data that identifies these specific subpopulations. you will notice on this side that certain guidelines are identified through the first column as needing a, "critical need." the recommendations address the needs of san francisco populations based on high rates health disparities. it is worth noting that the point of finding this recommendations is not to say that other recommendations in the plan are not critical. rather to say these guidelines have been identified as critical needs and they can potentially be addressed through development projects? ~. now i'd like to turn to how the plan's recommendation framework will translate into real world action after the plan is adopted. some of the recommendations are policy based in this plan. [speaker not understood] how we would implement some of the policy recommendations are indicated on this slide. for example, guideline 3.1.8 recommends completing the rezoning of the bayview health center mode to allow [speaker not understood] envisioned in

the bayview redevelopment plan. other recommendations are more tangible and can relate to development projects. this is where the consistency determination process comes into play. those projects that involve medical uses of a certain size which collene touched on earlier would be subject to consistency determination. the consistency determination process will weigh the project's merits against these recommendations. the task force encouraged us to explore an incentive base system that would encourage the health care infrastructure and facilitate projects that address the plan's recommendations and guidelines without creating unintended negative land use consequences. this slide shows the possible outcomes of consistency determinations. first there is consistent and highly recommended for addressing critical need. a little bit of both terminology, we felt it really described what it would achieve. this determination could apply to projects that on balance address the guidelines identified as critical needs. projects that meet this designation may be favorably

considered for expedited entitlement review. second, the consistent determination. this will apply to projects that positively affect hem care and access but don't specifically address an area of critical need. and lastly, an inconsistent determination. this designation could apply to projects that do not on balance positively address any of the health care service master plan recommendations or guidelines. these determinations will be based on a balanced assessment of a project on a whole and made by dph staff in consultation with the health commission. and this last guide outlines the general process that will take place for consistency determination. the planning department would be the lead agency, but it would refer all requests for consistency determinations to the health department. the planning department would rely on dph's recommendations, posting final determination on our website for 15 days. members of the public could appeal these determinations by making substantive arguments during the 15-day period.

substantive arguments are made, the determination would go to the health commission and would then come to this commission typically the same time as the related entitlement $. your decision could then be further appealed to the board of supervisors or board of appeals depending on the underlying entitlement appeal process. with that i'd like to you turn it back to claudia for next steps. >> thank you, liz. first, i'd like to sort of give you a quick run through of what we at the health commission [speaker not understood]. these are comments that we heard both from the supervisor's aide, from the public, as well as from commissioners. in general, we heard they wanted to ensure that projects would be reviewed against all plan recommendations, not just meet one or two for consistency consisted on balance. at least this is fully our intent just like we do general plan consistency for projects we'll be doing on balance consistency with the health care services master plan.

they ask for clarification consisting in how we recommend the critical need, address this part. doesn't mean all the recommendations are important or critical, but just the ones that we're highlighting are meeting a very important need and maybe consider when we review development projects and maybe they'll get priority processing because they're addressing a need that we thought was very important. we also heard that departments need more planning funds in the budget to monitor and update this plan on an ongoing basis. they want to make sure that they get -- that the data is updated periodically and there is ongoing monitoring and it is a living document, that it doesn't just sit on our shelves. they appreciated the alignment with the planning initiatives in the city, particularly what collene mentioned, the health planning efforts and all of this data will be used to inform other city initiatives.

they also appreciated infusion of the health lens in all policies as a very important outcome of this plan. in particular, when developing -- when evaluating development projects that we consider the impacts of health and the impacts on the population. there was a small comment in making sure that the role of [speaker not understood] play in the health care safety net. they are mentioned in the plan, but somebody wanted to make sure that we say a little bit more about how they are important, especially those that provide language access and cultural competent services. and like you heard from collene earlier, there are many services, there are many more -- we have a better ratio of bed per population. there is a good amount of services and, so -- but availability does not equal access. and we heard from the community that transportation and language access were kind of the key issues for them, especially for those folks -- folks who live in the southeast

part of the city, the transportation was key. and then lastly, we also heard that ensuring that the roads of the planning department and the department of public health are very clear. ~ roles hopefully the chart liz ended with [speaker not understood] how the land use applications will be processed by both departments. just a quick update on environmental review. we are preparing a preliminary negative declaration published at the edv of july as early as next week. for the benefit of the public, once published, they appeal for the negative declaration 30 days after publication. if we do publish it next week, that would close on august 23rd. here's the timeline in terms of next steps. we're in that first box. we're doing these informational hearings. we released the draft a week earlier so there is public comment. the next steps are, again, the

