>> >> good county of san francisco health commission meeting this afternoon at 4:00 pm., tuesday, july 16, 2024.) tuesday, july 16, 2024. secretary morewitz call the roll. >> commissioner chow present. >> and now will read the land acknowledgement. >> thank you. >> >> unceded ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the san francisco peninsula. responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory.

ramaytush ohlone community and by affirming their sovereign rights as first peoples. >> thank you. >> well, before we begin the formal agenda we're excited to have our new commissioner to join us and i wonder if i wouldn't tell you a few things about you we are thrilled you, you joined us. >> thank you, commissioner my name is commissioner giraudo appointed by mayor london breed

and lived in san francisco my entire life - thank you. >> um, i'm happy to join this commission i mentioned to the other commissioners, i grew up in san francisco without healthcare. >> and know what is it is to begin on the services we're providing for the aide residents and a small business owner i see day to day the challenges and a lot of businesses is trying to help their staff. and um, so i bring to the role my this knowledge sometimes, people don't understand what goes on behind the scenes to provide the services that the city and this way i can help my community with that knowledge and what is out there. so that's what i'm happy

to be here for and excited a reason people i met earlier today and glad to speak. thank you. >> your knowledge and experience will be a welcome edition and look forward to our counsel and advise and comments. >> thank you. >> so the next item on the agenda is of the minutes of the health commission community and public health committee meeting of june 18, 2024, meeting. commissioners have but the minutes any additions or corrections to the minutes if none motion to approve. >> second. >> public comment on the item. >> there is anyone in the room on this item a remote before go to that for

to that for agenda. with respect to agenda items, your opportunity to address the commission will be afforded when the item is reached in the meeting. and making requests to the dph please note each individual will have one minute and may not read statements from other individuals and written communications may sent to the health commission dot commission dot dph at sf.org if you wish to spell your name not taking a lot of time but the city policies and local law prohibits harassment and will not be tolerated and today i have a slide to pull up for review? >> all right. please give me a moment to pull up your slides and i'll start the clock.

>> your slide is up and the clock has begun. >> thank you. >> this is patrick and july 24th minutes are my testimony that the june 18, 2024, with the bed "midge wilson alley" initiative was the subsequent plan ongoing plans with the regulations present on april 2024 cm and after president green requested the report i objected it from another requester and recommended the - those minutes on page 6 commissioner giraudo talked about codes it is difficult to collect and report this data and suggested as dph as a corporation - and on

june 22, 2021, i published my article and one hundred and $67 million that reported ethic corporations with the entire module was information and this commission should direct they're requested to the module and that module is in the slide. i included that in my article and use is ethics system for san francisco and as soon as they're aware of discharged data empty and locations of discharge and with the database and commissioner giraudo has used this so dph and planning department should require all hospitals using this ethics in

their articles in the manual report described by the discharges for public districts and if the city feels not equal in the discharged locations one city in all of san francisco county if the discharges don't equal san francisco not an out of the county discharging this not not rhetoric commissioner giraudo should - an enhancement and as far back as 2020 are 2019 and confirmed the dedication is a feature incorporated into the system and patients module and not difficult for hospitals using itself to identify out of

the county discharge data. thank you. >> that's the any public comment on this item. >> and we should do a roll call on minutes. >> yes. i'll start with commissioner van buskirk, yes. >> commissioner christian, yes. >> commissioner chow and commissioner giraudo approved. >> next is >> next is general public agenda. with respect to agenda items, your opportunity to address the commission will be afforded when the item is reached in the meeting. discussing any item not appearing on the posted agenda, including those items raised at public comment. and everything else he said previously an i'm chris and today had injure duty

i want to present the presentation, however, i directed dr. colfax in public health and want to present it to them at first, because of dph impact i had a lot of experience with public health and a lot of things i want to make sure we cover just privacy and present it is for that we focus on this because the other day it was said at&t has over 75 million accountants accounts that is huge like i mind a breakdown but compacts personal relationships and health and i don't want to point fingers i know i don't have a lot of time but a lot of

people i don't know about the presence and violence and we do a lot of work with violence. and hiv and also for the - everybody knows i'm an investigative but we do core resources within within the community and bring the community together and other there think both sides and we have to do a better job of bringing people together i want to pledge to help the department of health i will do any part working with the health commission and public health department to work bringing the community together and there are things to be made in the next couple of days i have i can't share that but really that's really up to us is or dr. colfax

and board of supervisors the mayor's office to work together to happen - over the last couple of days violence and it is not enough we don't have an overdose issue positive impacts we're right direction but i pledge i work with the commission and the department of public health doing everything we can with my myself to make them a better - the power point presentation is ready but waiting for dr. colfax to schedule a meeting to collaborate and work together not negative but do something positive so, thank you. >> and there is one person response time has a comment. >> mark are you there.

