>> this is a reminder to silence all electronic devices. fire commission regular meeting wednesday, january 23rd, 2019 in the time is 5:02. roll call. president stephen nakajo. vice president franc francee covington. commissioner michael hardeman. ken cleveland is excused. joe alioto ve. >> members of the public may address the commission for up to three minutes on any matter

within the commission's jurisdiction and does not appear on the agenda. speakers shall address their remarks to the individual as a whole and not to individual commissioners. commissioners are not to enter into debate or discuss with the a speaker. the lack of a response by the commissioners or department personnel does not necessarily constitute agreement with or support of statements made during public comment. >> anybody wishes to give public comment at this time? are there any questions, discussions for the commissioners at this time? seeing none. public comment is closed. >> >> clerk: approval of the minutes, item 3. discussion and possible action to approve meeting minutes from a special meeting on january 4th, 2019. >> at this point, is there any public comment on the special meeting minutes of january 4th,

2019? are there any questions or discussions from the commissioners at this time? commissioner vice president covington? >> thank you, mr. president. yes, i did share with the commission secretary some minor adjustments. nothing of great importance. i. >> this is for the special meeting. >> the special meeting? >> clerk: yes on january 4th. >> we're doing them one by one. >> sorry. >> ok no problem. i'd like mont move the item. >> do we have a second? >> call for the question, all in favor say aye. >> aye. >> any opposed. none. thank you. >> clerk: an approval of the min es from a special meetig on january 8th, 2019. >> at this time is there any public comment on this special

meeting on january 8th, 2019? any questions, discussions from the commissioners at this time? >> i'd like to move the item. >> thank you, vice president covington. i need a second please. >> >> second. >> call for the question all in favor say aye. >> aye. >> any opposed? none. motion passes. >> clerk: minutes from the regular meeting on january 9th, 2019. >> the regular meeting january 9th, is there any public comment at this time? >> commissioner vice president covington, any questions, discussions from the commission at this point? >> as previously mentioned, i'd like to move this item as well. >> thank you, very much. is there a motion to approve? commissioner vice president covington has moved and i need a second, please. >> second. >> commissioner.

all in favor say aye. >> aye. >> approved. madam secretary. >> item 4. five department operating budget fiscal years 2019-2020 and 2020-2021. presentation from mark corso on the fire department operating budget for commission review and discussion. >> at this particular time, is there any public comment on this item of operating budget fiscal year 2019-2020? hearing none. public comment is closed. director corso. >> thank you, president. good evening. here to give a brief update and start the discussion on our 19-20-20-220 and 20-21 update.

it's an overview of time lines and instructions. things we've touched on in previous meetings. look at budget to date. some of the updates in the current year as well as some of the discussion that's we've had so far regarding priorities and challenges. as always, open up for any discussions or questions that you may have. as i mentioned at the last meeting, we received our budget discussions along with all other city departments in december. the city is projecting $271 million deficit over the next two fiscal years. and those deficits are anticipated to increase. that is detailed in the city's five-year financial plan update. they're looking at a 644 million-dollar deficit and fiscal year 2024. so all city departments have been requested to make reductions to the support that they receive from the general fund to the extent of 2% in both years. they would be on going. that would be a 4% reduction in the second year and in addiction, they would -- the

departments are being requested to submit a 1% contingency reduction. 2% is $1.4 million and 4% is $2.7 million. over all timeframe, we have a discussion at the meeting today and then potentially further discussion obviously in potential approval at the next next meeting. budget submissions are due to the mayor's office on february 21st and over the next few months the departments work with the mayor's office to submit a city budget that would be on may 31st do the board. and june and july are budget hearings at the board as well as budget being considered at the board. last year, we're in a two-year budget process. last year's budget process supplied a second year. as part of the budget last year, some with month indications our

