>> president breslin: the san francisco health board will now come to order. madam secretary, roll call, please. >> clerk: agenda item 2, roll call. [roll call] >> clerk: president breslin, we have a quorum. >> president breslin: very good. at this time, i would like our secretary to explain some procedures about this virtual

meeting. >> clerk: thank you. yes, just a reminder, this meeting is being televised through sfgtv so there is about a minute, two-minute lag time between what we're seeing as the producers and members of the live t.v. as opposed to the live event. so please be mindful of that during the presentation. we are going to have public comment on almost every single item on the agenda, and so everyone who wants to give public comment needs to dial into the conference line listed on the screen. everyone will have three minutes to speak unless the board president shortens that time at some minute during the meeting, and we will be giving about a 30-second delay between the start of public comment when it's called by the president. please follow the directions on this screen as it will be shown

before every public comment for your use at home. thank you, and that is my guidance for public comment. >> president breslin: thank you. item number 3, please. >> item 3 is the approval, with possible modifications, of the meeting minutes set below. the following minutes were set before the board for their approval and review. the finance and budget minutes from february 13, 2020, the governance meeting minutes from february 25, 2020, the regular meeting minutes from may 14, 2020, and the special meeting minutes from may 28, 2020. >> president breslin: all right. are there any corrections from the board to the minutes? >> commissioner zvanski: yes. this is clare speaking, commissioner breslin. i'm just going to send in a few corrections from the minutes on

may 14 and may 28. they're just small corrections on names and a couple of typos. >> president breslin: anybody else? >> vice president follansbee: president breslin, this is commissioner follansbee. i submitted a few corrections to the meeting minutes of may 28. i don't know if you have them in front of you. i have my own original copy -- there it is, so those are the suggested modifications, one of which is just a typo, and the other is some -- a couple of them are just adding what i heard as recommendation -- from the kaiser representative and then some explanation for what i was saying under the -- on page 32, 33 of the kaiser presentation. >> president breslin: okay. thank you. so i will need a motion to --

to -- jutorey d. sco >> this is commissioner scott. i move all four sets of minutes be approved with the edits and corrections that have been highlighted. >> commissioner zvanski: second. this is clare. >> president breslin: very good. any public comment on this item? >> clerk: we will now move into public comment. we will give the public about 30 seconds to catch up to the content that's being displayed. once that contime is over, i will begin calling for them to begin comment. >> operator: your conference is now in question-and-answer mode. to summon each question, press one and then zero.

>> clerk: all right. i want to make one more reminder. this is public comment, not question-and-answer, as the voice has declared. i know it's a bit confusing for some people calling in. this is just public comment, not question-and-answer. moderator, will you please open up the public comment line for the first caller? >> operator: you have zero questions remaining. >> clerk: that concludes public comment. >> president breslin: all right. all right. the motion has been moved and seconded to approve the four different minutes. all those in favor, signify by

saying aye. all opposed say nay. it's unanimous in favor of approving the minutes. all right. item number 4, please. >> clerk: item 4 is general public comment on matters within the board's jurisdiction. >> president breslin: this is a public comment item. >> clerk: again, we're going to give about 30 seconds for those at home to catch up with the lag time, and then, we'll open this item up for general public comment.

>> clerk: all right, moderator, will you please open up the line for the first caller? >> operator: you have zero questions remaining. >> clerk: president breslin, that concludes public comment. >> president breslin: all right. next item, please. >> clerk: item 5 is the president's report. this report is given by president breslin. >> president breslin: all right. i just wanted to mention some sad news, that our secretary, natalie eckbert, this will be her last meeting, and i want

you to join me in thanking her as she starts her next chapter in new york city. in front of me is a very artistic message that someone did a very good job on. since february, miss eckbert has served as the secretary to the health services board and executive assistance to abbie yant. she is the pinnacle of diligence and grace. she is a great colleague, and we wish her all the best. yes, thank you. i wish you all the best in your future endeavors, natalie. thank you for all your service on the board. >> clerk: thank you, karen. i didn't know this was happening, so thank you. >> vice president follansbee: this is commissioner follansbee, and i'd like to add my sincere thanks.

this has been a couple of years of transition, and natalie, you have been remarkable in not only adapting to the changes but troubleshooting and helping to facilitate the changes, keeping all the board members in the loop, working with each of us in our own weaknesses and some of the challenges that we've faced, so i want to thank you, too, for years of challenges, and you will be missed. >> commissioner scott: this is commissioner scott. natalie, you've been an absolute star during the operational transitions that we've had to go through, and i wish you the best of luck in your future endeavors.

>> clerk: thank you, both of you. thank you. >> commissioner zvanski: it is commissioner zvanski, and natalie, i would not be here if this meeting -- it wasn't for you, and i just want to thank you for all your technical knowledge. i'm sorry about dexter barking in the background. i've monitored all of your work over the last couple of years, and as i have previous secretaries, and you're just outstanding. i can't believe you're leaving. it's just killing me, so i want to definitely agree with my fellow commissioners. you've been wonderful, and i wish you the best in new york. but just know that you can always come back to san francisco. some of you will always need your technical expertise. >> clerk: thank you, clare. [inaudible] >> -- i just want to thank you

for walking me through all the various details. i totally appreciate you, i appreciate your kindness and your knowledge, and i will really, really miss you. >> clerk: thank you, commissioner howe. i will miss you. >> supervisor preston: this is supervisor preston. natalie, thank you for all of your work and helping me get up to speed as the newest member of this body. appreciate all of your patience and help. i wonder what kind of motion we can pass to make you stay, but i know the attorney will tell us we can't do that. i wish you all the best in new york, and thank you, thank you so much for everything you've done. >> clerk: thank you so much, commissioner preston and whoever put this together. thank you to that human. it's nice to have this moment with all of you but it's also very hard with me because i've built relationships and kind of

molded this job into something i don't see as a job. it's more of just who i am, so i am going to miss each of you in this position and my sfhss family. i truly became a better person because of all of you, and just guiding me with patience in the moments that i did not know what i now know. i did want to thank abbie, too, because she saw something specifically in me that i didn't know was here, and i think i've uncovered it over the past two years and really continue to develop it, so her guidance and leadership and just presence in my life has changed my life. so i am grateful for this experience, and i will miss every single one of you.

>> natalie, this is chris kent, and i will miss you. >> natalie, we had a team behind you putting this together in secret, so that was fun. and i think it epitomizes who you are. have fun in new york, and stay in touch, and we'll miss you so much. >> wait for that new york winter to hit you. you'll be back in san francisco. >> looking forward to some snow, but seriously, thank you. thank you, everyone. >> also, i'm looking forward to when we can get back to i in-person meetings so our members can express themselves

in person, and i also want to thank our first responders who are doing so much in this challenging time. let's move onto item 6. >> clerk: karen, we need public comment. >> president breslin: oh, public comment. >> clerk: thank you. i'm going to start the 30 seconds now.

>> clerk: all right. i'm going to ask the moderator to open up the phone lines in one moment. i'm going to ask everyone who's dialed into the conference line, you must press one-zero to be added into the queue. you are able to listen to the whole meeting on this conference line, however, to get in public comment, you must press one-zero to get into the queue. okay. moderator, can you open up the lines for public comment. >> operator: you have one question remaining. >> this is maureen o'shea, and

i would like to address the health insurance board, the retirees. i hope i'm not out of line, but my time is limited. i would ask the board to consider establishing a provision that the retirees would be able to enroll in the plan one city health plan as we previously had the opportunity. i feel that retirees should have more than one option as we currently have with medicare advantage. i had, as a 30-year employee, always been enrolled in the city plan one, and at the age of 80, i am beginning to have

more health problems, and it would be beneficial to me, as i'm sure to many others, that we have access to the best health plan available, and thank you for your consideration. >> clerk: thank you very much. moderator, will you open up the call line for the next caller. >> operator: you have zero questions remaining. >> clerk: president breslin, that concludes public comment. >> president breslin: okay. thank you. item number 6, please. >> clerk: item 6 is the election of the health service board officers, both president and vice president, for fiscal year 2020 through 2021. this presentation is done by president breslin. >> president breslin: every year at this time, we have an election for our officers, our president and vice president, and at this time, i would like to nominate dr. stephen follansbee as president for the next year, from 2020 to 2021. are there any other nominations

from the board? seeing none -- no? i wou -- no -- i would like to secondly nominate chris canning as vice president to the board. are there any other nominations? >> commissioner scott: this is commissioner scott. i move that we accept the recommendations for the new officers for fiscal year 20-21 of dr. -- commissioner stephen follansbee for president and commissioner chris canning for vice president. >> this >> commissioner hao: ts

commissioner had commissioner hao. i second. >> president breslin: okay. public comment. >> clerk: public comment will begin in 30 seconds starting now. >> clerk: all right. people who are on the conference line, please press one-zero to be put into the queue, and moderator, will you please open up the line for the first caller on the line?

>> operator: you have zero questions remaining. >> clerk: president breslin, that concludes public comment. >> president breslin: all right. the motion has been moved and seconded to approve the president as commissioner follansbee and the vice president as chris canning. all those in favor, signify by saying aye. any of those opposed, say nay. it's unanimous. all right. item number 7, please. >> clerk: item 7, vote on whether or not to cancel the july 2020 health service board regular meeting. this is presented by abbie yant, the executive director. >> yes, good afternoon, commissioners. we are recommending that we do not have a july meeting. i think the commission's worked

really hard this year, and i know the last two years, you've served your vacation month, and we'll be in transition with a president who is ready to go for the august meeting. >> president breslin: all right. do i have a motion? do we need a motion? yes, we need a motion. >> this is chris canning, and i move that we cancel the july board meeting. >> this is commissioner hao, and i second. >> president breslin: okay. public comment on item 7. >> clerk: this is the time for public comment on item 7. please press one-zero to be added to the queue.

all right. we will now begin public comment. moderator, will you please open up the phone line for the first caller. >> operator: you have one question remaining. >> clerk: hello. if you're on the phone line, we have you on public comment. >> this is fred sanchez, but i wanted to actually talk on item

8, plus 10 and 11, not on this particular item. >> clerk: no problem, mr. sanchez. if you just want to hang on the line, we will close out this part for you on the conference line. don't hang up, and when we get to those items, just press one-zero to be added to the queue. >> thank you so much. >> clerk: thank you. moderator, will you open up the phone calls for further public comment if there is one. >> operator: you have no further questions. >> clerk: madam secretary, that concludes public comment. >> president breslin: okay. we're going to move into the rates and benefits section of our agenda, and next item, please. >> clerk: item 8 is review revised rates and benefits calendar plan year 2021. this is also presented by abbie

yant, executive director. >> commissioner scott: excuse me. this is commissioner scott. we did have a motion on the floor. we didn't take the vote. i'm sorry. i meant to get in before. >> president breslin: oh, that's right. all those in favor of cancelling the july meeting say aye. are there any opposed to cancelling the july meeting? okay. so the ayes have it. sorry about that. now we're at item number 8. do you need to call the agenda again or should i just jump in? >> president breslin: i think just go ahead. >> okay. so the rates and benefits calendar is moving along. assuming we are able to pass all the recommendations today, that will conclude the health service board's duty of approving rates and benefits that will be carried to the

board of supervisors for their budget and appropriations committee, i believe it's now called, on july 15, and then, a first reading on july 21 and a second reading by the full board on july 28. any questions? >> commissioner scott: this is commissioner scott. i'm just -- we're all going to rely on supervisor preston to be vigorous and active in his support of our recommendations to the board. i put that forward at this time. >> commissioner zvanski: this is clare. i just want to second what commissioner scott said, but please let us know if our testimony is needed to support the department's budget. in the past, when the board of

supes held public comment in these hearings, it was easier for us to go to the chambers and support our executive directors, so i know that abbie and pamela have gone to these meetings, but if you need us to support you, supervisor preston, and department heads -- abbie -- we will be on call and stand by to be able to testify in support of that testimony. >> okay. and just to be clear, this rates and benefits package is a separate item than the department's budget hearing -- or they're different agenda items. >> commissioner zvanski: yeah, either of them, i'm just

notifying you of that possibility, that we can join those meetings if we need to. >> supervisor preston: yeah, this is supervisor preston. i'm looking forward to working with director yant and presenting this with my support to my colleagues on the board with further testimony and support if we need further information. thank you. >> president breslin: okay. i don't think we have public comment on this item, because i forgot to do that on a previous item, so now, we'll have public comment on item number 8. >> clerk: thank you, president breslin. a reminder to the public, if you're wishing to add public comment, press one and then zero to be added to the queue. we'll pause for 30 seconds and then begin public comment.

