didn't code as many serious illnesses in one year and that affected the reimbursement? and i would just say, i guess on the national level, the federal government has been pretty clear what it thinks about, not only the senior advantage programs and they've been paying too much across the board, not just to kaiser, but to all of them, but also that the providers are getting hit. so this is just a microcosm of a bigger issue that is happening across the board and that all medicare recipients should be cognizant of. >> makes excellent points. not an area of expertise on the coding versus what drove the risk change, but short-term, we can -- certainly, we can provide the information on what changed

that risk adjusting and validated a piece of it. i would present several pieces that go into that calculation and i'm sure that is one, but i'm not sure it's the main driver. >> i would be interested in seeing that level of detail. >> sure. >> the higher the risk or the more medicare reimburses you, right? they were doing with the upcoding. >> yeah, two components. so the higher risk score -- and again not an area of officexper but it's the relative risk across the program. so medicare for us is not dependent on your utilization. it's community rated and then risk adjusted. on the commercial side it's entirely utilization based. so if you're a higher utilizer,

you're rate is higher. if you're lower risk, your rate is lower. on the medicare side, it's a community rate approach and then adjusted for risk. so it's an adjusted community rating. so the higher our total program is in risk, the more reimbursement we would receive, also dependent on geography and other factors. the risk adjustment that is changing whether we go up or down and what we do in terms of reconciliation from year to year, is we get final notification of what that reimbursement will be. and that's a portion of it. but a bigger portion is the risk adjustment on that community rate on whether your population's risk is higher or lower than others within that community. that is the change. so it doesn't necessarily mean your group got substantially sicker. it's the comparison amongst the entire medicare population that we're rating as a community.

>> it's not the most straight forward approach. it is not unique. it is -- what is different is that we actually do the reconciliation, where others will provide their best estimate and then that is the rate. we're saying if we come out early, we want to provide the right rate. we don't want it to be higher or lower than we need it to be. so we want to reconcile. if we were to do the rate in july or august, there would not be reconciliation from year to year. we would have the data we needed in order to develop a firm rate for you. >> to follow-up on the request, can you give us that data analysis, the past 3-5 years, because it's curious to go from 13.2 decrease to 11.4 increase. >> sure. and part of it is the swing. there is a reconciliation down and then reconciliation up. so it's like the hip tax. when we took it off, it went

down a point. when you put it on, it goes up a point. the delta is two points, even though it's only a one-point change. so a good portion of that is there is reduction going down and then a reduction going up, so it makes the swing really big. it is still big, it's just not this big. it's only this big. but absolutely, we can provide that. thank you. >> thank you. the final thing i'll note is the proposed 2020 rate for kpsa even with the increase is actually lower than what the 2018 rate was. so 2019 received a substantial benefit from this adjustment methodology. >> i know there is at least one vocal representative in our audience today that says people are not living on 2018 income, they're living on 2020 income.

and there is impact to them. >> president breslin: any public comment on this item? seeing none. we've been doing this for an hour and a half. would anybody like to item 14. review approve medicare advantage preferred provider. >> mike clark. so now we're going to start our actual rate presentations with the united health care medicare advantage ppo. the uhg ma ppo.

as part of this discussion, if you look on page 2, the recommendations that we have to present to you today include two different scenarios, so one is what we're calling a status quo scenario, that is just straight renewal. no design changes, no program changes, but we do feel that a package of one recommended design change and one recommended new program for the 2020 plan year is the suggested approach, the recommended approach, but we do have information on both scenarios in this document. you can see the rates on the middle of page 2 for 2019 plan year expressed on a per member, per month, or pmpm basis. so 2019, the rate currently is $371.68 per medicare member.

that is a .7% decrease, that's due to the waiver of the aca hip tax. with aca hitback, 2020 rates are increasing 17% on a status quo basis, or 16.6% with the combination of the plan design change and program change that we're recommending today. i include for reference the page numbers for the actual rates and cards. and changes in total rates and member and employer contributions for each of these two scenarios. we will be suggesting and recommending for approval, the with proposed design and program changes approach. we'll walk through that.