budgbudget has approved. all known fringe rates, the results of the m.o.u.s are incorporated into our base budget. one time expenditures are taken out and equipment is usually extracted and target reduction requests are measured against the department's general fund support. taking our expenditures from the general fund, offsetting revenue that this general funds is contributing to our budget after consideration, that's from which our target reductions are based off of. so here is kind of a historic budget overview. so our budget over all, the blue you will see is the total department budget. the red or orange is the general fund department budget. as we discussed previously last year marked the first year we eclipsed the 400 million-dollar threshold for department budget. that's anticipated to increase as you will see on the next slide in the coming years. as a result of that, the general

fund, the non general fund is things like the airport and previously the port and other funds that aren't paid by general fund moneys so as i mentioned it's a 21% increase over this time. majority of that is due not to expansion of scope of services but to some extent for sure but it's salary and benefit increases. so here is a look at our current budget as compared to -- our base budget compared to our current and extended year budget. as i mentioned, we're looking at $400 million budget. and 413 the year after that. the reason that is lower, is because a lot of the one-time equipment and capital expenditures are scrape scrippe. that will reduce the budget until those allocations are approved. $269 million is our general fund support.

after revenue, after offsetting funds from other expenditures like the airport, that's how much the general fund is allocated for the department. so that's what the base -- after prop f staffing considering are removed, that's the amount from which the budget reductions are based off of. so current year, there were some changes that were approved last year. there was the addition of a grand writer. that position has not been filled but the announcement closes later on this week. we're looking forward to filling that. we had funding for q.r.v. vehicles, which is staffed and e.m.s. 6 which established a administrative position. there were changes to overtime and federal labor standards act. there were some impacts to the department. there were changes city wide and impacts with the department as well. the on going hiring and equipment plans were in the process of procurement and a number of apparatus and the next academy starting up next week, the fire academy.

fire prevention. we've expanded the scope of work along with city initiatives such as a.d.u.s and other plans and construction projects. we brought on additional staff supported by revenues to manage that workload and provide the bureau additional resources. there were other staffing include. airport increased some training staff and infrastructure staff as well as bike medic staff and there's marine equipment allocation added back as part of the budget process that covers marine equipment as well as the match for our dive boat that was allocated from a federal grant. so to date, last meeting we discussed our capital and i.t. requests. those were approved by the commission and submitted to the respective committees by januare deadline. there were a couple of changes to those due to some changes in the program. i'll detail those at our next meeting. we continued to work with

division heads on budget issues and needs assessments. we've reconvened the budget committee to discuss the needs of the department and prioritization of those needs. i have included some of the materials that were incorporated in your packets as well. we'll update staffing models as well as revenue and feed projections for the next two years. as far as over all departmental priorities, both the department effective may 2012 established under mayor lee's leadership, public safety hiring plan. that has continued through 2020. in addition in may of 2016, mayor lee established a public safety or fire department equipment and apparatus replacement plan and so from a departmental perspective, it's very important we continue thost

we can but enhance those to future years. that is an ongoing and in addition, we are discussion, along with the budget committee and labor departmental priorities and e.m.s. staff and cyst assistance and in addition to just over all staffing for increasing in calls as well as support for restoring funding for incident sports specialists so those discussions are on going with the budget committee. challenges, i think we've discussed the budget committee level, the large challenge is to submit a budget that would be in response to budget reductions but also have the department deal with increased call volume and increased demand for services. so not just front line calls but in addition the scope of services that the department

provides and has increased over the recent years such as public education and outreach and those kinds of services as well. so there's a very much a lack of budget flexibility that we have given the staffing requirements that we have and the number of initiatives we have. the consensus among the budget committee is that we are the department should not submit reductions to its budget. we have been proposed to the commission previously so it's up for discussion. that's been the message from the discussions at the budget committee level is due to the needs of the department, the department shouldn't be submitting any budget reductions. we're still looking if there's any revenue opportunities to offset some of that, currently that's been the discussions so far at the budget committee level. just going over the documentation that you had in your packets, just a very, very