>> clerk: all right, moderator, will you please open up the conference line to the first caller? >> operator: you have zero questions remaining. >> clerk: president breslin, that concludes public comment. >> president breslin: okay. thank you, item number 9,

please. >> clerk: item 9, review and approve the 2021 dental plan rates and administrative fees. this is presented by mike clarke from aon. >> hi. mike clarke from aon. before i begin the dental presentation, two comments. i echo everyone's comments, natalie. it's been a pleasure working with you the last two years, and i represeecho the comments everyone at sfhss. tom ricks has chosen to leave the aon corporation recently, and so perhaps fitting that i announce that during the dental

presentation because he would often present the dental rates to the board. so good luck to tom, as we always do, but we did notify president breslin earlier this week. just wanted to provide that information about tom leaving aon. so with that, i will begin my 2021 plan renewal presentation. so i'll start with some of our rate setting methodology previous that we did for the health plans two weeks ago, focusing on the dental plans and then launch into the 2021 plan ratingum renewal summary. first for the delta dental p.p.o. and then the fully assured planned which included delta retiree p.p.o. and the united health care and delta

dental h.m.o.s, and then, i'll ask for a statement from a delta dental plan of california representative. so with that, to start our rate setting methodology process, you'll recognize this slide from last time, and what we've highlighted is where the dental plans fall into the funding method chart. so you'll see on the left side of the page, under self-funded, that the delta dental active employee employee p.p.o. is self-funded, means it's paid by dollars provided by service members. aon is the actuary and use the plan to determine functions as well as health service board

retirees. you'll see the delta dental retiree p.p.o., the delta dental care u.h.o., and the delta dental h.m.o. you' next slide. and similar to last time, this is the five-step process, except for dental, we do not have sfhss specific cost elements, so it's essentially a four-step process for the dental plans to determine the needed rate change factor in this case from 2020 to 2021. next slide. so with that, we'll review ratings summary for the plan that we'll review today.

next slide. next item, please. the covered populations for the sfhss dental plans as well as the member contributions are outlined on this page. the active employees of three employers are offered dental coverage throughout sfhss, and those are the city and county of san francisco, the superior court, and the municipal executive employees. for the ccsf, ccsfmea, and meamta employees, they pay $10 a month for single tier and $15 a month for family tier in the p.p.o. these employees pay no contributions for the two dental h.m.o.s that are

offered. the superior court and superior court m.e.a. employees pay no contributions for dental coverage, and the active employees of the san francisco unified school district and city college of san francisco do not elect to provide dental through sfhss, so their dental occurs outside of sfhss. and all of those employees participating are offered dental plan coverage in retierr retirement, and retirees pay the full cost of each employer dental plan with no employer contribution. next slide. this page illustrates the renewal action summary that i'll be presenting today for recommended health service board action. we've focused on, for 2021 plan year, understanding how plan costs in 2019 are impacting 2021 rating actions, and you'll see the summary of changed

recommendations along with the total enrolled employee and retiree members in each of the programs offered for dental through sfhss. you'll see only one plan is proposed for a rate change action plan increase, and that is the employee action p.p.o. with a modest 0.6% increase. all other plans are proposed for a decrease due to the elimination of the federal affordable care act health insurer tax into the 2021 pay year. next slide. this page illustrates the total cost rates on a monthly basis for 2021 across the active employees in the first three columns of this illustration and the retirees in the last three columns of the illustration. with the delta dental p.p.o. in

the top set of figures, the midd middle p.p.o. in the middle set of figures, and the delta h.m.o. in the lower set of figures. so today's recommendations that i'll cover shortly are the 0.6% increase in total cost increase in the delta dental care p.p.o., a 3% decrease for the united health care dental h.m.o. plan, and the -- [inaudible] >> -- retiree p.p.o. next slide. so with that, we'll go into the active employee p.p.o. fees and rates. next slide. again, 0.6% is the recommended change in rates from 2020 to

2021. this incorporates favorable rate change as well as one half of the existing rate stabilization balance as was approved by the health service board in the may 4, 2020 meeting, and the recommendation includes a new recommended nitrous oxide and non-i.v. sedation benefit to support members during dental procedures which is expected to add $126,000 in aggregate claim dollars for 2021 or 0.3% which would be funded by the members in premiums or fixed dollar amounts. this is a slide that we reviewed earlier in previous

meetings to look at the experience of the dental plan, both in 2019 and over the course of time, and you can see that the loss ratios have been favorable. 100% in 2019, and the per employee per month claim and fee cost has been relatively constant each of the past six to seven years at $120. next slide. the administrative fees are under a rate guarantee, with 2021 being the third year of that rate guarantee for delta dental of california. you can see the history of the administrative fees on this slide, most notably $4.62 for employee per month will continue to be the ad stiff fee into the 2021 plan year for the delta dental p.p.o. next slide. and so this illustrates our

calculations that lead to the 0.6% increase in premium rates for 2020 to 2021, which includes one half of the rating buydown application and the addition of the nitrous oxide nonsedation coverage for the active employee p.p.o. the claims are used from january 18 to december 2019 to generate these rates with a 2% annual trend assumption, projected to 2021. and so our recommended 2021 self-insured rates for on a monthly basis are 57 consid$57 employee only -- [inaudible] >> next slide. so now, we'll transition into conversation on the fully

ininsuri insured dental plans. five fully insured plans are provided for h.m.o. plans and all for the active retiries, and because of the removal of the affordable health care insurance tax result in decreases. you can see it results in a 5% for delta dental, and a 3% reduction in uhchmo. so this results in the delta dental care rates transitioning from 2020 to 2021 for the active employees on the top part of the table and the retirees at the bottom part of the page. next slide. we present a similar exhibit for united health care dental h.m.o., where you see the rates decrease by 3% from 2020 to

2021, with active employees at the top of the page, active retirees at the bottom. next slide. and for the retiree p.p.o., delta dental has agreed to add the nitrous oxide and non-i.v. sedation benefit described earlier for the active employee p.p.o. at no additional plan premium to the retirees. and so the 1.75% reduction due to the elimination of the federal affordable care insurance federal tax will hold, and no additional premium is being added into the eat for the nice russ oxide and non-i.v. sedation benefit addition. next slide. so with that, i'll recap our recommendations for health service board action today. number one, for the delta dental active employee p.p.o., recommend acceptance of the

p.p.o. rates represented in this document, to the total premium rates, which include the provision for the added nitrous oxide and non-i.v. sedation benefit, as well as the holding of the 2020 administrative fees for the 2021 plan year, and then, tot the insured dental plans, accepting the rate renewals as presented in this document, which includes the provision for added nitrous oxide and non-i.v. sedation coverage being provided to the retiree. and with that, transition to the next slide and ask for a statement from the delta dental

representatives. do we have a delta dental representative on the line? >> clerk: mike, i don't see her name on the list, but i'm looking right now. give me one second. let me reach out to her directly. give me one second. >> commissioner zvanski: this is commissioner zvanski. mike, do we have representatives from the other plans who will be speaking or just delta? >> there are representatives from the other plans that will be available. we're not going to do this request for statement, but the representatives are available from the other plans as i do those presentations for any

questions that are best answered by the plans. >> commissioner zvanski: thank you. >> natalie, we can move on, if you'd like, to commissioner comments and questions. >> clerk: yes. we can move onto commissioner comments and questions, and i will continue to reach out to

her directly. >> great. so can we go to the next slide? thank you. president breslin? >> president breslin: okay. are there any questions from the board members? >> vice president follansbee: yeah, this is commissioner follansbee. i just want to make sure that i'm clear, that the only benefit change in these four requested actions or in the delta dental active employee for the nitrous oxide and non-i.v. sedation coverage, is that true. >> and also for the retiree, as well. the addition of nitrous objection item and the non-i.v. sedation coverage for the active employee and retiree p.p.o. are the only changes to the policies. >> vice president follansbee:

this is commissioner followans b -- follansbee. i do have a little bit of concern in older individuals. as far as the sedative is benzodiazepines, and i'm concerned if the study included some sort of observation on discharge from the practice because i do want to make sure that the benefits that we approve are, indeed, applied safely to all of our members. and again, older members may be on medications that may enhance the effects of non-i.v. sedation, but they may also be true of the delta dental, to active employees, as well. i'd just like to hear from delta dental about that. >> if i may, dr. follansbee, this benefit or these

procedures are being done now. they were not being paid for, so your questions on the sedation and the safety protocols in place are valid, and i'm sure that they can be validated. in the terms of the dental benefit, there are people that won't go to the dentist unless they get nitrous oxide or some sort of sedation, so it was looked at from that lens, but we do want to assure that it is being practiced safely. >> vice president follansbee: can i just maybe have some clarification. before we covered this, were members being billed additionally, then, for nitrous oxide and non-i.v. sedation? >> yes. >> vice president follansbee: i appreciate this may be something that's already in process. it adds a certain element of

risk now to us as a health service system if we are now covering this to know that those procedures are now in place. >> true, and yes, there's many examples of that. i don't know if there's any liability. that would be sort of a legal question, but yes, i mean, we always would look to a best practice and standard practices for these types of procedures. >> commissioner scott: this is commissioner scott. i have a question for mike. has the preventative side of our benefits utilization increased, stayed the same year over year? can you give me your impression of that, mike? >> certainly. it actually has improved somewhat, so in the last year, comparing statistics we received from delta dental

specific to sfhss employees and retirees on an aggregated basis, we did see a decrease by 0.5% on the active employees, and 0.7% on the retirees on the overall percentage of covered members who are accessing at least one covered service during the course of a year. >> president breslin: i would add to that that delta dental, we have been working with them to do more aggressive campaigning about utilization of the dental benefit, and they were working toward that when this covid hit. and so obviously, that's been put on hold for the time being. and we did include, in the director's report, a utilization summary over the last number of years, so we do continuously look at that with

del delta. >> commissioner scott: yeah. >> i was just going to make one last small additional comment. delta dental gives us their book of data, and it is higher among sfhss active employees than it is for book of business. >> commissioner zvanski: this is commissioner zvanski. it's been a long, long time since i sat in on those negotiations to get the dental plan. i thought at one point both unified and community college merged their active dental with ours from health service, and i'm just wondering when they split off because we usually say to the school district, if you take your actives, you take your retirees with you, and i notice that we are covering

both school district retirees, and they've apparently gone back to their active benefit which i have to say is a better benefit than what we were covering at first. does anyone have any idea when that happened? i'm just curious. >> it's something that we actually have been working with the school district over the last year, to consider taking over the dental benefit on their behalf. and we've asked that question and have not found anyone who knows the answer. so we can take this offline, but yeah, anyone that we spoke to, they could not document the history of how that got back to the school district. >> commissioner zvanski: okay. we'll talk about that later. >> president breslin: anyone else have anything else to say? i have a couple of questions. okay. i don't see a page for the -- for the retiree h.m.o. design

elements. there's one for the retiree p.p.o. design elements and there's one for the h.m.o. elements, but not for the retirees. i don't see that, the co-pays for the h.m.o.s. am i missing something? >> yes, i know there are appendix pages that have the design information, and we can certainly supply any additional design information. >> president breslin: that's the only one that's missing, unless it's the exact same as the actives. >> yeah, let me follow up on that, and we'll follow up after the meeting. >> there were no design changes, though, karen, in this year. >> president breslin: so the co-pays and all is what i'm

looking at, and so everything is, like, 100% covered for the actives, but is it also for the retirees? >> it's a different plan design than the actives, and mike, i don't know if you can recall offhand the details. yeah, i'm just stating that there were no changes this year to what was in place -- currently in place. >> are you looking at page 28? >> president breslin: yeah. >> i have page 28 that gives the retirees. am i not looking at the right thing? >> yeah, anthony, if you could please go forward -- [inaudible] >> president breslin: h.m.o. these are the h.m.o.s i'm talking about, not delta dental. >> got it. sorry. >> okay. we'll follow up after the meeting. >> president breslin: yeah, i'm just curious when comparing the two.

and i was also curious about the nitrous oxide. i called my desk about it, and they don't use any sedation at all there. they don't do it in their office, and they're -- i consider them top line dentists. nitrous oxide, they do. they charge $40 at the moment for that, and i don't know any much else. are there a lot of members that are asking for this sort of thing that you know of? >> we don't have a count on that. >> president breslin: so the 0.6% for active, does that include active predicted for this benefit next year? is that part of their 0.6% increase? >> correct. so it would be a 0.3% increase without this added coverage, and then, a 0.6% that includes

the added coverage. >> president breslin: should have probably had a second scenario on that, i think. so was this delta dental's suggestion? >> it was a proposal that they offered upon us asking if these coverages were possible to be added to the program. >> president breslin: because if you now have a very small usage of this program, it just means more money for delta dental. that's why i'm curious what the usage would be here? is it just going to go into the pockets of the delta dental or is it really going to be helpful to the members? >> yeah, and that's where -- [inaudible] >> yeah, and to the degree that people are going to the dentist that have this covered benefit, that will help.

>> president breslin: that's a -- >> yeah, it's a tough population to kind of get them to change their behavior to go to the dentist. there's just people that are very reluctant to go. >> commissioner zvanski: through the chair, this is commissioner zvanski. in my experience over the years, both when i was still active, since i've been retired, i've heard from many, many members who use the nitrous oxide option and wish that it was covered, but i know that there's a fairly -- at least the people i know, and maybe that's a specific group -- who commented on the fact that nitrous oxide is what they needed because they had such high anxiety when they went to the dentist. i have to ask dr. follansbee,

the active prescription, when they go to the dentist, do you know what that might be? >> vice president follansbee: i can speculate that it's not a drug like diazepam or valium, which has a very, very low short life. it's probably a benzodiazepam that's short acting. most of the time, this is a prescription medication, but a short acting one is what i would assume, that that was part of the general sis of my question to delta dental. >> there you are. we hear you now, sharon. >> sorry. i'm listening on my cell phone, and i'm hearing. >> and we're hearing you.

