that, so that when necessary and if necessary we could be able to assist. >> yes. and i did speak to the department of the emergency management and that is an area that they have not addressed. although your role would stay the same except we may ask you to as an example have more meetings because we may need to respond in some ways or spend dollars we didn't know we had to spend, but that is not an area that they have articulated to us ye explained to us. >> that's another area to be prepared. >> absolutely. >> any other questions? if not let's move to the next item. >> next is general public comment. oh there is a gentleman standing up. i didn't receive any comment. >> you wish to make a public comment. >> yeah, i turned it in. >> that's fine. why don't you

state your name and you will have three minutes. >> honorable president dr. chow and other honorable members of the commission, and also director garcia. i am ruben goodman. i'm a dual diagnosed mental illness consumer and the volunteer team captain of team dan goodman on the walk of alzheimer's on the 20th this year and begins at 10:00 a.m. at mission creek park and 3-mile walk and a one and a half mile shortcut for those that can't walk the 3 miles. there number information booth about alzheimer's research, help for caregivers of alzheimer's patients and the alzheimer's association has a 24/7 help line. i would like to invite

every member of the commission as well as director garcia and all members of the san francisco health department to participate. as far as i know two different departments within the health department have formed their own team and you go online to our website to get more information. i encourage everyone to form their own team and those that don't form a team you're invited to join team ben goodman in memory of my father who lived to 90 and the last years of his life developed alphasia and alzheimer's and i have given a challenge to the alzheimer's association to find better treatment in the next 17 years because if i am blessed

to live another 17 years i will be turning 80, and my father developed his issues between 80 and 90. i would like to see better treatment so my children standing before me or my grandchildren i will be able to recognize them. thank you very much. >> thank you mr. goodman. any further public comment? >> no. q. okay. >> sorry. >> [inaudible] >> oh -- >> [inaudible] >> jerry mehan and i came down here today -- [inaudible] >> i'm sorry. >> do i have three minutes or two? >> you have three minutes. >> okay just to let you know i exist and i want to talk about the healthy san francisco program, and i feel like i'm doomed in i lose it at the end of the year. i don't think i'm

exaggerating like saying it's a death sentence to me because it's been my primary care for the past three years but i would like to give a brief description of myself. i got here in the summer of 85 and i fell in love with the city after 15 minutes and knew i wanted to spend my life here and i got a job driving a taxi and have been doing that since and i am low income and with the pink mustache and the uber cap and a pigeon and looking for scraps and taking old ladies home from aif way and sticking a wheelchair in my trunk because people with disabilities have a hard time getting home and when i was diagnosed with a chronic disease similar to crohn's disease and i have been in and out of hospitals for the past

three years, emergency care, urgent care and i have been on so much medication and i am forever grateful to have the help they from st. mary's clinic and i was told we would lose healthy san francisco and i can't afford obamacare. it's up there in the stars. i can't come close to paying for that. i think my wife and i made $38,000 this year, so and she pays $5,000 for her health care, so i am really concerned and worried about being that i don't have a colon. i don't know if i mentioned that. my colon was removed the 26th of june and i need a lot of follow up care and monitoring and evaluation and i was just

over in my surgeon's office last week at st. mary's and in bold black print that said we don't honor covered california, so it just seems weird to me that even if i could afford for it i wouldn't get my doctors who have been great to me and given me such great monitoring and care. they have been like family to me at st. mary's center and i am just going to be devastated if i lose this. it's going to be a fight to live really, so i hope you can see right -- >> time is up sir. >> keep the healthy san francisco program for us residents. thank you. have a nice day. >> sir i don't want you to leaveout help that you need. we will have staff talk to you about that. >> thank you and we will remember that testimony under

item 9. >> i believe that is the last public comment. all right. so we move to item five which is the report back from the finance and planning committee. >> good afternoon commissioners. the finance and planning committee met before the commission meeting from before and we had a full agenda today and we had an update from the aca enrollment and also like the san francisco health network managed care report, so for those not familiar like we're combining some of our existing programs into the new office which we now call office of managed care which also include healthy san francisco i believe, and the other update that we got was the health care accountability ordinance and

