and given the mayor's augmentation included temporary initiatives. >> thank you. any discussion? >> i have a question. so can you define permanent? >> those are typically the flex pool subsidies that is what we call them, but they are basically a local section 8, so they-you pay 30 percent of your income and get supportive service but run in the private market and if you income goes above-you only get the subsidy while eligible, so if you--permanent, meaning it is- >> [multiple speakers] >> hard and fast deadline i mean hard and fast end time. >> any other discussion? >> so, let's say the family moves into

a subsidy under one financial bracket but through the year they elevate? >> they lose the subsidy. the subsidy decreases as income goes up. it works just like section 8. if your income goes up high enough you are off the subsidy and that can geto another family. >> there eligibility. it is 30 percent of income so if income goes up they pay a higher portion of theerant based on 30 percent of income. >> they can still stay? >> they can stay until they reach whatever the maximum income amount is that make them no longer eligible for the program. >> because they have tenant rights and they stay in the private market unit. change in family household is commonism maybe you are married and income doubles. >> any other comments or

questions? can we proceed with a vote, please? >> member friedenbach, yes. member haddix, yes. member jackson, yes. member preston, yes. member walton, yes. motion pass. >> motion passes. thank you. we got two minutes or no minutes, so what i like to say we have a critical issue that was behind jennifer's first motion that didn't pass and that is that we put that on as a future topic to learn more about the heart program. it sounds like both issues have training, who is involved in the program, where the referrals go beyond that, because it is mentioned as part of the continuum so we understand that. any statistics that can be shared with committee and public that others look at and so forth. that is one item. is there any other things that

people want to see on future agend as? >> i just wanted to add to that vote since i did vote yes for it. i really feel like the department, if they are coming to talk about a program that is in their department, i think that you need to be able--there should be a better sell. that's all. i just feel like that you need to be able to say why it is included in your budget. i had a really hard time seeing the connection with behavioral health and knowing how terribly unfunded behavioral health has been in the state, that is why i could not support doing that at this time, because the information i was given i saw no connection with behavioral health. >> i will say, we did have a

presentation first about program and about budget, but somehow obviously questions crossed over over the last number of meetings. any other future agenda items? >> i like to back up what you guys said. i just need more information. so i can look at boket both sides of the conversation. >> to that end, i took the role of data officer and just now picking up on it. we will be looking at how we want to structure our annual reports and then come december 2025, we are due to have the next publish the next assessment of the overview which is every 3 year project so we'll look to that going forward. >> i just wanted to remind member preston the point that you raised but this program lives in department of emergency management and they are not here today, so just flagging that for everybody that is here. >> i get it.

>> but we would like to probably get them in here to question and move forward. i are agree there is urgency because of where the budget process is, but i also know this committee has the ability to raise concerns, including what we might learn from the city attorney to adjust things even after general budget decisions are made, but it is harder, but i think we should take that attitude going forward, because these have been great questions today. do i have a motion to adjourn? >> i will make a motion to adjourn. >> second. >> preston and seconded by haddix. all in favor? >> aye. [multiple speakers] >> thank you all. >> friedenbach, yes. haddix, yes. jackson, yes.

walton, yes. >> thank you for your patience and attendance today. thank you to new members and existing members. i'm very excited as we move forward. thank you. [meeting adjourned] choose one important one of the gain sharing agreement as medicare plans increasing are willing to share that is where the plan performs better than expected return to the plan sponsor don't have a game in plan we want to engage sharing in 25 and the performance are

prevalent the kaktsdz mike clarke, aon and its teamwork with providers and requested two percent for performance ghettos and the audit credits so scoring the responses on each of the items made up the non- premium financial elements. >> mike i'm sorry sorry to ask a question. and two percent fees at risk can i elaborate on that category i'm not sure what that means. >> sure basically looking at member service xoengsz expectation and mental health access. you know, you can see some of the elements transparent requirements so the idea here to create standards that the