>> oh, my gosh. thank you. i'm so sorry, everyone. so i would like to provide delta dental's comments at this point in time? delta dental sincerely values our clients, and we understand the struggles that our patients and clients are experiencing at this time, which we have launched initiatives to support our patients and dentists. we do not intend to profit from this situation, and we will be announcing additional information in that regard later in june. through ongoing discussions with sfhss leadership, as just what has been presented within the recommendation, we will not enhancing the benefits in 2021 to include nitrous oxide and non-i.v. sedation coverage to both the active and retiree

p.p.o. dental plan. this change will be done with no impact to retiree premiums. we continue to encourage all members to follow at-home dental processes, such as brushing and flossing daily flo. on march 29, delta dental made an investment into helping those most affected by covid-19. $3.5 million will support increasing access to care across the foundation's 15-state area.

the rest will be appointed to federally appointed health centers that provide primary care services in underserved areas. $1 million available to these organizations responding to the public health emergency and to members experiencing increases in costs and budget shortfalls as a result of the pandemic. $5 million will be focused to california organizations to those dealing with seniors, those living with food insecurities, those experiencing homelessness, and home bound individuals. and on april 15, delta dental of california announced a $200 million loan program through a partnership with lendeavor that

will help organizations through 15 u.s. states and the district of columbia. thank you. >> vice president follansbee: so this is commissioner follansbee. thank you for that. i don't know if you heard some of the board members' questions and conversation prior to your coming on-line. the question that i posed was the issue of non-i.v. sedation, which i understand is already being administered in monany o these offices with an extra charge imposed to the member, and i applaud the intent, which is to encourage our members to seek services they might be avoiding because of an anticipated pain or discomfort, but the question has to do with the protocols and what drugs are being utilized for -- for

non-i.v. sedation and how they're being monitored and then how the member's being monitored after sedation before discharge from the practice. >> all very good questions, which i will take back and provide answers. >> commissioner scott: madam president, this is commissioner scott. >> clerk: karen, you'll have to unmute. >> president breslin: i'm muted. go ahead. >> commissioner scott: with

that, i recommend that we accept the presentations as outlined on page 32 of this presentation as made by our actuary. >> commissioner hao: this is commissioner hao. i second that. >> president breslin: this is a comment that i didn't get to finish. all dentists are charging for p.p.e., the protective equipment that they need to have now. i'm not quite sure what the charge is, but i know they're charging extra for that. and also, my observation is i think that the utilization would be down a great deal for 2020 because i know very few people that have been going to dentist unless it's an emergency, so i would suspect the new use would be way down. there is an additional charge for the nitrous oxide for the actives, so that was my question, too. some of these additional

charges keep being added on for something, and i always think we should look closely at them to see how they're being utilized. are they necessary or is it just money going into the pockets of the provider? for instance, last year, the addition of $25 a premium -- or i guess it was a co-pay for a premium, our network people, in my opinion, just added another $25 to the -- to the delta dental because, yeah, this is under the guise of more people going to the p.p.o., but my personal experience, i wouldn't be changing a dentist because it's very difficult to find one you're happy with just for another $25, so i thought that type of thing was just kind of a scenario. so this is just my statement. i'm not saying i'm not going to vote for this or something, but i do think we should look at

these little additions that are thrown at us all the time to make sure that they're good for the member. okay. so there's a motion on the table. it's been moved and seconded. is there any public comment on this item? >> clerk: thank you, president breslin. people who are waiting on the phone line, please press one-zero to be added to the queue. if you have any comments, which is the dental rates presentation, we're going to give a 30-second pause, and then we'll begin public comment. >> commissioner zvanski: i have a question.

this is commissioner zvanski. it looks like page 32 on the screen, it's 24 when i printed it out. i followed every page, and they were exactly the same. i just wondered what happened. am i the only one with a page 24 instead of 32, but it's the same page. >> clare, i can review that with you after the meeting if you're okay with that. >> commissioner zvanski: okay. that sounds good. >> clerk: moderator, will you please open up the phone line for the first caller? >> operator: you have one question remaining. . >> hello. my name is richard rossman, retiree, and i'm calling about the smile program, and i want to thank delta dental for the check they sent me for the

confusion, and the letter. and also, i read in the director's report that the smile program is part of the $1250, although the smile program is supposed to be for prechbs tiff cleaning, so i'm not sure why it's outside. but i'll accept that, and on page -- my page numbers 28, where it says delta dental of california retirees p.p.o. elements, and it says annual maximum, $1250 per person, excluding annual cleaning and exams, i think to make it more clear, delta dental should put a statement saying or a line saying that this -- the smile program is not part of the preventative cleaning and exams and it's part of the 1250.

i think that would go a long ways to ending the confusion. and then, the other thing is, on the flier they exhibsent ou where it says boost your benefits, they mentioned standard coverage, but most employees are on the p.p.o., so they should put out another flier comparing the p.p.o. benefits to the smile coverage, and i think this would go a long way to resolve this confusion, and thank you. >> clerk: thank you, mr. rossman. moderator, can you open up the phone lines for the next caller, please? >> operator: you have zero questions remaining. >> clerk: president breslin, that concludes public comment for this item. >> president breslin: okay. we have a motion on the floor to review and approve 2021 dental plan rates and administrative fees.

all those in favor, signify by saying aye. are there any opposed? it's unanimous. all right. item number 10, please. >> clerk: item 10 is the presentation of the 2021 medicare plan renewal summary. this is presented by mike clark from aon. >> mike clarke, aon. this presentation previews what i'll be walking through on each of the three detailed presentations that follow for the medicare retirees as well as the kaiser multiregion retirees for the 2021 plan year. next side. so today's focus are the medicare retirees as well as the multiregion retiree h.m.o.s. medicare has two programs that are available to us at sfhss,

the medicare plans through kaiser, kpsa, as well as united health care medicare advantage p.p.o. program. and then, in addition to the kaiser medicare advantage program plan in california, there are also the multiregion plans in washington, the northwest, which is primarily the portland, oregon, area, and hawaii for non-medicare retirees and medicare retirees. next slide. with the prenom cannant focus the medicare plans, you can see the covered medicare lines in the uhcppo, which is available nationally, as well as the kpsa, that's available in california. over 16,000 medicare lives in the uhcppo, and almost 13,500 lives in the kpsa, and with an

additional 67 covered lives in the medicare plans in kaiser washington, northwest, and hawaii, totaling almost 37,000 covered lives in programs across sfhss. there are also 33 early retirees in the kaiser multiregion plans. so the remainder of this overview will focus on the kpsa offered in california and the uhcppo offered nationally. in 2017, sfhss navigated retirees to the two medicare plans available today.

with the clinical and financial successes of the medicare advantage program over time, and continued enrollment growth that continues into today, both political parties generally support the m.a. program with rate stablt, enhanced medicare education, and enhanced payment models in medicare advantage plans. next slide. clinically, the medicare advantage program is designed to support enrolled members through more effectively managing coordinating overall care delivery, providing targeted and timely care and complex case management, managing lengths of stay, including the goal to reintroduce readmission rates, more effectively supporting retiree end of life cost needs,

and we'll talk at length about those for both plans today. next slide. these plans operate at lower costs than original medicare due to direct subsidies provided to the medicare advantage health plans as calculated by the federal centers for medicare and medicaid. these subsidies generally increase from year to year. because both sfhss medicare plans release next year's plan rates before the final c.f.s. subsidies are determined for the next plan year, there can be year to year rate change fluctuation in both of the medicare advantage plans offered by sfhss due to the fact that at present time those c.m.s. subsidies are projected to best estimate but are not yet final. next slide.

this table illustrates how medicare advantage plans are structured to reduce costs and improve overall quality of care. i'm not going to go through everything on this slide, but just focus on high level, the sources of those cost reduction and quality improvement initiatives on the left side starting with optimizing reimbursement to the plan, which helps to lower the cost that passes through after those federal subsidies to plan sponsors, like sfhss, with risk adjustments, and the star bonus programs, where higher stars represent higher revenue from c.m.s. flow into the plans and thus lowering the rates that plan onto sfhss. provider collaboration and building those provider relationships is another ski component of the medicare advantage program, and improving member health through care management, offering enhanced preventative care benefits relative to medicare,

and a coordinated integration approach to care and benefits that addresses complex medical needs and end of life care for members. employers committed to group a medicare retiree's benefits should consider a managed care approach where we see at least a 10% reduction in care offerings due to care management. next slide. in linking the goals of medicare plans and medicare advantage plans to the sfhss strategic plan, from an affordable and sustainable standpoint, these m.a. plans offer the greatest ability for us at sfhss to sustain affordable plans for medicare members, reducing complexity and fragmentation. these medicare plans guide members and partnership with patient advocates within both programs to encourage

preventative care and seek appropriate care alternatives when needs arise. the m.a. plans allow for value added benefits that go beyond core health plan coverage such as enhanced nutritional counseling, fitness programs, transportation services, and more that we'll discuss in each presentation that follows. next slide. and for the last two strategic plan goals, choice in flexibility is a goal for the medicare advantage plans offered in northern california, with the local h.m.o. model and the national uhcmappo program, and even those living out of the kpsa service areas, the united service model meets the client's needs as a plan. the m.a. plans are designed to support members across their

spectrum of health needs through coordinated care when needing care. for more information on medicare advantage plans, we encourage you to review aon's december 2018 presentation to the health service board, titled medicare managed marketplace overview, which is available on sfhss.org. next slide. so with all medicare plans being fully insured, the rate stabilization does not apply, and on a status quo renewal basis before any changes may be considered for 2021, you'll see that the status quo rating actions are decreases for both plans into 2021 after both plans sustained sizeable inskraess in rates for -- increases in rates for the 2021 plan year. the presentations that follow will document the rationale

behind how those 2020 renewals were unfair and how the rates next year are decreasing. we will provide an alternative are you negatal recommendation to introduce a meal delivery program that is the same program offered in the uhcmappo program, and this alternative would shift the 5.5% rate decrease to an overall 5.0% rate decrease for kpsa, and again, we'll review that shortly in the kaiser presentation. next slide. so i conclude my presentation by showing projected 2021 total monthly cost rates for the two medicare plans, as well as the employer and member contributions for medicare retirees who receive the full city charter formula employer contributions if all

recommendations presented today are accepted by the health service board, including a recommendation to add the post discharge meal delivery writer to the kpsa program. the tiers shown below assume all medicare lives, but we do show mixed -- [inaudible] >> -- so that concludes my introductory conversation for the medicare presentation today. >> commissioner zvanski: this is commissioner zvanski. through the chair, i have a question, mike. when i first heard medicare -- part of the medicare, i guess, enhanced benefits included the transportation and the meals, i

thought that that was granted through medicare, and that that would mean that medicare would increase its contributions for medicare advantage plans to the health plans, such as kaiser and u.h.c., and now, i see that this cost is being added to the premiums, and i'm kind of confused as to why it would be added to our presumiums if it s added to the medicare benefits. >> according to the presentation today, those program costs are included within the total premium rates that united health care is offering for 2021, and i will ask a kaiser representative when we conclude the kpsa

presentation later today to speak to the kaiser approach for the financing of those benefits. >> president breslin: any other questions? >> commissioner zvanski: excuse me, commissioner breslin, but it sounds to me, then, that the plans have increased their rates for their services and they're not getting additional -- that medicare is not granting them an -- the difference through what it -- it reimburses them for their medicare members because those plans -- u.h.c. and kaiser -- collect a lot of money from medicare for having medicare advantage programs and covering medicare, and that's kind of my question here, as to why we're all being charged that when it seems to me that medicare should be paying the plans to provide those, and that's what

i'm not understanding. >> sure, no, thank you for the question, commissioner zvanski. what i'd like to suggest, if it's okay, is to defer that question to each of the two presentations that follow so that we can ask representatives from each of the plans to speak to your very excellent question. >> commissioner zvanski: thank you. >> president breslin: any other questions from the commissioners? i have a couple, too, but i'll defer them along the same lines as commissioner zvanski. so is this -- let's see. this was an action item -- no, this was discussion. okay. we need public comment on this item. >> clerk: okay. we'll wait about 30 seconds for

the public to catch up. if you'd like too provide public comment, please press one and then zero to be added to the queue. we'll begin in 30 seconds. all right, moderator, will you please open up the conference line for caller number one? >> operator: you have zero

questions remaining. >> clerk: president breslin, that concludes public comment for this item. >> president breslin: okay. very good. now we've been at this for about 1.5 hours. i would assume everyone would like to take maybe about a ten-minute break. >> commissioner scott: absolutely. this is commissioner scott. >> president breslin: okay. so we'll have a ten-minute break, and that means we'll be >> this is presented by mike clark from aon. >> the fully ensured retiree rates for the 2021 year. next slide. we'll start with our recommendation and a summary of the recommendation, just

introducing the united healthcare advantage ppo plan and commentary on the proposed rates for 2021, which this year included two-year rate guarantee being proposed by united healthcare and review the 2021 monthly rate cards and finished with our recommendation and you can see the information that is in the appendix, as well, for reference and i will not be kind offincovering that today but its available for reference the summary, is it recommended the health service board accept united healthcare advantage ppo, retiree rate cards as presented today with a $422.22 per member rate for the 2021 year which representing a 22% rate from the 20-year level. this comes with the understanding that the 2020 rates are a part of a two-year

rate guarantee proposal including a $427.22 per member, per month rate quotation for th. next slide. so we'll go into our commentary on the rates. you can see no plan design or program changes are proposeds a part of this renewal for the united healthcare plan and the renewal is aided significantly by the permanent elimination of the federal affordable care act, health insurance tax part of the secure wan act passed in septemr of 2019 and this follows a 17.0% increase in rates from 2019-2020 where a majority of that increase was attributed to the 2020 return of the aca head tax. i also note in the footnote to this page that some members in this program have a part b-only

plan because they have not qualified for medicare aid either on work requirements and have chosen not to pay the premium and this is a small component of the total membership in this plan and presently 141 sf participants are on the part b only plan. >> this is commissioner zarsky, do we know if those 141 are mostly police and fire, mostly fire? do we have any idea? >> we can follow up with united healthcare to understand who these individuals are, to be able to know. >> it includes the rate plan for the 2022 plan year leveraging 2020 underwriting surplus by the suppression due to covid-19

pandemic for use in 2021 and '22 proposed rates and you'll see here at the bottom of the page, the current rates for 2020, 434.87 per member per month and how those will reduce in the 2021 and '22 whereand 2022 would increase by 9% but be 8% lower than the existing rate for planned year 2020. and the status quo basis, 2.9% decrease is driven by the major component of the affordable care act tax and this has been applying some years but not others for about the last five to six years and it was not applied in the 2019 rating.