high level overview outlining the department's costs, revenues as well as expenditures. there's a little packet on page five that outlines the different types of revenues that the department has. by project. on page 8, outlines the total expenditures by type. salaries, benefits, materials and supplies, et cetera for general fund and not general fund and then on page 10, or on page 12, it outlines the 14 it outlines the type of expenditure by division or project type. for example, sports services prevention, administration, et cetera. as you can see in all cases the budget rolls up to the 416 million-dollar base budget number that we were discussing previously so i'm happy to answer any questions. when we get towards budget approval detail and submission

budget book information will be provided to the commission in advance. and then on the last page of the packet provided, there's three pages here. it's an overview of the items needs that were identified both from different divisions as well as the budget committee and were currently up for discussion. we've met a few times and we'll send out communications for prioritization of these needs and we anticipate meeting either the end of next week or early in the week after to discuss and formally prioritize. just because the budget is submitted in february doesn't mean that our conversations with the mayor's office stops, they just quite frankly begin and many as facts so it will condition to discuss our needs and provide our data and justification for a lot of them over the next few months up until the mayor's budget release in may. with that i'm happy to answer any questions you may have. >> thank you, very much,

director corso. vice president covington, did you want -- >> i called for public comments. at this point, commissioners. >> >> thank you, mr. corso. you are doing god's work and we all appreciate it. >> thank you. >> i had a question. last year the issue of $100 million of fees that were uncollected and i believe those were ambulance related. is that in here? >> yes. so if you look on page 6, top line. >> so on page 5 and 6. on page 6, the top line, ambulance billings that shows the estimate total number of charges that we would be billing for.

actually the previous line on page 5, the last line on the bottom shows essentially the write offic offs for that and te anticipated revenue for that department. >> there's $135 million billed and there is $106 million that are written off. what does that mean written off? are you just not collecting that? is that something every year we just -- what is that exactly? >> it's a combination. it's for bills that aren't paid but it's also mainly based on the demographics, we run a lot of medicine' car medicare and me do not collect anything beyond for what they approve. if we have a $2,000 ambulance bill and the patient has medi-cal insurance, they will reimburse us $125 on that and

that remaining balance is then considered written off. there's no collecting ability on the department's behalf for that. same with medicare where it's $450 there's a big bill we're not able to collect. >> let's say that i need a ride to the hospital and i use an ambulance and it cost me a thousand dollars. my insurance covers 75% of that and i'm left with $250 bill for that. >> as a copay or something along those lines, right. >> i have to pay the department that money? >> correct. it would depend on the structure of your insurance but in most cases, a lot of insurance have a copay where the insurance will pay 75, 85% and there's a remaining balance, be it $50 or a few hundred dollars that would go to the patient. or to the patient's secondary insurance. >> what if i don't have any insurance at all which i imagine

is the case for many of the people using our system? >> correct. so we run people through the medi-cal and medicare to see if they're eligible for benefits and then we have an outreach that the billing company works with. if people do not have insurance, we have financial hardship program that allows for department's ability to write off bills if your income is below 300% of the federal poverty level where that bill would be waived. >> ok. >> it seems like in the system we've created for ourself, the system we've created people are being billio billed differentlye

same ride to the hospital? >> they're billed the same it just depends on the insurance they have. depending on private or medicare or medical, the charges are the same. it just depends on the insurance or the individual's ability to pay that fee where the account goes. >> in the three scenarios that you just mentioned, the ininsured, medicare, i'm the only one that pays in that circumstance? >> correct. >> everything else is written off? >> correct. >> ok. and so, over the last 10 years, by way of example. this number has been hovering at about $100 million. >> correct. >> we've written off a billion dollars in these fees over the last 10 years? >> correct. if you add that up. if you look at when we do a fee

increase, or costs over the years, costs of services may increase for the department and in turn our fees may go up and they go up by medical c.p.i. every year. that doesn't change the amount of reimbursement we're receiving from medicare or the amount of reimbursement we receive from medi-cal. it would extend the write offs with the structure of the insurance. >> you mentioned the general allocates, how much was that? $320 million? where is that number? >> i believe it's on the side. after accounting for our funds and our revenues it's about $270 million. >> $270 million? >> correct. after our revenues that we received.

