>> side and understand that last statement i just a member that the city plan was awesome for me i was married with 2 children and it was crazy so it forced me into another one i don't think city health plan people who i'm sorry the city plan, chairman thank you for your comment other any other comments if not we are ready to

vote on this matter all those in favo all those in favor say, aye. opposed nay

>>mdm. clerk can you move the next item? >>item 5 is an action item. staff recommendation: approve renewal. documents provided to board prior to meeting: report prepared by aon hewitt. >>before you you have their

proposal to reduce the rates between the 1st 3 years 2017 2018 2019to 2020. theoretically we could hold these rates for 5 years. from the chairs position of time. >>we have a presentation. ongoing with mr. chair and the body we recommend you accept these rates for the period of 5 years with the reduction of rates for 3 years as outlined on the schedule for rates

raising 2% a year for years 4 and 5. do we have any questions? >>do we have any questions from the members of the board to the actuary. i'm going to accept the motion. >>if the health service board except the five-year renewal. it >>this has been properly moved and seconded. if there not any more questions or comments then it is public comment. >>i want to thank you neil for that axillae and review of all the figures. i think he does a great job but that is just me.what i see is to move the

acute eye care plan this is an enhanced plan that talks about a few of the additional services which iand the

generous support of the fact that the rates are going down with a minimum increase of the future. but i think we need to know more about the shifts of plan because i think the devil is in the details. thank you. >>thank you for your comment.is there any other public comment? yes? >>my name is paula connor.for those of us who are in kaiser will we automatically getget all these ophthalmology services that kaiser is covering? >>i will turn that the director

dodd. >>you will to be able to get all your ophthalmology services. they want to be changing. >>i am just curious that does this mean that you that kaiser will not be required in in ophthalmology to provide that benefit to people that did not have a kaiser? >>i cannot specifically by diagnoses which optimizeoptima logical treatments that kaiser might provide. optometry benefits are not ophthalmology. >>the practice i go to is both an ophthalmologist examines me and does that but are these services optometry benefits or ophthalmology benefits? >>optometry benefits.

>>i'm a retired kaiser physician and my husband is a retired ophthalmologist and that does not make me an expert but i can tell you that these issues here are all medical. they are not optometry services there are services that an ophthalmologist as you were or a medical eye specialist would deem necessary or not. historically if there is something that that person and you agreed that you needed they would contract for outside services because it was a medical necessity but not because it was covered under a benefits package so my speculation is that if this is necessary because of your medical benefits these would be covered. >>i just know that my service has improved since i bring them

notes from other practices. >>thank you for your time. please step forward. when they read them in and in the like that >>we are replacing these with primary i care which is a larger scope. there is not one take away from going from acute i care to primary eye care and their 43 additional services that have to be covered under thatprimary i care purview. >>can i expand on what you have

said we've had an expansion of benefit that no cost. and expansion of benefits at no cost. >>thank you. >>thank you. yes, commissioner lim. >>and a reduced premium. >>and a reduced premium, thank you. >>will you be providing services to all of the members because the members know what their benefits are it doesn't make use to them if they just came from the management we are good at the rates and the premiums but we are not good at providing all this information to the members. so we will

need you to go into that more thoroughly. >>there will be a list of vdt codes that will not be available right now but we do usually go through them line by line. >>the staff has noted and we will make note of that request. >>i guess the question that i have is that something that i have that you found that is really not done under most medical health care plans. is this recommending service and monitoring under the necessary addition. >>regular screening for diabetics would be covered under primary care. >>for nonmedical situations that

uic would be covering this under primary care for diabetics. >>you can't speak for contracts under other providers. would this be additional coverage or duplicate coverage. one would assume it for diabetics that it should be part of all healthcare plans. and not necessarily be carved out for vsp plans that a diabetic would have to add to the coverage. >>khyber is separate but for all of their medical plans it's my understanding that everybody has the esp's. so under they have the blue shield or uscthey would come in and cover that for the diabetic. >>would you please standby i'm going to ask if there any other

public comments? >>claire lasky. i'm still not clear on the kaiser answer. if these are medical services and someone is a kaiser member and they go to a vfp service to the have to go back to kaiser for the service or they continue to get that service through a vsp ophthalmologist and it's covered under vfp and not under their medical. this is what is not clear and i think that is what the question was. where does that kaiser member go because all kaiser members can have the vfp as well or they do have. how does that get applied for those individuals who are to go to a vsp provider and then have a medical need or a medical procedure that requires it. >>if director dodd can respond

to that please do if not we will come back to this. >>if it is medically necessary ophthalmological services are provided by kaiser. i am a kaiser member, if i go to vfp and i haven't had my diabetic retinal screen the vfp my understanding here is that the vfp optometrist could be determining where i get that. is that clear? is that accurate? it is not accurate? >>okay clarification please? >>every optometrist and ophthalmologist under vsps network will provide under vsp the night referred to ophthalmologist.from the kaiser

perspective anything surgical would go back to kaiser all right are we ready to vote or are there any other questions? all those in favor say, aye. opposed, nay. >> >> [chorus of ayes] >>next session item.