it did come back for the 2020 rating and that's resulted in the high increase for 2020, but now, it is permanently eliminated in the 2021 planned year and this compromised 8% of the 2020 plan rate and so was the significant favourability to the rating for 2021. and then claim trend and underwriting factors with the center for medicare and medicaid revenues expected to reign relatively flat in 2020 to 2021, thelying rate increase before applying that affordable care insurance act would be approximately 9%. however, uhc has proposed to a cascade claim reduction in 2020 that stemmed from claim suppression due to the covid-19 pandemic situation and namely for healthcare services not happening during this time and

not expected to return later in 2020 to support lower rates for this plan in 2021 and in 2022 versus if the pandemic never occurred and so the end result is a 2.9% rate decrease for 2021 along with the rate guaranteed described earlier for 2022. next slide. and the proposed 2022 plan year rate is guaranteed by united healthcare and is subject to the following provisions worked through between sfhs and the united healthcare and essentially, anything that is within the united's control cannot impact the rate for 2022 and these stipulations outline contenoutlineconimaginecies to s laws and regulations,

assessments, taxes or marketplace changes that would have and impact over 2% of impact costs or revenue. the mappo plan includes the innovation benefits first introduced to the plan in 2019 that in support enrolled numbers all at additional planned premium for the 2021 planned year and so to address the commissioner's question in the prior presentation. these include the silver sneaker's program, which is a gym membership which has 4,272 enrolled lives and just over 1500 of these actively participating during 2019. and the second is routine and posed discharge transportation service where 236 total trips have been taken so far in 2020 through late april by uhcmappop members and the third is a post

discharge meal delivery of up to 84 meals consentin consecutiveld and so far in 2020 through late april, a total of 8,344 meals have been delivered and when setting the uhc premiums, we include the cost for the basic vision plan through vsp, which are unchanged from 2020 and the healthcare sustainability charge of $3 per retiree a month which is unchanged from 2020. next slide. so with that, we show the rate cards being proposed for 2021 and each of these are contained for 2021 with distinct medicare dolcolumns for the city plannedp

po blue shield access plus and trio. next slide. these rate cards presented in this document reflect the full employer contributions for retiree medical coverage presently available to retired employees hired on january 9, 2009, retired persons who retired for disability and surviving spouses or surviving domestic partners who died in the line of duty. retiree medical coverage but no employer contribution is available to retired employees hired on or after january 10t january 10th, 2009, at least five but less than ten years of credited service with the employers and coverage at 50% of the employer chartered contribution rate is available to retired employees after january 10, 2009 with greater than ten years but less than 15 years of credited service. the segment of retirees will receive the full employer chartered contribution for each

medical plan and coverage as reflected in the following rate cards. next slide. this rate card illustrates the total premium as we've discussed for the united healthcare ma plan, as well as the mixed family situations, two in medicare, one plus non-medicare and the right three columns of the page representing the non-different medicare plans that those dependents can enroll in and they include the vision plan premium for basic and the $3 sustainability fee and then, the allocation of the employer contributions in the middle of the page by coverage here to result in the final number of contributions and how those have changed from 2020 to 2021. this illustrates in a different way, the change in the monthly retiree contributions and the top part of the page, the

monthly employer contributions in the middle part of the page and the monthly total cost rates at the bottom of the page. in all cases where there is an amount, all figures for medicare retirees are decreasing by 2.9% with varying levels of increase or decrease depending on the plan, the non-medicare dependent is enrolled in for the non-three columns on the page. next slide. so with that, i'll present our recommendation. it is recommended the health service board accept the advantage ppo retiree '21 rate cards as presented today with a $422.22 rate for the plan year representing a 2.9% decrease and rate from the 2020 level and

this recommendation comes with the understanding that the 2021 rates proposed by the united healthcare are part of a two-year rate gained proposal that is including the $427.22 per member, per month rate quo quotation for the 2022 year. it's for the 2021 year plan only, but we want to acknowledge that the united healthcare proposal also includes this second year, two-year guarantee. >> mr. clark, i need to make a quick announcement. president breslin is trying to get back in the meeting via the phone line and having technical difficulties and i'll pass the responsibilities of the chair to vice president until president breslin can return. >> ok, thank you very much and this is vice president and i'll

be taking over as acting chair until president breslin returns. they can open up for the discussion of questions from the board members. >> hello? >> karen? >> hello? >> we can hear you, yes, you're on the phone line. >> in the meantime, any questions from the board members for mr. clark? i know we have approved some the

rate guarantees and other scenarios and is this something from your standpoint that you're seeing across the public and private sectors? there are a lot of things that can happen between one though, now and '22 and i understand this number within the control of the health plan, but is this something that is new, different or timely in this respect? >> yeah, thank you for the question. in this particular instance, this is not something that commonly see with medicare advantage plans. typically, it's a one-year renewal circumstance and especially in this case, with an early renewal before the final cms subsidy rates are set, but united healthcare did come to us, acknowledging the likelihood of lower claim exposure in 2020

to the covid-19 pandemic and the suppression of healthcare that's been resulting overall. and obviously that could not have been foreseen at the time they developed their 2020 rates last year and so, in an approach to their underwriting proposal, we had significant discussion about the amounts that were being applied for use for the future renewals for 2021 and downtow2022 as well as the infon presented earlier on a slide in this deck. and so in the end, it did result in a more favorable rate renewal than would have occurred otherwise with just a straight somewhat just typical underwriting proposed by united

healthcare and so, because of being able to achieve a lower rate than would have otherwise been in the case in 2021 and lock in a relatively modest increase for 2022, lead us to recommend this two-year renewal approach for united healthcare. >> again, it seems like there's an upside to it and i can appreciate to it. obviously, the down side is that a part of the diminished access to healthcare will be diminished access to screening for health problems that may go undetected, colonoscopies and artery disease and on the one hand, i'm impressed with the short-term benefit, but a little concerned about the health of our members in the long term with these

kinds of programs and done to try to catch up with the deficit in healthcare services that have been postponed during the pandemic. >> yeah, if i may, i will ask united healthcare representatives to speak about expectations for the rest of the year for members, how they're encouraging members to see their primary care physicians so that information can be captured as a part of the cms process for star ratings and the house call programs and so if i may call on united healthcare representative to speak about that. >> hi, commissioners. this is shannon hoss with united healthcare and yes, we are continuing to reach our membership to encourage them to take advantage of virtual visits as much as possible and then as

the different states start opening up for in-person healthcare services, we will be doing communication campaigns out to the memberships to encourage them to continue to get their preventative screens as much as possible. and so i just had a discussion with jessica yesterday about continuing those communication campaigns. >> through the chair, this is commissioner scott. what is the medicare star rating of the plan that we have? >> 4.5 stars. >> thank you. >> you're welcome. any other questions? >> karen, are you back online? is president breslin back on the

line? >> i can see her on a phone line. can you hear me? >> i can, but can you hear me? >> yes, we can. >> oh, you can, i didn't know you could. great, ok. my power went out here. and it isn't even fire season yet. [ laughter ] so i missed a lot of this because i trying to fool around with this stuff, but last year, you know, they came -- united healthcare came with a 17% raise, as we know, and you say the majority of that was a hit tax, but 8% was a hit tax and 9% was what their increase would have been without hit tax and so, then again, it looks like 9% this year except for some of the

other things you mentioned. and i'm wondering about this post discharge meals. how did they go from 1,344 -- two last year, to 1,344 this year? and what is the percentage of usage for these meals, because i think we should be looking closely at these things to see where the money is really going. >> so we can take that off-line and present those back to you. >> and assuming they say on all of these meals, two meals a day, usually, and i was looking at meals after safeway and what they would be and probably the most $54 or something.

and so, we're paying -- we're paying $1.75 for the meals a month and like the last time, the utilization was ridiculous. we should be looking at these things and seeing, are we getting our money's worth? there's other ways to get meals, maybe, besides this and basically the meals in plastic than you microwave them and nothing health cree abou healthd i'm just questioning this whole meal issue. >> thank you for the clarity. for clarity, the $1.75 is the kps charge i'll review in the next presentation and this year united healthcare is including the added benefits i discussed

earlier at no additional planned cost. >> so our members are not payed $1.75 per month for healthcare? >> that's correct. >> they're paying zero for these meals? >> that's correct. it's included in the plan. >> i looked at the agenda for june 2019 and looks like our members are paying a little over a dollars per member per month for the meals and so, when i do some sort of quick calculations, which i know have lost, we paid for this year, i think we've paid something like $65,000 for the number of meals delivered and i have to go back, to figure out how many meals we've delivered. so the additional rate increase, we did indicate that into last

year's rate interest. it was a little over a $1.04 per member, per month and am i remembering that correctly? >> yes, it was $1.01 in 2019, when it was introduced, correct. >> so we're not even paying the dollar now? >> that's correct. >> so we're paying zero and how did that happen? >> so it's not accounted for in the rate once -- so once we did the initial implementation for 2019, it's just included in the plan now and it's not an additional charge. >> it was into the total rate? >> correct. >> so then you are paying it,

right, in the long run? >> i'll come back with some additional information on how it's absorbed into the rate. it's no longer a charge. we're not charging as a part of thofthe premium for those meal deliveries. >> so i'm curious about the 1,344 bursts of last year. >> when you say two, i don't think that was our overall -- >> there were 125 meals across two individuals. >> versus 1,344 this year, i guess. >> correct. >> ok. and i don't know what percentage that would be. >> i'm not sure, too, was the end on.

i don't think that was the 2020 end of year number. >> that was 2019 year-to-date as we made the rating presentation for 2020. >> and the meals have to be prescribed. it's not the option of the patient being released from the hospital. it has to be prescribed as a part of the treatment, am i understanding that correctly? >> it's not necessarily a prescription. the case manager that is working with the patient just needs to recommend that they get post discharged meals or transportation and then they can take advantage of that benefit. >> and so this is commissioner scott. ithis is where i have a question only of you, but also in the upcoming presentation. at the time a person is being

discharged from the hospital, there are a number of discharge plan activities that are executed by hospital staff, by social work folks, so on and so on. there are a number of offices that get involved in that and my essential question is, who at that level is oriented or knows how this is being handled by our member who happens to be covered under your plan or under kp's plan? >> for united healthcare clinical case manager is assigned, when a member is inpatient is working directly with that member and they would be the ones making the recommendation. >> i see. and this is at the bedside of the person and their family

member -- if there's an accountable family member, they would be aware of this? >> it would likely be by phone, not necessarily in-person. >> i see. thank you. >> this is commissioner falls. number one, karen, i did a simple calculation based on the number of meals delivered through late april and what last year's new rate for these meals, per member, per month, ongoing and built into the current new rate and we're paying about $48.70, i think, per meal. >> $48? [ laughter ] >> that's my calculation based on the number of our members enrolled in this united healthcare medicare advantage program and the number of meals delivered and the rate from last year. i can guarantee that the rate

that we're being offered includes this. it's just not a change in benefit. and then to get back to the second question and the comment, the second observation and a comment, as someone who discharged lots of patients over my medical care, there are discharged instructions, people with heart problems and low sodium diets and it's in the health plan's advantage unti noo discourage habits that might prompt readmission within 30 days, because part of the medicare advantage rating includes readmissions. and so dietary recommendations that can be implemented into, in fact, meals so that for a person on heart failure, i would hope the meals provided are low sodium meals following the diet's recommendations.

it's an advantage to the patient and health plan and decrease the readmission risk for that member if they got and took their meals as provided and didn't supplement them with salty potato chips or hamburgers. so again, it's a two-way street and my calculation, i guess i'm wrong, we're paying fairly dearly for this but it would be a benefit to the members to be offered meals that are consistent with the recommendations of their medical team. >> correct, the mom's meals does offer different diet plans for various conditions, heart failure and low sodium being within ooneof those. >> the reasons this is discussed

today is because there were strong evidence that these meals do make a the difference, but they are noting in the patient's overall well-being and yes, the studies were done in relation to readmission rates which were exorbitantly high. this is a big piece of that. as fragments of our healthcare system is, this is a huge challenge and boils down to as commission scott was saying, in the hands of the case manager that is actually doing the discharge, are they able to connect the patients with these types of acute care services and i think you've heard from

shannon how united approached this and you'll have an opportunity to hear how kaiser approached it. they're similar and different, but at the end of the day, if they're able to systematically able to change the way we manage acute care, it will make a difference in the welfare of our population. >> that assumes everybody has a microwave, right? >> my experience with the programs is when they don't have one, they get one and i imagine those programs have faced the challenges as well, is looking

to ways to improve. i mean, we could work with shannon, with kaiser to see what the satisfaction is around these meals. that would be a reasonable thing to ask. i can't imagine these meals would keep anybody healthy but better than not having anything to heat but $48 a meal is ridiculous. >> that's the uptick rates that we had at that time, and so it is encouraging to see that -- keep in mind the target population here is hospitalized patients and as the number of people get hospitalized, it goes down. there's not -- you can't really think about it, even though we typically pay for these on a per member, per month and it's not a service that's readily available to every member because the target population is the sicker of the population.

>> it's the people discharged from the hospital, basically, right? >> yes. >> i think the point that the director is making, we would have to look at the number of individuals that are admitted to the hospital per year and i think out of our total membership, there isn't a significant percentage of individuals who are actually admitted since so much care these days is outpatient and more people are taking advantage of preventative care. so i think the population we're talking about is a small one, but it's usually with very acute problems or chronic problems that require that kind of hospitalization and the post-care. i've tested the meals on wheels as they were distributed not to one of our members but to a retiree in another county who

was being served by meals on wheels for that and the meals were actually quite good. and i was totally impressed with them. and so i think maybe we do need to have some kind of rating as to the quality of the meals and what is being distributed and if the individual is unable to have meals prepared for themselves and they're on restricted diets, it needs to be controlled somehow and they need to be fed, because many of the folks will have caregivers at home and not able to do their own care themselves, i think. >> ii want to point out that number one, this is a vulnerable population and sodium intake, for example, could put someone into heart failure and these meals should serve as a good template, whether they're palitible or not, but people should be able to make them palitible with other spices and

whatever. and i'm certainly not advocating that we take the $48 per meal and just hand it to our post discharged patients and say, here, you have $150 a day to buy food wherever you go, because there is benefit not only to the member's health to get ongoing instruction in appropriate dietary, you know, meal preparations and planning and whatever. but also, if we can help decrease the readmission rates, then rates go down for everybody, because those calculated again into the following year's rates, assuming that it's not a rate guarantee. >> good point. >> ithink we need to look at the statistics that now we have over 18 him meals distributed, i think the cost of the meal has

probably gone down significantly. although, i don't know what you used for your numbers, doctor. >> i just used the what the minutes of june 2019 listed as cost of odding thi adding this . now that it's a benefit, i'm sure it's ruled in. in. i don't have access to uhc's calculations for providing these meals. i know what we reimbursed across the board last month. >> we can do a report out on how these programs are working in the fall. >> madam president, this is commissioner scott.