>> it's twice the money we should be receiving in ambulance billings. the ambulance billings are $135 million. >> yes, that's an issue in jurisdictions with demographics we have, there's very low reimbursement. it's not very unique issue for us per se. >> who does the collections on the ambulance billing? >> we have a contractor that does our ambulance billing. we work with them to find better communications with hospitals and incorporating patient data and getting patient data. for example, when we pick up our patient, our crews may not collect the data on that patient before dropping them off at an

emergency room. we work with our billing company to set up with relationships to hospitals to get additional patient information from them for billing purposes. >> has anybody ever run the number as to how much of that 180 or $106 million a year that we are writing-off as homeless-related? >> i do not believe so. >> is there a way we can do that? now that we're tracking it, we've tracked that information for a year, we should be able to go to the mayor's office and say hey, madam mayor, 40% of our calls are homeless related. that's going to be a really low number because you know that more than 40% of our homeless population is using our ambulance services. assume that it's half that. let's call it 50%, which i think is still low. $50 million should be an added cost to homelessness to san francisco.

i just think that this type of information should be the information we're discussing with the mayor's office when we're doing budget analyzes. so when we're asking for -- when we're up at the mayor's office asking for -- just by way of example. a department electrician that cost $161,000. if you look at total of the asks on page 17, 18 and 19, that comes out to 29 million or $30 million. right. so, if we ask, for example, the homeless department, the department of homelessness to pay for the $50 million in homeless ambulance rides, we can get every little thing that is on that list on page 17 and 18 and 19 and have $10 million to

spare. i think these are the types of conversations we should be having since we're in a homeless crisis in san francisco. these are the situations we should be having with the other departments in this city since we're the ones that are picking up the slack on an issue that is technically not just our issue. our mission is to respond to 9-1-1 calls and make sure that people are getting emergency care. it seems like we're giving a large part of our budget to homeless people rides to the hospital -- given they need those rides in a lot of those cases and some cases they don't need the rides. it's cold outside and they know as the ms6 will tell you and some of the other people out in the engines other tell you, they know the right buzz words.

they say the right buzz words and wore going to show up and give you a ride to the hospital. that's probably a part of what is going on here. i think that we, the department should recoup some of those funds because they would pay for everything on our asking list plus another $10 million. i'm just talking to you because you are the guy bringing the news. it's not your fault, but it's something that the department could be better at, given that we're taking up a lot of the slack. i know the police department budget is $450 million when i was on the commission eight years ago. it's probably $500 million by this time and they don't have revenue sources like we do. their general fund pool is closer to their budget. we're the ones that are pulling in the revenue and pulling a lot of the slack for some of the

other departments. i just think that we need to do a better job of trying to get that stuff paid for. >> understood. those discussions are on going. i think that homelessness is being treated as a steed wide problem. to the extent that we have been able to insert ourselves in those conversations in general. we're trying to advocate for the department's position. >> let's try and figure out, if we could, i know jesus does magic work. if we can him to tie that number in an accurate way, the write-off number to homelessness, perhaps it's something we can ask out of the homeless budget. it's something that is happening. >> we can definitely look at that. >> great. thank you mr. corso, i appreciate the hard work you do. >> thank you, very much, commissioner alioto-veronese. at this point, commissioner hardeman.

>> thank you, mr. president. thank you for the clear speaking. your voice carried very good. probably always does. i just noticed how crisp and vibrant your voice was carrying. i just sat back and could hear very good. >> thank you. >> it's interesting, one of the reasons why graphs and charts and just information where you can view it is, you look at the base overview and you go back five years and you look at how it's grown. you look at how the department and the population have grown. that's a very modest growth in the budget. iin my opinion. i think we're holding the line very good. if you just grasp it, the