carriers will deliver for members and services hss. with up to 2 percent of premiums deducted if a particular cargo didn't meet on any of the performance guarantees 1962 something that cfo is reporting on, on the monthly updates any performance guarantees are paid back and also vendors for families to meet a particular requirement operational requirements or administrative requirements and member services expectation and demand time calls thaipz many categories we set an overall expectation a cargo will put in two percent. >> can i ask another question

about the caveats they include new drugs and an article today about within drug the medicare i think explained one hundred times more and last year 2018 i'm assuming that includes each kinds of changes but the new drugs and deduction act with medicare starts bargaining that fits into the 2015 sharing or is caveat sew it fits into the caveat the ideas we're seeking through three rfp to get multi arrangements from the carriers on standards and again, we doesn't make that a major part of scoring but reflect when we of the a carrier through preset standards so based on things

we're set up in advance of scoring brick had last thing that we thought would give them more ability to change a standard to change an approach or premium what have you and in the out years of award to looking psta 2024 and 6 and beyond not an concerts otherwise to adhere to baselines their responses to the rfp. >> a follow-up. >> this is a fully insured plan. so i guess a lot of the savings asks sooner has to do with with 26 and 27 i guess the question in the recommendation can we that board expect that the proposed rate for 26 of from the recommendation - the vendors that guess recommend we see

that. or a chance small chance or a big change we won't see that and the fact a difference, you know, contract. for 26. >> to me a caveat. >> we'll say hypothetically the population were to reduce by half for example, an extreme change that, you know, can trigger i assure you, your actuary i partner with executive team i'm in the negotiations with the veterans to hold them to what they previously oriented that's part of my roll, you know, a k34r5i678 a small trigger will reset the market-rate ms. what you called it. >> i guess the concern of this board the rates are good for

three years the achilles heels in the contracts that might come back to the boards in their future deliberations in 2025 in and i kills he'll with the vendors that is recommended. >> yeah. for me so my assurance as the actuary to make sure what is quoted i think what and also recognition this is is an organization recommended that i have partnered with for many years on the active ploy and early retiree population three 4 though covered lives a huge relationship was that organization blue shield of california that they would not want to see comprised by out of

the blue technicality they try to change had we quoted for 26 or 27 that's my feel. >> i have a quick question with they caps they're implemented and saving of $67 million but no caps savings will be? >> so i'll go back and say the savings are $67 million. so that presumes the rate caps would apply the retails were 26 and back to page if we look at the unitedhealthcare 2024 the parts ab the 64 for part b on the quoted rfp rates for 2030 that will apply for there what we're showing are premiums under the

unitedhealthcare for 26 and 27 as if the not to speed premium caps apply if is it possible unitedhealthcare can come back and say um, we don't need the 6 hundred plus now the analysis of spring of 2025 what was quoted the in an amount not-to-exceed quoted cappa. >> can we come back for more. >> no, what wearing showing as much the rates could be for unitedhealthcare for both 26 and 27. >> just to be clear, we expect the recommendations for the blue shield of california and there

is no bidding in 26 and 27 for i was or anthem or anyone else we expect the three year contract and. >> we'll still through the annualy until your vision plan has been under a 5-year rate agreement we negotiated. at the start of 2023 if i remember right but a renewal process to make sure the next year rates are confirmed but commonly have engaged in multiple year rate agreements with carriers to make sure we know what is protected in to support the budgeting processes to um, minimize risk to the sort of things if we can lock in a multi agreement this is the key importance to lock in

rates. >> okay. i'll moved to the non-financial elements on page 28 and in detail list out the high-level non-financial areas for scoring. and i'll go through plan designs physicals in the network and mike will accompany and talk through the questionnaire and all with the umbrella recognizing the goals at experience on the non-financial elements. so the key components we said that before passed is ppo the whole idea is planned design for the retiree and the constituents for the flexibility providers as well out of network providers a requirement forbid and little plan design is closely as potential replicates the supplemental we're going to talk