>>approval of "second opinion vendor" which members use to obtain expert opinions to validate diagnoses and treatment plans for the 2017 plan year >>on the 1st page a little

opinion on what a 2nd opinion would do in many cases a2nd opinion is for complex and or rare health diagnosis is it can be very beneficial to the member to obtain a 2nd opinion for nationally known expert and extensive experience and subspecialty expert in the particular area. the review is to ensure that the diagnosis and treatment is appropriate

and as well as looks to provide the most cost-effective care in the least invasive way to the member-based on clinical evidence.so they would contact the doctors the phone and up or web to initiate the case behind her as a ship to build long but i was gonna try along with the intake industry and then there was an

extensive- that would be identified in 450 specialty areas. the experts reviewed the results back to best doctors. at that time the physician would review the finding with the member as well as the members dr. i need on this how you get on their that expert on the report would be digitalized and they would remember to keep the feature. the doctor would reportwith that report the best doctors would also read the report of the treatment condition. >>we can read those but i do have a question about one.

ibmibm watson is a masterful computer. it is not? it is a computer responding to your questions. >>you can see the additional services on page 4 and on page 5 in terms of the fees the basic fee is athe fee is a recovery occurring fee per month and that will be identified once we have a headcount in the program. if we want doctors to look at claims data and identify members for outreach of our services and to include extended families and that would be covered under the plans and in-laws.the best

doctors physician reviews the expert findings and that the report is written in a way that can be easily understood by a non-clinician. then the physician from best doctorscompiles all information into a summary which accompanies the expert findings.the expert report and all medical records are digitized and put on a usb encrypted flash drive for the member.

>>thank you for your clarifications. is there a motion? >>i would move to ccept this the plan and get final rates for us to consider. is there a

second. >> so properly moved and seconded that we accept the recommendationto move to best doctors. a recommendation from the is there any public comment? >>i am gail bloom. i do not understand the nature of the proposal. i think everybody needs a 2nd opinion when you're sick. i think everyone needs an advocate. otherwise you don't know how to avail yourself. i have been with friends who are with kaiser who couldn't make that leap because they were too sick. that is my observation. when you're really sick you cannot work the

system to get yourself to the best doctor to get your evaluation. >>thank you for your comment. >>i don't know if getting a cd in the mail, i wouldn't want to get some cd in the mail telling me that i was sicker than i thought or that my treatment was weird.. that seems to be shocking. >>thank you for your comment. is there any other public comment please? please approach the microphone. >>i have a mother and a sister who both have chronic illnesses and i have watched throughout

the year how they have to deal with improper diagnoses improper medication that's being prescribed and i think that this would be worthwhile.it is great if you have a great primary care doctor they're going to give you rate information but unfortunately not all of us have great primary care physicians. recently there has been studies how women and people of color especially are diagnosed with people with chronic pain conditions. i think when think whenyou are one of those people it's facing a hard to navigate healthcare system then at least i know i have a phone call that i know i can make and they will at least review my case. i think that would be an

excellenttool for those who feel like they're not being heard and they have a place to go. >>thank you for your comment. other public comments? >>herbert weimer. i'm having some difficulty with this. i have had lousy diagnosis from one doctor and finally it's clarified sometime laterwith a proper diagnosis and i realize that some doctors make a improper diagnosis and there's standing for bellicose. i wonder if the best doctors organization, couldn't be with the blue shield with the city health planner with kaiser. i wonder if this system over

wraps somehow. i think this is very sound becausethere have been these diagnoses. i had a diagnosis that i would need to have a surgery but then i'd a 2nd opinion and they said that i would not need to do that and i've kept that doctor in because i like that evaluation. those that want it can have it those that do not want it can reject it. of individuals feel they are savvy enough to get a 2nd opinion to seek out it is fine.if they are done and they're absolutely in the state of panic and they do not know what the heck to do and they're very sick maybe best doctors would be good for them. >>thank you for your comment.

>>is there any

>>[gavel] >>we reconvene after close session and i'm willing to entertain a motion as to whether or not we report on the action taken after closed session. >>i move the action taken during close session.

>> seconded. >>action was taken that we not what report what was discussed in closed session.now we are ready it to vote. all those in favor say, aye. opposed, nay. >>now we want to take a vote where we would like to this goes any items are in close session. >>i move not to disclose. >>seconded. >>properly moved and seconded.all those in favor say, aye. opposed, nay.