there will be a resolution to come in front of the commission in the october meeting for approval and there will be presentations on that as well as the managed care report that will come to the full commission in october i believe, so and we have the contract -- monthly contracts report which are included in your consent calendar for approval minus one of them which is the public health foundation's contract because there's some wording issues we decide to defer that to october for review, so that concludes my -- also one more thing. the pharmacy san francisco general they have --

they have to enter a new agreement with the current software providers for the web based web based architect and that is included in the consent calendar for a vote as well. >> commissioners if i may the issue that commissioner chung just mentioned is in the contracts report. it's one of the contracts. >> yes. so what i would also like to encourage is that today we actually have three health things on our agenda. each are in differing stages. the health care accountability ordinance was heard at the finance and planning. it will come before this commission for final approval of their recommendations so it's important to read those. we

went into them in detail just like a subcommittee does and we will have the final hearing for that here i believe october 2. >> [inaudible] >> and so that's one of the healthy ordinances that we deal with, and we then need to make a decision, but that's in regard to 8c8o. there is also on the calendar today healthy san francisco and that's before us and we are also going to be listening to that, but as a full commission, and then in on october 2 or 7th. >> seventh. >> our first meeting in october we will take that one up so that's one of our ordinances. the third one is for decision today because we heard that last month which is the health care services master plan consistency determination so i found that

this causes some confusion because it's all part of our regulatory obligations, but that one also we will do today because we have heard it and the public had an opportunity to speak to it, so i just encourage -- for myself i needed to ferret all three out. i thought it would be helpful so we understand they showed up on today's agenda. >> okay. next item then please. item six is the consent calendar and again i would like to remind you that the public health foundation enterprise -- >> contract , right. >> has been taken off. >> the new contract has been taken off. the older contract which has extensions are in the contract report and again we don't want to get confused. it's the same agency but we are approving on the consent calendar the two extensions or additions related to funding that came in, and then we also

have a third new contract -- not a third contract, but the only new contract on here which is for macro helix. it is on the consent calendar. any commissioner can take any of these off. do i hear any wishing to extract from the consent calendar? if not we will proceed with the vote. all in favor of the full consent calendar minus the new contract for public health foundation enterprises say aye. >> aye. >> all those opposed? the consent calendar is adopted. >> the next item on the agenda is the health commission vice president elections. >> so as i mentioned in our last meeting if in fact we do have a new commissioner which we do, dr. pating then i recommend that we defer the election of the vice president until he is able to attend which will be agendized for the first meeting

in october because our next meeting is really a joint meeting with the commission on the status of women. if there is no objection we will move it to the first meeting in october please. i see no objection. so moved then. next item please. >> yes item 8 is the health care services strategic plan and consistency. >> >> master plan consistence for healthright360 and this item was brought to your attention in august and today you will be voting on it. >> good afternoon commissioners. i am with the office of policy and planning and as dr. chow mentioned this is one of the items you considered previously. at your last meeting we gave a presentation which was an overview of the master plan and the health commission's role and then a discussion of healthright360's application for consistency determination for their location on mission street, their new location on mission street, and at that time

we presented you with a draft resolution and it indicated that our staff recommendation was that the commission find this project consistent and recommended for incentives with the planning commission as it goes through the planning process and our basis for recommending consistent with incentives was the extent to which healthright360 does now and plans to in the future serve an under served population identified by the plan as important and recommended for incentives so specifically expanding primary care, expanding dental care, expanding behavioral health care to low income populations with high health disparities in under served neighborhoods in san francisco. at the time the commission reviewed our resolution and asked for additional detail on the specifics as to the extent to which healthright360 intends to meet the plans of the goal we so

interested that into the resolution and it's more spivelg how healthright360 will meet the goals of the plan and i know the executive director is here of healthright360 if you have any questions for her. also in response to the health commission's conversation we discussed how healthright360 would come back a year after opening to talk about how they're meeting the goals of the plan so we've had some preliminary conversations about what such a report to the health commission would look like at that time. >> thank you. commissioners you have the draft resolution redrafted from our input before you. was there any public comment? >> i have not received any public comment requests. >> okay. commissioners so we're prepared to have a motion for acceptance of the resolution before you. >> so moved. >> and so i heard a move and a second move which say second so we're ready for discussion. discussion of the resolution?