about the elements across that and procedure network match again, this is on a national basis for the network pharmacies and 14 percent of covered lives in the unitedhealthcare and ppo plan live outside of california and people may not recreation that an important component to all the network evaluation because a lot of members that live outside of california we're looking at this on a national basis. the physical people don't want to have to have co-changes in our prescription drugs we'll talk about talk about the work and the km s and the thinking how we set up the scoring and what we observed from the bidders so for plan design on page thirty if you add that the number 88 design

elements and four reply indication certainly expected you're encommunity will offer those the rfp was other respondents. do they match all the elements for medical benefit elements? like debe deductibles and co-payments but elements for the planned dined covered from the standpoint the retail and the supplemental benefits add several years and in the ppo plan like, you know, meals, did i chartered meals the transportation benefits post discharge as well as not you are talking about transportation for confirming appointments the coaching benefits and all of those were scored as part of this process to make sure they can be replicated. if a star

rating standpoint calls medicare and meds that is is cms have an exhaust process to look at 40 measures of performance for the medicare plans costs cargos like providers satisfaction and member services and members satisfaction and screening rates, you know, our members getting their cancer screening and sfofbt so for the cms a circle starts with the data collection in the first year km s issues their star rating point the oversee ever bonus payments into the plans and certainly the

more the payments the last it is cascaded to the planned sponsors like - hss those scores california change every year and more fluid in my prior years and have been in the last couple of years and recent past so the scoring set the high bar on the star ratings 5 point available to the star rating and the reason why points are awarded 4 maximum 5 because that's where that bonus payments begin but the recognition a planned again out of 5 stars is still and above average rating. you know, we've kind of looked at the ranges from the stand point and so if didn't get points in the blue brick we set a high bar to

set points starting with a bonus payment of 4 stars but blue shield when they look at the and score relative to medicare still rates in above average star rating. from a network page three three i mean clearly the ability for people to maintain in their patient providers is critical. so that's the pass ppo approach and how we access this we looked at 22 what he 2 three explains hss to understand the backpack impact and page 34 the y idea with mecca particular procedure allows themselves to see medicare patient will be covered providers in those

medicare ppo plans now certainly incentive for someone willing to accept and lower reimbursement rate to have a more prominent placement of in their fact they're contractor procedure on a carriers website bottom line if i'm a procedure and accept medicare, i can go see them and covered rarely of whether i'm a contractor procedure or not and as you can see on the considerations especially in the middle of page non-contractor providers that accept those members they soap medicare receive the same time reimbursement that they would receive if a member was covered by ab traditional or original medicare the contractor providers get a rate with the plan and must abide by that negotiated agreement to when we looked at the procedure disruption it really not the same we think about in a traditional sense at the end of

the day, in what procedure soaps medicare not accepting medicare in the ppo of unitedhealthcare of anthem or blue shield of california. so when he did the analysis on page 35 at the time we collect occupying all the data in the bidders and asked them to tell us based on the utilization whether a procedure being seen was a contractors procedure in neither network know non-contractor but a history of accepting medicare within the 12 months or non-contracted and doesn't have that history of sole purpose medicare in the last 12 months and again, a procedure typically acceptance medicare will accept - will be non-contracted but accepting under the traditional medicare. so on page 36 our original scoring.

>> wait a minute when you say they'll accept traditional medicare or non-medicare did that mean they're accepting the rates as stated for the reimbursement? they're not saying we want more we expect more and going to get more. >> >> (multiple voices.) >> and correct. >> and they have to - they're going to accept medicare or non-traditional medicare have to accept this state of the reimbursement and exactly they'll accept the same reimbursement rate if i recall walking in a part ab up and coming for medicare. >> okay. thank you. i predator that clarification. >> thank you. >> can i clarify the answer to that question. my understanding - the providers here may refer to individual providers, you know, the doctors and they're used to sing but may actually refer to the medical group they

belong to not contracting with individuals so some of the providers maybe medical group providers and some not from the individual stand point will not accept medicare and they will get a certain low rate they can feel the difference so to their patients they don't accept medicare and get a low payment they tell their patients that, you know, i will take $30 on the one hundred for medicare by our responsible for the 70 if 2023 soap medicare can't bill the difference if they don't accept mecca bill the difference that's my understanding. >> i agree with you and the important distinction whether i as a member of a physician group or a practice h sole

