where a revenge status and yet we have papers talking about the you know families losing not only family members but i mean literally go having their family members decapitated and trying to come here as refugees and hear the undocument and unwanted and let's build a bigger we'll somewhere we reach a tipping point we have to say this is what a refugee is and would you it gets to me the fact we've also been such a leadership have played a leadership roll in working with our diverse communities although we'll have historical events but again in today's age it could come from

our health department i mention that violence for years and mentioned so the medicine is saying we need to look at the violence not much has changed but redefine that at the state and national level. >> we certainly will immigration is a national issue and the fact we've had a city in san francisco for many years huntington park help is with that, i totally agree with you dr. sanchez and we're thankful to the president for allowing many of the families there are still people that are not qualified so we'll use the safety net to insure that everyone feels welcome within the department and we'll work with the national level as well. >> thank you. >> was there any public comment.

>> there are no public comment for questions. >> proceeded to the next item. >> general public comment we have a one request. >> yeah. mr. gasping rose you have 3 minutes, sir. >> good afternoon, commissioners i'm my name is michael i've been a resident of san francisco for 16 years now an economic researcher on topics of hiv i'm hiv positive and i have used several of ryan white services i served many years of the hiv planning council who's duties include even though allocation of ryan white i sent a lengthy document to the commission that

provides greater detail about any comments i've come to draw your attention to the document as i provide what i assert to be corrupts false claims falls indication of documents and more in the application and expenditure of frill ryan white funding as a last resort for the impoverished and vulnerable population in the past few years san francisco is out of compliance with the will fundamental conditions for eligibility to receive the ryan white grant funding the council has been wieldled down to 24 and for years has been lacking in the representation of community of color youth and the incarcerated the city contracted

the support staff as appropriated and performs many of the responsibility but not only significant a conflict of interest but violations of congressional law it is evidences in the material of public records iments the prevention and care of the counsels are in the process of integration and lack of diversity and having a place at the table and the illegal operation is taunting the mergers and the care planning for years to come i make those xhmsdz from a place of good faith i want to quickly talk about the care and prevention planning councils the latter of which in their opinion has acted with the most district and

transparent and accountability i request all inquire and intervention within the board authority and jurisdiction. >> thank you very much. >> there are there any others public comments. >> that's the only general public comment. >> next item is the finance and planning committee report back. >> commissioner chung. >> my apologies i dissipated out pr the finance and planning committee met prior to this commission meeting and we had recommended a set of grants and also a request foresight

approval that is included in the consent calendar for us to approve and in addition we had another review of the changes you know to the contract review crazy and we believe that we will be able to get the final draft for the commission to approve at the next meeting on january 20th also we had an opportunity to review the draft of the annual report and it is shaping up quite greatly i think the time

that will be up our approval next month thank you any questions commissioners and questions? any public comment on >> no public comment requests for this item and we'll go on to the next item. >> the consent calendar which commissioner chung noted it contains the relocation of the larkin street and the january 2015 contract report. >> the consent calendar before us commissioners for action we can take the consent calendar as a whole unless somebody wishes to extract any of that. >> specific recommends for moving the larkin street center by the committee. >> you'll precede commissioner chung. >> we are recommending to approve the site relocations

request and one the reasons they've helped to e held two community meetings and neither one had anyone showed up that has you know to oppose the move and also you know from the standpoint it so you would it is going to actually be a you know make things more affected because they have separate set closer to the site they're planning to move to it makes existing services for the community as well. >> commissioners, if we are prepared and nobody wishes to separate any of the items we'll proceeded to vote on the entire consent calendar all in favor, say i. >> i. >> the csas has bun adapted

thank you, commissioners item 7 is the gifts received in 2013-2014. >> good afternoon commissioners it's i'm pleased to present the annual report of g received in 2013-2014 there are gifts were given to the public health department from the san francisco general hospital function and the san francisco public health department and organization i'm pleased to present to you it was a total of $9.6 million received in fiscal year 2013-2014 of that amount 5.8 millions from the san francisco general foundation one hundred and 97 from laguna honda foundation and the health foundation had $3.5 million and

on the attachments to this it lists out the gifts over 25 thousand for each of the organizations and lists house the organizations distributed the funds during the year and the last page is the board of supervisors for each of the foundations and i must say that the department a grateful for the gifts i'm sure the commission is as well thank you. >> thank you was there any public comment. >> no public comment and commission i'd like to make a correction it says the approval was approved no action needed and commissioner discussion. >> certainly is wonderful that our public whishes to support our department and its activities and you're saying that oh, we're looking at what was life

insurance dispersed in terms of the expenditures. >> that's the second item on the attachment. >> obviously a large number of projects get small amounts of money and some get quite a bit arrest commissiioner sanchez. >> yes. i would say this is an excellent report and those who are revolved involved in the foundation are putting in the dedication to make sure those options are available in particular i want to the sf general foundation it is allocation of funds for many of the key programs that effect our patient and students sf general and the community and also mentioned one the main fundraiser is their hearts and heros is february 12th next month we don't have it in the

ball park but at the night one and quote the people that want to danced the wee hours in center field when a baseball player was on second basis if our interested contact the san francisco general hospital foundation they're a major contributor to many of the medical supplies we can't get so thank you them and gone down honda and thank you for step forwarding to the plate. >> thank you any further comment we're press the appreciation of the commission so for all of the donations that are listed here and appreciate

the staff also for bringing it altogether to we can acknowledge the doongsz and the care that our people have had in order to want to fund an environmental program so that we have accepted this report with our appreciation for all the public. >> thank you. >> thank you. >> commissioners the next item is the revised mental height rates for 2014-2015 and 2015-2016 and sf again and the next item are the advised patient rates for 2014-2015 and 2015-2016 this is only for outpatient mental health services the reason wear rising it there was a significant increase in the interim rate for outpatient mental services what

the interim rate is the rate that the state pace us for services provided during the year there's a whole process they see calculate the numbers they recently changed the rate and increased above the prior rates we approved we're asking for retroactive approve e approval of the item i want to point out few of our patient are charged this rate it is our published parting chart and most of the patient pay on a sliding scale and in mental health it's set by the state of california i guess that's about it as you can see the rates on the following page there are significantly higher

that brings them up above the interim rate it maximizing our reimbursement. >> we're competitive with the our industry rates for 2k3wrur789. >> well, the pushed rates the way the states compare the costs if our published rates they reinforce - reimburse you it's a strange animal medi-cal requires the published rate but that's not what they reimburse us. >> this is medi-cal. >> yes. medi-cal. >> wait this is the rate only

for medi-cal or this is the published 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 comparing