>> service board to order. we have agenda item no. 2. >> thank you, president follansbee. agenda item no. 2 is roll call. president follansbee. >> present. >> vice-president canning. >> present. >> supervisor chan is absent. commissioner breslin? >> present. >> commissioner hao. >> present. >> commissioner scott? >> present. >> and commissioner zvanski? >> present, thank you. >> thank you. we have quorum. >> thank you very much. can we have agenda item no. 3, please. >> yes. agenda item no. 3 is the approval with possible

modifications of the minutes of the meetings set forth below. the health service board regular meeting minutes from may 13, 2021. >> any questions or changes to the minutes as outlined? >> mr. president, i have one slight edit that i shared with the secretary, changing of a word. >> thank you. any others? >> i have the same that was changed earlier. it was only a typo. >> great. thank you very much. >> i move to approve the minutes of the may 13, 2021 minutes. >> second, scott, i second. >> thank you. it's been moved and seconded that we approve the minutes of the may 13, 2021 health service board. we'll open this up for public

comment. >> public comment will be available for each item on this agenda. each speaker will be allowed 3 minutes to comment in length unless the president deems new public comment time limits during the meeting. as a reminder, a caller may ask questions of the policy body, but there is no obligation to answer or engage in dialogue with the caller. when i welcome you on the call, you're welcome to state your name clearly, although you may remain anonymous. after your three minutes, you will be placed back on mute. remote viewing is available on sf gov tv.org and sf channel. opportunities to speak during the public comment period -- by dialing the number on the screen. the dial-in number is 415-655-0001. again, 415-655-0001. when prompted, use access code

187-003-9306. again, 187-003-9306. then press pound and pound again. you will enter the meeting as an attendee on the public comment call. dial *3 to be added to the public comment queue, and when the system message reads you are unmuted, it is your time to speak. sf gov tv has a standing 40 to 45-second delay. we will take a 45-second pause to allow the systems to catch up and allow callers to dial in. our 45-second pause will begin now.

the 45-second pause has ended and our moderator will notify us if there are any callers in the public comment queue. >> madam secretary, if you could please share host privileges, we currently have three callers on the phone line. zero callers have specifically entered the public comment queue at this time. a reminder to all callers on the line, you must dial *3 now if you want to join public comment for this specific agenda item. we will wait five more seconds and then close public comment for this agenda item.

board secretary, there are still no callers in the public comment queue at this time. >> thank you, moderator. hearing no further callers, public comment is now closed. >> thank you very much. so it's been moved and seconded that we approve the regular meeting minutes for may 13, 2021, with some slight editorial changes. all those in favor please signify by saying aye. >> aye. >> opposed? thank you. it carries unanimously. if we could have -- open up agenda item no. 4. >> thank you, president follansbee. agenda item no. 4 is general public comment, an opportunity for members of the public to comment on any matters within the board's jurisdiction that is

not on the agenda, including requesting that the board place a matter on a future agenda. >> so we will open this up for public comment. >> thank you, president follansbee. i'll read our instructions. public comment will be available for each item on this agenda. each speaker will be allowed three minutes to comment in length unless the board president deems to change time limits during the meeting. as a reminder, a caller may ask questions of the policy body, but there is no obligation to answer or engage in dialogue with the caller. when i welcome you on the call, you are encouraged to state your name clearly, although you may remain anonymous. when your three minutes have ended, i will thank you for your comment and you will be placed back on mute. remote viewing is available on sf gov tv. opportunities to speak during the public comment period are available by dialing the number on the screen.

the number is 415-655-0001. when prompted, please access code 187-003-9306. again, 187-003-9306. then press pound and pound again. you will enter the meeting as a public attendee on the public call line. when the system message reads your line has been unmuted, this is your time to speak. for those already on hold, please continue to wait until the system indicates you have been unmuted. sf gov tv has a standing 40 to 45-second delay. for viewers watching our live broadcast online, we will take a 45-second pause to allow the systems to catch up and allow the callers to dial in. our 45-second pause begins now.

the 45-second pause has ended. our moderator will notify us of any public callers in the comment queue. >> board secretary, we have four callers on the phone line. zero callers have specifically entered the public comment queue at this time. a reminder to all callers on the line, you must dial *3 now if you want to join public comment for this specific agenda item. we will wait five more seconds and then close public comment for this agenda item.

board secretary, there are still no public callers in the comment queue at this time. >> thank you, moderator. hearing no public callers, public comment is now closed. >> excuse me, one caller just ascended their hand. i am elevating that caller now. >> thank you, moderator. welcome, caller. welcome, caller. >> board secretary, it appears that caller user no. 12 has their hand elevated but no audio is coming through outside of the transmission. muting them now. >> thank you, moderator. seeing that there's no further

transmission, public comment is now closed. >> thank you. so this closes agenda item no. 4. i will call agenda item no. 5. >> thank you, president follansbee. agenda item no. 5 is president's report, a discussion item, which will be presented by president follansbee. >> so in the interests of time because we have a very full agenda, i have no formal comments in this agenda item, so we'll go ahead and close this agenda item. we can move to agenda item no. 6. >> thank you, president follansbee. agenda item no. 6, the election of the health service board officers, president and vice-president, for fiscal year 2021 to 2022, and this will be presented by randy scott, our governance chair committee -- our governance committee chair. >> hi, good afternoon.

i wanted to place before the board the terms of reference, no. 101, and term of reference 201, which governs the election of service board officers, president, vice-president in june of each year, and their terms begin immediately in july of the next meeting. president stephen follansbee and vice-president chan and canning have served one year in their respective roles. i make the following motion that they be re-elected for an additional year of service in their respective offices. >> i'll second that. >> it's been properly moved and

seconded that stephen follansbee serve as president of the board for an additional year and that christopher canning serve as vice-president for the ensuing year. properly moved and seconded, so we will entertain any public comment on this item. >> thank you, commissioner scott. i just wanted to check that our feed is coming through. if our tech support could clarify that. checking on the back end. thank you for your patience. okay. it does look like our feed is coming through. just wanted to check. i will open this up -- >> thank you. >> -- for public comment. public comment will be available

for each item on this agenda. each speaker will be allowed three minutes to comment in length unless the board pierre trudeau deems new public time limits during the meeting. as a reminder, a caller may ask questions of the policy body, but there is no obligation to answer or engage in dialogue with the caller. when i welcome you on the call, you are encouraged to state your name clearly, although you may remain anonymous. when your three minutes have ended, i will thank you for your comment and you will be placed back on hold and the moderator will unmute the next caller. remote viewing is available on sf gov tv.org and sf channel 1. opportunities to speak during the public comment period are available by dialing the number on the screen. the dial-in number is 451-655-0001, again, 415-655-0001. when prompted, please access code 187-003-9306. again, 187-003-9306. then press pound and pound again. you will enter the meeting as a attendee on the public comment

call line and dial *3 to be added to the public comment queue. when the system message reads your line has been unmuted, this is your time to speak. for those already on hold, please continue to wait until the system indicates you have been unmuted. sf gov tv has a standing 40 to 45-second delay. for viewers watching our live broadcast online, we will take a 45-second pause to allow the systems to catch up and allow the callers to dial in. our 45-second pause will begin now.

the 45-second pause has ended. our moderator will notify us of any public callers in the public comment queue. >> thank you, board secretary. i would also like to clarify for the record that the caller from the last round of public comment likely elevated their hand by accident. all that was coming through was the broadcast in the background, and the same caller, no. 12, has been disconnected. just wanted to clarify that for the record and let everyone know that there are still three remaining callers on the line. [indiscernible] specifically enter the public comment queue at this time. we are hearing background noise, to a reminder to all members to please mute their mics, and a reminder to all callers on the line that you must dial *3 now if you want to join public comment for this specific agenda item.

we will wait five more seconds and then close public comment for this agenda item. board secretary, still no callers in the public comment queue at this time. >> thank you, moderator. hearing no further callers, public comment is now closed. >> with public comment being closed, we're now ready to take a vote on this item, the election of the president and vice-president. all those in favor signify by saying aye. >> aye. >> aye. >> aye. >> all those opposed? i wish the record to reflect that president stephen follansbee has been unanimously re-elected as president for the ensuing year and that vice-president christopher canning has been re-elected for the ensuing year. and as chair of the governance committee on behalf of this board we thank you for your past

service and we look forward to working with you in the coming year. mr. president, i turn the chair over to you. >> great, thank you. if we can move on to agenda item no. 7. >> thank you, president follansbee. agenda item no. 7 is the director's report. this is a discussion item and will be presented by executive director abbie yant. >> thank you. good afternoon, commissioners. i'll just go through this briefly as we do have a full agenda, as president follansbee has noted. i will say that we are all celebrating the fact that 80% of eligible san franciscans have now received the vaccine. that's quite phenomenal, and congratulations to all of us who have been brave enough to step forward and take the vaccine and be assured of being very safe in today's environment, even with

some of the variants around us. we -- those of us who have chosen to get the vaccine have an extraordinary amount of protection, and so i continue to encourage each and every one of us to step forward and take the vaccine. i do want to remind -- and the other thing that -- as it relates to the vaccine, the [indiscernible] had an emergency meeting last night again to visit regulations about workplace safety as it relates to covid. they will be issuing new regulations i believe next week, so we're all waiting to see what they say. all city departments are developing return-to-work plans, but obviously that guidance document and regulation will be pivotal in us being able to have a robust plan. so please hang on. we'll issue the plan as we're able to.

i do want to state that the blackout period has been a very long one for this body because of the r.f.p., but we do anticipate that it will close at the end of this meeting today, assuming that we approve all of the plans that are being presented today. i do want to acknowledge the race equity action planning information that we've provided in the director's report. it does highlight the vaccine approach has been very much guided by racial and social issues for different segments of our population, and it is working. so we are having success with certain populations that have been hesitant to get the vaccine, but as the outreach gets more and more personalized, we're able to bring more people into the vaccinated world. i also want to acknowledge the

well-being and the communications team that have put together the background that you see from me and many other materials celebrating the pride month this month, and upcoming celebration of juneteenth, which is an anniversary commemorating the end of slavery in our country. also in the reports today i have -- staff has assisted me in putting together in a rather brief way the state of the lawsuits that have been in play for some time regarding sutter's business practices. the first of the two lawsuits that has moved forward into the settlement phase and we have actually applied as an entity that may benefit from the financial award in this

settlement. we have no way of knowing at this point in time what that dollar amount might be. it has a lot of dependencies, but i did want to bring that to your attention, that that has been -- that first step for us to take to receive the financial benefits in the first lawsuit has occurred. the second lawsuit has not been settled, and so we will apprise you of that once that settlement is reached. there are also out there a blue cross blue shield settlement notice. that has -- our group as a government entity purchasing blue shield products on behalf of our members, we are not eligible to participate in that lawsuit, so i just wanted to draw that to people's attention because i know that some of our members have gotten notice of that because they've done a very wide reach, as is the standard practice in class action lawsuits, so we have gotten a few calls from people that have

not [indiscernible] and it's not clear to me even at this point whether i for instance received this notice in my email and i don't know if i received it because of my current plan or because i had a blue cross plan in my prior work. and there's nothing on there that would give me a clue. i understand the confusion that's out there, and we are able to guide people back to the faqs on their website. it's a pretty informative website, so it helps explain what's going on if anyone has questions, and it's embedded in the email that people have received. i did want to follow up with the delta and blue shield questions that came from the last meeting. at this point i'll talk about the blue shield and the infertility website and information that's up there is a -- what's called a rider, a

part of our -- a part of the blue shield authorization from the department of managed care in sacramento that described the infertility services in very clear terms that meet the definition of infertility at a state level. as we all know, having gone through this discussion for a few years, that can be very confusing to the consumer because it's kind of insider baseball talk. and so we have worked with blue shield and continue to to try to -- to submit the request to have that information changed because it does have to be posted, and so we're just trying -- it's an ongoing nuance with the communications around infertility, so i did just want to let the board know that that's very much on the radar screen and we're continuing to work through that. the legislative report, i think

we have -- latticia has developed a simpler format to try to highlight some of the -- much -- there's so much legislation out there, but she tried to select and highlight. if commissioners have particular legislation that you would like us to look at or add to this report or comes to your attention and you would like to know a little bit more about it, please let us know. we're happy to do some investigation into that. we have been able to do that for a few of you, and we would love to continue to support the board in that manner. on the operations, i think it is open enrolment, open enrolment and open enrolment is what has everyone very much engaged at this point. we are bringing in a new member services manager, which will be a very welcome addition to our leadership team, and -- but all the staff and member services,

communications and enterprise systems and analytics are all hyperfocused on the open enrolment seeing as we have plan changes to understand, embed and program in everything that we're doing for open enrolment, so it's quite a heavy lift and very much appreciated. the well-being team is, as you would imagine, very focused on the return-to-work anxieties that people have. there's a lot that people are working through, so we're working with d.h.r. we're working with the city administrator's office and others to help people with this transition. i think many of us wonder if we're still in a state of emergency, and the answer is yes. part of emergency planning and response cycle includes the

recovery period, and so that is where we are. we're having to recover and demobilize all of the standup operations that occurred and then shift from large vaccination sites to smaller decentralized distributed model, et cetera, et cetera, does continue as we get more comfortable with the reopening plans that will be taking place starting june 15, as far as the state is concerned. so i think it will be quite an adjustment, and in many ways, as we have learned through this entire time, we don't really know what we're doing until we're doing it. this is an experience that we have had to learn through -- at every moment. so i did want to tag that, and holly, did you add some slides