practitioner that is my relationship to accept medicare patients or not to not different depending on blue shield the ultimate payer but i agree with you. >> so some members ended up paying and significant amount of the money for access to a certain providers and that is happening today under the current plan. >> it based on that providers decision to accept medicare or not and or not. >> okay. so if they don't accept medicare they can bill that difference they can - where that their member our member pay a lot more for that same service i for the procedure that didn't

soap medicare. >> but that's try 2024 and effect and true in 2025 that is independent. >> do our members understand and know that that's the question i have. >> they know they're going to pay a lot more to go to procedure f versus procedure b or he procedure g? or they told that in advance how do they that find that out you look like you're ready to answer. >> i think no problem today but can occur. >> the situation has been going on for years. >> right and no legislation nationally for some of this but a challenge for the industry.

and you often see headlines of physicians lobbying in washington and increases in neither reimbursement for medicare. >> (multiple voices). >> right and so that's an ongoing issue that is for separate and related to um, the item before you today. >> thanks. >> we don't know we have any specific problems within our system or haven't heard from member that - >> i've not been made aware of anything and i believe a rearview mirror has to advise a medicare and hey i don't accept medicare you're responsible for my fees whether you pay 100 percent or whether you, you know, have the courtesy that's similar like the dentist decides

didn't accept delta detrimental but getting that reimbursement but hold the patient responsible for the diverse 6 charge and same with the con they don't accept any insurance. >> that's a different kind of program have the money up front and- >> (multiple voices). >> my point every member should understand this on afghan individual base the carrier has no. >> can make choices that's their decision i think that most of our retirees are being certainly, you know, focused on finding providers that accept medicare for starters, you know, $100 fees from islamic and

regardless of what the price of that uhc that is important they accept the coverage that is offered and -- excuse-me. so the rfp we received all the information that did the analysis and scoring what we discovered for the blue shield they're a contract percent was the same as contractors plus, you know, non-contracted but has a history of seeing medicare patients so after the post analysis, you know, we went back to blue shield to say are you sure those are not contracts are truly not seeing medicare that is their responsibility to - none the scoring was impacted just, you know, die to the

reich's concerns about, you know, making sure we did the network analysis and substantially heard from blue shield up to 94 percent are contracted or non-contractors with the history of seeing medicare i can't take for a physician seeing medicare and accepting medicare under the plan so by to explain the disruption resulted and then the next couple of pages touch on. >> commissioner. >> just to be clear, on slides 36 the column on 2023 was guess initial report of each of the - three applicants. >> correct. >> and so the evaluation committee went back to them each to look to see the fact you're initial analysis is correct and only blue shield of california changed their evaluation to

reflect our initiate survey was incorrect and now up to 90 and so first of all, unitedhealthcare was at the 100 percent had that scores the 2023. so after the scoring was complete after the analysis was done and after the may 3rd or was the posted on may 3rd okay. we went back to blue shield just to say. okay. you know, by then that was publishing released the recommendation we wanted to go back to blue shield because there are rfp responses so if we can back to page 35 what they said was in they're reporting they don't capture this is if a procedure is but no history of

accepting medicare or not their they're their systems, you know, kind of capturing if someone is contracted or not and so we challenged them to go back and say. okay. you know, you have to show when you're paying that claim is that procedure accepting medicare or not so we asked them to basically row look that incremental 18 percent of dollars to see, you know, were those dollars being occurred with non-kr5shg9d appears that don't accept medicare so and again, i can't say has 2 to 3 bearing on the scoring and that was after the results on may 3rdrd. it was really to go back and just say if blue shield

