>> the commission will please come to order. yes. >> and commissioners please make sure that you speak into the microphone commissioner taylor-mcghee. >> present. >> xh*ix chow. >> present. >> and commissioner karshmer. >> present. >> and chung. >> present. >> first is the minutes. >> so moved. >> second. >> are there any comments on the minute. >> i have not received any public comment. >> we are prepared for the vote, all of those in favor of the minutes of march 18th, say aye. >> all of those opposed the minutes are passed. >> item three of the director's report. >> good afternoon,

commissioners, i wanted to inform you that the urgent care clinic has responded its capacity and this is under the progress foundation and pleased to announce that it has expanded from 12 individuals to 24 hours a day and 7 days a week, and as of march 24th. and urgent care provides clinical interventions with individuals who are experiencing escalating psychological crisis and require rapid engagement and assessment and intervention in order to prevent further deteration that may result in involuntariary detention and hospitalizations we have been working on this for quite a while and i do want to inform you that the funding for this came from the c, pmc association with the city and we are pleased that we are able to open 24 hours, previous to this, they could only keep the people until three in the afternoon and now they are able to keep the people to the 24 hours and this helps with the

capacity and supports our emergency area. >> a part of our ongoing process to improve our hr process and are the human resources director, ron, has started working on how to improve the hiring of our rns in our system. and so, he brought together, over 30 staff to discuss how to identify more meaningful minimum qualifications and criteria and so this is one way to be able to identify quickly how we could improve our hiring of rns. and so i want to thank him for his continual improvement process. and as many of you know icdten which was to acquired this year, and icd ten is classification system and currently being used, to provide inpatient classifications, diagnosis, as well as the issue of being able to bill, and has been delayed

for a year, so that will help us greatly in the department and we were working hard on the icd ten and the implementation and so with this delay they will give us an opportunity to be able to continue to work towards icd ten implementation. and as an agoing process of the reorganization and i wanted to announce that judith who was the director of primary care is now in the position of director of nursing for the entire san francisco health network primary care and so this again is reflection of the merging of both the campus clinics, and the community primary care clinics and so we are happy to have her on and she will be working closely with them and the other members of the san francisco primary care team to integrate the homes to reach the goals of providing excellent care for the patients and insuring prompt access to care and positive and a healing

experience for all patients and a work environment that is safe and sustains an engaged staff and provide a workforce, also to let you know that a dear friend and dph employee jane lev passed away march 24th at her home after battling cancer, i worked with her personally when i first came into the department and she was an amazing health educator and health organizers and friend to many, and so we will miss her greatly. >> that is the end of my report, unless the commissioners have questions? >> commissioners any questions on the report. >> no. >> the only question that i would have is on the icd10 delay, we did have a contract that i forget which company it was, it was going to also be providing, some of that training, does the contract get extended or we are going to

move forward and train them for in october of 2 on 10 deadline when it was been extended. >> we have to relook at that dr. chow when bill or it director gets back and we will be really looking at that contract. and whether we need to continue that service or not. >> okay. >> we will come back to you and let you know that. >> all right. >> thank you, is there any public comment on the director's report. >> no, there is not, i have not received any public comment on this item. >> okay. >> commissioners any other comments? >> if not, we will go on to the next item. >> the next item is general public comment. >> and we have received one. >> we have one, general public comment, from kelley watts. >> mr. watts will be showing a video, he came to my office ahead of time and it is three minutes and it fits in the public comment and he will not be speaking just putting the video on. >> okay.

>> it worked earlier today, it might be the connection.

