>> can we have the roll call?

>> thank you president follansbee. call to order at 1:03 p.m. and our roll call. president follansbee? >> present. >> vice president canning will arrive later. supervisor chan? >> present. >> commissioner breslin? >> present. >> commissioner hao. >> present. >> commissioner scott? >> present. >> commissioner zvanski will be joining in a moment. with that present follansbee, we have a quorum. >> if we can move on to item number 3, an action item. >> thank you president follansbee. agenda item 3, the resolution

allowing teleconferencing meetings under the government code, this is an action item. >> so, we've had a chance to review this resolution. i'm not sure if you're going to project it, but -- >> i wasn't planning on it. would you like me to? >> it is pretty straightforward. every 30 days we have to update our resolve to allow teleconferencing. if there's any discussion from board members? >> this is commissioner scott. i move we accept the resolution. >> i second. >> thank you. so moved and seconded. with that, we'll open up for public comment. >> thank you president follansbee. the public comment remote viewing access is going to be displayed and i'll read it.

public comment is available for each item on the agenda. each speaker is allowed three minutes unless the board president deems new time limits. as a reminder, a caller may ask questions of the policy body but there's no obligation to engage with the caller. when i welcome you, you are encouraged to state your name clearly but may remain anonymous. after three minutes, the moderator will unmute the next caller. remote viewing is available. opportunities to speak during the public comment period are available by dialling the number on the screen. 415-655-0001. use access code, 2498 558 9355.

then press pound and pound again. you will enter the meeting as an attendee. dial star 3 to be added to the queue. when the system message says your line has been unmuted, it is time to speak. for those on hold, please wait until the system indicates you have been unmuted. we have a standing 40-45 second delay for viewers online. we'll allow the system to catch up and callers the dial in. the pause starts now.

the pause has ended and the moderator will notify us of any callers in the public comment queue. >> we have four callers on the phone line. zero callers have entered the cue 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. there are still no callers in the queue at this time. >> public comment is now closed. president follansbee, right on time, public comment is now closed. we'll want to make sure we can hear you. and we have had commissioner zvanski join the meeting. >> okay. moved and seconded that we accept the resolution allowing for telecommuting for the next 30 days. please say aye in favor. any opposition? it passes unanimously. if we can move to item 4. >> thank you president follansbee. the approval with possible modifications of the meetings of the minutes set forth below.

you will see two meeting minutes for the governance committee on december 2nd and full board on december 9th. >> any discussion from board members regarding the minutes of the two meetings? >> yes, president follansbee, this is randy scott, as chair of the governance committee, i would like to call the attention for everyone that throughout the governance committee minutes and calendar that were distributed for the meeting, we indicated we would be bringing forward terms of governance and policy document today for discussion at this board meeting. i want to first of all indicate that the work has been completed. i thank very much our council, larry loo for his efforts from the finance and policy review

standpoint. we didn't take into account a 10 day prior notification before voted on by the board. so as a result, it will need to be delayed until the february board meeting. it is all complete, all the work is done, we just need to do the proper notification so indeed it can be voted on by the board and we determined that would be at the next board meeting on february 10th. >> great.

any other comments on the minutes from the two meetings? >> the acceptance of the december 9th regular health service board meeting minutes, move acceptance. >> can we move acceptance of the governance as modified for december 2nd as well? >> we can approve minutes, it's just the document, right? >> that's correct. >> then i will amend my motion to accept both without objection. >> second. >> thank you very much. so moved and seconded. now we'll open it up for public discussion.

>> thank you president follansbee. instructions are going to be displayed while i read them. public comment is available for each item on the agenda. each speaker is allowed three minutes to comment. all public comments made concerning the agenda item presented. as a reminder, a caller may ask questions of the policy body but there's no obligation to engage with the caller. you are encouraged to state your name but you may remain anonymous. after three minutes, the moderator will unmute the next caller. remote viewing is available on channel 26 and web-ex. opportunities to speak are available by dialling 415-655-0001.

use code, 2498 558 9355. then press pound and pound again. you'll enter as attendee and dial star 3 to be added to the queue. for those already on hold, please continue to wait until the system indicates you have been unmuted. sfgov tv has a standard 40-45 second delay for those online. we'll allow 45 seconds to catch

up. the pause has ended and 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 star 3 now for this specific agenda item. we will wait five more seconds and then close public comment.

there are still no callers in the queue at this time. >> public comment is now closed. president follansbee, want to make sure we can hear you. i'm just going to support for a second. president follansbee, i'm going to unmute your -- president follansbee, can you hear us? doesn't look -- we may have lost reception with president follansbee. >> i'm here. >> great. >> sorry about that. i'm trying to deal with an

emergency here. okay, there were no public comments? >> no. >> correct. so moved and seconded that we accept the meetings of december 2nd, 2021, and meeting of december 21st. any opposition? it passes unanimously. thank you. sorry about the delay. if we can move on to item 5. >> item 5 is general public comment, an opportunity for members of the public to comment on any matter within the board's jurisdiction, including anything not on the agenda or requesting a matter on a future agenda. i'll pull up our instructions. public comment will be available for each item on the agenda. each speaker is allowed three minutes to comment in length

unless the board president deemed new public comments during the meeting. a caller may ask questions but there's no obligation to engage in dialogue with the caller. when i welcome you on, you are encouraged to state your name but you may remain anonymous. when three minutes has ended, the moderator will unmute the next caller. remote viewing is available. opportunities to speak during the public comment period are available dialling the number on the screen. the dial in number is 415-655-0001. when prompted, use access code, 2498 558 9355. then press pound and pound again. you will enter the meeting as an attendee and dial star 3. when the system message says

your line has been unmuted, this is your time to speak. for those on hold, please continue to wait until the system indicates you have been unmuted. there's a standard 45 second delay for those watching online. we'll take a pause to allow the system to catch up and callers to dial in. it starts now.

the pause has ended and our moderator will notify us of callers in the public queue. >> thank you for transferring privileges. we have four callers on the phone line and one caller has specifically entered the queue at this time. other callers may enter the queue as public comment continues. i will indicate when there are no more callers in the queue and you will hear a brief silence as we transition between callers. elevating the first caller now. >> welcome caller. >> good afternoon commissioners. i'm a retired san francisco firefighter and i continue to be part of the peer support team and critical incident response team. i spoke at your december meeting during general public comment to

be placed on january's agenda to make a presentation for the san francisco fire department. it consists of 1700 personnel and we are looking to provide more treatment in behavioral crisis. we understand there are resources in place through the aep, compsych, creating the care bridge. we are starting to get more clinicians on board to support in a behavioral crisis. international association of firefighters, centers of excellence for behavioral and health facility licensed for ptsd, trauma, substance use and other behavioral health challenges. we would like to give our members to have an opportunity

to attend this facility and receive specialized treatment for behavioral health issues. the health service agency can contract as many other plans have done. the center of excellence all have a network access to insurers, most which offer ppo plans. in california, the two largest groups aside from cal fire are l.a. city and have access through anthem plans. the center of excellence is building near san diego, this treatment facility will be open at the end of 2022 and has another treatment facility fortitude specializing for other essential workers, police, nurses, 911 dispatchers. in a behavioral crisis, the more resources, the greater the likelihood of seeking assistance and hopefully finding a

treatment plan that works for them getting the care they need in a timely manner to recover quicker and return to living a productive life. this is a priority for the san francisco firefighters local 798 and i would like to be placed on february's hhs agenda. i have e-mailed my contact information and would like to set up a meeting with staff for further discussion. thank you. >> thank you caller. our moderator will elevate the next caller. we have zero callers in the public comment queue at this time. a reminder to all callers on the line, you must dial star 3 now to join public comment for this specific item. we will wait five seconds and then close public comment for this item.

we have another hand raised in the queue, elevating the caller now. >> welcome caller. >> board secretary, the call has been disconnected. there are no other callers in the queue at this time. >> thank you moderator. hearing no further callers, public comment is now closed. >> thank you, this closes item 5. please call item 6. >> i would like to make a comment about the last agenda

item. >> okay. commissioner breslin? this is on the director's report as well. if you want to hold it or comment now, it is up to you. >> referring to the member who just spoke. >> okay. >> and since he did recommend to be on the agenda before, i think it's a good time to put this on the agenda, not only for firefighters but all first responders. he did mention in his letter that there's also this place called fortitude, i wasn't clear on the facilities, if they were all in patient or out patient and i would like to know more about them. and he mentioned nurses, police and dispatchers. especially during this pandemic, there's been a lot of extra problems and the police i know have really had a difficult time because of the negative stuff in the press, etc cetera.

so, i think it would be nice to have an agenda item with this idea but maybe make all mental health services a little better since this is a big issue today. and i just -- actually i just asked my provider about a mental health provider not particularly for me but in general, she said -- united healthcare, this is ucsf and she said it is very difficult to get a mental health worker right now. it is a huge issue we have. whether it is reimburse -- they say the lack of providers but on the other hand, it was mentioned in the original report that -- >> can i interrupt you.

you have gone way beyond in responding to the call-in person and brought up another issue that we're continuing to deal with and will be on the agenda. can you focus on the response for the caller and move on. >> that is my response to the caller. >> provider reimbursement seems beyond the comments of the caller. do you have other comments in response to the caller? >> no, i think we deserve to give our first responders the best care we can. >> thank you very much. if there are no other comments, i close item 5. we'll move on to item 6. >> thank you president follansbee. i will display our agenda. agenda item 6 is the president's

report. >> i have no report. i'm going to close agenda item 6. >> okay. thank you. item 7 is the director's report, a discussion item and presented by executive director abbie yant. >> good afternoon commissioners. happy new year. and thank you for showing up today. we have in the director's report, i will provide some highlights. i think it is stating the obvious, we are still in the pandemic and dealing with the omicron issue. we're hoping that we're at the peak of this right now and that we may start to see the downward trends in infections in our communities. we are all being super diligent. our workforce at hss is working from home again, we had returned to the office last november but

that has changed once again and as all things covid, the virus is adaptable and so must we be. that's where we are. i do want to announce that our chief financial officer larry loo has accepted another position outside of our organization and will be leaving us tomorrow is his last day, ouch. i just realized that. and we were very fortunate to find a very well qualified replacement. mr. zang is on the call today. we did a record in hiring civil service time to the credit of our personnel officer from the department of human resources

was super helpful. we double teamed this and able to secure a well qualified financial officer in time to learn -- get the hand off from larry and learn our budget process, which is with us as we speak. so i would like to say thank you very much with sadness and fondness that larry is leaving us. he is going to be at the chinese community health plan. i'm sure we'll still see him. it is a small town. and welcome iftikhar. >> i'd like to start. this is larry loo, outgoing chief financial officer. first, i want to thank abbie for

really going through the process and allowing me the honor to serve the city during these trying times. it was an incredible experience and highly recommend it to anyone who wants to serve the city, it opens your eyes to what it takes to get things done. as i mentioned, as a city native, i was born at chinese hospital. i am a city boy through and through. and it was really just a great opportunity for me to help in any way possible to lend whatever experience and background i have had with the industry to help. i want to thank the staff and finance and contracting area.

to all those who helped and keep the financing for our trust fund active. and keep our procurements underway and help us with the general fund budgeting and sustainability fund. the numbers don't appear by themselves. so really they are a special team and they have also taken the extra step to come in to process checks. checks don't process themselves either. they made it through for lack of mass transit to come in once every three weeks the make sure things were going smoothly. i want to thank mitchell griggs for welcoming me on board.

