>> oh, yeah. >> who is going to evaluate the result of this? >> actually that's the commission at a closed meeting. >> okay. so it's not going to be oewd? >> no. it's -- it's this commission in a closed meeting. >> is that right? >> correct. yes. >> okay. any other questions? okay. great. next item, please. >> clerk: item 7, director's report. update and report on the office of small business and the small business assistance center. department programs, policy and legislative matters. announcements from the mayor and announcements regarding small business activities. discussion item. >> so thank you, millimans. -- commissioners.

d.b.i. is sending out a final mailer this week to 9,000 noncommunity property owners, for the december 1st deadline. and so just again there might be a spike and you might hear from some property owners. the tobacco economic mitigation working group held its second meeting last wednesday and was -- we received a detailed review of the tobacco permitting process from the department depf public health. it was very informative. and then just i wanted to make sure that all of you are aware that the city is now requiring all commissioners to go through implicit bias training. so dough minka has forwarded an email to you.

it's due by the end of the year. and then following up on some of the legislative matters, so a new piece of legislation has been introduced, that is going to require all departments to hold two meetings, regarding the annual budget. so this will be something that, if passed, we will be adding to our calendar. we will need to finalize those hearings by the end of february. so the likelihood that we're hearing those in january and february. in terms of the -- items that you have heard, the job housing linkage fee had its second vote last tuesday on november 5th. i did inform you that supervisor haney did adopt a recommendation

of doing a tiered fee for the small cap and the large caps. and soar the small cap projects up to 49,999 gross square feet will be capped at $62.64 for office space and laboratory use will be $38.37. the initiative ordinance on the vacancy tax is being heard tomorrow at the budget and finance meeting. supervisor peskin's office has informed us that there are amendments. he did present on some of them at the meeting, at the last meeting. but there are likely some others coming forward as well. so i don't have final details on

that. so i can't communicate what it is. sweetened beverage legislation was heard in committee. it will be heard in committee this coming -- it was heard in committee on friday and because i was absent, i don't have the results on that. but i don't see any reason why it did not pass out of committee. the health code food preparation. that is changing from the numerical scoring to the green, yellow and red placards. that passed out of the full board on last tuesday, on november 5th. and it is at the -- it's before the mayor to sign. and then the promotion of the renewable food service ware, which the commission did hear, it's still with supervisor peskin's office at this point.

and then last meeting commissioner sharkey asked in regards to whether we could look at shifting the second meeting of the month to an evening meeting. so i've done a preliminary look at the availability, it look thes like there is availability to shift that meeting, when we initially scheduled second meeting in the month for the commission, there wasn't the availability. >> right. >> i will submit that request, if that is what the commission is interested in. >> absolutely. >> and with that, that concludes my report. >> okay. >> unless there's questions? >> commissioner yee riley. >> hi. on the a.b.e., we're sending out 9,000 notices. the final notice. do we know, as of now, how many have responded and comply? and how many still need to be?

>> i think , i will get back to you on the specific number. >> ballpark? >> i would say -- i would say 3,000 to 4,000. >> okay. i heard that majority of them have not responded. >> yes. the majority of them have not responded. >> yeah. and december is the deadline. >> december is the deadline. and december is the deadline to submit the check list. so it's not like the entryway has, you know, completed its permitting process. the december 1st deadline is to submit the check list to identify what level category your entry is in and what remediations, if any, need to be done. >> well, hopefully they all respond before the deadline. >> yeah. >> thanks.

>> okay. any other questions? let's open it up for public comment. do we have any members of the public comment who would like to make a comment on item number 7, the director's report? seeing none, public comment is closed. great. thank you, director regina dick-endrizzi. next item, please. >> commissioner's report. allow president, vice president, and commissioners to report on recent small businesses activities and make announcements that are of interest to the small business community. >> i don't have any past stuff to talk about. i would like to invite all of the small business commissioners and director regina dick-endrizzi and anybody else from the office of small business, that we'll be doing a holiday tree-lighting ceremony at castro and 18th street on monday, december 2nd at 6:00 p.m. everybody is welcome.