>> all of my power is out here and so maybe i'll just let commissioner fong speak to run the meeting because i can't mute or un-mute or anything here. >> then through the president and acting chair, i would like to offer the following motion, that we accept the actuary's recommendations as outlined on page 25 of the presentation, which includes the rate cards that are included in today's presentation. >> thank you. do i hear a second? >> second. >> the motion has been made and seconded. i would like now to open up the phone lines for public comment. natalie? >> thank you. put we're goinwe're going to had

pause for members on the phone line and members watching catch up and i will start that 30-second pause at 30 minutes and then we'll open up the lines. >> can we show that page 25? because that doesn't match my printed-out copy either. i'm sorry. >> anthony, any way to go back to page 25? is that the recommendation page? >> yes. >> thank you. >> claire, for my own personal preference has been to open up my ipad at the same time and so i have access to the slides

independent of the projected page. because i agree with you that it is difficult with you to refer back to previous slides under the current formatting. >> thank you, doctor. this is actually page 16 in the items that i printed out, the attachments that were given to us and i haven't figured out how to use that ipad yet but i appreciate the comment because i'll spend more time trying to learn that. excuse the interruption for the meeting. thank you. >> thank you, commissioners. moderator, can you please open up the phone line for the first caller. >> operator: you have two questions remaining. >> i'm herbert winer and i was wondering at the point of clarification, did we do item 10 already? this is item 11 and i just want

clarification on that. >> yes, mr. winer, we did it before the break and we started with item 11 after our ten manufacture minute break. >> ok. and one question i have is, this plan seems very comprehensive and i'm a member of united health. and my concern is we only have two plans, united health and kaiser. and i would like to see the city plan restored for retirees. otherwise. i have no comment on what is proposed and i disagree with the competition, the orders to keep the rates down and to provide very good service for retired and active members. >> mr. win winer, is that all yu need to say or anything else? >> that's all i have to say.

>> thank you for your comment. it's noted. moderator, will you please open up the lines for the next caller, please. >> you have one question remaining. >> this is fred sanchez, the president of protect-our-benefits and i echo some of the same comments mr. winer just said. i would love to see a return of the city plan. i mean, the comment was made earlier about the two choices of flexibility. the best way to do that would be to get as much providers bidding on the health service system and so, when we have that rft done, hopefully it will be so attractive, we will get multiple providers that aren't providing services now and the they will e in.

interesting stuff because of the short-term visits down and i share the concern that later on we might have a case of more dramatic patients coming in becausandthen we'll have a dramc increase in rates and that's a real concern. speaking on the meals, if it really does mean less readmissions, that sounds like a good thing and it's kind of like paying it forward like the silver sneakers, keeping people in better shape so that their need for admissions for various medical issues become lessen. that's the thing that if they track over time and if we can

get more providers, we would like that and we would like to see possibly the city plan coming back for the retirees. i'm very concerned about the early retirees. their rate increases over the last few years has been so substantial that it's hard for that group. they need more providers. thank you for everything that you guys do. >> thank you, mr. sanchez. >> moderator, will you open up the call line for the next caller, please. >> you have zero questions remaining. >> vice president, that concludes public comment on this item. >> so i think that we're ready to go ahead and vote on the motion that's on the table for this. would all members signify by

saying aye and any opposition? it passes unanimously. we can move on to the next item. >> yes, item number 12 is the review and approval of the kaiser senior advantage medicare fully ensured retiree rates and premium contributions for california, and this is for plan year 2021 and this presentation is done bymike clark from aon. >> we'll review the senior advantage or kpsa, fully ensured retiree rates for the 2021 plan year in california. next slide. wool start with our recommendation and then an introduction to today's discussion, provide commentary on the kpsa 2021 rates,

including program writer considerations, presenting monthly cards for two scenarios, including a comparison of 2021 versus 2020 rates. closed with a recommendation. and as with prior presentations, we have appendix slides i will not review but are there for reference. next slide. it is recommended that the health service board accept the kpsa medicare hmo retiree rate cards as presented under the post discharge meal delivery writer's scenario which would include the adoption of a new post discharge meal delivery writer as described in this presentation for kpsa in 2021 and this would result in a 5.0% reduction in kpsa per member, per rate. next slide. and so we'll start our

commentary and introduction to this presentation. next slide. we'll comment that as we reviewed earlier, there's 13,463 medicare eligible retirees enrolled in the kpsa plan and since a request by shsf, kaiser provided an early estimate for the following years and kpsa member retiree rates to be used in rate care development. next slide. after our 12.2% rate increase from 2019 to 2020, the premium rate before considering the addition of a post discharge meal differrery program is decreasing by 5.5% from 2020 to 2021 and it would be a decrease including post meal discharge delivery program.

the rate also includes an enhancement of the transportation service's rider that was added for the 2020 planned year as wheelchair and gurney transport will now be included with program fees increasing for this, as well as a fee for the existing silver and fit fitness program. you see the pages where i'll review it later in the presentation, the rate cards for both scenarios. next slide. the derivation including all three programs, includes an added post discharge meal delivery writer if approved is shown here starting with the 2020 pre-cms reconciliation, kaiser medicare member premium rate and the change in the year-to-year medicare

reconciliation was favorable and favorable underwriting adjustment from '20 to '21 and it added for th the innovation includes the enhanced benefit, included in the premium rate if all three are included in the program of $347.37 and the sum released before the 2021 final approval that we reviewed earlier today. next slide. the proposed rate adjusted for prior years cms reconciliation variances is an estimate since kaiser has not received that final approval from cms for the 2021 rate. given it's an estimate, kaiser will reconcile any differences between the 2021 rate provided today and the ultimate final 2021 rate next spring. and this difference will be

applied to the 2022 rates. since it's a risk rated for the medicare population, the final rate could be higher or lower than estimated applied. although the desire is to be as close to the initial estimate as possible. they cannot project the final rate, nor predict the ultimate variance between the initial and final rates at this time. next slide. both the medicare reconciliation adjustment and trend are favorable for 2021 as we discussed earlier and as a reminder, when we set our total kpsa premiums and rate cards, we include the vsp basic plan, vision premiums and the sfhs healthcare sustainable health charge. next slide. now we'll go into a conversation on the program writers. next slide. and in recent years, as we've discussed today, medicare have

been encouraged to provide support for members around the healthcare services they obtained. three programs were discussed for the 2021 plan year which represent a mix of programs already in the plan this year, as well as an enhancement in new program consideration. so you'll see as we talk about each of these, we'll discuss the continuation consideration of silver and fit for fitness, the enhancement consideration for the transportation service and new consideration for the post hospital discharge meal differrery service. next slide. and the silver and fit program is an exercise and healthy aging program which is similar to the silver sneaker's program we discussed earlier than the united plan. they provide a fitness program and the 2021 premium charge for silver and fit is $2.80 per

member, per minute or $452,000 total, which is a pass-through of the program cost through the organization that operates silver and fit, american specialty health. in terms of utilization for the 2019 plan year, there were 1,185 members enrolled in the gym membership and 125 members enrolled in the home fitness program. so in total, approximately 10% of total kpsa plan members elect to enroll in the silver and fit program. next slide. as background in the transportation service discussion, the health service board approved transportation benefit enhancement to both medicare plans recently, the united healthcare plan of 2019 and kpsa for the 2020 plan. this provides transportation services at no cost to the

member up to 24 one-way rides annually, as well as a post discharge after a hospital stay ends within a 50-mile distance limit per trip. presently, the kpsa transportation rider does not accommodate participation of a member in a wheelchair or gurney during the ride. they must be moved into a seat and the vehicle presently for transport, where the wheelchair, for instance, can be tucked into the van, but the passenger would not be riding in the wheelchair in the van. next slide. but for the 2021 plan year, kpsa is preparing to accommodate the transportation of a member in a wheelchair or gurney to allow for the transportation rider fee and the kpsa rate would increase from the current $2.75 per member, per month, to a proposed $3.87 per member, per month in 2021 and this represents an nursincrease of $181,000 annual.

for the first three months, there were 47 rides and i'll verbally update that for the first month dates, there have been 63 rides delivered to kpsa members through the existings transportation rider. so again, 63 rides now through the first four months of 2020. and pricing is based on these utilization assumptions from ktsa derived from kaiser's observations for these services and other kaiser planned geographies and expect 5% of members for medical appointment rides and 3% for total members for post discharge rides. and there is a small additional amount within the pricing to cover administration and information technology support for the program. next slide. in the new consideration for post discharge meal delivery, if you recall 2019, this was added

as we discussed earlier today for the united healthcare plan. for 2021, kpsa has the ability to offer a meal delivery service which is not offered in kpsa today. up to 84 home-delivered meals following a hospitalization, when referred to by a clinical staff member includes three meals per day, limited to one utilization. all meals are ordered in succession immediately following an in-patient hospitalization and cannot be spread throughout the course of the year and the cost for the meal as benefit for kpsa members is $1.75 per member, per month, for 380,000 total. the pricing assumes the 3% utilization of total numbers for post discharge meal delivery on the experience of the vendor, mom's meals with other plans and there is also a small additional amount in pricing to cover

administration and information technology support. next slide. (please stand by).

>> just as a reminder that the rate cards are for those with full contributions, and there are other cards for those with other coverage or contribution, depending on active or retiree. so this illustrates the difference between 2020 plan year retiree contributions under each of the two scenarios that we're presenting today. the top set of figures are the status quo contribution. that is if the meal delivery rider is not offered into the kpsa plan versus the retiree contributions in the bottom table for 2021 if the meal delivery rider is included. you will see that the retiree only contribution is zero throughout, so no impact there. for those covering family

members, there's a small differential in retiree contribution between status quo and the meal delivery contributions. this card shows the meal delivery rider scenario, building on the total cost items in the upper part of the exhibit. the employer contribution in the middle part of the exhibit, and the final member contribution and the change in member contribution in the lower part of the exhibit shown in this chart for the three medicare only tiers, medicare retiree only, plus one, and plus two or more. we have appendix in the exhibits that capture mixed medicare family rate tiers to exhibit the impact of retiree

contributions in the appendix, as well. next slide. this shows the change in retiree contributions and contributions and rates under the status quo scenario. next slide. and then, we have two pages, starting with the rate card if the meal delivery rider is offered, and the next slide is the change in rates for contributions if the meal delivery rider is offered. so we'll go to the recommendation page. it is recommended that the health service board accept the kpsa medicare h.m.o. retiree rate cards as presented today under the post delivery rider as presented in today's presentation that would result in a 5.0% reduction in kpsa per month member rate.

vice president follansbee, i turn to you. >> vice president follansbee: okay. thank you very much. i'd like to open this segment up to questions and comments from commissioners. >> commissioner scott: this is commissioner scott. i don't know if there's a plan representative on from kaiser, but it's regarding the wheelchair costs, and have you or has kaiser contracted with a different vendor to provide wheelchair-type of transportation versus the vendor that you currently had or how is that working and why is there this expansion of costs of $181,000? >> thank you, commissioner scott. kay kessler with kaiser permanente. we are continuing to contract with the same vendor, and we've been working with diligently

with them. i know that we've had many discussions over the past yea,s maybe longer, about adding this benefit. and based on the usage that we've seen with this type of transportation in other regions and some of our other business lines, we determined that this would be the correct rate to include the gurney and wheelchair transport. it's a specialized type of transport. >> commissioner scott: but it's adding $181,000 to the cost? >> yeah, i believe -- and i don't have the page in front of me. mike, i think it's $1 -- >> commissioner scott: $1.75 or something. >> that's correct. it is adding that to the total cost. and i think, commissioner

scott, when we had talked about this in previous meetings, i believe we've always been very transparent that the cost would change if we did add the wheelchair gurney van service to this item. i know that it was an important part of the benefit. we did not have it in place to start, so the total cost that you saw for 2020 did not have that included in there. in an effort to really get this in place to start the benefits in 2020 while working towards this for 2021, and so i believe, though, from a total cost standpoint, this would be fairly comparable to what you would see in the marketplace to this type of a benefit. >> vice president follansbee: any follow up question, commissioner scott? >> commissioner scott: thank you. >> president breslin: i'd like to ask, if i could, the wheelchair and the gurney, is

that customary for people that provide transportation -- vendors that provide that? >> i'll ask my colleague, julie brady, to comment on -- i'm not sure if we have data on how common it is that we use those services. julie, do you have that information with you today? >> hi, this is julie brady. i do not have that information with me today. we can go back and ask member services for that information. >> president breslin: i'm sure curious because many people say they get you out of the chair and put you in the regular chair and store your wheelchair. they don't put a whole gurney in a back, so if you have to put a whole gurney in a van or something, that's a whole different thing. >> you're right. it absolutely is. that's a specialized type of

transportation, and it really is based on the needs. there are some cases where people cannot get out of the wheelchair and have that put into the trunk, and so it was important for us, and i know important for the board to have the complete benefit added for 2021, and we're pleased to be able to do that. >> president breslin: so you're anticipating 3% utilization for the meals? >> yeah, that's what we're using as our figures and what -- for working with the -- and we have the same provider that u.h.c. does, and so based on information from them and what they've seen from other health plans, that's how we've developed the rates. important to note, this is a new benefit for us for 2021, so we're using that information. obviously, as we move forward, we'll be able to assess what our own utilization is and what

the cost should be in the future. >> when i see these utilization figures and what they cost, it just seems like i just don't know how sometimes we can justify adding these benefits for such small usage, when everybody's paying for them and very few people are using them. i don't know. it just kind of -- [inaudible] >> president breslin: it's 10%, which i guess would be about 1300 people or so using them. it's quite a few, i suppose. >> just, president breslin -- i didn't mean to discuss you. >> president breslin: no, go ahead. >> the discussion that we were having previously about the meal service, it was a good discussion. this was a service that we

looked forward to provide, and we look forward on reporting out to the board on what the usage of this is and how people like having specialized meals upon discharge. and also, we want to continue, should you continue with these benefits, all three of them, moving forward, it's important to continue to work with executive director yant and her team, and we've had a lot of discussions about this, about how we can continue to make sure that communication is out there and getting retirees to use the benefits that are out there for them. they serve a purpose and they're very important. >> president breslin: and another question that came up, you get reimbursed for medicare for these benefits? >> we actually don't. i know that it can be very confusing. we can be allowed to offer these benefits, but they do not reimburse us any additional

money when we offer these benefits. >> president breslin: well, i think the big problem is -- excuse me. i think the big problem is with medicare advantage problems is lock of transparency because we -- lack of transparency because we don't know how much these vendors are getting reimbursed. mike, correct me if i am wrong, but we don't know how much they get reimbursed from kaiser, from kaiser or united health care. i know they look at a lot of things, but there's a lot of upcoding that goes on today. i know that for sure in united health care, and so just maybe you can shed some light, if you think you know about these cases and how much they're getting upcoded. >> yeah. i can comment on what i see.