that's all i wanted to say. >> good afternoon. it's a pleasure to be here. my background is on the provider side. i have worked with all systems, southern, dignity and el camino hospital before come together this position. i look forward to kind of completing the other side of health insurance to make sure we provide affordable care and good quality. and then larry has helped in the

transition. we've only had two weeks to work together but i appreciate the cooperation and help and patience he has given me. and also met the staff, so we have a good team here and i'm happy to be here and look forward to working with the board moving forward. >> thank you very much to both of you and best wishes larry. moving on, personnel changes, i did also write into my director's report kind of a well kept secret in that mitchell griggs is planning his retirement next year. so we are going through a recruitment process now to fill that position. i'm not saying replace mitchell, we can't replace mitchell but we'll fill the position with someone else who is qualified to

perform the duties of the chief operating officer. there will be much more to come as we go through the selection process and goodbye process with mitchell. i'm sure we'll have celebrations and farewell send off to him. he will have been with us 10 years next month. and has contributed a lot, i think, to the operations of hss. so much more to come on that. we did want the board to know. we are going through the recruitment process and hope to have what we have seen now twice, of various degrees, an overlap of outgoing executive with incoming executive, we find that that ensures a smooth transition. that's what we're aiming for with the chief operating officer position as well. in other matters on my report, i

know larry worked with aon and has provided some language in my director's report talking about how we're going about the rebate audit and so that is the approval process is underway, it does take some time. and then we'll bring the results depending on what they are, if they need to have a committee, we'll consider that as an option or the full board. the blackout period as you know continues. we are at the beginning of the 22 rates and benefits cycle to plan year 23. leticia harris has provided a racial equity action planning update and that's in the report and speaks to the upcoming holiday celebrating the life of martin luther king. our work in that area continues

and i appreciate her leadership and keeping us engaged and informed in the areas we are still learning. you did hear, again, from public comment on the disorder services. we -- i have spoken to mental health and particularly mental health with public safety to this board for the last two years. we were able to secure additional services starting in april of 2020. i believe i have commented on this almost every board meeting. it is an destroy in great flux. there's a great demand and the services are bouncing all over the place right now. the workforce is not adequate in numbers and they're shifting as new employment opportunities present themselves within the service arena. we're keeping up with that with our partner health plans.

we have spoken to them directly about these particular programs that this gentleman has brought to our attention. we are learning and considering what options can and should be available through our mechanisms versus other mechanisms. there are several models in the city on how the services are provided. we're keeping up with all of that, we've had a couple of really good in depth meetings and we'll be able to advise you on our ability to engage these services through our health plans. we're not inclined to do direct service contracts as you know. it is problematic for a lot of reasons. so it is much better if all services are through the health plan, particularly with substance use disorder. one of the things i would ask the board to keep in mind is

that the clinical assessment of a person prior to going to residential care is incredibly important because often the addiction is disguising underlining conditions that can be quite dangerous if not screened appropriately before going to a residential care service. on the flip side, when one returns to their prior life after leaving residential services, it is clinically very important they are engaged in the local care system. it is pretty serious disease that folks are often prone to relapse and so if they have a local resource to shore up their services, it helps ensure a smoother stabilization period. there's a lot to be considered. we know that mental health is of interest to all of us and is a

key factor in our strategic plan and a key factor in our work over the last couple of years. and we provided a transparency update in the report with the new regulations in place. this will -- this is kind of one of those things we'll have to see what really -- how that available data does change practices. so there's more to come on that. there's information about that in the director's report. holly provided the quarterly e-mail outcome report and the divisionle reports are embedded as well. the one thing i wanted to kind of pull out, i spoke at the last meeting about being able to do our projects with help of an outside vender to help us on programming needs that we need. and our initial plan was to kick that off in april.

that start date is now up in the air, we weren't able to secure through the process an adequate support service. we're looking at any and all options at this point, hoping to find a way to do some of the auditing this year. we think it is a very important business practice that not only may find fraudulent behavior but sends a message to our membership at large that that won't be tolerated. so, we're in the process now of kind of figuring out what the operating plan is to be able to do some -- to have a process that is embedded at the agency and done on a regular basis. so more to come on that. i think that's all the highlights i have out of the report. happy to entertain questions.

>> so i'll open it up to board members for comments. >> abbie, this is randy scott, could you provide a little more detail about the diva process. were we not able to get the venders we wanted, was it pricing, timing? i'm -- just clarify that a bit. >> i'm going to ask mitchell to respond to that if i may. >> thank you. >> so the timing of the audit -- >> the ability to secure the resource we needed to do the diva. >> right. finding a solution, so right now, we are looking at -- if we do something like abbie

mentioned, a lesser population, that will give us a little more time to work on the rsp and get specifics on what it is doing eternally. so, we're not really sure. this would allow us to do that and select someone and start that and get it going to do a full audit in 2023. >> so mitchell, i thought we did it and it didn't yield the results we needed. >> right. so we're doing another one. we're expanding.

they were not able to do based on the review of the rfp, there was only one response as i recall. they were not able to comply. >> i would just say i'm sure you are very aware we went for a long period of time prior to the last audit, this last process and i'm just concerned that we engage and follow through even on a limited basis to commit ourselves to do this in a best practice way. so, i just wanted to get a little more background. thank you. >> yeah. happy to hear your support. that is precisely the conversation we were having this week. how do we keep that commitment

going. i think we'll find our way. >> any other comments? i guess i'll take this moment to actually thank larry loo for really an incredible job in what seems like just yesterday when you joined us. there have been evident changes in the reports and with education to all of us on the board and membership at large as a result of your contributions. so your legacy will move on -- will continue on despite your moving on. i'd also like to welcome mr. hussein, as someone who moved from the provider side to now the contracting side in my own professional life, i think you will find this position now both challenging and rewarding. and your expertise and

background will be of immense help. mr. loo has set a high bar for excellence and i have complete confidence having seen your cv that you will meet the challenges and with pleasure and a smile which is important for all of us. again, thank you to both of you for your fine work and for taking on this assignment. >> i'm having video problems but i would like to make some comments as well. >> yeah, supervisor zvanski -- >> not supervisor but -- >> sorry, commissioner. >> thank you.

i wish to thank larry loo for his service. i was incredibly impressed with his background and what he's been able to bring to our board and to the system for the time he's been here. it really speaks well for his background and i think the chinese health plan is very fortunate to get you as one native to another. but i think that i just want to thank you very much and we are very impressed with what you brought to us. and i want to welcome mr. hussein. i'm going to practice your first name a little better. it sounds like you bring to us a special and unique background and we obviously need that because of the kind of work we do. i look forward to your service

and the last thing i want to comment is that i think abbie, you pointed out how you have been speaking about mental health issues and services for the last two years and you're absolutely correct. there is a process. what i want the firefighter to understand, who has both written to us and now spoken, there are processes that we as a city agency must go through and we have made decisions overtime. i think there's no question that during this time, all of our emergency services are overtaxed and necessity for mental health services is huge. we understand that. but there's collective bargaining, you have a bargaining process within your department, within all of our departments and also there's a process we have to go through in terms of rfp's and when we bring

in programs and if we're going to decide to do any special contracting or work through our plans. and so, i just wish this colleague, this employee would understand that we would like to fit them into the process and consider the recommendations but we need to be consistent in how we do the work to bring what we hope would be the maximum services to all of our employees, especially our emergency service responders. i think all of us on this board value them and are very aware of their needs and service to the city. but we have to stick to a process that is not to say no, we're not shutting out the recommendations, we're saying there are other ways to maximize having the opportunities

available to the active employees who will need them. and also to those who then retire and take leave from the service for mental health reasons. we need to make sure that we can maximize the benefits that are offered. but there's a process to get there. and for this employee to respect that process and work within our system to make that happen. >> thank you. other comments from board members? if we could maybe not debate some of the issues, it would probably be healthy for us. supervisor chan. >> i just really actually some

of the comment already, to thank mr. loo for your service. also very pleased to hear you are going to the chinese community health plan. my mother, her first job in san francisco was a processer for chinese hospital and second job was with chinese community health plan as enrollment coordinator and my first internship in high school was office clerk filing papers at chinese community health plan office. so nothing pleases me more than to hear that you're going to serve at chinese community health plan. i think we are going to miss you. here, i didn't have the good fortunate to get to work with you as long as some of my fellow

commissioners have. congratulations on your new post and i look forward to also welcoming mr. hussein and so glad that we get to have you on board. so fast and be here with us and also thank director yants and just working over the holidays to really get and stabilize to make sure we have both outgoing and incoming cfo in great timely fashion. and want to thank you for working with our firefighters and making sure they will take the appropriate steps to get the care they need. i for one do not know the process, and really still learning a lot more from you. sorry to hear that mitchell has

to move on, i concur with you the fact we can't replace him. you can't replace the expertise and institutional knowledge of a decade. but i trust that all are well and all in good hands in your hands. thank you director yant for your hard work and thank you president follansbee for allowing me to make remarks. >> other comments from board members or questions or -- >> go ahead commissioner scott. >> go ahead. >> i will be brief. thank you mr. loo for all you brought to the health service system and thank you for your commitment to all the lives that this system covers. so thank you so much.

and best wishes at your next gig. and welcome mr. hussein. we look forward to working with you. i want to say as a public servant, i hope you get the public service fever and enjoy the work you'll do as a member of this team. >> thank you very much. i'll call on commissioner scott again. >> yes. mr. president, i would like to offer the following motion that the board commends and thoroughly thanks larry loo for his service and commitment during his tenure as our chief financial office and wish him well with the chinese health plan. and we would like to welcome to

the health service system, iftikhar hussain as our new chief financial officer and look forward to working with him. i present that as a motion. >> can you do that motion without it being -- >> second. >> on the agenda? >> yeah, why not? >> i think it's a good question. we need public comment on this. but i think you're right, there's no posting. >> it's not an action item. >> i would then defer that we adjourn the meeting with that accommodation. >> okay, that we can definitely do. assuming there's no objection to that. >> i think that's a motion in order for any item.

i think it's a good motion and i wanted to second it. >> can we ask our attorney to comment on the process at this point? >> yeah, i mean, technically, if you want to vote on something and take official action of the board it has no be notice as an action item, otherwise it is a discussion item. if you voted, it wouldn't be legally an official action of the board. if you -- if you want to characterize as a discussion and take a poll, that would be okay. >> so -- >> while adjourning the meeting. >> so commissioner scott, could you withdraw your motion but reinstate your recommendation for accommodation to be noted at the end of the regular meeting today. >> i will do that mr. president, thank you. >> thank you very much.

okay. thank you very much commissioner breslin for bringing that up. i think it's an appropriate question. any other questions or comments for director yant at this point? >> i agree with all the comments about mr. loo, although i don't think i ever got the chance to personally meet him because of the pandemic, face to face. i welcome our new mr. hussein. so i mean to be brief here, too. thank you. >> thank you very much. other questions or comments? >> i just want to say -- this is commissioner zvanski. i apologize, i forgot mitchell, i hope there will be more time for us to talk about mitchell and commend him for incredible

service. >> any other questions or comments? hearing none, i open it up for public comment. >> thank you president follansbee. i'll share the instructions visually and read them. >> each speaker is allowed three minutes to comment in length unless the board president deems new time limits during the meeting. as a reminder, the caller may ask questions of the policy body but there's no obligation to engage with the caller. when your three minutes have

ended, you'll be placed on mute and moderator will unmute the next caller. remote viewing is available. opportunities to speak during the public comment period are available by dialling the number on the screen. the dial in number is 415-655-0001. again, 415-655-0001. when prompted use access code, 2498 558 9355. again, 2498 558 9355. then press pound and pound again. you will then enter the meeting as attendee and dial star 3 to be added to the queue. when the system message says your line has been unmuted, this is your time to speak. for those on hold, please continue to wait until the system indicates you have been unmuted. sfgov tv has a standing 45 second delay for the live

broadcast online. we will take a pause to allow the systems to catch up and callers to dial in. it starts now. (please stand by...)

. . . >> thank you very much. we will now close agenda item number 7 and move on to agenda item number 8. >> agenda item 8 is hss report

as of november 30, 2021. this is a discussion item. this will be presented by chief financial officer larry loo. >> thank you, commissioners. happy to present and some of the highlights of the financials for the san francisco health services system through november 30, the first five month of our fiscal year. and in the board commissioners packets and also available on the website to the public. we are five months into our fiscal year and important to note that the fiscal year starts in june and ends in july, but the plan year starts in january and ends in december. so we're at the cusp of getting into the end of the first half of the year and rolling into the new plan year. having said that, and this is a

reminder to the commission that the commissioners that we have several sources of funding. one major source is the trust and then also the general fund budget which serves as our really operational budget. and so in the trust and the balance of $123.4 million. as i mentioned in previous report, it is a little too early to tell exactly where we're at, but the first five months that is kind of where we are. but with regard to our funded plan, we are projecting to have a variance of $77,000 to the fund balance that does include the projection of $8.7 million in the pharmacy rebate.

year to date we received a little less than half of that already. and an additional source of revenue to the trust fund is from performance guarantee. typically we prefer to see it as low as possible. these are agreements that we have with our plan and administrators that if certain things such as the calls are not getting picked up in time to the extent we both agreed to, there are things to monitor. and we received $21,000 in the form of the securities. an additional source of funds includes the income from interest. that is typically posted by the treasurer's office on the schedule. typically that happens closer to the year end and as the time of this report, there is no interest posted.

with regard to the funds where we do build a budget and use debt for communicating our benefits, developing well being programs for all of our members and covered under sfhss and also creating initiatives to reduce the cost of health care, that fund is projecting a fiscal year end balance of $2.7 million. and then moving on to the general fund administrative, that is our administrative budget. we have that intended to be net neutral. currently we are showing a surplus of $492,000. we do manage that to have a no surplus, no shortfall position. and with everything all told, currently projecting a fiscal year end change of a smidge above 0 or an addition of $3,000.

