14-15. $1, 896 and one time savings. this will allow a $69 million or 3 .6 percent in the 15 budget. in addition we also recommend placing $8, 477, in salary and fringe benefits for committee reserves until such time as the department can provide more detail about increased enrollment in the san francisco health network and the cost of expanded service in increased capacity. on 15-16, a recommended

reduction for the budget proposal $2, 491. million. on going savings and one time savings. we are working with the department and will report to you back next week. i do want to call out to the committee, if you look on page 51 of our report, we point out that the sfg pro projected is surplus, let me just, i would like to read this. the fiscal year 2013-2014, budget including funds for a longstanding dph deficit largely in salary. due to delay in hiring, we are not blaming anybody for that, just pointing it out, due to delays

in hiring, san francisco general hospital projected 14-13 salary is surplus is $13.9 million. that money is there. $13.9 million. while the department anticipates increased hiring prior to the opening of the new san francisco general hospital building we anticipate the department will experience a high salary is surplus again in 14-15. if you also look on page 50, we also had that a similar explanation for one of our recommended reductions on page 52 and then on page 54, mr. chairman and members, we are recommending to place $8, 490,000 on budget reserve.

the budget salary in fiscal year 13-14 of $8.7 million. that's in addition to $13 million that i mentioned. the point that i'm making supervisors when we make the recommendation, to cut a total in the department of public health of $3.9 million in fiscal year 15, i would like the supervisors to consider the fact the is surpluses the department has been experiencing in 14. >> i have a question, mr. avalos. >>supervisor john avalos: mr. rose, i had a hearing at the hospital and another hearing this month and through the

hearing we addressed the conditions at general hospital including the emergency room. many nurses working with the ratio to patients was higher and not according to state law and the people often doing more than 1 person's job and seemed like that was a big issue was that there weren't a rapid enough hiring of nurses and clerks in that department to enable people to do their work adequately. what was discussed was that there was going to be aggressive hiring plan. there had been a big backlog and many steps that create delays in hiring process that were going to get rectified. i would like to be, i would like to see that process continue. i know there has been a is surplus because the hiring process didn't happen as quick he as it

expected. i would like to meet with your staff and dph staff to a look that the issue and look in depth because as i imagine they haven't resolved the hiring issues yet and because of the shortage of the cuts being proposed with your recommendation can be made. i would like to be part of that process. >> we would be happy to meet with you, supervisor. it's not putting blame on anyone for this hiring process, it's simply a matter. when you have 28,000 employees in the city and county of san francisco, it takes time for the department and the human resources department to recruit, test and so forth and it's simply a part of the bureaucracy. that's why the city every year, not just

this year and not just this department winds up with huge is surpluses. of course, that is surplus is used to fund the next year's budget. we are saying to the board, there is no sense in leaving excess amounts in the budget that you know are not going to be expended particularly if the board of supervisors has priorities for spending money on items that the mayor has not included in the budget. that is your priorities. that's why we make these recommendations. >> go ahead. supervisor? >> my comment is if we can pull together maybe late tomorrow or monday at some point to kind of get a handle on this to come back next week to have a better sense of what people can live with, i think that would be appropriate. i want there to be more nurses and medical staff available in the emergency room and the

adjacent wards with the emergency room after evening the conditions people are working in is almost horrendous especially as we are opening up a new hospital in the middle of next fiscal year or the year after that we should be prepared with that with adequate staffing level. i want to make sure the decisions we make next year are going to happen. >> they will contact your office tomorrow for that meeting. i want to state to you that our recommendations will not impact the problem that you are referring to. i state that unqualifiedly. >> that's great to hear. i just want to go through the numbers. >> great. >> supervisor breed, you want to talk first? >>supervisor london breed: he can finish his report. >> you are finish with dph?

>> okay. supervisor breed. >>supervisor london breed: i appreciate you specifying that the is surplus was not necessarily the fault of the department of public health. in estimating budget, we sometimes are over and we sometimes r under and specifically as it remits to -- relates to this department there was a huge deficit that we anticipated last year that the city took care of and now we are in a completely different situation. i'm excited that funds were not wasted just because funds existed. i don't want the department to think that we would penalize them by taking away funds, but to also remember that we are willing to do what's necessary to deal with define -- deficits as well. the department can't continue to hold onto funds that we can use in other areas. i definitely under the

process. i have had people contacting me and frustrated by the process and trying to get to employment opportunities through various departments. i know it's a process. i definitely believe that if it's at all possible to remove these fubdz as -- funds as well as change any potential reserve and put those in general funds, i prefer we do that, bought at the end of the day if there is still a need, we are going to come out as a city and do whaef -- what we have to to make sure the department is a whole. i don't think we need to take away from the department. >> i totally agree with your comments, supervisor breed, by the way, that's exactly right. the department -- if we were wrong. that's why you have the general fund reserve. the department can always come

