>> the san francisco health service system board will come to order. please stand for the pledge of allegiance. i pledge allegiance to the flag of the united states of america and to the republic for which it stands, one nation, under god, indivisible with liberty and justice for all. all right. madam secretary, roll call, please. [roll call]

>> clerk: we have a quorum. item 4 the approval with modifications of the minutes of the meeting set fourth below. this is the regular meeting minutes from february 15th, 2020. >> are there any corrections to the minutes? seeing none, i'll ask for a motion. >> i make a motion that we approve the minutes from the february meeting. >> second. >> any public comment on this item? seeing none. all those if favor say aye. aye. any opposed. it has passed unanimously. >> item 5, general public

comment from matters of the board's jurisdiction. please come forward. >> i have a comment on the assistance dealing with this coronavirus and the healthcare and they have already got someone that had already got it and would not allow them to even be any lessons because the school and i went to in 200 200r

this issue and what they did is that they bribed me and tried to make it work where everything was off base that other things that trying to teach me i was really upset about that because of the healthcare issue and they were towing it and because of the example that i am here we get through the coronavirus and this is serious and people, you know, see that.

this is something i've always been through. to show an example, if the healing care issue and i shouldn't be ignored or anything in this matter. >> thank you, very much. next speaker, please. >> hello, my name is alice mosley and i'm a retired teacher, although they've asked me to come back part-time to help out.

as of last july. i've had a serious difficulties with getting my healthcare because i was not told i it not have -- when i went to sign up for the social security and i didn't know about medicare because i never had it before, that i required part a and part b and then i was told after i already signed up that i did not require part a because i it not qualify for premium-fr premium-. i think the fshhs should tell all teachers because increasingly, you are going to find teachers who have not accumulated 40 quarters if they've worked for sfusd because sfusd does not pay into social security, who are not eligible for premium free part a. because i had signed up for it not knowing that, i was billed

by medicare forever and ever and i was considered ta lin delinqud when i withdrew i dis enrolled from medicare advantage which are sfhhs has us to. i've got $5,000 worth of bills because i it not find out until months after the fact so i'd love it if someone could advise me exactly of what the situation is. there is someone at sfhhs who is looking into it but i haven't heard and i've got this -- i don't want my credit rating to go down many of it's now been rectified but i still have bills for a period of time and i would never have gone to the doctor if i had known. i have medical supplies ordered on october the 31st when my new coverage kicked in on november 1st. i just didn't know. they need to inform teachers as we not paid into part a or

part -- the 40 quarters for social security. >> someone look in that, please. thank you. >> good afternoon, commissioners. richard rothman, row tired city worker. two items about delta dental. it says the maximum of dying knows and prevention services to not count towards the maximum. and then on the smile program, which my wife and i signs up for, i just paid my wife's premium but delta dental needs to put out a new flyer.

is this 100% coverage before? is that included in the diagnostic coverage or is that except from the 1250 calender year all these that are listed on the page here? so maybe they could clarify this with a new flyer because i certainly don't understand it. then i want to talk about kaiser. when you e-mail kaiser, or their member services they come back with answers that really, i don't know, insult my intelligence. the last time i was here, i talked about why when they have contract nurses, they can't electronically communicate with kaiser and the doctors and i got an answer saying they can't answer the question. what kind of an answer is this? you know. and my doctor changed my wife's

medication but how is the contract nurses supposed to know if they come out. but i want to talk about saint francis pavilion. this place, you should never send anybody, even your worst enemy there. there should be a provision when you negotiate the contract with kaiser, that no city employee or retiree or any member of the healing services system should be sent to that location. that place was dirty, understaffed. he won't go into the details of what happened. mitch can send you the letter. i just don't feel like it should be publicized. it was one of the most horrible experiences in my wife's and our, you know, years. it was terrible. and i'm still bothered by it. why kaiser sends anybody there in the discharge nurse wouldn't eand talk to us and it was

filthy. the bed was old style. when you put in the for a st. john's fran pavilion. >> ansanfrancisco pavilion. >> clerk: this report is given by president breslin. >> i wanted to mention i received a phony post regarding the coronavirus. be aware of that. it's going to a lot of people. instructions seem to be the same, wash your hands and stay out of large gatherings and stay

home if -- well it's very important. our distric director said the ws up tated frequently regarding the virus so that's a go ahead place to lock for accurate information regarding the virus. that's all i have to report. any public comment on this item? >> can i just comment, i think that you make really a good point about the information. we're all getting inundated and i think a lot of it is well meaning. i don't think poem are out there to enhance the risk but a lot of the recommen recommendations why look logical at face value are not really shown to have been effective as anti viral mechanisms avoiding ice and water, for example, which was in the message that you got. it was not shown to decrease

ones' risk of acquiring colds or influenza or coronavirus. and so, i to think the other side of this is that i think the advice that you can get by going to a websites that are monitored and screened and updated regular low, and often refer to so san flare says this. sanford university doesn't provide healthcare, individuals do, doctors do. they are scientists and they're physicians and nurses and all so

to say stanford is saying this and organization should be suspect and it does to some extent when you start seeing all these different recommendations it doesn't undermine the good information that we can access and the good information because the message sub limb alley is well, why aren't they telling us to avoid ice cubes? why aren't we doing told this from our own public healing department or the state or center of disease control. i want to reinforce your comment. it's well taken and i think we have a responsibility to help our family and friends and colleagues and under how to access information. it's really trying to cope with a very stressful information for every single person in this room and lots of people outside this

romijroom, including in the wor. >> if i could echo some of that, obvious will he we wanobviouslye information. the updated friday directive from department of public-heal h health officer just to take it seriously. the recommendations around social distancing avoiding larger gatherings and less essential -- at the board of supervisors meetings, for example, we've -- the recommendations are around folks, you know, trying to be throthree or feet from other fos to prevent spread and we've an active in our district, things that bring people together, if they're vulnerable populations,

seniors, folks with underlying health conditions to be encouraging folks not to have those sort of group gatherings unless those are essential. i just think at every opportunity including for folks in the room or folks watching this on tv, it's important for all of us to be making sure those recommendations are getting out there. >> thank you. >> all right. item number 7, please. >> clerk: item 7 is the director's report. this report is given by abby yant, the executive director. >> good afternoon, commissioners. thank you all for being here to the. and my director's report i comment on the covid-19 19 and our city's emergency operation center has been up and running for eight weeks now. we have a department low low a. we are working to keep our members informed by updating the

website regularly as chairperson breslin has commented, we have coordinated from the onset with our venders to be sure those micro sites, if you go on a general site you will see one thing and if you go on our site you might see something different. those companies that we work with cover geographical areas different than san francisco. we do direct links to our local department of public-health. we don't do distric direct linky department. we advise those who live outside of san francisco to connect with their local department of public-health for local guidance. as far as operations go, at health service systems, we are preparing to telecomute where it makes steph and we're preparing

staffing models do you to the social distances directive or whether we have illness or exposure within our workforce so we have all of those plans under way. and are being very aggressive about working through all of that. we're very active on the covid-19 and should any of the commissioners have any questions at any time please, let me know. moving off of that, we are in a vendor blackout period. we are at the table with all of our major vendors right now and just an admonishment to all of us on the board that those kind of conversations should not take place outside of those renewal meetings. the health service board election for this year, we did have one very qualified candidate who has submitted all the paperwork and was the soul

nominee and she met all the qualifications, we have declared her the newest member of the health service board that takes effect in june and between now and then, we will orchestrate the wearing in ceremonies. so thank you and welcome, claire. >> i will say she's been very helpful in making sure our website is up-to-date. [laughter] which i appreciate, it's good to have that perspective from outside the organization. i did put in a small paragraph about the infertility services update. we're anticipating having on the agenda in april update to the board as we work diligently with blue shield to see we can address the questions brought before the board. also the next item is the supper

anti-trust case as i put in here as the update from the pacific group on health. that care is still pending additional court action and so it is not finalized at this time and we will advise you when it is. we have continued to work on this mental health program expansion budget to the submitted to the mayor's office and that will be completed some time within the next two weeks. the operation report i just wanted to call out a few things, one is jessica, she who wasn't able to come today is our new communications director, she just started this week, last week. and it seems like she's been there a while. she jumped in and is not shy

about asking questions. it's a great addition to the team. and i it want to add to this that we did receive reluctantly the notice from sha von o'conner who is in the audience and has been our members services manager for the last throw and a half years has rentered her renr resignation april 6th. with the modernization of sales force and the ecm and it's just been outstanding. we will miss you and we thank you for your service. [applause] just a few other things to highlight as we continue conversations with the school district on how we can continue to partner with them offering benefits is pretty complicate

and mitchell can describe it better but it's a project that we're interested in finding modernizing and helping and working with their newly modernized system in a way that doesn't disrupt the relationship that we have. the new telephone system is on our desk, turned on and we'll complete the conversion, i believe, we're scheduled to awe over again and -- there was a

question about met foreman. the doctor did find a very useful reference we have dig contributed that talks about the question of whether there's a cancer-causing ingredient. this article states the fda has been involved in researching this question and at this time they have not determined if there is -- it doesn't contain -- it does not contain dangerous levels of this chemical and they have an ongoing investigation and it's certainly a challenging question

for them and because it is such an effective drug and they're really aren't alternatives for it it's still -- they're not recommending any re call here in the united states so i thank our member who brought that to our attention and it's an interesting story. we'll continue to follow it but at this time, we are following fda recommendations or our practitioners are following fda recommendations. so with that, i think i'm finished. >> my public comment on this item. >> i'm sorry to hear that shavon is leaving and it's the first number i have to help with our