commissioner dooley. >> i have two things to report that should be of interest to our audience. and to the commission. after posting i think it was about 38 vacancies last year in north beach. i'm happy to announce that we now have 22 new businesses. >> that's great. >> open or will be open or in the process of opening. four of them are restaurants and 18 are shops and services. and i wanted to run down just to give an example to other neighborhoods how this came out. we still have 28 vacancies, seven of them vacanted a not for lease and one lease but vacant. of the ones that there's two reasons why half of the for-lease buildings are the way

they are. first is five of them have exorbitantly high rent, crazy rent. and those are put out there by the two really bad landlords in our neighborhood, that hold their business -- their sites open for years and years and years on end. so that is half of our for-lease vacancies. so it's a good report. and it just shows we can get out there and hustle for some new businesses. they're all unique and interesting businesses. the other part is i became aware recently of cafe sapore which is a popular neighborhood cafe. it has been there 22 years. the landlord decided to evict them, citing because it was because of seismic retrofit. after some dig, we found that

basically the seismic retrofit for that building would not have impacted on the cafe for more than one or two days. so the whole neighborhood is gathered together on this. supervisor peskin is participating. and we will be holding a press conference on thursday at 11:00 a.m. in front of cafe sapump ore to try to reason with this landlord. >> great. thank you. any other commissioner comments? do we have any members of the public who would like to make comment on item number 8? seeing none, public comment is closed. next item, please. >> new business allows commissioners to introduce new agenda items for future consideration by the commission. >> commissioner ortiz? >> in recent months, there's been a developing things happening in my neighborhood. and recently everybody is seeing

the newspaper, one of the founders from uber just received $400 million in start-up funding for cloud kitchen. [ please stand by ]

>> the other thing we should talk about is maybe even with the planning, i don't know if you guys did it at north beach, you know, the changing of the neighborhood commercial -- what is the word i'm looking for? the m.c.d.? in the castro, all the neighborhood groups got together in the castro and we listed the

type of businesses we wanted and what we didn't wanted and what we would consider -- what we would allow for conditional use, but we didn't care if they didn't do a conditional use, as long as they came into the neighborhood. we went through this whole big project. and i don't know if you guys did this at north beach. >> we have been doing that regularly over the years asking the residents -- the residential groups, of which there are 22 they most wanted to see. >> we did the same thing. and then the whole thing stopped >> scott sanchez is still here, this is the other -- >> i am trying to think of the other guy's name. not scott sanchez, i can't think of his name. >> i know you -- i know you were talking about. >> he passed away suddenly and then that whole project kind of died. that is something that can help with neighborhood vacancies.

this stuff goes back to 1987. it can also address what he was talking about with kitchens and stuff. i would like to put that sometime on our agenda. it doesn't need to be immediate. >> i do think it is a little bit of a conversation and going back to commissioner ortiz's point that was brought up earlier about the online delivery and what that whole component is, and sort of some discussion we have had a little bit is -- so the kitchenware these cloud kitchens are going to operate out of -- so we heard from the department of public health. they have now created a new category called the shared kitchen. so those areas will be permitted to, but to your point, uber eats

, for each of their virtual restaurants that they are creating, are they having to get the same, you know, the same playing field? so the challenge is, the planning department, we went through this with the formula retail about creating a definition for online entities, and they are like, we are a land-use based entity. we wouldn't create that nexus. >> not to interrupt, i want to be careful because uber eats sometimes does help smaller restaurants. if i am a chinese restaurant and there's a high demand for hamburgers in my area, and that helps augment my revenue, i am supportive of that. i think i e-mailed you regarding the complete cloud kitchens. >> right. so, yes.

i think the evaluation of what is an equivalent regulatory environment to this new business model, and then even with d.b.h. around the muscles regular -- massage regulations, now there are online entities that are convened years, so to speak,, but they are operating in multiple cities and they are a big entity. i think the departments are still sort of under their perspective that, how do we regulate this if their business model is in the cloud? we are so -- our licensing, our inspecting, all of that, is a land-use base. so this is a really good time for us to really start asking

these questions and having the commission sort of be the forum of which departments come and present and have these discussions. >> again, i want to go on record , their intent is to disrupt and circumvent all the things small business have to do with getting permits, licenses, insurance, ordinance. they are backed already by half a billion dollars. that is not to compete. that is to annihilate. i have to go on record. we cannot let this happen. we have to act faster than not. if not, we are going to have a ton of vacancies. that affects the quality of life in our communities, not only our small business communities. >> yes, i would agree. >> and i would still like to go back -- regina and i spent a lot of time with the planning department trying to get a handle on what would be considered a chain store, and