>> yes. you have three minutes menshaw. >> i'm speaking on a topic please don't cut me off it is dph and agency by no jcc and after at all it has stood up and created in 13 for mental clinics. but sadly we never hear about j.c. c about the primary care and health clinics because of the umbrella that suggests to obvious as the governing body over the mental health clients it is time we have an agency overdue and since it's creation

has unfortunately, been stuffed with managers - running disappointing two hospitals with the nursing facilities for 200 plus and this is a nursing home residents anticipate no originate how it is managing the pc health centers. >> thank you. >> and the last comment for this item. >> thank you next item is director's report. >>. thank you. >> at the commissioners and good afternoon. um, i want to turning your attention to the director's report. >> an item about the surveillance united against hate wastewater and information how the surveillance occurs in san francisco and point out two

water sheds in the southeast section slide. and i'll be happy to answer any questions you may have. >> um, i also want to turn your attention to the reaccredited by the jcc congratulations a stressful survey so kudos to the entire team to make that happen and cf g has now staff that are appointed including the interim combierm and lair pierson with the administration and financed and finally, i want to highlight that we - the office of health equity recently had to screening at the medicare and showed when medicare was implemented it was

used to segregate it was power documentary it is if it comes around we'll let you know and recommend it for the covid i want to provide updated numbers as of today, the ruling is 6.9 percent and 22 percent of residents objective vaccinated up to date. and that's. thank you. for the report any public comment on this item? >> any public comment in the room remotely none through we go i see a hand up. >> mr. menshaw you have three minutes. >> sorry i was trying to lower my hand mark sorry. >> so no public comment for this item. >> commissioners questions or comments? >> all right. seeing none,

thank you for that report and we'll go on to the next item an action with the. >> pull up there we go. >> great. thank you, everybody and good evening, commissioners i'm max the health planner with the office of policy and planning first presentation is to share recommendations for revisions to the healthcare accountability with the minimum standards for fiscal year 2025/26 and to rice the minimum standards for the next two years to answer any questions you may have. >> at the end of presentation. next slide, please. so the healthcare accountability

was impacted in 2001 to reduce the number of uninsured in san francisco and to increase the number of workers to affordable health insurance and san francisco properties provide healthcare insurance for their employees and the employers was if necessary choose not to offer a healthcare that meets the minimum standards for the department of public health and intended to cover the cost of healthcare within san francisco network. the law requires those standards are updated every two years. next slide, please. so this slide shows the relationship at the office of labor standard at dph has an enforcing with the cio and

impact with the covered employer for the law as diagram shows to update the standards and for combinations. and focused on enforcement and engages like responding to working complaint and auditing employers. next slide, please. so again pursuant to the ordinance they are reviewed every two years and revise the standard since 2004 develop recommendations to the health commission and the rectify of standards and the revision considered affordability to employees and non-employers and the policy and planning research and analysis works with the stakeholders to develop recommendations and. next slide, please. so from may to gin of this year

dph convened three meetings and members representing employers and health plans and agencies. and several of members have been involved in the inception of the law. and note the workers are represents for labor and employers impacted by the ac i o and at the to the members this year's members for the contributions and process and attachment c in the packet the members with their respective organizations. next slide, please. so during the workshop discussions information and cost sharing elements and to provide levels i want to review several of the terms first, the out-of-pocket maximum 24 is the

healthcare experiences and beneficiaries and the amount they pay anti before the healthcare poise pacing and the co-insurance and percentage for medical beneficiaries must pay for example, one hundred dollar the contract is $30 you pay $30 for our insurance and they charge you three percent and the copayment is beneficiary pays each time it is used. next slide, please. so over the years the working rurnlt balance the needs of employers and employees given the right to cover costs for example, hsa accounts and the health employees pay for some tax vantage and for accountable