reccff members so i wish shavon well but i hope that we can find someone to fill her shoes, she's been invaluable during the time that she has been here and she's been very helpful and abby you can't leave either. thank you, very much. >> i think shavon should stay

and help us get more even with our healing care and you know, in the healthcare events and it could be more glad if you approve to make sure that lives will get too far in society with our to to whatever and this is worldwide and this already thousands and thousands of people, you know, that is going on and stuff. better healthcare and in the age

we can we're putting things off and which we shouldn't have to for our healthcare. >> for our babies too. >> item 8, i believe it's denise rodriguez, the director of strategic accounts and the public sector presenting? >> good afternoon. denise rodriguez with kaiser perm ant tee and it's a quiet room today. i wanted to come back this quarter to give you an update and i've committed to doing that

every quarter. i know you are very interested in seeing how it progresses in terms of usage and as well as where we're at with adding and wheelchair ban and coverage. i'm excited to report that we've had 27 transportation requests and successful requests in the month of january alone and that was just with moderate communication. i've got julie brady here with me, she's one of our medicare consultants that will talk about our plan to make sure people are using the benefit that you are paying for. i will have february numbers by the 16th so as soon as we have updated numbers for february usage, we'll share that with executive director yant and her team. in terms of the wheelchair van and gurney van, we recognize this is important we recognize the importance to this population we want to serve them. i shared with you the challenges with ragged this benefit so quickly this year and it had to

do with cms compliance issues. we're still working towards adding it for january 1st, 2021. no further updates on where we're at for adding it mid cycle. i did want to remind you all that you are not paying for that benefit that would include gurney van or wheelchair transportation. you are paying for it which is just the said an wheelchair transportation. any questions or comments about that beforehanded off to julie to just over the communications plan? thank you. >> thank you. >> hi, i'm julie brady. executive retiree solutions manager with kaiser. i wanted to give you an update on the communication plan that we have in place to include out

bound phone calls alerting them to the new transportation benefit and we also took that opportunity to remind them about the silver and fit benefit as well. we added the transportation. we created a transportation benefit flyer to outline exactly how they needed to go about seeking this service. that has been added to the kaiser site. we have shared with hss that same flyer so i would work with them it figure out where we can share that flyer if we post that on their website or if there are any upcoming news letters that we can send out to your members so they have the flyer there as well. we are in the process rit now of mailing out a letter to all of your retirees, all of your kaiser senior advantage retirees that will include both the

transportation flyer as well as the silver and fit flyer designed to have step-by-step exactly what they need to do so they can get these benefits. we know many people don't necessarily lock at e-mail or respond to phone calls so we wanted o mak to make sure we han a variety of methods. we're also -- we send aging kits when your members are turning 65 and we've added that transportation flyer to that kit so when they get that kit in the mail, it tells me about the senior advantage plan. it will also have the transportation anier. also, the open enrollment kits so that will be later in the year. are there any questions? >> since we've -- coronavirus as

come up several times but this is a population that should see itself at particular risk for the complications. we've been getting lots of e-mails from bakery and all kinds of what they're doing. so, does kaiser have a paragraph or a sentence or something that might reassure our members who would like to use this benefit about the sort of methods that are being used to show that these are clean vans or whatever? >> i would have to get back to you on that. i'm sure our vendor has something and maybe we could potentially -- the letter hasn't gone out. i don't know if there's something that we can put in it although that information is changing everyday. maybe we can at least post something on our micro site. for them to look at there. and then, would we -- should we take that back and get some more

information to share with district or yant. >> i'm not concerned about what they're doing because as you point out the instructions and the procedures will change. just that this is an issue that we address among the other issues about safety and all that. just so it's a generic issue that we include this in our concerns. >> i appreciate that. i work directly with the person who is overseeing this benefit and i'll ensure she's working with the vendor so we got information how they're managing and cleaning these vehicles. i was coming here today and they're wiping the handrails down and i felt safe with that observation. we'll certainly follow-up and close the loop with you on that. >> one more quick question. of the 27 transports in january, to we know how the recipients were aware of the benefits if it was by a phone call or the e-mail so we can target and i think if we don't have any information maybe it's something that we can rehave you to find a more targeted approach to

getting the information out. >> so we do not know how they were aware of it. is that something we can potentially ask the vendor when they're taking the calls to ask how the members heard about the benefit? >> that's actually a really good suggestion because i think it would be helpful for us to know to be intentional in our communication so we'll ask it. the plan is to come back again in july and there's a different varieties of data the way they cut the data so i'm trying to understand that and see what is meaningful so we can bring it back to you all. and we can see if we can add that piece. >> thank you so much. >> ok. thank you. >> any public comment on this item? >> seeing none, item number 9, please. >> clerk: item 6 the financial report. as of december 31st, 2019. this presentation is done by pamela levin, the chief financial officer. >> good afternoon, pamela levin,

chief financial officer. sorry. i had to take a breath. health service system. the report that is in front of you summarizes the revenue and expenditures for the trust and for the general fund administrative budget threw thrh december 31st as well as fiscal year and projections through june 30th. the trust ended the year last fiscal year on january 30th, 2019 with a balance of $92.2 million. based on activity through december 31st, 2019, the fund balance is projected to be $91.8 million, which is a decrease of .4 million or $400,000. we're projecting a decrease in the fund balance for the uhc/ppo plan due to unfavor claim

experience for access plus, the fund balance is projected to increase 11.6 million primarily due to pharmacy rebates and favorable claims experience. for the tria plan we're projecting a 4.9 million decrease in the fund balance compared to last month when we came in it was 5.8 so we continue to have unfavorable claims but things are getting better. we're projecting a 4.2 million decrows in the fund balance for tell ta dental. this is intentional to stabilize the rates the healing care sustainability fund will have a year-end balance of

$2.7 million. we expect a one million in montreal earnings although that may change. we won't really know until we get closer to june 30th. 300,000 in performance have been received through december 31st. we have not had any reimbursements under the adoption and surrogacy assistance plan and in december and we're projected again to have have the 185,000 from the fund balance for reimbursement under the plan. the amount of forfeitures for unused spending which reside in the trust, until that time for the administration of the

benefits. as of december 31st, we have 2 million in pharmacy rebates and the year-end projection is for uhc and ppo plan and trio which is consistent with the previous reporting and right now we're projecting to end the year with a balance of $128,000. there's been no instructions given out by the controllers' office on any adjustment that's we would need to make in the budget given the effect of the coronavirus on revenues so that

is kind of the thing i'm watching for and will let you know if we get that kind of direction. in prior years when we've had problems, we have in 2008 there were directions sent to departments. if you have any other questions -- >> thank you, any public comment on this item? no public comment. so now we're going into our rates and benefits section. and item 10. >> the presentation of the 2020 rates and by is by the executive director. >> thank you, is the rates and benefits calender and i will call to your attention that we do have a special education board meeting scheduled

currently for march 26th at 1:00 p.m. given the fluidity of the coronavirus situation we are consideringal continue tive ways of presenting that information. we are restricted current low under charter sunshine brown act on how we would do any meetings so wore taking that into consideration how we present those to the public and to the board members and this important understand the rates as you will see seeing them in the months following. so we'll keep you posted on that and i do want to acknowledge at this time that many of our vendors are under increasingly under travel restrictions our united team is not here due to travel restrictions and blue shield made it here today and kaiser made it here today, delta

made it here today, vsp did not make it because of travel restrictions. i think that's kind of a sign of things to come and sort of all things coronavirus that we're evolving and adapting on a daily basis so we'll keep you informed. outside of that, just so you are clear that i'm clear, that we have a very important timeline to to to a meeting like that. please, bear with us as we work our way through this very unique situation. >> so i just want to out the educational forum will not be held in this room, is that

right? did i see an e-mail that said it's changed? >> yes, so we spoke as leadership team and i spoke to the technical team at my office and we are going to move it to the wellness center so we can stream it since it's educationally based and there's no action items and commissiones can call into view the information. it's open to the public and it will be online. >> we'll still have the meeting. >> we're still going to be the meeting but not here? >> just not in this almost. >> i think everybody needs to be notified of that. >> special meetings have a 10-day notice requirement and at this point hold the date in the

calender, please. >> can i -- maybe expound on this. this seems germane because when you see all the recommendations to work from home and alternatives so if we could in the next few months a fact sheet about where those prohibitions and mandates through the charter and the brown act and how they entered our set of rules and regulations because it seems like it's not very modern given the technology what we're sort of forced to face by this

problem but to be the future. it seems like it's not very contemporary. >> often, under stress we find new ways of being and changing the law can result from that but we are under current state of merge and this county and in this state so i don't want to speak for our attorney that is present but there are legal matters legal questions on how you go about doing these maneuvering in an emergency situation versus an ongoing one. >> if i could, just to add that there are -- some are state law issues and it's discussion between the mayor and governor. my understanding is there was update to the governor's executive order that actually just today that addressed some of the brown act issues that are state law issues. in some circumstances may prevent meetings that are not

in-person like this so i too know if the amended order today directly effected our meetings but it is -- folks are much active in sac sacramento to make sure those adjustments can can be made to bring us no this september re whecentury. >> the brown act is a good thing. open meetings it's hard to visualize. >> yep. >> any public comment on this item? >> ok.

and on this, i've been in federal and issue and and and and one reason why i think it's very take this and this is a health that we're talking about and doing examples with that i can maybe bye-bye and thank you, very much. ok. >> item number 11, please.