to the director's report here? >> yes. >> okay, thank you. if you could advance, that would be good. i did want to provide some answers to questions that came up and inform the board -- i have told some of you, i think, but we are meeting weekly with delta dental to get clarity around the number of the questions and issues -- holly, you can advance to the next slide, please. and so a couple of particular questions, commissioner brenz breslin, i wanted to be certain that you saw the answer in writing. the answer is no. as of 2014 and going forward, all newly contract providers with delta dental contractors, both premiere and p.p.o. so what's the discount difference that a provider gets? it's pay po versus premiere, and those vary by provider type and

service and geography, obviously, but for -- [indiscernible] provide an average discount of 28% while premiere provides an average discount of 14%. so for our members, the discount rate for to the provider is 28%. so that answers that question. we are, of course, continuing to, as i said, work with delta to really understand some of the nuances of the network turn, in you will, who's coming, who's going, and is there a trend in a direction that is not going to be able to serve our membership. we're also looking to develop regular report outs on satisfaction scores from both providers and our members. we're continuing to work through them, and we have seen some increase in the utilization of smile wave, but we're going to develop communication plans and measures to be certain that we're going in the -- continue

to go in the right direction with smile way, and similarly we need to kick off utilization plan for our active members. it's probably a terrific time to be doing that since we are in this sort of "we're all better" kind of state of mind and we can go back to normal activities. i'm sure that i'm starting to hear -- i don't know if you're experiencing this as well, but just getting routine appointments anywhere booked pretty quickly. so i think we're going to see a pretty steady uptick in utilization of many of our services and hopefully many of the preventative services that people have deferred during the pandemic. that concludes my remarks. i can take any questions from the commissioners. >> so i'm going to use the president's prerogative and first of all ask commissioner breslin, would you like to pose any follow-up questions or issues regarding delta dental or

anything else to director yant at this point? >> well, at the last meeting i asked delta dental specifically are new dentists able to go into the premier option, and they responded yes, of course. or yes. and i don't know who responded, but they said yes. so i didn't ask about being in the p.p.o. exactly. i asked at the premier, because i have been told that you were no longer eligible to go into this premier, but they had said at the last meeting yes you were. so that kind of contradicts what they told me at the last meeting. and i can't imagine, i would think if you're going to be in both of these options, the contrast now, like the contract was an option, and then you're also now contracting with two options, so this has to really complicate things in your office, you know, whoever's doing this work. and you know, i also asked it in the future, are they trying to

get rid of the premier. well, this would be a good way to do it, because now a dentist has to make up his mind. are you going to be in the premier, which you cannot do unless you are also in the p.p.o. so you are in a bind. either do straight p.p.o. or they have to do two, and i'll have to get a little more feedback from a dentist as to how this complicates things, but i have heard before when you have two different options going it's just -- you know, following it at all, just more complicated. so you know, i'm just disappointed that they gave me the wrong answer the last time, which i think they did, and maybe not intentionally, but it was so. and so later on i want to ask -- i don't want to hold everything up now, but i want to ask about them assigning benefits on network providers because that's another issue that makes it just

easy to get it out, network provider for our members, and i'm a fiduciary. i'm trying to do what is the best thing for our members here. i don't see anything in the charter that says we have to do what's best for the delta dental, so i intend to follow that last question, but i'll ask this at the end of the meeting, not to hold any more of this up, thank you. and thank you for following up on this, director abbie yant. >> yes, you're welcome. >> any other comments or questions from commissioners? regarding this presentation? hearing none, i just want to make a comment. i think that 80% of vaccination rate from the city and county of san francisco is truly remarkable, and i think that we need to extend certainly i'll extend personally but on part of

the board our thanks to director yant, but also the staff of h.s.s. for their role in helping to roll out and continue to update information with links to appropriate sites for accurate information. clearly the department of public health, the city and county of san francisco, and the mayor and mayor's office really deserve a lot of credit for their early and aggressive response to this emerging pandemic. if anyone has any questions about the response, i would recommend a book, actually, called "the premonition" by michael lewis. and it is a sobering and first-hand account of what the response has been in this country and around the country in the face of this pandemic, sobering from the fact that,

director yant already referred to lessons learned, and the need as we prepare for subsequent pandemics that hopefully we can move forward with maybe a better preparedness on the part of not only city and county but also the state on a federal level. so again, i want to thank director yant, hss staff, the mayor's office, the mayor, grant colfax and the department of public health for their really aggressive management and guidance through this pandemic. it is not over. so again, thank you very much. >> i just have one more comment about delta dental, if you don't mind. i've forgot. >> no, go ahead, please. >> in may of 2019, the board increased the out-of-pocket deductible for premier and out-of-network. now most large percentage of our people are in premier. i don't see how this is for the benefit of our members, and i

think that was the big mistake, and i would like to at some point go back and correct that, because it will just make it more difficult for our members to get good dental care, and i see no reason to add on another $20 for those two networks. i, of course, [indiscernible] but it passed, and i don't think it was the right thing to do for our members. so at some point i hope we can look at that again. >> thank you. thank you very much. any other comments from board commissioners? or questions? hearing none, we'll go ahead and open this up for public comment. >> thank you, president follansbee. public comment will be available for each item on this agenda. each speaker will be allowed three minutes to comment in length unless the board president deems new public time limits during the meeting. all public comments are to be made during the agenda item that is presented. as a reminder, a caller may ask questions of the policy body,

but there is no obligation to answer or engage in dialogue with the caller. when i welcome you on the call, you are encouraged to state your name clearly, although you may remain anonymous. when your three minutes have ended, i will thank you for your comment and you will be placed back on mute and the moderator will unmute the next caller. remote viewing is available on sfgovtv.org and sf channel 1. opportunities to speak during the public comment period are available by dialing the number on the screen. the dial-in number is 451-655-0001, again, 415-655-0001. when prompted, please use access code 187-003-9306. again, 187-003-9306. then press pound and pound again. you will then enter the meeting as an attendee on the public comment call line and dial *3 to be added to the public comment queue. when the system message reads your line has been unmuted, this is your time to speak. for those already on hold, please continue to wait until

the system indicates you have been unmuted. sf gov tv has a standing 40- to 45-second delay. for viewers watching our live broadcast online, we will take a 45-second pause to allow the systems to catch up and allow the callers to dial in. our 45-second pause will begin now. .

our 45-second pause has ended and our modifier will notify us of any public callers in the comment queue. >> board secretary, we have five callers on the phone line. zero callers have specifically entered the public comment queue at this time. a reminder to all callers on the line, you must dial *3 now if you want to join public comment for this specific agenda item. we will wait five more seconds and then close public comment for this agenda item. board secretary, there are still no callers in the public comment queue at this time. >> thank you, moderator. hearing no public callers, public comment is now closed.

>> thank you very much for the detailed report and comments. we will now move on to agenda item no. 8. >> thank you, president follansbee. agenda item no. 8 is h.s.s. financial reporting as of april 30, 2021. this is the discussion item and will be presented by cfo larry loo. >> hello. thank you, commissioners. this is larry loo, chief financial officer for h.s.s. happy to present a report on our multi-financials for san francisco health services. just as a reminder to the board, as well as to those who are participating remotely, that our fiscal year runs july to june. we are reporting for the 10 months through april 30th. there are two sources of funding for which san francisco health service system uses to carry out

its mission, and i will be reporting on it. the [indiscernible] board packet and also available online. so just to recap, the trust fund is currently projecting a fiscal year end increase of $17.8 million, projected to end with a balance of $133.8 million, which is an increase from where we ended last fiscal year. the source of the increase is primarily from the performance of our self-funded plans, self-funded and flex-funded plans. all of those lines of businesses expect to produce a gain of $17.7 million, of which $7.3 million are from pharmacy rebates, but setting that aside, the performance of the self-funded and flex-funded plans are pretty positive, and

that's reflective of claims not being as high as we anticipated when we were setting the rates last year. year to date with regard to the rebates received from the cariers, we received 5.8 million of the expected 7.3 million, so that's about 83%. another source of funding that goes into the trust fund are performance guarantees. we are projecting about $319,000 by fiscal year end. to date we have received $176,000 in terms of performance guarantees. typically we don't expect to or hope to expect to receive a lot of performance guarantees. that's always a good sign because our administrators are doing a good job for us, according to their performance guarantees set. in terms of additional revenues, we are projecting that we will receive by fiscal year end $1.2

million in terms of interest. thus far we have received $638,000 year to date. and then within the employee benefits trust, there is the health sustainability fund, which we have a separate budget, and that is projected to end the fantastic year end with a $4 million balance. with regard to the general fund administrative budget, that is funded through the city, we are, again, projecting, you know, no surplus or gains and no shortfall for this year. we have trued up our expenses to end the fiscal year pretty much even. that's it from my report, and i'm happy to take any questions if you have any. >> i don't know if there are any questions or comments from board commissioners? >> chief financial officer loo, this is randy scott.

i wanted to know, you're projecting a year end balance in the sustainability fund. could you tell us where that is at as of this period? >> yeah, that's trending towards our -- you're talking about the expense? >> yes. >> the expenses are actually a little bit below what we had budgeted. so part of that is -- as we do annually, we anticipate any requests for funds for certain initiatives that have been -- that are helping with our communications as well as, you know, administering some of the benefits. and we -- you know, the funding is requested and some of the initiatives that we have requested funding for we were not able to carry out during the pandemic. >> i understand. thank you. >> yeah. >> just to follow up, since we're not able to carry out those initiatives, is the plan then as we ease restrictions

later in the pandemic those initiatives can be begun and we can expect to see this balance diminish appropriately? >> yes. >> help fund those? >> yes. in fact, that was factored into the health sustainability budget requests that we did earlier this year. so a lot of those initiatives carry forward to the next fiscal year. >> great. any other comments or questions from board members? okay, seeing none, i will go ahead and open this up for public comment. >> thank you, president follansbee. public comment will be available for each item on this agenda. each speaker will be allowed three minutes to comment in length unless the board

comment time limits in the meeting. all public comments are to be made during the agenda item that is presented. as a reminder, a caller may ask questions of the policy body, but there is no obligation to answer or engage in dialogue with the caller. when i welcome you on the call, you are encouraged to state your name clearly, although you may remain anonymous. when your three minutes have ended, i will thank you for your comment and you will be placed back on mute and the moderator will unmute the next caller. remote viewing is available on sfgovtv.org and sf channel 2. opportunities to speak during the public comment period are available by dialing the number on the screen. the dial-in number is 451-655-0001, again, 415-655-0001. when prompted, use access code 187-003-9306. again, 187-003-9306. then press pound and pound again. you will then enter the meeting as an attendee on the public comment call line and dial *3 to be added to the public comment queue. when the system message reads your line has been unmuted, this is your time to speak. for those already on hold,

please continue to wait until the system indicates you have been unmuted. sf gov tv has a standing 40- to 45-second delay for viewers watching our live broadcast online. we will take a 45-second pause to allow the systems to catch up and allow the callers to dial in. our 45-second pause begins now.

45-second pause has ended. our moderator will notify us of any callers in the public comment queue. >> board secretary, we have five callers on the phone line. zero callers have specifically entered the public comment queue at this time. a reminder to all callers on the line, you must dial *3 now if you want to join public comment for this specific agenda item. we will wait five more seconds and then close public comment for this agenda item. board secretary, there are still no callers in the public comment queue at this time. >> thank you, moderator. hearing no further callers, public comment is now closed. >> thank you. this concludes agenda item no. 8. i'd like to call for agenda item no. 9. >> thank you, president follansbee.

agenda item no. 9 is sfhss revised fiscal year 2021-2022 and fiscal year 2022-2023 proposed general fund administration budget. this is a discussion item and will be presented by chief financial officer larry loo. >> i just realized i was on mute. sorry about that. commissioners, this is larry loo, chief financial officers for san francisco health services system. i'm going to provide a discussion on the revision for our general fund administrative budget for fiscal year 2021 through '22 and also fiscal year '22 through '23. this is an action item that requires a board approval. what i'd like to begin with first is sort of a broad

overview of the process for setting the budget and to get us to where we are today. in december every year the mayor's office issues what's called the budget instructions on december 16 we present those instructions to the health service board in january, when we did, and in those instructions there was a targeted overall reduction to the general fund budget of a reduction of 7.5% across the board. san francisco health service systems portion was a little bit less than that. it was a targeted reduction of $273,000. management went to work to develop proposals to meet that budget target. we presented that to the health service budget and finance committee and then to the overall board for review and approval, which this board approved. we then submit that budget with the targeted reductions to

the -- through the portal to the -- so that the mayor's office can then begin their review. that's typically called the mayor's phase, and in it there is some, you know, back and forth that we need to work with with the mayor's office. as you may recall, there's one item in there that we were not happy presenting as a proposal which was a reduction on the 24/7 employee assistance program, so we requested for that to be -- that funding to be restored, and so i can give you -- and i'll give you an update on where we are with that. so the revised budget that the mayor's office then includes with the general overall budget gets submitted to the board of supervisors on june 1, and so our budget is part of that, and so i will take you through that. if we can go on to the next

slide. okay, so on this next slide i want you to pay attention to the column that says revised. so there is a bottom line it for you. there's really good news here. the funding for the 24/7eap program was restored, so that constitutes the majority of the positive variance that you see of -- in the first -- in fiscal year 21-22, positive variance of $537,000. largely that's from the eap program as well as some additional savings that were technically introduced in the budget negotiation process. the revised budget for fiscal year '22 through '23 is 2,900,805, and that's an improvement from what we were previously submitting.

