all right. 10, 9, 8, 7, 6, 5, 4, 3, 2, 1. yeah! ladies and gentlemen, lafayette park is officially open! >> yea! i would like to welcome everyone to the special planning commission health commission joint meeting. the commissions do not tolerate any outburst of any kind. silence all cell phones. when you speak, please state your name for the record. excuse the cramp quarters. some of you

will be sharing monitors so those requesting to speak will be reflected. i would like to take roll at this time. commissioner wu, fong, moore, sugaya, hill it's, antonini, >> good morning commissioners. i will call roll for you, sugaya, mcgee, singer, commissioner. present. >> thank you. commissioners that will place you under your special calendar. each secretary will call the matter for the record and you will be

hearing public comment and presentations shortly but acting on them shortly. item 1: item 1: care services master plan - on november 23, 2010, the board of supervisors adopted ordinance no. 300-10, requiring the department of public health and the planning department to prepare a health care services master plan "hcsmp"), to "provide the health commission, the planning commission and board of supervisors with information and public policy recommendations to guide their decisions to promote the city's land use and policy goals developed in such plan, such as distribution and access to health care services". the ordinance created planning code sections 342 and 342.10 to create and implement the hcsmp. an informational hearing on the draft hcsmp was held at the health commission on july 16, 2013. an informational hearing on the draft hcsmp was held at the planning commission on july 18, 2013. public comment on the draft plan closed august 22, 2013. planning department and department of public health staff will present a summary of public comments and a revised draft of the hcsmp at a special joint meeting of the san francisco health commission and the san francisco planning commission. at this joint meeting, each commission will consider adopting a resolution to recommend approval of the plan by the board of supervisors. the planning commission will also consider adopting the negative declaration prepared under the california environmental quality act ceqaa for the hcsmp, and making ceqa findings. preliminary recommendation: adopt a recommendation item 1: sf 112341234 >> good morning commissioners. i'm coal deputy director. this represents a milestone in the work that we have done over the last 2 years. this is a result of the comprehensive data and community driven process that included a 40 member plus task force. many members are here in

the audience today. a hundred plus community members were engaged as a part of this process. it's the result of legislation passed by supervisor campos and i know hilary from supervisor campos' office is here today. we presented a draft to you on july 16th at the health commission and july 18th at the planning commission. we received oral comment from the commissioners and the public at the meetings and written public comment afterwards. this draft that we are presenting you today is based on the comments we received and it will reflect the former draft and the draft before you today. this is an overview of my presentation. i will do a brief overview of the master plan since you already heard of it. a summary

of public comment, summary of the key changes made and the next step. i will share this presentation with claudia flores from the planning department. just a brief overview on the health care services master plan. this was a result of legislation sponsored by supervisor campos. it requires that the health department and the planning department together create a health care services master plan that has six primary components. there are 5 assessments and policy recommendation. the purpose of the plan is twofold to identify current need for health care services in san francisco and to recommend and how to achieve the appropriate distribution of health care services across the city. this extends beyond land use but policy discussion as well. at this point i will turn

the presentation over to claudia flores. >> good morning commissioners. claudia flores, department staff. once "the master" plan is adopted certain review projects is consistent with the plan. these thresholds are obtained to use of medical use that is 5,000 square feet or greater. the ordinance uses the planning code definition for medical uses but also generally by health care professional licenses by state board, dentist, physicians, podiatrist

and psychiatric services. and the master plan has the exact table with all of the definitions. on july 11th, there were a couple hearings at the health commission and the planning commission to receive public comment. the public comment ran from july 11th to august 22nd. there was comment on the right side is the list of the organization that provided both oral and written comment. the critical needs for

guidelines was for the people to identify those guidelines that is meant for those development projects that make them eligible for incentives for entitlement process and all the guidelines are considered critical needs for the city but only certain once meant by the project. for example, there is a guideline for san francisco. that is a program provided by the city. the city does not need a development incentive process for that program. the program is already in place. we are only identifying a small set that met certain needs that is met by development projects. so we change that designation as a legible for development incentives instead of meeting

critical needs because all the goals and objectives in the plan is critical. hopefully that clarifies the designation. the consistency determination process was very confusing to a lot of people. that's the key role for the planning department and for the planning commissioners, how medical use project is going to use this process. we consolidated and improved those sessions so it will be more clear and moved it to the very front of the plan. there was also language to clarify this role and updated the graphic to show these clarifications. just really quickly to remind folks. here is the mouse. relevant medical use applications will come to the planning department and the planning department will basically check these applications to make sure they

meet the medical use and the right threshold and the check to the department of public healthand they will forward back to planning. these are the outcomes of the determination process. i'm going to the in next slide. the task force, the health care master form recommend we use a base system. we came up with these outcomes for the consistency determination. one is for the development incentive and this means on balanced projects meet one or more guidelines are best eligible for incentives and these are for expedited review. they are those projects that

are simply be consistent and we don't want to dictate where those projects should go, but they still might provide something the city needs and the market is demanding be it a plastic surgeon or podiatrist but still in goal with the guidelines and recommendation. inconsistent is the other outcomes. these are ones that do not affect any. a project, there might be a clinic and change of use that might go from a clinic to a pool hall. it's getting rid of changing the use of something that it's not meeting health care needs. that could be something that would be considered inconsistent. i'm turning it over to colleen.