health plan they're more common over the last decade. next slide, please. please and so just to for the process dph conducted a plan in the local market and how to address the standards evaluated one hundred and 78 small health plans across 9 carries a have less flexibility in choosing a plan. and therefore it is crucial crucial that the minimum standards are metaphor heat plans for a small market and the findings with the general are compliment with the minimum standards and only three three percent of plans are to be compliant this is down from 70 percent in 2022 the standards

were initially approved by the health commission this limit the available and mainly by increases the plans out of pockets and primary care co-pays and prescription drugs that exceeds the standards next slide, please. so i want to share several things that are provided context for the promoted provisions first emphasis on the healthcare for employees and insure the employers have staff, and, secondly, the work members raise concerns about the care and challenging situations to employers and employees especially in the nonprofit and with the city sustains budget deficits nonprofits are face budget cuts and those cuts on

top rising cuts will attribute to the pressure for the city nonprofit segment and those dimensions to provide affordable health 0 coverage and the standards need to last two years to make sure the plans remain available during the entire cycle. next slide, please. and now i'd like to share the recommendations for the minimum standard revisions for your consideration and want to note the ac i o for the minimum standards and first, the workers acted to continue to have the platinum plans as long as the employers cove the premium and deductibles and they provide the

generous benefits to the employees and the standards simplifies the employers they encourage options to provide a golden plan and recommending maintaining the requirement that the employers cover the premium and sometimes necessary to preserve the affordable ability for workers the next set of recommendations should be considered to have the employers cover the healthcare experiences and expanding the compliant health plans i'll start with the out of pocket standard and the courage workers agreed to retain the plan by guess 2022 workshop and this framework employers cover the employee out-of-pocket medical expenses up to 50 percent out-of-pocket maximum

and cost sharing are encouraged which are the compliant plans we have an example in the out-of-pocket is $8,000 and the employer must cover the employer must cover the 4 thousand for the out-of-pocket and expenses are covered on a first dollars basis and deductible and co-pay my account for the out-of-pocket maximum and employers may use other appropriate options to manage the reimbursement of the managers out of pocket maximum and reimbursement opens are hr a and hsa and no need to create the full amount fully required amount. this reimbursement process is on some form under the standards since 13 and

lastly, the out of pocket ma'am, should be out-of-pocket federal out-of-pocket limit for example, only kofrnld plans benefits out-of-pocket limit and the analysis the out of pocket maximum benchmark is reducing the availability for the planes overall i retaining the framework to cover the costs the group agreed some level of the cost sharing standards to allow for greater available i'll talk about and. next slide, please. so this slide - is there. >> kenya is running the slides remotely can you try to go to the north and.

next slide, please. so this is the cost responsibility for the employee healthcare costs by providing the out-of-pocket with the federal out-of-pocket in 20025 that is 9 thousand and an employer should be up to $4,600 an additional 225. to the healthcare from the current standards and note those contributions i'd like to reiterate the 4 thousand tell you must cover the experiences for medical and prescriptions co-pays and must be covered on the first dollars basis and despite those cost responsibilities greater available for the plans allowed by the changes for the cautionary standards are

desirable for their make up and needs next slide, please. i'm going to review the recommendations for the prescription drugs deductible and co-payments and co-shiners given this required out-of-pocket ma'am, experience the workshop recommended the standards be evaluated and disagreement but found the $300 deductible is reaching a census to change to reach the maximum of $4,000 and simile copayment from 60 to $56 for or if co-insurance is provided no better than recommendation car insurance standard and finally the workshop whether to increase of co-insurance the department is proposing to adjust rates by

60/40 split to 65 or in the network services that increases the co-pay prescription drugs the availability of several plans to 77 percent and the minimum standards need to last for two years and other plans from a diverse arrays of and it was analyzed after 2023/24 and setting rates to being proposed for the availability of the compliance and making sure the standards and durability to the life cycle and concerns were raised about greater cost sharing under the co-insurance increases the out-of-pocket requires employers to could have

additional healthcare dollars and. next slide, please. so wanders to the upper standards this deductible will be 7 or $3,000 and automatically compliant and must fully cover the deductible and the workshop will maintain the standards for prescriptions remains consist with the state law and for the health benefits are anymore straightforward with an early census. next slide, please. so altogether those recommendations increase of number of available plans and the percent of compliments if to 77 percent and the standards will provide an opportunity for employers to over gold or