so with that, i can get into a little further discussion about some of the drivers of that change, so next slide, holly. so as i recap some of the main drivers for the revisions include the restoring of the eap program. for the first fiscal year it's $588,000 and in the second year it's $488,000. the lower number in the second year is due to carrying forward of some unused session credits that we anticipate. with regard to a decrease that we needed to have in this revised budget, as you may recall, we requested for a reclassification upward of a position to help with the new management strategy overall.

the mayor's office thought hard about this and said we need to increase attrition if you're going to do that, so these are the amounts that we agree to. lastly on a technical matter, typically interdepartmental charges do not change from year to year. the department of health human resources have been monitoring our workers comp cases and realized that we are trending below what they had previously budgeted, and so, therefore, there's a credit of $36,000 for each of the ensuing years. so i think that's the end of my presentation and happy to take any questions. >> mr. president, this is randy scott. >> yes, go ahead, commissioner scott. >> i'm confused a bit about the

nature of this particular item. it's listed as a discussion item, yet in the presentation, and i thought chief financial officer loo alluded to it verbally, he was seeking action. >> mm-hm. >> on this today. so can you clarify that? >> i believe it is -- yes. this is news to me as well. there's an error, i think, in the agenda, and this is an action item. >> all right. >> i assumed that the recommendation from financial officer loo that we approve the modified budget when we get around to the action, but thank you for clarifying, because i noticed that too at the beginning of the presentation. >> yeah, i don't know that it requires your approval. that is why we have put it on as an -- we have not put it on as an action item. i may be mistaken, but this

budget that was modified by the mayor's office is in the hands of the board of supervisors at this time. so i think that's the way the process works. you know, we negotiate with the mayor. we inform you of what we submitted, and any changes that happen along the way, but you know, the approval of the budget was done in february. >> any comment from legal counsel on this? >> over the years it's sort of gone both ways. i don't think there's any requirement that the board, you know, vote or approve it as an action item. regardless, at this point it's been noted as a discussion item, so while the board and commissioners are free to make any comments they want, this budget was already approved and is now at the board of supervisors. there's really no need to take an action item, especially the way it's been -- the agenda's been drafted. >> we'll leave it as a discussion item then. >> yeah. >> any comments? >> right, and obviously if

there's a concern about that, people can -- you know, commissioner breslin obviously will make a comment. >> as far as i know from the rules before, if something isn't posted as action item, in other words it wasn't put out as an action item, we can't take action on it. now if it was posted as an action item and we didn't take action, that's fine, but you can't take action on an item that was never posted as an action item. >> right. >> so i don't think legally we can take action on this item today. >> commissioner breslin is correct, and she said it much more eloquently than i was able. >> okay. so noted. so this will remain a discussion item without action. so thank you very much for everyone's chaifgs clarification. >> thanks so much. >> other comments from or questions from board members? >> this is commissioner hao. no questions, but just a comment that it's always nice to get good news from the mayor's office. so you know . . . >> mm-hm.

>> other questions or comments? thank you very much. i think we go ahead and if we're seeing none we'll go ahead and open this up for public comment. >> thank you, president follansbee. public comment will be available for each item on this agenda. each speaker will be allowed three minutes to comment in length unless the board president deems new public comment time limits during the meeting. as all public comments are to be made concerning the agenda item that has been presented. as a reminder, a caller may ask questions of the policy body, but there is no obligation to answer or engage in dialogue with the caller. when i welcome you on the call, you are encouraged to state your name clearly, although you may remain anonymous. when your three minutes have ended, i will thank you for your comment and you will be placed back on mute and the moderator will unmute the next caller. remote viewing is available on sfgovtv.org and sf channel 1.

opportunities to speak during the public comment period are available by dialing the number on the screen. the dial-in number is 451-655-0001, again, 415-655-0001. when prompted, use access code 187-003-9306. again, 187-003-9306. then press pound and pound again. you will then enter the meeting as an attendee on the public comment call line and dial *3 to be added to the public comment queue. when the system message says your line has been unmuted, this is your time to speak. for those already on hold, please continue to wait until the system indicates you have been unmuted. sf gov tv has a standing 40- to 45-second delay for viewers watching this live broadcast online. we will take a 45-second pause to allow time for the systems to catch up and allow the callers to dial in. our 45-second pause begins now. [pause] the 45-second pause has

ended. our moderator will notify us of any callers in the public comment queue. >> board secretary, we have four callers on the phone line. zero callers have specifically entered the public comment queue at this time. a reminder to all callers on the line, you must dial *3 now if you want to join public comment for this specific agenda item. we will wait five more seconds and then close public comment for this agenda item.

another reminder to all panellists on the line, please ensure that you are on hold as we are hearing some feedback. board secretary, there are still no callers in the public comment queue at this time. >> thank you, moderator. hearing no further callers, public comment is now closed. >> thank you very much, and thank you to all who educated me on the issue of discussion versus action versus agenda items, so this was a discussion item, and this item no. 9 is now closed. so i would like to move into the rates and benefits section of our agenda, which will be agenda item no. 10. >> thank you, president follansbee. agenda item no. 10, presentation of the rates and benefits

calendar for the year 2022. this is a discussion item and will be presented by executive director abbie yant. >> good afternoon again, commissioners. i think [indiscernible] rates and benefits cycle [indiscernible] plans before this body today. just wanted to let you -- to advise you on the second page of the rates and benefits schedule is what happens next, and that is that the rates and benefits package will be introduced to the board of supervisors by supervisor chan. we are preparing materials that will go in pretty darn quick here, and we'll get those introduced to the board of supervisors where they are heard at a committee on july 14, and then read by the full board on the 20th and 27th of july.

>> any questions or comments from commissioners? >> this is randy scott. are we anticipating any concern as this moves through board of supervisors at this point? as far as you know? >> we are not at this time. >> all right, thank you. >> mm-hm. >> this is commissioner zvanski is supervisor chan and her staff completely up to date with all of the issues that -- all the revisions and what's being presented since she's not been on our board previously and doesn't have any experience with this? >> she's a very quick study, and she has a very experienced team. >> good to know. thank you. >> any other comments or questions from commissioners? hearing none, we'll go ahead and open this up for public comment.

>> thank you, president follansbee. public comment will be available for each item on this agenda. each speaker will be allowed three minutes to comment in length unless the board president deems new public comment time limits during the meeting. as all public comments are to be made concerning the agenda item that has been presented. as a reminder, a caller may ask questions of the policy body, but there is no obligation to answer or engage in dialogue with the caller. when i welcome you on the call, you are encouraged to state your name clearly, although you may remain anonymous. when your three minutes have ended, i will thank you for your comment and you will be placed back on mute and the moderator will unmute the next caller. remote viewing is available on sfgovtv.org and sf channel 1. opportunities to speak during the public comment period are available by dialing the number on the screen. the dial-in number is 451-655-0001, again, 415-655-0001. when prompted, use access code 187-003-9306.

again, 187-003-9306. then press pound and pound again. you will enter the meeting as an attendee on the public comment call line and dial *3 to be added to the public comment queue. when the system message says your line has been unmuted, this is your time to speak. for those already on hold, please continue to wait until the system indicates you have been unmuted. sf gov tv has a standing 40- to 45-second delay for viewers watching our live broadcast online. we will take a 45-second pause to allow time for the systems to catch up and dialers to call in. our 45-second pause begins now.

45-second pause has ended. our moderator will notify us of any callers in the public comment queue. >> board secretary, we have four callers on the phone line. zero callers have specifically entered the public comment queue at this time. a reminder to all callers on the line, you must dial *3 now if you want to join public comment for this specific agenda item. we will wait five more seconds and then close public comment for this agenda item. board secretary, there is still no callers in the public comment queue at this time.

>> thank you, moderator. hearing no further callers, public comment is now closed. >> thank you very much. so now we will close agenda item no. 10 and move to agenda item no. 11. >> thank you, president follansbee. agenda item no. 11, health plan 2022 rate summary, made carry retiree and kaiser multi-region retiree health plans. this is a discussion item and will be presented by mike clarke at aon. >> good afternoon, commissioners. as the board secretary grants me sharing privileges, this will be the first presentation and overview of the three action item presentations that i'll be sharing and requesting your approvals for after this presentation.

so my first presentation is an overview of the health plan 2022 rate proposals that we are presenting this afternoon. so the medicare retiree plans and the kaiser multi-region retiree health plans. so this summarizes information on the rates we will ask you to approve today, as well as general information on medicare advantage plans, which i know we'll go further in-depth on during item 16 later today. all retiree health plans that are presented today are fully insured, which means that the health plan sets the rates for these plans, the scrutiny by the aon actuary and hss staff. california washington northwest

which is predominantly oregon and hawaii along with a national prescription drug plan that's available across the country. and then there's also non-medicare retiree plans offered through kaiser in washington northwest and hawaii as well. you see here the distribution of covered medicare lines based on the information contained in the s.f.h.s.s. demographic report from the march 2021 board meeting. the united are in the -- advantage plan, approximately 17,000 retirees and dependents, but also a large number in the kaiser permanente plan in california, approximately 14,500, and then 85 covered medicare lives in the multi-region medicare plans in washington northwest and hawaii. there is also 44 early retirees

in the non-medicare multi-region plan. so this document will focus specifically given the number of covered lives on kpsa and the united health care medicare advantage plans. just some background, i won't go through this in detail, but the plans that you'll see today were formalized as the plan offerings in 2017 with the two plans offered united health care medicare advantage and kpsa. and just some background on the advantage program, it was approved by the federal government in the late 1990s to address shortcomings of original medicare and with focuses of recent government policy action on rate stability, beneficiary benefit flexibility, enhanced education and emerging value-based payment models that are present in -- plans. you can see the areas by which

medicare advantage plans are designed to support enrolled members, and also these plans operate at lower costs than original medicare due to the funds that are provided directly into medicare advantage plans by the centers for medicare and medicaid, central agency c.m.s. these subsidy amounts generally do increase from year to year, though economic conditions and changes in known health risk data for a given plan can impact the amount of funding into those plans. an important thing to keep in mind, especially as we look at the medicare plan rates that i'll present later in this meeting, is the next year's rates are being released right now by the health plans before the final c.m.s. subsidies for 2022 are known. so there can be year-to-year rate change fluctuations in both of the advantage plans offered

by sfhss due to subsidies being projected at this point, but they are not quite final. and just some information on how ma plans are structured to reduce costs and improve quality: optimizing reimbursement, building provider relationship and improving member health. as you see at the bottom of the page, there's generally at least a 10% financial advantage to medicare advantage plans relatively to conditional plan offerings due to the superior care management of m.a. plans. we have identified linkages to the strategic plan across each of the five elements of the sfhss strategic goals from an affordability and sustainable standpoint. these plans are for the greatest ability to sustain affordable plans for medicare retirees independence. reduce complexity and fragmentation as these plans offer an integrated approach and

encourage preventive care and to seek appropriate care alternatives when needs arise. engaging and supporting through the value-added benefit that had been added in recent years. from a choice and flexibility standpoint, offering two high-value choices for most medicare retirees in sfhss through both the kpsa and the uacmacd model, and for a whole person and health and well-being perspective, plans designed to support members across the spectrum of their needs. these prior most recent presentations that we provided on medicare advantage plans is available on the sfhss website from the november 2020 health service board meeting. so the rates we'll look at today will involve a decrease for the kpsa plans, a larger decrease than last year, and for united health care, recalling that we asked you to approve a two-year

rate approach for united health care last year, which involved a 2.9% decrease for 2021 and a 1.2% increase for 2022. so on a net basis, the 2022 rate for united health care will actually be less than the 2020 rate. and so just to close this presentation, these are the total rates as well as the employer contributions and member contributions that we'll seek your approval for today. as a reminder, the employer contributions are determined by city charter formula, but the -- with the plan costs, the plan rates for retiree only being less than the county amount for both plans, the retiree-only member contributions are zero for each of the two plans. so that concludes my introductory presentation on what we'll present today. president follansbee, i'll turn

it back to you. >> thank you very much. so we'd like to go ahead and open this up for questions or comments from board members. again, this is an overview. we are going to talk in detail about specific plans and the uhc i think is agenda item no. 12 and the kaiser senior advantage no. 14. so specific questions about the plans we will be able to address in detail. this is an overview discussion. so with that, questions or comments from board members? >> i just have one question. >> yes, go ahead. >> on page 2 you say there's only 44 early retirees in the kaiser multi-region plan, but i have 64. are you saying 44 members or is that members and dependents? >> that's actually a retiree count, and then some of those

retirees are covering dependents as well. >> i'm looking at early retirees only in that kaiser -- and you see that on the other -- one of the other slides, one of the other sections. so anyway, that's all. >> any other questions or comments or requests for clarification? >> i just wanted to follow up with commissioner breslin. i had the same numbers, and i was curious as to where we went wrong. i guess it's those that have dependents. thank you. >> other questions or comments? hearing none, we'll go ahead and open this up for public comment. >> thank you, president follansbee.