>> thanks. so the additional changes are comments that we received. many of them related to recommendation 3.1 about increasing access to appropriate care to san francisco vulnerable population. to address several comments we made several changes ; some of them more substantial than others. changes are outlined in more detail in the memo you received in advance. the first one relates to health scare services. the expansion of the guideline to support an assessment of the density of services provided within an area was appropriate and we agreed. the analysis within the health care services master plan points to this also. while it's important to increase access to care and san francisco's low income and

under served neighborhoods, it's also important to see how much care is provided in those neighborhoods. while china town and bay view hunters point are considered low income area with high need for medical services, there are more services already existing in china town than the bay view. so that should be factored into the consistency determination. the guideline was expanded to address this issue. the second key issue that was raised was around the cultural of providers. it's really important that our providers serving our low income population has cultural diversity also and ability to serve the population. three guidelines, 3.2 and 3.8 were amended to ensure that

competent providers were what we are trying to incentivize. california's medicaid program is called medi-cal. medi-cal has among the lowest reimbursement rate for any care in the state. this is for providers who participate in the program. the rates are sufficient and at least at medicare rates is important to encourage greater provider rates. so guideline 3.9 is amended to reflect this. we also received significant comment on mental health services. there is a discussion significant discussion in the master plan and several commenters so guideline 3.2.1

was expanded to support an integrated approach to include behavioral health into primary medical homes. the converse was included in that with primary care and mental health. guideline 3.4 was community base mental health services added to our population. several comments also commented and many health care commissioners commented on the value of the master plan beyond the development plan decision. this was an ultimate decision of the task force used to make broader policy decisions. it's called "the master" plan of the health policy resource. "the

master" plan should be a living document that is used to inform, guide and support citywide strategic and health improvement plan efforts. and then there are also several information changes and style updates that were really not substantive in nature but were made to the master plan, some related to style and structure for the recommendation and guidelines in the summary or refining the wording in some sections. others were made for other information not available at the time that the document was initially drafted. most of that information that was updated is a result of progress on the implementation of health reform. so, for example, at the initial writing of the health services master plan we didn't know the name of the california

health's benefit change. we now know it's called covered california. then it was inter connect for individual consumers and that program has been terminated and no longer exist. we now know there are parameters for how health plans for covered california must include providers. we included additional information on these items as a result of health reform implementation. so, finally some commenters suggested an analysis issues that were not included or not covered as comprehensiveively as some of the commenters would have liked in the master plan. these include pharmacy services and end of life care including hospice and substance abuse in san francisco specifically the

abuse of prescription drugs in san francisco. these items were added to future consideration so we make note of these request by commenters to ensure the process includes analysis of these issues in the next data of the master plan. the final section of our presentation is next step. on the slide that where we are is highlighted in orange. this makes it look like we are more than half way through which might be the case. in july, we completed the draft master plan and released it for public comment. that's going to be the presentation to the to the planning commission and environmental review. in august the public comment period closed. the ordinance required 30 days of public comment. the

actual time was 4 # 2 days. when it met on september 3rd, the commission voted to draft "the master" plan for this meeting for your joint consideration today. the environmental review was finalized this month and today you have the revised draft before you for your consideration and approval. or if you desire additional discussion on the master plan you can request additional hearings if needed. we anticipate still that the mast arer plan onced approved by the body will be up for consideration in the winter of 2013-2014. "the master" plan is updated once every 3 years. so just to conclude our presentation we wanted to make sure that we provided you information on the on going commission roles with the

health commission and the planning commission. on the health commission side, the health commission will make recommendation on projects that staff recommend as consistent and recommended for incentives for inconsistent. in our conversations with health commissioners, they felt they wanted notice of consistent determination, but that unless there was an overriding need it didn't necessarily need to have automatic health commission hearing, but those that would be recommended by staff as recommended for incentives or inconsistent would automatically have a hearing at the health commission. and then on an on going basis, that the health commission would utilize the data in the master plan and the analysis in the master plan to inform health policy decisions. on the planning commission side, the planning commission would be using that master plan to inform medical use project siting and to

