it's going to be on the side of m error we have to have a capacities in the city you guys are going to be here forever and probably prudent to see how the data shacks out i've not heard a convincing agreement argument with the supply of beds out weeks ago the demand >> director and director garcia i completely agree with you we're not not first and second ending and out it is brooklyn beyond the sniff beds but that's

a right conversation we're modern willing to participate in what the department and commission feels is a right venue in trying to meet the needs we've got 35 years and, of course, over time we'll understand and learn more and hopefully, we'll learn more together. i would you know the hospital council of san francisco is a very active group with our various health care side and this is a much boarder conversation but i have to the evidence will then show the hospital impact and that's a good approach for you guys because this is i wasn't here for the last routinely with c pmc and the department agreement

i'll tloul tell you obviously the dialog and the passion this the long term investment by c pmc and the health department in building trust in those two institutions is more are important than a financial move it's a decision i want to see a trusting relationship because everyone will benefit and this will take some work >> through the chair. (inaudible) >> a point of order. >> (inaudible). >> thank you sir, that's not a point of order by a point of personal privilege.

>> thank you (inaudible) hopd is not involved in long term care it is not - >> thank you, mr. shaw that's a point of information not a point of order. >> commissioner. >> i don't have anything to say. commissioner miller and i think my comments will anywhere what i said last time and it has been said here today that is c pmc needs to step forward and figure out how you can contributed to your charity care dollars and community benefits so build some of the beds in the community if needed because the refreshment we're working on present information and we know that our population is getting older and that those beds maybe needed not

future therefore when i vote i will vote that this will have an effect in our community (clapping) >> so i still have one or two questions i want to talk about in regards to the other areas we've not touched on within the board scope of which your addressed the broad question of the beds under the demonstration agreement we're going he are 0 we're not going to readdressing this in 2013 i want to talk about the process under that request. it's quite a few close to what you're proposing but in the

redevelopment agreement what initiatives has been addressed in the master plan and the institutional plan and in lieu man's report >> commissioner chow you're asking what have we done up think around the - >> and helping to address that that was a specific request we've broadened the topic about adequate placement of people as they place into a needed place of plays. i want to see how c pmc can work >> to the best of my knowledge this is ail documented in the

report we have a filing of public comment on that if i'm not mistaken on the agreement and we have done our obligation in reaching out to other mefbz of the community to determine the plans and see if their changes to my knowledge there's not been any outside of our filing but i believe we've fulfilled our obligation and mar la in her is our - is mary here. >> we've met with the hospital commission and all the other providers no 0 san francisco about the question of subcutaneous care we're not middle of doing another survey if you remember before the survey was created we met as a

group flo the hospital council and done a study for transfer subcutaneous at all the hospitals it was only two, that had a significant population of people that needs substantial cute stwrit from the hospital we were meeting our needs and automatically was comfortable with their contacts we're redoing the survey i've been in touch with the hospital council and had a meeting with people there ones and sending out our survey and based on what we find out what change then we'll have more kflz we're engaged with the hospital council now. >> director is there any relationship with the department in terms of the subcutaneous. >> i assume we're involved in

that commissioner chow and we can follow-up through our membership. >> you're right the two institutions that feel be xhofbtd and the two institutions are programs or plans that didn't have it found it is not easy to find a subcutaneous bed in san francisco and realized this is a boarder issue not because of the numbers the lower numbers of subcutaneous seems like it is more of a recreational issue your eliminating the sub kite in our licensing we really need to have that as part of the additional dialog how placement is married and how do we take care of those people at least the blue ribbon

people recognize that i will ask you outreach further because that's a critical mask that's feasible would be one of which it's a regional answer that was not only c p m obligations this is why the commission looked at the number of beds it wanted you to be comfortable about having enough beds for your population and not imposing on who was left on the open sniff category i recognize our working one with but commissioner singh said the issue is boarder there's also and that we recognize as a minimum you should not be be putting the patients into and taking up other slots and what's

the obligation of the institution to then also answer the public needs i don't mean the public but the patients most residents have insurance so if that makes sense to you. okay. so commissioners there is a revised resolution that taking into consideration the questions concerning sniff and our concerns which crafted and we'd ask if a commissioner would like to place the amendment resolution before us for adaptation? do you all have it?