i'm just going to take a moment while those privileges are passed back and i will project the public comment instruction. >> and if i may interject really quick while you're doing that, there are 44 retirees and 20 dependents for a total of 64 covered lives in the non-medicare multi-region kaiser plans. >> early retirees, yeah. okay, thank you. >> thank you for your patience while i pull up our slide with instructions for public comment. public comment will be available

for each item on this agenda. each speaker will be allowed three minutes to comment in length unless the board president deems new public comment time limits during the meeting. as all public comments are to be made concerning the agenda item that has been presented. as a reminder, a caller may ask questions of the policy body, but there is no obligation to answer or engage in dialogue with the caller. when i welcome you on the call, you are encouraged to state your name clearly, although you may remain anonymous. when your three minutes have ended, i will thank you for your comment and you will be placed back on mute and the moderator will unmute the next caller. remote viewing is available on sfgovtv.org and sf gov channel 1. opportunities to speak during the public comment period are available by dialing the number on the screen. the dial-in number is 451-655-0001, again, 415-655-0001. when prompted, use access code 187-003-9306. again, 187-003-9306. then press pound and pound again. you will enter the meeting as an attendee on the public comment call line and dial *3 to

be added to the public comment queue. when the system message says your line has been unmuted, this is your time to speak. for those already on hold, please continue to wait until the system indicates you have been unmuted. sf gov tv has a standing 40- to 45-second delay for viewers watching our live broadcast online. we will take a 45-second pause to the systems to catch up and our callers to call in. our 45-second pause begins now. >> can i ask about [indiscernible] why is that? >> yeah, this is mike clarke. these are retirees who became employed on or after january 10, 2009, and have since retired, and so there was a change in the

employer contribution approach for individuals who were hired on or after january 10, 2009, so that there is a years of service component to the contribution that is earned towards retiree medical coverage from the city. >> yes, now i remember. thank you very much, mike. >> you're welcome. >> and our 45-second pause has ended, so our moderator will notify us of our callers on the public comment queue. >> thank you, board secretary. if you could please share host privileges. we have four callers on the phone line. zero callers have specifically entered the public comment queue at this time. a reminder to all callers on the line, you must dial *3 now if you want to join public comment for this specific agenda item. we will wait five more seconds and then close public comment

for this agenda item. board secretary, there are still no callers in the public comment queue at this time. >> thank you, moderator. hearing no further callers, public comment is now closed. >> thank you very much. we'll go ahead and close this discussion item and call for agenda item no. 12, which is an action item. >> thank you, president follansbee. agenda item no. 12, review and approve united health care medicare advantage p.p.o., fully insured medicare retiree 2022 rates and contributions. this is an action item and will be presented by mike clarke. >> thank you, mike clarke again,

and i will share the presentation. this presentation is the united health care medicare advantage p.p.o., fully insured medicare rates for 2022. so we'll start with our recommendation on the plan and commentary on the renewal before presenting the rate card and asking for your approval on our recommendation. information is also in the appendix with the 2021 current rate card. footnotes for the rate card's definition of medicare advantage for mapd plan and the advantage

exhibits i will not be reviewing the exhibits, but they are there for your own viewing. overall we recommend that you accept the uhc mapd rate cards as presented today which includes a 1.2% increase in the 2022 plan year which follows a commitment by united health care last year for the second year of a two-year rating proposal at $427.22 per member per month. and this is presented on a status quo, no plan design or program change basis, and if you recall with the on-set of the pandemic last year when we received the renewal from united health care for the 2021 plan year, last late april, it came with a commitment for united health care for a two-year rate

renewal, and so with the first year there was a decrease in rate, from 2020 to 2021, followed by a commitment from 2021 to 2022 for a $5 pmpm rate increase to $427.22. and you'll also see in the footnotes the -- there is a separate rate for retirees who only qualify for part b. these are plan members who have not qualified during their working years for medicare part a based on work requirements of the federal medicare program and choose not to pay the part a premium in lieu. as i reviewed earlier, there's about 17,000 covered lives in this united health care mapd plan. the vast majority are in part a and part b, so with the rate

there are 144 participants at the higher part b only rate. and for the non-medicare dependents of retirees enrolled in the plan as well as the non-medicare retiree dependents with at least one family member is medicare eligible and enrolled in the uhc mapd plan, united health care will continue to be the plan administrator into the 2022 plan year, but the p.p.o. plan that is available to non-medicare family members in these split family or mixed medicare family situations where at least one family member is enrolled in the united health care mapd plan. so put another way, the non-medicare family members of a retiree where at least one family member is enrolled in the uhc mapd plan will continue to have the same plan choices and same administrator choices for those plans for non-medicare

family member enrolment. in other words, those non-medicare family members can enrol in the blue shield of california access plus plan, a trio plan or the united health care non-medicare p.p.o. plan and choice not available plan. the uhc ma p.p.o. does include benefits you see below for the plan year, and you'll see participation from the 2020 plan year for the silver sneakers program, which is fitness and gym membership, routine and discharge transportation services and post-discharge meal delivery for those discharged from an inpatient setting. and when we look at the rate card, they do include the basic vision plan premiums as well as the sfhss health care sustainability fund charge, both of which are unchanged in 2021.

so with the rate card we'll show the distinct mixed medicare family columns as well as the everybody in the family in medicare for each of the three plans that i outlined earlier that will be available to non-medicare family members where at least one plan -- or at least one family member is in the uhc mapd plan. for administrative purposes going into 2022, as we have looked at the plan choices available, there is no change in the available plan choices for mixed medicare family members who are not yet medicare and mixed medicare family enrolment will not be available in the 2022 plan year for the non-medicare health net canopy care plan. and to commissioner zvanski's question earlier, the note in difference in employer

contribution for those hired on or before january 9, 2009, versus hired on or after january 10, 2009, those who were retired employees on a report january 9, 2009, retired persons who retired for disability with surviving spouses or surviveling domestic partners, active employees who died in the line of duty, received the full city charter contributions. there are no city charter contributions available to retired employees hired on or after january 10, 2009, with at least five, less than ten years credited years of service with the employers. those greater than 10 but less than 15 in that circumstance receive a retiree medical city charter contribution of 50% of the full rate. and the rate cards that result from the united health care renewal information that i've discussed earlier in this presentation is shown here with

columns for all numbers in medicare retiree only, retiree plus one, retiree plus four or more, as well as full family circumstance with two on medicare, one plus and non-medicare. and this shows the change in total retiree contributions, monthly employer contributions, and total rate that result from the renewal information provided by united health care. and so with that, staff recommends that the health service board accept uhc mapd medicare retiree rate card as presented in this material, which includes a 1.2% insured premium increase for 2022 that follows a commitment by united health care last year for a $427.22 per member per month rate quotation for the 2022 plan year. president follansbee.

>> thank you very much for walking us through a fairly complicated rate cards and explanation. so that will open this up for questions or comments or clarifications from board members. yes, commissioner zvanski? >> thank you. just want to clarify, are we proving the rates on page 10? is that the rate card we're looking at? because i notice 11 has a little -- a different detail in the changes, but we're approving the rates on page 10? >> yes, commissioner zvanski, correct. page 10 is the rate card. page 11 is there just for a helpful comparison to 2021. >> oh, i appreciate that. thank you very much. >> yes, commissioner breslin? >> yeah, on page 8 you say the mixed medium family enrolment not available in 2022 plan year for non-medicare health net canopy care. now why would that be? that seems like an unfair

advantage, especially since it's a new plan, and part of the idea i thought was competition for blue shield when we got a new plan, but why would they not be allowed to take some of these non-medicare people? >> i may have to defer to sfhss. this is linked to [indiscernible] considerations for this -- >> it looks like an unfair advantage to health net canopy care, which is our new plan. >> commissioner breslin, thank you for asking that question. it is a big programming issue for our administrative team that is not where we need to be spending our energies this year, and our efforts with health net is to get them up and running and not to present them with one

of the most complicated situations we could. and our e.s.a. team did over 10,000 lines of programming for these split families in the past, and we're really looking forward at this point forward to resolving that and putting -- doing everything we can systematically to keep family within -- families within one carrier. it's just not worth our effort at this point in time, and so we're just not doing it this year. >> okay. do you have any idea -- >> likely not going forward. >> how many non-members there would be? >> i don't know the answer off the top of my head. it could be a solution if we had a problem. we don't have a problem, and the solution is really difficult. so i think we just need to -- on how that, how we manage families that are currently split because of the nature of the setup.

i think [indiscernible] will solve some of this with some of the medicare -- >> this is only for this year, right? >> mm-hm, yeah. >> okay. i was happy to see all the post-discharge meals. i mean, if i remember, a couple years ago, or a while back, there were, like, two meals, or something, something very strange, and this is, like, 11,000 plus meals, so i thought that was quite a change. anyway, that's all i have to say. >> thank you. >> any other questions? >> mr. president? >> yes. >> this is randy scott. i want to move that we accept the staff recommendation as described by our plan actuary for the uhc mapd plan recommendations and rate cards as presented. >> i second. this is commissioner hao. i second. >> thank you very much. moved and seconded that we approve the recommendations, including rate cards. any further discussion from

board members? hearing none, we'll go ahead and open this up for public comment. >> thank you, president follansbee. public comment will be available for each item on this agenda. each speaker will be allowed three minutes to comment in length unless the board president deems new public comment time limits during the meeting. as all public comments are to be made concerning the agenda item that has been presented. as a reminder, a caller may ask questions of the policy body, but there is no obligation to answer or engage in dialogue with the caller. when i welcome you on the call, you are encouraged to state your name clearly, although you may remain anonymous. when your three minutes have ended, i will thank you for your comment and you will be placed back on mute and the moderator will unmute the next caller. remote viewing is available on sfgovtv.org and sf gov channel 1. opportunities to speak during the public comment period are available by dialing the number on the screen. the dial-in number is 451-655-0001, again, 415-655-0001.

when prompted, use access code 187-003-9306. again, 187-003-9306. then press pound and pound again. you will enter the meeting as an attendee on the public comment call line and dial *3 to be added to the public comment queue. when the system message says your line has been unmuted, this is your time to speak. for those already on hold, please continue to wait until the system indicates you have been unmuted. sf gov tv has a standing 40- to 45-second delay for viewers watching our live broadcast online. we will take a 45-second pause to allow time for systems to catch up and callers to dial in. our 45-second pause begins now. [pause].

45-second pause has ended. our moderator will notify us of any callers in the public comment queue. >> board secretary, we have three callers on the phone line. zero callers have specifically entered the public comment queue at this time. a reminder to all callers on the line, you must dial *3 now if you want to join public comment for this specific agenda item. we will wait five more seconds

and then close public comment for this agenda item. board secretary, there are still no public callers in the comment queue line at this time. >> thank you, moderator. hearing no further callers, public comment is now closed. >> thank you very much. it has been moved and seconded that we approve the staff recommendations for the united health care fully insured medicare retiree rates and contributions with a rate card as presented. all those in favor please signify by saying aye. >> aye. >> aye. >> aye. >> all opposition? it is passed unanimously. thank you very much. i think what i would like to do is move on to agenda item no. 13. for those who are looking

forward to a break, we'll take a break after item no. 13. >> thank you, mr. president, for acknowledging my message. >> unless i hear objections to that. so we'll move on to agenda item no. 13. >> thank you, president follansbee. this is agenda item no. 13, review and approve kaiser permanente multi-region retiree hmo plans fully insured 2022 rates and contributions. this is an action item and will be presented by mike clarke at aon. i'll be passing over presenter privileges. >> mike clarke aon. i will look to expediently guide us through the multi-region conversation. this presentation is for the multi-region h.m.o. plan fully

insured 2022 rates and contribution for the washington state northwest and hawaii region where northwest encompasses oregon and southwest washington. and again, information for your reference in the appendix i will not cover today. these plans were introduced in 2018 to enhance the medicare offerings for certain retirees living in geographies where kaiser has plans available, and so in washington state northwest region and hawaii the second plan, the kaiser plans, are available to these multi-region medicare retirees as well as the early retirees. and these are the head counts and the rate change action summary in total for 2022. expect an annual premium across the three regions. it will be about $1.2 million. unlike the counts we reviewed earlier for the early retirees,

these include -- so these add up to the 64 covered lives that was referenced earlier. these add up to the 85 covered lives for medicare retirees dependents referenced earlier. what you will notice are generally favorable rating actions with possibly one exception. the kaiser washington region for early retirees, and you'll notice as we go through the rate cards, the washington early retiree rates are higher in 2022 than they are for northwest and hawaii, and that difference is growing for 2022. these plans, due to the low size, the low numbers of individuals in the plans, are what's called community rated by kaiser. so unlike other sfhss plans that have many thousands of individuals in the plans that can be underwritten on an experience basis specifically sfhss experience, these plans

are community rated, and it just so happens that the kaiser costs in washington that provides the care overall to those numbers is higher, and it's just a function of the plan environment and the provider environment in the washington region, which is primarily the seattle tacoma area, puget sound, relative to what kaiser experiences in their northwest region, which is proximate to portland oregon and their hawaii region. still it's a 6.9 increase, but only impacting 11 total early retirees and dependents. so overall when you look at the renewals overall it's a 4.7 decrease and a 2.7 decrease for medicare retirees, on the

insured rates 2021-22. as we looked at earlier, the rate card will include division and sustainability information. just a note about the fact as i mentioned earlier that these are estimated c.m.s. funding that feeds into the development of the medicare rates, and so these are pre-reconciliation, so just to note that as that reconciliation will then fold into the 2023 plan renewals, and as i mentioned earlier, there are various levels of city charter contribution, depending on the higher date and for certain retirees, the service, accredited service. so starting with the washington region, this is the rate card that i will ask you to approve on page 7. for the washington region, which contains the insured premiums plus division and expense, and then the application of the city