back and request a supplemental appropriation. we believe that will not happen. also we are not singling out the department of public health here. this attrition of savings and is surplus, our methodology is the same for every department including the next department. it's the same methodology. it's just there is bigger numbers in the department of public health. mr. chairman, members of the committee -- >> just to follow up on that, i totally agree with supervisor breed. however since i did the hearing and saw the lengthy hiring and the work that perhaps has been done. that's why i wanted to take that time. >> absolutely. mr. chairman, members of the committee on page 60 of our report, the human services are

recommended reductions >> we still have the same recommendations on page 60 as a total. we are recommended $2, 204,000, the change is that general fund is $641, 621. and $1, 562, 49. we are recommending total reductions in $2, 286. the general fund

recommendation are 494, 594. the general recommendation are $1, 092. we are happy to answer any questions. >> thank you. any questions for mr. rose's report? >> okay. mr. rose are there any other underlying items for dph or hsa that you would like to comment on? >> i commented on the 3dph items. excuse me. yes, i'm sorry, mr. chairman, item 5. let me go back to that. thank you for reminding me of that.

on page 59 of our report, this is the expenditure plan for the human services care fund. to make a long story short on that one, we absolutely recommend that you approve that resolution. >> okay. thank you. okay. colleagues, any further questions for mr. rose, otherwise we are going to spring him from his duties to finish the report for monday. okay. why don't we start with dph, ms. garcia and team, thank you for waiting. >> good afternoon, supervisors and chair farrell. just to comment on this last bit of conversation. i totally appreciate the conversation going on. we not only had the issue of vacancies in our department particular in our hr department. time is an essence at this department as

we higher and we'll be cooperative with mr. rose to ensure the budget is reflective of our needs, but i also want us to be conscientious of the fact that time is not on our side with the 24 -hour facility in a trauma center that we have to get nurses in as soon as possible. we are working to make sure they are hired as soon as possible. we are doing a lot of work in our hr department, we recently hired six individuals to help us move that along. getting into our budget, of course have a budget this year of $3 million increase of $1.8 billion budget. we add 100 fte, which brings it to almost 6300. we are looking at additional 350 fte's for fiscal year 15-16.

that not only includes nurses but other staff to support a whole new facility. we've been for the last two 2 years and particular this last year working on the issue of health care reform and we have created a new san francisco health network. we put our icon in the corner for you to see. this network is prepared and is already delivering integrated delivery system to many new patients in our network to improve quality and increased access to care. one of the areas that all the federal government is measuring on is our enhancement of patient experience and all of this also in aspect of controlling our cost. our san francisco general hospital, we are on time and on budget . we expect that will be the same towards the end of the hospital built. in

the state and the federal government, they are changing the way they are funding the department. this is another area we have been prepared for which is the fact that we are being paid for value and not for a number of individuals we are serving. that's why it's so important to build this network and ensure we are much more integrated an ensuring individuals instead of silos as we were several years ago. one of the biggest areas of our health care reform is we have to, required to in accrues the s -- increase the special mental health services to expand our san francisco health net client base. so we've made many investments in our primary care hours and the number of people we can serve and the state government has added back and we are preparing back for services and i know many of you know

that dental services are the most needed services that we've had for several years and eliminated by the state. we are increasing the mental health services through the mental health services act. the call center that will enable us getting patients in a more timely manner by centralizing all of their appointments. the rebuild as i spoke to before in 14-16 budget has a $26.5 million budget. the hospital has say new detailed and complex process. it cost money to move from one hospital to the other and ensure all the process and delivery systems are intact. we are also looking at an additional $27 million of operating cost for our new hospital in 15-16 and looking for furniture and fixtures

for the next two 2 years budget. one of the responsibilities that we have in a new network is to ensure that we have a strong infrastructure for our hr and rt process. i spoke a little bit about increase of human resources staffing, but also critical is the hiring of and basically building our core infrastructure for our rf and 14-16 budget for it structure security enhancement which is a very important component and we did also have a breach in our department from a third party vendor. security enhancement is a very important process to ensure the safety of our information of public information as well as private health information. we are working towards an electronic medical records and we are in the process of developing a telehealth program which is i think a very important creative process to ensure experiment

services are spread throughout our primary care system through our telehealth model. there is two divisions in the department and one is the health network that i spoke about. the core program is the core system as well as other areas and we want to stress the fact that the mayor's office has back filled our revenue loss and has for many years the city has for the hiv prevention and hiv services. that is an important component. we are looking to back sale our revenue loss for tb control area. that's the end of my budget. our cfo was going to talk about legislation. i will be available for questions. >> thank you, ms. garcia. >> good afternoon, greg wagner. c fo for dph.

