. And they've basically said what you said, just not in a nicer way. They were like, you know, having an HIV diagnosis and being undetectable doesn't mean you can't work. So I've literally heard that before. Like I say, it wasn't as nice as you said it. It was in another facet, but you can imagine who I'm talking to. And then the other question is, are you guys going to be doing the SWV checks or is this going through DES? Because I know I was on one call with another state and they were using their unemployment rate. Bureau's software since the unemployment checks has all the pings in the background to check income and things like that.

Yeah, we'll be working alongside DES to have them, you know, do their piece of it. And we'll be more focused on kind of the health side of things. But yeah, it's a partnership to handle all the pieces.

Because I think that'll help Eric and I as we strategize moving forward with how DES checks eligibility and checks income and You know, kind of to Jason's point about our gig workers and our folks that work, you know, under the table, what they would now have to show is income or how we're going to have to navigate these waters that, you know, Eric and Jason both are spot on. I appreciate your transparency. You know, at least you told us where we stand. So that's, I'm glad.

Yeah.

That's it for me. Thanks.

Sure thing.

Is there any more questions for Dr. Ramon?

Dr. Ramon, I'd like to say thank you for being here and bringing that information to the council. It's important and I'm really grateful you're here as part of the council to share with us and inform us on all the different changes.

Thank you for those words. Yeah, no, I'm I'm happy to be able to update you all. And I think it's important that there is that this doesn't come as kind of a shock and surprise at the end hour. But it also, you know, there's, there's a large team of us on the internally, you know, discussing this on a daily weekly matter to try and figure out the, all the nitty gritty pieces of operationalizing this. And now with the kind of last minute changes that are put upon us, you know, how do we make that work, you know, and make it function and, you know, do it in such a way that it meets the requirements, but also, also it takes care of our members, how we believe they should be taken care of. So.

I appreciate your time and update and thank you again.

Happy to hear you.

So, at this time, we'll move on to Ryan might part be representative Jimmy Gordon Jimmy borders. Excuse me. Does Parker, do you have any updates?

I'll just, Deb didn't leave me any. She's on vacation, much deserved vacation. And then from the ADAPT side, we've got three important meetings coming up in July. Now, in addition to what Dr. Robin just clarified, we set up the negotiation table the week of the 20th with Gilead, Merck, and Veve, negotiating sub-342 pricing for our uninsured. So this will definitely be critical given what we just learned, because that's the pricing that we buy drugs for our un- and underinsured folks through our contract pharmacy app. We wrap up the HIV viral load suppression work group that we've paired up with Access over the past few years. The last week of July in Salt Lake City, the folks at Access and us got together, and we've been able to come up with some Viral load suppression rates for access patients and some really good partnership opportunities there presented themselves where we were able to educate access folks on what Ryan White is and how it helps our clients get services such as dental and housing and all that great stuff that helps their overall health care. And then the last meeting, I'm sure a bunch of you guys will be there too, will be the Ryan White National Conference in D.C. the week of August the 3rd. Be ready for a lot of humidity and mosquitoes and probably thunderstorms because that's the East Coast in August. So if you're going, I will see you all there.

That's it from us. Thanks. Thank you, Jimmy. Is there any questions for Jimmy? Awesome.

Moving on, we will now move into updates from Ryan White, Part C and Part D representatives, Jason Val Cruz and Taylor Kirkman. Are there any updates that you would like to share with us today?

No updates to share today. Thank you. Thank you, Jason.

So, we can move on to item line item number 12, training, education and membership team committee update. Randall furlough, would you like to provide a update on the teams committee?

Sure, I facilitated the last meeting, so I'll go ahead and report the notes from that meeting. um we talked about at that time that there was an opening for chair and vice chair of that committee as michael said earlier he has appointed tanika drake as chair of the committee there's still an opening for vice chair if there's anyone that's interested they can talk to michael or gwen and they can talk you through that Everybody in the subcommittees is supposed to be working on their policies and procedures right now. Team committee reviewed theirs, made some edits, made it through completely, voted on it. And then we found out later in the day that there was a factor that we needed to look at. So at the next team committee meeting, The thing that needs to be looked at is got to do with attendance policies. And all three subcommittees will be looking at that for a standardized attendance policy for subcommittees. So we currently do not have any applications to review. And the next team committee meeting is Tuesday, July 28th. at 10 a.m. If anyone's interested, please attend that meeting. They're always looking for members. And I'm complete.

Awesome. Thank you, Randall, for the update. And again, thank you for filling in as I was on vacation. I really appreciate your help in stepping up. Next, we'll move on to item number 13, Community Health and Planning Strategies, CHIPS Committee. Eva will provide updates for the work on the CHIPS Committee. Eva, do you have any updates?

Hi, yes, just two. It's pretty brief. At our next meeting, we're going to be continuing preparations for our PSRA, and we will also be updating our committee policies and procedures. So if you guys want to participate in those are listening on the discussion. Our meeting on the 28th is going to be at 12 o'clock and that's it.

Awesome, thank you Eva. Next we'll move on to item number 14, the standards and rules start committee update and Erica alternate over to you.