is the recommendation obviously a expectation that a member seeing a procedure who acceptance medicare today and continue to see that procedure and accept medicare tomorrow. so, you know, what we stressed with blshdz you got to demonstrate the digital that providers has recently accepted medicare, you know, for us to feel confident that there is minimal sdumgsz to the members going forward. >> i'm sorry hang on the good news because our process was so detailed no other purchaser of blshdz of california, you know, you know, medical anyway plan i asked those questions that was a question to blue shield no one concerned we're concerned we

asked so talk to blue shield and go back and request presumably. >> (multiple voices). >> correct. >> so just to attribute to the thoroughness of our possess we went back but clarifying the point system was fine before blue shield went back and clarified. >> exactly. >> this whole post announcement has no bearing whatsoever on the scott weiner that mike clarke, aon shared previously and yeah. to go there them quickly the next slide the members use diode contract cp non-contracted but the history of - have three thousand claims over the last year and over 95 hundred total providers all the top ones here in san francisco and is bayview are cracked and pharmacy work on

this make sure that the members can access pharmacies 64 thousand of them nationwide sf members use 76, 36 and only 36 of those primarily really small dependant were afforded not blue shield national network and this is less than out of 4 hundred scrips and in the network for both unitedhealthcare and blue shield we expect very, very minimal pharmacy network disruption and formula was the drugs that is available under the current plan that changes from fremont and changes over the course of time and - but certainly access to drugs is obviously, a concern and the goal to limit the negative tier

changes that means someone to pay a higher payment for an existing drug or slight disruption you can't get the drugs and hss process make sure the pills are available during the transition if we look at the data on page 42 last year ether 4 thoughts scrips dispensed by the ppo plan and, you know, the replication of those prescriptions is very high any first of all, from the tier changes startup 17 thousand scrips a member will pay more but 5200 scrips will pay less based on the unitedhealthcare formula and then for absolute only three hundred and three 2 of those seven hundred and 91

scrips will not be available under blue shield under the teller formula that was less than what is reported for the unitedhealthcare. so i'll transition to michael to talk about the questionnaire. >> before transition can i ask a question i'm sorry. >> those are excellent and detailed proposition my finding the premium response to the three, you know, plans that did respond finally was a - the difference between is blshdz of california and the oat two unexpected yet we looked at the procedure networks we look at the medical networks we look at want pharmacy disruptions we look forward the formula disruptions it seems quite

minimal frankly and all those slides so my question is what accounts for a difference in the premiums there? why can one vendor come in so low when on the surface looks like, you know, there are offering duplicate medical groups and medical setters and formula and pharmacies can we figured out why one payment is lower despite the slarlts and the fact we know that blshdz 19 of california not-for-profit and i was for property companies is all profits on their part blue shield of california or some other issue. >> i that's a great question. and unfair for me to speculate

how they derivative but i'll say though since somewhat of an unprecedented time in the medicare pricing phase for the actuaries of any organization underwriting those products of how recent federal legislation has transformed the basically the elements of what goes into the government funding of the products. so if you think about that, you know, for the non-medicare plan not medicare out there so the full costs full capacity of the rates for the medicare products the majority of the cost is actually funded by the federal government there the, you know, through the subsidy approach that kind of

replicates what they'll pay in the traditional formulas lots of differentials towards here's the funding that a 34ek will that get we talked about star rating benediction payments or things of that nature he e looking at their financial requirements to provide this coverage so we with the great history and making walk you through earlier we with all the change out there i talked about that last year during the m a ppo renewal so again, i sort of recognition speaker card to three new commissioners today but we went through the process of explaining the impact of inflation reduction act which is troovrm in the reaction i guess

to that and how it is impacting their projections of funding and receive from the federal government what premium they need to be on that to be planned sponsors one way of saying each organization is reacting to that information agency they are and i think that 23450i7 just, you know, nature opinion a contributor to the premium in the rfp it is not a cut-and-dried approach right now to federal funding into those programs. there's lots of assumptions and difference of opinion on the forecast of government funding influence the premium rates were submitted through the bidders. >> thank you that is helpful i

