captioned by the national captioning institute --www.ncicap.org-- supervisor chu: a vote, but from to the right to the meeting of -- hello, welcome to the regular meeting of budget and finance. mr. young, do we have any announcements today? >> please turn off also phones. if you wish to speak during public comment, please fill out a speaker card and present it to myself. items acted upon to they will appear on the board of supervisors agenda, october 4, 2011, unless otherwise stated. supervisor chu: please call item no. 1. >> item #one. resolution authorizing the san francisco department of public health to accept and expend a grant from department of health and human services, substance abuse and mental health services, and center for mental health services in the amount of

$473,485 to fund the primary and behavioral health care integration for the period september 1, 2011, through august 31, 2012. supervisor chu: thank you. we have tony from the department of public health, i believe. >> good morning, chair person, supervisors. good morning on this beautiful day. i am here today to come before you with approval to accept and expand the grant for community behavior health services with integration of primary care and behavioral health. this is an exciting opportunity for us. we are fortunate to have this opportunity, given the national picture where health care is headed. we submitted this claim in 2009. we receive the actual spores,

which were very high, but it was a very competitive picture at that time. we receive notification during the summer that with that the application, we could move forward with funding health care as proposed in the grant application. this project was very much in line with the national picture for health care reform, happening locally for several years. particularly here in san francisco. there is a large homeless population. given what we see in behavior health services, we are looking at having to formalize integration to do very specialized service for clients. the four -- the focus is for those who are seriously mentally ill and are at a high risk of homelessness and a slew of other chronic conditions. chronic heart conditions,

diabetes, as tvs, they are very common in this population. many are at very high risk of serious mental illness and some are staying in our behavioral health clinics. we were excited to have the opportunity to have a project for primary care. this is a great opportunity where you have many clients who are more comfortable receiving our services in a mental health clinic. that is what this application allows us to do in a formalized manner. we have an opportunity for clients to have a health care home in this mental health clinic. we are hoping to reduce the volume that you often see in chronic care, like emergency rooms and the very high volume the to have their, as well as high costs associated with that. what we really have here is a focus on prevention and

education, as well as a care for individuals. we have a dynamic team. we are excited to have the opportunity to evaluate the program. to really have a tracking system where these clients can be tracked throughout the entire system of care. a great opportunity to have the funding support needed for these efforts. we have primarily service positions in this application and coordination between mental health and the call center. >> for clarification, this is a grand where we are partially reimbursing the position without requiring you are positions. >> i had some follow-up questions. -- supervisor kim: i had some follow-up questions. i think that this will provide important integration services

to the city. but you were saying that this would allow us to attract patients better? how do we track them now? >> currently we have a case management system that has been integrated for some time. that is through a very small project that we have between behavioral health and market. we have funding that began back in 2004 due to the amount -- mental health services act. we were able to have a project with the fire department, really looking at some of the data around this small population. this allows us to expand that. the baseline is already there. we can build the infrastructure by collaborating with general hospital, as well as all of the data systems that we have in the health department. >> will this allow you to do

more -- supervisor kim: will this allow you to do more outreach? >> absolutely. this allows us to do the outreach in a more targeted wave. we currently offered to do that with these two partners with which we are able to do outreach and additional clients through primary care services. supervisor kim: by the way, i am a huge fan. an amazing testament to your work. >> i had an amazing conversation with the doctor this morning. supervisor kim: thank you. supervisor mirkarimi: i would like to second the comments from supervisor camp. -- kim.

anecdotally, as the state is lessening its obligation and deflecting more into local government that much more, and i chair public safety, and we are trying to figure out what kind of population we are dealing with. we never get very accurate numbers. really, what is that population? between law enforcement and city government, they seem to have conferred that we would have stepped up our game. that reality is going to grow. especially with the alignment starting this week.

can you expelled on that? i am beginning to try to figure out how to enable. >> you are absolutely right. when questions are posed on the data, it is very challenging. that is where the coordinated case management system is in dire need of support. actually able to attract clients through systems. that does not include the criminal-justice system. the chief, and her wonderful work, we have several partnerships under way. given that the realignment of the population that we often end up serving in some capacity, through these coordinated case management systems, it provides a base line for how you begin to expand what we have in the general hospital and health department to other systems.