so brief introduction which i mostly covered in the prior presentation in my opening statements, again, almost 16,000 medicare eligible retirees in this plan. page 5, i talked about this as well, the fact that the majority of the increase is due to the return of the aca hip. this is 10% of the overall increase. the remaining 7% is underwriting claims and forecast, et cetera, so really the underlying insurance part of this renewal is a 7% increase. which is in line with our national health care costs trend expectations. and then just as reminder of page 6 when we set the total premiums you see today, we also include the vision service plan, vsp basic plan premiums as well as the health care sustainability fund charge of $3 per retiree per month.

and the expert opinion service is no longer offered starting in 2020. we formally included that in the cost. with the recent board decision to allow that contract to expire, you'll no longer see those doctors in the rate cards. with that -- >> can i ask a question. why are they applying the hit tax and kaiser did not? >> it's a function of what each particular organization, what they pass on their writs. -- rates. united health care is choosing to pass it and kaiser does not pass it. >> are there any rules that we don't allow either one?

we have nothing to say about it? >> i can ask a kaiser and or united health care representative to speak to their organizational positions. it is a tax that is placed on health insurers by the federal government, because these are full insured plans, it's the health insurers responsibility to compensate the tax back to the federal government. every plan differs in terms of their approach as to whether they choose to cascade it in they're rates. >> is there a health care representative here? >> united health care care? >> this is a huge addition to our increase. >> they all have to pay it. >> we understand that. >> good afternoon.

hi, so from our perspective we see the hit tax, it is something we have to pay. so we see it as a pass-through only, so we're just calculating the tax based on the equation given to us by the federal government and then passing that on to the client based on the premium. it's a 2.01%. and each firm is taxed differently, depending on their tax status. we are for-profit company, so we get the full impact of the tax. >> but that's very much like some of the mandates that we have here in san francisco and whether a person in a restaurant setting decides to pass on the full amount and increase their menu rates or whether they're going to absorb that to some degree to maintain a client base coming to their restaurant. so i'm raising a question. not about your tax status, but about the policy or the

perspective of passing it totally through, versus assuming some portion of it. >> absolutely. we do standardly pass the full thing through as a pass-through with all of our clients, regardless of size and status, et cetera. but i can absolutely take it back as a question. but it's something that we have consistently passed through. >> i understand your current practice. i'm asking for the rationale. the policy rationale as to why you would do that versus absorbing some portion of it on behalf of your members? i think that's the thrust of our question. it's 10%. and it's a big hit. and so you've elected to do it. and i'm only asking why? >> absolutely. and we can follow up with a direct answer on that. at this point in time, what we've been given as why we passed the tax through is because we're being charged it.

it's a cost of business that we don't typically have. it's been off one year, on the other. we do give a credit back each year when it's not taxed, so we're just doing a pass through. there is no calculation. it comes in after the fact of the renewal calculation. however, i can come back with additional responses. >> thank you for the explanation. >> i have a question. >> just one follow-up on the hit tax topic. if you recall from last month, kaiser does pass the hit tax in their non-medicare premiums, they're just not passed on the kpsa premiums. i'll explain each in further detail as to why we recommend

these in subsequent pages. one plan design change is suggested to aid in lowering the premium rate increase for 2020, as well as to provide a coverage for the cost of the recommended new program below. so that is the increase the specialist office co-pay from $15 to $20 proposed. and then the new program to support members is 14 annual male benefit from mom's meals nourish care. this is in addition to the program implemented in 2019 in this plan. to the co-pay change on page 9. currently, office visit co-payments for the uhg ma ppo are $5 for primary care provider. and $15 for a specialist physician. you can also see for kpsa $20