item 11 a stop loss recommendation that is. >> good afternoon, commissioners, mike clark and before i begin my presentations today a special thanks to mitchell gregs given our travel restrictions shal. i'm glad to be here with you today's to present several

presentations and we're starting with the stop loss recommendations, this is an not you'll review that we do for the health service board right around this time of the year to talk about the environment or stop loss reinsurance for the healing plans offered on a cell funded basis or a flex financedded basis by the san francisco health services system. our recommendation at the end of my presentation will be that sfhhs purchase stop loss pretext for the self-funded and flex funded healing care plans and i'll present information as to why that is our recommendation. so on page 2, you see the programs offered today that are self-funded or flex funded, in other words, not full fullien id by insurance organization so the

claim spenc experience flows thh the members. the united healthcare for active employees and non medicare retirees, the blue shield, access plus tree owe hmos and active employees and the delta dental of california ppo plan for active employees. so some general commentary around stop loss reinsurance in order to obtain this coverage, plans sponsor would remit a premium to an enter tee who would then reimburse that plan sponsor when the claim cost exceed a certain threshold based on the insurance level purchased. this is an insurance product so when claims not excessive it may not pay out at all but, if the

claim amounts are high there will be reimbursement. you expect, during the course of time, the premiums paid by organization would exceed the claims reimbursed otherwise the organizations would not be having a good business proppization. we also say at the bottom of page 3, dentsal plans are not candidates for stop loss insurance. it's limited via annual all service and lifetime oth don i i cadonicmaximum. there is a contingency reserve policy today as we note on slide 4. that for very large pools, this is a common approach to financial risk mitigation. especially in a public sector environment and so there is a contingency reserve policy in place that does articulate this

purpose for sfhhs and we discussed in january what the recommended contingency reserves were that the board approved as of june 30th. and then specific to the stabilization policy, which is another protective policy for sfhss it provides the ability to cushion changes in planned experience over the course of time to a three-year amortization of those gains or losses. for instance, today i will present on the blue shield plan stabilization policy so it's an added protection besides the policy that protects sfhhs. on page 6, you do have a

reinsurance component or a stop loss component on the blue shield flex funded product requirements. as part of these programs, sfhhs is required to have a one million dollar per claimant large claim pooling provision which means that there is a premium charge today in 2020 and has been each year prior and will be going forward for which that pro voids a one million dollar year access protection so if a particular claimant were to go over $1 million in total medical and pharmacy claims in a given year, any amount over the $1 million is reimbursed back back to sfhhs we'll look at what that looks like as an example for 2019 when i present on the blue shield experience later

today. on passenger 7, revisiting my recommendation as in prior years, we ask the health service board approve today the recommendation for sfhhs to not purchase external stop loss insurance for its self-and flex funded plans into the 2021 plan year and again noting the reasons why that include plan stabilization reserves, the fact that blue shield plans have large claim pooling, and the fact that for dental employer exposure is through the plan design. n any questions, i move that the stop loss insurance for flex funded healing care plans. >> i'll second. >> public comment?

all those in favor, aye. opposed. it's unanimous. thank you. >> thank you. >> item number 12, please. >> a presentation by mike clark from aion. >> mike clark, before you is the san francisco healing services report for the 202010-couldn't tee survey. i am presenting the information but this is information that is compiled by sfhhs and this is from those that compiled the information you see in this document. so, i will talk through the overview page and note after the overview page just a description of the information that is contained in the rest of the documents. so, as you can see, the over vow

page is broken into several sub headings. the process, which is essentially describing how the city charter specifies the survey to be done for the 10 most populous country and to collect the amount contributed by the flier fo reply employee r employee-only coverage. for certain, covered members, within the city and the plans covered by sfhhs certain members do have the employer contributions determined if part by the 10-country amount. so you see additional information on the approval of the change rule in april of 2012 by the healing service board and there were in major changes chas

collected for the plan. it's noted that while information is presented in the document included for the calpers design and the sfhhs designs, those organizations are not enclouded i inincluded in ty survey. you will see the description of the average contribution under the use of the 10-county amount. paragraphs in this page. and see how in june of 2014, the impact of the average contribution on rates was eliminated in the calculation of premiums for most of the act of employees. and you will also see on the right side of the page, at the very top, there will be circumstances where the city's premium contribution may fall below the lesser of the average contribution determined by this report or the premium itself so that the city would pay the difference between the premium m

contribution and the average contribution. there are some plans for which the contribution is actually below the 10-couldn't te-countyt because that's where the premium level sits. to get to the actual amount that i will ask you to approve today, you will see that under the result and observations section. we have cal could you lated a cd $729,000.19 to be used in plan year 2021. this figure is 3.3% higher than the amount in place in 2020 of $705.92. we describe an example of and information on the method ole gougmethodology.if you turn, yo0

couldn't tease in order los angeles,al amir da, sacramento and fresno and in the right you see the $729.19 and it's an average in the counties represented in the study. the remainder of the information in this report, i will not go through it but it's plan-by-plan premium information for the plans offered by each of these 10 counties as well as detailed plan design information. i go back to the figure on the overview slide, page 2, results and observations, and i'm asking

the healing service board to approve a monthly contribution of $729.19 for plan year 2021 --

item number 13. >> clerk: review and approve the vision service plan fingerprinted by mark clark from aon. >> mike clark, aon. in it presentation, i am seeking the health service board to be plan year 2021 for the vision service plan vision plan offering that i'll describe in this document. so as i indicate on the introduction page, there are two plan designs offered to active employees and retirees through vision service plan or bsp. there is a basic plan which is offered for many years and it comes with enrollment into any sfhhs medical plan and the

premiere plan that offers a higher level of benefit than the traffic than and and members to wh -- difference between thepren total premium rates and i'll show illustrations in a bit where you can visualize that and see what those contribution amounts are. there are sfhhs members who have access to a computer vision care benefit and as i stated at the outset, this outlines a recommendation forc for the rats many of at the conclusion of this presentation, on page 2, i will ask you to confirm today rates for the 2021 plan here that enclou include basic rates, premiere rates, computer vision

care total rates and finally the premiere plan participant contribution rates that are over and above what they pay beyond the basic plan. we'll go into the following page anpages so you can see those amounts and how vision service mandy arrive that given it's a plan. so if we go back in time. effect i have january 1st, 2017, sfhhs and vision service plan entered into a five-year agreement. the plan here i'm talking about today, 2021 is the fifth or last year of that five-year agreement and initially there was a decrease in rates for 2017 and no change for 2018-2019 and a provision it would not increase 2% over all depending on how plan experience derived for the

plan based on the loss ratio which is the comparison of actual claim experience versus the premiums paid. what happened in year two was the premiere plan was added and it was not part of this agreement for 2017. it was added for 2018 and what is essentially happening, since foretells they elected the plan have benefited well from the parole plan but it's also meant that the claim experience for the premiere plan is at a much higher level than the premiums that are being paid by the member. so loss ratio has exceeded more and the 2% not to exceed over all premium increase has kicked in for 2020 and 2021.

is on page 4, if you recall from last year we had a discussion from the health service board that led to a rate action with the 2% premium incres so having no change in premium rates for the basic plan of the computer vision care benefit because both of those insurance wise, are operating from a financial perspective versus the premiere plan which is the plan creating a very high loss ratio so basically loading the dollar value of the increase no the premiere plan. we're recommending the same for this year. spreading the 2% increase so that there's no change to the basic plan rates, no changed to the computer vision care rates a 4.1% increase to the premium plan rates so the premiere rates and this mathematically results

in a 2% over all increase. i want to show you on page 5 that since the interrogation of the pre more plan, so we now have a third year of enrollment, as of the january 2020 open enrollment cycle, this plan is gaining popularity with sfhhs members. started out with about 15% of total and it rose to 21% average enrollment in 2019 now a full 1/4, 25% enrolled in a vision plan are enrolled in the pro premiere plan. so while the majority of members remain in the basic plan, which again is part of medical enrollment, it is good to see that this choice that was added for 2018 is gaining popularity for members.

so the specific rates on page 6 that i'm asking you to approve today are the cy2021 column. cy standing for calender year. we illustrate next to that on the left of the cy2021 columns the current rates that are in place for 2020. and so, for the basic plans, again, you will see no change in the propose the rates. rates part of the medical rate cards when we present those in may and john. for the premiere plan, you see the total premium rates for the over all coverage and then the total premium rate for premiere minus the basic plan rates become the member-paid contribution rate and you will see rather lengthy foot note underneath but saying that it's a difference in premium over and above just the m.o., load into the rates that are part of the vision plan basic plan benefits. and then computer vision carrie

maining at its current rate into 2021. that leaves us to page 7 where i ask the health service board to approve the vsp plan rating actions for the current plan dough signs fodesigns which ence change. for the computer vision care benefit and a 4.1% rate increase from 2020 for the premiere plan with the paid contribution impact illustrated on the prior page and to point out before you consider that recommendation just page 8 is a one-page appendix showing the plan design comparison between basic and premiere if it helps you to visualize the difference in benefits. >> any comments?