reality isn't the city. if the city would just hold its own and not growing any in population or in workforce, for this department, you would expect anyway. doing this under the circumstances of growth and the 40% that no addresses. is there a collection of any money for the 40%? or we don't even try to collect that. >> we do. we bill, in some cases, those people have medi-cal or medicare insurance. they just don't have an address. we'll take a closer look at it. we do bill and to the extent that we have information on individuals to see if they have insurance, we look at that as well. >> some of that is collected? >> i'm sorry? >> are funds collected. >> i would imagine for some of

them, yes. >> another thing, like i say, i like the written information. the revenue summary, the expense by type, ex pensio expense by dd the needs and review how you indicated everything. thank you. very good. i appreciate that. i might be sitting in on a budget meeting here. i really like to have this stuff in my mind before that happens. thank you. >> thank you. >> thank you, very much, commissioner hardeman. chief hayes-white. >> thank you, president nakajo. thank you to director corso. i would say that it might be helpful, because like commissioner hardeman finds charts helpful to track over a period of 10 years, the percentage of reimbursements that we get to see.

if that's changed or if it remained relatively steady. i think it's been fairly steady. it's a huge loss, i agree with you. i know time after time that has been brought up during the budget process. i just wanted to make clear that what we're tracking is not an exact science. again, non identifiable address does not always equate to a hopeless person. sometimes if there's a bicyclist that's down that is not with someone, we may not obtain that information. i just want to make sure when we do the comparison we're mindful of that. i'd also like you to provide, for me as well as the commission, the large urban jurisdiction collection rates, if you will. it's a huge number that we're not capturing or losing out on. just to provide some historical

data would be helpful i think for the discussion. thank you. >> thank you, chief hayes-white. vice president covington. >> thank you, mr. president. i look forward to getting those figures so that things lineup in a logical manner and that we have the information we need to really push for those dollars to come from other departments to assist us in this. this is a very, very heavy load that we have been required to carry year after year. the homeless crisis is not going to go away next year or during this budget cycle. we have to come up with the way

to happenedel this. mr. corso, i heard you say that conversations are on going regarding how to share this heavy weight. i would like to know from chief hayes-white, what is the plan? >> if you can be more specific, i'd be happy to answer your questions. >> ok. from your point of view, we have this 106 -- excuse me -- >> the uncollected e.m.s. revenue? >> yes, the $106 million per year in uncollected revenue. what is our plan going forward

in terms of getting dollars from elsewhere to cover this amount so that we don't have to go hat in hand for enhancements every year. >> i would say out of the 15 budgets that i've prepared, 12 of them have requested reductions which the department has always pushed back at. one of the reasons -- many reasons is that discussions such as this service that we provide, which is obviously a service that we need to provide, we're shorted by quite a bit. our collection rate is dismal at best. recognizing that it is sort of the industry standard, we bring that forward during the budget season and there's an awareness of that. we can continue to advocate. one of the reasons i asked mr

mr. corso to look at the data, i think our percentage is about the same or has it dropped? >> it's the low 20s. >> that's been pretty consistent. i think when i first became chief, it might have been 28%. it's been at that dismal level. i'm not saying that's something we should be proud of but it's become sort of -- it's a methodology and it's an issue that we bring up that we would like to have factors in and we have not been successful with that. i know that there's a new department created. i know that there's this 181 million which is maybe $185 million. these discussions will continue to occur in terms of making sure that we either get credited or that there's some sort of discussion to help offset that.

it has been difficult. we've not been successful at doing that. i know that when we are asked, well what is l.a.'s percentage of collections like or what is seattle's or phoenix, it is similar for the most part. i see the e.m.s. chief and you are welcome to join in if you want. i think i'm covering most of it. it's sort of the -- why want to say it's a cost of doing business because it's not a good answer but we're not alone in being a city that has challenges. i do not want to provide service because they don't have insurance. none of us want to do that to see a higher percentage would be something we'd loov to work on

with you. >> i don't know if that answered your question or not. >> >> this is such an important matter. no one wants a call to go unanswered. people call and help does not a arrive. i don't know if you, mr. corso or you chief hayes-white which would know the answer to the question which is, when the medical side, the ambulances came over to the fire department, were there any moneys at that time shifted from the health department's budget to the fire department budget. i know it was 17 or 18 years