co-payments apply for all office visits, primary or specialist. we're recommending the increase to $20 to partially offset the 17% rate increase. it's a $2.50pmpm increment. but we also feel that the primary care physician copayment should remain at $5 to enhance the importance of primary care to members. and with the increased focus of enhancing access to quality and nutrition options to these medicare members, that's why we also recommend the new meal delivery benefit which we present on the next page, knowing that the funding for this benefit does come from this specialist copayment change. just background on page 10. around cms now allowing for

medicare plans to allow enhanced benefits. you see the list of programs that were implemented for 2019 into the uhg ma ppo plan from transition support with transportation services and meal delivery post discharge, routine transportation services and nutrition counseling benefits. what we're recommending with the 14 meal delivery which is the same organization that provides the post hospital discharge delivery service today. and more information on the moms and meals program, we list out on slide 11. so this is a one-time shipment of 14 meals, home delivered, freshly made, annually per

member. these are regardless of medical requirements. so there is no particular diagnosis, no medical reason to then qualify for these. these are available to all members who participate in the uhg ma ppo program. they would call the service, mom's meals nourish care to access the benefit. you can see an array of meal options to tailor to a particular individual's needs. breakfast, lunch and dinner options are available and a wide array of culturally diverse meal options as well. the meals remain fresh in the refrigerator up to 14 days and can be frozen up to 90 days. so this comes in one shipment, 14 meals, members do have the ability to purchase meals on their own after this annual

benefit has been exhausted at the cost of $6.99 per meal with free shipping. the rate increase for this particular meal delivery benefit is $1.05, pmpm. >> quick question. do you have any information -- i understand this is new in 2019 as a percentage of members that took advantage of that new program? >> so the post discharge meal delivery at this point, only two have taken advantage of the post discharge meal delivery. one did use the entire 84-meal allotment. another member used a 21-meal allotment. i can follow up with the information on the transportation services and the enhanced access to nutritional counseling will follow up and have available for you after the

meeting. >> president breslin: how much extra did we pay for those meals, per member, per month? >> i'll have to follow up. i remember the total pmpm for all three, i just don't remember how they portioned out. >> you have 22 people using this, you know, these things need to be looked at. that just -- >> yeah, they certainly do. and one of the things that we've identified, a this is a function of a referral mechanism on a post discharge. and at discharge process in most hospitals is complex and there are many case managers involved. so clearly this is a very useful and needed, necessary benefit. the breakdown is occurring somewhere in the referral process. it could be -- i ran a number of these programs, the cms innovation programs and part of

this is often having, in our case, the member know about it from a trusted source. so we have some responsibility here to make sure our members know when they're offered these services that they're sanctioned by us and they're not something just falling from the sky. because none of us really like strangers knocking on our door giving us anything, right? so it has to be from a trusted source. so there is work to be done. but the efficacy of post discharge in meals has been proven over and again, but we have to figure out have to get the uptake on the service. >> but two people out of 16,000 or whatever we have. it's ridiculous we're paying for that. you know, of course it's a good thing, but if nobody is going to use it, what good is it? and people don't trust that. it's like --

>> just for reference, so it's available to anybody after a hospital discharge and that was three months -- the first three months of information, so granted a low number just with the recognition, that's a three-month number. and only those discharged from hospitals would be able to access the benefit. >> under this particular new program you're saying anybody can access it? >> correct. so all members have access to this 14-meal proposed benefit. >> i'm sure my mother will turn over in her grave, she was a nutritionist. it's hard to question mom's -- [laughter] -- four words in the program, nourish, meals, care. they're great words. we're not questioning the data or the value of post discharge

nourishment and some monitoring of that, which this program could help, but i guess the question i have, are there data on providing 14 additional meals over the course of the rest of the year for whatever reason? i did go online and look at their website, and you know, it's impressive. everything is frozen. i'm sure they have good vendors who make all this. and i'm sure it's produced more locally and hopefully more sustainably, we're not getting corn from somewhere outside our borders, but i don't know that this is really essential based on a data-driven analysis. that 14 more meals will make a difference for our members who are otherwise healthy and not been hospitalized or suffering illnesses that would complicate their ability to acquire good food from their family, friends or themselves. >> president breslin: i just, when i first looked at this, 14