>> any questions? >> well, i sound like a broken record. year after year, referring to page eight which basically teases out members who cost, look, for other providers of eyeglasses who go to costco and get half of reimbursement and i know we withi went threw the wee calculations and i just do know this we have ever done this in the past, where we've teased out a provider of healthcare products either medications or devices and done this and so i guess at some point i would like

to hear from our vision care people just how many -- what their average -- what percentage of their claims come from costco in each of the two plans and what their average payment may be, does it really justify such a different reimbursement rate. i know that some providers walk by on the stress they say, buy one and we'll send one street to somfree to aneedy person in cen. that's great. the benefit of that to the world is incredible. it's one of the few things we can to that shows benefit in our giving. the people who can't afford it can can now work. i'm not trying to penalize, you know, those programs but i kind of makes me a little -- i still

question the issue. it won't effect my vote today but it would be noise to kno nia little bit more. i can provide a partial answer knowing that our vision service plan representative was unable to attend in-person today. although i know they're livestreaming so, any question i'm not able to answer, hopefully they'll follow-up with us quickly and we can report back next month. the costco relationship or vsp is relative low knew so it hasn't done something like go become in the history of vsp. at some point as more and more pressure came for vsp to consider a and that's what led to the alignment with the costco organization several years ago.

perhaps eight to 10 years ago. because of costco buying power relative to the buying power of a typical vsp lower cost than a typical network provider so vsp constructed the frame allowances this way in order to close low a loin the total percentage of available frames that are available through a non costco network provider at or below the frame allowance to then be similar to the percentage of costco provided frames add or below that allowance and so for instance, based on information that it provided to me, probably this $80 allowance provides the

ability for someone to purchase perhaps north of 60% of the frames available at costco with no cost sharing beyond the frame allowance and i don't have the specific figure but it just, that's a round about estimate and that is similar to an estimate now granted it may vary depending on network provider to network provider whether you go no vision provider a or b, et cetera. but the ideas to try to map the approximate percentage of frames someone could purchase in full given those allowances on page 8. we know the costco organization with the much dope deeper discog versus other providers in the vsp network. you raise a great question on what percentage of tole frames

dispensed are coas costco that l be something that will last vsp to follow-up on because i do not know that answer. >> that's helpful. just to be sure i'm clear, vsp has a network of optometrist who provide frames so the member has to look, if they want to get this reimbursement they have to use a vsp provider that's available to them in a brochure or online. >> and you can secure benefits outside the network. you are just subject to much more cost sharing on your own for purchasing let's say a friendshiframeoutside of the nee it's a retail price versus toes wholesale price that vsp has negotiated and vsp's goal in working with the plan design.

so for instance, this 150, 300 for non costco is a particular plan dough sign provision offered by sfhhs. it's not a universal approach for all vsp clients as an example. if there were a lower frame a lieuance there woulallowance, ir frames at a non costco without cost sharing because miz frame is under the allowance. >> thank you. >> to i need an action item here? yeah. >> i move that we approve the vsp re newell rate a renewal ra. >> second. >> all those in favor say aye. aye. opposed. it is unanimous. item number 14, please.

>> item 14 review and approve united healthcare city plan's prefer provider organization ppo administrative fees, presentation and this is done by mike clark ie from aon. >> so for your call last month, we discussed for the united healing care ppo city plan the 2019 claim experience and the rate stabilization recommendation. this presentation focuses on request for approval of the administrative fees that will be used by aon and the rate-setting process in a couple months for the 2021 plan year for the self-financedded united healthcare ppo city plan. this includes their administrative services only or aso fees and some fees i'll describe and also, we build in the rate card for the city plan b healing care sustainability

budget fee. and our aggregate are based on the january 2020 total active early retiree count of 1,857 and you will see fees expressed on what we say pepm so when you see the acronym pepm it's per employee per retiree per month. our recommendations in two areas on page 2, first, approve a 2% over all increase in the base administrative services coated by uac for 2021 and when we incorporate other elements of fee payments to united healing care for other programs, approved a total expense pupm figure we're recommending for the 2021 plan year. following pages providing information to support that recommendation. i will start with the base administrative fees.

again, 2% increase is the recommendation. most of the enrollees in the city plan are cap interested ine two columns. we do have, as of the renewal presentation by united to us, 121 retirees that are captured in the medicare eligible map enrolled in medicare column. i know that sfhss strives to work with retirees to support enrollment in medicare when eligible but again, there are, as of the time of the renewal presentation by united to us, 121 retirees. the reason that the fees on the right side for the medicare eligible but not enrolled are lower, is that there's a presumption that someone is enrolled in medicare when the benefits are paid so just simply a lower amount of administration for those participants.

and on page 4, there are additional savings programs that united healthcare sponsors for sfhss that generate savings for the city plan but then also have a shared savings component or the savings are split between sfhhs and uhc. the first of those programs i describe on page 4 it's called the shared savings program. what that does provide discounts to service rates for certain out of network healthcare providers that are not part of the primary ppo network, the main network of physicians and providers for you knitted healthcare but they do negotiate a smaller secondary discount with those providers and for that, sfhhs keeps 70% of

the savings generated for these secondary network providers, 30% is paid back to united healthcare as a program fee. the second program applies to a little bit different facility situation. it limits the planned financial exposure when care by a member is sought at a network facility but the treatment is provided by a network provider. which we know from reading about surprise medical bills is something that can occur. or when an individual is treated to the non contracted facility for emergency care. and similar to the first program sfhhs keeps 70% of savings generated from this program and 30% is cut by united healthcare. and then there's a smaller program financially called value-based contracting which pays financial incentives to certain providers who participate based on achievement

of some pro set quality cost and efficiency metrics sfhss financedded thosfundedthose pay. on page 5 i describe a shared savings fee example. so, assuming someone incurs a procedure, $1,000 is the row tail cost and physician a might be a network provider and receive a 10% discount so the discounted cost is $500. and that is how the claim is processed. physician b may not be a network provider in the primary network but has agreed to a 20% discount so a lower discount and it's part of this shared savings. so that the discounted cost for the service would be 800 and then with the differential of 200, sfhss keeps 70% of that and pays the remainder back to uhc and program fee many of this is

this is a example of how the programs work. there are typical in the industry. you can can see on page 6, up through 2019, these programs have generated $6 million of savings, 4.1 million has been kept by sfhss, about $1.9 million has been paid back to uhc as their fee. so, bringing everything together, on the uhc/ppo administrative fees. we discussed the 2% incres there and again i note in the foot note that there's lower aso feed for medicare eligible but not

enrolled. the shared savings program fee pepm estimate facility rnc and value based contracting payments are essentially developed by us based by aon on a best estimate of what we think those programs will produce for savings and then the shared component back to uhc and in 2021, based on the last couple of years of experience, and then you will see finally the fifth line item for the total fee administrative fee for the city plan is the $3 sfhss sustainability fee. so our recommendation to the healing service board today if you go to page 8, is to approve the 2021 united healthcare base aso fee which is a 2% increase over the 2020 fee and then approve the total expense pupm

figures we show on the prior page which represents a three and a half percent increase over the 2020 total expense figure. >> questions? >> it's an action item. >> yeah, this action is very clear. i appreciate the clarity of all of this. so just, so we pay a per member per month to blue shield to institute these programs. >> to united health. >> i'm sorry, united healthcare. so we pay on everybody. if they -- when there's a charge, then they apply -- they make more money we make money on this as well. so we pay them to do this and then they make more money when they find this. so, i guess, yeah, i just want

to be clear on that. i'm glad they do it and i'm glad they make money on it we make money on it it just seems wore paying twice for them to be successful because they should be hopeful low they'll be doing this for everybody, whether we pay for it or not because they could make money with the 70/30. and lastly, there's a discrepancy in terms of the per member per month charges between the three different programs and is there some explanation why the facility rnc went up so much when the others came down? >> sure, what aon does, we lock at the most recent two years of actual experience in these programs to apply a trend factor to of what we think we will be translated on a per employee-per month basis. so as you can imagine, we have

no idea this is a best estimate. there's been, especially on the facility rnc program, for instance, there was a big increase in the last couple of years on how many dollars ran through that program so you will see so for instance on slide six, we do know each program carved out on its own but you can see in total as an example that your highest savings of any of the five years over all were in 2019 and for the program in 2019 relative to the past where the shared savings program intended to have a higher amount. so this it mean, as an example, when you go back and lock at the

description of the facility rnc program, well it did mean that there was -- by having this program in place, cost exposure that would have been purely paid at a high retail basis, you know, unchucked so to speak, for use of an out of network provider when someone was going to a network facility or someone happened to go in an emergency facility that ended up not being a network. those are the protections those programs have. now i will say organizations like aon and our fellow consultants, we work very hard to troy to drive a higher percentage for the client and a lower percentage for the plan of these, special will he as more and more dollars flow no those programs. for instance, you used to be at a 35% share on the shared

savings, we brought it down to 30% in exchange for a slight increase last year and that was a win-win for sfhhs because the amount you save in transition to united for this program more than offset the incremental ppm amount that was negotiated in return. >> i guess the observation is just that again, the frnc program, this is a big teal for members that they would go to a facility thinking that they're going to get their professional fees covered and they find that maybe even the physician who they are using for the regular care who then comes in and who is contracted, on weekend, is covered by someone else who is not a member so are these

arrangements increasing where there's a bigger discrepancy between the providers in that facility who are essentially credentialed to provide those procedures and care and we're seeing this as a trend because it is a big jump. >> it is. and in general, we talk about an average healin healing care tret be 6% increase, the increase of dollars flowing through these programs is much highwa higher. while we appreciate the health plans offer these, as a consulting organization, we encourage the plans to negotiate these particular providers to be in their regular network to the extent that they can achieve

that and also encourage migration of the cost sharing where that's not possible. so that for instance, it may be at 70/30 this year but let's migratmigrate it next year to to combat the increase in dollars that are flowing threw these situations. >> a member has no control over this. the member cannot being exacted to understand when they are getting professional fees who -- in those kind of situations within a facility, who might be covered and who might not be covered and say no, i won't see cardiologist a today because that cardiologist is not covered by my plan. i'll wait until b comes around. and hope there's a b. who is covered so this is really an unfortunate situation that we have to come up with fees for. >> i agree.

