Housing Works: Housing Prevents AIDS. Housing Improves Health.

In a sharp blow to Department of Health Commissioner Tom Frieden’s anti-community agenda, the New York City Ryan White Planning Council voted overwhelmingly Thursday afternoon for a resolution demanding that the DOH withdraw a case-management proposal with unfair eligibility requirements. The structure of the proposal makes it nearly impossible for community-based organizations to compete for $24 million, or one quarter, of all the city’s Ryan White funding.

“The devils are in the details and in this case they were certainly devils,” said Matt Lesieur, the planning council member who proposed the resolution, which passed 19-2, with 10 members abstaining. The planning council members who didn’t vote in favor of the resolution were government and hospital officials. The resolution declared, among other things, that “The New York City Department of Health and Mental Hygiene deliberately withheld key components of this service model when it brought forth its ‘care coordination’ model to the Council in 2008 for approval.”

The proposal in question is the Ryan White Coordination of Care Proposal, a DOH initiative intended to reach approximately 4,000 New York City residents living with AIDS who are not accessing AIDS care and services. Advocates raised concerns back in July before the request for proposal (RFPs) was instituted, stating that the program would duplicate services provided by COBRA case management and would favor large hospitals over community-based organizations.

“I urge Planning Council members, who not only represent their organizations, but also the New York AIDS community, to carefully consider the programmatic and financial implications of adopting a significant paradigm shift in how case management services will be delivered and to exercise their vote honestly, carefully and with integrity,” Housing Works Vice President of Advocacy and Organizing terri smith-caronia said at the July meeting, according to the minutes.

But the Council voted heavily in favor of the proposal then,with 22 in favor and two abstaining. But after the proposal was released, many members were outraged by the requirement that agencies to have a caseload of at least 500. However, making it even more difficult for CBOs, the RFP stipulates these numbers could not include Adult Day Healthcare or COBRA case management clients. This requirement prohibited even the largest CBOs from applying without partnering with a medical facility.

Community outrage

Yesterday’s resolution came after an impassioned comment period from speakers, a “who’s who” of HIV community organization bigwigs, with reps from Harlem United, Housing Works Village Care, Gay Men’s Health Crisis and Bailey House among those voicing opposition. More than 75 people attended the packed meetings.

“I have never believed the rhetoric that the New York City Department of Health systematically redirects funds away from community-based organizations,” said Harlem United President and CEO Patrick McGovern. “However, this formula belies these claims. I urge you to rescind this RFP.”

GMHC President and CEO Dr. Marjorie Hill said that she worried that people with AIDS in the city would be most affected by the proposal, because it limits the choices of where they can receive case management. “I’m not about GMHC or Harlem United or Housing Works. It’s about people living with AIDS in New York City,” Hill said.

No one questioned the inherent worth of the proposal.. “I know it’s a good plan because it’s a copy of COBRA,” said Kenneth Stewart, director of community case management for Village Care of New York.

After the resolution passed, smith-caronia said, regarding the Planning Council’s original decision, “I wouldn’t say it was a breakdown of process but a breakdown of trust. I want to applaud the Planning Council for finally having some cojones.”

What happens next

It is unclear how much impact the Council’s resolution will be able to have. The RFP has already been filed, and hospitals and organizations, including many that spoke out against the proposal, have already applied. However there is a precedent of New York City agencies withdrawing RFPs after hearing community outcry. The Planning Council resolution will also carry weight if community-based organizations decide to file a lawsuit against the city.

At the Planning Council Meeting, Dr. Monica Sweeney, assistant commissioner for the DOH’s Bureau of HIV/AIDS, said she wasn’t able to comment about the RFP. “We’re in the middle of a process. The question and answer time has passed,” Sweeney said.

But in a statement to the Update, the DOH disputed the resolution’s claims:

“Community-based groups are afforded equal opportunity to apply for services under this contract. In fact, the primary objective of this initiative is to promote effective collaboration between care coordinators in the community and medical providers for people living with HIV/AIDS in New York City. This request-for-proposals seeks to leverage more than two decades of CBO experience in case-managing the care of people living with HIV/AIDS. The eligibility rules provide two separate ways for CBOs to apply (outlined in the RFP and supplementary documents): either as a lead agency for one or more partner medical practices; or as the sub-contractor to a medical facility.”

The DOH now has to decide if it will listen to the community input. The DOH, under the direction of Frieden, is increasingly trying to run the show at the planning council. See the Update‘s Frieden Power Grab Averted for more on that.

See the entire resolution vote on by the Planning Council below:

HIV Planning Council Resolution
March 19, 2009

The HIV Health and Human Services Planning Council of New York declares that:
• the recently released Ryan White Part A “Care Coordination” RFP is seriously flawed and far too rigid in its scope of services and staffing patterns,
• Is grossly skewed towards funding for large medical institutions (as demonstrated by a worksheet/formula that biases against community-based systems of care such as COBRA case management and AIDS Day services),
• By redirecting 25% of the Ryan White portfolio towards large medical institutions, it eliminates PLWHAs choice in where they receive their coordinated delivery of care,
• Is inconsistent with the intention of the Council when it approved the “care coordination” service model in 2008, and
• The New York City Department of Health and Mental Hygiene deliberately withheld key components of this service model when it brought forth its “care coordination” model to the Council in 2008 for approval.

Furthermore, in a resolution passed by the Council on July 24, 2009, in relation to the new Care Coordination model, the Council approved the following:

“All providers, up to and including, hospitals, CBOs, clinics, health centers and consortia who have demonstrated the ability to provide the scope of services will be eligible to apply”

The Council declares that such language was disregarded in the RFP and that both the spirit and intent of providing guidance on the Care Coordination model was not followed and disregarded by the grantee, in violation of the Ryan White HIV/AIDS Treatment Modernization Act.

As such, the Council demands that the grantee recall this RFP and not award any contracts based on the “Care Coordination” service model as described in the RFP.