Thank you Michael. So we do have an item to review today that is then. We'll be up for a vote in standards. We work on updating all the standards and so our current one that we just finished is health insurance premium cost sharing assistance services. Just as a reminder, this category has two kind of distinct sets of services. One is truly the HPSCA of paying health insurance premiums and cost sharing, which is medical deductible copay coinsurance costs for clients. So that's one part of this service. The second part of the service is the dental insurance premium assistance program known as McDip in which Ryan White pays for dental insurance for our clients. So the standards are broken up a little based on those different service categories. So if we can continue scrolling, these are the basic definitions, program guidance from HRSA. We can keep going. Intake and eligibility is the standard intake and eligibility language. Here, the program outcomes for both the premium and cost-sharing assistance and dental insurance are about retention and care as We want with everything we do in Ryan White is helping clients stay in care and ultimately also become virally suppressed. So we're looking at 90% goal for both of those. Next page, please. So here, start the actual standards. And even within the traditional HPSCA, we have them broken out between premium and cost sharing because they are run a little bit differently and have some different standards and things to consider. So first, when talking about health insurance premiums, we're looking at the adequacy of the insurance. We want to make sure that the insurance that is being paid for is going to be comprehensive for the needs of our clients. So 90% of requests have proof that it is comprehensive primary care and that all HIV medications are covered. Again, then next, a cost benefit analysis to see that it also makes financial sense to pay a premium for insurance versus other options that might make more sense for someone and be financially more affordable for Ryan White. And then finally, processing time frame. This is a very time sensitive service because premiums have to be paid in a timely manner. And so that the premium payment will be processed within 10 business days of a complete application. And then all the goals for all of these are 90%. Any questions about that? OK, next we'll move on if you can scroll down just a little further for cost sharing assistance. So as I said previously, this is the financial assistance for deductibles, copays, coinsurance for individuals who have insurance. So some standards here are that cost sharing assistance is for HIV related care, and so that documentation has to be provided. Additionally, documentation requirements are that we have the provider invoice and we also have an explanation of benefits available so that those two items can be reconciled to make sure we're paying for the correct amount of the bill. And then finally, processing timeframe here is much longer in terms of 60 business days, because this is really financial assistance after the fact, after a client has received the service, it's assistance to help pay a bill. And so there's not that urgency of paying it because it's not something that's paid ahead of time. And for again, all of these things, 90 is the goal any questions there okay if not we'll move on then to the final one which is the dental insurance administration and so really here what we have to remember is uh we're not setting standards on clients getting dental care or how good is the actual dental insurance. What Ryan White is in charge of here is really administering the program, signing people up and paying for the premium. So the first is the referral timeline. So as with all Ryan White services and referrals, that request should be processed within five business days. And so we want 95% there of those referrals attended to in a timely manner. And then the second goal here is actually kind of on hold right now because we're not doing predeterminations for additional funds. But if we have the opportunity to do that in the future, if funding changes, this is about dental insurance predetermination. will be made within 10 business days of receipt of a completed request. And again, we want to be prompt in this because often these predeterminations for additional funds are about kind of a large and often, I don't want to say necessarily urgent, but important big dental needs that need to be met and usually need to be done in a timely manner. So 80% of those fund requests will have documentation of predetermination completed within 10 business days. Any questions about the Dental Insurance Administration Standards? Okay, next are all really very standard personnel qualifications that are specific for this standard are listed. Assessment really applies to the cost benefit for HIPAA, for HIP and dental insurance. There aren't service plans, so the rest is then all the standard language for all of our services. So you can scroll through those and on the next page. Again, all standard language. And that is the end. Any questions overall about the standard?

Okay.

Well, if there are no questions, then I would look for a motion to approve the HPSCA service standards.

Stacy J.

Thank you, Stacy J., for the motion to approve the standards. Do I have a second?

I have Benjamin's second.

Okay. Thank you, Benjamin, for the second. Any discussion?

Okay, hearing none, can we have a vote Gwen? Randall Furrow?

Yes.

Eva Galindo? Yes. Eric Eason?

Yes.

Alan Barnes?

Yes.

Erica Teacamp? Yes. Anthony Holscher? Yes. Bradley Reese?

Yes.

Brian Hagenbart?

Yes.

Celeste Amaya. Yes. Karen Rahman.

Yes.

Emily Holling. Yes. Jason Val Cruz.

Yes.

Taylor Kirkman. Yes. Jimmy Borders.

Yes.

Eduardo Marrera.

Yes.

Grace Ashu. Yes. Benjamin Pearson?

Yes.

Stacy J. Cavalier?

Yes.

Motion carries.

Thank you Gwen and thank you Erica and all the members of the Standards and Rules Committee, all your hard work and going through all these. I know it takes some time and commitment and I've been there for committees, committee meetings and all your your dedication to the council, so thank you. Next, we'll move on to review of the result parking lot items. There are no parking lot items, so we can move on to agenda item number 16, and that would be to a determination of agenda items for next meeting. Let's go ahead and pull up the PCAP documentation to share with the council to review what we'll be covering at our next meeting. Thank you, Gwendolyn. On the PCAP for our next meeting in August, we have basic reports at the top. Part A expenditures, updates from partners, committee reports. looks like the the major thing standing out here is the psra priority setting session for grant year uh resolve allocation set session and uh um it's on the ae the ae am is on here again when i don't know if we're going to be doing that again or not no that would just be on there in case like we were delayed in getting the data back but since he presented that it doesn't have to go on again awesome So the next item on our agenda is line item number 17, 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.

Is there any current event summaries?

Seeing none, we can move on to line item number 18, call to the public. This is the time for the public comment. Members of the committee cannot propose, discuss, deliberate, or take legal action on any matter voiced during this time. The planning council can request part A office to follow up after the meeting on a matter discussed at this time. Is there anything from the public

from the public for our meeting today. Seeing none, we will move on to the adjourning of the meeting.

I announced the meeting adjourned at 3 or 4.03 PM. And thank you. And the next planning council will be August 26th 12 p.m. for PSRA day one. So thank you, everybody, for your time today. And feedback.

Thank you, everyone. Thank you.

Have a great day, everybody.

Awesome. Thank you, everyone.

Bye, Michael. Thank you. Bye. Thank you. Bye, everyone. Have a great day.