>> thank you, mike. in terms of dollar amount increase it's very minimum but i got your point that maybe in the future we could increase or decrease the steering program to at least be able to minimize and increase no more than 2% if it happens in the future to be over 2% so we could negotiate on the shared savings program. >> thank you. and approximate i will pick up and strive for that for next year. >> thank you. >> i move that we accept the recommendations and to approve the 2.0 over all increase in the uhc the plan expense per member per month for 2021 for active and early retiree ratings. >> i second the motion. >> public comment?

>> all those in favor. aye. >> aye. >> oppose. it's unanimous in favor. does anyone foal lik feel like a break or would you like to continue on? i'm giving you the option. >> i'd like a little break. >> we'll have a little 10-minute break at the most.>> go ahead. . all right. item number 21. >> yes, out of order, item 21 is to vote on whether or not to hold a closed session for the public-employee performance for the sfhhs executive director presented by president breslin. >> i will node need a motion. >> i move we go into closed session for this item. >> second. >> all right. >> all those in favor. >> aye. >> opposed.

>> so now we are in closed session. >> item number 23. >> review and approve -- >> number 23. worwore backwe're back in open . it's 23. >> clerk: i'm sorry, my apologies. possible report on action taken in closed session regarding employee evaluation presented by president breslin. >> i move we not disclose the proceedings of the closed session. >> not the report. >> yeah. >> second. >> any public comment on this? seeing none. all those if favor. aye. opposed. it's unanimous not to disclose. item number 24, please. >> item 24 is vote to elect whether or not to disclose any or all discussion held in closed

session regarding the public employee performance evaluation. presented by president breslin. >> we have a motion. >> i'll resay it. this is the time i should be speaking. i move we not disclose that proceedings. >> second. >> i mean the previous one is not the report. it's been taken. >> all those in favor. aye. >> all right. >> so now we can go back to item 15. >> clerk: blue shield of california flex funded non medication claims presentation this is presented by mike clarke from aon. >> what you have before you is our experience document for the blue shield 2019 flex funded hmo plans. two plans access plus and trio offered to active employees in early retirees.

the access plus plan has been offered for several years to the sfhss employees and retirees trio was a new lower premium plan that was first available to members january 1, 2018. what you will see for trio is near two of the trio experience. the reserve increased by 7% on a retiree per moth basis from 2018 levels. this is just slightly higher than a national cost trend increase. this compares to a total premium increase of 10% on a pepm basis

from 2019 levels. if you will recall, the over all rate increases for these plans from 2018-2019 was 9% and then the incremental 1% has to do with some shifting of members that occurred from trio back in access plus so most trio populations for 2018 stayed in tremendous owe from 2019 but there was some migration back to access plus from 2019 and that's why thing aggregate actual premiums in this plan from 2018 to 2019 increased 10%. and just as a row fresher too, we're focused on 2019 plan experience here but it's just a reminder for the 2020 plan year, the over all rate premium increase was 2% as we presented at the may 2019 board meeting last year. this translates to a loss ratio

for the blue shield plans of 95.3% and the loss ratio was defined as planned expenses divided by the total premiums so another words expenses were lower than premiums by 4.7%. fair favorable to the plan and prescription were the most expense it stayed constant versus 2018 a lot of this is generated by a high prescription drug rate of use that actually so good news on the pr pre -- a,

that was due in large part to an increase in claim dollars for very high cost claimants in 2019. there were eight victims who exceeded the 1 million-dollar pooling point i discussed earlier in the stop loss presentation versions only five members and 2018. so you will see, i constructed a table here at the bottom of this page 3 that shows what the and you can zizi that after the reimbursements the increase was 9% versus 11% before you considered those reimbursements.

on top of page 4, part of the agreement that blue shield strikes with the physician organizations and other providers as part of these accountable care organization collaborations, includes incentive payments if they meet certain cost targets per employee -- i'm sorry, per member. in this particular instance for 2019, there was a incentive payment earned by the brown and tolland access of close to $1.1 million after there were no provider collaboration payouts in 2018. we reflect that in this report. there was a slight increase in the over all projected ibnr incurred but not reported reserve so these are moneys on hand to pay for claims that are expected to be paid after a certain date where the services

incurred before those dates and the case of us at hss we measure at the fiscal year, june 30th, and then there was a light decrease in the reserve over that period as well. so, on page 5, we show the over all change and experience 2018-2019 by line item. on a total toll ar basis, now you will see in our first bullet above the table that the average total number of employees and retirees decrease slightly from 2019 versus 2018. these are the actual actual toll dollars. you will see 10% on medical claims being a higher than expected number but then you will also see as you go down the

page, large claim pooling. in 2019, there was over $9.2 million paid back to sfhss on that million dollar large claim pooling representative of high cost claimants that included one claim over 4 million total and one claim over three million total and additional three claims that were almost two million or more and you will see the favorable prescription drug experience. you will notice the term capitation on this page. it's for certain physicians services that are offered. there are fixed dollar amounts per member that are paid to those physicians to provide an array of services. in exchange for the financial renumeration on a per-member basis to those physicians. so while page five looks at total dollars on page six we do

the math and divide by the employee and retiree members so those are expressed on a per employee or per retiree per month basis and because the head count change is slight, the percentage changes from page 5 to page 6 are similar just slightly higher on page 6 because of the slight reduction and head count. page 7 is -- we break out the experience between active employees and early retirees and so the majority of individuals covered under the blue shield plans are active but there are 2800 early retirees in the plan as well. you can see how the experience premiums and the expense components and compare and the loss ratios at the bottom of the page for each of the two

populations. so both finish with loss ratios under 100%, meaning the expenses were below the premiums collected. page 8, just shows month by month dough tail of all the annualized numbers i just showed you so i will not go through that in detail. page 9 shows the month by month dough tail for access plus. if you are interested in looking at the experience just for access plus, and page 10 looks at trio specific experience for 2019. one thing i'll note, you see the correlation on trio to what chief financial officer pamela levin presented, you will see for instance, in five of the six months during this current fiscal year, july through december, read for the premium less expenses lyn loin on page ,

you will see how trio expense has been higher than forecast to bfor the last six months of the year but you will see in the first six months of the year more black than red meaning trio ran well so this is a calender year view versus the view from the financial reporting that is fiscal year. then we just have last couple of pages an appendix and glossary of terms. i will be happy to answer any questions you have. >> questions? >> so the ratio is below 100%. all the medical claims went up

by around 7%. the paid loss is lower because of the 10% increase so it difference the the ratio below 100%. >> if we go back when we presented the rate increase for 2019, after a pretty low increase for 2018 with the interrogation of trio, i felt that a higher increase was warranted based on recent plan experience and -- what the

increase was from 2018-2019 and our team will now take this information and start to work on our rating forecast for 2021 that will present at the may meeting. >> any other questions? >> the only question i have, i think the difference between five and eight is small. there's no way one it trend this or raise a siren or anything. anything. how do we look at these high costs to see what was the care provided or issues.

was there a group of dying know sis we need to focus on as a health service or whatever. i mean, what happens to these high cost claims internally? >> fourth coming on the agenda is our audit plan and we will audit high-cost claims this year. i don't know if it's been done in the past. it is of concerned and these numbers are so alarming and that we are obligated to do the audit and consider how that -- how the plan is managing these obviously highly complex cases and so, there are some very good questions to be locked a lookede

won't do an audit on the large claims. >> all right. accepts this is a discussion item, there's no action to be taken. any public comment? >> seeing none, move on to 16. >> review and approve the presentation and this is presented by mike clarke from aon. >> morning clarkeaon. my final presentation is to provide aon's recommendation for the blue shield of california hmo plan rate stabilization plan action. you can see on page one this is based on the policy that requires the annual determination financial loss or gain for self-financedded plans and any difference between expected and actual cost would then be added to the existing stabilization amount and

amortized over a three-year rating period. in the the third paragraph, it'a surplus position as what i'm going to present today. for the first time in many years. so, december 31st, 2014. it's been indeficit for the last six years and i have a buy down of one-third of what is now a stabilization surplus balance for the tree owe plan and access plus. and this should preliminarily be expected to represent approximately a 0.8% rating buy down when we present the 2021 premium rates in may. and that compares to what is now

a 0.6% buy up and the 2020 premium rates for the blue shield plans. so some history, last march, at this time, we presented a recommendation of a deficit balance. a the board approved and 1,886,000 as a buy out to 2020 active employee and early retiree premiums for access plus and trio which left the deficit carry forward balance of 3,791,000 and as i its rated on the last page, we have a surplus position. page 3, so, in part this switches from deficit to surplus

enable by the premium actions that took place and the blue shield plans from 2018-2019 it creates a flip to a surplus position. page 4 illustrates a table that shows the comparison of the original expected claim administrative expense contribution and the shortfall or surplus of each plan for 2019 and we expected the revenue surplus of $3,162,000 and we ended up with a revenue surplus of 14,639,000 so that creates the favorable adjustment of

$11,000,000.04 had not $77,000 and what is currently a deficit balance but we'll flip it over to surplus. and you will see that on page six or five, excuse me. you will see the math behind the figures on the prior page as they cascade into the surplus position that we have calculated as of december 31st, 2019 of $7,686,000 and we take one-third of that and recommend that be a employed to 2021 rate buy down for the blue shield plans that amount is $2,562,000. in summary on the bottom of page 5, what i ask you to prove today is aon's recommendation per their requirement of health service board approved rate stabilization policy that the surplus amount of 2,562,000 or

one-third of the stabilization surplus balance be a replied towards buy down across tiers for the hmo plan applied per policy between active employees and early retirees. this will leave a remaining blue shield hmo plan carried forward surplus balance for your 2022 and beyond of $5,124,000. >> questions? >> comments? >> this is an action item. >> i move to approve the blue shield of california flex-financed rates stability a reply one-third of the surplus for the premium premiums for 20.

all those in favor. aye. it's unanimous. >> thank you. where are we on this agenda if. >> 17. >> we'll go to number 17. reports and updates from the contracted health plan representatives. >> i have one more thing, you are not done with me yet but it's not a presentation. so what i would like to do today is inform the health service board that on march 9th, 2020, three days ago, aon corporation announced intent to come together as an organization with will he iwillis towers watson, a worldwide consulting and risk management organization just as

aon is, and so it is now in full announcement phase we expect that should all regulatory agencies approve the transacti transaction, it will take 12 to 18 months and requires regulatory approval from countries around the world. more information on thissance noment is contained on our website i wanted to inform you of this public announcement of my organization. so, the organization willis towers watson, in my starting out in the business, was known as towers parent and at some point they came together with the watheththe wyatt organizatiy

came together with will is and watson. >> it was when i first started. >> it was my recruiting couldn'tecounterpart in 1989. >> i have one question. we've got word of this and i looked it up online and this is -- i don't know about this whole field. aon is a u.k. company, right? aon is in ireland but we have been a u.k. company. we recently switched our global headquarters from united kingdom to ireland but it's in the financial district of london.