preliminary negative declaration as well as closing public comment. this would take place no sooner than august 22nd. and the reason why we're saying no sooner than august 22nd is because the ordinance requests that a joint hearing by the planning commission and the health commission be held no more than 30 days after the close of public comment. so, if you wanted to hold additional hearings or you needed more time, we could extend that public comment period and make sure that we meet that no less than 30-day benchmark. in the fall, we could have additional commission sessions if desired. and after that, at some point schedule a joint hearing for approval and consideration of the final plan, at which point you would forward it to the board in the winter and they would be approving it in the winter. and then the legislation mandates an update every three years. this is just for the benefit of the public on how to submit

public comment. and the reason why it would be a public hearings as well as e-mail or hard copy to the department of public health, and this is just to ensure we capture everyone's comments. it's really hard when staff recalls sort of informal conversation. if we have it all in writing, it is there and transparent. so, this is on the memo. this will be on the website to make sure people know how to submit comments. and lastly on your [speaker not understood], on sort of the development and approval of the process, like i said, and this is a question to you. if you desire, we could hold additional public hearings either separately or jointly with the planning commission before you take action and make a motion for a recommendation of approval of this plan. there is the required joint hearing which is where you would make your approval motion. so, you could let us know today whether you like either a couple of joint hearings or

just another hearing on your own before we have a joint hearing. we understand that joint hearings are a little bit challenging to schedule. and then in terms of ongoing and implementation, again, as liz mentioned, your role and the role of the staff would be to consider the consistency determination findings which when being formed by the department of public health, as you review and approve medical use entitlements that are subject to this. and in general, they would so much data in analysis that went into this that we hope that this data would be useful in informing the siting of health facilities and other decision making that you may need to do. so, that concludes our presentation. we're available for questions. but first i'm going to turn it over to hillary ronan who would like to address you. >> [inaudible] and committee right now otherwise he'd be here himself. just wanted to start off by

saying thank you so much. we're so excited, supervisor campos is so excited to finally see the fruits of this landmark legislation that was passed a few years ago. wanted to thank the planning commissioners, director lam, and especially claudia flores and claudia for their tremendous work for this incredible, comprehensive health care services master plan. and, of course, we cannot fail to mention the amazing work of [speaker not understood] and collene who really we did not -- the board of supervisors did not designate any extra funds to the department to create this unbelievable plan. and yet director garcia and deputy director chola ran an unbelievably comprehensive community process and really just embraced this project completely. so, we're enormously appreciative to them. supervisor campos created this legislation because the land

use decisions affect our entire health care system. there shouldn't be evaluated simply as building projects like any other. he believes the board of supervisors, the planning commission, and the entire city family needed the tools to think about the system as a whole and to protect the health care needs of the entire community. now with this draft health care services master plan, we almost have that tool at our disposal and ready. now city departments and policy makers have the information and analysis that they need to evaluate the health care service needs of san francisco residents. this information will allow policy makers their queue to plan for sufficient and equitable distribution services throughout the city. overall, supervisor campos is impressed with the [speaker not understood] of the orientation of the plan. we're particularly appreciative of the fact that the plan provides a good map for bettering hem and health services for san francisco's sun drably population. ~ health

[speaker not understood] taken into consideration by the department, the first one we were surprised that guideline 3.1.14 talks about the goal and recommendation of preserving healthy san francisco program was not identified as the critical need in the plan. we all know that a key constituency undocumented residents in san francisco is completely left out of federal health reform and they will continue to rely on healthy san francisco as their primary vehicle for health care services. it's not only the undocumented community that will be reliant on our landmark health care security ordinance and the health access plan that it creates. it's also the documented individuals in our city who rely on the employer spending requirement and employer dollars [speaker not

understood] in order to purchase insurance and meet the individual mandate that's required under federal health reform. this is especially the case for lower wage workers in high cost cities like san francisco. so, we really believe that healthy -- that this particular guideline should be identified as a critical need in the plan and hope that that change will be made. the second comment that we had as it's currently drafted in the plan, it appears that the consistency determination will be made by the planning and health department based on whether or not the project meets one or more of the recommendations as laid out in the plan. we just wanted to make sure that that's amended to reflect that the project needs to be viewed on balance as a whole. these projects tend to be as you know incredibly complicated and we can't imagine a fatal project that wouldn't meet at least one of the recommendations under the plan, but recognize that it's really

the on balance look at the project that would -- that will determine whether or not the net effect of the project is a positive one on the health care system in the city. but it appears that that change will be made and will be reflected in the plan. so, thank you so much. we really appreciate all your work on this and look forward to seeing the final plan. >> thank you. okay, opening it up to public comment. the number of cards here, jim i nugent. win ly yang. seth chan. emilie yee. susan fang. stephanie lynn. and cindy young. >> if your name has been called, please approach the podium. hello, my name is jimmy and

i'm a member of the chinese progressive association and youth [speaker not understood]. ~ in 2011 i participated in collecting over 800 surveys which asked community members about their health care needs and about what barriers they had to accessing those needs. and we presented those 800 surveys to the health care services master plan task force and we are very pleased that many of our recommendations have been incorporated in the current plan. but while we're really happy that there's been a lot of progress, i'm also here to talk about like some suggestions for how we can improve on those plans. so, in particular, i'd like to talk about health care sources recommendation master plan 3.1, specifically [speaker not understood] it says increase access to appropriate care for san francisco's vulnerable population. and in guidelines 3.1.1 through