charter formulas for the derivation of the city contributions, the full city contributions with the difference then between the total rate and the city contributions being the final number contribution. and then for comparative purposes, just a comparison of 2021 to 2022 where you see that 6.9% increase, for the early retirees, and approximately 10% decrease in the rate overall for the medicare retirees for washington. then on page 9 i'll ask you to approve the page 9 rate card for the northwest region with, again, the premiums, vision and expense deriving the total, the charter formulas guiding the calculation of the city contributions, to then result in the retiree non-bargained contribution rate, and then the comparisons to 2021 where we

have a reduction in required contributions for early retirees and just a slight increase for the medicare retirees, and then finally for hawaii, same format, i'll ask you to approve the page 11 rate card for hawaii and decreases across the board based on the renewal action by kaiser for early retirees and medicare retirees in hawaii. so with that, it is recommended that the health service board approve the kaiser permanente rates and contributions for the multi-region h.m.o. plans and early retirees and medicare retirees for washington northwest and hawaii regions as presented in this material. so again, just to be clear, these are the rate cards on page 7 for washington, page 9 for northwest, and page 11 for hawaii. president follansbee. >> thank you very much for walking us through this, again, complicated series of

presentations and information. so now open it up for questions or comments or clarifications from board commissioners. yes, commissioner breslin? >> i just have a comment here about the early retiree in washington region, retiree with two dependents in a family would be $2,074 a year, but almost 25,000 annually. i mean, that really is unaffordable, i think, for most people. and you're saying that's because of the regional pricing, not the individual person? the high cost is a regional thing? >> that's correct. so it's based on the regional cost of that plan in washington state for kaiser, and some of it is how that plan has evolved. it was actually -- so kaiser

washington evolved from an acquisition oaf an organization called group health cooperative about two or so years ago, and so some of it is kind of the cost basis that kaiser has been working on that acquisition. i will note that of the 11 individuals, the covered lives in kaiser washington for early retirees, seven are retiree only and then four covered lives, or two retirees, are in retiree plus one. so there are no current enrollees in the retiree plus two or more tier for kaiser washington early retiree. >> well, the statistics you showed back there were 11 early retirees. >> so 11 retirees plus dependents. so that breaks into seven retirees are in the single tier. two retirees are in the plus one tier, so two retirees plus one

means four total covered lives, and so with the seven plus four equals 11 total lives, which is nine retirees and two dependents. >> hmm. okay. >> thank you very much. other questions or comments or clarifications from commissioners? >> i would just like to comment, dr. follansbee, that our members do have a choice outside of kaiser in washington state. they can purchase the united health care product. >> thank you. >> but is that any more reasonable? that's the question for early retirees. a single person is not -- early retirees are a problem, we know that. i agree. but there is a choice that they can look at, yeah, it's a challenge.

>> mr. president? >> yes, go ahead. >> this is commissioner scott. i move that we accept the staff recommendation for the kaiser permanente single advantage retiree rate cards as presented by our actuary. >> i'll second. >> it's been moved and seconded that we approve the multi-region retiree h.m.o. plans and rate cards on pages 7, 9 and 11. so now open this up for public comment. >> thank you, president follansbee. i'll just take a moment to pull up the slide on public comment.

public comment will be available for each item on this agenda. each speaker will be allowed three minutes to comment in length unless the board president deems new public comment time limits during the meeting. all public comments are to be made concerning the agenda item that has been presented. as a reminder, a caller may ask questions of the policy body, but there is no obligation to answer or engage in dialogue with the caller. when i welcome you on the call, you are encouraged to state your name clearly, although you may remain anonymous. when your three minutes have ended, i will thank you for your comment and you will be placed back on mute and the moderator will unmute the next caller. remote viewing is available on sfgovtv.org and sf gov channel 1. opportunities to speak during the public comment period are available by dialing the number on the screen. the dial-in number is 451-655-0001, again, 415-655-0001. when prompted, use access code 187-003-9306.

again, 187-003-9306. then press pound and pound again. you will enter the meeting as an attendee on the public comment call line and dial *3 to be added to the public comment queue. when the system message says your line has been unmuted, this is your time to speak. for those already on hold, please continue to wait until the system indicates you have been unmuted. sf gov tv has a standing 40- to 45-second delay for viewers watching our live broadcast online. we will take a 45-second pause to allow the systems to catch up and callers to dial in. our 45-second pause will begin now.

our 45-second pause has ended. our moderator will notify us of any callers in the public comment queue. >> board secretary, we have four callers on the public comment call line. zero callers have specifically entered the public comment queue at this time. a reminder to all callers on the line, you must dial *3 now if you want to join public comment for this specific agenda item. we will wait five more seconds and then close public comment for this agenda item.

board secretary, there are still no callers in the public comment queue at this time. >> thank you, moderator. hearing no further callers, public comment is now closed. >> thank you very much. it's been moved and seconded that we approve the kaiser permanente multi-region retiree h.m.o. plans fully insured for 2022 rate cards on pages 7, 9 and 11 of the presentation. all those in favor please signify by saying aye. >> aye. >> aye. >> aye. >> all those opposed? okay, good. thank you. that passes unanimously. and with that, we'd like to declare a 10-minute break, so we will reconvene at -- i will give you 12 minutes. >> i'm going to call the meeting to order again. start with the roll call.

>> clerk: thank you president follansbee. (roll call) we have quorum. >> thank you. agenda item number 14 please. >> item number 14 is review and approve kaiser permanente senior advantage california fully insured retiree rates and contribution. this is an action item and presented by mike clarke from

aon. >> this is the last of the action items that i will be presenting to you today. this is presentation of the kaiser senior permanente fully insured medicare retiree 2022 rates and contributions. we'll start with the introduction and commentary on the rate renewal followed by the proposed 2022 monthly rate card and recommendation. with the prior presentation, information is available in the appendix. i will not review that specifically in the presentation but available for reference. staff recommends that the health

service board accept the rate card as presented today which includes a 10.83% reduction in the insured premiums for the 2022 plan year. as we displayed earlier today, there are 14,544 total medicare eligible retirees enrolled in the kpsa medicare hmo plan in california. since 2014, per request of sfhss, kaiser has provided an estimate of premium to be used in rate card development. so every year there's a reconciliation that occurs. last year after a 5% rate decrease that included a new delivery program, the rate on a

status quo design basis, no change of plan design or program is decreasing again from 2021 to 2022 by 10.83%. you can see it's a combination of several elements that contribute to this very favorable renewal position by kaiser. first, there is a prior year reconciliation that was not available for the 2021 rate but it is available now that we know what that ultimate reconciliation was from last fall. so has a positive impact or decreasing impact on the renewal. and then also the underlining trend assumption by kaiser for this plan is very favorable. in the end, it's moving what is now ability rate of $347 in 2021 to a proposed premium rate per

member per month of $309.70 in 2022. you'll see some information in the foot note here regarding the programs that are included into the rate. that includes the fitness benefit and enhanced transportation rider including wheelchair and post discharge meal delivery. as we discussed earlier today, this is an estimate but the rate will hold as the funding rate for 2022. any discovered variances between the projected funding for 2022 and what actually turns out to be the funding that will be known later this year will be reflected in the 2023 rates. as we discussed earlier, the rate cards not only include the premium but also the basic plan

vision premiums and sustainability fund charge. and we discussed the city contributions depending on hire date and for those on or after january 10, 2009, service. this is the rate card i ask you to approve today here on page 10 for the kpsa california rate card which includes the medicare only tiers for retiree only, retiree plus one and plus two or more and the family rate for situations where there are two medicare individuals in the family and one non medicare in the right side column. non medicare leverages the rates approved by the health service board by kaiser california in may. for reference purposes, this illustrates the change in

monthly retiree contributions and total rate from 2021 to 2022 where you see that almost 11% reduction cascade through the contributions of the total rate. this incorporates with the non medicare family members and kaiser. staff recommends that the health service board accept the retiree rate card presented on page 10, including the 10.83% premium reduction into the 2022 year. president follansbee. >> thank you very much. so we'll open this agenda item up for questions and comments and clarifications from board members.

any questions or comments? i don't see any. >> i just want to say i'm happy to see the rate reductions and true-ups that come closer to the year so that if there's any additional discount or reduction that kaiser is very involved in working with us to provide that for members. and i think that's something good to hear and see and i wish all of our contractors would do the same. thank you. >> so i have a question mike. that is, the enhanced pamphlets include chiropractic, the meals look the same, some of the other items -- the silver program the silver sneakers is different. but the chiropractic, can you

compare the differences in the two programs. >> my understanding they would be similar and included. i know kaiser specifically has a rating element where they specifically look at the rating components of the chiropractic and that's why it is specifically called out the way it is. >> okay. and next year obviously approve the 2022, we wouldn't see these items teased out in terms of a cost. they would be included as i understand unless they're taken away or something. is that correct? >> correct. we displayed the cost of the add-on for full transparency to the health service board. they are included in the full premium. >> all right. any other questions, comments or clarifications from board members? >> i'm curious about the

chiropractic. that's been around in most plans forever. i would be kind of stand -- why would it be a stand-out now? >> could i ask a kaiser representative to speak to your underwriting approach for the chiropractic benefits as specifically identified in the build out to the medicare advantage rate. >> good afternoon. for the chiropractic benefit, what we do is we treat it as a community rate. we take the specific sfhss enrollment and derive that from the community rate starting point. >> does the benefit cover a

certain number of sessions, is that equivalent? is that included? >> yes, the benefit that the sfhss plan has is actually a $15 copay up to 30 visits. it has been in the plan for several years now. >> is that referral from the primary care provider or member initiated, how is that deemed part of medical care? >> i will ask my colleague here to step in and answer that question. i believe it is self referral. >> that clarifies for me. other questions or comments -- thank you very much.

any other questions or comments from board members? >> mr. president? >> yes mr. scott? >> i move that we accept the staff recommendation and rate card as presented and convey to kaiser deep appreciation about the reduction in premiums. >> i second that motion, this is commissioner canning. >> moved and seconded that we accept the staff recommendations including the rate card i believe on page 10 of the presentation. we'll open this up for public comment. >> thank you president

follansbee. public comment is available for each item on the agenda. each speaker is allowed three minutes unless the board president deems new time limits during the meeting. all comments are to be made during the item presented. there is no obligation to engage in dialogue with the caller. when i welcome you, you can state your name clearly or you can stay anonymous. opportunities to speak during the public comment period are available by dialling the number on the screen. 415-655-0001 use access 187 003 9306. then press pound and pound again and then enter the meeting as an

attendee and dial star 3 to be added to the public comment queue. for those on hold, please continue to wait until the system indicates you have been unmuted. sfgov tv has a standard 45 second delay for viewers watching online. we'll talk a pause to allow callers to dial in. it starts now.

our moderator will notify us of public comments in the queue. >> we have five callers on the phone line. zero callers have specifically entered the queue at this time. a reminder to all callers on the line, you must dial star 3 now if you want to participate in public comment for this item. there's still no callers in the public comment queue at this time. >> public comment is now closed. >> may i jump in with a -- able

to confirm both kpsa and united healthcare plans have a $15 copay with $30 annual visit limits for chiropractor. it's a consistent benefit. >> thank you for the clarification. moved and seconded that we approve the senior advantage california fully insured medicare rates and contributions to the rate cards presented. all those in favor, say aye. opposed? thank you it passes unanimously. we can move on to agenda item 15. >> thank you president follansbee. approval of the june 2021

addendum to plan member rules and section 125 cafeteria plan, being allowed employees earning $130,000 or less to increase dependent care and two, to allow all employees to carry over unspent healthcare plans to plan year 2022. this is an action item and will be presented by mitchell griggs chief operating officer. >> good afternoon. if we can go to the amendment document. there we go. we like to review a bit to remind everyone that every year we approve the cafeteria plan document, the board approves the

planned document every august or september and this will be the third amendment in the document since the pandemic. at this particular time, these amendments are based on legislation passed by the federal government. this particular amendment pertains to flexible spending accounts and healthcare flexible spending accounts. to start with independent care, there was a provision in the american rescue act that employers could temporarily increase the accounts from the current 2021 maximum 5,000 to up to 10,500. in the provision if approved by the board is only applicable to 2021 and does not apply to plans in 2022. the particular amendment we would like to make is allowing enrollment, employees who have

enrolled in independent care fsa's to increase the maximum to 10,500 if they earned 120,000 or less in 2020. what we have done in the past -- just to explain it as best i can right now precisely is fsa's are regulated by the irs. we have to follow the regulations to keep the accounts non taxable. one of these regulations that applies to independent care fsa's, for employees who make 130,000 or less must have average of at least 55% of the election average of employees earning over 100,000.

that's 55% average for the lower earners of the average election of the people earning over 130,000. so currently, we're at the maximum amount and right now that percentage is less than 55%. we are not making that regulation currently. if we do apply the increase to the lower earners then this means hhs has to bring the percentage up. for example, if one of the employees is earning over 130,000 maximum of 5,000, right now i'm going to have to reduce the election to 3,975. so looking at this and doing a lot of research, legal research and looking at different

scenarios of what could we possibly do, you know, with this legislation and how we can apply it to our benefits, we determined that allowing employees earning 130,000 or less increasing theirs -- allowing them to increase it up to the 10,500 would get us closer to the 55% election goal. by doing that, it would provide an opportunity to keep the original for the higher earners or reduce them by a lower amount. so, you know, this will be an opportunity not only for employees to increase up to 10,500 but also the ability to maintain the elections of those who earn 130,000 and over. so that is the reflection for

flexible spending accounts and the amendment that we are asking for the board to approve. before i move on to the next section of the amendment, are there any questions regarding this particular revision? >> mr. president, this is randy scott. do we have data that shows us how many people it would impact if adopted? or conversely, how many would be impacted if we didn't adopt this? >> right. so as to this is what we call a non discrimination testing, an opportunity for our administrator to take all the enrollments that we have. they also have the 2020 earnings and they determine which fall into less than 130,000 and which are over. we have those numbers.

so right now it's about 500. it's pretty much split down the middle. we have about 900 or so in a care flexible spending enrollment and about 500 or 130,000 or less and about 422 are over 130,000. >> thank you. >> i have a similar question but sort of the other way around. if this is allowing this increase to then to make under 130,000 wouldn't the folks who make more than 130,000 say this is being applied that they are being excluded the option?