>> can he checked this out of ahead time and it seems like this is not going to work, i apologize. >> thanks. >> too bad. >> and i have not received any other requests. for public comment? >> okay, there are no other requests and he is coming back and we are going to try to solve this for him? >> i am concerned about time

and so i am not sure what, and i am not tech savvy and everything worked earlier today on the same computer. >> and so, he has one chance here. okay, there you go. we are rolling. >> okay. >>[video] >> i am a mother and i am tired of debating about the rubber and the black pellets that get everywhere and everywhere and contain, lead and benzene and carbon and a whole host of carbon and now flame retardant, what is good for a fire is not good for a child. >> all right. >> repeat after me, there is no such thing as an acceptable level of lead for children. [ applause ] >> and i am so tired of reading

scientific studies that say that a product is safe, only to find that the study was funded by the industry that is just exonerated. we know that you have the talent pool to do better and yet, right in front of us, and things that we may exposed to every day synthetic playing field and the toxics have gone untested on human health and certainly one tested in aggregate and for me and many of us here today this is not acceptable and there is nothing more important than protecting the health of our children and generations to come. and no one's profit margins can justify that to our children and the future generations. thank you. >> reporters are pushing to make the legislation stricter and to put safety ahead of profit.

>> jennifer, really meeting with members of congress. there is you know the rates of autism and asthma and adhd and all kind of hazard illnesses have gone off and can't be explained. there was a synthetic field that was put in in chicago and 30,000 resurfaced tires which carry... in california, and somehow, you know, people think that it is safe for my kids to play on and i want to see, again, pregnant women and vulnerable communities protected. >> you mentioned system wide that law because the united states has never filed a precautionary principal. >> there are a lot of parents out there and a bipartisan group that deeply care about their children and the future generations and you know, no one's profit margin can justify. >> okay, thanks again for it,

we appreciate it. >> okay. >> so we can go on to the next item? >> i was just going to ask that perhaps our community of public health and the committee, and could just also get a report from the department on the specific issues. >> okay. >> yes. >> and the next item on the agenda is the finance and planning committee report back. >> good. >> good afternoon commissioners. >> and the finance and planning committee met at 2:00 p.m. this afternoon prior to this meeting and we have voted and approved to add the following items to the following consent calendar and the april contract reports. and the approval relocation of

the lutheran south services and the mini, management program and it is currently on 8th street and it is going to move back to its old home. on golden gate avenue. and we also heard and voted to approve a new contract with health right 360 in the amount of $154,086 to provide physical intermediatary and if he can cal assistance to support the department of psychiatric inpatient unit project and in addition to that, we have also agreed that the aca updates that was originally schedule to

be heard in front of the finance and planning committee because of the nature of it and also we want to make sure that all commissioners have a chance to participate in their discussions that we are suggesting that carline, and come and do the presentation. and during the commission meeting. and in addition to all of that, we have also heard from kim oka, and that the pd director of managed care and the director of herpes san francisco on the outline of the herpes san francisco and a new report for 2012 and 2013. and we are expecting to see a draft in our next meeting and the finance and planning committee. >> and lastly we have also

explore some of the agenda setting mechanisms currently in place for the committees, and want to make sure that we in the spirit of transparency look at how to redirect some of these agenda items back to the full commission. and so that all commissioners can participate. and you know, and without like having the staff like provide you know like every single presentation two times. and that is our report. >> so, we believe that at this time, we will get the ac a, enrollment update as part of the finance committee request that it be presented here. so kol lean? >> thank you. good afternoon, commissioners i am happy to be here and very timely that we are here with the enrollment report and as you know, march 31st was the end of open enrollment for coverage california and we will

go over a little bit about that here today. but, over all 7.1 million americans have enrolled in health insurance through the federal or the state exchanges in california we had 1.2 million who have enrolled thus far and you will hear a little bit about the extension of the enrollment time line to allow people to complete the applications that have been started in coverage california. and 1.5 million californians have accessed medical this far and so these have all exceeded projections for enrollment and we will continue to provide you information then with the information that you will hear today is enrollment information through the end of february which is the latest information that we have available for our specific county and we will can't to provide you updates as we know more and i would like to turn it over to anika and tala who work with me on implementation.

>> good afternoon, commissioners. okay. so, as claire mentioned the aca enrollment numbers that we have are for through the end of february and these are actually cumulative numbers that i am going to be showing you from october to february. and so first up would be medical and as of right now we have over 33,000 people enrolled in medical and in the city. and this is mostly people who were eligible under the aca expansion, and so those are the two maji populations that you see and expansion and sf path and there are traditional people who are also elible and by traditional, we mean the people who were eligible for medical before the aca, but may not have enrolled for whatever reason.