commissioners, yes commissioner. >> just for clarity this is the first time we have done this based on the new process, correct? so i am pleased we have the built in follow up that we're going to see this because this is sort of our testing how this process works so i am pleased we have it in there. >> thank you. >> thank you. commissioner singer. >> yeah, i second that thought and colleen i have a question and thank you very much for the follow up. it was thorough and helpful. i don't have any questions regarding this particular motion but i was curious about what appeared in here to be kind of a pausity of data relating to the actual patients searched in the past and more related to what is the zip code -- the demographics of the zip code and i hope it adds. our it system gets better as we have new programs and approve and constantly thinking how do we improve our data collection

because i think that will lead to a more precise understanding who we're serving and who we need to serve and aren't. >> certainly we will make note of that in future applications. thank you. >> further comments? if not we're prepared for the vote. all in favor say aye. all those opposed? the resolution is passed. >> congratulations commissioners. the next item on the agenda is a proposed changes to eligibility requirements for healthy san francisco and the administration of the city option. >> so here i am again. i am not diana. i am presenting the changes -- the proposed changes to healthy san francisco for you particularly they came out of so many policy endeavors we under took last year and early this year. so the genesis of the proposal that you have before

you is really -- has many elements. first we wanted to align healthy san francisco with the affordable care act. we don't want to create an disincentive to take up subsidies on covered california but healthy san francisco is available to those that can't avail themselves to those options. secondly as you're aware the hospital department convened a council in late summer and fall and made recommendations that were related to healthy san francisco. among them were the expansion of healthy san francisco to certain populations specifically seniors and people not subject to the mandate scprts insuring that healthy san francisco remains available to them and that's what these suggestions do today. also minimizing gaps in health care coverage for san francisco residents. as you know any

applicant to healthy san francisco comes in and the eligibility workers help them find whatever coverage they're eligible for and make the best financial decisions for them about own roling in health care coverage. the recommendations increase the flexibility of the city option to facilitate the option of health insurance coverage and as the health commission remembers this has two components. healthy san francisco is one but for those not eligible for healthy san francisco it's medical reimbursement accounts and reimburse people for the health care related expenditures. the recommendations also continue the healthy san francisco mission of serving populations not available for aca -- eligible eligible for aca and important state and federal dollars are maximizing before a local dollar is used to support health insurance. so just an overview. there are two

components to the changes we're proposing today. one are changes to healthy san francisco eligibility and the second are changes to the city option. so changes to healthy san francisco eligibility there are three key changes we're proposing today. the first is to remove the upper age limit so currently healthy san francisco is available for 18-64, but this leaves out seniors who are otherwise eligible for healthy san francisco, seniors who are undocumented or seniors who have not qualified for medicare are not eligible for healthy san francisco and this was one element that was raised in the universal health care council with san francisco aging population as something that is important. our current estimates indicate this would be about 1200 san franciscan if we remove this limit and be eligible. the next is decrease the limit to 400% of the federal

poverty level and align the income limits to the income limits for subsidies on covered california. currently anyone with income 400% of poverty or less is eligible for subsidies on covered california so this would mirror that. currently there are fewer than 175 healthy participants that have income in that level and of the 25,000 currently enrolled in healthy san francisco so those individuals could retain their coverage until their next renewal time. at that time they're no longer eligible for renewal and then the third change that we're proposing for you today is to extend the healthy san francisco transition period for covered california eligible employees through december 1, 2015. the health commission previously approved the extension through 2014 and said in committee today to

allow what is newly health insurance availability to many people. not everybody knows how to navigate it so to make sure everyone had care during this period. we are proposing extension through 2015 for the department to come up with the affordability program that was discussed earlier so the health care security ordinance amendments passed by supervisor campos this year required the health department to come up with a plan to make health insurance on covered california more affordable for individuals that have employer contributions so we're working hard on that plan. we will come to you by august of 2015 but while we work on that affordability program we wanted to extend healthy san francisco to make sure no one is without health care services because of affordability issues so these are the proposed changes for healthy san francisco eligibility and if it's approved by which commission at your october 7