meals delivered at one time. so you're going to keep them in the refrigerator for a week or you can freeze them. they lose a lot of their nutritional value right there probably, but i just -- so this would cost $1.05 per person per month for this nutrition program. and people are paying -- losing $5 on the co-pay for the specialist, so if you had the extra $5 for the co-pay, 10 of those would give you 14 -- well not quite 14, but they said you can purchase these meals for $6.99. well, that's not a bad deal, but to have this added -- i don't know. i just really question -- because i don't know anything about how the meals are. you know, i just don't know what kind of a deal this is. costs $200,000 annually, probably for this plan. >> correct. >> president breslin: 200,000

plus annually. and we don't know how many people take it. i'm all for people keeping healthy, as everybody knows, that's my big deal. and we have -- we're also paying $3 for the health care sustainability, for the wellness program basically. so this is kind of extra in that direction, but is it really effective? i just -- i really question it. i ask everybody else what they think about this. >> i'm curious, the basis for the recommended add. >> the basis is that this is a social determinate of health is the adequate nutrition of our membership. all health care systems are looking at how we can impact the health of our members outside of an institution. and so these programs that, you know, we started with the post discharge program, we already addressed those challenges. then this program was a way to

introduce our seniors that may not have access to affordable food, a way of getting that delivered to them appropriately and delving into addressing one of the major social determinates of health. >> i guess the question, is this something we should be doing, or the health plans should be doing it? people would hope that those in need of this would have the diagnoses and have access or the counseling about how to acquire this. the thing that bothers me about this, and the first proposal as well, is that we're -- the people who are the most ill and see the most specialists are going to be paying more to see those specialists. and they're already under financial strain. now this alleviates a little bit

of that. provides 14 additional meals, assuming they haven't been hospitalized, but i think it's a small fraction of what they would be paying. i was a specialist. i'm actually concerned more about the additional cost to our ill medicare members of seeing a specialist which is critical to their ongoing health, and $5 doesn't seem like much if you're only doing it once a year, but many of these people have several specialists that they're seeing, sometimes monthly, or quarterly, or semi-annually. and so i question actually both of these in terms of cost effectiveness for our goals. >> president breslin: any other comments? okay. >> we'll going to page 13 where

we present two sets of 2020 rate cards. the first set is pure status quo. no plan design change, no program change, incorporating the 17.0% uhg ma ppo rate increase. and then with the proposed design and program changes version reflecting a 16.6% rate increase in the uhg ma ppo. we present each of these versions with columns that represent the array of plans that non-medicare dependents can enroll when the medicare retiree is under the uhg ma ppo plan. page 14. just a reminder that the rate cards we present in the document represent the full employer contribution for retiree medical coverage that is available to retired medical employees hired

on or before january 9, 2009. there is retiree medical coverage available, but with no employer contribution to those retired employees hired on or after january 10, 2009, but at least five, and less than 10 years. on page 15, you see that retired medical coverage at the 50% employee charter contribution rate is available to retired employees hired on or after january 10, 2009 with greater than ten years of accredited service, but less than 15 years accredited service. the segment receives 50% of the contributions for each retiree medical plan, coverage here is reflected in the rate cards. again, just a reminder there are

varying levels of employer contributions, what we present in the rate cards are the full employer contribution version. so on page 16, before we look at the rate cards and the full rate comparison. this is really the bottom line for the member. this is the page where we look at the actual contributions the retirees would pay for each level of coverage. and we do have some additional coverage tiers with medicare families in the appendix as well. between the status quo retiree contributions, so no design change, no program change, the top half of the table. and then with proposed changes, design and program at the bottom half of the table. so this allows you to see the

difference in retiree contribution for retiree only, zeros throughout. the city charter contribution formula covers the full cost of the retiree only coverage, but for those who are covering dependents, we'll see various differences in the contribution levels required of those retirees, depending on the tier. not a great deal of difference between the contributions for 2020, between the status quo and the with proposed changes. so for the member, covering dependen dependents, while there is difference between the two scenarios, not a great deal of difference, but because the overall rate increase is less under the with proposed changes scenario, the contributions required of the member are slightly less in the bottom table versus the top table.