>> so, as a point of reverence. we went over these a little bit last time, but our city wide estimate for people who would be nearly eligible for medical, were 81 to 95,000 people. and this included people who were uninsured and who currently buy their own insurance and to have employers sponsored insurance and obviously not all of those people who are going to take up at the same rates and so we estimate that about half of those people would enroll in insurance. and so, it is not a bar, but it looks like we are doing pretty well. so, coverage california, we have a total of 27,809 people enrolled and most of these people well over 80 percent are in subsidized coverage. and which is again, what was expected. so, in our city wide projections we estimated that 44,000 to 71,000 san franciscans will be eligible

just for subsidized only coverage. and so and of that, we estimate that 29 to 44,000 will enroll and again it looks like we are on par for meeting those projections. and so, healthy san francisco has provided as a reference and this is enrollment at the end of february. and this at the end of january, we reported about 46,000 people, and so, this is another reduction, just a caviot that any of the enrollment that you see in medical does not mean that it came from healthy san francisco and we actually don't know if the aca coverage previously had insurance or not and our healthy san francisco people are obviously uninsured. so, these are a little bit of the trends that we have from people who are purchasing plans on coverage california. and so on the left you see that the subsidized group that is a

large group of 22,000 people, most of them are purchasing silver level plans, and that is where the plan covers about 70 percent of your costs and this is probably also reflecting the fact that a lot of people up to 250 percent of poverty also get the assistance for purchasing the silver plan and within the subsidized group, the chinese community health plan is the most popular plan, and because their premiums are actually quite low. and in the unsubsidized group we will see a reflection of the state wide trend where the bronze plan that is the lowest and where it covers 60 percent of the costs and at the lowest premiums that is the most popular among the unsubsidized group. and so something of note in the unsubsidized group is that this black piece of the pie here, represents the minimum coverage. and which is available only to the people who are under 30,

and people who qualify for some sort of a hardship exemption from the aca, so in san francisco we see the second highest percentage of people enrolling in minimum coverage throughout the state. and the other two regions are in the central valley, where presumably more people might be eligible for exemptions and as more data becomes available from coverage california, we are hoping to see what might be going on here. and most of the other regions have right around 5:00 percent. and the unsubsidized group and the commercial insurancers take a bigger piece of the pie than the chinese health plan. so we previously presented an estimate of the residually uninsured and we needed people who will stay uninsured after the first year of the aca implementation and in order to to better align those estimates

with our city enrollment projections and the fact that 100 percent of the path population has transitioned and that we have granted an extension to the healthy san francisco participants to be able to stay in the program through the end of this year. and we updated these numbers. and so in this in this respect we have 87,000 uninsured and 18 to 64 and of those, most of them are in our healthy san francisco or in the sf path programs and whereas there are almost 28,000 who are unknown for our systems and so, when we tried to determine who was eligible and in those groups we find that in both groups, most of the people are eligible for medical or for subsidized on coverage california. but, combined, we have about 18,000 people who are not eligible for coverage. and first we are due to the undocument status that it was also included and because of

this case, we classified eligibility as subsidy and so that some people who are not eligible for subsidies or they are not eligible by age. >> and so, we know that everyone who is eligible did not enroll, and so at the end by applying estimate and different scenarios who is likely to enroll and not, we come up with on the left, among the unknown population that more than half of them are not going to enroll. and this would likely be because this population did not really take an initiative to enroll in the coverage when they had, or to enroll in healthy san francisco when they had the option or so they might not know about it. and on the right, we have we have more than half of the hsf and the sf path association likely to enroll and over all when you combine them for the gray boxes and so that the people who are not eligible for the aca and those who are eligible and may not enroll for

whatever reason, and will come up with 43,000 to 52,000 people. and it will stay uninsured at the end of this year and we expect to update these numbers for 2015 as we get more trend data coming through this following year. >> so, to out reach to all of those people who are not signing up, i will turn this over. >> hi, as she mentioned last night ended the coverage california open enrollment period. yesterday by two p.m., there were about 324,000 unique visits to the fight along. and so individuals who are unable to start an on-line application or complete an on-line application, due to technical difficulties, and will be given until april 15th to actually select a plan for