the additional version is - colleen do you want to explain the resolution and i've been working to have it casted to taking into consideration all the dialog >> it's at the back of our additional pact at the he said. the changes it makes to replace the table with the additional information that was provided with licensed sniff and on page 2, it discussed the changes proposed that will occur as a result of the rebuild reducing the number of skilled beds to 38 and identifies many in a whereas the commission is concerned about the ability of the skilled beds as memorialized in two

previous verifies of the commission it notes that dr. chow mentioned the development agreement requires the c p m is required to work on the issue of the subcutaneous beds and the therefore, be it resolved c p m to work with the agencies to address this citywide beds short term >> so commissioners - yes commissioner singh. >> one of the issues which is we're studying and come back to you will say independent of how we get through to particular sniff issue today because if other institutions feel the way that c pmc do today, this is not

going to be an issue that goes away i would like to have a deeper understanding of the policy frameworks that drive reimbursement that are son this item okay look there's less need for sniff beds to understand that and how to think through that as we face what i'm predicting you increasing the discussions we have a changing demographic and changing health care policy and being asked to be really thought full they're moving around i feel what we can do go deeper into what is going on into sniff that causes an actor to manage things this is the appropriate way to manage it

that may well be we should understand the principleal forces. >> are you moving the resolution. >> i wasn't i was asking. >> i will make a motion that we - i will make a motion that we passed this resolution as written. and that indicate it will have a detrimental quack that on this health care services within the community >> thank you and a second please. and i'll second it. thank you. and so commissioner singh as you've had decision i take it interesting another institution is taking a position so it's obviously an important question

so i think the question is still to be clear it is not just sniff beds it's really the question of short term sniff beds versus a long term sniff best evidence bed another issue so issues are so multi lard >> we as a city within the city there are micro demographic problems that drives people so we would be better stewards of our responsibility. >> i took that is as recommendation for commissioner singh to work on. >> right and within the resolve in the encouragement of c pmc to work with the department and stakeholders we expect progress before on this as i think

director garcia noted that's within the context. is there further comment on the resolution which now t is moved to having a detrimental effect and ask for further coordination in terms of resolving this >> if not are we prepared all in favor, say i. opposed? therefore the resolution has passed with a 4 to zero vote. thank you (clapping) our next item, please. >> the next item is the 2 year dph update. >> as we go on to the next item

thank you to the staff for the background work including some of the original documents that i'm sure it was great i found no one had the documents we could, in fact, find so again, this was very helpful in the discussion. >> good afternoon, commissioners greg cfo a brief report on the budget. we have a budget that was as of this afternoon approved unanimously by the board of supervisors so we have one that final are hearing with that the second hearing performer a larger than the budget that similar to the budget we've discuss in the past so a few minor changes we're close to the end of the process. as we do every year we go

through the process with the board of supervisors where the budget analyst depositions o comics through our budget and sees things to be reprogrammed we have a process worked with the board of supervisors budget analyst to identify savings of about 1 point about $2 million i million dollars in the first year and 2 pointed plus in the second year we're under agreement with those restrictions and put back into the pot of fined to be relooked at by the board of supervisors for their priorities. in addition, we have a reserve placed on and general fund salaries of $8.4 million based on the budget analyst of our salary spend we explicit agree

with their analysis but we'll demonstrate that this is funding we'll use >> so i'm not sure i follow they think we're going to spend less or more. >> they think we're going to spend less yeah. >> they are willing to put all the reserve rather than not having that. >> they're projecting it out their projection showed they were going to spend less is that money to be reprogrammed we said no our projects take into account other things we'll place the money on reserve and if we don't need it it will go back to the general fund unless we need it. >> so when you populate the budgets for the different parts

of department do they get their salary budgets targeted with this not in them or is this in them. >> they will be with this in them we'll not be asking our diversification's to religious $8 million of salaries from what we planned and then - and exactly we'll say work within our budget if this savings materialized if we were is too sequesterer than that will be surpassed to the general fund but we're not protively asking it to be reduced for the salaries. >> so the results in many years we've identified savings that go to the pot to be relooked at and