>> thank you very much. and i open up the floor for questions or comments from whole service board members. >> i have a question and the point and what i see in these fluctuations are some of the figures going to and that works out. and expected sooner in our fund. >> yes, that is the plan in effect.

that is probably good opening salvo to the mrabing that is done for the rates and benefits. when the rates are set, there is a projection on where claims and expenses are projected to be on the funded plan. there are fund that are used from services in the past and the funds and decreases in the in the area. and building up reserves and a couple of points on that is pay attention to what utilization which drives cost and then it will drive surpluses and expectations along those lines. and in the long term in the last several years, everything netted out to be on balance.

in other words, no shortfalls or gain. on dental, however, there were surpluses on the self-funded side. and so there is a strategy to mitigate that. >> thank you very much. >> any other questions or comments for mr. loo? hearing none, we will open it up for public comment. >> thank you, follansbee. instructions for public comment will be displayed visually and i will read them aloud. public comment will be available for each item on this agenda and each speaker is allowed 3 minutes unless the board president deems new public comment time limits. all public comments are made concerning the agenda item that is presented. a caller may ask questions of the policy of the body but there is no obligation to answer or engage with dialogue with the

caller. you are encouraged to state your name clearly although you may remain anonymous. i will thank you for your comment at tend of 3 minutes, you will be placed on mute and the moderator will access the next caller. opportunities to speak during the public comment time period are available by dialling the number on the screen. the number is 415-655-0001, meeting code 2498 558 9335. again, 2498 558 9335 and press pound and pound again. you will enter the meeting as an attendee on the public comment call line and dial star 3 to be added to the public comment queue. when the message says your line is unmuted, this is your time to speak. for those on hold, please continue to wait until the system indicates you have been unmuted.

sfgov has a standard 40 to 45 second delay. we will take a 45 second pause to allow the systems to catch up and callers to dial in. the 45 second pause begins now. the 45-second pause has ended. the moderator will notify of us

of any callers in the public comment queue. >> we have three callers on the phone line. zero callers have specifically entered the public comment queue at this time. reminder to all callers to dial star 3 now if you want to join public comment for this specific agenda item. we will wait five more seconds and 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. >> this closes item 8. let's move to ie agenda item number 9. >> thank you, president

follansbee. mayor's budget instructions for the sfhss general fund administration budget for fiscal year 2022-2023 and fiscal year 2023-2024. this is a discussion item and will be presented by hss chief financial officer larry loo. >> thank you, commissioners. i am here to present the mayor's budget instructions for health services board as we are doing annually, we are building a budget, a general fund budget for the biennial period for fiscal 2022-2023 and 2023-2024. it's an annual cycle that is driven by the mayor's office for all intents and purposes sfhss

staff is treat as a department within the city's budgeting system, and this budget rolls up into the mayor's budget so that is why we have the instructions for this budget are important. the mayor's budget office released the instructions and on december 15. we'll pause to note that there was significant good news by the mayor's office. for the first two years there is a projected surplus of $108 million and followed unfortunately by some structural shortfalls, so this is incredibly good news and a significant turn around from the liability of last year when we were projecting significant deficits to the tune of about half a billion or more. what's driving this is to point this out here and the newer

sources and coming in greater than what was project bid the controller's office, and so that is driving one source of that. one of the drivers of costs include the liability for the retirement system and all the benefits that they must convey on retirees. and quite frankly, they had a record year in terms of returns on their investment. it was stated the return and their assumption was about .2% return on investment but their actual was about 33%. so what that does is reduce the future cost estimate for the city as a whole. the other driver of better than expected income for the near term is the extension of the emergency relief dollars.

and not necessarily a good thing because we are still in an emergency. however, there are dollars flowing into the system to offset some of the expenses. and the other driver to the positive view of the next two years is that the operating costs of the city's departments have been moderated. they were not clear ex-pend which you ares as quickly as anticipated. so with that in mind, it is very good news. and the cities and the mayor's office and the priorities going into this budget setting cycle to restore vibrancy of san francisco including public safety and street conditions, most notable there is a lot of activity to insure that the streets are safe and clean. so that there is more commerce to be had in the city which, therefore, drives the revenue.

the focus is also in recovering the local economy driven by returns of residents and tourists and even office workers like ourselves back into the office so that that drives the economy. n internally or at least more specific to city services, really wanted to reprioritize the funding to improve core services and what really is working and what is not really working. there is a push towards more accountability and equity in programs and services and the way that we account for that and the way that those are prioritized moving forward is also a priority for city. so with that there are some specific instructions that the department must abide by. first, there is no mandatory reduction. so not only will it pause for positive comment there, but everyone who has worked on the budget at hss has experienced

reduction targets every single year and this is the first year there is zero reductions. the flip side to that is no targeted enhancement, so we're not supposed to be putting enhancements into our budget. the focus should be going back to basics filling the funded vacancies in a lot of the departments. some of the savings that we have mentioned above include the fact that it's been tough filling some of the vacancies. and so there is a big push to insure that we complete the filling of vacancies that are budgeted and keeping this budgeted vacancy. and focus on programs that produce meaningful, ethical results. and quantifying that and our other departments are focused on having those departments balance their budget within their own revenue projections for the

non-general fund departments. what are the implications to sfhss? first, this kicks off the budget setting segment. we have worked with managers to identify what are the needs for the next two years. we will be developing the general fund administrative budget as well as the health sustainability fund budget on parallel tracks. we will have to have that go through the budget and finance committee and to the full health service board and are required to have two public hearings to ask for public input and to track that. and the most significant change this year is also that there is new budgeting software so that should make the process a lot more efficient in terms of turn around times. however, with any new system, there are hiccups, so our staff and trained and provisioned to add software and we are ready to

take on the challenge. with that, that concludes my report out on the mayor's budget instruction. i will take any questions. >> thank you very much. it seems encouraging and a challenge. i would like to focus on the priority of restoring vibrancy. i can speak from my position as the board that vibrancy is about people, and that includes our active employees in the employers that contract with us including the city as well as early retirees and retirees and their dependents. and so the challenge includes mental health, substance abuse, counseling and improving on that as well. i think we can meet this challenge not only to restore, but maybe exceed vibrancy that we have been used to in the past. i think this is a great summary of what we're facing for the

next two fiscal years. thank you very much. any other comments or questions from board members? i am glad there is an emphasis placed on accountability and equity and that is the past strategic plan and priorities as well as as well as the program that we have been putting in place for diversity, equity and inclusion. so i think that these priorities overall are not going -- we are not going to be misaligned in the current and future thinking as a board around these issues.

those are the strategist and goals we are about to put in place. >> a commissioner follansbee, i would like to support what commissioner scott indicated and also just to comment when i see no mandatory reductions on a budget year, i am so thrilled i can hardly speak. that was some of the best news and it looks like we will have good opportunities going forward for the next two years. so that's great news. i think this will be able to maintain service and do what we plan to do for the next two

years. thank you. >> thank you. other comments from board members? >> commissioner, larry, this is great news. i was a longtime san francisco public servant as well. so that you are able to fill all funded vacancies is like magic, and i guess that begs the question, how many unfunded positions do you have? >> we have about four unfunded positions actually. and one of the things with budget proposals and requests, and will be trimming that out to look what we need going forward with all the programs we are trying to support. >> great. thank you very much. >> thank you. important point. thank you.

any other comment from board members? i would also say the agenda item number 11 strategic planning process will have the chance to see the budget instructions incorporated into the planning process as well. hearing no other comments, would like to open this up for public comment. >> thank you, president. our instructions are being displayed visually and i will read them allow. public comment will be allowed and each speaker will be allowed three minutes to comment in length unless the board comment deems new public time limits. you are encouraged to state your name clearly, although you may remain anonymous. you will be placed back on mute

after the 3 minutes and the moderator will unmute the next caller. remote viewing is available and opportunities to speak are available by dialling the number on the screen. the dial number is 415-655-0001. again, 415-655-0001. when prompted use access code 2498 558 9355. again, 2498 558 9355. then press pound and pound again. you will enter the meeting as an attendee on the public comment call line and dial star 3 to be added to the public comment queue. when the system message says the line has been unmuted, this is the time to speak. for those on hold, wait until the system indicates you have been unmuted. sfgov tv has a standard 40 to 45 second delay for viewers watching online. we will take a pause to allow the system to catch up and callers to dial in.

our 45-second pause begins now. the 45-second pause is ending. the moderator will notify us of any public callers in the comment queue. >> we have three callers on phone line. zero callers have specifically

entered the queue at this time. 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 will wait five more seconds and 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, this is closed. >> this closes agenda item 9. i would like to move to agenda item 10 which we postponed from our december meeting and then i will promise everyone we will take a break after the completion of agenda item 10. >> thank you, president follansbee. agenda item 10 is a board education item, health insurance portability and accountability act, hippa and is a training and

discussion item and will be presented by rin coleridge, enterprise system and analytics director. i will be passing over the presenter privileges to you momentarily. >> thank you very much. good afternoon, commissioners. i appreciate your time today. and as soon as i get those privileges, i will share my deck and we will get started. >> it is coming through clearly. >> great. thanks for acknowledging that for me, holly. so let's get started. rin coleridge with the health service system. and we are a covered entity and

as such we must rely on the accountability and health information technology for economic and clinical health act, also known as hi-tech. the recent change that occurred last year is sfhss is designated a component of a hybrid entity, which is the city, along with other departments that fall under hippa requirements. for example t department of public health, fire department, city attorney, department of technology, and treasurer, tax collector. and that is an administrative construct to help simplify when we have to go out and do various legal compliance items. compliance requirements do extend to health service board commissioners and in the presentation we're going to provide introduction to the sfhss privacy officer and that will as well as your role as

commissioners and a general overview of hippa and the penalties and the practices to which we must adhere. i know many of you are conversant with hippa and so the details is in the latter part of the presentation because i want to focus the little time we have today to let you know about how does your role intersect with hippa and what you need to be aware of. hippa does not override state law and we are mindful of the state regulations that we have to comply with and so especially that are as protected of hippa and today we are focussing on the federal regulation. we will let the privacy officer and a look at my credentials. i don't need to read them. the privacy officer is part of the hippa regulation and within

that role i am a resource for you. so some of the requirements in that position are to deliver training so that is part of what we are doing here today. and also to develop our privacy policies and procedures to make sure those are implement and receiving and investigating and responding to any requests and logging disclosures and filing annually with health and human service. regularly monitoring our compliance around those hippa regulations. taking a look at the data we have and determining the classifications and that final bullet point, i want to stress that i function as a resource for any questions or concerns. and really if you ever are unsure, ask a privacy officer prior to releasing information. and that is how we make sure we remain compliant and keep everyone protected.

let's talk about your role as commissioners for the health service system. and on the health service board. i think one of your activities is that you receive, consider, and act upon member second level appeals. as part of this process a significant amount of protected health information is shared with the board. there are times that you are also receiving communication directly from our members outside of the apeels process and our membership does reach out as individually. and while a member can share any of their information, somebody is allowed to do whatever they want with their own information, but once you receive it, it is govred by hippa because we are part of the covered entity and you are careful with that data and make sure you treat in it a compliant manner. it doesn't matter how you came to have that information.