ago. >> it was just the personnel that moved over in the operating budget for equipment. things along those lines. -- >> in terms of equipment it was sort of used equipment that literally came over and we repainted it. i mean, i don't know that it was a july 1st of 199 #. it was personnel. the f.t.e. count that came over. >> i see. >> well, i think that's just a start. the whole financial landscape of the city has changed from that time to this this merger of sorts predates the crisis we find ourselves in. so, with the onset of the

homeless crisis, we have it to make adjustments and the rest of the city has to make adjustments. this is the situation that is untenable. we cannot continue like this. >> thank you mr. president. commissioner veronese. >> thank you for pointing those items out. you are absolutely correct. commissioner covington, you are also correct in over the last few years, the city has a homeless department that is a 300 million-dollar budget. as of last year, we approved prop h purports to bring another $300 million to the city. i know we had a windfall of $400 million this year, much of which is going to homelessness or housing.

which are all very good causes but what we need to stress to the mayor's office and the board of supervisors, it's great that we have all this money and we're putting autopsy thi all this moo homelessness but we're addressing homelessness over here so some of that should come to us. as opposed to finding new projects to pay for and new departments to pay for. i know the department of health last year, i want to say they were over budget by several hundred million dollars and as i sit here and think about the billing, what do you know we pay our billing company to service that? >> it's commission-based so it's 3%. >> 3% of collections. >> of what is actually collected. i don't know why this -- i don't know why this fire department is in the business of collecting

fees for ambulance rides? we don't collect fees for calls when the fire engine shows up to your house. we don't bill for that. we should not be in the business of billing individuals in san francisco. it's not even within our mission. i don't know why this departmeny even consider this since i believe that to be true, why aren't we just billing the department of health? and the department of health, which has a full collections department, because when you go to stay in the hospital, they'll come and collect. why aren't we just adding that onto the people's bills for when they a arrive at the hospital? i get a ride to the hospital, i'm not just getting a ride to the front door of the hospital for what happens inside.billed why isn't the ambulance bill part of what that person gets from the department of health and we bill the department of health. >> not all of our calls are

transported to general or department of public-health hospital. that would be a little more difficult in those regards. we do work with public-health and general et going patients and we haven't explored the we work very closely with their billing and then in addition other cities resources, tax collect are et cetera for additional follow-up. in many cases, when they don't have someone that pays and there's a corresponding ambulances, we beverage leverage resources to pursue payment on that invoice together. >> let's say we deliver a patient to saint francis hospital, right, that person is going into saint francis and they'll get a bill from saint francis. by the way, we're dplivering business to saint francis. so saint francis wants us for those types of calls that they take, which is mostly burn-type

stuff. they want us to deliver to them. it's revenue for them. >> not necessarily. >> well, because they still have similar problems to our problems. a lot of the people we're delivering to these hospitals are unable to pay. i'm not saying they have 25% collection rate but their collection rate -- they're also very challenged. it's an interesting concept what you are saying. i think it would be more easily applied if it was to a department of health hospital. saint francis is private hospital, private entity. and so your suggestion is we just tack on our ambulance bill. >> whether it's saint francis or any hospital. >> nine receiving hospitals. six of them, seven of them are not affiliated with the department of public-health. it's an interesting concept. i applaud you for thinking outside the box.

it would require separate negotiations with each receiving hospital to suggest, when you bill, tack on our ambulance fee and they pay us. what i would first like to know is how of these receiving hospitals, what their collection rate is. i think they're equally challenged. i do. because of the way the health-care system is in the united states. when we bring someone to their e.r., they love to have business if the person is a paying customer. if they're not, they're in the same boat as we are. it's a larger discussion. it's a very interesting concept. >> i just think it's something we should explore. my bet is that they would rather have us bring people to them because they're in the business of doing this. if we don't bring anybody to them, they're not getting any business and they're not thriving hospital. there's a incentive to us.