many of the reallocations come back to the department there were a number of reallocations in the process we have $100,000 in every year program to continue a service we've started in t in the fiscal year 2013-2014 and this helps with job outcomes $250,000 this is larger than related to the transition costs to place clients associated with the university women's home closer so that allows us funding through that one hundred and 25 thousand for a breakfast scar support services and $125,000 for a continuation of funding for our supporting of the

streets program and the grants to the administrators of that program. homeless services in the mission that's an additional position for our hot team in the mission and continuation of the funding for our 0 prior year add back. and lastly $75,000 which is planning if you believed that will louse allow us to do the plans for the facility with the idea we'll develop a medical shelter to allow us to do some of the drawings in the facility. so on the ad back those are vamgd by us so the board of supervisors can say they go into the programs and those are not being because we're working on

this actually >> the board wards the contract and that's right the board fwufs the intent of the appropriation and the board talks about the general intent so we administer the execution of it. >> just before greg finishes i want to acknowledge all the staff work he's done and jenny particularly as well as we move into the next year budget so looking at the budget initiatives in terms of what we've funded and recorded requirement of each sections we have initiatives and we'll be having the report to us and eventually have the reports the

implementation of the brand new initiatives we've spending millions of dollars on i want to hold the accountability for our budget for the next two years you get an update address don't forget when a about what happened and we're bringing you updates along with the initiatives. >> i want to congratulate you both on that when you start to do that you begin to be able to look resources so the 1771 are getting the best health care for what we spend which is a hard thing to do hard for you and the commission there's not been a single thing that comes to us

it's not a totally liability i need for health care but we live in reality. everyone else in the country thinks about us (laughter) so congratulations >> thank you. >> it's a long huge process. so and so that basically wraps up we have again one more hearing at the full board that is essentially a foefrment and the mayors signature of the budget happens in early july and then we move on and do it again in a few months >> yes. commissioner. >> we need a copy of this that is readable. >> that will be useful. >> i think the last time i asked i didn't get it. >> commissioners that's my

faulty, forward that to you. >> thank you to our department and finance for the good work. >> it's on and on online too. >> it's online. >> yeah. the package. >> that's right. it is online. >> to read on and on online. >> but if you want a hardcopy. okay. well it's very nice to actually put our salaries on reserve so i think that's a sign of confidence ♪ vice president; right? they could well have eliminated it and we'd have to go back a ask for that >> that's right then we'd start at paying attention position of asking for that.

>> next item and next item is the joint conference off ramp business and i did want to take it up under 9 consent calendar not to cause for confusion by i noted that we don't seem to be following the protocol we used to have the prop i hearing how we were going to communicate with the neighbors and then also how were you going to get the reports of what were the records from the minutes in terms of we didn't get a list of the attendees until lacerate when we had 74 i thought i'd ask director garcia we need to understand why or the protocol

needs to be better misunderstand. >> one of the reasons this came back to the commission great from the previous committee i did not feel a they've had followed the procedure so many of the programs don't move caring considering the high rents we getting get out of the practice so i spoke today with the director of the processing process and talk about u haubd u talked to to run state the educational process we have the last history when people leave so we're going to be working on that i've asked joe robinson or whoever to insure they will have met the policy requirements so i've asked for a quality

assurance review so we don't have to send it back to them and have the regulations and a so we'll be working on that and give you an update probably about a month is thank you, commissioner. >> i actually forgot on the previous item there was a comment because i didn't have no slips. >> there was one. >> i wanted to recognize that our own vice president this is her last regular meeting as she moves on to the police commission but certainly the police commission gain we'll look forward to having you there as someone that understands and

consider that a value to an important department and the work they do. thank you very much and - and it's been a pleasure working with all of you >> congratulations. >> are there other items under business that you would like to bring up and commissioner chow i want to at the last meeting i requested an update on the local enterprise firms i'm wailing e wasting for that. >> we'll be providing that in our calendar for the commission i've spoken to our commission in terms of bringing a report to you, we have it listed thank you. >> thank you. thank you >> any other business at this point and the next point there's no public comment on this item. >> no