once you have it, you are bound by hippa. so one of the things like to share as a good takeaway for helping us stay compliant and protecting our members information is to always comply with the hippa minimum necessary requirement. essentially i am not sure a named person with rights to receive the information and we have ways to do that on our website in the privacy section. you will find all the hippa authorization forms that members can use to designate a third party be allowed to receive that information, but just being a commissioner does not grant you that permission to anything other than minimum necessary. an example might be follow-up information on what happened for the members who contacted you or participated in the appeal process. and that is not necessarily a requirement for resolving the issue. so minimum necessary is really the minimum amount of

information needed to either resolve the issue or complete a task or objective. that is what we mean by minimum necessary. we're always questioning ourselves with regards to me to answer the question do i need to share item a or are b and c also necessary. and fairly often you can really limit the amount of information you are sharing and still achieve the end state. and another activity as health service board commissioners is to be compliant with training requirements and i would like to extend mycin sere appreciation to all of you for completing your 2021 training by end of year so that kept us as a department completely compliant with insuring we did that. and i do believe hss in terms of insuring the commissioners also

have this information and practiced in cyber security. that is a little bit about what you are allowed to do. and that is local rules under hippa but the main are the privacy and the security rule. under the privacy rule, we are able to use and disclose phi for treatment, payment, and operations without having that explicit written consent that i referred to in the previous slide. but that did not mean, oh, hey, we all work for hss and are all on the board, so we can always have that information. no, it's really specific to, are you working on one particular issue? and so we see that frequently on member services and might have a role in resolving an issue that doesn't involve a member of finance or communicationser to welding team. it is not an umbrella, hey, we are hss and deal with benefit

administration and we all get to do this stuff. nope, it's very specific. you can always provide information to the individual who is the subject of that information. our members are allowed to have their own information. i did mention that for third parties the way they can be granted information is by obtaining written consent and we do have all those hippa forms on our website. and those are reviewed to the officer prior to releasing any information. there is some discretion they utilize in making a determination to release data under certain conditions and finally, one of the ways that we release data is by de-identifying that data. fit's got on the a point where it is no longer personally identifiable, we are okay releasing it. there are two ways to do this

with hippa. one is this scientific principles to make sure that we have reduced the data to a small risk to identify an individual. we do not use this data in how you define an expert and what are the scientific principals that you want to apply. we're going with something that is much easier for everybody not to deal with the data. you don't have to be an expert. this is accessible to everybody and that is the safe log-in method. we remove 18 type of identifyers and once we have made sure they are not in the data or information we are releasing, we know it's being de-identified and that keeps us hippa compliant. we will look at the identifiers in a moment. here is some of the department practices for insurance and

compliance. and that is the primary entity is always accountable for the protection of the information. so that is us. minimum necessary we talked about this but we limit the amount of personal information we collect, use, or share to only what -- to having a clear reason for why it's needed to take care of those activities. we do not discuss people and our members information outside of the treatment, payment, or operations. if we are discussing with within that realm, we do in it a secure manner. some secure mail. it is not in a public setting whether it is an elevator or health service board meeting or break room and only to the individual who is have a need to know it so there again, you may find at different times as your roles as commissioners you

interact with phi but your need to know it may vary at different times for the process. we do not put any phi or pii on our own computers. we keep that on secured servers that aren't something breaks into -- you have heard the stories and people leave the laptops in the car and sitting there with a coffee at a coffee shop and grab the laptop and runs. that is the world we live in. we do not put any phi or pii on those machines. pii is personal identifiable information. if we have hard copies of items that have to be shredded, we have those and i have a compliant manner when no longer needed. phone communications is another area to be careful. we don't leave voicemail with specific information if we

haven't actually reached that individual on the phone, we will wait for a callback because you don't know who is picking up the voicemail. essentially if we don't need the information, we don't store it. leaving that information around opens us up to risk. and there again, back to the privacy policies and forms that i have mentioned, there is the url for it which you don't have to remember. if you are on any page and you scroll to the bottom of that page in the footer you will see a link for our privacy policy. and of course, we must complete required training. we have done that already. and when we talk about no phi or pii on computers, we also have to be careful about hackers, right? they can access our systems. and then get into maybe even the other systems that we've got more secure down. and that is why we are providing

all of our health service board commissioners with laptops. and recently sent off by our executive director. abby. but this we find is a really critical piece as well because we want to make sure we can fully protect the systems with the end point solutions. cyber security integrates strongly with hippa because some of things that we can control like us learning about this so we know what we should and shouldn't do and there are the very capable threat actors and the items they can do to insure one less risk in terms of your own personal computers and who you have using those personal computers. and what sites will using the secured provided hss labtops

that you have for the protections on it and do remote support and making sure it's upgraded so you have to latest protections. those also are in the way. if you suspect any type of information about how to protect and go about securing it, please contact me. i am your resource. we want to make sure all the questions are being answered and empowering you before we do something we don't want to do. we went a little bit out of sequence, so let's quickly talk about hippa. what, why, how, boom. but it comes into use and transfer of false information. iesz essentially is basis of this is to protect the

continuity of care if they move from providers to specialists or to other hospital systems, so it's really both side of that coin is allowing the data to move but allowing and putting controls about how we do it so we know we are doing it in a way that helps protect personal privacy and what hippa applies to. medical, dental, prescription drug, long-term care, health and flexible spending care accounts. all of those are bolded because those are items the hss admin registers. what it doesn't apply to, long-term disability, worker's comp, accident or life insurance. and so we have a little bit of those as well. and it does apply to covered

entities which i have said we need that definition. and any of our business associates or subcontractors. so we work very closely with our contract team to have the proper legal documents in place before we share anything with our associates. and we all have a role in that privacy governance. so protecting members privacy and the security is just as important as assuring quality health benefits. i talked about phi so thanks for bearing with me if that was a new term for you. so when you take a component and mary that up with health information, we have protected health information. it is considered any

identifiable health information whether it's used, maintained, stored, or transmitted by a covered entity or our business associates in relation to the provision of health care payment or services. but it's not just past or present information or current that is aid. it is also future. it is also doesn't just have to be written or digital data. it can be verbal. it comes in any form. physical, electronic, etc. and so all of health information is considered phi when it includes any kind of individual identifiers. so back to a point i want to stress with you because members reach out to you directly, it is phi and it falls under hippa and doesn't matter how it came to

any of us. we have to protect and treat that data very carefully and who we're turning around and then sharing that information with really has to be only those that we have the protections in place that are for the treatment payment operation aspect but not just this is what i did at the office today. all right. let's talk about the 18 identifiers that i really like to use for making sure our data is accessible and you don't have to have any advanced statistical degree to be able to do this. you pull out all the items, names, geographic subdivision smaller than an estate, and any kind of dates. you can go with year and as soon as you have added a month to that information, that becomes identifiable. phone numbers, email addresses, medical record numbers. any kind of account numbers. and you can see the list but url, internet, and so the ip address cans be traceable to

individuals by a metric identifiers and finger, voice, and facial recognition as well. and number 18 is that catch-all. any other unique identifying number characteristic or code. so if we do need to share information outside of ppo, we render it as non-phi and to do that, we remove all of these items. frequently the zip code you can only do first three digits and no further down than that. as i mentioned earlier, there is a couple of components of the hippa and the privacy rule and the security rule. and so i briefly mentioned earlier that the privacy rule is really about establishing those standards to protect individuals and medical records and other personal information. and the security rule is where we get into all sorts of layers of protection for that

electronic phi and that gets subset further. we don't have time for that today, but into physical controls and that might be access to administrative controls and these are like pause words and log-ins and other technical solutions, such as when we equip information, for example, to keep that data confidential to make sure that the data is accurate so that is speaking to the integrity of that information and the people's information isn't changed in the way it should have been changed. it is available which means whether the members are requesting their own information or we need to be able to provide that information to the provider, we can get to it. we haven't done so much locking down and the annual security service training is what helping you understand on a high level how to protect some of that information.

and just a little note there are violations that you can encounter, so these violations are across four tiers. and they can go from tier one which you are looking at, like $100 per violation all the way up to a tier four which you are looking at $50,000 per violation and upwards of 1.5 million per year and i assure you we don't have that type of money to spend even though it sounded like a good budget report from the cfo. the difference between the tier one and tier four is really all about if you are completely unaware and maybe if you would recognize some due diligence, you might have known how we have a risk here all the way to willful neglect meaning that you knew you had a risk and you had no effort whatsoever to correct that vulnerability, and so that

is how these get assessed. but i want to let you know as well as the civil money penalties, there are criminal penalties that we can face, which include up to 10 years in prison. they could be lawsuits. it could be loss of a medical license. it could be employee termination and so these are significant. and at any time if there is more than 500 individuals in a certain geographic area affected by a breach, we have to notify outlets and the california attorney general's office and we want to make sure we are compliant with all of this information. and with that, i will bring my presentation to a close so that if there is any questions, i am more than happy to take those. >> thank you very much, rin. it does complement the training that we have taken and the

mandate to take yearly, so i appreciate that. with that, i will open this up for questions or comments from board members. >> this is the board secretary. rin, seeing that the presentation is still up if you were trying to take it down and screen share. >> is it still up? >> yes. >> i lost the nice bar that makes me stop doing that. >> mr. president, i would only add to your comment about this presentation supplementing what we have gotten in our training, and we speak to this in the terms and governance provisions that we have talked about in terms of policies and regulations that apply to the hss board. and i particularly like the fact

that, rin, you tailored some of the comments to our roles as commissioners. that was very useful. >> thank you, commissioner scott. and part of the reason for that as well is because in that hippa requirements we do have to do annual training and i know there was a couple minutes of hippa overview as part of the security training and this is requiring about our own policies and procedures. you use the third party tools, they are not talking about what we at hss expect. >> thank you. and if i could add to this, i think that two points. one is that the hippa rules are never supposed to interview with the actually delivery of care, but we are not delivering care in our functions, hopefully that is not an issue. but as a member of the board f we get a specific issue from one of our enrollees who don't know

where to direct the issue, it might be better as an intermediate step as to sort of send a jenin kwirry to the person we think might be responsible without forwarding the message saying i have an inquiry about benefits around the dental care or something like that. are you the one who should be dealing with this issue before we send off this message and it may go to the wrong person and department and technically that would fall into a violation if we said to someone who really should not have had that information and the wrong department and person and puts one more step in there if we are not sure where to forward a concern or complaint as a board member, we need to ask generically and not specifically before we forward it. >> i would only add to that the first stop should be to abby and i would recommend as a board

member and then certainly she can get it to rin or whomever. but i think that if we get those kinds of messages from members containing this information, the two of them should be kind of where we're sending that initial email. hey, i have received this. how do we want to process it? >> we have a pretty strong system set up for the board email and that was a risk and we shored that up so the emails come to holly, mitchell and i and we make a determination on who will address it. what we don't do is we don't tell the board what we did with it. because that is where the -- you have handed that you have to us. we have to be super careful we don't get into specifics of specific cases. we will on occasion and you may not even know sometimes when we bring things forward that have

been addressed and maybe affected more than one individual or something like that. and we have the responsibility to take affect and so we will come back and tell you about something new we are doing. and not necessarily tie it back to a single incident and that may indeed have been the instigator or something like that. we don't get into a discussion with a board member about how to manage a particular complainant. that gets into messy territory. >> again, just to alert board members sometimes members may have a personal email address for a board member through another route. and those are the times when our system can't really triage that in a way and monitor that. so those are situations where either we send it directly to

holly to deal with or send it directly to the director and not try to self-direct or whatever. i think that is a good -- the process is robust. and i think that it needs to be reinforced even if we get personal emails. we're trying to get away from that specifically. >> any other questions or comments? >> and this is commissioner and my original start date on the health service board was way back before hippa, so it's been interesting to see how things have changed over the years and rin, i want to thank you for this training and for the ongoing trainings in hippa because this, when it first came about, it was a very big issue and a number of staff were sent to specific hippa training, but i think it's essential for those of us on the board as well in my

personal experience and all the years that i have been involved with health service systems is a number of employees from all different classifications that will reach out. and either make a phone call or an email and when i have said, i don't need to hear all the details. these are projected, etc., etc., after hippa came in, what i find is that most employees because of their situation or condition or issue are incredibly willing to provide phenomenal amounts of personal information. they say, no, they're trusting you and willing for you to have it. what i also find is that when i can call abby or mitchell and say here's an issue and can somebody call back or someone in

customer service or whoever we want to deal with, when it is passed on, what i usually find is that employee will often call back and say this was resolved. it wasn't resolved. only this much could be and whatever and those employees are grateful for the assistance and very often easily relinquish what i would consider too much personal information. but they want the help and they are trusting of us. and so i think it is incredibly essential that we understand hippa and that we respect these rules and that we abide by them and we make sure that every effort is taken to ensure their privacy. what i tell them is don't give me all the details in your email. i have don't want it.

just let me know part of what the issue is and i can get someone who will call you back and deal with all those other essentials. but a lot of our members are just so desperate for the help and so trusting that they do share the information. so i think it's very, very important that we have this training and that we respect those guidelines and those boundaries, and that we work closely with our staff to make sure our members are protected. >> thank you very much. any other questions or comments from health service board members? >> i would like to comment that the line that keeps me on a narrow path and i would advise commissioners to do as well is minimum necessary. so should you have a colleague or someone that you know who has an issue and handles hundreds of the calls very effectively, and

please just take the minimum necessary information that will definitely protect you and is the right thing to do. so that we can promptly get to the concern of the member we need to talk to them directly. >> any other questions or comments? hearing none, we will open this up for public discussion. >> thank you, president follansbee. i will be pulling up the instructions. i will be reading our instructions aloud.

thank you for your comment. you will be placed back on mute and the moderator will unmute the next caller. remote viewing is available on sfgov tv channel 26 and online on web ex. opportunities to speak are available by dialling the call-in number on the screen. the number is 415-655-0001. 415-655-0001. when profrmented use access code -- when prompted use access code 2498 558 9355.

then press pound and pound again. enter that meeting an attendee on the public comment call-in line and when the system message says is line is unmuted, this is your time to speak. for those already on hold, continue to wait until the system indicates you have been unmuted. sfgov tv is a standard 40 to 45 second delay for viewers watching the live broadcast online. we will take a 45 second pause to allow the system to catch up and callers to dial in. i realize my screen is not being displayed. is that correct? >> yes. >> the instruction screen is not visible. >> only says agenda item 10. >> i want to post that for anyone who may need that and just give me a moment.