>> when you say multiple countries have to a of this, how many are we talking about? at every continent? >> i've been told 100 countries will need to weigh in on this transaction. >> thank you. >> again, i say statements today, please refer to our website. i speak to anyone, our website will have the official information that you should be following. >> thank you. >> >> good afternoon, denise rodriguez and i wanted to take this opportunity because coronavirus, covid-19 is on everybody's mind. san francisco is quiet today. and i just wanted to rewind you all or just reassure you all that kaiser is really well positioned to manage this crisis right now and we have business

continuity of plan, we have a command center looking at managing the situation with our employees and keeping them safe as well as treating the patients and we've been asked by the center for disease coal to participate in the first clinical trial for vaccinations and so we're really being seen as leaders in this and i'm sorry, correct myself, national institute of health. we're collaborating with cdc to help with the health infrastructure and respond to the systems to stop this spread of covid-19. so, one of the things that kaiser is doing is we've made a donation to 10 leading public-health organizations to subpoena or the this effort so we're out there in the forefront. additionally, i just want to assure you one of the strengthens of our model for many years we've been able to cover telemedicine which

includes tele appointments as well as phone appointment and we have of course our advise line. we are really ramping up on this and there's been an uptick and it's more critical that we utilize that service. we're reaching out for or vulnerable appointment appointmo change it to phone if it's appropriate. additionally, we're looking at alternative ways to provide testing for covid-19. we problem have heard in our medical centers we've had pop-up tents but it's really a drive-thru service. you call in and talk to a physician or nurse add vis and they direct you to go get the test. we're not ready to do testing because we don't have enough tests. no one does right now. they will be directed to go to a

drive-up testing ctstv.co testi. wore encouraging our members to go to the cdc as well as our web page for the latest updates. we're adjusting how we care and the cdc provides more guidance. >> thank you for that clarification and drive-thru testing because in the new -- this morning is kaiser is offering a drive-thru coronavirus testing and i said is that offered to all the members. thank you for the clarification. >> you are welcome. it wasn't a san francisco journal a couple of days ago.

we wanted to end on a positive note so i'm going to hand this off to my colleague to present something positive in our partnership with san francisco health services system. >> good afternoon. debbie with the kaiser perm anent. i would like to provide you with good news with a research study between kaiser and san francisco health service system. the collaborative study called comparative effectiveness of two diabetes prevention lifestyle programs in the workplace, the city and county of san francisco randomized control trial was accepted for publication as an original research article and the johnal preventing chronic j. >> this is to evaluate the cdc disease prevention program implemented in the workplace.

we appreciate your partnership with your team. director yant and fisher and todd over the years of the study and we'll work with the director to come back with another bored meeting to present the process result and outcomes. any questions? good news. >> thank you. >> paul brown from blue shield. i do also want to make a quick comment on covid-19, coronavirus. we too are acting in support of governor's request to provide access to care re lated to the coronavirus and we are removing all copays related to it for

offices at out patient emergency room, in-patient care so there's no copays and we're eliminating all utilization levers we might use for an inor out patient state to interact cease to i int you to be aware of that policy. >> thank you. >> anything else? all right. public comment on this item? >> i would like to learn more about this. and you are speaking in this

where we will have a more epidemic that costing any other, you know, with our children and our healing care issue, thank you. >> any other public comment? all right. public comment is closed. item number 18, please. >> clerk: item 18 opportunity for the public to comment on matters within the bored's jurisdiction. >> all right. this is your opportunity. seeing none, item number 19. >> the opportunity for the public to place items within the board of jurisdiction on future agendas. >> any suggestions other than what we normally have? no? ok.

we're going in the governance committee matters. since commissioner scott is not here today, i will be doing this. which item is this on that you are referring to? >> this is your emotion policies that you worked really hard and i appreciate it.

thanks for, you know, for the property. thank you. >> all right. so governance committee matters. were the number 20. >> the review of the sfhss audit policy and the approval for the audit plan for cal ter year 2020 presented by president breslin. >> are you going over this? >> i would happy to speak to this. as i mentioned earlier, we did develop a health service system and audit policy which is an administrative procedure for the department. what i did want to draw that to your attention where we need your approval, however is that we have put together an you had

its plan and we looked at what we will be doing for this 2020 year. and there's a number of internal audits that are conducted by hss staff that are on the first page of the planned document including the financial statements things like that that you are familiar with. there are other things that you are not aware of and we take a robust risk assessment and look at best practice and standard of practices and have gotten good advise and council from aon and some of their subject matter experts. on the second page, it's some of the external audits that we required external support and thatten clouds looking, there's a mandate to look at the mental

health parity so we'll start with the uhc and looking at that. we're looking at the high claims with both blue shield and kaiser because that is a growing trend of concern and so we're diving no that fairly aggressively this year. there are hip a privacy security audits and we're weighing the city improves the standards as cybersecurity is more and more of a risk and there may be things that we are not regulated by the city that would bee hoff us to take a look at and it's under consideration right now. the fraud waste and abuse audit, i'm sorry, this doesn't have on here but i believe we're doing that with blue shield, am i

correct? blue shield and uhc. thank you. so that's kind of a typo there. so we'll be doing that this year as well. and this is all presuming that current funding that we have available will continue to be available. these come at a price and all things considered it's a wise use of our funds. any questions? >> >> so money from this audit is out of where? >> our budget. >> it's been approved? >> the funds are available. >> any other questions? any comments? we need a motion to approve. >> i move we approve the audit policy and schedule as presented and incorporated within the

presentation. >> second the motion. >> second it. any public comment? all those in favor. aye. opposed. it's unanimous. we are at the end of our agenda, i believe. yes. so it's confusing for me today too. i think this is about -- >> you did a good job. >> all right. >> this meeting is adjourned if there's no objection.

>> the bicycle coalition was giving away 33 bicycles so i applied. i was happy to receive one of them. >> the community bike build program is the san francisco coalition's way of spreading the joy of biking and freedom of biking to residents who may not have access to affordable transportation.

the city has an ordinance that we worked with them on back in 2014 that requires city agency goes to give organizations like the san francisco bicycle organization a chance to take bicycles abandoned and put them to good use or find new homes for them. the partnerships with organizations generally with organizations that are working with low income individuals or families or people who are transportation dependent. we ask them to identify individuals who would greatly benefit from a bicycle. we make a list of people and their heights to match them to a bicycle that would suit their lifestyle and age and height. >> bicycle i received has impacted my life so greatly. it is not only a form of recreation. it is also a means of getting connected with the community

through bike rides and it is also just a feeling of freedom. i really appreciate it. i am very thankful. >> we teach a class. they have to attend a one hour class. things like how to change lanes, how to make a left turn, right turn, how to ride around cars. after that class, then we would give everyone a test chance -- chance to test ride. >> we are giving them as a way to get around the city. >> just the joy of like seeing people test drive the bicycles in the small area, there is no real word. i guess enjoyable is a word i could use. that doesn't describe the kind of warm feelings you feel in

your heart giving someone that sense of freedom and maybe they haven't ridden a bike in years. these folks are older than the normal crowd of people we give bicycles away to. take my picture on my bike. that was a great experience. there were smiles all around. the recipients, myself, supervisor, everyone was happy to be a part of this joyous occasion. at the end we normally do a group ride to see people ride off with these huge smiles on their faces is a great experience. >> if someone is interested in volunteering, we have a special section on the website sf bike.org/volunteer you can sign up for both events. we have given away 855 bicycles,

376 last year. we are growing each and every year. i hope to top that 376 this year. we frequently do events in bayview. the spaces are for people to come and work on their own bikes or learn skills and give them access to something that they may not have had access to. >> for me this is a fun way to get outside and be active. most of the time the kids will be in the house. this is a fun way to do something. >> you get fresh air and you don't just stay in the house all day. iit is a good way to exercise. >> the bicycle coalition has a bicycle program for every community in san francisco. it is connecting the young, older community. it is a wonderful outlet for the community to come together to have some good clean fun.

it has opened to many doors to the young people that will usually might not have a bicycle. i have seen them and they are thankful and i am thankful for this program.