meeting then they would be effective january 1, 2015. the second group of changes is to the city option which again is a medical reimbursement account or healthy san francisco. previous to health reform if an employer corrected to the city option on behalf of an employee the city option if they're eligible for healthy san francisco so if they're a san francisco resident and not otherwise insured they are automatically put in healthy san francisco and made sense before health reform but now it doesn't make as much sense because if i have an employer contribution made on my behalf and it's may and i can't enroll on covered california until november because that is what open enrollment is so then it gives the contribution to the city for healthy san francisco and i cant use it to pay for

the insurance once i am eligible for it so this change would help with that. it says rather than giving an employer healthy san francisco if uninsured will give them a medical reimbursement account so that way they can accumulate contributions once they can buy health insurance. the second element of city option or the recommended change is waive the documentation requirements to transfer employer contribution from healthy san francisco to medical reimbursement accounts and right now we ask for this and removes this barrier so if these are removed from the health commission they would go into effect more quickly to enable people to purchase health insurance on the exchange and implemented november 1, 2014 and that is the conclusion of my presentation.

you have in front you a resolution that would implement these changes and for your consideration and vote on the october 7 meeting. >> thank you. commissioners we have one public comment which i think we will take at this point. dina long. >> good afternoon commissioners. i am the vice president of policy and advocacy at the san francisco community clinic corsortium, coalition of nonprofit clinics. we work with dph on many things including healthy san francisco program. i am here to support changes. the post 65 while it doesn't affect a huge amount of people is important to the clinics because they couldn't explain to a senior who was comfortable lean at a clinic for years once they turned 65 and not eligible for medicare and get this

program and helps the seniors. the other thing i wanted to mention i think there is uncertainty in the community because we know that healthy san francisco is shrinking and it's because of a positive reason. they're moving primarily to medi-cal and get comprehensive insurance and see the same provider in most cases but i think we always need to be clear to the community what we're doing and why and this program will remain for those that still need t the other thing i want to mention i go to meetings with other clinic consortia and in many reports say that the clicks have a hard time. >> >> clinics scheduling because they haven't had service for years and coming with chronic illnesses and we aren't experiencing that as much in san francisco because we have healthy san francisco so

someone moving to medi-cal from healthy san francisco doesn't have as much back up care so let you know we improve health with this program we hope to continue. thank you. >> thank you. >> commissioners, we're prepared for questions. i would like to start with the first one because i am curious about this slide which is up right now. all employer contributions, so that means that the people who are paying into healthy san francisco in the past we sent the money either to us or those who lived in the city or eligible and we sent it to a reimbursement account if they lived in san matateo or outside the city but now you're saying it would be sent into -- an account that the employer has that it goes into? >> let me preface by saying

that the health security ordinance mandates the contributions and the vast majority of funds provide insurance for people so 88% of the funds go to provide insurance. some go to provide healthy san francisco or the city option or other accounts, so this is a smaller proportion of all of the employer contributions ever made in the city, but what happens now if it goes to the city option the city does one of two things with it. if the person is a san francisco resident and doesn't have health insurance regardless of their income then it automatically goes into healthy san francisco so the person is given an opportunity to enroll in healthy san francisco at a discounted rate. what we're seeing now is the funding would automatically go instead into the medical reimbursement account and that individual it use that to purchase insurance on the exchange and accumulate until they are eligible to purchase health insurance.

>> so if choose to sign up with healthy san francisco is that still the option? >> we can convert it at that time. we wouldn't go back and take retroactively retroactive payments but we could convert it and with healthy san francisco. >> so you're saying through -- this is actually through the 2015 and your recommendation even if they were eligible for the exchange they still could come into healthy san francisco if we passed the extension through 2015? >> that's correct. >> so then they hold an option either to use that money from the employer to partially or fully be able to purchase on the

exchan they could continue to in healthy san francisco. >> that's correct. >> so it's one mechanism for everyone coming in whether they're in san matateo or not. it all goes into a medical savings account. >> medical reimbursement account, yes. >> sorry. >> those funds are administered by the san francisco health plan and not reimbursable to the employer so they're with the employee for the life of the account. >> they with the employee for the life of the act so they can spend it years from now. >> that's right. >> okay. all right. commissioners any further questions? i thought that one -- >> i have one question, one comment, so it sounded like this was 12% of the dollars but i'm not sure. >> less than that. >> and how