coverage on may first, and provided the payment is made. >> the next open enrollment period will start in november of this year. and for coverage beginning in 2015. and there are some opportunities for enrolling outside of the open enrollment period which are qualifying life events, for example if you are married or get married, or divorced or have a child, if you permanently move from one area to a different area, that has other health plan options, if you lose other healthcare coverage such as medical or other coverage or if you experience a change in income that will effect your eligibility for a financial assistance. >> and then, just a couple of updates on out reach activities related to dph. and dph and have to say that they had the first meeting with the sheriff in march.

and the sheriff is planning on potentially partnering with the community based organizations, to assist with the enrollment with the enrollment of inmates prior to their release. and he is also considering training more than 20 of his staff, and in the local on-line enrollment systems for medical and healthy san francisco. and since january, approximately 325 applications have been submitted from medical. and on march 22nd, healthy san francisco had their enrollment event that san francisco city college to assist individuals with the enrollment and to health insurance. and 200, to 300 people were expected to attend and more than 223 individuals attended. and 72 applications were completed and 41 of those were for coverage california and 31 of those were for medical and 31 were initiated but not

completed. this was made possible due to the partnerships with many organizations who provided the volunteers and staff time to support this event. and now that the coverage california enrollment period has come to an end, this city will be looking at ways to target medical population as a medical enrollment is year round. >> so, we are happy to answer any questions that you may have and i thought that it was probably worth mentioning the article that was in the paper today, about healthy san francisco, it is important to note that healthy san francisco eligibility has not changed since we started the program, healthy san francisco has always been available for the people who are not eligible for other publicly subsidized health insurance and uninsured folks who are not eligible for those programs and that includes medical, medicare and subsidies on the exchange.

and we did as the commission know and extend the eligible for healthy san francisco through 2014 just for those people eligible for subsidized health insurance on coverage california and the actual program requirements remain the same, supervisor campos is introducing legislation today to make the changes to the healthcare security ordinance that will propose the changes to healthy san francisco and the city option under the current healthcare security ordinance and we have yet to do an indepth analysis of the ordinance to determine what the impact would be on our budget and on our programming and our policies and on our operationalization of the programs that are envisioned. so we will be doing that and bringing that back to you. >> okay. >> and i just want to pull up

and let commissioners know that this will be continued item and that we are planning to have this as a continuing agenda item, on the finance and planning committee and we will probably come back to the full commission to give updates you know like on the more periodic basis when we have more aggregates and more concrete data, perhaps, three months to six months and depends on how this continues to evolve. and with that i actually have a couple of questions. and first question that i have is would we be able to track the data on how many young adults enrolled in the systems and i think that is also one of the priorities, you know, like for the affordable care act, is to really look at the populations that have historically under uninsured, and but would have the ability,

you know, to get covered. >> and so i suspect that coverage california will provide some break down at some point of the population that enrolled during this open enrollment period. and i don't know if data is available by age now, is it by age now? >> occasionally they report the data broken down by age, so they have a group for 18 to 34. and so, we anticipate that they will make that available when they are a little less busy. >> okay. >> and the second question that i have is pretty much like a follow up question, from the commission meeting last time because we just got information that when i might part d would be eliminated and that the budget would float into the part c, and because at the same time we have medical, expansion here, and under sf path and

also under affordable care act, and under our california jurisdiction, i am curious, like how that transition takes place. because it is effect different part of our budget. >> i am not personally familiar with the part c and part d of ryan white but i will tell you that the extension of healthy san francisco to the end of december actually first began with the people living with hiv. and there was concern that the individuals who were on healthy san francisco who have to transition to health insurance would have to change providers, and if particularly if they were eligible for coverage california. and the department of public health not being a provider on coverage california, they were not able to keep the provider with the department of public health and other healthy san francisco providers and so at least for 2014, and people eligible for healthy san francisco, or i am sorr