nothing was done. not a single thing was done, you know, just trying to define what makes something the formula retail and what doesn't, how that applies to things that have a heavy online presence, all of that. it was very discouraging that they decided to do nothing. and i still think it is something we need to think about >> yes. i agree. okay. do we have public comment on new business? seeing none, public comment is closed. next item, please. >> please show the slide. >> again, it is our custom to begin and end each small business commission with a reminder that the office of small business is the only place to start your new business in san francisco and the best place

to get answers to your questions about doing business in san francisco. the office of small business should be your first stop when you have questions about what to do next. a small business commission is the official public forum to place your opinions and concerns about policies that affect the economic vitality of business in san francisco. if you need assistance with small business matters, stopped -- start here at the office of small business. >> item 10 is adjournment. action might him. >> do we have a motion to adjourn? >> i moved. >> second. >> all in favor? >> aye. >> meeting adjourned. thank you.

>> this is one place you can always count on to give you what you had before and remind you of what your san francisco history used to be. >> we hear that all the time, people bring their kids here and their grandparents brought them here and down the line. >> even though people move

away, whenever they come back to the city, they make it here. and they tell us that. >> you're going to get something made fresh, made by hand and made with quality products and something that's very, very good. ♪ >> the legacy bars and restaurants was something that was begun by san francisco simply to recognize and draw attention to the establishments. it really provides for san francisco's unique character. ♪ >> and that morphed into a request that we work with the city to develop a legacy business registration. >> i'm michael cirocco and the owner of an area bakery. ♪ the bakery started in 191. my grandfather came over from

italy and opened it up then. it is a small operation. it's not big. so everything is kind of quality that way. so i see every piece and cut every piece that comes in and out of that oven. >> i'm leslie cirocco-mitchell, a fourth generation baker here with my family. ♪ so we get up pretty early in the morning. i usually start baking around 5:00. and then you just start doing rounds of dough. loaves. >> my mom and sister basically handle the front and then i have my nephew james helps and then my two daughters and my wife come in and we actually do the baking. after that, my mom and my sister stay and sell the product, retail it. ♪ you know, i don't really think about it.

but then when i -- sometimes when i go places and i look and see places put up, oh this is our 50th anniversary and everything and we've been over 100 and that is when it kind of hits me. you know, that geez, we've been here a long time. [applause] ♪ >> a lot of people might ask why our legacy business is important. we all have our own stories to tell about our ancestry. our lineage and i'll use one example of tommy's joint. tommy's joint is a place that my husband went to as a child and he's a fourth generation san franciscan. it's a place we can still go to today with our children or grandchildren and share the stories of what was san francisco like back in the 1950s. >> i'm the general manager at

tommy's joint. people mostly recognize tommy's joint for its murals on the outside of the building. very bright blue. you drive down and see what it is. they know the building. tommy's is a san francisco hoffa, which is a german-style presenting food. we have five different carved meats and we carve it by hand at the station. you prefer it to be carved whether you like your brisket fatty or want it lean. you want your pastrami to be very lean. you can say i want that piece of corn beef and want it cut, you know, very thick and i want it with some sauerkraut. tell the guys how you want to prepare it and they will do it right in front of you. san francisco's a place that's

changing restaurants, except for tommy's joint. tommy's joint has been the same since it opened and that is important. san francisco in general that we don't lose a grip of what san francisco's came from. tommy's is a place that you'll always recognize whenever you lock in the door. you'll see the same staff, the same bartender and have the same meal and that is great. that's important. ♪ >> the service that san francisco heritage offers to the legacy businesses is to help them with that application process, to make sure that they really recognize about them what it is that makes them so special here in san francisco.