>> thank you for your patience. >> i will set our clock for our system and our 45-second pause will begin now.

the 45-stekd pause has ended. we will wait for the moderator.

there is still no callers in the public comment queue at this time. commissioner, hearing no further callers, public comment is now closed. >> thank you very much. this concludes agenda item 10. and what i would like to do is take a break now. it is 3:03. we will resume at 3:15 with a roll call and agenda item number 11. so a little break until 3:15 which is 12 minutes away. thank you. >> president follansbee, i wanted to make a note that commissioner hao did need to drop off for about 30 minutes and will return. and then i believe vice president canning has joined. >> president: thank you very much. we still have a quorum at this point, but we will resume with another roll call. thank you very much.

[roll call] >> thank you. president follansbee, we have quorum. >> i can call for agenda item number 11. >> thank you, president follansbee. i will be pulling up the screen momentarily. and agenda item number 11 is strategic planning process update and this is a discussion item and will be led by the leticia harris senior planner and program lead. i will be giving the presenting privileges over momentarily. >> please pass presenter

privileges to brian, that would be most helpful. the advanced strategic planning through 2020 to 2022 next slide please. this slide provides a brief overview of our agenda and i will begin with the review of

the perspectives with a profound and lasting process and discuss how the original strategic planning process framework has evolved over time. i will share a timeline of milestones with spotlights on tactical approaches and refresh activities linked to 2023 to 2025 planning cycle to seek input from the health services board and commissioners. next slide please. when we think about formative strategic plan perspectives, we are acknowledging our past, present, and future. what were we facing and thinking about when we put together our existing plan? what are the pieces of our reality in the current state and has anything changed about the reality for which we need to adjust in the future. when we designed our strategy in 2018 health care perform was a driving factor fining a line on

premium costs and affordable and carrier and provider consolidation and health and through the department and citywide and encouraging information among disparate partners. in addition to reducing cost barriers and simple i willfying membership and initial focal areas with opioids and maternity and fertility. in the pregnant day the covid-19 pandemic is a driving factor of market dynamics and keeping an eye on the pandemic's effect on employee turnover, not only for ccsf and provider retirement nationwide. over the last 18 months we have seen a virtual shift to care. the key difference now is it is being provided by those who have historically performed only in-person care versus specialty tele medicine vendors and the stress of the pandemic and societal events increase and the

number of members seeking mental health support and is responsive to this shift with the integration of well being and established citywide and emphasizing mental health and emotional well being. for the future we are aiming to link day-to-day work of organizational excellence and working to collect and leverage data driven insights around population health and also equity. building on the department's lean training to focus on employee engagement and member needs and continuous quality improvement and using pricing transparency to guide rates and advocate for providers to comply with rules and krinting to the growing body of knowledge involving health care value, cost savings and quality through our evaluations. areas of focus include ageism and emphasizing mental health and care agent mth and tapping into the unique sphere of influence to the organization's

goals. next slide please. as part of the strategic planning process we want to listen to the stakeholders and to manage, change, pivot and respond to member needs with the continuous improvement con cements noted in the blue arrow spectrum. for the 2023 through 2025 cycle and analyze the initial plan to identify successes and growth opportunities including what is driven and prohibited the implementation framework when it comes to making decisions, changes, modifications or additions. to identify the progress over the life of the plan and conducting an environmental scan

of the health care eco system to inform our go forward strategy. the strategy refresh exercise wills refine the quantity and scope of the business initiatives and measurable values to achieving mission and vision for 2023 through 2025. next slide please. this slide shows a timeline of strategic planning development milestones from the beginning of the timeline and milestones in blue which represent activities that occurred pre-pandemic. and back in july 2018 we had the innovation day to bring stakeholders around facilitated discussions to guide the strategic health philosophy and guiding principals and in august we engaged all staff around discussions to develop the foundational principals with leadership and staff. by september our plan had been approve and endorsed by the board and in june and september we concluded a two-part health

plan market assessment. the first part including analysis of health care systems models, friends, major players, contracting strategies and the second piece being an sfhss member focus group entitled your health plan options 2021 and beyond. we heard from many members in that feedback session and 34 unique departments clibt kribting to the inclusive strategic planning process. in the same month we are tapping our staff through the employee engagement survey to understand how we aligned with team growth, fit, voice, values and in october we solicited our members again for a premier open enrollment survey, specifically gauging customer effort and satisfaction using national benchmarks and our response levels grew from the initial focus groups to gauge 1,000 responses from 49 unique departments. and as we move to the right-hand side of the screen, i want to indicate red post pandemic

milestones to point out two previous strategic plan progress reports received by the board. one in november 2019 and again in march of 202. these reports speak specifically to the status of sfhss goals and business performance and key performance ind kaytors. in other words, how much of the plan is accomplished. i want to convey to the board that these previous reports are publicly accessible online and distinct from today's report which speaks to the methodology that is used to inform our planning process shortly after that preliminary report on november 2019 we leveraged the board's input and learnings and partnered with the controller's office to redefine quantity, scope, and as we advance, we see in red the post pandemic milestones and think about the staff and the work force conversion they took part in

extending the gratitude to them as we shifting to remote work environment and we want to acknowledge efforts of well being, finance, contract division that executed contracts in response to the mental health crises spoken to today. launching the app and customized wellness for first responders, current employees and retirees and our esa and member services work tirelessly to make member services e-benefits accessible to all sfhss members. in the communications division to lead a development of a comprehensive suite of webinars and with interdivisional support and health partners to acknowledge the gratitude to the board for the participation of the milestones in green and the rfp for health plans 2022 plan year that concluded in february 2021 as well as our medicare rfi and that concluded in december 2021. this time reminds us of

everything we have accomplish sod when we go forward, we will raise the bar and challenge the limits of our own capabilities. next slide please. enterprise systems and analytics is building an sfhss project portfolio that maps the rates and benefits timelines to interdivisional initiatives and annual reports, audits, sum system upgrades and the creation and manager of the portfolio will aid in the 2023 through 2025 strategic planning process. and this is because a tactical approach to project portfolio management involves the continuous process of selecting and managing the optimum set of project oriented initiatives with the portfolio management to strategy and balances the resources to maximize the value delivered in executing programs, projects and operational activities. some of the benefits include greater visibility, to ground

realities about resource utilization. realtime alignment of project timeline, increasing collaboration among the team members and reducing duplicative work and reimproving productivity and it helps to benefit governance and the portfolio helps to build structure timelines around reporting and project initiatives. this streamlines the evaluation of the progress and identifying barriers, interdependencies because we can use predictive scenario modelling that is mapped out in the timelines that the portfolio contain. and lastly, control. this tactic affords greater command of the strategic direction with day-to-day operation and strategic business having been clearly defined, refined and aligned through project portfolio management. overall the portfolio management focuses the organization on achieving what is needed not merely on doing what is best but elevating performance and not just productivity.

next slide please. we're always striving to convene multistakeholder experts to promote with and engage in unique sphere of influence as mentioned by the commissioners that involves a direct link between the budget and strategic planning processes. having met with the finance department, i can reassure there is a great deal of intentionality around meeting for the fiscal year 2022 through 2023 as well as 2023 to 2024 budgeting in anticipation of the february budget deadline with allocations for strategic planning and engagements of members, staff, and equity considerations. we are proposing another kickoff day and reminiscent of innovation day back in 18. this is projected for april of 2022. we want to bring together our stakeholders and have another meeting of the minds bringing together a broad set of thinkers and perspectives that help shape our current and future programs and services to best meet our

population's needs. this is centered in between a preand post refresh exercise with our leadership which will take place in march and may, again, wanting to engage all staff at every step of the process and build a consensus around the implementation framework for the future. we want to assure the board that existing data around active and retiree member engagement from focus groups and surveys will be analyzed to determine whether new touch points and data points are needed to inform contracts, programs and communications. we aim to deliver preliminary drafts of the next strategic praft in june with the presentation of the final draft in august. our health care board secretary with the scheduling of exact dates and the distribution of calendar holds pending all covid safety protocols in relation to meeting digitally versus in person as the pandemic is continually monitored. i would to thank the board for the ongoing endorsement of the strategic planning work and the

high level planning is a preview of the strategic plan refresh activities and deeper level workshoping to come and i hope this overview is helpful to you. thank you for your time. >> thank you. this is a great presentation to get us really starts thinking about this in a real concrete way. i recall the kickoff meeting in 2018 and how robust that was and i am confident that that meeting that prow proposed will again address really the changing landscape and a lot of the barriers and successes and changes that have occurred in four years since we had that meeting. that is great. i look forward to that. with that, i will open up the discussion and questions from members of the board. >> i would like to follow on the

comments of president follansbee. this process has evolved over the it racingses of my tenure on the board over the last five to seven plus years in terms of where we started and in terms of the first effort and for strategic planning and got more sophisticated in the june 2018 every ra and now we have taken it to another level and the presentation today is a good road map to that, so i thank you for your work on this. i look forward to participating in april as we go forward to complete the plan. >> thank you. other questions or comments? from any board members? >> this is commissioner zvanski. this is a wonderful appreciation. i appreciate it and a better focus and understanding of where

we're going and look forward to seeing how this all plays out. i think it is very thorough and well organized report. thank you very much. >> thank you. >> other comments or questions about the presentation or the sort of timeline for the future. it seems ambitious, but i am thinking that, again, the board has been doinged in leadership at hss and the board has been doing a lot of the work in prep pags for this as we have implemented the last strategic plan, so i think that all this seems quite doable and challenging and will be quite rewarding, i think. >> thank you to all the commissioners and president and the key objective to identify as you mention the important

changes in the circumstances and our knowledge that we can use to keep our strategy relevant and refresh it. thank you all for the engagement. >> if there is no comments or questions from the board, i will open this up for public comment. public comment will be available for each item on the agenda. each speaker will have three minutes. all public comments to be made

concerning the agenda item as presented. a caller may ask questions of the policy body but no obligation to answer or engage in dialogue. i encourage you to state your name clearly although you can remain anonymous. remote viewing is available on sfgov tv and webex. opportunities to speak during the public comment period are available by dialling the number on the screen. it is 415-655-0001. again, 415-655-0001. when prompted, use access code 2498 558 9355. again, 2498 558 9355. then press pound and pound again. you will enter the meeting as an attendee and dial star 3 to be added to the public comment queue. when the system messages says your line has been unmuted, this

is your time to speak. for those on hold, wait until the system indicates ufb unmuted. with a standard 40 to 45 second delay for viewers watching the live broadcast online. we will take a 45-second pause to allow the systems to catch up and callers to dial in. the 45-second pause begins now.

the 45 second pause has ended. i will now check to see if there are any caller who is wish to make comment on this agenda item. we have three callers on the phone line. 0 callers have specifically entered the public comment queue at this time. a reminder to all callers to dial star 3 to be added to the public comment queue to be added for this agenda item and wait five second and close public comment for this agenda item. there is still no callers on the public comment queue at this time. commissioner, hearing no further callers, public comment is now closed. >> thank you very much. this closes agenda item number 11. i would like to call for eeg item 12. >> thank you, president follansbee. i want to know for the record that commissioner hao has returned to the meeting. we have quorum for all further action item.