they want us to bring patients to them. if we can leverage that to get them to do the billing as well, we can save at least on the 3%, and their collection process is better than our collection process. i will bet you that we get back half of that money. it's just a guess. i will bet you there's a lot of money we're leaving on the table by doing this for ourselves. >> for a large population, a percentage of our population it wouldn't change. we have 20 something percent medi-cal and 20% medicare patients for example, and whether we bill it or they bill it, we're not going to get additional reimbursement. unless the hospital wanted to pay additional, like you are saying, the reimbursement we would get directly or indirectly would still be the same because the reimburse the rates are the same for the ambulance and we would be getting paid via

indirectly or directly to the department. that won't necessarily change. that part of that write off is not really flexible because of the rates set fourth by the federal and state government. that's an issue that, just given the population, would not move much. >> i still think it's an issue that is worth looking into. i just don't think we should be in this business. we're obviously not good at it. we're writing-off $100 million every year. we're not good at collections. my bet is you are saying is that their write-off rate is the same as ours. they're going to want us to bring patients to them. we should leverage that to sew if we can do the collections through them or at least just look into it and see if there's something to this argument. >> it's worth looking at. just to reemphasis is we have a high percentage of people that

have a fixed reimbursement. so if it's a $2500 bill, whether it's saint francis, saint mary's, chinese hospital, or san francisco fire department, we're only getting $150 or $400 on medicare or medi-cal and that percentage is about 40%? >> i think, yeah, i need to look at that. >> it's worth having a discussion. i'm with you. >> i wouldn't say we're bad at collections per se, i think it's the way the system is structured. when we bill a medicare patient we get 100% of what we can bill for. to the extent we the patients don't have insurance and we try billing them if they just don't have insurance and don't have the ability to pay, it's not that we're bad at collections per se, but it's the way that the insurance are structured. can we improve? absolutely. a lot of it is the way that private insurance and

governmental insurance are structured that limits what we can and cannot collect. >> if i may through the president one final point. say if it is 30 4:00% and we want to medicare and medical the patients that respond to 40% who ponded to medical and medicare patients. that is a guaranteed 100% reimbursement and is very low. i was going to use another word. >> i think what this is telling me that we need to look closer. if what the chief is saying right, i think that's probably

correct, let's say 40% of medicare then a big chunk of this money is money that we're not going to get back no matter how hard we try. so let's figure these numbers out. if after those arguments are flushed out, it only comes out to a 30 or 40 million-dollar write-off and, you know, 50% is no homeless address, i think still it's important data for the mayor's office and board of supervisors should know. if this is a little bit miss heading and miss heading in a bad way because it makes us look bad. i stand firm on the fact we

shouldn't collect. we should stick with fighting fires. but thank you. i appreciate all the hard work you do and i am sorry you have to answer these. >> thank you, very much, commissioner. vice president covington. >> thank you. >> there are two things that come to mind. one is with the hospitals that are not associated with the department of public-health, they have foundations that help out with the money that would come to them but don't come to them because people simply don't have the money.

so we don't have a foundation that raises money. the other thing is that this is a problem. the reimbursement, just listening to the conversation, the reimbursements are a problem for us and for every other major city in america. it's a fixed amount. it seems as though we need to have the conversation at a much higher level. the fire chiefs of the united states level. this is not something we can do in san francisco. increase the rate of reimbursement for medi-cal and medicaid. we have a lot of people in the department who belong to various

organizations. this should be a broader discussion. the only way it will be changed is through the federal. we're uniquely impacted because we're the oldest city in the united states. we have the most -- well we have the fewest number of children of any major city. and we skew much older. there are more people who are getting money to help with the reimbursement of their bill but they're living on a razor-thin budget because of the cost of living in san francisco. it's not that they're trying to skip out on the bill, some of them, it's they just don't have the money because they're on social security or some social security or something else.

