rate which we bill medi-cal and then are you saying that medi-cal reimburses the published rate whichever it lower. >> your totally correct i misspoke the published rate for all payers but it is primary the rate is based on our medi-cal reimbursements that's our major pair this is higher than the other payers like medicare but medi-cal is our primary payer in the mental health services. >> does that help commissioner. >> yes. thank you. >> is there any public comment. >> i've not received windows. >> any further comments from the commissioners we need a motion to accept the patient rates. >> so moved.

>> second. >> any further discussion if not all in favor, say i. >> i. >> all opposed the rates are passed. >> thank you very much. >> the next item is item 9 the depending the state and protective plans. >> good afternoon commissioners director andrea with the office of policy and planning i'll talk about our state and protective plans a little bit of your background on the plans those are guided by our priority

position and we promote those those plans are incorporated into the citywide legislation plan their presented to the mayor's office and they serve as a guide for monitoring the policy issues as well as any advocacy action on the issue the plan is provided to the lobbyist so they know what to work at the state or federal level the plans are developed with entity from the experts throughout the year we track the issues we gather the information and in december 2014 we held a policy forum where policy experts from the department could provide input from the draft plans as well as highlight the emerging

issue from the perspective action their covering a board range of issues and that are drafted by the lawmakers at various levels in your packet you have the draft plans so i won't go over the plans in detail but highlight some of the major themes as well as hot topic issues we'll be following throughout the year into state and federal legislators have reconvened some bills will take white to get through some issues we track and support fall within the basic themes at the state and federal level we want to support the affordable health care act and sustain the safety

net systems and we are interested in maintaining or funding for communicable disease control and perspectives we are land use & economic development interested in increasing the access to integrated health care services as well as that or not funding for affordable housing this is an important health issue. >> so in state issues to watch the 1115 medicaid renewal is happening waivers allows the states to retailer how they deliver their deliver health care to their populations a major driver behind the transitioned to meld and allow the states to realize some sooifgdz compared to fee for services the current waiver was

authorized in 2010 and expires in 2015 and at the end of october this year and this waiver is significant source of fund for public hospital assistance so through the safety net care pool we get if those mitigate care costs for the general and then our department system wide and also it provided some money for public hospital systems to revamp how they deliver care to do lean improvements and things like that as i mentioned the 1115 waivers are a major imthat is true tuesday for the care it resides within the waiver and this past the current reiteration allows

the current expansion for the transition of the seniors and the person's of daubltsdz into medi-cal to allow the states to dispictures or percent the medi-cal and this current waiver lazy the fraction for performance is based improvements in the managed care providers so overall the current waiver is worth about $200 million a year annually to the department so we care and the renewal process itself is compacted the state started this kickoff 0 process in july of 2014 they expect to submit in their renewal proposal in february and after they submitted it they'll still go through months of new york city before it's approved it may not

be how it is now but there are several important aspects that the state is pushing the whole care like housing and integrated health and medi-cal support this is not something the federal government has funded, however, we're trying to make the case this is an important health issue and we're interested in decreasing the costs through payment reforms and recruiting the benchmark population so dpw has an internal work group that is following the process as it goes through the state we work with our partners at the california association of public hospitals and health systems to monitor the process and to insure that the final proposal

that the states submits has the appropriate performance measures that our systems are able to meet and as well as programs that benefit our clients and build on our department strength. >> so the affordable health care act implementation is also an opening issue to watch to the republican the reason the election for the majority to congress and awhile full appeal is not likely was the wanting will veto it the lawmakers have appointed they want to see changes one of the major things that might be changes to provide the health insurance this was slated to happy in 2014 and then went to 2015 and the fair implement is not until ru89 we

they want to see the definition of the employee changed so more employees are required to provide affordable health insurance toronto employees working 40 hours per week the affordable health care act requires all health plans to cover the services including preventive services at no cost so we're expecting the implementation bills we're expecting more and we anticipate there will be overlap with the expansion effort the supreme court will be hearing a utility against the ac a happening in march this decision is not going to fecal we have a state basic

go change, however, we'll be following it it might cause confusion for the organization c a enrollment and the behavioral health rather than the excuse me. medi-cal go programs will be where i reside to provide specialist mental health services as of last year we're anticipating more implementation bills from the state and are interested in pr this it may affect how counties provide the care to the mentally ill people the medi-cal program provides the subsidize programs to the patient recently the state presented a waiver to the current amendment to the current waiver reorganizing the medi-cal program so we're interested to