>> [chorus of ayes] >>it is unanimous.we are now ready toadjourned this session of the health

. >> golden gate parks largest body of water ska great labor for scrolling and picnicking and both miking which can both be rented at the boat house and the lakewood design for leisure boatings and carriages and a treasure trove passing hunting ton water falls two bridges connect the strawberry island and inclient to the hills the highest upon the in golden gate park and more than free hundred

feet and you can catch glimpses will from the city at the top of a romantic look out and for go.

>> shop and dine the 49 promotes local businesses and changes san franciscans to do their shopping and dooipg within the 49 square miles by supporting local services within the neighborhood we help san francisco remain

unique, successful and vibrant so where will you shop and dine the 49 hi in my mind a ms. medina .

>> shop and dine the 49 promotes loophole businesses and changes residents to do thirds shopping and diane within the 49 square miles of san francisco by supporting local services we help san francisco remain unique and successful where will you shop and dine shop and dine the 49. >> my name is neil the general manager for the book shop here on west portal avenue if san francisco this is a neighborhood bookstore and it is a wonderful neighborhood but it is an interesting community because the residents the neighborhood muni loves the neighborhood it is community and we as a book sincerely we see the same people here the shop all the time and you know to a certain degree this is part

of their this is created the neighborhood a place where people come and subcontract it is in recent years we see a drop off of a lot of bookstores both national chains and neighborhoods by the neighborhood stores where coming you don't want to - one of the great things of san francisco it is neighborhood neighborhood have dentist corrosive are coffeehouses but 2, 3, 4 coffeehouses in month neighborhoods that are on their own- that's

>>good afternoon everybody and welcome to the san francisco board of supervisors meeting tuesday, april 12, 2016 mdm. clerk can you please call the roll. >>[roll call vote] >>please join us in the pledge of allegiance. [pledge of

allegiance] >>olleagues, can we take this without objection. without objection the meeting minutes are passed after public comment. let's go to our consent agenda. items 1 through 5 would comprise our consent agenda and consider it routineseeing no names on the roster mme. clerk

please read the role on items 1 through 5. [roll call vote]have passed unanimously. >>item 6 is an ordinance as part of a provement of a chinese hospital pursuant to the sale agreement need to copy these in favor of third-party utilities and private party owners and seqa determinations and adopting

and adoptingother findings. >>without objection this has passed unanimously. >>item 7. same house and call without ordinance this has been passed unanimously. roll call vote on item 8. [roll call vote] >>9 ayes, 2 nos. the ordinance

has past. >>next item please. >>roll call vote on item 9.[roll call vote] to visit

thank you >>ordinance passed 9 and 10 together.

>>item number 16 is an ordinance amending the building code to authorize the director of the department of building inspection to stop all work on a construction project whenever there are repeated violations of city codes on the project; and affirming the planning department's determination under the california environmental quality act. and item number 17 is an cohenordinance amending the building, housing, electrical, plumbing, fire, health, planning, and administrative codes to clarify and

standardize enforcement procedures for violations of municipal codes relating to buildings and property, to require departments to report on code enforcement activities, and to direct the city administrator to coordinate the preparation of standard citywide model forms for code enforcement proceedings; setting an operative date of june 1, 2016; and affirming the planning department's determination under the california environmental quality act; and making findings of consistency with the general plan, and the eight priority policies of planning code, section 101.1. question: shall this ordinance be passed onhas been living in unacceptable conditions for quite some time. what we had

we discovered looking into this issue and having an oversight hearing a year or so ago and we have found that there is not enough coordination among the department or the city codes are not consistent with one another and there is no requirement that the department has actually asked to address a code violationwe need serious ones. the city attorney does not have the pool that he needs to go to court when there is a serious violation.they equip the unified code enforcement process for building construction, for the fire department and to and for the public health and we are taking further administrative action and we are referring problems to the city attorney's office for litigation. second, we will provide the

city attorney clear authority to act by going to court and we will 1st require that the department actually asked the city to tourney to act and currently the city attorney typically cannot file a lawsuit in less the case is referred to by a department and this significantly hamstrings our city attorney's ability to act and protect the public welfare.. 3rd our legislation in designate quarterly requirements for accountability i am sure we can all see what is pending and asked why this will not go forward. nation

creates a code

>>supervisor wiener is proposing it will have a significant impact on those who are forced to live in homes that are notthe legal muscle to go after the bad property owners. that's what i have just met. thank you. >>thank you supervisor:. >>mme. sec. can we take items

15,17 and 18 same house same call [gavel]item 11 please. >>