3.1.6, it says basically increasing the availability of primary care pre-nate 58 care and dental care in low-income neighborhoods. so, low-income as we know ~ is the finest in federal terms is below 200% of the census party threshold. and while this is good, we want to see increased services in low-income areas, areas of high disparity. we'd also like that we should consider where in particular like the density of health care services should be. for example, in chinatown it could be considered a low-income area, but there is a lot of -- there is a high concentration of health care services where already there is a number of clinics, a number of practices. another area southeast, excelsior, bayview, those areas, there is a significant -- there are significantly less services concentrated in those areas and those areas could be considered low-income. and not to mention the fact that the southeast is the fastest growing population area

right now, i'd just like to say that we should not only consider as we are now where in particular the low-income areas are and in places of higher disparity, but also exactly where services are currently located because we can't just say we are going to put this here because there's a lot of low-income people. we also have to think about we need to put this here because there is low-income people and a lack of services there. thank you. >> thank you. next speaker, please. hello. i'm michelle. i'm also a member of chinese progressive association. and like jimmy said, we've been working on this campaign for roughly a few years and i personally would like to talk about recommendation 3.5. so, we all commend the various [speaker not understood] ideas that were presented there. we would like to also emphasize a lot on public transportation.

first of all, me and my family take roughly an hour from the sunset to chinatown to fulfill our health care needs. that responds to [speaker not understood] excelsior and chinatown people who also travel -- take public transportation to fulfill their health care needs. roughly a quarter of them take an hour to get there, too. so, instead of using maybe private shuttles or taxi vouchers, we would like to emphasize public transportation since it is a system people already use. it is a system that fulfills the needs of everyone in the city. and it's a system that everyone can have access to and we believe it's also -- will lead to the bigger impact on the lower income communities. thank you. >> thanks. next speaker, please. hi, my name is stephanie and i am a member of the

chinese progressive association and [speaker not understood] organizing. and i would like to talk to you today about the importance of linguistics and specifically guideline 3.4. so, personally whenever my grandmother goes to her health care provider, as a chinese speaker, she doesn't understand when the doctor speak to her so sometimes i have to translate. it will be difficult to translate the medical terms. when we were serving in the chinatown and excelsior district, we also gathered that people chose their health care providers because of the language services the health care provider has. they're less likely to go to other places [speaker not understood]. we think health care services providers should have interpretation services and language translation and that should be a critical need in the health care services master

plan. thank you. >> thank you. good afternoon, commissioners. my name is emilie lee, i'm with the chinese progressive association. some of you all just heard our youth members speaking today about their own families' needs related to this master plan and i just wanted to, you know, acknowledge that it's been a long process that this master plan has come before you today. back in december -- november, december of 2010, we had also come to the board of supervisors to pass this legislation. so, we have been eagerly awaiting to see what the plan is going to, you know, mean for our city. it could be passed [speaker not understood]. so, to that end, our members have collected over 800 surveys in the excelsior and chinatown neighborhoods asking exactly what do low-income immigrant communities, people of color communities need in our city. and from those 800 surveys, we found that there is a lot of issues that are addressed in the master plan and in some of the things we wanted to

highlight and mark as critical needs for our communities. so, we are happy to be able to come before you today and tell you what we think about the plan and also to see -- hope the changes we recommended and incorporated in the final plan. and i think, you know, there are a few other items we wanted to point out echoing hillary's comments around the consistency of determination that it does seem that the whole project needs to be reviewed and -- because some of these recommendations arvery broad, they could be, you know, any project can meet those needs. so, we really need to look at what is -- what is the overall impact on the community of any development project that's coming into a neighborhood. and that while we understand the, you know, various departments -- you know, we can't have a hospital in every neighborhood, that's true, but when you look at where hospitals are currently located right now in the city, we really need to realize that there are only two hospitals serving the entire southeast and south of market portion of the city and that is where

low-income -- our communities of color, immigrant communities are concentrated and growing in this city. so, i think that's definitely something we want to highlight as it's not just easier for anyone to travel over an hour from excelsior, visitacion valley to go to chinatown for their services. so, we just want to make the emphasis it is about placing services in neighborhoods as well and making sure there is a distribution that is equitable and addresses the needs of low-income communities. so, thank you very much. >> thank you. hi, good afternoon. my name is stephanie. i'm also a member of the chinese progressive association. i just wanted to highlight two quick guidelines, 318 and 319, and specifically suggest that guideline 319 be emphasized as a critical need. 318 seeks to increase the supply of providers in

low-income communities, especially communities with high rates of medi-cal and uninsured patients. guideline 319 takes this increase by advocating for sticksv of the medicaid primary care provider reimbursement rate which was established under health care reform beyond 2014. this extension is especially important in allowing primary care providers to [speaker not understood] serve low-income communities. and this is especially important in california because we are one of the states with the lowest medicaid reimbursement rates. both advocating for this increased reimbursement rate could reshape incentives for primary care providers in a sustainable way, allowing them to better serve patients longitudinally which is why we like to highlight guideline 319 as a critical need. thank you. >> thank you.