but, again, this is not including the impact of the specialist co-pay change on the member financially. this is strictly the monthly difference in member contribution. >> can i just point out, i'm going to restate what i already stated. that is that -- so for all of our medicare retirees with one or two or more dependents saving 70 cents roughly per month is subsidizing what will be a bigger expense for our ill medicare patients who are seeing specialists at $5 more a visit. i'm not going to speak for our healthy medicare retirees. they're here and can speak for themselves. the question is, are you willing to accept a 70 cents reduction so that your colleagues and

former colleagues pay more? out of pocket. because they happen to be ill? and i'm not sure that is fair. from a societal standpoint. >> it's always a question of how much the value of prevention is. you know, i mean, we have this argument all the time in public health. how much do you invest in prevention in order to keep people from becoming ill. and it's more or less a rhetorical question, but i think that's the question. can i just respond to that, because i think it's a good question. i tried to do a literature search in anticipation of this constitution. unfortunately, the literature is actually -- not robust. it's fairly robust around emergency room co-pays. and what happens when up institute co-pays in emergency room and the impact of people -- 50% reduction in emergency room visits for people who never should have gone to the emergency room anyway. but 30% of reduction for

business who should have gone to the emergency room, we're not even talking about that. we start to look at primary care and specialty care and the impact of these on sort of a societal basis and this has been looked at in australia. it was looked at in one of the european union countries and i saw very little impact across the board on quality or utilization. they couldn't measure it, or they said we don't know. but on individual basis, i would still argue if you have coronary artery disease, diabetes, peripheral neuropathy, and are seeing a specialist, this adds up to them, frankly. they can't reverse these diagnoses by more attendance to our wellness center at this point in their lives. >> okay.

so just as a refresher, page 17 is the rate card under the status quo scenario. so as a board, if you decide that is the scenario, page 17 contains the rate card with page 18, the year over year comparison and contributions and total rates. the with proposed design change program rate card is on page 19. and page 20 contains the year overyear comparison of with proposed design change and program change scenario. so on page 22, the recommendation is that the health service board accept the uhg ma ppo retiree rates as accepted today under the with

program design, which include the two changes that are outlined on page 22. but again, with the reminder that we've presented both rate cards knowing that we ultimately need a rate approval for the uhg ma ppo today. so we've provided both rate cards for that purpose. >> i'll be a sacrificial lamb. i move that we accept the status quo rate cards for the 2020 for this program. >> second. >> president breslin: any discussion? any public comment?

>> good afternoon, dennis kruger, active and retired firefighter and their spouses. a couple of years ago we tried to improve the dental program by offering a higher amount of coverage. and the board sent out a questionnaire to everybody. at that time there were different rates for different amount of increase of coverage. and the majority of the people that sent back the questionnaire, said, no, i can't afford this, even though some of it was $15 a month and the max i think was $50 a month. i tend to agree with dr. follansbee, that the $5 difference to the people who couldn't afford that improve

their dental benefits, are the same people affected by the rate increase. so i would hope that you support the doctor's motion and that we don't raise the specialist to $20. thank you. >> president breslin: thank you. >> good afternoon, commissioners and welcome commissioner canning. representing sciu west bay retirees. quite frankly, i'm going back to what nancy jin told us many years ago. she said what members said, what retirees said at that time, if you increase my monthly premium, i can budget and figure out what i have to do, but if you increase my co-pays, especially to specialists, but the regular co-pays, i don't know and i can't budget, because i don't know when i have to go see the doctor. or maybe i have to see three