♪ so we'll help them with that application process if, in fact, the board of supervisors does recognize them as a legacy business, then that does entitle them to certain financial benefits from the city of san francisco. but i say really, more importantly, it really brings them public recognition that this is a business in san francisco that has history and that is unique to san francisco. >> it started in june of 1953. ♪ and we make everything from scratch. everything. we started a you -- we started a off with 12 flavors and mango fruits from the philippines and then started

trying them one by one and the family had a whole new clientele. the business really boomed after that. >> i think that the flavors we make reflect the diversity of san francisco. we were really surprised about the legacy project but we were thrilled to be a part of it. businesses come and go in the city. pretty tough for businesss to stay here because it is so expensive and there's so much competition. so for us who have been here all these years and still be popular and to be recognized by the city has been really a huge honor. >> we got a phone call from a woman who was 91 and she wanted to know if the mitchells still owned it and she was so happy that we were still involved, still the owners.

she was our customer in 1953. and she still comes in. but she was just making sure that we were still around and it just makes us feel, you know, very proud that we're carrying on our father's legacy. and that we mean so much to so many people. ♪ >> it provides a perspective. and i think if you only looked at it in the here and now, you're missing the context. for me, legacy businesses, legacy bars and restaurants are really about setting the context for how we come to be where we are today. >> i just think it's part of san francisco. people like to see familiar stuff. at least i know i do. >> in the 1950s, you could see a picture of tommy's joint and looks exactly the same. we haven't change add thing. >> i remember one lady saying, you know, i've been eating this ice cream since before i was born. and i thought, wow! we have, too.

♪ >> the san francisco health services board will now come to order. please stand for the pledge to the flag. all right. madam secretary, roll call, please. >> roll call. [roll call]

we have a courtroom. >> okay. item number four. >> item four is the approval of possible modifications of the minutes of the meetings set forth below. the regular meeting minutes from september 12th, 2019. >> are there any questions -- corrections to the minutes? >> i move the minutes from the september 12th, 2019 meeting be adopted. >> second. >> any public comment on this item? all those in favor of approving the minutes signify by saying aye. >> aye. >> any opposed? it is unanimous in favor. will all right. item number five. >> item five is a general public comment on matters within the board's jurisdiction. >> do we have any public comment

this is the time to come forward if you have any questions or concerns about something. please come forward. >> hello, my name is jason and i am from ucsf. currently vaping and e-cigarettes are still widely used and there are many programs in place that offer preventive health care screening and mental health care consultations. what are your thoughts about implementing or expanding the tobacco cessation program? >> that is a good question. could i ask our director about that? >> i'm sorry. i have only heard part of what you were saying. >> yes. what are your thoughts about implementing tobacco cessation programs? there are many preventive screenings currently in place, but there is none for tobacco use.

>> we do have tobacco cessation programs, correct? through the health plan. >> yeah,. >> through the well-being program? >> what was that? >> maybe you could come up and say something. >> she is mentioning that the newer tobacco cessation program addresses vaping in particular. let us do an assessment with the health plan on whether that is currently the case. i imagine that it is but i can affirm that with the health plan , but, yes,, tobacco is one of the leading preventive measures that we can do and we will take a look at that. thank you. >> thank you for bringing that to our attention. thank you. any other -- >> maybe we could find out if our own wellness program that we

operate deals with tobacco or not. i heard you say no. i am not clear that is the case. >> yes, currently we have tobacco cessation programs through our health plans. we currently do not have anything that we offer directly through the well-being program. we used to when we had one of our counsellors here probably about five years ago who went through a particular training, tobacco cessation training that she did offer to city employees, however, when she retired a few years back, we did not actually supplement that by getting an additional person trained because we felt, at that time, the health plans were able to meet the need. >> it wasn't tobacco specifically, but as abbey indicated, we have to do an assessment on the vaping case. >> what i'm worried about fake being is is it the same addiction or different addiction

>> it is also an addictive disorder. there is a collective concern about the uptick of teenage utilization which is exactly what the sales of tobacco products target. then you get someone who is addicted for a long time. i think it is a very valuable thing for us to check into and report back on. >> i think with the report back weekend maybe assessed if there is something that needs to be enhanced within our own program and to our own employees that we can assess that when we hear what the health plans are doing. >> okay. >> i just read that another person died from it in california here. i think it was around this area or something. all right. okay, any other comment on this

item? seeing none, public comment is closed. item number six. >> item six is the president's report. this report is given by president breslin. >> i have nothing to report at this time. we can move on to the governance committee issues. >> item seven is the approval for the initiation of the health service board annual self-evaluation process regarding the fiscal year of 2018 through 2019. this will be presented by committee chair scott. >> thank you. the governance committee met earlier this week to review both the health service board evaluation form, as well as a timeline that is proposed working in strong cooperation with the department of human resources, which is really the administrator of this survey.