consider is consistency determination findings when review medical use project are before you for approval. so this concludes our presentation. claudia and i are available to answer any questions that you might have. i really appreciated the opportunity to work on this important document. this is not something that exist in other jurisdictions. we are operating from a blank slate. but you -- it was very exciting to work on this master plan and look forward to work on the implementation. >> thank you. opening up for public comment. i have one speaker card. susan fang. >> any other name is susan fang from the health policy from the chinese organization. we were one of the many organizations involved in the development of

the master plan and made public comment orally. so we are excited that a number of our suggested changes were included in the final draft and a number of them were also not included and we are interested in hearing why. and i'm just going to reiterate some of our comments on the new draft as well as reiterate our comments from the previous draft and the latest changes on the new plan. on page 20-22, there is a lot more clarity on the determination process. but we are still concerned that just meeting one highlighted guideline makes the project eligible for development incentive. their language around engaging community

transparent and inclusive process but we think it's vague and should be made more exclusive and made in the plan and that project will have a clear idea on the impact it will have in the community. this is also related to recommendation no. 2.1. so supporting healthy urban growth which we submitted written comment about and that was related to our concerns around the impact of development on gentrification and the surrounding communicates. some of our previous comments were around guideline 3.1. a lot of the changes that we commented on have been included such as language around culturally competent providers and the

density of services, but we think the plan should also be explicit about which areas are receiving these new services such as the bay view and another guideline we wanted to comment on was the guideline around preserving healthy san francisco and we wanted to ensure that both the requirement and healthy san francisco were included in the guideline because these are the two 2 pieces of the healthy ordinance which was established in the first first. and guideline 3.5 we commented on investing in public transit as opposed to a general transportation issue. thank you. >> is there any additional public comment? >> hi, my name is hilary rowan

an a legislative aid for supervisor campos. we are here to say thank you, we are so excited. we finally have the healthy master plan. we've been working on this for a year and it's a landmark. we are just amazed and delighted at the product. we wanted to extend a special thanks to directors, barbara garcia and john ram. we passed this legislation and asked to take this task without additional funding. we are amazed at how much you both stepped up to the challenge and really did tremendous work with incredible robust community input and outreach and we are just unbelievably grateful. we wanted to also extend a special

thanks to the kota chairs who really led the task force down an amazing path. finally, thank you so much colleen who ran this process. i know we just need to give her a round of [ applause. [ applause ] and jody cook. we are so graeft full and excited and urge you to adopt this plan and recommend for it's passage and we are so excited to use it as a final policy document and land document in the city. thank you very much. >> commissioners and director

ram, strictly speaking as a public resident and long time resident of the bay view community, i also was a part of this process. i think all of us need to congratulate the health department and the planning department. it has taken a tremendous echoing what the previous speaker said and here we are before you now to give you a blessing on this important milestone in the city and county of san francisco. yes, barbara garcia, mr. ram and also the staff, please stand up. commissioner guy. the reason i'm here is to look at the way the bay view hunters community is to look at the concern on the health and disparity in the community. this problem looks at the community citywide. we feel

strongly and a lot of people here today that this master plan is a map, is a road map for us to move forward in this city and i also say that it can also be a model for the region and for the country as well. so congratulations. we hope that you will give this plan your blessing so we can get up to the next level. thank you for your time. >> commissioners, i'm lucy john's. i set on the task force that helped produce this document and in addition to thanking the wonderful people who made this possible, i just want to let you know that for about 10-15 years in the far past, san francisco did engage in health planning. and then in

the early 80s. it completely died. then supervisor campos and hilary thought we can't be making decisions institution by institution. we need something that looks at the city as a whole and establishes how a particular institutional proposal will affect the entire city. so this master plan legislation was a result of being concerned in particular about institutional development, but it really morphed into a huge policy statement about how to improve health in the city. i want to thank the task force for

enabling the task force to move far beyond individual organizations and start to think about how to improve health based on the huge determinance of health framework that you find a little bit buried in the document, but it is there. that really framed our discussion in all our community meetings. what are your problems? how can we help you r e solve them? and many have nothing to do with buildings. i think this is a wonderful document. thank you barbara for pulling your staff out of their otherwise really important task to get this done. i commend it for your approval. thank you. >> hi. i'm dina from the san francisco consortium representing clinics in san francisco. i want to thank the

staff for their work and specifically we submitted comments and staff got back to us and we went back and forth and they acknowledged our issues and in the revised version. i want to thank everyone for this impressive document. thank you. >> thank you. any other speakers? public comment closed we'll open up for commissioners questions and comments. commissioner antonini? >> i have some questions in general about this document. there is a different between city owned medical facilities and non-city owned medical facilities. i guess my concern is that we talk about this eligible for development initiative an