(role call) item 2 is pledge of allegiance. i pledge allegiance to the flag of the united states of america and to the republican for which

it stands, one nation under god, indivisible with liberty and justice for all. >> please be advised the ringing of and use of cell phones and pages are prohibited at this meeting. and be advised the chair may remove anybody using a cell cell phone or electronic device and the public has up to three minute to make pertinent comments unless the port commissioner dubs a shorter period. the moderator will instruct dial-in participants to use touch-tone phones to register any desire tor public comment. comments will be taken first from in-person participants and then dialed-in participants. audio prompts will signal to dial in when the input has been

enabled for commenting. the comply with the declaration for covid-19, that you remain an arm's length distance. we are not requiring speakers to fill out a card but speakers can go up to the podium one one at a time or queue up in line but please maintain the social distance. item 4, declaration of emergency port commission meeting. >> thank you, everyone, for joining us today whether in person or by phone. the mayor, the state of california and the federal government have declared that the coronavirus pandemic is a public health emergency and ask that the people stay at home, which is where i am. the mayor's office has

determined that the port commission has an urgent need to take action on the matter before us to ensure public health, safety and essential government operations and has authorized the port commission to meet on this matter. i move that we hold this emergency meeting because of the coronavirus pandemic as an emergency that severely impairs public health and safety and the matter before us demands prompt action and is necessary to ensure that there is no disruption or threaten disruption to the public facility. >> do i have a second? >> second. >> all in favour? >> thank you, commissioner. item 5a, requests approval of resolution authorizing the executive director to recommend the memorandum between the port and the department of homelessness in support of housing to expand the capacity

of embarcadaro centre due to the coronavirus outbreak. >> so moved. >> good morning. i am the director of the communications for the port of san francisco and i will make brief remarks and i will provide an overview of the proposed amendment to the port's mou with the department of homelessness and support of housing for operations at the embarcadaro centre on sea wall lot 330. the commission approved the existing agreement between the port and the department of homelessness in support of housing at the april 23rd, 2019 meeting. in declaring a local emergency in calling for all efforts to protect the health and safety of the public, the mayor's office is asking the port and hsh, the department of homeless housing to revisit the embarcaro centre,

the ramp-up. it calls for one change. the proposal is to change the ramp-up schedule articulated on page 10, section 11.1 of the agreement under permanent uses to allow hsh to expand bed capacity beyond the ramp-up limit to accommodate the city-wide coronavirus response. all other terms and conditions originally agreed to on april 23rd, 2019 would remain the same and not change. i have emily cohen here from the mayor's office who will provide a short presentation articulating the urgent need for the amendment, as well as un-update on the state navigation centre operation. after the proceedings, we will be available to anticipation any questions. answer any

questions. >> good morning. this is emily cohen, the mayor's policy advisor on homelessness and thank you for convening today and thank you to the members of the public who have joined either in person or via phone. can everyone hear me all right? >> yes. >> thank you. i'm going to walk you through a brief presentation as randy said and we are proposing an amendment to the mou between the port of san francisco and the department of homelessness and support of housing and i want to give a little background context to this. as many folks know, the safe navigation centre, which is operated by five keys opened the end of december. it is currently operating at a capacity of 130 people each night. during the first two months of

operations, all placements into space navigation centre were made by the homeless team working in the homeless zone in the immediate area of the navigation center. san francisco has two, two-person teams working in the outreach zones full-time and they have an additional two-person team working with one shift and one on the weekends and folks are invited into the navigation center. we've had a tremendous amount of success in engaging folks on the street in the area and inviting them indoors. as folks remember from the original mou, we designated both a safety zone and outreach zone within the safety zone which is smaller and immediately surrounds the center. sfpd has applied beat officers to the zone seven days a week, five keys have been mentioned as

the operator and made a phone call available where neighbors can call or text with concerns about the need area, the perimeter of the navigation center. as everyone in the room or on the call is well aware, we are facing a public health crisis, the covid-19 or coronavirus. in response, mayor breed declared a state of month in february. when i put this presentation together a few days ago, there were 23 positive cases in the city of san francisco but the course has continued to evolve. san francisco has taken serious steps to mitigate the impact of the coronavirus on our community, including the most recent shelter in-place ordinance issued by the health officer earlier this week, wellspan aaswell as declareing l emergency and one of the big

areas has been focusing on, for me and my work focusing on the impact, the potential impact of the coronavirus on people experiencing homelessness or living in other congregate facilities. so we've allocated funding to enhance services at drop-in centers, shelters, navigation centers and other congregate environments. as you can imagine, the coronavirus epidemic represents a significant health risk represents .people experiencings have limited access to preventative measures including hand washing, home isolation, avoiding high-touched surfaces and people experiencing homelessness may have more chronic conditions making them

more vulnerable to the virus. as i mentioned before, we are taking proactive steps to protect the vulnerable population within the homelessness population, including expanding cleaning, expanding hours of programs, enhancing meal delivery for people in supported housing and occupancy hotels who have been advised to not go out because of their conditions. and we're extending a lot of this operation not to the publically funded housing but to private owned sros and increasing or outreach. we've deployed 30 handwashing stations for people unsheltered and bringing online rvs and hotel rooms, places where people can isolate and self-quarantine if they've been exposed to the virus but don't have problems. so part of our need and part of our strategy for protecting people experiencing homelessness

in san francisco is to expand our shelter capacity. we want to mechanic sure that people experience homelessness have state places to be, abilit, hygiene, meals and other basic healthcare. as randy mentioned, there are currently 70 empty beds at the embarcadaro center due to what as lined up in the mou. as i mentioned earlier, there are 130 beds currently in operation and that was the agreement per month, one through three, of the navigation center and we're due to expand to 165 beds for months four through six anand 200 beds in july. we feel we cannot wait until jusjuly to have access to the b. so the court is requesting an amendment to the mou to allow hsh to expand the bed capacity

beyond that ramp-up limit, to accommodate the city-wide emergency coronavirus response. this is my brief presentation and i'm happy to take additional questions from commissioners. thank you very much for your time. >> thank you, randy and emily for your presentation. is there any public comment in the room? >> yes, commissioner. >> please state your name. >> i'm elgin rose and we do outreach with hundreds of homeless people i in the

tenderloin community and outreach into tents. so the 70 beds opened that could be filled with people and could get rest and take in information is very important. and i think just making people feel like they're a part of the population is a key to maybe making it better and taking this covid-19 thing serious. so definitely, i'm here to support just getting more people with those beds and if anything else the tenderloin could be supportive of, we are interested in doing it. thank you. >> thank you. >> hi, thank you for having me here today and also the people who are on the telephone. i'm the executive director for the tenderloin and since this crisis hit, we have not shut our doors. we have a serious crisis on the streets. people are out there that don't

know what's going on. we've giving them soap and water and hand sanitizer and a lot of these people are elder people, grandmothers, grandfathers and these are handicapped people in wheelchairs and they need some place go. i walked through the tenderloin this morning and i saw easily 100 in two blocks living on the streets, who are dirty and being exposed. i'm walking here through the farmer's market and if that's not a lot to say. like, we need to help these people and we need more beds. we had a young man who came to us, to our pop-up and said, you know what, i've been on the streets for three years but i'm scared right now and i want to go somewhere. where can i go? a 22-year-old man who finally had a revelation he wanted to change his life is still on the streets. so i'm here in support of

expanding the beds and i hope we can move this forward. everyone has that right. >> thank you. >> my name is joseph norez and i work for the co-tenderloin and i've lived in san francisco for 26 years. i think that on monday, i was asked to come to work to get materials so that i could work at home and on the way to work, at the corner of golden gate and hide, which is one block from the federal building, there were tents, there was a shooting gallery right on the street and so, anybody that's gone through the tenderloin in the last few years or along market street, bart stations know that san francisco has been the site of a national health crisis for quite some time and in the last couple of weeks, it's become

exponentially worse. so common sense says that if our most at-risk individuals who already have a compromised immune system, off on or barista, we're all vulnerable. we work with the most vulnerable and underserved people in our city and they need beds. canary in the coal mines at golden gate and hide is taylor and jones and the bart station and they need help. put to thank you. thank you. >> thank you.

>> good morning, i'm an education coordinator and i'm a pastor. i'm here to stay i support this for compassionate reasons. like donna mentioned earlier, walking through the tenderloin in general, having worked in this area for over a year and a half, i see a lot of disparities and a lot of crime and pain and hurt and i see a lot of people who want find a way into a better life and better situation and now with what's happening with covid-19, now they're in even further danger. every population, every culture -- and i feel the homeless situation in the tenderloin is a situation in itself and it's not just the tenderloin. you have people in the bayview where i grew up. i grew up in san francisco and people are hurting and right now

covid is doin going after the ey and i want to support this effort and say we should move forward with the expansion of the beds and with helping these people as much as possible. we need someone to know how it and how we can help this effort. thank you so much. >> thank you. >> that's the last speaker in the conference room. >> thank you, amy and thank you everyone from the tenderloin. any more public comment or in-person? >> no. >> so the in-person public comment is now closed. now we will open up the phone lines to take public comment from members of the public who

are joining us on the phone. >> thank you, president brandon. at this time, we'll open the queue for anyone on the phone who would like to make public comments. >> in question is now in question and answer mode. to alert the speaker you have a question, press one and then zero. >> please dial 1-0 on your phone and the system will add you. you will be entered into the system in the order you dialed 1-0. the system will let you know when it's ready and others will wait. public comments limited to three minutes per person. the queue is now open and please dial 1-0 if you wish to make a public comment. >> thank you. do we have anyone on the phone? >> there are five public comments via telephone.