after reviewing the survey itself, we agreed that the survey that was used last year should be used again this year, and that the timeline would start this friday with the notification to board members or the self-evaluation and to continue on for about two to three weeks to allow members to complete the self-evaluation, and then we would come back in january with a the report of the results. so that is a broad timeline. it is outlined in our terms of governance that we do this annually, and this is, i believe , the fourth year we have conducted a self-evaluation of board activities. with that, i would like to move that the recommendation of the governance committee, that for the self-evaluation form and

timeline be adopted. i will second that. >> i have one question. during the governance committee meeting, somebody brought up the issue of being a unable to assess the new board members. i don't believe we ever added on an extra item for that. did we? >> i will defer a bit to the secretary, but my understanding is that we have not done that. we have tried to maintain consistency with the prior administrations' survey, and that board members who are not able to assess any particular item or area of the survey are asked to complete that in the comments section of the form. >> that is correct. >> i have the same concern, particularly around the orientation since most of us have not be reoriented since the last survey. so if we don't answer the question, then is the survey not complete?

we have to answer the question in the comments and say, please ignore my response to question number whatever and whatever? >> essentially, there are further guidelines that will be e-mailed to you all tomorrow, but we are asking every question be answered. if you select neutral because you feel as if you do not -- you cannot answer it in any other accurate way, we ask that at the end of the section for that grouping of questions, you explain the neutral responses in a sentence or two sentences to give context. >> and then the neutral will be discarded? >> no, it just basically is ensuring every answer -- every question is being answered. we still have the same number of questions from last year without altering the survey completely by giving six response questions we did not want to alter the survey. >> we may have to cook to -- may have to consider the results as we start and not compare them to the previous years.

>> i can tell you, speaking as an individual, if i'm going to change my answers to some questions because of the neutral option where i feel there has not been anything that applies to me in that question. so there will be some changes, but you will just have to contend with the account if you are not going to ignore it. >> but you will also have an opportunity to comment about your neutrality or why you didn't respond. they are doing the analysis. >> okay. >> so it has been moved and properly seconded. is there any public comment on this item? hearing and seeing no public comment, we are ready to vote. all those in favor of the item as presented, signified by saying aye. >> aye. >> opposed? it passes unanimously.

>> all right. we are back into regular board matters. number eight, please. >> item eight is the director's report. >> thank you, good afternoon, commissioners. i would like to begin my director's report by acknowledging the passing of the c.e.o. of kaiser permanente. i'm sure many of you have read the many accolades of bernard's contribution contribution to healthcare. i know i didn't have the opportunity to work closely with him, but i know many who have, and people who worked with him since he was a medical records clerk all the way back. so he is a very revered and, as i said, the accolades i don't know in my memory of ever seeing a healthcare executive receiving the types of accolades that he has upon his passing, and it just speaks highly to his

contribution. i did want to acknowledge that. i know their archives a representatives representatives here that may have additional comments. >> good afternoon, i am from kaiser permanente. i thank you for the opportunity to say a few words about our very highly esteemed chairman and c.e.o. of kaiser permanente bernard thyssen. i come up with a heavy heart. we started our careers around the same time. he was with us for over 30 years and has been our c.e.o. for the last six years. he was passionate, a passionate leader. not just for the people, but also for our members and in the healthcare industry. he was an advocate for a lot of change around pharmaceutical companies and challenging them on some of the costs, so he was very active and really believed all people should have access to healthcare.

and very committed to the well-being of the community. so reaching out and trying to help the communities that we serve to be healthier and have a healthier lifestyle. he was an amazing visionary. i can tell you, being an employee of kaiser permanente, what i experience. it was a visionary with a really big heart. if you ever had the opportunity to talk with him, you felt that. he always felt like he was a friend. we are going to miss him greatly we are confident with our interim c.e.o., greg adams, who worked very closely with bernard he has a lot of experience inside and outside of kaiser. we are very confident that his work will continue to move forward in this organization. i will share with you there will be a viewing of his body that is open to the public on sunday in oakland. it will be from 11:00 a.m. until 3:00 p.m. for anybody interested it will be at the oakland rotunda, 300 frank "all applause in oakland. thank you for this opportunity. >> thank you.