>> thank you. >> agenda item 12, delta den that quarterly report. this is a discussion item. and will be presented by a representative from delta dental. i will be passing presenter privileges momentarily. good afternoon. again, my name is sharen stanek-lowe with delta dental. thank you for having me today.

today we'll be discussing the quarter three, so q1 through q32021 report to the health service board. during q3 of 2021, our focus was in the following three areas. improve oral health, network, and member satisfaction. you may call in q2, we presented this dashboard that focused on sfhss utilization of the dental plan both sieve and retiree members and the focus primarily was on prevention and looking at and pulling data for cleanings, the smile way program, online accounts and then overall utilization by type of service. i would like to go through each of these boxes to update you on

the q3 numbers. so first in the upper left-hand corner, number of submitted cleanings and the teeth on the left-hand side, one cleaning, two, and three, pretty self-explanatory. but when we are looking at numbers if we look at the active column, those are the number of active members who have had at least one cleaning from january 1 through september 30 of 2021. for retirees that number is 11,702. and when we look at the total population of individuals that have had cleanings, 40.8% of the actives and 35.2% of the retirees had at least one cleaning as of q3, 2021. 60% of our actives and 61% of

our retire rear population have had a cleaning as of september 30 of 2021. this will become much more relevant as we move from 2021 into 2024 and a more non-pandemic view of the utility i willization. the positive information here is

that as of right now we have q4 data to utilize the benefit and surpassed the book of business benchmark of 58%. and next our smile way program we have the total enrollment of 1,672. with the call out to the right explains the members receiving one, two, or three cleanings as well as the members that have received a root planing. as that asterisk indicates, members can receive more than one benefit. there are six dental codes that encompass the smile way program

and they could have a root planing as well as a scaling counting towards the number of utilized benefits. what is important here is that the smile way program is designed to allow and afford the members both active and retirees who are enrolled that third cleaning as well as the root planing at 100% if they are seeking services from a ppo dentist. this san added benefit and demonstrating that members are utilizing this benefit once they are enrolled. next our number of online accounts, why this is important is because this -- these members and actives and retirees have given us authorization, delta dental, to be able to communicate and with them electronically. this will allow us in the future to continue to promote

prevention type activities to drive more individuals to get cleanings and more individuals to enroll in the smile way wellness program. last but not least is our utilization by type of service. and there are three primary categories, dmp, diagnosic and preventive. basic and major services. this is both for actives as well as retirees. what you can see from this data and we are utilizing 2019 as a benchmark compared to 2021-2019, prior pandemic, so that's a more solid number base or database or benchmark to utilize. when we look at the utilization for actives in dmpa slight increase as well as for the retiree population. and there is a slight decrease

in both basic and major services for both actives and retirees. these are numbers we want to see. we want to see more individuals in the dmp category where we identify a situation, a dental situation and hopefully provide that prevention so it doesn't move into the major category. you might be looking at these numbers and saying, well, wait, dmp, 75.3% of activities and 69.3% of retirees use this benefit and up above when i talked about the cleanings and 60 and 61%, why don't those numbers add upper to equal the same? dmp encompasses not only cleanings but it also covers exams, x-rays, and fluoride

treatment with a little bit of a difference in the percentages when we look at dmp usage comparative to the cleanings up above. i will pause here for any questions. and then i will go on to the network slide if that is agreeable to the commissioners or i can continue. >> maybe the question i have -- this is president follansbee. the question i have is going to be addressed and i have to go through the presentation beforehand and in terms of, for example, the cleanings, do you have a breakdown in terms of whether the cleaningses are being provided and how provided for h.m.o., ppo and out of network? because one of the concerns we have had along is around access to the hmo and ppo because of

the out of network or members have a much higher share of cost in terms of the costs of the claims that may be billed directly back to the member. not reimbursed by delta. do you have a breakdown of that or is that coming up? >> it is not in this slide deck, so that is something that we can circle back with the information going forward as well as provide that to abby so it can be incorporated if she so chooses in the director's report next month. >> i would urge that and this is an important part of our understanding and both the positive side of this report but also where we can focus our efforts as the health service system in trying to improve this as well. >> thank you very much for that feedback. >> i just have a clarification

on this under the number of submitted cleanings and one cleaning is 30,000 something members. two cleanings is 13,000 members. so do you add these all together to get your 58% you said? >> the percentages. that is correct. 60%. and then the same for retirees. >> there is still only 40% have one cleaning, right? >> no, 60% -- you are correct. but overall, your population and that one individual has had two or three cleanings, they have also had one cleaning already. we add those total numbers up.

the 40, the 18, and the 9 to get the 60%. >> that is a little deceiving because the merge that has only had one cleaning is still 40.8%. and people that have had two cleanings is 18%. so they still need a little pressure for these people having only one cleaning. that is why we have this dashboard together to monitor this behavior and take action and i appreciate your input. i am being sensitive to the time and we might want to continue on. >> great. thank you. >> our next is the network and this is just a sampling of california counties. and this has this particular information has really morphed and works with not only our actuary department and also with aeon and the executive team to

really build a more thorough as well as informative slide and comparative to years past and why i say that is before what we would report on to the board is the number of dentists in our network and the numbers of dentists being utilized, added, termed and now this report is actually taking sfhss's claims data and the dental claim data and looking at how those dentists are being utilized. so when we look at the third column in, unique in network providers utilized by sfhss, those unique in network providers and unique in network refers to our ppo and premier contracted providers. and then we're looking at specifically that top line

alameda county. and there were 924 utilized dentists that are contracted with delta dental that were utilized by sfhss members. when we look at next column as of september 30, 908 of those dentists remained within our network. that change is a negative 16. they are 16 dentists that sfhss members were utilizing and are no longer on our network. and those can be reasons for the great resignation where they have decided to either sell the practice, retire or leave entirely and become a concierge type dentist. and the percentage of the next one over is that percentage of change so what that 16 den cysts who have left the network, what

that change is specifically to sfhss and the good or positive information is in total our network has grown in alameda county by 88 newly acquired in network ppo and premier dentist. and here january through september we have added 88 den cysts in alameda county to demonstrate counties that we have reported on in the past. and it's going to be a really great, useful tool in the future as to monitoring any specific county where we might see a very high uptick of utilized dentists that have left the network and drilled down as to why and how

it might have affected your population. so we're hopeful that with all of the work that so many partners have put into this that this is going to be a much. relevant and useful tool so sfhss and the membership. and that concludes my presentation. i am happy to sake any questions. so open up the floor again to questions and comments from board members. i would like to thank you for the last slide because this one is a very data driven provider definition for us. and i think that where this conversation bebegan, i had at least the initial impression there was a large provider shift

going on and going on. we can talk about which group they're in and all of that and this clearly demonstrates that the magnitude of this is not as expansive as the initial impressions might have been and without this type of data, and monitoring going forward, we would still be in that place of kind of guessing at provider changes there are. so thank you for this level of specificity. >> further questions or comments from board members? >> thank you. >> thank you, dr. follansbee. i can't resist pointing out with

relatively strong populations as part of the hetch hetchy system and employees and other remote areas. i think that speaks well so mu my concern is only this week i received calls from local member who is actually represent organizations of other members and they were talking about their only personal dentists in santa clara counties but the comment was their dentists were complaining to them. and letting them know as long-time patients that they were no longer accept delta as

the complete reimbursement and going to charge this regarding cleanings. and they were going to charge their patients the full billing rate and they would submit their invoice to delta on behalf of the client, the patient. but the reimbursement that would come would go to the client so that the dentist maintain the full reimbursement and the dentists complain they have been in practice a long, long time and were finding it extremely difficult to continue with the reimbursement rates and delta had not increased the reimbursement for such essential services such as cleanings and close to five years.

i was looking to see how many were leading and san mateo and santa clara and san francisco as well. and even contra costa because we have been getting a few -- or i have received calls from members in these areas and dentists have indicating they are leading delta because of reimbursement rates have not increased in a number of years. and the addition of in-worth network providers and we don't know if those are group practices where there are a lot of new dentists so as long as

the number goes up in the last column and gaining over losing 97 and i think you will need to look at that and be realistic about what it is the impact and they will have to pay $130 for a cleaning because the reimbursement from delta is too low for the dentists to make it worth his or her while. thank you. >> thank you very much. >> thank you for your comments. commissioner breslin, is that you? sorry. other questions or comments?

>> awe i am sure it is continuing. the cost of delivery is higher in the bay area and that they are in other regions.

>> and bringing new people into the network far exceeds and i do think part of the return level in such an organization. and to me that is a low number to have that little bit of turn. and where we're delta is help in helping us is these are the dentists that are serving our members. this is not a list of people we don't relate to. and getting into the relationship between delta and their dentist and the rate setting process is, i am not certain that is where we want to go. >> it is a complicated issue and we have to acknowledge how difficult it is for the members who have been dealing with the data for sometimes years or

longer to have to then seek out and interview new dental practices knowing that their own dentists are still in practice because it is and especially with inflation, everyone's costs are going up. we have to acknowledge the pain that this may engender for

people. [reading of instructions] when your 3 minutes have ended, the moderator will unmute the next caller. remote viewing is available on sfgov tv on channel 26 and webex. opportunities to speak are available on the number on the screen. and the number is 415-655-0001. access code 2498 558 9355. press pound and pound again. you will then enter the meeting as an attendee on the public comment call line and add star 3 to be added to the public

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our moderator will notify of us any public comment callers in the queue. board secretary, we have three callers on the phone line and zero have specifically entered the public comment queue at the time. a reminder to dial star 3 now and you want to join public comment for this specific agenda item. we will wait five more seconds and 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 and thank you very much for the presentation and the discussion and feedback.

that closes agenda item number 12 and we would like to move to item 13. >> thank you, president follansbee. this is a discussion item and will be presented by executive director abbie yant. >> you have in your packet the rates and benefit season. and we will update this and pre-present at each upcoming meeting. we put holds on these months for a second meeting. and this just is what gives us space if things get complicated. and i think we have only had to invoke one of these one time. so don't stress about it too much.

and our february meeting i think is pretty straightforward where we'll be looking at the hartford insurance policy that's the extra item that will be at that meeting and so on and so forth. so should -- and do pay attention to sort of when this is dated because as i said, it does change throughout the experience that you want to keep track and know you are on the right page and you will have to look at to put it at the top as of january 7. this is the plan. thank you. >> thank you very much. attempt to quell anxiety as well. and in these times. open this up for questions and comments from the board. hearing none, we will open this

to public comment. >> pibb lebron jamesing comment will be available for each item on this agenda. each teaker will be allowed three minutes to comment unless the board president deems new public comments and all public comments to be made concerning the agenda item that has been presented. a caller may ask questions of the policy body and no obligation to answer or engage in dialogue with the caller. you are encouraged to state your name clearly and you may remain anonymous. when the three minutes have ended, you will be placed and mute and the moderator will replace the next caller and available on sfgov tv channel 26 and webex. opportunities to speak are available by dialling the number on the screen. the dial-in number is 415-655-0001. 415-655-0001. access code, when prompted use access code 2498 558 9355.

and then press pound and pound again. you will enter the meeting as an attendee on the public comment call line and dial star 3 to be added to the public comment queue to ind case this is a standard 40 to 45 second delay and the hah-second pause begins -- the 45-second pause begins now.

the 45-second pause is ended. the moderator will notify of of any public comment callers in the queue. board secretary, we have four callers on the line. zero callers have entered the public comment queue at this time. 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 will wait five more second and close public comment for this agenda item. board secretary, there are no callers at this time.

