DOH vs. Ryan White Planning Council : The Saga Continues
Sweeney’s case management proposal is no beauty contest winner
The ongoing battle between the New York City Department of Health and the Ryan White Planning Council keeps heating up. Last week, the DOH refused to recognize the Council’s rejection of the DOH’s misguided plan to use Ryan White funds to expand access to care for 4,000 New Yorkers living with HIV/AIDS.
The DOH told the Ryan White Planning Council last Thursday that the Council’s resolution “demanding the Department of Health withdraw a case management proposal oversteps the Council’s authority. The letter, signed by Assistant Commissioner of the Bureau of HIV Prevention and Control Monica Sweeney, said that the DOH considers the resolution to be “without effect.”
Although the Council approved the DOH’s “Coordination of Care” plan last July, members were appalled when the actual details of the proposal were revealed this year. The proposal dramatically favored large hospitals over community-based organizations.
The resolution in question, adopted by the full Council by a vote of 19-2 on March 19, demanded that the DOH withdraw the Coordination of Care proposal because “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” and because the Request for Proposals is “grossly skewed towards funding for large medical institutions.”
The DOH’s unwillingness to compromise leaves the fate of a $24 million proposal unknown.
“We’re in a gray area and it’s completely unclear what’s going to happen next,” said Matt Lesieur, the Planning Council member who introduced the original resolution. Lesieur said possible next steps might include filing a formal grievance against the DOH or asking the Human Resources Service Administration (HRSA), which distributes Ryan White funds, to intervene.
The Ryan White Coordination of Care Proposal is a DOH initiative intended to use Ryan White funds to reach approximately 4,000 New York City residents living with HIV/AIDS who are not linked with AIDS treatment and services. The Planning Council voted overwhelmingly on the proposal in July based on the DOH’s initial summary of the proposal presented to them. But when the full RFP was written, the details were troubling to many Planning Council members.
Many members were outraged by the requirement that in order to be eligible to submit an RFP, agencies must have a caseload of at least 500 patients. And, making it even more difficult for community-based organizations, the RFP stipulates that these numbers could not include Adult Day Healthcare or COBRA case management clients. This requirement prohibited even the largest community-based organizations from applying without partnering with a medical facility and would completely cut out smaller organizations that serve targeted populations.
“The DOH said the RFP is basically the same thing the Council agreed to with more meat on the bones. But the DOH created something with 10 fingers on each hand,” said Housing Works Vice President of New York Advocacy and Organizing terri smith-caronia. “That’s the stalemate they’re in.”
And one of those fingers is a middle finger towards providers that serve targeted populations.
“The RFP doesn’t seem to give allowance to special populations or agencies that serve them. In our case the homeless are cut out, even though research has shown that is where the epidemic is taking off,” said Care for the Homeless Executive Director Bobby Watts. Watts was told by Public Health Solutions that his agency didn’t qualify to apply.
Conflict of interest?
At a meeting of the Ryan White Planning Council Rules and Membership committee earlier this month, some questioned whether voting for the latest Council resolution was a conflict of interest for Planning Council members. Members are supposed to abstain from voting if they have a conflict of interest. Rules and Membership members questioned whether people belonging to agencies and hospitals that already submitted funding requests for this pot of money should have been allowed to vote. The Rules and Membership committee decided that the bylaws of the Planning Council about conflict of interest were too vague and need to be clarified for future instances.
The role of New York City’s Planning Council has swung back and forth over the years. The Planning Council used to play a much more involved role in giving guidance to DOH in how to administer funds. But during a 2003 HRSA site visit, the feds said that the Council gave too much guidance to the DOH.
Under the tenure of Health Commissioner Tom Frieden, the DOH has had a heavy hand in the Planning Council, even trying last year to add extra voting governmental representatives.
The prominent role of the DOH on the Planning Council differs from other large cities. In San Francisco, for instance, no members of government sit on the Planning Council and the administrative work, which in New York is done by DOH employees, is contracted out to community-based organizations based on a competitive bidding process.
Posted on April 16, 2009 at 10:59 pm
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