>> if i can make one comment as well. having been in my professional career at kaiser permanente, this is to remind the audience that kaiser is a three like it's tool. it is a nonprofit health plan and a nonprofit hospital and it is a medical group. he was the c.e.o. and head of the nonprofit organization which was the health plan and hospital system. speaking as a physician, one can see throughout my years on the board some of the tensions that can occur between physicians and health plans and physicians and hospitals. i would say that he was a true partner in working with the medical group and furthering goals, so i know that the physicians share the extreme

fondness and loss of the leader of the other two thirds of the stool. but to make sure everyone is understanding that this partnership, as you can tell from the press, is always tense in healthcare delivery. he managed to really show that there is a way forward. and for that he could also -- he should also be recognized and modelled in all health plans and medical groups. >> i would only add to that the reason why i am in san francisco is that i was recruited by bernard to serve as a vice president for h.r. in a prior structure at kaiser permanente called the golden gate service area. i also have a personal relationship with him through a professional men's organization that he and i are members of. both from a professional and personal standpoint, he was and

had been a friend of mine throughout my early career here in san francisco in human resources until my leaving kaiser in 2001. i will miss him personally and professionally. thank you. >> thank you. turning to the director's report , in the packet it highlights -- the highlights included are the decision not to release a request for health plans for plan year 2021. as the board knows, we have been monitoring the marketplace and it continues to evolve. there are -- one of the things that has occurred since we last met was the announcement of the settlement with sutter, and that settlement will not be public until late february, early march of next year. it is possible that it will have

impact on the market here in san francisco. so that is one that we are anxious to see what the settlement entails. we are also continuing to serve the development of the can be product and watching the sutter product develop. we will be coming before the board again in december to talk about the member focus groups that we did throughout the month of october where we did a significant number of listening sessions with the members to understand their current experience and to get their input regarding their questions and concerns about possible models. going forward it was very informative. i have reviewed the polemic area results and have the draft final report on my desk unread at this point. i am anxious to call through it -- go through it and make the presentation to the board in

december. we are also in the process of updating the strategic plan based on the activities that have occurred over the last year and, again in december, plan on reporting out in the form of the annual plan and strategic plan update simultaneously, since they are so interlinked. we are anxious to do that. we have done some initial assessment about accomplishments for this year, and as always, when you take the time to do a look back, is always amazing how much you get done. we are pleased about that and we will be looking at those areas that perhaps we didn't accomplish and understand why. it could be that there were dependencies or sequencing that we needed to recognize or give more time to the strategic plan. it was written over a three-year period and was quite ambitious in the number of activities that

were suggested to accomplish some of the goals. we will be reporting that out to you in december. i will, at the conclusion of this director's report, stand at the podium and give to you the results of the employee engagement survey. i will defer on that for now. also as a follow-up to an earlier meeting when the care coordination presentations were done, we had a breakdown in communication with kaiser and have given them the opportunity to put together a presentation on complex care coordination which be -- which would be more comparable from what you heard from the other plans. that is in process. there have been some investigations into some of the issues that some of our members are experiencing. we want -- when they choose to

buy a concierge service, but it is not required to be a one medical participant and it is precluded from positions to charge an extra fee, but it is considered an ad on option that members may choose to charge. as we become aware of any of these situations, we are better able to investigate. we have heard it mentioned that there was some issues with some providers. we have communicated to them at large. but as most of us know, it is very difficult to correct a problem when you don't really know where it exists. i really do encourage the members to advise h.s.s. when they have questions or concerns about their plan coverage. we do hold that information, the privacy of that information and would protect the member from any procedures and retaliation

that they maybe fearful of. i would encourage people to talk to us. >> can i ask? >> yes. two questions. i guess there are two parts to this topic. one is that the one medical. so when you just walk into one medical, because they are everywhere, the front windows now say they are associated with dignity and the healthcare system. there is one in west portal that i walked by. so our potential patients given a sheet that alerts them upfront what the fee schedule will be and that they are, maybe at risk for paying those fees depending upon their health plans? i don't know how this works. someone is nodding yes. so they are given one they walk in the door.