doctors this month and five next month. we don't know. so, dr. follansbee, we support strongly maintaining the status quo. those copayments are onerous to many members across the board. and for many of these things, i'm not sure that the benefit is justified, but the co-pay issue is significant and very difficult for a lot of our members to deal with. especially the older retirees who are on the more restricted income. we appreciate your proposal and hope that all of you vote to support dr. follansbee's motion. >> president breslin: thank you. next. >> good afternoon. i'm the director of strategic partnerships for mom's meal nourish care. i wanted to say thank foss are the opportunity. i also wanted to say this was not a business development function. i didn't find out this was a

part of the benefit until i was asked to come to the meeting. i think your concerns are well founded from that standpoint. you know, any questions you have, i want to kind of leave you with an independent survey we did in the fall of 2017. we did jay group out of chicago did a survey with a thousand medicare recipients, as well as a thousand medicaid recipients, asking them how they would like to take care of their conditions, chronic conditions. they had a list of 10. we were hoping from the meal standpoint we'd be in the upper half. eating healthy was the number one way they wanted to handle their conditions. some of the lower stuff, doesn't mean they wouldn't do it, but stuff like nurses, it's over the phone. prescription medication was low on both sides. so eating healthy was something they wanted to do. so we've seen through the social determinates of health initiatives over the last year

or so, how important that is, not just to keep them out of the hospital, but to keep them with a healthy lifestyle. what i can tell from this proposal, it was a way to get them -- okay, here's a way to test eating healthy and then a way do it affordably on a long-term basis. that's what we looked at. we have all the data, post discharge, chronic care, we participate in nih funded studies to show that piece. but it's gotten big ferry the standpoint -- bigger from the standpoint of eating healthy. i understand concerns from that and welcome any questions you have about mom's meal nourish cares and the meals itself. >> president breslin: thank you. any other public comment? there is a motion on the floor to approve the status quo. >> so for clarity, page 17 -- >> page 17, thank you. all those in favor?

all those opposed? the motion passes unanimously for the status quo. >> may i make a comment? >> yes, please. >> number one, i don't like to increase premiums even if they can be budgeted, but -- and i would hope that we as a board are not saying we're rejecting a component of what might be a broader program as we're looking at revising and reviewing the whole plan landscape next month, that, yes, there are things we need to take into account in making planned design changes. and they may have these broader implications about social determinates of health, but it needs to be put into a context rather than just like a one-off thing to reduce the impact or the premium. so it's not that i'm necessarily against meals. and that kind of context. but it needs to be part of a

broader approach, all right? that's where i'm coming down on this. and i always defer to my colleague, dr. follansbee and his logic and research. [laughter] >> president breslin: thank you. item number 15. >> 15. review and approve kaiser permanente senior advantage medicare fully insured retiree rates and premium contributions for california. presented by mike clark from aon. >> mike clark, aon. we're going to present the kpsa fully retiree rates fort 2020 plan year. page 2, outlines the recommendation that i'll talk you through in this document. that we recommend adoption of the rate cards, display them as material that are based on the rate of $365.76 per member per month. which would be a 12.2% increase

from 2019. this does include provision for a new recommended transportation benefit rider that i'll talk through shortly. so i know that our representative from kaiser permanente talked through the cms reconciliation process. this illustrates the transition of the 2019 rate, $325.89 per member per month to the $365.76 and all of the elements that play into that. i will note that of the increase, only 2% is underwriting trends. so underlying experience of the plan is increasing only at 2% rate, very favorable to national trends. the other elements of the increase are due to the reconciliation adjustments and the $2.75 for the recommended

transportation benefit rider. >> president breslin: do we have data on how this transportation benefit was used in united health care? because that was added on last year, right? >> we'll need to follow up with that information. if i recall off the top of my head, it's -- i don't want to speak a number i'm not accurate about. we'll follow up. it's only three months in. i think it's been somewhere in the hundred number range, but we'll follow up with the exact number through the first three months. >> agree, it's a good benefit, just are people using it? >> it goes back to something that director yant said about