>> hearing no callers, public comment is now closed. >> thank you very much. this concludes agenda item number 13. we can move on to agenda item 14. >> thank you, president follansbee. agenda item 14, approve the june 30, 2021 incurred but not reported ibnr reserve and contingency reserve amount for self-funded and flex funded health plans. this is an action item and will be presented by mike clarke with aon. i will be passing over presenter privileges. >> thank you. good afternoon, commissioners. i will shortly share my presentation.

i will be reporting on the ibnr reserve and from flex-funded plans and today's discussion focuses on the first two. and the ibnr occurred and not reported is our estimate and actual estimate of the unpaid liability that would be expected for runout claims for the services are incurred.

these are calculated as of the end of the plan year, december 31, and we will be discussing stabilization reserves in the march time frame. there are these three distinct reserve policies that i just covered for the following plans. flex funded nonmedicare and hmo

plans and the self-funded dental ppo plan presented by delta dental of california. two important notes in the latter half of this page. first, we will not be talking about health net because the plan was not authored as of june 30, 2021 and in the future we will develop ibnr and flex reserves for 2022. and secondly there was the transition of the medical plan administrator and most participants and early retirees with uhs continued to administer for non-retiree and noting the two elements that are not part of today's presentation because the measurement data is june 30, 2021. this presentation request and health service board approval

today for the incur but not reporting and contingency amounts that will be displaced on the next coup of page. for the ibnr, this table where the top of the table is for the blue shield access plus and trio plans with the nonmedicare ppo plan administered by uhc and the self-funded dental ppo plan administered by delta dental. a slight decrease in suggested reserve for the blue shield hmo planned and substantial increases for the other two plans and as you see in my notes generated by the fact that on the prior measurement data june 30, 2020, there were substantial covid-19 claim suppression impacts during the second quarter of 202 especially in

dental, most pronounced. and what we're seeing for june 30, 2021 a return to more expected an typical levels for the incurred but not reported reserves relative to more suppressed levels for the ppo plan and the dental ppo plan that existed as of june 30, 202. in total, the overall ibnr reserves are projected to increase 1,800,274. and for contingency reserves we are seeing in total a near flattening of the suggested figure from june 30, 2020 to june 30, 2021 and though certainly with variability by individual plan. a slight reduction in the calculation of contingency reserve for the blue shield plans and as you see in my notes

at the bottom of the page, the more substantial increase for the mon medicare ppo plan came with a suggested change in methodology that we use for the calculations of cycle going to more of a large claim predictive modelling approach. we discuss this at length with chief financial officer lieu and the update to methodology was prudent since this ppo plan does not have stop los and the delta dental ppo plan to recommend a change in methodology that was discussed and agreed upon by chief financial officer lieu knowing for dental the plan exposure is essentially catched

on how much per individual the plan will pay versus medical where the participant exposure is capped through maximum out of together levels. the health service board policies are captured on the website within the governance policies in terms of reference documents and with the web link included here in this presentation. and with the numbers that you see at the bottom of the page. and finally just to note the changes in contingency reserves

will be a component of the december 31, 2021 stabilization reserve calculations that we start to present to you in march. so with that, i will stop sharing. commissioner follansbee. i have one question and that is

where i can understand and the concept to deal with this regularly in terms of the pandemic effects, is there any suggestion that there's been some delay in the actual mechanism of billing? and members are being seen or hospitalize and because of staffing problems and billing offices and whatever that we have not been getting more timely reports? in terms of reimbursement? or is it all just around the utilization that i can understand, but i am curious about the actual process of getting the charges to us. thank you for the question. what is interesting is the calculations around june 30, 2021 and we were not necessarily observing any patterns of difference in the first half of 2021 and interestingly for many

of my clients as we have done year end reserves and december 31, many of my clients and the fiscal year on december 31, and we have seen some instance with some carriers of longer lag times to process and pay claims. so it is something we will keep an eye on for us at sfhss to see if that may have impact on what to calculate as of june 30, 2022. and fantastic question. we just didn't necessarily see it as of june 30, 2021. >> thank you very much. so it's been moved and seconded that we approve the recommendations and any further discussion or questions before i open it up for public discussion? hearing none, i will open this up for public comment. >> thank you, president follansbee. i will be pulling up the instructions to display visually and reading them aloud.

>> public comment will be available for each item on this agenda and each speaker will be allowed to comment three minutes in length unless they deem new public comment items concerning the agenda item as presented. the caller may ask questions of the policy body and no obligation to engage in dialogue. when i welcome you on the the call, you may state your name clearly although you may remain anonymous. i will thank you for your comment and placed back on mute and unmute the next caller. remote viewing is available on sfgov tv and webex. opportunities to speak are available by dialling the number on the screen.

the number is 415-655-0001. access code is 2498 558 935 # an and wait until the system indicates you have been unmuted with a standing 40 to 45 second delay for viewer watching the live broadcast online. we will take a 45-second pause to allow the system to catch up and callers to dial in. the 45-second pause begins now.

the 45-second pause has ended. our moderator will notify of us any callers in the public comment queue. >> board secretary, we have four callers on the phone line. zero callers have entered the public comment queue at this time. reminder to all callers on the line to dial star 3 now if you want to insure public comment for this specific agenda item.

>> item 15 is reports and updates. this is a discussion item.

i am continuing with delta dental and still behind the scenes. but we have now been fully staffed both directors and v.p.s, national account manageers and so i officially will be handing off sfhss to the most capable jen and she will be spro deucing herself in the next moment to give you her history. not to worry. i am in full support of her and full support of sfhss.

>> sharon and ri in constant contact. lucky sharon. i am a manage we are delta dental and in the employee benefits industry for 17 years. all within the consulting world. i have started my career actually at aon. and i frequently say i grew up at aon and most recently i am coming from haze company. while i may be new to delta dental, i am not new to the industry and throughout my

career the data can tell us the story to make critical decisions and pinpoint behavior population and as well as identify critical opportunities to allow us the ability to better strategize and make recommendations as appropriate to the needs of your population. so with that i really look forward to working with the team and learning how we can continue to build on our partnership and city and county of san francisco in the future. thank you very much.

>> thank you. >> how long were you here? >> four years. >> any other comments? >> this is commissioner zvanski. all those days when i was off the board and we were sitting in the back couple of rows. the hearing room. and i will certainly miss the chatter and camaraderie back there. and you have been a wonderful representative for delta and thank you very much for your work. i am actually very happy to hear that you will remain with delta. i want to welcome jen. i think it's going to be -- i am glad the hair color seems to be consistent so i won't get the

reps mixed up but i want to welcome you on board and it is interesting you came out of aon and this should be familiar ground. i think you will find this is a good group to work with. welcome aboard. >> thank you. >> thank you again. any other comments? hearing none, any other reports from plan representatives? ? >> hearing none, i would like to open this up for public comment. holly? >> thank you, president follansbee. >> i would like to make a comment. >> yes? >> i would like to see what the mental health reimbursement is for the providers, for the mental health providers from each plan if that is possible. probably not. but i know that it came up in

kaiser representation. part of the problem is the reimbursement level for mental health providers in our plans. i think that could be a big issue because that is a difficult job. if that is possible, i would like to hear that in the future from our health plans. thank you very much. and any other comments before i open this up for public comment? hearing none, we will open this up for public comment. >> thank you, president follansbee. i will be displaying our public comment instructions visually and reading them aloud.

a caller may ask questions of the policy body but there is no obligation to engage with the caller. when the 3 minutes have ended, i will thank you for your comment and you will be placed on mute and the moderator will unmute the next caller. remote viewing is available on sfgov tv channel 26 and webex. opportunities to speak are available by dialling the number on the screen. the dial-in number is 415-655-0001. access code 2498 558 9355. again, 2498 558 9355. and then press pound and pound again. you will then enter the meeting as an attendee on the public

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

the 45-second pause is ended. our moderator will notify us of public comment callers in the queue. >> we have three callers on the phone line and zero callers have enter the public queue.

>> public comment is now closed. as we approach item 16 which is adjournment, i would like to restate the unanimous commendation of the health service board and the city and county of san francisco for the work of larry loo during his tenure as cfo of health and human services. much appreciate and we all wish him the very best in his new position in san francisco. but not with us. again. thank you very much. with that, i would like to adjourn this meeting.

francisco. >> my name is fwlend hope i would say on at large-scale what all passionate about is peace in the world. >> it never outdoor 0 me that note everyone will think that is a good i know to be a paefrt. >> one man said i'll upsetting the order of universe i want to do since a good idea not the order of universe but his offered of the universe but the ministry sgan in the

room chairing sha harry and grew to be 5 we wanted to preach and teach and act god's love 40 years later i retired having been in the tenderloin most of that 7, 8, 9 some have god drew us into the someplace we became the network ministries for homeless women escaping prostitution if the months period before i performed memorial services store produced women that were murdered on the streets of san francisco so i went back to the board and said we say to do something the number one be a safe place for them to live while he worked on changing 4 months later we were given the building in january of

1998 we opened it as a safe house for women escaping prostitution i've seen those counselors women find their strength and their beauty and their wisdom and come to be able to affirmative as the daughters of god and they accepted me and made me, be a part of the their lives. >> special things to the women that offered me a chance safe house will forever be a part of the who i've become and you made that possible life didn't get any better than that. >> who've would know this look of this girl grown up in atlanta will be working with produced women in san francisco part of the system that has abused and expedited and obtain identified

and degraded women for century around the world and still do at the embody the spirits of women that just know they deserve respect and intend to get it. >> i don't want to just so women younger women become a part of the the current system we need to change the system we don't need to go up the ladder we need to change the corporations we need more women like that and they're out there. >> we get have to get to help them. >>

>> everything is done in-house. i think it is done. i have always been passionate about gelato. every single slaver has its own recipe. we have our own -- we move on from there. so you have every time a unique experience because that slaver is the flavored we want to make. union street is unique because of the neighbors and the location itself. the people that live around here i love to see when the street is full of people. it is a little bit of italy that is happening around you can walk around and enjoy shopping with gelato in your hand. this is the move we are happy to provide to the people. i always love union street because it's not like another

commercial street where you have big chains. here you have the neighbors. there is a lot of stories and the neighborhoods are essential. people have -- they enjoy having their daily or weekly gelato. i love this street itself. >> we created a move of an area where we will be visiting. we want to make sure that the area has the gelato that you like. what we give back as a shop owner is creating an ambient lifestyle. if you do it in your area and if you like it, then you can do it on the streets you like.

>> clerk: sfgovtv will be streaming this hearing live, and each item will be available for public comment during the public comment period. dial 415-655-0001 and enter access code 2487-948-6468.

please press star, three to enter the queue, and listen for the prompt that your line has been unmuted and begin to speak. best practices are to call from a quiet location, speak slowly and clearly, and turn down any speakers on your television or computer. i'd like to take roll at this time. for the planning commission -- [roll call] >> clerk: thank you, commission. >> clerk: i will take roll for the health commission. my name is mark [inaudible], and i am the clerk for the health commission. [roll call]

>> clerk: thank you. >> clerk: thank you, commissioners. we have one item on your special calendar today. item 1, case 2016-004775-mcm, for the california pacific medical center annual compliance statement. this is an informational presentation. elizabeth, are you prepared to make your presentation? >> yes, i am. >> clerk: the floor is yours. >> thanks. good morning, presidents bernal and koppel, and commissioners. i am elizabeth purl, planning department staff. the presentation before you is an informational hearing of the california pacific medical center annual compliance statements.

2021 is the eighth year of the ten-year planning system. today's hearing is one part of the annual review process required by the development agreement -- excuse me. i'm a little too far. the development agreement requires cpmc to hold a code of compliance and for the commission to. following this year, the directors of planning and public health will determine if cpmc is in compliance with its obligations for the next two years. a director will review the

findings and present them to the board of supervisors for approval of his findings. a development agreement required that the replacement hospital be opened within two years of opening the van ness hospital. sutter health, which is cpmcs parent organization, met this commitment in 2018. the d.a. also required payments for a range of public benefits and improvements. sutter completed their payments in 2017, with total payments over $73 million. for the combined presentation, my colleagues will go into some of these into greater detail. construction of the van ness hospital is complete, and the associated medical office building opened in 2019. future constructions include a

medical building at the bernal campus and other structures. >> good morning. so this part of the agreement covered rate increases the health services system is responsible for benefits to city and county employees [inaudible] agreement on charge increases for the earlier years, it was 5%, and for the beginning of 2018, the payments were based on the medical inflation, which was roughly about 3%, thus, 1.5%. we do have an outside party

who's engaged to monitor compliance, so for 2018 and 2019, they perform the review of increases that are 1% above the mark. >> thank you, with that, i'd like to introduce ken nim of the office of economic and workforce development to go over workforce requirements. >> good morning, commissioners. thank you for having me. let's see...is my audio on? video on? happy 2022 so far, and as you know, the project right now, the work is done, and we're going to go through old data. next slide. so what's in front of us here

is the various obligations on the first floors for construction. and in this slide, you'll see that the majority of the work that was done in program years and st. luke's campus opened in 2017, and the van ness campus opened in 2019. most of the campus was in the facility of closing out and is in the middle of tenant improvements. so of the 32 placements that were involved in this slide, the majority of them are from our construction-administrative- professional services academy. the program is hosted by [inaudible] which is hosted by city college and is a workforce facilities providers. we'll go to the next slide. thank you. so referrals include students in the san francisco unified san francisco, and they are partnering with mesa, which is

mathematics, engineering students association, and there are 30 contractors hiring in various forms on this project. we'll go to the next slide. under this hiring goal, 50% of the entry youth apprentice candidates will be filled with [inaudible] 30% of the applicable union construction jobs. although it's below 50% of the union process, both of their contractors have made efforts to hire through on going referrals, and during this time period -- this was before the pandemic -- there was a boom in construction in the bay area, and during that boom, there was a shortage of workers and everyone was stretched on