>> mr. wagner. sorry. madam clerk can you call item 17-20. thank you. city clerk: item 17. a resolution retruax actively authorizing the department of public health to accept and expend a grant in the amount of $166, 446 from public hementdz foundation enterprises. >> item no. 17. accept and expend grant probability based is survey of hiv risk among transmenusing a novel sampling method. item no. 19. resolution accept

and ex-spent grant ryan white part c outpatient ei circumstances program. $322, 645. item no. 20. #15e79 and ex-spent grant medical monitoring $20. #15e79 and ex-spent grant medical monitoring project. $556, 874. >> thank you. >> very briefly as mr. rose touched on a number of these, we have a couple of pieces of legislation in front of you. item no. 4 is our patient rates. this is our annual update to our patient rates for medical services. these are our official rates, although the vast majority of

our payers including medi-cal clients do not pay these rates, but they are the bases of funds that we recapture through commercial payers through san francisco hospital. that is a very important financial driver for us. we have the recommended rate adjustment based on a consultant study of where the rates are in the market. we also have regular item that comes before this committee annually. we have a number of grants that are annual but require approval annually of the board of supervisors for us to accept and expend those. there is a list of those. those are the same items that you have seen and approved in past years that will allow us to continue with those programs. we have a resolution before you to authorize us

with the assistance of the controller to purchase $41 million worth of the ff ande furniture and equipment for the general hospital commercial paper program that will allow us to expend some of the cost of equipment over the paid cash and that will give us flexibility. lastly we have four grant items, 17-20 which are individual accept and expend approvals and we have program staff to talk about those should you have any questions on them. >> thank you. colleagues, any questions. mr. wagner? any questions for ms. garcia? okay. any final comments. otherwise we'll understand we'll see you back next week.

okay. thank you very much. up next we have our human services agencies, madam clerk, can you call item no. 9, please. >> city clerk: mr. chairman, would you like to have public comment for items 17-206789 >> thank you very much. we do need public comment. mr. roark, real quick, we are going to ask for public comment. anyone wish to comment on those items? okay, public comment is closed. colleagues do we have a motion to send those items forward? >> okay. we can do that without objection. madam clerk, can you call item no. 9. city clerk: item 9. approving expenditure plans human services care fund for fiscal

year 2014-2015. >> good afternoon, you are very familiar with our budget. i was here a couple months before with our budget supplemental and went through a lot of detail and similar to what is today. i will be brief. to begin with our proposed about you -- budget for 2014 represents about an $87 million increase, 94 percent is an increase by the state and federal government for our programs. you can see from the slide that h sa is comprised now of three departments. department of human services, and this year the newly formed office of early education and you can see the total breakdown of funds there with the services and adult services and a little under 10 percent being

oechltece. -- oece. and it, hr and all three departments to create a nice efficiency for three departments. the next breaks out, i'm not going to talk about them in detail. you can see the total budget, the different programs that support our aging and adult services population. and then in the human services side, the bulk of our funding goes towards homeless services, families and children and child welfare and welfare to work programs. so slicing it further, where does the funding go, really for large buckets. a little over 40 percent to families, single adults, children and adult home care providers,

non-profit partners to provide vital services in the community. about 30 percent is our hsa staff and the operations of the agency. the majority of our 50 percent of aid payments go to wages and benefits close to 20,000 providers that we have in the city providing in home care for our senior and dependent adult population and foster care payments and adult and county work systems for payments. there is really six areas, and i talked about the growth of our budget of $87 million. it's really these areas that i will speak to briefly. the first i talked about is the implementation of the affordable care act. since we began enrollment or preenrollment in october through may, we've seen over 50,000 new enrollees which is

an increase in medi-cal load. we are getting city of city of san francisco the health insures. -- insurance. we've had over 38,000 of medi-cal applications through various channels whether they are walking in or online or via phone or mail. we are providing the paper they need as well as meeting the standards. similarly in cal fresh, the california's name for federal food stamp program. it's not called food stamps, it's called snapped. we've seen an increase with families and individuals on cal fresh. we have not seen a

18 -- increase in staff. despite all of our efforts there are still over 35,000 san franciscans who we believe are eligible. >> sorry. i didn't mean to interrupt the report. i had a specific question about cal fresh. i know the food security task force made a recommendation for an additional $400,000 to do outreach to the communities where people potentially qualify for cal fresh and they believe that if they receive this additional $400,000 that could lead to an additional, i guess close to $3 300-0000 of participants in this particular program. are you father-in-law -- familiar with that request? >> yes. i am familiar with that. our cal fresh director is part of the task force.

the task force is correct. there is a service, a large number of families that haven't accessed benefits. it could be they are eligible for a small allotment, maybe $10-20 a month which is not worth it. we are changing the way that folks can apply. they can apply online or by phone to make it a simple transaction as possible. i don't know what they want the $400,000 for whether it's tied to what we are requesting funds for. >> the $400,000 is specific to outreach. >> whether cbo outreach or internal. >> it looks like cbo outreach. >> what we are doing is proposing a new unit of cal fresh eligibility staff to partner with the food bank and community organizations and partner with feeding sites,