publicizing these, somehow featuring them on the website or in communications with the retiree community could help to, if we want people to utilize these things, to help them to do that. i recognize it's a short period of time, but we need to give operational thought about how we communicate to the membership. it's just a recommendation. >> can i just add to that and say we have an all claims database. that lags often behind the real discharge, et cetera. but there are lots of opportunities for follow-up nutritional counseling, calling someone from our program saying did you take advantage of the meal program since you were discharged? or have you taken advantage of our transportation? because once a member finds out that he or she didn't take advantage of it, they're more likely to take advantage of it the next time and also to say to

their friends, gee, kaiser provides, or united health care provide transportation. so we have a responsibility to make sure not only that we're publicizing it ahead of time, but i can't remember what my dental benefit is unless someone tells me when i ask. so we have the of responsibility here. and hopefully, we have the staff. >> one of the tenants of the strategic plan, assuming our budget goes through as it's currently written, there is a position in there for an engagement specialist to help us understand the segment of the population and match the benefits. we have a very large population that is diverse and needs to receive the message in a way that they can act on it. >> hopefully that representative from the board who is not here today, will also understand that budget recommendation and advocate for us.

>> page 4, just includes information that i talked through. page 5, rate increase history or decrease and now the increase. particular note, page 5, the status quo, rate card information, page 16 and 17, with transportation rider added, pages 18 and 19. page 6, i know our kaiser representative walked us through in more detail than page 6, but happy to entertain any questions on funding reconciliation before we move into evaluating the transportation rider, or if there happened to any remaining questions. okay. and page 7, just a reminder that we include the v.s.p. vision

basic premiums in the rate cards. so page 9, talks about the transportation rider in further detail. so we've talked about how this benefit was added to the uhc ma ppo in 2019. and in 2020, making a similar rider available. please do note the footnote that kaiser is working on implementation of this benefit now. it's targeted at this point for january 1, but with the recognition that the actual implementation may vary on any given month and if there are unforeseen challenges as part of this benefit development, and if that occurs there will be a mechanism for kind of future crediting of the premium paid for a service that may not be available, depending on the actual month of availability. but the transportation benefit

rider would provide nonmedical transportation, so not ambulance, wheelchair, transport. but otherwise nonmedical transportation up to 24 one-way trips for routine and post discharge needs with a 50-mile distance limit per trip. >> can i ask a question at this point? i know that kaiser has fairly vigorous home care program that people who are bed bound and require an ambulance or gurney can get home care. i'm assuming united health care has some similar home care program that they oversee as well. you know, riding public transportation as i do, i don't consider wheelchair bound people as medical transportation. i consider that transportation to the citizens and others in

the city and county of san francisco. so i guess the question i have is really about this exclusion of wheelchairs. since the city can provide this through their transportation, why are we allowing hour health plans not to provide wheelchair transportation? >> kaiser has advised us that it's due to vendor limitations. i don't know if a representative from kaiser may be available to be able to speak more thoroughly on that? >> we're looking to expand the benefit. we're trying to go live with it january 1. in collaboration with san francisco hss to provide this benefit to their retirees. that is a piece of the benefit that we'll be looking at expanding. we're just not able to accommodate right now, because we don't have the types of vehicles that we would need to accommodate that.

>> are you actually -- excuse me -- through the chair, are you actually providing the transportation, or are you subcontracting it to someone else? >> we'll be subcontracting it with the voen door. -- vendor. >> there are partnership opportunities like san francisco para transit and on and on. they do this stuff every day. they've got wheelchairs and walkers and all kinds of mechanisms to do this. >> even über and lyft. >> yeah, so i will take -- that's great feedback. i will take that back as we build out this benefit. right now we're trying to make the benefit go live, we're working within the limitations. i wouldn't say that this is the final product. right now we're bringing it to market specifically for san francisco hss. >> i understand and appreciate

that and thank you for the opportunity to partnership, but i think waiting a year to try to find a remedy for wheelchairs is a little long. and so i hope you can advance the schedule on that. i'm not talking about impacting into our program, but in your planning model, seeing if you can look at an alternative vendor that might be readily available that does this type to have stuff. >> okay, i'll take it under advisement and share it with the team. >> i will second that. to exclude wheelchair -- postpone it, is really a disservice to certainly our members. and so sometimes wheelchairs are only necessary for a month or two after orthopedic procedures or whatever, but it is a disservice. if we're paying for transport in our new rates, we need to make sure we're paying for all of our members as best we can.