>> the federal regulations just is the opportunity for the employer to raise it to 10,500. i'm going to have to continue to reduce those higher earners even more because the calculations we come up with the reduction. so an example of that would be someone who decided, i only need 3,000. i earned over 130,000, i'm not going to raise mine to 10,500 because i elected 3,000 only and had the opportunity to enroll at 5,000. i'm probably going to have to reduce it closer to 1,000.

>> i'm sorry mitchell, i was on mute. i have one question. you said there are slightly more than 900 participants in the program at the present time. about 500 are below 130,000. is the non discrimination based on the total requested withholding or -- or transfer or whatever -- not the number

who take it but the total they request above 130. so if a few people above 130 requested more and nobody below 130 requested more, then the percent we're out of compliance would go higher and there would be a reduction in the allowable non taxable portion more in the 130. there would be a greater reduction overall in their ability to take any amount out. is that right? >> yeah. and that definitely hinder those who keep it at 5,000 or less. it would be difficult to keep track of the percentage. it's a moving target.

>> so it's based on dollars requested as opposed to numbers in those two groups. >> right. >> thank you. >> so that's -- we want the people earning 130,000 or less to put more money in their wallets. it doesn't -- the only way it would help, if more enrolled at a higher level. so it's a percentage of the average enrollment. the more people put in to their particular accounts, it's going to raise that percentage. >> yeah. i can just see for many essential workers who make less than $130,000, increasing their

contributions to the sfa makes it a very expensive community, may be impossible and i gather the irs doesn't recognize regional differences in cost of living. between the bay area and say montana or north dakota. >> yes. so 130,000 gross earnings is applied nationwide. this is an early amendment. we allowed those enrolled in dependent care, the balances in 2020 we let them roll over into 2021. it probably brought the average election amount some. people could use the money they

may be couldn't use last year. a lot of people working from home didn't necessarily need care for their kids and that type of thing. this is a reflection of the two years, especially for dependent care. an advantage to members to have direct communication campaign to those earning 130 or less to make sure they know they can do this. we will work on configuring the system and communication. the system is not designed to do this. we're having to make some system changes as well.

we'll send out communication to about 500 employees. >> when do they get the statement for the irs that says how much they can allow of the money they may have transferred, that comes from us, right? >> it's part of the w-2 reporting. for the years we've had to reduce the higher earners, we sent them a letter and then we go into the payroll system and reduce the annual. so it's never -- the amount we have to reduce, it's not tax

determined. so far, we've gotten it done before the w-2s go out. >> this is commissioner hao. assuming we did nothing, stood still at 5,000. does that mean you will then do the reduction? >> right. we would have already probably started by now. we were trying two things to figure out what could we do. we want to offer a benefit like this. and the second thing is, whether it's legal by irs standards to do two different elections. as well as there was some hope that the legislation would change and irs rules but it did not. if this had not happened, we would have been sending out letters for the reduction of the

higher earners. if you have money remaining after the 2020 election, they're going to typically allow you to carryover of $550. if you had a balance in there that we determined in late april

because people don't submit claims until march 31st, if there's a balance, you can use that for 2021. we have gotten that worked out. basically as it says here under this guidance, we're going to ask the board to approve the carryover of unspent amounts remaining in sfa's any questions

about that section? >> this is randy scott again. how many people do we have enrolled in our healthcare flexible spending accounts? >> we have about 4,000. >> when you talked about the 900 originally, you were talking about, the fsa covers many expenses. you're talking about childcare cost only correct? >> yeah, the first section is just about the childcare.

the second part is about the healthcare flexible spending accounts. those have a higher enrollment because it covers all different kinds of expenses and they have added new things, too. >> covers premiums and co-pays? >> it covers co-pays, deductibles, now it covers ppe. a lot of over the counter things

now. >> i move that we approve the described changes in the addendum to our section 125 cafeteria and reimbursement. >> i second that. >> sorry i didn't say the title here. >> any further questions from

board members? seeing none, we'll open up for public comment. at this point, secretary, are you going to acknowledge the e-mails we have been receiving on this item? >> yes president follansbee. i'll give a short summary of each one of those before we open it up. we received three. first, the request to approve agenda item 15. and another employee who requested the board approve the item. the third e-mail from emily wallace, local 21 member and

labor representative who submitted the public comment on behalf of an sf employee and requested the board approve the item. those three e-mails were forwarded to the board and will be noted in the meeting minutes. with that, i'll open to public comment instructions and read those allowed for anyone on the phone.

opportunities to speak during the public comment period are available by dialling the number on the screen, 415-655-0001. use access 187 003 9306. dial star 3 to be added to the queue. for those on hold, continue to wait until the system indicates you have been unmuted. there's a standing 40-45 second delay for viewers watching online. we will take a 45 second pause to allow the system to catch up and dialers to call in. the delay begins now.

our moderator will notify us of callers in the public comment queue. >> we have seven callers. four callers have entered the public comment queue.

i will send the first caller now. >> welcome caller. >> hi, i'm robin hansen. i currently work at the airport as a civil engineering technician. i'm in charge of designing and checking air field plans to make sure aircrafts park safely at the terminal gate. i'm a local 21 member who has raised three children of various learning disabilities. i have been a volunteer parent mentor for support of families with children of disabilities. i would like to thank supervisor chan and sfhss commissioners for the opportunity for the community. when my sister had her first child, she was excited to have the fsa available. at that time the limit was

$5,000 per year. in a year she paid 6,000 total but could take 5,000 pretax. it was a pretty good deal. the next year she was surprised to be expecting another child. it exceeded it. seven years later, the infant costs had jumped to $700 a month and toddler care about $500 a month. this combined cost of $1,200 was more than my mortgage at the time. it may not sound like much, the mortgage was about 30% of family income. when you double that by adding in childcare, it makes it extremely hard to make end's meet. today one single instant care is $1,200 a month at a cost of $14,000 per year but fsa still only allows $5,000 a year. i am asking the board to

increase the pretax dollar amount for all families so they can afford to live in the san francisco bay area without hardship and i request that they take measurable steps to educate employees about their fsa benefits to encourage city employees to enroll in the programs. thank you for listening. >> thank you caller. moderator, unmute the next caller. >> good afternoon commissioners. i am a father to a 4-year-old. i would like to thank the commissioners and supervisor chan for listening to us in the last meeting and proposing at

this meeting. i'm extremely positive there will be many families who quickly sign up for a program. >> moderator, elevate the next caller. >> welcome caller. >> good afternoon, my name is natalie. i'm a professional civil engineer at sfo, a member of the parents group at sfo and member of local 21. thank you commissioners and supervisor connie chan for

listening to us last month and putting together a proposed solution on the issue. my husband and i have two young children, both in paid childcare. childcare costs in the bay area average around $2,000 a month for one child ages 0-5. i estimate my husband and i will spend around $46,000 for our two children this year. as you all know, the cost of living in the bay area is extremely high and sometimes i feel like i'm living paycheck to paycheck. because i make over $130,000 a year, i wouldn't be eligible to receive the new dependent care increase as part of the board's proposed solution. however, i strongly encourage the hss to actively reach out to employees who earn less than $130,000 via phone, text, e-mail, teams and other outlets to educate them.

thank you very much for your time and consideration. stay safe and healthy. >> thank you caller. moderator, elevate the next caller. >> i'm an engineer at public works hydraulic section and local 21 member and parent of six month old and 3.5-year-old. thank you commissioners and supervisor chan for hearing our input at the previous meeting. we appreciate the step.

this will be a great thing for my family. much like the previous caller spending on childcare, i feel it is a bargain because of the higher costs at typical corporate daycare facility and we are lucky enough to have neighborhood in home daycare for one of the kids. i'm happy to hear that the board will outreach to the 500 employees below $130,000 per year. >> next caller.

>> all callers have been attended to. no other commenters in the public comment queue at this time. thank you. >> thank you moderator. public comment is now closed. >> we'll go ahead and call for a vote on item 15.

all in favor say aye. opposed? it passes. i want to thank everyone again. if we can go on to item 16. >> medicare evaluation request for proposal. this is a discussion item. and executive director abbey yant will open the presentation followed by mark clarke. >> thank you. good afternoon commissioners.

>> advance to the next slide please. >> thank you very much commissioners. as you know, we have done a deeper dive into the medicare market last november 2020. we stated we would bring before you in june of this year, our findings from our examination of what's available on the medicare market and our plans to move forward with at this time an rfp. we have had a couple of reasons for looking at this.

the selection for retirees outside of the area and we saw some of the challenges our members may have with affordability of a kaiser product in the northwest, we wanted to see if there was more than one choice for our members so that is one of the purposes of the rfp. and we spoke about this earlier, about developing of the product selection and unintended consequence a few years ago, not to have split families. it's an enormous challenge. when i first joined the team at

hhs, the team was getting acknowledgement, giving out awards and i was stunned to see i believe it was well over 10,000 that had to be changed to accommodate these families. and that is clearly not the industry standard. all of the software has to be customized for this. going forward, it is just not prudent to continue that

practice. we looked at different ways of approaching the market and we're going to talk about moving forward with an rfp on medicare advantage plan. in the work we have chosen to move forward with, we have elected to not have kaiser bid on that process. they are a very stable, high quality affordable product, we know if for some reason they -- we don't want to disturb the 15,000 retirees well managed in the plan. so i want to turn it over to anne thompson and mike clarke. >> thank you. today we're going to walk you through a few different things.

the publication outlining the evaluation of the medicare market we have been looking at over the last couple of years. the goal of today's meeting are several. a current state and prior discussion, reaffirm the medicare plan getting to the strategic goals, describe the pathways and considerations we considered for the medicare plan offering in 2023. discuss a request for proposal for plan year 2023 and most importantly obtain your input on our key goals and objectives that we have drafted and will share with you. we appreciate the dialogue today and questions and comments you may have as we move ahead in this process. it will help guide us as we develop the rfp.

we have the national plan and then the kaiser permanente plan available in california, hawaii, oregon and washington. we have various employer contribution in two main categories guided by city charter. i will not read this to you. mike clarke reviewed most of this previously.

from our previous discussions we wanted to highlight that we've had several conversations around the health plans, including the medicare plans. going back to 2018 and strategic planning development, we have innovation day in 2018. i know many went there but we have some new faces and were not part of the process. we did deep dive digging into the health plans and what the market was looking like at that time to really identify what were the vision, values and goals as we move forward. later that year, we adopted the strategic plan in october of 2018. then we did a medicare market update in november of 2020. we wanted to stay on top of the market. that brings us to today. we're seeking your input on the

goals and objectives of an rfp for 2023. we've talked about plan design and impact on member out of pocket expenses and we have talked about adjusting

inequitable. and we've had the opportunity to receive input from members on the medicare plan offering. those looked at options for out of california members, offering comprehensive coverage and eligibility for non ssi contributors. there are some employers within the city that don't contribute. so how does that work with medicare advantage. we look at linking the plans to the goal. i will not go through all of these individually. we reviewed these with mike in the renewal presentations. >> with the pathways and considerations, the first

decision point pathway that was considered was offering group medicare plans, in other words group being sponsored and or offering individual medicare plans via a third party administrator or tpa. so the following slides will outline the benefits of each of the pathways resulting in the sfhss conclusion to continue to offer group or hss-sponsored medicare health plans. in the top part of the chart, we talk about the benefits and bottom part of the chart, the risks of each of these two approaches. the benefit is they have a higher level of control over the plans that include claim administration, control over the cost environment for the plans,

plan design customzation and member resolution. employers generally sponsor 1-3 plans on a group basis that could have the potential to limit member choice depending on the number of plans ultimately offered. on the individual medicare marketplace side, one benefit is it could offer dozens of plan choices for any member in a given geography. the two come into play on the individual marketplace approach. the first, sfhss is not able to provide member support should issues arise for members and individual plans and the second is individually directed nature of the approach could result in unequal member access. you'll see at the bottom of the page, the conclusion reached is group plans will allow to have

support the needs of retiree constituents. in considering the group versus individual plan path relative to each of the five strategic goals, how does it look from the retirees perspective. what you see on the left side of the page are each of the five strategic goals with commentary in each box in the first column for the group and the second for the individual medicare plans. you'll see yes's in each of the items related to the strategic plan for group-sponsored and for individual medicare plans, a mix of yes, no or maybe. depending on the particular linkage to the strategic goal. so this, again, is leading to the conclusion that group plans by strategic goals.