guess anxiety we have a fully plan rate for three years we're looking at for the achilles heels is holes that lie blue shield california to actually come back and say well never mind on the rate in 26 we certainly don't want, you know, appreciate all the work and historically all the contractors and no placements but our anxiety over the huge differential with no differential and the two applicants and the one service system the one is recommending. >> michael is going to cover the last slide. >> thank you. mike. >> so, yes as that question

and go back to the slide that showed caveats and the points deducted zero points if blue shield necessary didn't include caveats and let them get out of strong commitments that's what we be looking for we want to commit and again, mike clarke, aon we can't hypothesize but asked them go to i'm sorry to make and jump back to slide 43 we asked 66 questions in the questionnaire have discuses by the 6 member panel and those computed specific questions as o rating methodologies and approach to the inflation act and those showed additional confident confidence as blshdz who understand the and our population 34 actually members

so confidence in their methodologies and trantdz and their approach to the it inflation reduction act. >> i had a procedure question basically i say way i said the medicare on the front end no difference on the back end but in terms of approvals, you know, for different cares like someone needs an approval is there a difference, you know, like i have currently blue shield. with the medicare advantage in terms of approvals blue shield or unitedhealthcare making those approvals for the treatments as well or just medicare making the approvals? >> that's a great question. >> that is medicare no steer one of the things we required here the beginning of the process we wanted that same open

access. and that was paramount's right off the bat it was clear we're having the discussions last year and opened were to the do you remember on the 12 and posted in december no ambiguity there whatsoever we held the high bar more medicare high standards. >> that's a great question. >> very hard commissioner if i don't call you assert in my prior work thank you for that question. and again, if no more questions i can get to the next across the state in the interest of time 66 detailed additional questions and 12 meetings of our evaluation panel and the new aspects that really effect a member experience with any one of the three respondents and

what that experience is like and those questions are technical questions to make sure they're work well with us and understand the systems and progressing. and finally on i'll make a quick comment important rfp we have an oral process a live process we know you can have a lot of very, very talented people to write the proposal we want 18 will support in account management transitional account underwriters and actuaries we require them to come to a live interview and hit them with hard challenging questions to it do business with us and in the environment we know our plans will have to be standing he podium and answering questions to they will be with an actively managed partner that hss is. so we replicate that 90 on oral

interviews from the ranking on the screen own our incumbent scores 82 percent and get it delta drawing on the members and again, a challenging process and on purpose we want to make sure they bring the best in class and support for us is selected. so with that, i hand it back to mike clarke, aon. >> your explanation why the ranking was the way it was the issue about the hss members unitedhealthcare an advantage over blue shield and um, anthem and explained the bid on the premium rate you think that experience adversely again adversely effected blshdz of

california ability to really gives an accuracy premium rate given they couldn't address the questions orally as well according to our estimate. >> green that everyone of the 5 entities had to execute confident that agreements to get the actual population census data zoning administer's will makes evaluations and so mike. >> what you're saying they all had the same data and unitedhealthcare had experience both the other contractors had a leg up and it is- >> (multiple voices). >> is that what you're saying. >> we to set benchmark and will be an unavoidable advantage for an incumbent go ahead mike and to stress the information

provided for each bidders bidder is same the beauty everyone has the ability to take the same information and craft the responses they will. so by blue shield quoted the lowest premium rates in the rfp process. you know, all respondents had the same opportunities to quote what they of the they need to cover the overall expenses of this plan. >> yeah. i appreciate all that i guess i'm a little bit hung you think or up on the question fair with the very important to us as board members members needs a strategic plan and supports for hss. and you're saying they're able to draw above the data he provided he agreement gave them a leg up

with the member needs with the strategic planning goals and not outlined in the detail that the unitedhealthcare already had basis of their own experience. >> michael correct me, if i'm wrong this is collection of scoring 6 that panel members do their assessment what necessary observed in the oral interviews and producing scoring been is panel member observations so why think any of us can peak to what going do so on in the thinking of each of those panel members we're creating our perception of a comment on page 44. and i'm to make a point now and then try to repeat myself later we have we all understand how because of