>> it is my understanding, at least from their website, that you can join and pay a fee on the website. what is not clear is -- we have done some secret shopping and tried to understand where the confusion might be. i think one medical in their general marketing practices do advertise a membership fee and they state it is for their extra attention and concierge type services and receiving appointments. what our plan is, particular with the ma p.d. is prohibitive if you are under contract. i don't know how every one medical office brooke -- operates in -- as far as informing members, but it is important that if you are a member that you don't have to pay the fee. >> okay.

so that is evident to our members, how? how do they all remember this day today when they're walking down the street? >> it is fairly to folk -- typical. once they determine you're not there for an emergency, the next thing they ask is for your insurance card. again, we need to continue to ensure that when medical is following these procedures and assists the members should they require assistance. >> okay. >> the second item has to do with tolling. we have talked about these additional fees on other occasions. so what i understand you to say is the board is clear on this. sometimes, and maybe other health plans positions who are also not as clear on this or members are not as clear, this is prohibited. this is clarification that when we get these complaints there is follow-up with medical groups or

health plans? >> yes. >> along that point, if i may, would be possible to communicate to membership perhaps on the website or through members that have healthcare plans that would like to be able to shop around for physicians to give them a heads up to look out for these extra fees that may not necessarily be covered? >> i think we can take a look for our communications team as to what the information is that we give about the plans and on our website, and we can talk with the plans to see what they are staging stating. >> thank you. >> i am still not clear. if they charged us fee, will we pay it? >> no. >> okay. my understanding is that we have to pay this fee in order to belong.

>> it is my understanding that that would not -- that would violate the contract. is that correct? >> i am with united healthcare. so with the group medicare advantage p.t.o., they are prohibited against their contract. if their conch -- if they're contracted with our network, then they cannot charge the fee. somebody can be on an individual medicare advantage plan and be charged the fee. it is their option to choose it or not, but there is no protection on the individual medicare advanced plans, but your group plan is definitely protected. >> so they can charge this fee, but it is not -- >> it is not against the law. is up to the member to opt to pay that and it comes along with the fee. they can choose to pay the fee

and take advantage of those additional services. it is prohibited if the provider is contracted with the healthcare. >> second thing i hear you say, members may be telling them that are medicare options. they maybe saying medicare's primary. >> it is hard to say. there are so many different insurances that these front offices manage. so to ensure that they have a clear understanding of the differences is a big challenge for them, but that is their business model. i think we have to hold them accountable for their contractual obligation. >> having been in this service practice, it is possible that one medical is from a business standpoint but asked somebody to

pay upfront and say that if you want us to bill medicare and see if we get anything back, then we will reimburse you. but of course, they won't. they certainly won't if they belong to the p.p.o. so members have that option, but usually lots of other providers charge that office the upfront. so you run it with cash or credit card or whoever you want to pay and then hope to get reimbursed by somebody. >> yes, and this is a little bit different. to the general public, they pitch it as a membership fee. >> right. >> i think what i need to do is have a conversation with one medical to be clear what the practices are and what they are doing to meet the needs of our clients. we need to look at the plants -- plans as to how many members we have under those that are using those services. it could be we do a direct outreach to those.

>> you go there and you have your medicare card and it shows what your coverage is and what your co-pays are. why would they be confused? >> because they may be trained under the membership fees to be adjusted for everyone. this may be an exception. i don't know how any exceptions they accommodate. we were able to hire a whole bunch of folks to help us with open enrolment this year and other agents of services. i would like those that are here today to stand so the board can recognize. with open enrolment we have... -- with our member services team we have... [calling names]

[applause] and we also have hired a new assistant health educator. there we go. [applause] thank you. we are very adequately staffed for open enrolment this year which is really great. it is like a trial by fire for an orientation for the team. welcome aboard and thank you for helping us. the next item on the director's report is responses that marina wrote a very generously to a couple of technical and difficult questions, and one i wanted to highlight was the member feedback that grady ellison who is letting the board members know. i think we have deputized him as an investigator on the team. he was -- he has really worked

closely with us to help identify some problems early on with our electronic enrolment. he was very helpful. it was a very hectic time for the department of technology, but we all overcame those barriers and it was really great to have a member so engaged with us in our services to identify issues early on and get them corrected for our membership. i thank him for that. i also, marina wrote a pretty robust response to some technical questions that you had that the phones be on the dashboard. i hope that we answered your questions. and thirdly, from the report, i will ask her to step up to the microphone. i just want her to read it into the record so the individual can hear it on the recording