platinum and once the standards are offered to all businesses that contract with the city or the type plans to offer their employees and the office of labor enforcement and education to explain the standards and answer questions that the employers may have and overall dph supports this page and respectfully ask the health commission to approve the coverage for fiscal year 2025/26. next slide, please. and one last thank you for the members for their participation to the progress and thank you, colleagues for her support at this i'll be happy to answer any questions you may have. >> commissioners. thank you for your time. >> first of all, thank you for the presentation and i think we agree that all of the work was done by the office of policy and planning and the collaboration

is typical of san francisco stakeholders who find a way to reach census and all the employers issues with healthcare across the country not to emission san francisco are able to come up with a plan the number of what was that one hundred and 78 different plans three work alone is remarkable and thank you for everyone that participated and thank you for your time and expertise and looks like a wifi executive session you said a collaboration census i believe we will entertain a motion is there a motion to approve the recommendation from the h c a o. >> motion. >> do i have a second? >> second. >> and now we'll go to public comment. >> yes. we have anyone in the

room. >> yes. a member of workshop welcome i have three minutes on the clock. >> thank you, commissioners. good to be here. and i'm with san francisco health and human services an association of about health and health services for most of them with contractors and i've been - one on the workshop every two years since that began and um, i'm here to express support for this proposed standard and preserve both the availability of plans and affordability of plans for both employers and employees. and i think that all of us share deep concerns as the rising costs the co-pay and co-insurance the deductibles and as employers and nonprofits we

need flexibility. to choose plans that we are working for and for example, young healthy would it be fair to say can save a lot of money with the plans of hmo and use the infrastructure money for the win-win solution we had several years ago with 60 percent on the first dollar covers the employee costs so very scary some employees will have catastrophic illness and projects and that is a problem that none of us have been able to crack yet i see port of pair and some kind of solution to that problem but outside the scope we have this win-win for - and the nonprofit we are raising

wages we have been suffering with the recruitment and retention 345kz that more and more difficult and problems we can't hire the staff to do it with going with the plan and covering the employees costs we can set for money aside for more important issues for the employees right now. and a lot of this um, of course, note that given i have a hmo an employee can choose a different plan a lot of plans to chose from if you're willing to put in the presumes for the plan you can do that and another and educating the people for the scenario and

now you do preload but employee carries and card around not worried about coming up with the co-pay. >> your time is up. >> and no other public comment. >> wonderful. >> what about commissioners questions or comments? >> none? >> commissioner chow do you have any. >> i want to commend staff and thank you for the thoughtful answers - and help explain the recommendation that are before us and i will fully supportive resolution. >> thank you. >> i had two questions if you remarked indeed this is extremely complex and what historically you briefly mentioned seminars for employees

but what kind of advise can employers figure out the numbers can be daunting i know there are insurance at it sometimes will direct an employer to a certain plan based their own reimbursement for that work. so what are we trying to get employers really high quality analyze of what might be the best steps. >> that's a great question. so the base line level we provide the standards and f a q on the website that employers and others can access and work with the standards and enforcement to require the development for webinars and been through the standards the option that an employer can accept and safety the standards with a health plan and a q and a attached to that

and also provide the contact information so are for the employers with the office of dmv and have questions about the standards and how to apply as well on different options. >> for example, the employer wanted some unbias advise and submitted the age of their employees gender whatever impacts the premises premiums is that some information they can get available without the broker having secondary interests or get unbiased advise. >> i understand the employer will kind of all the scenario of the employee composition to an employer like the rates that match. their employee base. the department didn't have that what we do there is a question about

a certain standard and whether or not the plan can mrieldz or didn't comply and that is brokers and the capital hill to make sure that um, in their they have imagines best interest at heart and the didn't want didn't do that i'm sure the office of labor and standards has that and . >> and the last question remote work lastly what happened if for example, the nonprofits has a few people worked in lake tahoe how does that work? with the employers. >> with the specifics of which employees are covered? that usually falls under the labor statistics and i can come back