united health care, we are provided with an underwriting sheet that lays out the total expected costs as well as what is expected to be reimbursed by c.m.s. into the plan that produces the net rate that you approved earlier in this meeting. while we don't have exactly what the c.m.s. is created in the united health plan, we know what the estimated costs are on the estimated gross costs. miss kessler, i would ask you to comment from the kaiser perspective. >> yeah. i'll have my colleague, yolanda, comment on that, if you wouldn't mind, on the

c.m.s. reimbursement and setting our rates. >> hi. this is marina from united health care. so i would say the process was very similar to how mike described for united health care, u.h.c. we go through a process where we get some preliminary notices from c.m.s. regarding what they are looking at as far as anticipating reimbursements throughout the year, and as mike mentioned, we don't get that final notice of what reimbursements are going to be, really, until the fall -- late summer or fall. and then, we take that information which has a really similar process which calculates the expected reimbursements and then what our expected costs are based on

the benefits that we are offering. what might be different between kaiser permanente and some of the other plans is that we do not experience greater use actually claims and developing rates. we're using the reimbursement as the basis, and then, the other benefits that we are offering that built up the community rate for the medicare plan. >> president breslin: yeah, i understand that there's a rate, but if you present to medicare, that's an individual that has all these other health plans, and they reimburse you a lot more for that, and we have no idea how many people that could have been done with, and we have no way of knowing what you get for all of these actual individuals, right? >> yeah, that's correct.

they do do a risk adjustment based on how c.m.s. looks at our overall population to determine the reimbursement that they supply to kaiser permanente, and we do include those assumptions in our rate development for the actual rates. >> and then that's presented to mike, correct, lorena? >> yeah, that's correct, and then, if there's more information, we can help develop. >> president breslin: is mike able to see how you're reimbursed -- maybe 500 people you're getting a lot more money for than some other 500? is that based on your book of business and not our specific population? >> that's correct. >> president breslin: but

there's an update now, and medicare followed suit. >> but karen, if i'm understanding what the representative from kaiser just said -- this is commissioner scott, they are not looking at individuals, they're looking at their whole book of business. we're not specialized in their population or predefined, we're part of their whole book of business, and that is what they are presenting to medicare for reimbursement, not individually-based claims. it's a community-rated process. we're rated as a community. we're not individually or, in our own right, evaluated on that basis. >> vice president follansbee: and this is commissioner follansbee. i can reiterate that, that that is, in fact, the case. i also want to be careful that

no members of our board accuse either individual providers or health plans of upcoding. that is fraud. that is definitely fraud, and i can definitely -- excuse me. let me take a quick drink of water -- and having been investigated for fraud by the state when i was accepting medicaid and found that i was not fraudulently billing, i know that d.h.s. is very concerned about fraud, and as you alluded to, karen, they have actually gone after systems for fraudulent billing, so i don't think we should be in a position of accusing either u.h.c. or kaiser of upcoding fraudulently, which is kind of the concern you were saying. my point is benefits are hard to approve once you take away them. i'm a little concerned when we

approve mom's meals for u.h.c. a year ago, the price was $1.01 per member per month, and kaiser's going to charge us $1.75. and i don't know what u.h.c. now pays, but that's a huge increase in meals and -- with the same vendor. i don't quite understand what the difference is in services that will be provided to the different health plans. likewise, we're being now asked to subsidize silver and sick, and we have high utilization. 10% of our members, which i think is fantastic, but i'm wondering if kaiser has data because of the division of the research or whatever that shows in fact they have to charge more because it's not really in

our interest for members to be silver and fit; why we're being charged for something in this cycle that we weren't charged for in the other cycles. >> yeah, kay kessler. let me address the silver and fit and then we'll address the meals and the pricing. silver and fit is what is charged by american specialty health to us, and we had, when we originally implemented this, as a special arrangement, you know, as starting out with the new benefit, we had offered that we would cover the cost for the first two years. we expanded that last year because the rate increase was so high already because of the reconciliation from the previous year, but we were very clear that we would need to begin charging for this. again, we're not reimbursed for. it is something that we pay

directly to american specialty health, and it's not based just on the rate usage of san francisco. again, it's something that the members had asked for and wanted to be a part of this. and then, let me answer the meals and i'll see what follow-up questions you have. the meals piece, when you look at it -- again, we worked with mom's meals to look at what their experience has been with other health plans, but remembering that we're an integrated delivery system, have the ability within our hospitals especially to make sure that this is really integrated with that discharge planning, we actually believe that usage may be slightly higher. now we'll have to see. again, this is a new benefit, but when our actuaries look at that, there may be a difference in pricing, but i have no idea what the cost of mom's meals is for this year. >> commissioner scott: so to this point -- this is

commissioner scott -- of discharge planning, i go back to my prior question of u.h.c. so how does that work with you folks? again, you've got many people touching that person as they're leaving the hospital, so how do you get kind of that prescription for this particular service to that individual? >> yeah, no, great question. julie, if you could walk-through the process. you've been great in putting this together in how our nurses will walk-through the discharge orders with the discharge nurse? >> yeah. it'll be part of our paperwork. the member will receive a call from the vendor. the vendor will figure out what kind of meals they want to be charged for, what kind of meals

they want, and where they want them delivered to. so if they want the meals delivered to their daughter's home, they can have them delivered there. if there is a special meal they need, that'll be able to be figured out. all of this will be figured into the discharge plan and customized for the member. >> commissioner scott: thank you. >> sure. >> vice president follansbee: i just have one other question in that i remember very distinctly our concerns when the transportation benefit was added, that we were concerned about wheelchair access because public transportation allows anyone being transported in san francisco through -- through muni to have wheelchair access. i don't think that we were necessarily addressing gurney access, but we now are being

asked to cover both wheelchair and gurney. do you have some estimate about how many the gurney portion of this contributes to this surcharge and how awere gurney patients being transported before and to what costs were they being subjected if this was not a benefit? >> yeah, great question. i know that me and julie, we mentioned earlier, we'll have to go back for some of those numbers. i don't know, julie, if you can comment on the wheelchair, the van, gurney, it comes kind of as a specialized vehicle. just julie, i don't want to assume, so if you could comment, and if we need to get back to commissioner follansbee, we can. >> yeah, i think we might have to get back to him. i do know that they sort of do work hand and hand, but we'll

have to go back to the vendor to find out about that. >> so we will follow up with the numbers, the percent, because it sounds like, just to be clear, you want to understand the percentage of the time that it's actually gurney transportation since the conversation had been very much about wheelchair and van usage. >> vice president follansbee: yes, in part, because i think we realize given some of the stresses of our municipal transportation system, some users were having to change buses several times, stresses over scheduling, and it was really that population, the wheelchair users that seemed to be accommodated by public transportation when possible, but all of the benefits of the transportation rider weren't being extended to them. the gurney rider, that didn't extend to them.

they were never subject to delays or public transportation riders. not that i'm trying to deny gurney patients transportation. >> yeah, absolutely, and let us get you that information. i don't want to makeup numbers in any way, but i do believe that it is a combination to having both but not necessarily the focus on gurneys. we'll get you the information. >> commissioner zvanski: this is commissioner zvanski. in working with some of my retired patients a few years ago who were kaiser patients, i learned a couple of things. one, not everybody has a wheelchair who folds into the trunk. some of our members have electric wheelchairs or other devices, and so a van that drives up to take them has a ramp so that they can drive up that ramp and into the van and

remain in their electric wheelchair or cart or whatever it is. so that's very different than the standard type cab or car that would come to pick up someone who doesn't need a wheelchair or is a wheelchair user with a chair that can fold up into the trunk. i don't know that there's a different charge for that, i just know that it was a different type of transportation. lastly, when one of my colleagues was being sent from the rehabilitation center where kaiser placed him and needed to go back to kaiser for various tests and other appointments, it was an ambulance that was sent, and the member was charged separately for the ambulance ride both to and from his appointments as other kaiser facilities.

he was in pacifica, so he was going to south city and san francisco for different appointments, and he was charged the ambulance rate because i guess they transported him on a gurney and not on a wheelchair even though he was pretty ambulatory. it occurs to me that when we talk about gurney transport, it is this transportation versus ambulance, even a b.l.s. ambulance, which is lower cost versus some of the other transportation options now available through transportation companies that contract with kaiser or other places. and those are just my observations for whatever they're worth. thank you.

>> commissioner scott: this is commissioner scott. if there's no other comment, i am prepared to make a motion. >> vice president follansbee: go ahead. >> commissioner scott: i move that we take the suggestion of our actuary of the rate cards with the proviso that we will monitor the recommendation throughout the year. >> second. >> vice president follansbee: now, we'll open it up to public comment. >> clerk: thank you, vice president follansbee. one more time, we're going to wait 30 second to allow those of us at home who are watching the feed on sfgtv to catch up to where we are. the 30 seconds will start now.

all right, moderator, can we please have you open up the phone lines to see if there's any callers remaining. >> operator: you have one question remaining. >> hello. my name is richard rossman, and about the transportation, when i had a family members discharged from a kaiser facility, we got the exact opposite information, saying that the gurney and wheelchair

would be free, but if they can walk, kaiser wouldn't pay for it, so i don't -- this was in february. second, since kaiser's saving money on not building a new building in oakland, and they give money to the warriors and the san jose sharks, maybe they should use that money to build another post acute -- a post care facility so kaiser can be in charge of the patients post recovery, which i think they should be from the time of the surgery until the time they go home and not pass the buck to third parties. and lastly -- oh, the other thing is that i found out kaiser has an ombudsman. i never knew about that. i found out about that almost

accidentally, and this notice should be placed in the hospital rooms and sent to our members, and this ombudsman has been helping me in my ongoing saga with kaiser. and i find the person very neutral, and i don't know why kaiser doesn't advertise this service. and finally, when -- after the rate study period, i hope health service board and kaiser can work on setting up an advisory committee. i think it would be good for our members with kaiser so we can meet and try to work out some of these problems that keep popping up. thank you. >> clerk: thank you, mr. rossman. moderator, will you see if any other callers are on the line?

>> operator: you have zero questions remaining. >> clerk: vice president follansbee, this concludes public comment. >> vice president follansbee: thank you very much. so i now call for a vote on this item as proposed. all those in favor? all those opposed? okay. it passes unanimously. thank you very much. we can move onto item number 13. >> clerk: item 13 is a review and approval of kaiser permanente's multiregion retiree plan rates and premium contributions for plan year 2021. this is presented by mike clarke from aon. >> commissioner scott: excuse me. this is commissioner scott. i wanted to have -- through the president or acting chair, i wanted to have placed in the record that we're going to

monitor periodically these supplement c supplemental benefits that exist with u.h.c. that we now have with kaiser, so i'd just like to have that on record and get some sense of cost throughout the plan year. so i'm asking director yant to make note of that. >> yes, i've noted that. thank you, commissioner scott. >> vice president follansbee: thank you, as well. >> commissioner scott: i'm sorry to have interrupted. >> vice president follansbee: no problem. move on now to item number 13. >> mike clarke, aon, and my last presentation today will be to review the kaiser permanente 2021 multistate regional rates for early retirees and medicare

retirees. i'll start with introduction, move quickly to the commentary on the rate actions, and move to the rate cards, to the recommendation for the board today. next slide. staff recommends that the health service board accept the kaiser multistate region plan premiums that are shown in the resulting rate cards and best material. it demonstrates current membership enrolled in each plan along with the total proposed kaiser rate actions from 2020 to 2021, the total expected annual premium for all three regions for this plans, approximately $942,000. you can see the distribution of covered lives across early retirees and dependents as well as medicare retirees and dependents and the rate change actions being proposed today. increases for the washington region that are at or slightly

below national trends, and decreases for the rates in northwest and hawaii regions. next slide. in 2018, sfhss introduced a new set of kaiser plans for retirees living in certain geographies where kaiser plans are available. they are available in washington state, the northwest, which is primarily the vancouver, washington and portland, oregon area, and hawaii. next slide. the overall average rate changes that we reviewed earlier are 1.7 decrease for early retirees and 0.7% decrease for medicare retirees. when we set the total premiums, we also include the cost for the v.s.p. basic vision plan

premiums and the fhsb sustainability plan charge. and just a reminder that these rates are set early in the process, so any reconciliation to ultimate final 2021 rates will occur next spring. next slide. and just a reminder that the rate cards in this document are for those who earn full employer contributions for retiree medical coverage based on the criteria listed on this page. there are also alternative levels of employer contributions or coverage with no employer contributions, depending on the retirees scenario. next slide. so with that, we show the rate cards for starting with washington, the rates of the contributions similar to the format looked at earlier. next slide. here, you see the changes in rates focusing on the monthly retiree contribution changes at

the top of the exhibit for early retirees on the left side, medicare retirees on the left side. you'll notice there is no required contribution for retirees and early retiree coverage and medicare only retiree coverage for any of the contribution plans. next slide. these are the rate cards for the northwest region. next slide. and the change in rates for the northwest region plans early retirees and medicare retirees. next slide, and we finish with the rate card. next slide, and the changes in rates. next slide. so we go with our recommendation that the health service board approve the kaiser permanent say 2021 premium plan rates and regional rates for early retirees and

medicare retirees. vice president follansbee? >> vice president follansbee: mike, thank you very much. let's open up the item for questions, comments from board members. >> commissioner scott: this is commissioner scott. in light of this extensive discussion we had on retiree supplement, what i'm talking about in terms of the enhancements, do these same programs apply to our retirees in this -- in these other regions? >> i'd like to defer that question to a kaiser representative, please. >> hi. kate kessler, kaiser permanente. they do not all apply to the other regions. julia, i want to confirm that that is correct. >> yes. this is julie brady with kaiser permanente. yes. currently, these services are only offered in california. we are looking at expanding,

but the regional footprint is much smaller than california. >> president breslin: i just have an observation. washington is, like, $1,940 a month for a family. that's $23,000 a year. you know, i don't know who can afford that. that is really something, and the northwest is also really expensive. i'm curious why hawaii would be so much less since hawaii is very expensive to live. they have a very high cost of living there, and i'm curious why hawaii would be so much less. >> sorry. i was trying to get off mute. so i don't know the reason that the rate is so much different