see how that turnout and if that gets approved that big part of it might be the scope of services covered under the direct medi-cal program proposition 47 was recently passed in the november 2014 election and essentially it does reduce the criminal severity of certain crimes to misdemeanors rather than felons those are not permissibleable in state prison so the state will save money for mental health programs those grant will not be available until 2016 by the implementation language will be coming through the legislature through this coming year and make sure that pioneer kintsz like san francisco are not punished and

affordable housing is included as an option for getting money we are seeing a program with the people of see schizophrenia to be eligible for money right now and the administration is due to present it's result and bans those results it may disthat mental ill could be included in the definition for disability. >> on the crime prevention side there was an interest in the diabetes last year a bill to enact diabetes plan that failed and maybe be reintroduced again on switchblades we may see a

plan to reduce consumption and tobacco is a big issue notably the bills are for the regulation of e cigarettes or minors not to smoke those are prohibited access to hewitt food and nutrition is going to are activity and the nursing activities low provide grants they'll send nurses for home visits for the first time protecting mothers this is great nor prevention and helps to improve outcomes san francisco is a participant in the point out and wants to see this program expanded and on the federal level we will are monitoring this which is a

target for the centers public health preparedness we have a budget funded through september of 2015 and it largely fund communicable disease at static levels as the of previous levels, however more funding for the preparedness as well as the fund interested to see p how that plays out at the state level it turns out that public health preparedness is also under fund we're interested in supporting any efforts that addresses that as director comparingcy mentioned it could entitle resident to medi-cal the

distinction it will be paid for state the governor will have a lot to say about 3 the previous executive action a president obama did a couple years ago did allow a new more young people undocumented young people to be on medi-cal by it took the department of public health almost a year to get that approved at the state level a bill offers full medical despite the documented folks the bill has been reintroduced and in general health care financing issues will be medi-cal reimbursement this year marks the end of the increased medi-cal provider payments under

the ac a in the governors budget that will be something to watch the ada realignment it they may or may not revisit it based on the parents we'll be watching that and the state is planning to do pilot for from me qualified health centers so the health centers we're interested in monitoring the development and on the federal level for disproportionate health care reforms in 2016 under the ac a some cuts that are slated to happen and the county health centers bumps were provided to the health centers that were due to expire in 2016 so commissioners you have before you a revolution approving the

state and federal plan those plans went to the mayor's office this year early so the revised plans will be resubmitted. >> there's no public comment on this item. >> thank you, commissioners. >> i'm sorry it looks like someone has a comment. >> oh yes and this is deanna we've shared many of the priorities i want to bring to your attention to the issue you mentioned about the community health center funding issue it's a significant issue both for the clinic that are part of the thought consortium and part of the health department the owner because of the segregation but

basically, if we fell off the cliff and not keep the level of funding we'll receive less funding than before the ac a so there's a big bump there's been new assess points out and new grant and back counsel to a level before the ac a was implement we don't know and the federal department is not saying how phil they'll do the cuts we know that overall it is 60 to 70 percent but how they'll take the cut for example they'll could choose i'll fight against it to fight the areas where they're the clinics and that's the only option if that hams f that will

defund san francisco disproportionately they could effect the homeless program you know it's the root so we're you're going all of you to take part in some of the campaigns against the health center and the cliffs led by the association of the health centers we meet with the city lobbyist and discussed that state will took a concerted effort there's not a push people are not worried about it and it didn't happen until october there's not a great vehicle that gets it by congress it is an area of that big concern of ours. >> thank you health center cuts and all where is that in our presentation you

spoke about is it under safety net carpool. >> it's at the end it's a federal issue it's the last slide or slide 11 i'll go up to it. >> oh, okay. >> it's the federal. >> it is it says to watch so, i mean is it many the documents that. >> it is part. >> those things are highlighted but you already have them as part of things and you've now summed and highlighted those are big items we have to keep a watch over. >> the protective or the health center is included in there in the federal plan and file number called out we wanted to do in the presentation to highlight the actual issues the plans are