with the information whether or not the standards apply. >> good job leading from san francisco with remote work and if somehow employers can not have to cross the burdens with healthcare and thank you so much and i believe we should entertain and do a roll call now. >> yes. commissioner van buskirk, yes. >> commissioner christian, yes. >> and commissioner chow and thank you for your hard work and it is incredible. thank you. >> all right. next item is and this is for the report for dph. >> good afternoon, commissioners thanks for hearing this cfo here to bring the

manual report during the course of fiscal year 2024/25 this is represented inclusively by the nonprofit test kits and accepting as gifts in the department. other than highlighted by at one hundred thousand in documents generously to laguna honda and 29 thousand for the central and - and like i said represent the large testing received in the prior year. which is in line with the current inventory levels and i'll be happy to answer any questions you may have. >> any public comment. >> i see no public comment in the room or online. >> in any commissioner questions or comments? >> no. >> all right. hearing none, i guess thank you for the report

and explanation. >> the next item is conference committee reports from laguna honda and convenience report and i'll give three report the first about the committee meeting that was wonderful for the staff and the hard work that led to the medicare detection that's the first meeting and we were delighted and got the team report that some of the excellence newly hired leadership were so encouraging and enthusiastic about the commitment and specifically the dedication of the population we heard from each one of the newly hired leadership team and that was wonderful and the so moved with dr. lamb reviewed as you're able laguna honda is on it and the proper - efforts to isolate

and prevent the residents from having exposure and contained the outbreak and - the head of unit gave us an update on the oh, on priorities and that was snared at the last commission meeting and reviewed the regulatory report and that includes the dph surveys this seemed to come which we're doing quite well with and the license plate also working to reconcile the quality insurance group to reconcile we have it's been a long time coming. and have a clean slate as quickly as possible work with dph and the

research report and as across the department we have minimal open positions and excellent nursing staffing which is a real credit for the h.r. division and approved a series of policies and calendar x targeted the committee of the confident in recommending now on the consent calendar for approval by the commission as a whole. and then is there any public comment on this report? >> yes. >> mr. menshaw is there and you've got three minutes mr. menshaw. >> thank you excellent. >> if reports president green for july 9th for the jcc meeting she didn't mention on the presentation of our of town district by the hospitals in calendar year 2023 and - a

photocopy question how many skilled nursing beds remain in san francisco and included in the minutes of july 2nd, 2024, just approved president green provided the data on this remaining and mr. moore refused to provide me with the data and i received it today under the records request and significant in which the admissions and the number of beds was going forward and sadly the dph relied on california department of information and h ocii for the beds for 2022 financial data and that data reporting 1,000 plus freestanding beds that over stretched by - and i indicated in any article published the

health department i spent less than a meeting freestanding beds so i calculated nine hundred plus beds and one hundred - from 2022 which is zero on the data. and f dph does not have enough beds but the freestanding beds why is the planning department used two doobts and that's weird and free standing. the context is 90 one hundred and 8 three by these this information was to submit and waiver for the 120 beds and - direct them to do so.

la claims will submit the waiver for they certification happened a month ago to what is the delay in submitting the waiver request?. thank you. >> that's the any public comment on this item. >> any commissioner questions or comments on the report? >> all right. seeing none, next item is the consent calendar and the items on the consent calendar comprise the policies and procedures that jc c recommend and some are july 9th meeting at the jcc a motion to approve the items on the consent calendar. >> so moved. >> and a second? >> second. >> public comment on this item and no public comment on this item. >> we'll a roll call. >> commissioner chow, yes. >> salgado.

>> yes. >> commissioner christian and president green the policies are approved. >> thank you next is the committee update and commissioner christian will give us that report thank you, president green today, we have a presentation from the reserve for accelerated disease response or radr a very inspiring and amazing presentation and also as often the case left with the funding for this amazing work by these dedicated and employees of the dph and so i'm starting at the end. this is the second presentation we had so the workers who provide front

staffing for the disease episodes in the city with those mentioned specialists workforce and again, the front line the public health for the infectious diseases a incredibly important group of people and as we experience throughout the um, city addressed the system and country public health department turnover is a problem and losing people for over work overload and lack of investment opportunity to address this work and strengthening this workforce is crucial and this presentation how the department is going about work and strengthening that structure. so radr