in hawaii, and i'm wondering if, lorena, if you have the information. i know these are very small early retiree populations. many times, these are manually rated, and it's not based on utilization at all, and it's very much based on the rate usage in this area. i wonder if you can comment further. >> we would have to take this back and look at some additional information, but in general, it is manually rated and based off of the demographics, but there may be a different demographic between the members in washington than we have in hawaii, but we'd have to look at that closer for you. >> very small populations, as you saw, so they could be very different from one another. >> president breslin: well, hawaii is 25 and washington is 16, so it couldn't be that much

different. >> but very different people, so we don't know what the population is yet. >> president breslin: this is something i think we should be looking at for the early retirees with dependents because i'm sure there's going to be more with all the things going on. it's getting almost unaffordable with them, and the same with blue shield in san francisco. it's also in the bay area. it's, like, $16,000 a year or more. i don't know. talk about that more later when you talk about the r.f.p. i look at these figures. i don't know -- that would be a quarter of people's salary or more of some people's salary. >> yeah. the employer contributions from the city charter do provide for the full employer contribution for the retiree coverages only

for these plans, both early retirees and medicare retirees. there is an employer contribution for the first dependent for the city charter, but the second and subsequent dependents receive no incremental contribution per the city charter. >> president breslin: i'm talking about the employee and retiree and family, which may be one child in the house or something. that's what the problem is. the single person in all categories is not that high across the board, but -- but that particular group is really, really vulnerable. >> commissioner zvanski: this is commissioner zvanski. can i ask a question, as well -- i'm sorry, karen. are you done? >> president breslin: yes, i am. >> commissioner zvanski: i'd like to know first of all why -- if i'm not understanding, why the rates for washington overall are so much higher than every other

place, and my understanding from actually co-workers who were from hawaii and went back to hawaii when they retired was that hawaii has -- that kaiser is sort of the state of hawaii plan or sort of the state coverage that is offered to everybody. so i would expect that whatever we contract would be probably rated with that group and would be a lot less, and i don't know -- if i'm understanding correctly, with all of these out-of-area people, that they are all being rated individually, and so that means that in hawaii we would not get whatever the hawaii rates might be with the state of hawaii, but we're being charged a separate rating based on the individuals that we have there, and i'd like clarification of that. but i do want to know why

washington state is so much higher than anywhere else. >> yeah. so i will -- commissioner zvanski, i'll comment on the hawaii rate as far as the estate plan, and this has nothing to do with the rate. the state of hawaii offers kaiser permanente as an option, and of course they're rated according to their utilization, and that's a completely separate plan. and so we can get additional information on the details of the rating for hawaii versus the washington state area. again, these are each very small populations that are typically manually rated from -- for each of those areas, and we can certainly get additional information for you. >> and i do know the kaiser actuary shared with me before the meeting that specifically

for washington state, there was the recent acquisition that kaiser made of the cooperative health program in washington state, and so there were some underwriting methodology changes for the 2021 plan year that drove that 6.3% increase in the early retiree rate in the washington state program, so the one-time adjustments, now that the underwriting is fully under kaiser and kaiser owned, so we would expect per the -- what the individual shared with me before the meeting that there would be a stabilization of that increase going forward before this one-year adjustment in the underwriting. >> commissioner scott: through the chair, this is commissioner scott. to michael -- mike, at this point -- you did say these plans were community rated, all

three? >> that's correct. >> commissioner scott: so it's not that they're looking at our utilization per se and then coming up with a rate, they're looking at their book of business or whole community, and we're a part of that, correct? >> correct, and certainly happy to ask the kaiser underwriter to speak of demographic adjustments or anything else that may happen within the community rating environment. >> commissioner scott: okay. thank you. >> yeah, absolutely. go ahead, lorena, if you would like to comment on that piece of it. >> yeah, so for these small populations, they would be manually rated, and so none of their utilization or experience would be included in the pricing of the rates because it would just be too volatile. one person going into a hospital in a population of 15 members could skew the utilization experiences or what it would look like.

these are small populations, and they're based on the demographics of a retiree population. so, for instance, if, in washington, you know, the population had an average age of 64 whereas in hawaii, it had an average age of 55, then you would see a difference in what that demographic factor would be. it would also be, to your point, president breslin, is that the mix -- and so one of the things that we'll take back and look at is exactly how many families, how many subscriber only contracts we have, and then how that is impacting the rates because that can also have an impact in implications and development to the rates, as well. >> commissioner scott: so for the record, maybe one of the things that he we h things we need to -- and this

is to director yant -- maybe get some information on the group rating and individual rating processes, and we can have our actuary weigh-in on that as we go to an education session later this year. >> vice president follansbee: any other questions or comments from the commissioners? if not, i'll entertain a motion regarding this recommendation. >> president breslin: did we have public comment? >> vice president follansbee: until we have a motion that's passed, i can't have for public comment. once i do, i'll ask for public comment. >> commissioner scott: this is commissioner scott. i move we accept the recommendation of the actuary as outlined in his presentation and summarized on page 24 with the underlying rate cards for the kaiser plans that are in

multistate regions. >> second. >> vice president follansbee: okay. it's been moved and seconded that we approve that recommendation. now we'll open it up for public comment. >> clerk: thank you. another reminder that we're going to wait 30 seconds for the public to catch up to where we are now. that 30 seconds will start now. >> commissioner zvanski: while we're waiting, this is commissioner zvanski, seeing that we now have, i guess it's two more categories of retirees, the january 9, 2009, and the january -- and then going forward, the january 10 hires, and i know it adds to the rate cards, but i'm used to seeing rate cards that had

about five different options on them, on one specific card way back before it was aon hewitt, but it would be nice to see those rates, as well, so that we could have rate cards that show us what those retirees are costing and what they would be paying out-of-pocket and compared to the previous year. i would really appreciate it. and lastly, i just want to understand with mike that these individuals that are being rated in the multistate, you said they were getting the full -- the full, i guess, supplement, so this is the ten-county -- they're not getting the difference between the ten-county map and the full cost of the plan as we have in our other medicare advantage

plans that are then passed on through employee plus one and family rate, correct? >> yeah, the employer contributions are developed, you know, first for the single tier based on looking at the plan costs, as well as the other features of the formula, and then, the subsidy contribution applies to that first dependent. >> commissioner zvanski: right, right. so what i'm seeing in the rate cards that that's the difference between the two costs, and it's not the full ten-county amount, it looks like. >> based on the calculations, that's correct. >> commissioner zvanski: thank you. >> clerk: thank you, and i just want to remind you, commissioners, the reason we

have a 30-second pause so the people at home who are experiencing a delay in presentations can actually catch up before -- to hear presentations before we move into public comment. so i would request that we use that 30 seconds for silence. moderators, can you please open up the call line for me? >> operator: you have zero questions remaining. >> clerk: vice president follansbee, that concludes public comment for this item. >> vice president follansbee: so i'd like to go ahead and open up this item for a vote. all in favor of the recommendation and to approve the kaiser permanente 2021 multistate regional rates for early retirees and medicare, please signify by saying aye. anyone opposed? it's unanimous.

thank you very much. this concludes the rates and benefits section of the meeting. we now open up the meeting to the regular meeting. i'd like to remind the board members that -- and the public that number one, we have three very important items, one of which is an action item, but we'd like to see if we can move through the rest of this agenda, including the action item, in the time we have remaining. so i'm going to call for item number 14. >> clerk: yes, no problem. item 14 is the director's report. this report is given by abbie yant, the executive director. >> good afternoon, commissioners. thank you very much. due to the lateness of the hour, i won't spend a lot of time going over the director's report in your packet. i anticipate there may be some

questions about a few of those items, so i just wanted to highlight in the report that the health service system continues to operate in a virtual environment very much like we are today and do not have any plans of opening to the public any time soon. we're preparing our health and safety plan to be submitted to the city administrator's office which outlines under very restrictive guidelines how we mail out some additional personnel into the office on very specific focuses and schedules. all persons will have to self-certify as to their wellness, where they -- anyone who's ill will not be allowed to report in to work. many more details on that, should anyone need that, they can talk to mitchell or myself. the -- also, i acknowledge the -- we have on our ongoing strategic plan for the health

service system, addressing the social determinants of health. we talked a little bit about that through the transportation and yield discussions that were quite robust, though we do need to have a conversation about the impact of race on health and health outcomes, and we will be doing that again in the second half of the year where we're looking more closely at our data and how we can support our members whose health is related to their rates and how we may be able to work together to improve' the health of our membership. i also want to ask, after several years of postponing the decision, that we will proceed with doing a competitive bid for our medical plans, and that is officially, as of today, this is the public notice that we will be doing that. we have included in the

director's report a memorandum to that effect admonishing each of the commissioners and advising on what your communications cannot be -- can and cannot be with anyone who we are currently doing business with or who is potentially bidding on the plans. i will note that we should call that a blackout notice, being se sensitive to the situation that exist in all of our communications. i reworded that to a communications notice. the impact of covid on our membership and being seen through the plan claim utilization is just now starting to come in, and we hope, again, in future months, to be able to report back to you, as you. as i think all of you are

aware, san francisco as well as the bay area has done a good job in suppressing the wave of the covid, but as things open up, there may be outbreaks and clusters of covid that occur, and so the health system is certainly more ready than it had been to accommodate the care needs of persons infected with the covid virus. but at this point, the problem has, at least as we understand it, has been an underutilization which has been spoken to several times today. as we continue to get these measures to work with our health plans, we will be reporting back to this board. i did want to move into the -- quickly into the fact that we do have some folks that are going to be able to retire this year, and so i just wanted to

recognize of our staff that came to the city from blue shield in 1991 and has really carried a great institutional memory and has been a stalwart advisor in our member services area. we wish her well. she's had nearly 30 years of service and has been a pleasant woman to work with. anabelle perr began her career in 1980 at the school district, and then she moved around a bit and ended up in city services where she is a member benefit analyst. she has a lot of compassion for our members, as well, and has been a stalwart member of member services. with that, i would like to say i wish both of these women well

in retirement, and we will be looking to fill those positions in order to serve our membership. i also wanted to acknowledge the work that we continue to do in i think really important ways of collaborating with public safety agencies, with the health department, with the department of human resources and many others in bringing well-being with a focus on mental health to the workforce today. it certainly has been an issue for us that we've wanted to delve into deeply for several years now, and the crisis has afforded us the opportunity to really dig deeply into mental health issues and bring tools and work closely with these -- with many departments, so with

him being's, like many of us in this new covid world, has been incredibly adaptive and creating in finding new ways to work with our partners throughout the city. so i think with that, i'll close, 'cause many of the other things -- smile way -- have been mentioned in this lengthy meeting today. let me just pause there and see if there are any questions or comments from the commission. >> i just got a message that someone was trying to call in on 13, and they said there was no public comment, so please check the line. she said there were a couple other people in line to get on, too. >> clerk: yes. were they pushing one-zero to get added to the queue?

>> president breslin: i don't know. it just said there was no public comment. >> vice president follansbee: no, no, that item is closed. >> president breslin: no, i was just saying that they were trying to get in. maybe something was wrong with the system. i have a couple of questions about the r.f.p. it's going to be for actives only and early retirees, not kaiser, of course, but what i've heard is i know you had the focused group, and a lot of members saying they want more choices -- more choices besides blue shield, and maybe blue shield and somebody else because without any competition for blue shield, prices can do whatever they want to do there. more choice and more competition is always good. also, the city plan, in order

to make that viable again, you're going to have to open it up to all members. it just doesn't seem right to separate our members for these different plans. i looked around at the ten counties, all the ten -- almost all except two didn't have a p.p.o., and some of them had two p.p.o.s for sure. and then, i noticed the county with the fewest selections, which was santa clara, was the highest across county. so it just seems that we need more choices, not just to take away one and get another one. more choices. and then, early retiree with family death, they need to find something -- it seems they need to find something more affordable for that group because it's just getting unaffordable, especially with blue shield. and the city plan isn't working

either, because of the medicare people being taken out of there. and then, i don't know if the board -- did the board personally weigh-in on this r.f.p. and what they would like to see or was it just the focus group? >> this is commissioner zvanski. i have a question, as well, through the chair. >> vice president follansbee: wait. we're still waiting for a response to that question. you were muted, i believe. >> no, i've been actively listening to this board for 2.5 years, karen, and we've had a number of sessions dedicated specifically to this. so i did hear what you're saying. i would like -- the one comment that i would like to make, though, is we are not including in this competitive bid the medicare business. it would be too much for us to be able to take that on, and the disruption to the entire

population would be almost impossible to manage. so we are focused this year on the medical plans for the active and early retiree populations. >> president breslin: so no p.p.o. in sight for the medicare population? >> we're not addressing the medicare populations this time around. >> vice president follansbee: commissioner zvanski, you had a question or a comment? >> commissioner zvanski: yes, thank you, dr. follansbee, i do. i hate to admit this, but in the boxes that i have at home from previous r.f.p.s, god knows why i saved them, or even brought them home -- i guess they were delivered or -- whatever. the r.f.p.s that went out previously always included the medicare, and it was only during dr. dodd's administration that somehow blue shield was given the exemption of carving out

medicare business, and that somehow that then became a different kind of structure, and i don't recall it. i don't know -- i really don't know if i was on the board at the time or it was after, but that was the first time that any of the vendors that provided health benefits was allowed to carve out medicare, the medicare population. and so i'm just pointing out that i think it was the charter language that required us to include also that any vendor that did business with us had to provide coverage across the board which included medicare. and maybe it was changed in prop c. i don't know, but i think we need to check the charter on that issue to make sure that we are in compliance with that

r.f.p. abbie, i hear you absolutely that this would be rather overwhelming for the staff, and it's not my intent to add that, but i just want us to have a consistent policy with consideration to everyone and that we're not out of compliance with our charter r.f.p. thank you. >> president breslin: i just wanted to make another comment on the health and safety issue. my hope is that we can get back to a normal in-person board meetings in the near future and not a year from now, i'm hoping, because it is much more difficult for members to weigh-in on these meetings, and someone called in to the board of supervisors the other day and was really describing how difficult it was for them because they had a bit of a handicap. and like i said, some peoples don't even have computers.