the scoring this single issue around premiums set a high bar how any of the blue shield california presented in the response so a high bar in terms of how too narrow that dangerous weapon so those of us on the boards reviewing the detail see that the gap was narrowed and several other categories in the questionnaire and the narrowed in the interviews and other categories but not enough to complete will i gait the scoring one issue that was premiums both 25 and 26 and 27 we're trying to weigh all that i appreciate it's been transparent and appreciate the work and understand each

member of the board has to then sort of sing news that >> our objective to explain is elements asbestos as, you know, we potential, based on the rfp responses. >> if i could make one to me i don't see a huge differential in the oral pregnancies 81 and 71 you're in a ball park where the difference of organizations been here for seven years and up and coming is going to be far better permitted not just in terms of their ability to respond to an oral buff but know us and know what questions will come to us they know us around this program

so they can just - didn't surprise me at all a new contractor will score lower than a contractor been here for seven years. i think that while the financial aspects have been, you know, the higher scoring parts of the rfp and blue shield bend from that the fact they benefited unitedhealthcare is one of the largest healthcare providers in the country i don't know and they're for profit i don't know what their ceo and overhead costs no information about that, you know, at all really. but it is gigantic organization and managing so are their premiums higher because the elements of overhead and the

element of, you know, in addition to everything else in our structure produces the premiums they're required to recover and theirs a profit margin as well. i think that it was theirs to lose theirs to lose could have come in with a more competitive bid they didn't so i don't know we should be necessarily looking at the blue shield as somehow should have charged more not really we can't say one way or another as a matter of fact, but didn't submit and competitive bid period. and appreciate that and. >> you're directing our comments to me, i'm the with an that is i don't know other board members i want to say this was a rule set up valuing a number of

items and with a certain scale when you add you were the points you see that the gap that was here with premiums alone was not didn't narrow because didn't have as many points assigned to it not prioritized by industries not set out of the sky based on industry standards and lastly, say if i had two children came home with a math score one 81 and one at 71:00 think i'll think they are different i think i want to know why the child has a 71 and 81 doesn't seems like a big category but more than 10

percent difference as the staff indicated that was a 10 percent difference. >> i'd like to clarify not a committee to create this scoring the staff and consulting. that created this. >> staff for follow up. public comment is limited to a total of 15 minutes; however, an opportunity for. >> if have any say in establishment of by brick i misunderstood that it recent stashdz before the committee was put tonight the staff that stashdz that without putting it to the committee members drawing from, you know, is three segments. >> the committee didn't a score like the oral. >> i don't know to go to the wait cards so if this recommendation is approved today the cards will be part of that recommendation so, so as mentioned earlier the blue shield would take over with the

recommendation today, the administration of the ma ppo plan as well as the non- medicare covered life and family and page 47 a reminder that the we are talking about cards include the basic vision premiums from this and the charge you'll see those mixed medicare as part of the rate cards and as as reminders not available for canopy care those rate cards represent those ifville's with the full charter contributions and the bullets the criteria for that that retired medical coverage but in contribution to those retired employees hired on after january 10th, not with less 10 credits to service and the criteria for those receive 50 percent and 75 percent of the

charter contributions rates. so the we are talking about cards page 50 portion of this day should the recommendation be approved will be the rate card that will apply for the medicare members and the m aye a ppo plan and we have differential workplace 2024 and is contributions total cost rates versus 25 under blue shield construct with that, uniforms i'm going to turn it over to chief to reach the implementations and outreach strategy. >> good afternoon for the health service system upon approving by the staff recommendation hss staff will meltdown century with the blue

shield manager debbie to talk about the transition plan that will provide members with a transition to the blue shield and medicare ppo plan lickingly as mentioned will be made easier members will maintain their county procedure to participate in medicare and willing to accept the plan in addition to a continuity for any members in the treatments blue shield campus agreed to preload to receive the unitedhealthcare and for honoring procedure keys and providers in addition to assure medication blue shield has agreed to preload approvals for any members stacking appropriation drugs that require authorization and at the same time our contracts inspires finance division will be focusing on all the business tasks