we do have some partnerships with the criminal justice system that are very well developed and we can build on our clinical case management system. we have better access to that. these clients are very involved and in order to better serve them, we have to have client information as well as health information. we are hoping to build on the partnership with the chief. supervisor mirkarimi: i would really encourage that. encourage the department of public health on that collaboration of data. not to see the mental health side of it as it rushes of. supervisor chu: let's open this for public comment.

seeing no one. public comment is closed. item #2? no. 2 and no. 3. >> #2. resolution authorizing designated officers and employees of the city and county of san francisco to examine sales or transactions and use tax records of the state board of equalization pursuant to california revenue and taxation code section 7056. item #3. resolution authorizing muniservices, llc, to examine sales or transactions and use tax records of the state board of equalization on behalf of the city and county of san francisco pursuant to california revenue and taxation code section 7056. supervisor chu: thank you. we have our controller. >> good morning, supervisors. benjamin rosenfield. consistent with practices of most other cities and counties in the state, we routinely

worked to audit with the state board. a standard practice. we were contacted for this service. it has been more than 10 years. state law requires the board of supervisors approval in cases where officers and contractors with the government are required to examine confidential taxpayer information. that is what we are here asking today, access for the comptroller's office. someone in this case needed access to this confidential information. i will be happy to answer any questions that the committee has. supervisor chu: thank you. let's go to the budget analysts report on these items. >> madam chair, members of the committee, on page 5 of our report, under file 110961,

between the comptroller contractor, munis services, and% of the sales tax revenues in excess of the amount of the sales tax amount, which had been allocated by the state board of equalization to the city. in addition, additional sales tax revenue to be realized are estimated, based on historical data, $2.8 million over the five-year term of the agreement, resulting in the total estimated payment of $500,000 over that period. as the report points out, the agreement itself is not subject to board of supervisors approval, as mr. rosenfield has stated. this would simply, if you

approve this, you would be giving authorization to the control board and his contractor. we recommend that you do approve both of these resolutions. supervisor chu: thank you. let's open these items up to public comment. any members of the public that wish to speak of items two or three? >> good morning, budget and finance. ♪ budget by which we had some tax on when the day is done and we worked hard at in the setting sun budget budget budget song i wish we had more and find more by and a tax store -- in a tax

store i can still see her standing by the water of the day after the taxes rhymed ♪ supervisor chu: thank you. are there any other members of the public that wish to speak? seeing no one, public comment disclosed. these items are before us. can we send them forward with a recommendation? without objection? thank you. item number four, please. >> item #4. resolution authorizing the director of public health and the director of the office of contract administration/purchaser to retroactively contract with the san francisco community health authority for provider payment services for the healthy san francisco program for the term of july 1, 2011, through june 30, 2012.. supervisor chu: thank you. for this item we have tangerine brigham, department of public health.

>> thank you, supervisors. this contract with at the san francisco community health authority, a key partner with the city and county on the administration of the healthy san francisco program, as i am sure that you are aware, this allows the uninsured to get access to comprehensive health care. it has been a public-private partnership since the beginning. we have an excess of 20 private providers. kaiser permanente a, the community health authority participate in this program. we provide medical reimbursement for health care services. it could be primary-care services, specialty care services, and emergency care services. for this contract, and we would

allow the community health authority to essentially pass through funds from the department of public health to these providers that deliver valuable services. this contract would be for the final systole -- final fiscal year and a total of $15.9 million. it would cover over 46% of our healthy san francisco participants. over the years, many individuals in the program have increasingly selected nonprofit partners to receive their services. we certainly believe that that choice is important and that we have enabled that choice for participants. supervisor chu: i did have a quick question. do we have the most recent numbers about enrollment?

it has been some time since we checked in. >> we ended the 2010-2011 fiscal year without an estimated 20,000 in the program. there are an estimated 64,000 uninsured adults in san francisco. in terms of percentages, we are serving a 85% of the uninsured population. we have increased the medical over one-third, starting in the fiscal year of 2007, 2008. we ended in 2011 with 36. we have consistently tried to insure that people have had access. every having -- as we have increased and will and we have increased the number of medical homes to make sure that people have the ability to receive services. supervisor chu: following up on the medical homes, in the sunset

district, as well as the site close to 24th avenue, i think? >> yes, all of the sites are participating in healthy san francisco. as they open up additional sites, they participate. the chinese community health plan participate, along with chinese hospital. kaiser permanente is a medical home. finally, we have barbara community health care as a medical home. supervisor chu: with respect, we have heard from a few constituents that the space or medical homes with slots available are close to capacity and not there already. what happens in that situation? >> last fiscal year, 6% to 8% of

all of our medical homes were open. we asked them each to provide upward capacity. for the 2011-2012 fiscal year, the capacity of 14,700 individuals, they are at capacity. they determine their capacity not just on health the san francisco participants, but all of the other patients that they had. those that were on medicare, metical, other state-funded programs, such as healthy families. we certainly work with each of our medical homes. imbedded in this contract you will see increased capacity to determine whether or not they can increase capacity and, if they can, we are able to do that. certainly, we do monitor that.