so i know that you don't even have control over that, but i'm hoping that this isn't going to be another 12 months for that sort of thing. >> yeah. i do know that we will be drewingdre introducing a different platform for doing these meetings. is that webex that we're exploring? >> yeah, we're looking at different options. >> commissioner scott: this is commissioner scott. i would recommend that you also include go to meeting in that list of possible vendors, but i wanted to raise a question about the steering committee, abbie, on the social determinants of health. it is my hope as you're working through this process that we will have some early engagement by this board in looking at the some of the stuff the steering

committee will be looking at so we are in sort of a parallel track in terms of taking a wider view of this issue as we are considering various policies per medical plan designs, etc., going forward. i recognize that you're in the early phases of this, but i'm hoping that there's some interactivity with the board around this issue so that that will feedback to the steering committee and vice versa. >> much appreciated. thank you. >> president breslin: when you're talking about other types of meetings, you're not talking about inperson? >> commissioner scott: no, i'm talking about other -- >> president breslin: i'm asking abbie about the other types of meetings. >> commissioner scott: i understand that. i thought we were finished about that topic. i was talking about another topic, social determinants. >> president breslin: i understand that. >> i think i can handle that. one is we will work under

whatever the city standard is for public meetings. i understand the options are changing, and we'll let you know more when we know more. be aware that we may be doing something different in august, and i have not heard any discussion about no longer doing virtual public meetings. when i do, i will be sure to let you know. and then, on the social determinants of health steering committee, it's kind of a different meeting. commissioner scott, because we're developing -- we have wanted to do this when we got sort of diverted with covid, but we hired derek and marina, and then, you've met leticia,

our other facilitator, and carrie and beshears on the well-being team, particularly challenged with mental health and the different issues that relate to mental health and how services are accessed and delivered. and then, marina, of course, being our data guru and myself as sort of leading off this exploration as how we look at social determinants of health because one of the things that is not written a lot about in any of the major research on social determinants is the impact of work as a determinant of health, and so we are looking -- robert johnson has recently let out a request for proposals to look at that very issue, so there's a lot going on that we're just trying to get our hands around what kind of approaches or what our universe might be, and so

certainly to involve and have conversations with yourself and other board members will be very appropriate. >> vice president follansbee: i have one other comment, and then i'm going to close this item, and that is that the comment about transitioning to medicare, social security in their processes that they handle backlog, i appreciate that we are going to adhere to the members rules, i wonder in august if we could have a report of denials of members who weren't able to transition to medicare for one reason or another compared to other years? because i am quite nervous about the communications that have come from the federal government agencies, not just the h.h.s. over this period of

time. so i want to make sure that we haven't denied members' access transition to medicare. if we could do that in august or september. >> yeah, we could take a look at that because it is an issue on a regular basis, let alone in the covid world, so would be happy to take a look at that, and certainly at how we look at helping people transition to retirement is something we looked at that's a big area of concern. fran frankly, it's something that nobody looks at, and then, they see it, and they have a lot of questions. >> vice president follansbee: so if there are no other comments or questions from the board, i'd like to open this up

for public comment. we will respect the 30-second rule before we go to public comment. we have two other important items, so if we can keep mindful of the time and the fact that we have two important issues, as well, to issue, one of which is an action item, so i'm going to turn this over to open this up for public comment. >> commissioner zvanski: dr. follansbee, this is clare zvanski. i just have one important question. in monitoring the retirement board, there was a new order from the mayor's office that their office is staying closed for a full year, and i'm wondering if health service has received any kind of further direction from the mayor's office, and if this would be the place to include that? and also, i just noticed how

they have their board meeting rooms where two staff people and the president of the commission were actually in their board meeting rooms while they were doing the virtual meeting, so i don't know if that's an option for us to consider in the future. but i'm most concerned about the mayor's office statement and that office being closed for a year because there's so much that health service does with regard to retirement and vice versa. thank you. and now, i'm quiet. >> commissioner hao: this is commissioner hao. i would really appreciate it if our colleagues would help us move along with the agenda. the hour is really late. thank you. >> clerk: thank you, commissioners. we're going to start the 30 seconds now, and for those on the phone lines, please press one-zero to be add to the queue. if you are listening on the conference line, you will not be added to the queue until you press one-zero.

the 30 seconds starts now. thank you. okay. moderator, will you please open up the public comment line for the first caller? >> operator: you have zero questions remaining. >> clerk: vice president follansbee, that concludes public comment for the director's report. >> vice president follansbee: thank you very much. we'll close this item and move onto item number 15 then. >> clerk: yes. item 15. the san francisco health service system revised fiscal year 2020 through 2021 and

fiscal year 2021 through 2022 proposed general fund administration budget. this presentation is done by pamela levin, the chief financial officer. >> vice president follansbee: before we begin, i just want to remind the board members that this is a critically important issue that we are about to hear, so we need to devote our attention to pamela. the discussion from the mayor's office seems to change periodically, and so this is a moving target, and the success of our health service system relies on our ability to meet the financial constraints but also meet the demand for services which will only increase in these periods of stress, so pamela, please proceed. >> good afternoon. pamela levin, chief financial officer, health service system. the item before you is the revised proposed general fund administration budget for 2021

and 21-22 for your approval. i want to note that this differs from the one that was originally sent to you because of some changes in the direction from the mayor's office that occurred early this week. next slide. the city now faces a deficit of $1.7 billion over the budget horizon due to losses associated with the pandemic. for comparison, the two-year deficit in february is $420 million. a recovery is not expected for four years. in may, the mayor issued revised budget instructions to try to close that deficit. departments are now required to submit a revised budget with mandatory budget reductions. for 2021, the planned -- mandatory budget reduction is

10%, and for 2021, the mandatory budget reduction is 15%. in addition, departments are required to submit a 5% contingency plan for 2021 totaling $180,325, but this may not be implemented. it depends on if the budget projections, if they worsen. as further reductions, we are to stream line positions, consolidate b consolidate costs. departments are to determine which serves are to be delivered in person or if they can be delivered remotely and to look at increasingly how technology can be used to provide services on-line. page 2 -- next slide.

so when we looked at the budget, we tried to do everything we could to balance it with the mandatory and make the mandatory guidelines and also maintain our position authority. initially because there was a hiring freeze that started in march, the only positions that were critical to the operations would be approved by the mayor to fill. what we needed to do is rather than having positions actually eliminated, we increased our atrition for those positions that we knew we wouldn't be able to fill.

this'll be a combination of the natural occurring attrition because people are leaving or retiring, and the attrition because we won't be able to fill positions because of the freeze. next slide. this slide shows the 2021 revised budget side by side with the budget approved in february before the pandemic. as you can see, the reduction targets are being met by increasing attrition and decreasing nonpersonal services while maintaining the increased funding levels that we requested in february as much as possible. funding for materials and supplies is increasing at the same level as requested in february, and no reductions are proposed for work orders.

the reduction that you do see in the line for on-site activities and a reduction in the line for contracts, we moved the funding because we knew that it's unlikely that we'll be able to do in-person activities in 2021, so this funding will be rolled in and be able to use it for additional mental health programs. we're also cutting more than what's required in the first year so that we can partially fund the expanded employee assistance programs that we added in april that consisted of a 24-7 e.a.p. and a direct

responder mental health application. next slide. when it came time for the contingency plan, we looked at areas that would be occurring in 2021. since the budget would not be approved until october, and all the expenses have to be approved by june, that reduction -- partial reduction of the grants is on the contingenci contingency plan. in addition, the instructors for rec and park is cut for 2021 because we do not think

that in-person classes will be possible due to social distancing requirements. next slide. this slide shows the 2021-22 proposed budget side by side with the budget that was approved by the board in february. in order to meet the mandatory reductions, attrition is increased like in the prior years. funding for nonpersonal services is reduced, again, while trying to retain the increases that were proposed in february as much as possible. materials and supplies are increased at a much lower level than what was approved in february. funding for the work orders for the fitness instructors is reduced by 37%, with the anticipation of some in-person classes being possible in february 21-22, and we have

also reduced the work order with the city attorney's office to reflect the prior year's expenditure levels. finally, the main proposed budget will be released to the board of supervisors on august 1. the budget hearings are in august, and the board will approve the budget in september, and the mayor will sign the budget on october 1. this budget is extremely difficult to put together, and it's going to be quite a challenge to negotiate with the mayor's office and the board budget analyst because of, you know, the fact that we're not in the office and there are expenses that may be viewed as

being discretionary, that we may differ in that viewpoint. i'll be glad to answer any questions. >> vice president follansbee: so are there any questions for pamela levin? >> commissioner scott: this is commissioner scott. pamela, i want to say that i commend you and your team for what i know has been a difficult week or more in putting this information together. i think that you have identified, based on my prior experience with some of the budgets that we submitted, areas where reductions could be made. while painful, but if it's under a mandatory framework, we hope they'll have minimal impact while continuing to support our members as well as continuing to do the ongoing business of the system. so thank you for what you've done, and to the degree, as was

said earlier in the meeting, that if, indeed, there is some level of interfaces that we as individual board members can support you and abbie as we go forward with this process, i would stand ready to do that, so thank you. >> one last thing i'd like to point out as i mentioned in the beginning, there is a recovery down the road. they're expecting it will be in four years. it may be a little longer, and at that point in time, we'd still have the positions that we could fill, although, you know, we're in -- all of us are in kind of a -- a new way of looking at our work and -- but still providing the necessary service to our members. >> vice president follansbee: are there other comments?

i'd just like to also thank you very much for this report and also remind those -- the public but also our board members that this time will be increasingly stressful for all san francisco employees, and we've already seen some evidence of some members of some departments sort of not being very supportive of members of other departments, and there'll be increased stress for those employees who are continuing to work and trying in good faith to handle their jobs, and that includes our own hss staff. and so this is not a time for us to pull back on the mental health options that we can do to support other departments and other employees of the city and county of san francisco as well as our other contracted employers. any other comments?

so i'll -- i guess this is an action item. do we need to approve the report as you've submitted it or what's the action that we need? >> the action is to approve the budget as submitted for the department to submit the budget to the mayor's office tomorrow. >> commissioner scott: commissioner follansbee, i'll make the following motion -- this is commissioner scott. -- i move that we accept and instruct the departmental c.f.o. that we accept the budget as proposed and forward this to the appropriate city authorities. >> commissioner hao: this is commissioner hao. i second that motion. >> vice president follansbee: so it's been approved and seconded that we approve the current budget as outlined by

pamela levin today to be forwarded to the mayor's office tomorrow. i would now like to halt conversation from the board members and open up the line for public comment. >> clerk: thank you very much, vice president follansbee. we're going to put a 30-second pause on conversation for people at home watching this meeting to catch up to what we have just discussed. that 30 seconds starts now, and i want to remind callers, if you are dialing in, please press one-zero to shabe added the queue. thank you.

>> clerk: okay. moderator, can you open up the line for public comment? >> operator: you have no questions remaining. >> clerk: okay. commissioner follansbee, public comment is closed. >> vice president follansbee: okay. on the motion to move the budget to the mayor's office, all in favor? opposed? let's go into item 16. >> clerk: item 16 is the infert willi infertility benefit status update for blue shield of

california, presented by shawn lovering. >> i would be remiss if i did not think, on behalf of -- did not thank, on behalf of blue shield, natalie, for all of her work and support. we are going to miss you. next slide. next slide. so we're here today to give you an update on our efforts around infertility. it was brought to our attention last year that there were some issues, and we're going to bring to your attention that we can fix things.

[inaudible] >> -- when they added the custom benefits that you see on the right. next slide. so we did a ton of research when this was brought to our attention, and we identified the following areas where we had gaps. benefit authorization and identification process. we understand that infertility is a prepersonalize -- very personalized and very difficult process to go through, so we had to adjust our authorization timelines to better fit the challenges proposed by receiving infertility treatments to extend those. [please stand by]

>>. >> as i mentioned before, we pulled all the previous denials for infertility services, rereviewed them. we also created access for members to a dedicated internal subject matter expert for assistance in navigating the matter with our patients. we have put in an end-to-end process and oversight for every infertility request that comes in. in addition, we have created a more friendly overview of the

fertility services available to sfhss members and put that on the sfhss microsite. next slide. access to meds. this, as you know, was an area that was brought up to be very difficult to navigate. [please stand by]

-- so that the members have additional options when it comes to getting their fertility meds that are -- allows them to use their insurance and is easy to access and timely for them. we anticipate that these new contracts should be in place by november and we certainly will come back and update you on that item at the november board meeting. are there any questions around what we identified, what we have corrected? and going forward how this will work for members? >> let's open up the discussion now to the members of the board. any comments or questions? >> this is commissioner.

and looking at this presentation i see only one picture that points out a non-heterosexual couple. i think in your materials it would be nice to have a few more depictions of alternate family groups so that it's not quite as heterosexual oriented. i think that is especially important for a number of members of our health services system membership. thank you. >> thank you, that's a point well taken. and on the -- on the website the information that we uploaded there we have certainly were focused on making it extremely culturally compassionate for all members. so if you take a look at that i think that you will find that we did achieve that.

>> other questions or comments? i have a couple. one is that, you know, it's pretty -- i think that you covered from the beginning of the -- of this benefit in the beginning of 2018, so we had more than a 30 denial rate which looks to me, except for the few individuals that were not covered benefits were reversed. over the two years now, 2 1/2 years, you know, that's a long time for people who are trying to undergo fertility. and i don't know that -- it's not germane for what you're doing for future, but there's a significant fallout for the individuals who were inappropriately denied coverage. i'm just kind of curious to know if you can maybe in three months or so to provide some follow-up information to those 58 individuals who were denied the service inappropriately.

the way that i understand your presentation. the other thing is that the pharmacy benefit item is still very real and the information that we have been provided by -- obstenostensibly from a member o resourced this considerably, is that like a lot of pharmacy benefit systems or companies, that there's a very complex interrelationship between these companies and the providers. the pharmacy is now been brought out by express scripts. express scripts is now a subsidy of cigna insurance. and i think that there's some concern that maybe cvs or walgreens are trying to buy it, but there's now cigna. and so my understanding now is that the decisions and the relationships and the reimbursement and the pri