>> just to that point, your point with regards to changing state or federal and having chiefs' organizations to that and the chief can probably talk to it a little bit when it started. i guess five years ago now, there was efforts at the state legislature level to incorporate what has been approved as gemc oround emergency medical transport supplemental reimbursement program, which essentially is set up through the state, other states do it and this is pertaining to medicaid patients. there's a established cost share agreement with the federal to reimburse jurisdictions for that difference. essentially split with the federal. as a result of this program, we've been able to, i believe over the past five years, about

$10 million in additional revenue into the department and part that have is incorporated into our base as far as what our assumptions are but that was talked about on the chief's owessizatioassociation phone cad for state legislation and there in other efforts to expand that and increase the scope of reimbursement but there was one particular effort, unfortunately that was vetoed by governor brown so there have been efforo! efforts, those rates have not really change and have actually gone down due to state and federal funding issues over all. i think there are some of those efforts. i think more to your point there's an over all structural issue that's a hot topic of conversation nation wide. >> who is our advocate from our deposit at the table for these discussions five years ago? >> it was done at the administrative level through

chief hayes-white and chief myers. we worked with sacramento metro led the way and we had representatives in those work groups on kind of facilitating that program all along the way through approval. >> it would be worth while to renew that effort. very much so. >> i have monthly calls and there are topics brought ip for legislative changes. this is something we're actively discussing. and as mr. corso said, we reached success and added to our budget and the most reseptember legislative effort was vetoed by governor brown. >> we have a new governor. >> yes, we do. he made me chief. that means new opportunities.

go get 'em. >> thank you. >> thank you, very much. >> i didn't mean to interrupt. >> director corso, do you have any other remarks? >> not at this time. we will keep the commission aware of the progress of the budget committee as well as an invitation is always extended. i will get this additional information we talked about. >> i have a couple of questions. was there anything you would like to verbalize? >> thank you, president nakajo. other to reemphasize, for the next meeting, there will be this item and it will be agenda as discussion and possible action. if you chose not to act, which this is a big topic, we will need to have a special meeting prior to the meeting, the second meeting in february.

>> vice president covington, thank you for your engage discussion. the questions that you asked, the probing we're talking about, as you can tell, the commission is involved, as point of information, there was a budget meeting held on january 16th, and as the commission made reference, commissioner hardeman will be involved with the budget committee via the representation of the commission. my last question, director corso, is it your intention february 13th to have this budget approved by this commission? >> correct. we'll make any changes or any other further discussions and be presenting at the next meeting. i will have the materials to you in advance outlining where we are and i'm happy to answer questions. that's is the desire at next meeting. >> thank you very much for your answers and thank you very much for your interpretations.

>> thank you. >> madam secretary. >> item 5. chief of departments report. report from chief of department joanne hayes-white on current issues, activities and events within the department since the fire commission meeting on january 9th, 2019, including budget, academy, special events, communications, outreach to other government agencies in the public and report from administration, deputy chief jeannine nickolson add administrative divisions, fleet and facility status and updates, finance, support services, homeland security and training within the department. >> thank you, madam secretary, chief hayes-white we'll take your report and i will hold public comment in your report as concluded ex then we'll have deputy chief nickolson. >> thank you. good evening. it is my report since our last meeting january 9th. regarding the budget you just

heard from mr. corso related to the budgets moving forward in the next two fiscal years. we are currently on trlck in our current fiscal year related to our budget. mr. corso mentioned the grant writer position and good news is that the deadline for applications is this friday and to date we have received 50 applications. they are gathering those and sorting through them and categorizing them. making sure they met minimum qualifications and they will be forwarded to mr. corso for his review. i anticipate a three or four-person panel to select the grant writer. we appreciate your input vice president covington on enhancing the job announce.

related to our division of training, we will welcome 42 members into the 125th academy january 28th. they will be joined two weeks later by 12 members from station 49 who are currently being processed through the repartment physicians office for a full compliment of 54 members. we anticipate a class in the fall of 126 academy also comprised of 54 members. and we are planning to have a h3 level one emt class coming in in the summertime. one of my goals is to select those dates for my successor to be able to work with when he or she gets named and assumes the role. activity since the last meeting, january 10th, i attended, as i do every two weeks,