we also do have other medical homes that serve the population. specifically the chinese english population, with the chinatown health center in the vicinity, which i said before, we have had the chinese community health plan that partners with children's hospital serving that population. certainly with all of the other medical homes, we have language capacity in the chinese speaking populations. supervisor chu: regarding this site, we do not have many public health clinics in that area. i think that you often have people than roll right away.

to the extent that there is the capability to increase enrollment at that location, it would be helpful. we have heard that people have been turned to [unintelligible] which is a bit of a ways from sunset. not the best in terms of public transportation either. supervisor? supervisor kim: i had two questions. >> yes. supervisor kim: we had a two year contract with the san francisco health community? >> we have not done that in the past. the challenge is that enrollment fluctuates and the capacity of the clinic fluctuates. if we did it through the budget, which would be preferable, we would have to build in generous assumptions as to where we think the enrollment and capacity will be. doing that as we certainly would

toward a two year period. supervisor kim: so, we have not been able to depend on a level of consistency in terms of implementation? >> over the life of healthy san francisco, we have served over 100,000 people. quelle% of the population. we have a civilian enrollment system that follows every one. certainly, the majority of the individuals have income at or below, and their income status changes. so, some people move in or out of san francisco. we could certainly look at historic trends, building them into the equation. it would just be based on not

being able to project adequately and accurately what enrollment would be in that particular medical home at the end of each fiscal year. so, we would have a little room. supervisor kim: the numbers overall go up and down throughout the city. is it per health care provider? >> it is more per individual, who will select their own medical homes. for example, if you have individuals who are primarily -- they may have children enrolled in health the san francisco. as a result of a pregnancy, they may be in the program. that is a change in the need of the population, but more their financial status has changed as they are eligible for public insurance.

we have to look not only at enrollment, but this enrollment. we are meeting the attention target. an excess of 54% of the peoples they enrolled in the program. it is just that people's situations and circumstances change. supervisor kim: my question is more -- does the number, even the individuals within the population, if they change, are the numbers consistent? >> it is getting consistent now. the net increase in help the san francisco was around 3% to 4%. we are at that point, so we may have saturated in some ways a

low-income population. now may be an opportunity where we may say that if we are at 85%, at any given time our involvement will be 90% of the uninsured population, using that number as our base and moving forward. supervisor kim: as we hit a level of consistency -- and i understand that the first couple of years were startups -- and this is not so much a question as it is a statement, but i would love for the contract to come to us sooner with greater predictability getting the retroactivity of this contract. if we are starting to see some stabilizing of the numbers, the greater level of predictability that we can have, ideally, that would be two years out.

thank you. >> thank you. supervisor mirkarimi: i want to take this gratuitous moment to thank the department of public health. while we were on recess, department of public health were able to celebrate the opening of the lyon martin health center. nine months ago, people were writing its obituary. it had not been for the incredible outpouring of support by the community, particularly the women's, lesbian, transgendered community. i want to say great job. it really put a smile on my face. back to this subject at hand, i do not know if the general public quite understands the relationship between healthy san francisco and the health care system. that might confuse them in

trying to delineate where one picks up and where one leaves off and how they may not help each other. >> a great question, a supervisor. from the beginning of this program we have been challenged in communicating that this is not insurance. it is an access program limited to the city and county of san francisco. under the affordable care act, the notion is transitioning more individuals and to help the insurance programs, which we have always said it is certainly preferable for the uninsured population. as opposed to an access program that is not portable outside the city. connections between the two, we believe upwards of 60% of the healthy sentences go population will migrate to health insurance when the individual mandate kicks in, january of 2014.

individuals that will belong to medicaid, metical, or the california health benefits exchange, we have consistently educated our health the san francisco population through our quarterly newsletters. we will still have 40% of the population that we believe will need access to a comprehensive delivery system. the program will but sees, but it will certainly serve fewer people in 2014. we are starting to work with all counties in california, around what will be the very real challenge of communicating across states. across