hi, commissioners. my name is susan fang, i'm a health policy fellow at the chinese progressive association. so, i just want to rei am fa size what hillary had just mentioned about recommendation or guideline 3.1.14, about preserving the healthy san francisco program. she already mentioned that a lot of folks aren't going to be covered, but i also want to highlight that employer spending requirement will still be [speaker not understood]. that is also a part of that recommendation. for a lot of -- we know that health care reform is coming. unfortunately, the employer mandate is not going to go into effect until 2015 and health care reform actually incentivizes employers to cut hours so that big employers don't provide -- they'll have to provide health care.

so, research has shown that restaurant workers, health care workers, nursing homeworkers are the most vulnerable to having their hours cut. so, [speaker not understood] a lot of [speaker not understood] and this makes employer spending requirement part of the health care security ordinance much more importance for ensuring that low and moderate income folks still have a means of accessing health care through healthy san francisco. and other research has also shown a majority of businesses actually support the health care -- employer spending requirement in the health care security ordinance. so, there is more information for us and more reason for us to preserve it. and without the employer spending requirement to finance our local safety unit, the remaining uninsured will have to utilize more emergency rooms and acute [speaker not understood] which will not only increase health care costs because we'll be treating folks in emergent conditions, but

also shift the cost of care to taxpayerses in the city. so, again, i want to highlight the guideline 3.1.14 preserving healthy katrina voss program should be more [speaker not understood] critical need and employer spending requirement should also be a part of that. >> thank you. are there any further public comment on this item? yes, good afternoon. my name is hiroshi fakuda. just a few comments in regard to the healthy s.f. master plan. i'm not sure there is enough emphasis being put on mental health services. i saw a line in connection with behavioral health medical services. and i think there needs to be a stronger emphasis on the mental health aspect. it is a major problem in the country. we're having a number of veterans returning from the war

and i don't think it's being addressed enough. for example, the cpmc matter, they tried to i think reduce the number of mental health beds. in fact, they should be increasing them for the future. now, in regards to the western side of the hospital -- the western side of the city, there are very few -- there's no hospitals on the western side of the city except for the veterans hospital. they're not capable of doing emergency services and i think there has to be a plan in the future for some type of emergency services in the event of an earthquake. we know that it's going to happen some time, and we don't have a plan for that type thing. when there is an earthquake, the west side of the city will be cut off because -- well, because of the quake and the problem [speaker not understood] traffic and the streets.

so, i think those things have to be considered in the future. thank you. >> thank you. good afternoon. thank you. my name is cindy young with california nurses association and i'd like to really thank the planning commission, department of public health for the great work that they've done on putting together the planning document for medical services in san francisco. we want to echo the comments that were made by the chinese progressive association folks as well as supervisors campos' office around looking at the consistency requirement as a whole. and then just as a nurse, i want to say that the elimination of the or not including the healthy san francisco program as a part of the critical need is very short-sighted. when we see uninsured patients come into the emergency room or come into the medical services, they are, you know, so sick by

the time they get there, the cost to treat them is twice as expensive. that program is absolutely critical. the employer spending requirement is critical and we should absolutely keep that program in place to save the patients of san francisco. so, i'd ask for your consideration on that. thank you very much. >> thank you. any further public comment? okay. seeing none, public comment is closed. commissioner sugaya. >> yes, thank you. i think this is really great. back when we were debating cpmc years and years ago there was a lot of discussion about how that facility fit within the -- within providing health care in san francisco and there was no master plan at that time. regrettably, the cpmc has now moved forward and we didn't have the tool at that time to actually apply what this plan

is presenting to us to that particular project. and perhaps if that had been around -- if the plan had been around, we would have had more tools to evaluate the desirability of the cpmc proposal. so, i'm particularly glad that this is coming forward. in terms of mental health, we also raised mental health issues and psych beds and psych wards and everything. during the cpmc hearings ~. and it seems like even though we raised the issue, it has not been getting a lot of attention even in this plan as was just mentioned by mr. fakuda. i think several of us or more than several of us have visited the psych -- emergency psych unit at general hospital and also set foot within the sheriff's department mental health ward