developed to support those others three are responding to enter situations like an impact of covid which we've recently been dealing with and the group later on done that by developing a module and training for those frvrndz in understanding everything about their jobs from on on board and computers to understanding the diseases i think that is over 80 cases they were responsible for learning about and knowing how to respond to. and the letters we had the three presenters julia janssen, radr medical director and joshua cristantiello, radr program manager. and jennifer banta, radr training coordinator. were incredibly enthusiastic about their work and almost glowed with the enthusiastic and dedication to what they're doing

and to their colleagues and they are unfortunately, this is a like some other things funding has been tied to a federal covid and under see the um, american rescue plan that has been cut. and so we be at the chief to lose this group of people that have been this initiative work and unfortunately, they're working to make sure whatever comes they're work is preserved will be available online and in other resources that people can a access currently looking forward to others funding and they're intending to put this into the other dph sections and struggling dph can figure out a

way to accomplish that setting - voting as well getting more funding. the other presentation we had are we had a presentation from the hiv health services had offer sees money for people living with hiv and the federal funding has been federally reduced and there are efforts to cut it completely. and mayor london breed has admitted to the cuts made to the ryan white funding to sustain our san francisco unfortunately, don't have the funds to extend it but thankful mayor london breed is committed and one of the issues in the is the hiv epidemic people are xrernsz homeless and incarceration and people are

high risk of substance abuse. hiv health services has two populations black/african american those are at risk to improve viral dispensation and the san francisco hiv community planning council represents san francisco and san mateo by the ryan white funding priority each year and so obviously a group is doing incredibly important work and happy to hear their presentation tonight. and have any questions or commissioner sal glad. >> thank you. >> they enjoy their job would be a shame to have any of their

work lost i'm radr has until the 1.5 for the funding so it would be nice had a system where everything is document for future reference and not just put on a shelf i think that is a waste of money doing everything over and over again, when they present the information and, you know, being able to provide the service to the city i think the chief mind in san francisco alone i can't think of 10, you know, would be on for fraternity frontd but a small city

departments like this. >> one of the things i wroend in the presentation was a description those are the people that takes care of of people that takes care of of the city and, you know, first of all, as they said that the person who was talking about this so that phrase i could see the pride and dedication in that room but just how critical it is for us to find ways to find and the country to find ways to support of the health workers and continue to grow the pipeline and have the resources that the individuals on the front line need to get up every day and did they're work

but preserve their work and move forward rather than losing it as we tend to do when the finland's runs out so really appreciate this meeting them and hearing from them. >> thank you. >> any public comment. >> no public comment. >> i have one question just what efforts are they making to get funding for grants like private foundations do we know at all that work is wealthy and actually the kind of work in the jurisdictions is there a kind of organized efforts we can't get this funding? >> this is to speak about the course of action they're looking at the city for the department is looking for money to replace that which has been lost. but it was clear they were trying to do

it so i don't know what the department within dph within the city takes primary responsibility do you have a sense. >> i want deputy director to jump in but in general we the dph doesn't fund the positions the grants the permanent positions are dph they have another source and nonprofit they hire for grants a whole i'm sure they're looking at that by looking for hard money to submit those folks to the department on an ongoing basis and members of the ph.d and sections i forgot several sections they overlap and seeing 23 they can get funds for other sections but didn't specify anyone else.

>> definitely joe biden it is grave and andrea better so gave us the orange card and those are the people that i'm looking at most easily here on that chart. and it was the people the disease intervention specialists motion of people are experienced with those issues and so they come from the community and it takes 6 or more months of training to get them up to speed and huge assessment and i didn't applaud the radr people to institutional liquor license but those definitely and

an enormous loose to public health and public safety to lose them. >> thank you. >> all right. i guess the next item on the agenda is other business any other business from the commissioners? >> i would like to say we get that beautiful well done annual report and so representative of the incredible work anyone in the community wants to know the debt and breath of work done by the dph and many of issue residents would have no idea all the positions and accomplishments of dph so beautifully done and stunning. and mark is there a place for people to see this online small business owner somewhere on the capital hill and i can put the link to the report for the

materials for this meeting so folks can come back and look at this. >> thank you hearing none, no other business entertain a motion for adjournment. >> thank you. >> so moved. >> do i have a second? and roll call. >> start with president green, yes. >> commissioner chow, yes. >> commissioner al glad and commissioner christian and commissioner chow congratulations getting to our second meeting today commissioner sal glad. >> thank you. >> [meeting adjourned]