>> please open the line to the first caller. >> hello, earn. everyone. i'm a community member in rinkton hill, and i'm an immunologieimimmunologist. from a human standpoint, i can be on board but my concern lies from a health standpoint, specifically, if someone tests positive, what is the containment plan? are all individuals contained to confinement and do they have an appropriate infrastructure? for example, like a pod or some sort of isolation tent? additionally, if these

individuals test positive or have an exposure, how will they be kept inside and liable to say inside of the navigation center or whatever facility they're in. they should not be able come and go as they please, specifically for drug use. this will add to vulnerabilities and put further strain on the immune system and i'm not aware of any data about how withdrawal would influence the course of the coronavirus infection or another respiratory virus infection. with that said, i agree that is a vulnerable population, but it could ultimately turn into more of a risk and potentially an epicenter of a new wave of infections in san francisco. so my question for the board or

just in general is, what is your plan and how are you going to mitigate any risk? thank you very much. >> thank you. >> does this new amendment allow the city to put more than 200 people in the navigation center or is it just to expand up to 200? thank you. oh, and one more thing, is there a sundown period? i guess it won't matter. if it's up to 200, it won't matter because it can stay up until 200, but if it goes over 200, is there a sundown period?

in other words, does that end at a particular point in time? thank you. >> please state your name. >> my name is bruce goldetski. >> thank you, bruce. >> moving on to the next caller. >> hi, commissioner and port. i'm florence and i have the same concern that the first caller had about the crowding situation in the navigation center. right now there's a lot of tents on main street, as you can see, and most residents are concerned about the virus spreading if they go into a shelter and i'm really concerned about their health situation if they were to be packed in even more and more beds were to be added. i would like to understand what

kind of risk mitigations and procedures will take place if there are beds that will be added. thank you. >> thank you. >> we'll continue to the next caller. >> my name is judy lynn and i'm a neighbor of the navigation center and i live at the watermark and i wanted to echo with the callers have stated already. i am all for expanding the shelter capability in general to help the homelessness but i think it's the department of the homelessness needs a plan to mitigate risk to the homeless population while they reside in these shelters, particularly for the navigation center. is it going to be reconfigured to keep the six-feet distance

while they're sleeping or interacting and what are the health checks that will take place to keep the residents and staff safe, to determine if they're trying to show symptoms. and also to echo the quarantine issue, if they do start to show symptoms, how will they be quarantined and kept separate from the other guests? and i just wanted to echo, what are we going to do about the 50% of the navigation center residents that are drug users, if they start exhibiting symptoms or need to be quarantined, does the staff have the kat capability to treat pose withdrawal symptoms? how are the rules in the navigation center going to change to comply with our current shelter-in-place order? earlier this week, we were seeing needles and people outside using drugs. and so those are my questions and i hope emily can address

them. >> thank you. >> we are moving on to the final phone-in of the caller here. >> hello, this is katie ladell and i sent a letter in yesterday and i do have some concerns that the previous speakers have, but in the meantime, we've got 130 people over there already, or 135 and we really do need to help these people out. i am also a neighbor. i walk by quite often and it's very quiet over there and i've been inside a couple of times because i've taken over some donations. it's been a very good neighbor. it's been well run. i do encourage you to let executive director forbes give

her permission to up the ante to 200. thank you very much. >> thank you. >> president brandon, at this time, there are no more members on the phone wishing to make public comment. >> thank you. seeing no more public comment, all public comment is closed. >> president brandon, if i may interject, i have an additional letter from wallace lee whom i would like to read into the public record with your permission. >> ok. >> the letter is dated march 18th, 2020 and it was presented to presen president b. i am writing on a safe embarcadaro for seawall lot 330 to allow for the accelerated expansion of the center. please support the actions the city believes to control the transmission of sars-cov-2

during this public health crisis and we do not oppose the accelerated expansion of the navigation center given the circumstances. however, we would be remiss not to bring to the commission's attention the many problems the nav center has brought to the neighborhood, even at the current size. an increase in public drug use, frequent use of war for drug sales and new incantments from those who moved as well as they say have a space in the navigation center but prefer to sleep indoors. this can be found in the attached. it's www.safeembarcadaroforall. sincerely wallace lee. and attached to his letter are several pictures which have been

provided to you and can be uploaded to the port's website and that is the end of wallace's letter. >> thank you. >> so randy or emily, do you want to respond to any of the callers' comments or any of the public comment? >> yes, thank you, president bran ton. thibrandon. i'm happy to respond to questions. and i think there's excellent questions around the safety in the navigation center and i want to assure folks that the department of homelessness and supportive housing is working very closely with our department of emergency management and department of public health to improve the safety of all of our congregate facilities, including this navigation center. so what that looks like is certainly enhanced cleaning of the site, disinfecting of frequently touched surfaces, handwashing stations, encouragement of good hygiene

within the facility. we're also working with the department of public health to tea emplodeploy a health screenl for people coming into the navigation center and as folks come in, they will be asked a series of questions. if they answer question to a sensor numberacertain number, ar yes, they will be isolated in a certain area where they will ask for a health worker to come on site and do an assessment of their healthcare. if they distribute symptoms of the covid-19, they will not permitted into the facility but in a self-quarantine isolation area unless their symptoms warrant hospitalization. so we have procured some rvs, trailers for this self-quarantine, as well as procuring hotel rooms for people exposed to the virus. and so folks who live in

congregate facilities like homeless shelters. so the intent is really follow do everything we can to remove anybody from the navigation center displaying symptoms to have quarantine spaces available for them should they not warrant hospitalization and if somebody is exposed to the virus, similar precautions will be taken. so we hear that call and we share everybody's concern around the congregate environment. we are working on social distancing within the shelters across our shelter system and that will mean generally, that we could lose capacity in a number of shelters and that's why we're working to identify so many more facilities where we can spread people out, too. these are, of course, for folks who are asymptomatic not exposed to somebody with the virus. for those symptomatic or who have tested positive, we will have a positive intervention for them. again, the department of

homelessness and support of housing is taking the lead from the department of public health on all of these protocols. we've issued new policies and protocols to all of our shelter managers' organizations so they're aware of all of the resources that are available to them, how to interact somebody who demonstrates symptoms and how to get them the care that they need. of course, access to supplies remains a challenge. we're all moving as quickly as possible, but we have deployed handwashing stations on the streets, as well as to some of the shelters that don't have as many sinks and showers as we would like and we're trying to bring in supplemental services. i think that answers some of the questions. if commissioners have additional questions, i am happy to respond. >> one additional point to clarify some of the questions about the amendment and what it means. i wanted to rei reiterate the proposed amendment calls for

only one change to the existing agreement and that's to change the ramp-up schedule as ar take articulated in 11.1. in the presentation, emily eluded to what that ramp-up schedule would look like, existing agreement calls for 130 beds from months one through three and from months four through six, up to 165 and beginning in month seven, up to 200. the proposed amendment would change that ramp-up schedule so additional beds could be used now. no other terms or provisions of the existing mou would change. >> just to clarify, there would be no more than 200 beds. >> thank you, emily and randy. is there any other information that the staff would like to share before i open it up to the commissioners? >> one other point is as we've been moving quickly to put

together huge thank you to the port staff for the emergency meetings, i had the opportunity to talk with the vast majority of the state's navigation center advisory group members, letting them know about this amendment and everyone i spoke to was largely supportive of this work. >> i will open it up to the commissioners and for the record, i would like to state that commissioner wuho had a conflict and she would like to express her support for more ramp-ups in the capacity of a

navigation center given the dire need to help the homeless community in this crisis. so i just want to make sure that is a part of the record. commissioner gilman? >> thank you, commissioner brandon. first of all, i want to thank all of our front-line nonprofit workers who are continuing to go to work everyday, particularly our emergency service's staff. too often nonprofit workers are not thought of by the public as first responders, but they're the ones keeping our shelters and navigation centers and supportive housing everyday. i want to thank emily for your work. i am fully supportive of the item. but i have one question for emily. they want to procure hotels and

for people who need to self-quarantine or symptomatic but he called for the priorization for people vulnerable to the illness or folks over 60 in the homeless population to be sheltered first. my question is, are you looking at that population first for priorization into the navigation center or will you use coordinated entry? >> that's a great question. thank you, commissioner gillman. we are looking at the governor's guidance that came out yesterday and working with the department of public health to put together our priorization tool, but people with preexisting conditions, people over 65 are our priority to serve. >> thank you. that concludes my questions.

can you please speak into the microphone. >> i support this navigation center. >> vice president adams. >> i want to thank the community for coming out. i want to thank mayor breed for leadership and this is a situation we must act swiftly. we saw that this is coronavirus and the federal government removed in a swift manner and that's why we're behind the 8-ball. there was a lot of good questions and a lot of good concerns. but this coronavirus is an enemy, an enm enemy and we can'e it. this is a life and death matter.

it's a national crisis and a world crisis. we're talking about our community. we must act swiftly and i live a block from the navigation center and we must provide for the beds and we must move. if we don't, i think there will be a price to pay. so i support it and i would ask my fellow commissioners to support it unanimously. >> thank you. emily and randy, thank you again for this presentation and thank you for all of the the work you've done to bring it to this point. i would like to thank mayor breed for having the foresight to having this facility available for our very vulnerable population and to show the need for so many more beds. this is a crisis and hopefully,

we can get out in front of this and make sure this population is taken care of along with all of our other city residents and it's a small part that we can play and i want to thank the community. i want to thank our advisory group and i want to thank everyone supporting this item, because we really need it. so with that, all in favour? >> commissioner, we need to have a role call vote for resolution number 2016. (role call) all in favour, thank you, commissioners. >> so resolution 2016 has passed. >> thank you.

>> thank you, commissioners. >> thank you. >> can i have a motion to ajourn? >> motion to ajourn. >> is there a second? >> yes, second. >> all in favour? the meeting is adjourned at 10:40 a.m. >> thank you, commissioners. >> thank you, everyone.