transitioning the second pathway that is under consideration is to whether to offer a medicare advantage plans and or medicare supplement plans with prescription drug plans. like the first pathway, the next couple of slides will present benefits and risks of both pathways and linkage to the strategic plans. as we go through this, you will see the conclusion continuing to offer only medicare advantage plans. from a benefits standpoint for medicare advantage plans, they are clinically based to address a number of needs you see in the upper left box correlating to medicare advantage plan benefits, including the effective coordination of overall care delivery, targeted timely care and complex case management, management of

inpatient hospitalization use and length of stays to reduce readmission rates and retiree end of life needs and added benefits and medicare plans provide intensive quality focus not present in other plans through the star rating process. and the identified risk is typically these are provided through hmo or in network only approach or ppo or network design which has the potential to perhaps limit provider choice. with prescription drug plans, essentially provide an overlay on the supplement for medical to original medicare offers, they are provided through a broad provider choice open network

approach. they're meant to fill in financially the gaps that exist through original medicare plan deductibles and co-insurance requirements. but when we look at the risk for medicare supplement plans with prescription drug, original medicare is essentially unmanaged plan characterized by high degree of inefficiency that led to the development in the

first place. you see yes's across the board for the medicare advantage plans and medicare supplement you see some yes's from an rx standpoint only as rx plans are star rated, even though the medical supplement plans are not. in evaluating input, the staff has concluded the current

approach provides retirees with high quality cost efficient plan options across the geographies represented by sfhss retirees and support the staff and strategic goals. >> similar to what we looked at on the active and early retiree rfp, we wanted to get a visual. there was a lot of great text but to give a visual for the current offering, we have the kaiser offered in the four states that are listed there and on the right, we have the united healthcare ppo offering. you'll see down where can you seek the care, do you need a referral, mostly copay based.

you can see here. and at the bottom, which aligns with the conversation or the dialogue that mike just had, who do you call for issue support. that would be the vender. kaiser you would see and sfhss. looking for choices outside the kaiser area and looking to be copay based and supporting retirees and venders support directly as well.

as far as the plan, which we shared earlier, we kind of ruined the surprise, is that we do want to go ahead with an rfp for the 2023 plan year and -- outlined the remaining reasons here that competitive bidding, opens the possibility of a second national plan offering giving more choice. and it allows for the adjustments to the plan offering to help resolve that split family issue that was outlined earlier. staff is planning to perform the rfp for 2023. retaining the current group medicare offering framework with the potential of expanding the offering to sfhss medicare retirees. it would exclude kaiser.

and on the next couple of pages we'll look at the goals and objectives we have outlined and would like the board's feedback on. for the rfp goals we have identified four key pillars. quality, cost, benefits to the administration and legal and policy guardrails. for quality, you'll see there at the bottom that sfhss will prioritize plans for star rating 4.0 or higher. we want to leverage the system in place, it is well established and documented and supports quality plans. and we want to leverage that work that has been done. for cost, we want to make sure we are offering transparent sustainable high value cost effective care choices and to retain the purchasing power of

sfhss. we expect no increase to premiums. under benefits administration, we want to optimize the member experience through convenient and coordinated care management. we are looking for advocacy and navigation of systems and benefits of partnership support through culturally competent care systems. we expect the superior customer service and program offering. our legal policy guardrails, we'll abide by all. we will work within the construct of the city charter. as far as objective. we have several outlined here. we want to focus on high quality cost effective healthcare programs and options and enhance diversity of options

geographically and reduce administrative complexity of split families and partner with plans with strategic goal of health and wellbeing of members and reducing health disparities and innovate for better care management and minimize member disruption maintaining cymbals of current co-pays and deductibles and enhance plan competition and reduce future premium costs. next steps would be to revise the goals and objectives based on the conversation we're going to have. and review the goals and objectives at the august health service board meeting. we anticipate releasing the rfp in september and bring the recommendation to the board in february of 2022. with that, i will stop speaking

and let's go back to each page and we can open it up president follansbee to you and your commissioners. >> great. just to make sure -- i'll start with one -- two questions. one is just to make sure i'm understanding the reasons why we're excludeing kaiser senior advantage in this. is it because we have a high percentage of non medicare members are in kaiser now? it's not because of the percentage of senior advantage kaiser members. they're smaller than the uhc. it's a non medicare -- in terms of continuity. is that the rationale? >> i think it's two fold. a change in the kaiser plan would be 100% disruption to the medicare retirees. if that plan would be eliminated. the other is keeping that around

does support the split family -- resolution part of the resolution to the split family issue. >> okay. >> also the kaiser plan is one of the few medicare plans in the nation that has a five star rating and has since the construct began. so they are meeting in some ways the very things we're trying to outline in the rfp construct. >> if i recall the november 2020 conversation, there seemed to be very high star rating in more regionally confined medicare advantage plans opposed to the

broad geographic. i'm wondering if you can estimate the plans available across the country, including hawaii and alaska, four or five stars now. i thought that was a smaller number. >> i'll take that one. part of why kaiser earned the five star rating is because of the group model nature of the program and the fact that members have a very close association to their physicians within the group model and so they're able to capture a maximum amount of data on plan participants and health risks in order to be able to maximize reimbursement into the model.

i will absolutely compliment united healthcare for achieving largely a 4.5 star rating program for the national ppo platform. however, any ppo environment is more difficult for united healthcare to put closely align the physician into the experience with the member. so we've talked for instance in the past about house calls, it's a program that united healthcare offers to promote a greater understanding and support for the member on their health risks that also has the benefit of trying to increase the reimbursement to lower the premium to their group plan sponsors. >> how many other plans other

than uhc are nationally available would fit into the models you are proposing, we put out for competitive bidding? >> there are several. i can't quantify exactly how many, but there are an array of national plans that would include the health net organization, several other large national health plans that would be recognized for commercial insurance also sponsor national ppo medicare plans that we would hope would be willing to participate in the rfp process. we expect to have an array of those national ppo carriers as well as local and regional interest on the part of organizations who may operate more like a kaiser. >> okay.

other questions or comments or clarifications? commissioner zvanski. >> i would like a little more information how through the rfp, the medicare benefits are going to be evaluated since this is medicare focus but looking to eliminate the need for the split family so we find a kaiser-like product that would be all inclusive. i'm worried about going outside the parameters of the rfp to say this is what your focus needs to be and this is what you need to primarily do with -- how is that evaluation going to go forward to the extent that we will be comfortable in knowing

whatever plan is chosen will also provide a sufficient or meet or goals for the non medicare side of a split family. does that make sense? >> it does. go ahead. >> i think that's a part of what i was trying to find while i was on mute. our objectives. this is precisely the kind of conversation we want to have. we want to hear your questions. let's take note of it. as to how we imagine that playing out.

>> from a financial standpoint, what i would anticipate from the process, ask each of the bidders throughout the process by which they are able to provide a seamless integration of coverage for non medicare family members. >> go ahead commissioner breslin. >> all the members i have talked to have been happy with the flexibility of the ppo. and the fact that you don't always have to go through your primary care doctor. it is very important at this time because it is difficult to get a new primary care doctor.

what areas does the united healthcare not cover. do they cover hawaii, washington and oregon, all these parts of the u.s.? are there some areas they don't cover? >> i know they cover the 48

states. i don't know if i'm allowed to ask -- i believe we have a representative on the call to answer the question. >> go ahead shannon. >> they would be allowed to compete with other plans and give the driver to some extent the issue around the mixed families. is that -- trying to understand how we're going to rate, how the hss will rate these various issues when it comes down to a final evaluation.

i think it's up to us to help with the principles to make the decisions regarding the rating. >> as i mentioned before, the ppo aspect of this that you did not have to go through your primary care doctor. that in my opinion saves money a lot of times. not all medicare advantage plans have that ppo in the plan. you have to go through a regular doctor. that part i think is very important to have in this united healthcare. that was the first time we had a medicare advantage like that.

>> this is secretary holly lopez. it looks like the lines are clear if any representatives want to step in. >> was it shannon who couldn't get in? this is commissioner zvanski. i wanted to comment about what dr. follansbee was saying. once the process starts, we're not involved in any way. we're not adding to the points and we're not pointing out the points that any of the raters get to consider. we have to rely on an unknown group of people who are going to do the evaluating and we won't see any of the information. i don't know how we can influence what goes on in this process anymore than what we're doing today. which is an outline.

a statement of intent. >> i would like to suggest the goals and objectives are primary to an rfp process and this is indeed where you have significant opportunity to weigh in and to inform the process. you are right, this is it. but it is incredibly important that these drive the process. >> i wonder what the possibility would be to survey the membership for their priorities, that could help influence the process as well.

>> answer the question, it is the 50 united states plus the 5 u.s. territories. >> thank you. >> thank you. >> i couldn't get the microphone working. >> mr. canning, do you want to complete your thoughts? >> that's all right. the only point i wanted to make, i'm hopeful there's a possibility we can survey our members who will be affected. their input i think is critical and would be very important particularly with something as unique as the medicare

population. >> we can take that into consideration. we've had input sessions with members about their own experience. those were summarized on one of the slides. these were the key things we heard from focus groups we did with members and the options for out of california members was very important. that we had comprehensive coverage and we addressed -- i don't know if this was a problem or concern of members about -- i believe it's prior school teachers that don't contribute to ssi and doesn't have bearing on that. it's not my understanding that it does. that needs to be made clear.

and then we summarized above that, the matters that relate to the medicare products we heard from the board. so we went back over all of our notes from prior discussions. i do like to do surveys. i don't really want to talk too off the cuff about what is possible in the timelines that we have because as we outlined, we would have to move forward. we would come back to the board for approval in august and then we need to drop the survey -- or the rfp in september.

there might be an opportunity. i don't want to commit at this point. but i hear you. i think the member voice is always important. we'll take a look at what is currently available. >> thank you director yant. the outreach that has been done, there's been no big changes to the products available. i just wanted to make sure that whatever the sequencing is, the members voices have been heard. >> yeah. >> the board will have a chance at the august meeting to hear the progress of goals and objectives and give feedback at

that point. these are not items that take action on our part but feedback in terms of how we see those and understand those, is that correct? >> today is the opportunity for feedback. integrate what we hear from you and bring it back in august to affirm that we have captured what you have suggested. yeah. this is the moment to really give feedback to things you want us to look at that would inform the goals and objectives. >> other questions -- yes? >> commissioner scott. i hope that as this slide and the other one that has the more detailed objectives on it -- that there is some effort to link the objectives and the four

pillars back to the strategic end goals. for instance if you go to the four pillars, you mentioned quality. i think that is strategic goal around engagement, support, the whole person, that type of thing. cost is affordability and sustainability and of course we're going to follow legal guardrails. policy 207 talks about working within the charter and we as a board delegate to the staff and to others through the contracting process certain responsibilities. so terms of reference 207 would

support the legal and policy guide rail. i think pointing out the specific link between these pillars and these objectives back to the strategic plan would be helpful. >> yes, and we did -- do you want to scroll back to the strategic plan discussion we had internally. >> i know you did it there. i'm saying bringing that forward to the pillars and citing the terms of reference 207 on the later slides. >> yeah. and they're not all one but where we can link them back, it

sort of sets that as a framework or backdrop to this effort. >> right. >> there will be some overlap, you're right. >> we'll find a way to make that sort of funnel effect i think. taking high level thinking and bringing it down to the plan level. >> good, other questions, comments, clarification. comments about sort of priorities, etc cetera. hearing none, we'll open up for public comment. >> do you want a motion? >> this is a non action item.

just a discussion item. no action. i don't want a motion. >> well, you won't get one. >> good, thank you. okay. holly, you can proceed. >> thank you president follansbee. public comment is available for each item on the agenda. when i welcome you on the call, you are encouraged to state your name but you may remain anonymous. i will thank you for your comment and you'll be placed back on mute. remote viewing is available. opportunities to speak during the public comment period are available by dialling the number on the screen, 415-655-0001.

when prompted use access 187 003 9306. then press pound and pound again. you will then enter the meeting as attendee and dial star 3 to be added to the queue. there's a standard 45 second delay for viewers watching online. we'll take a 45 second pause. it starts now.