>> okay. >> president breslin: do you know if united health care covers wheelchairs? okay thank you. >> thank you for what you've done to date on this. united health care did say yes, just to add that on the record. on page 10, the additional premium to add the rider is $2.75 pmpm. it is recommended this be added to coverage effective january 1, 2020, in support of those members with need of transportation services and to provide consistency to the plan enhancement. you can see what the rates are before transportation rider and with transportation rider on a per member per month basis on the bottom of page 10.

so transitioning to page 12, like we did with the uhc ma ppo presentation, we have two sets of rate cards. a status quo rate cards incorporating the rate increase. it's recommended that the rider rate card. pages 13 and 14, just a reminder of what the rate cards represent and the different employer contribution structures for the retiree plans.

page 15 is illustration of the member contributions, under each of these two scenarios. and so it allows you to see what the impact of adding the transportation rider does to retiree contributions in kpsa for those who are covering at least one dependent. again, there are no member contributions for retiree medicare only, but there are member contributions for each of the tiers where at least one dependent is covered. so as an example, a retiree plus one, all medicare, the contribution differential, the member contribution differential on a monthly basis is approximately $1.37 different.

page 16 shows the rate cards without the transportation rider, again the page 17, the comparison year over year of rates. with transportation rider, somewhere exhibits, pages 18 and 19. with that, on page 20, our recommendation is the health service board accept the kpsa rates presented today under the with transportation rider scenario that includes adoption of the new transportation benefit described in this presentation for kpsa in 2020. >> as part of this new -- as part of this new rate card.

in other words -- >> i second the motion with the clarification that information be brought back to us at an early meeting. so that we kind of directionally know that it's being worked on, these are the options or what have you. if it's going do be operational day one, we'll know that as well, but i'm not willing to support this by delaying it a full year, as seemly was presented. so i think we can explain to our members it's a new benefit, kaiser is working on it and it's going to go live march 1, versus january 1, whatever. >> thank you and you have ann's commitment to work with kaiser to assure we bring frequent

updates on this to hsb for the duration of 2019. >> can i just add to commissioner scott's statement and support it, but i would like to hold us to, not prejudge what is an appropriate delay. three months is okay, but six months is not. six months is okay, but -- i think we need to hear this and we'll make a separate determination at that point what to do to make sure that our members on wheelchairs who have kaiser have access to this transportation benefit. but without the sort of waffling over how long is okay. at this point. >> okay. i'll defer. >> so i think you should clarify that for the benefit of the record. and our secretary. so it is easier to take down. >> restate the motion, please.

>> okay. i recommend that we accept the kpsa medicare retiree rates with the transportation rider to include transportation for all of our medicare members, including those in wheelchairs as of the january 1, 2020. >> second. >> president breslin: some of the other exclusions were like for ambulance or whatever, so we want to make sure we're not talking about that either. >> i was not including -- my intent was not to include that because i think there are other options for transportation and care available. but wheelchairs are something that i think we all are not necessarily medical conditions that an ambulance or a gurney

would indicate. >> all right. public comment on this item. i have a second. >> yes, i second it. >> president breslin: public comment on this item? seeing none. all those in favor. opposed? there are none. unanimous. in favor of the motion. by the way, my neighbor is using something for transportation, called go-go grandmas. and they actually use lyft and über, this organization. but i like the term. [laughter] >> okay. item number 16. >> item 16, review and approve