so board to cover anything and everything that comes up. >> i'm trying to clarify what it is a complicated program so in which they have increased the primary care for two years and going basis to non-medi-cal rates. >> right. >> there's within no movement to actually tie that for 2015. >> we don't expect the state to keep up that. >> commissioners commissioner pating. >> i'd like to tell everybody on the policy and planning division i think this is a great set of policy issues i think for the positioning as you place this going forward where we need to be it is consistent with the

future plans on both sides and i can read two or three of the staeveng plans i really like n this menu of policies two quick questions you're calling this a watch those are watch because we that haven't taken a follower position i said to ask you we've approved this easy approving a position paper or a watch list for more information on that part and second more complicated i have issues around larger budget concerns a lot of the various issues life's blood eir like the 2015 manner has unfunded and how we track that at the last meeting i was impressed on a personal level mr. wagner's sense that we've begun 63 quarters of positive

earnings and positive krblgz sooner than later with the 1115 b and the prop 47 and others i support one hundred percent i wanted to make sure we have recycling and budget averaging plans in there while we support those make sure we look at the framework to support those commitments for me those are the right commitments so could you answer the first question position around the watch and what we're looking at in terms of what can be unfunded for a broader picture. >> those are noted action issues to watch because that's how we monitor them but for in general we do have internal

department positions on who we support any of the measures but as a department we're not allowed to take an official position which the city can so the ac and the protective plan we tried to highlight how we will support issues or oppose issues and then in regards to our second question the a lot of the things like the ac pilots those are issues to watch because the starter if have a plan they've started something like a proposal that will need to get approved by the legislator and they'll implement the bills to make it happen those are things we need to follow throughout the year according or occasionally what happens we like a proposal but once it goes to the

legislature it changes so we need to change our position so the protective plans allows us flexibility on what action to take. >> it's complicated the waiver it is so many different parts in the package we like 90 percent but 10 percent we're worried about you don't have to complicate it but how your approaching this as a c pack and agencies begin to lobby for us. >> we mentioned we have an 1115 internal group we meet twice a month the public health systems is taking the lead on the waiver specifically around the hospital financing portion of the waiver so greg wagner and valerie are both our key members of our

internal group and we discuss the implementations all the time a lot of what wear concerned about the waiver is frankly more entities want part of the waiver but the waiver part the amount of funding for the public hospitals we're the only ones that put up the non federal share they require the federal dollars and the state didn't put up a dollars donate one thing to make sure that we maintain at least the same level of funding and the second thing a lot of it is tied to metrics you've heard if you see the district program the system the repayment program those are the funding is tied to us achieving certain metrics we work with the clinical leads within the hospital to make sure

those metrics mediated our purposes and meet our standards and connected to goals we want to chief at the hospitalities that's a long answer to our question i'm sorry we're integrated in the way we're responding to questions. >> i assume the project is complex you'll keep obvious posted. >> yes. >> if i could clarify for sure that's where i got trapped in the term watch it means monitor not an official protective position. >> those are items we're highlighting could it be easily said issues to be highlighted. >> commissioner chung. >> a couple of questions the first one under the communicable federal budget is there a reap why hiv i'd say and ryan white

are two different bullet points. >> now it was just something. >> the second question really is because ryan white part b is more of you know it goes to the state and they create the policies and you know and they get to decide how that money is being utilized. >> what gets into the area i know there are states that are looking at to aid the dollars to you know support ac enrollment do we know if there's anything like that happening in california specifically. >> yeah. we know that the california office of aids uses ryan white to offer support to

purchase insurance to undercover california and i don't know if there's other - >> so when we say we watch do i actually watch how know like those changes happen for instance like the utilitytion of this coming year like the ac and post medi-cal extensions. >> yeah. so actually what happens is by the end of the february all bills that are going to be introduced at the state legislator are introduced we flag them for you know this is a mopgs health bill, etc. and send it out to expert and get review back and depending on that review we sort of that's when we develop our internal position do we oppose or watch

it the hiv programs are also on our list to watch and monitor so if there's anything to monitor through the legislation or the budget we definitely keep an eye on it. >> of course the bills passed we have to don't worry about that it is something the nuances. >> but last year there was definitely some interest in using the office of aids funding to support ac a implementation and this i image is still going on. >> okay. thank you. >> commissiioner sanchez. >> no, i just think that the department is we've done a comprehensive job and preparation and whereas our whereas you give us historical context property owner