>> thank you. we have three callers on the phone line. no callers have specifically entered the public queue at this time. a reminder to all callers on the line, you must dial star 3 now if you want to join public comment for this specific agenda item. we'll wait five seconds and then close public comment for the

agenda item. secretary, there's still no callers in the public comment queue at this time. >> thank you moderator. public comment is now closed. >> thank you very much. i want to thank abbey yant and staff for the presentation of the item. i look forward to the august discussion as well for finalzation of goals regarding the rfp. we'll move on to agenda item 17. >> thank you president follansbee. agenda item 17 vote on whether to cancel the july 2021 health service board regular meeting. this will be presented by president follansbee. >> historically we have cancelled the july meeting. we put it towards the end of the agenda to make sure we got through all of the items.

i strongly recommend we entertain a motion to cancel the july 2021 regular board meeting. >> commissioner follansbee, this is commissioner zvanski. i would like to make the motion at this point to cancel our july meeting and wait until august because there's so much that the staff and everyone needs to do to prepare for open enrollment as well as the rfp. the motion is to cancel the july meeting for the health service board. >> second. >> moved and seconded. i will open up for public discussion. >> thank you president follansbee. public comment is available for each item. each speaker is allowed three minutes to comment. all public comments for the

agenda item presented. you can call the number on the screen, 415-655-0001. when prompted use access code, 187 003 9306. then press pound and pound again. you will enter as attendee on the public comment call line. for those on hold, continue to wait until the system indicates that your line has been unmuted. there's a standing 45 second delay for viewers watching

online. we'll take a pause to allow the system to catch up. it begins now. moderator, do we have calls in

the public comment queue. >> thank you. we currently have three callers on the phone line but no callers have specifically entered the public comment queue at this time. a reminder, dial star 3 now if you want to join public comment for this specific item. we will wait five seconds and then close public comment for this agenda item. board secretary, there's still no callers in the queue at this time. >> thank you. public comment is now closed. >> thank you very much. it's been moved and seconded that we cancel the july 2021 regular hhs board meeting. all those in favor say aye.

opposed? passes unanimously. thank you. >> surprise. >> move to item 18. >> thank you president follansbee. item 18, reports and updates from contracted representatives. this is a discussion item. >> kaiser permanente. i wanted to share that kaiser permanente is joining the white house national action to support vaccinated 70% of adults by july 4th. it looks like san francisco is way ahead of that. our approach is to launch a variety of initiatives by increasing confidence and encouraging them to get vaccinated. these include open to all

vaccinated members 12 and older. those who cannot get vaccinated for medical or religious reasons, there will be winners and rewards tied to treats and gym equipment, memberships and park activities for families. kaiser has contributed 25 million to fund community grabs programs targeting community-based organizations. we will contribute another 10 million to target organizations to receive funding to continue to promote vaccine confidence. utilize social media campaign targeted to the 18-30 year olds. we'll publish a vaccine confidence tool kit that shares best practices that we have found that have helped to increase vaccination rates that

can be shared and utilized by vaccine providers to help them accelerate vaccine rates and finally, we'll continue to have our member communications through a variety of outreach mechanisms, texting, e-mails, etc cetera and one-on-one for in person visits with physicians, the physician will take note if they've had the vaccine and maybe address concerns they have about hesitancy. thank you for the opportunity to share this today. we're very excited about supporting this program. >> thank you very much. and i get as a kp member myself, california has vaccinated over 12,000 people home restricted. think have gone into the homes to do that for people who can't get out. and there are mobile vans for

mobile office visits and i'm assuing that also offers vaccination opportunities in your mobile offices. thank you very much. other plan representatives who want to make comments? i think we had a robust discussion earlier about delta dental. is there someone here from delta dental who wants to make a comment or follow-up. >> i have a question to ask if there is. >> this is valerie, the vice president of national special accounts for delta dental. >> okay. at the last meeting in may i asked delta dental if new

members are all dentists were able to go into the premier option. i was told yes, that was true. all members could. i had heard that any new members that option would not be available to them. i have since read the director's report that says in order to go premier, you have to go into the ppo status. i don't know how that works. i know there's a contract for the premier option, so i'm assuming you would have to have two contracts. and thinking this is going to make it very difficult for the doctors, just more paperwork and more problems of course. and so, since this has been going on since 2014, i would guess this would be a way of diminishing the premier option because as these doctors age out, then how many of them are

going to come in and sign up for two options here? i have to speak to a few more dentists to see exactly how it would work if they had to sign up for both of these plans. i know it is complicated. i find this just another way to make it difficult for people to go into the premier status, which that group was one of our largest groups as i recall. so, you know, down the road here, we're going have more people go out of network or stuck with the ppo, which all the reports i'm seeing, they're cutting back on their payments for them and reimbursements. i think we should all be concerned about this. dental care is very important. i can attest to that from my fast bad dental care i had and what happens with complications of it. bad dental care means more

dental care which benefits some people i suppose. and a second question i asked the last time was assignment of benefits out of network providers, which doesn't cost delta anymore. it just makes it easier for out of network providers and from your perspective it makes it harder. why would you not allow that. i would hope that in our negotiations that that would be something that we should demand. we should ask. other insurance policies do that. so i would like to -- if you have an answer to those two questions right now. >> sure. thank you for asking me and allowing us to clarify. with regard to the network contract, there's only one, the dentist contract under two

arrangements or two different sets, but it is one contract. all of our dentists hold one contract that allow outlines all of our policies and all of the fee arrangements. so there is no intention to eliminate our premier network. we value that network very much and we continue to have quite a few dentists in that network. there are very successful and expanding the ppo network as we move forward and many dentists have chosen over the recent years to offer the ppo in addition to the premier, recognizing that there are patients in the marketplace concerned about cost. that is our continued strategy, to emphasize the ppo.

we are not eliminating the premier network. our goal ultimately is to have the best access. so we're focused on that at all times. >> but let me just ask you, if i go to the dentist -- how do i know do i become a ppo dentist or part of the premier. how do i know which one? >> you can ask your dentist or look online. delta dental can tell you if you're participating in one plan or both. >> do they tell you now you're here and if you take this option you pay more -- how do they explain it to -- >> there's no option. they recognize that you are enrolled in a ppo plan and so they are going to tell you they're a ppo dentist yes or no. they're a premier dentist and you'll be reimbursed based on premier fees and not ppo fees.

>> but our systems automatically recognize what dentist you see and what the contracting status is. it's a matter of for the member asking their dentist or if their interest is visiting a ppo dentist looking online or asking the dentist if they participate in the ppo network. >> she said they're both. the dennist said ppo and premier. how would i know? >> the dentist knows if they're both. they look up your plan and see you're in a ppo plan. they're going to advise you that they participate in ppo. >> what about the premier part? >> that really doesn't matter. when you're in a ppo plan and visiting a ppo dentist, it

doesn't matter that they have premier status as well. your plan is the ppo plan. >> okay. >> excuse me, this is randy scott. it's just the same -- doesn't your enrollment, when you enroll and take the premier, that is what we're paying for for you and that's how your record shows is that you enrolled in the premier plan. when you go to the dentist office and call up your name in the delta system, they're going to see you're a premier member. >> ppo. they're going to see you're a ppo member. >> this is what is confusing to me. >> you have a ppo plan and they're going to see enrollment is a ppo plan, the dental office

is going to see you're in a ppo plan. the customer service recognizes you are in the ppo plan when you look at your highlights of benefits, your benefits of coverage, all of those say ppo plan. that is the plan. that is your status. >> if you are registered as premier, you're a ppo that means the dentist gets reimbursed on ppo level and not premier level. >> yes, if you are visiting a ppo dentist -- >> dentists with contract with us currently are automatically enrolled in the ppo and premier

plan. there are some dentists on the books with premier only -- >> i'm talking about two plans. >> i think -- i'm sorry i'm going to interrupt. this is an opportunity for plans to update all of us on changes in the plan and all of this. i think these are important issues. i think commissioner breslin, if you have questions about your own participation in delta dental, maybe it could be worked out one-on-one in terms of how the explanation of benefits gets described to you in a summary or to other members. i think most dental offices know how to access delta dental if you have coverage and can ask to make charges before procedures and then at least give you a statement of benefits, what they paid, what they didn't pay and responsibility. that's pretty standard across the industry. maybe we should refocus this

discussion on what delta dental or other members want to speak up about changes overall in their plans and announcements at this point. >> i don't want to hold this up. it's 5:00 already. but i think this is the first time it has come up that you're not in the premier anymore. you couldn't do that after 2014. so i'm still confused and maybe -- >> i can call you commissioner breslin after the meeting. i would happy to do that. >> i think we can arrange for that. i think it's -- i think what i said earlier in my report is that we are meeting weekly with delta to clarify a number of

issues. some of which have been brought forward today, again, and they have been asked and answered. the additional questions that are being raised here today we will make sure they are addressed in a future director's report or discussion item on the agenda. >> we will open up for public comment. >> thank you president follansbee.

public comment is available for each item on the agenda. as a reminder, they may ask kwp questions about the policy body. when your three minutes have ended, you'll be back on mute. remote viewing is available and opportunities to speak by dialling the number on the screen. the dial in number is

415-655-0001. there's a standing 45 second delay for viewers watching online. we will take a 45 second pause to allow the system to catch up and callers to dial in. the pause starts now.

>> zero callers have specifically entered the public queue at this time. you must dial star 3 now if you want to have public item for this agenda item. board secretary, still no callers in the public comment queue at this time. >> public comment is now closed. >> thank you. agenda number 19, adjournment.

i'll remind everybody that the july 8th meeting is cancelled and we'll meet again on august 12th and with that, i will now adjourn the meeting. thank you very much for participation today. >> thank you. is is is is >> restaurants will be open for take out only, but nonessential stores, like bars and gyms,

will close effective midnight tonight. [♪♪♪] >> my name is sharky laguana. i am a small business owner. i own a company called vandigo van rentals. it rents vans to the music industry. i am also a member of the small business commission as appointed by mayor breed in 2019. i am a musician and have worked as a professional musician and recording artist in the 90s. [♪♪♪] >> we came up in san francisco,

so i've played at most of the live venues as a performer, and, of course, i've seen hundreds of shows over the years, and i care very, very deeply about live entertainment. in fact, when i joined the commission, i said that i was going to make a particular effort to pay attention to the arts and entertainment and make sure that those small businesses receive the level of attention that i think they deserve. >> this is a constantly and rapidly changing situation, and we are working hard to be aggressive to flatten the curve to disrupt the spread of covid-19. >> when the pandemic hit, it was crystal clear to me that this was devastating to the music industry because live venues had to completely shutdown.

there was no way for them to open for even a single day or in limited capacity. that hit me emotionally as an artist and hit me professionally, as well as a small business that caters to artists, so i was very deeply concerned about what the city could do to help the entertainment committee. we knew we needed somebody to introduce some kind of legislation to get the ball rolling, and so we just started texting supervisor haney, just harassing him, saying we need to do something, we need to do something. he said i know we need to do something, but what do we do? we eventually settled on this idea that there would be an independent venue recovery fund. >> clerk: there are 11 ayes. >> president walton: thank you. without objection, this resolution is passed unanimously. >> and we were concerned for

these small mom-and-pop businesses that contribute so much to our arts community. >> we are an extremely small venue that has the capacity to do extremely small shows. most of our staff has been working for us for over ten years. there's very little turnover in the staff, so it felt like family. sharky with the small business commission was crucial in pestering supervisor haney and others to really keep our industry top of mind. we closed down on march 13 of 2020 when we heard that there was an order to do so by the mayor, and we had to call that

show in the middle of the night. they were in the middle of their sound check, and i had to call the venue and say, we need to cancel the show tonight. >> the fund is for our live music and entertainment venues, and in its first round, it will offer grants of at least $10,000 to qualifying venues. these are venues that offer a signature amount of live entertainment programming before the pandemic and are committed to reopening and offering live entertainment spaces after the pandemic. >> it's going to, you know, just stave off the bleeding for a moment. it's the city contributing to helping make sure these venues are around, to continue to be part of the economic recovery for our city. >> when you think about the venues for events in the city,

we're talking about all of them. some have been able to come back adaptively over the last year and have been able to be shape shifters in this pandemic, and that's exciting to see, but i'm really looking forward to the day when events and venues can reopen and help drive the recovery here in san francisco. >> they have done a study that says for every dollar of ticket sales done in this city, $12 goes to neighboring businesses. from all of our vendors to the restaurants that are next to our ven sues and just so many other things that you can think of, all of which have been so negatively affected by covid. for this industry to fail is unthinkable on so many levels. it's unheard of, like, san francisco without its music scene would be a terribly

dismal place. >> i don't know that this needs to be arrest -- that there needs to be art welfare for artists. we just need to live and pay for our food, and things will take care of themselves. i think that that's not the given situation. what san francisco could do that they don't seem to do very much is really do something to support these clubs and venues that have all of these different artists performing in them. actually, i think precovid, it was, you know, don't have a warehouse party and don't do a gig. don't go outside, and don't do this. there was a lot of don't, don't, don't, and after the pandemic, they realized we're a big industry, and we bring a lot of money into this city, so they need to encourage and hope these venues. and then, you know, as far as people like me, it would be

nice if you didn't only get encouraged for only singing opera or playing violin. [♪♪♪] >> entertainment is a huge part of what is going to make this city bounce back, and we're going to need to have live music coming back, and comedy, and drag shows and everything under the sun that is fun and creative in order to get smiles back on our faces and in order to get the city moving again. [♪♪♪] >> venues serve a really vital function in society. there aren't many places where people from any walk of life, race, religion, sexuality can come together in the same room and experience joy, right?

experience love, experience anything that what makes us human, community, our connective tissues between different souls. if we were to lose this, lose this situation, you're going to lose this very vital piece of society, and just coming out of the pandemic, you know, it's going to help us recover socially? well, yeah, because we need to be in the same room with a bunch of people, and then help people across the country recover financially. >> san francisco art recovery fund, amazing. it opened yesterday on april 21. applications are open through may 5. we're encouraging everyone in the coalition to apply. there's very clear information on what's eligible, but that's basically been what our coalition has been advocating for from the beginning. you know, everyone's been supportive, and they've all been hugely integral to this program getting off the ground.

you know, we found our champion with supervisor matt haney from district six who introduced this legislation and pushed this into law. mayor breed dedicated $1.5 million this fund, and then supervisor haney matched that, so there's $3 million in this fund. this is a huge moment for our coalition. it's what we've been fighting for all along. >> one of the challenges of our business is staying on top of all the opportunities as they come back. at the office of oewd, office of economic and workforce development, if you need to speak to somebody, you can find people who can help you navigate any of the available programs and resources. >> a lot of blind optimism has kept us afloat, you know, and there's been a lot of reason for despair, but this is what keeps me in the