getting enough workers to work on the various projects. this includes drywallers, lathers, sheet metal workers, operating engineers, which made it difficult to fill the positions without system referrals. we'll go to the next slide, please. 30% of trade hours of union journey men and [inaudible] 5.618 of the total hours [inaudible] no new hours were reported for that program year for both van ness and mission campus [inaudible] close out phase and majority of those hours update was from the tenant improvement, and the construction work of the medical office building. all right. we'll go to next slide, please. thank you. this is a breakdown of the

hours by san francisco residents, and as you see on the chart, the pie chart, san francisco residents were represented 35% of the overall apprentice work hours, and 24% of the total work hours were performed by san francisco residents. we'll go to the next slide, please. thank you. and the majority of san francisco work hours through these neighborhood breakdowns, and most of the residents came from ingleside excelsior neighborhoods, bayview-hunters point, in addition to visitacion valley, and these made up 60% of the san francisco work hours, and these are the neighborhoods targeted and having an emphasis and priority because of the disadvantaged residents, that we want to make sure that these residents get the first opportunity for these new jobs. next slide, please. now we'll go through a

conviction presentation on just the local business enterprise program. this is from our city project management division. and in addition to having workforce goals, there were also goals to hire local businesses, so in the goal for the cpmc program is 14% of [inaudible] awarded to certified l.b.e.s under the development agreement, so the progress was an accomplishment for cpmc. the van ness hospital has 15%, which equates to about $148 million. the replacement hospital, the mission bernal campus had a 22%, which was about $62.43 million. the van ness medical office building has 13%, which was $16.76 million, and the van ness medical building, the t.i. work, had 4%, which was $259,000. and all the projects combined

as of july 2019 is 16%, which equates to 227.59 million revenues through l.b.e. all right. we'll go to the next slide. so also, under the agreement, in addition to the construction and l.b.e. is the end use job, the job that happens at the hospital for the operations. so the goal is to fill 40% of entry level positions with system referrals for the fiscal year, which is the august to july year. we had 55% of the goal and hired 11 out of the 20 employees for the workforce system referral. just as an update, in this time of the hospital and everything else needed for the covid response, it's actually been

higher now, and when i report back next time, they'll be a higher hiring number for this program. so the total placement, we have 326 placements so far. we'll go to the next slide. and of the program year for 2021, the hiring goal was 50%, and the key neighborhoods are western addition, tenderloin, mission, soma, outer mission, excelsior, mission, chinatown, and sunset neighborhoods. the retention is 82%, and 342 hires were retained over 180 days. next slide. in addition to providing the opportunity, there were also workforce funds that were provided to the neighborhoods. the fund targets educational and nonprofit organizations

that work in priority neighborhoods and focuses on various employment and job opportunities. so first grantees are about $375,000, include j.b.s., self-help for the elderly, success center, code tenderloin. the amount remaining for the workforce funds, the final three years, is approximately $960,000, and the code tenderloin is one of the newer programs working with job replacement, job preparedness, and job placement services. and in 2019, we brought on code tenderloin downtown streets team as well as a new c.b.o. partners working with residents in tenderloin and sunset neighborhoods.

with that, i'll hand it back to the health care part. >> thanks, ken, and i'd like to introduce gretchen polley of the department of public health. >> good morning. my name is gretchen polley from the department of public health. next slide. exhibit f of the development agreement provides multiple provisions related to health care, which is designed to ensure that cpmc continues to provide high quality health care to san franciscans. so this slide shows a summary of the health care commitments. there are five baseline commitments to maintain the same level of care of benefit and charity care. two provisions on the innovation fund, which a fund of a total of 8.6 million for

four years, four years to fund community services and programs, and there are five additional programs in the d.a. ranging from self-health care services to on going care programs. additional health care provisions specific to the new hospital campuses are now in effect and were reported in 2019 and 2020 compliance review. these additional provisions include two provisions related to the number and type of bed space available at the mission, bernal, and van ness geary hospitals, and four provisions to ensure specific services and programs at the mission bernal campus. this helps to ensure seamless care to san franciscans. the next slide will provide more information on health care progress to san franciscans and the progress on each of them. the complete list of each can be found in the city compliance

report. [inaudible] the city's holding a two-year compliance hearing for 2019 and 2020, and the completion of the 2021 third party audits [inaudible] there was a pause on nonessential health care services and delays of health care orders. there was also an increase in medi-cal enrollment due to loss of employee sponsored health care coverages, and therefore, there may be a chance to increase medi-cal coverage for 2021.

next slide. this slide provides details on each of the health care commitments and cpmcs performance and compliance on each. in 2019, cpmc exceeded the requirements in caring for charity care or low-income patients. in 2019, cpmc cared for 35,246 undocumented charity care payments. in 2020, cpmc fell short of this progress, caring for 28,000 patients. however, the two-year rolling average and applies patients from the preceding or following year to meet the average. cpmc reports that the decrease in average is due to the pandemic and patients staying

home instead of getting care. in 2019 and 2020, cpmc exceeded the community benefit requirement providing over 13.6 million and 15.1 million respectively in 2019 and 2020. cpmc increased initiatives to increase access to care. examples of partnerships include operation access, providing screenings and specialty procedures to uninsured patients. the compliance of these two provisions were verified by the deloitte audit.

the last revision on the slide is for cpmc to continue their support of the bayview child health care. the ownership has been transferred to south of market health care. cpmc has provided bayview child health center with a health care grant, and is still the hospital's specialty partner to [inaudible] to bayview residents. next slide. the following three provisions in the d.a. focus on medi-cal, which is public insurance for many low-income san franciscans. with the expansion of medi-cal under the affordable care act, it's an increasingly important health care option for san francisco residents. cpmc has continued to participate in managed care as required. in 2014, cpmc met its obligation to assume responsibility for 5,400 new

medi-cal beneficiaries and continues to meet this obligation. cpmc had a total of 38,183 beneficiaries at the end of 2020. under the d.a., cpmcs required to serve 1500 as a new medi-cal beneficiaries, able to contract with medi-cal managed care. in june 2020, northeast medical services opened a primary care clinic in the tenderloin located at 650 polk street. the cpmc reports it is a health care program for 6,352 nonduplicated lives in the tenderloin. prior to june 2020, there was no such provider. in order to meet this obligation, cpmc has partnered with n.e.m. to bring st. anthony's clinic as a primary care provider in the tenderloin in 2019. at the end of 2019, there were 172 members enrolled in the st. anthony's partnership, and

at the end of 2020, 173 members enrolled in the st. anthony's partnership. cpmc continues to reach out to st. anthony's to support the partnership. the d.a. requires cpmc to make payments and establish the [inaudible] fund. the provision describes how the funds will also be used, and cpmc along with the department of public health and the health commission sit on a [inaudible] in programs that promote the health of san franciscans with specific focus on the city's most vulnerable communities. in 2020, cpmc granted the remaining funds of innovation funds, approximately $840,000

to mission language and vocational services to support citywide efforts for the latinx community disproportionately affected by covid. the second provision on the slide requires that the mission bernal campus hospital be 120 bed jenna cute care hospital [inaudible] with emergency services and provide certain in-patient, outpatient, and urgent care services.

in 2020, in-patient labor and delivery services at mission bernal campus were temporarily located to van ness campus. cpmc did not provide the city with such notice and were therefore noncompliant with this issue. cpmc indicated that the noncompliance of such provision was due to the covid-19 pandemic, and cpmc has no plans to restore labor and delivery services at mission bernal. next slide. [inaudible] and serves patients in chronic disease management. cpmc reported the following for the health first program. in 2019, cpmc provided care to over 700 unique patients and

had 1400 encounters. staffing included three spanish bilingual health providers. they also convened one board meeting in 2019. in 2020, they provided care to over 800 unique patients and had 2400 encounters. due to the pandemic, they replaced the board meeting with remote events.

the third provision on the slide requires cpmc to submit a proposal for the development of the mission bernal campus office building within five years of the opening of the mission bernal campus hospital. in april 2020, cpmc submitted permit applications to the planning and department of building inspection and are in process of developing proposals for the sutter west bay board for use of the medical office building. next slide. the remaining health care provisions in the d.a. are stand-alone and cover multiple topics. the first provision on the slide requires cpmc to provide specific proposals for providing subacute care services, a form of skilled nursing for patients that require a higher level of

service, and to present those proposals to the health commission. this obligation was technically completed in early 2016, and this is the only provision in the d.a. that addresses subacute care services. cpmc is currently engaged [inaudible] citywide. in 2018, cpmc held meetings with public and private stakeholders to determine additional subacute care services citywide. in 2020, subacute care planning was delayed due to the pandemic, and it has resumed in 2021, and cpmc has not yet committed to supporting any proposals. a second provision in the slide

is around the integration of staff among cpmcs campuses. in 2016, cpmc completed the integration of the [inaudible]. cpmc is also required to continue their partnership with chinese hospital. in early 2020, cpmc and chinese hospital settled on a new negotiated agreement, which satisfied cpmcs compliance with this provision. the last provision is on national and linguistically appropriate standards or class standards. it is cpmcs [inaudible] to deliver mandates appropriate with these standards.

information on the process cpmc uses to incorporate patient perspectives into its class standards, as well as patient code data by campus, and the supplemental information is provided to the health commission for consideration, and that concludes the health care portion of this presentation. >> thanks, gretchen. so to conclude, sutter health is generally in compliance with

the requirements of the cpmc development agreement. there are some on going areas of concern. they include provision of services at the mission bernal campus and fee increases for services. so far, the information we've received for 2021 generally indicates compliance. staff's recommendation to the planning and health commission will be to find cpmc in general compliance for the 2019 and 2020 reporting years, and that concludes our staff presentation. we understand that sutter health representatives do not plan to present today but are available by phone to respond to questions. >> clerk: thank you, elizabeth.

we'll go to public comment. members of the public, this is your opportunity to address the provisions of the report by pressing star, three to be added to the queue. through the chair, you'll each have two minutes, and when you hear your line has been unmuted, that's your indication to begin speaking. go ahead, caller. >> is that me? >> clerk: yes. >> hi. good morning. my name is colette hughes, and i am a resident of san francisco for 47 years and a champion of human rights attorney. [inaudible] we have bonded together to restore services at the campus that provides needed critical [inaudible] therapy

for people with conditions that cannot exercise on land. it is crucial to help. i had the privilege of working at the [inaudible] services. now, i cannot get the services that i need and was told i needed for the rest of my life. please consider all the statements of harm that have been put in. cpmc's actions by shutting down the wellness program at the upper campus in pacific heights as well as the davis campus in 2020 [inaudible] for warm water therapy and of these needed exercises for low-income elders and people that are injured and disabled. sutter plans to [inaudible] but it can't even provide essential

service. it is no longer even a renowned center. they no longer provide transitional services to home. [inaudible] for the exercise you need before and afterwards. this is very cruel. we want to know, were we abandoned because we're not fee generating enough for the center? we want to know if proposition q required a hearing before these services were shutdown. we want to know, what is the actual standard of the bayview program as we see shifting explanations. i call and am told, call back in a month [inaudible] we want a notice to our people and to the public at large. at some point in time, there has to be -- >> clerk: thank you, ma'am.

can you mute your television or computer? hello, caller? [inaudible] >> clerk: caller, you should mute your computer or television, however you're watching this. are you with us? >> yes. >> clerk: okay. you have two minutes. >> again? >> clerk: oh, is this the same person? >> yes. >> clerk: okay. sorry. >> my name is hannah molder, and i am proud to have worked since 2015 as a mid wife at mission bernal womens clinic. during my time here, i've witnessed the tremendous amount of loss, change, and upheaval.

the contract we're discussing today is the kind of essential public policy required at this time. allowing corporatized health care to march on unchecked, decimating the cultures and communities that have lived in this part of san francisco for generations is inhumane and unacceptable. while the necessity of this kind of policy has only increased dramatically during the pandemic, cpmc has turned its back on the portions of the city that need it the most as sutter strips the community of essential health care systems that it deems are no longer needed by patients. i've listened as patients express pain, disappointment, and confusion about why their

health care home where they were born, where their own children were born, where they recognize familiar faces, where employees were their neighbors and spoke familiar faces is no longer available to them, by requiring cpmc maintain a robust presence in this city [inaudible] and we are committed to keeping you, your families, and your residency safe. by allowing cpmc to turn their backs on this community, the city communicates just the opposite. >> hi. my name is antonio rivera, and my sister is a patient in the subacute care facility at the davis campus in san francisco.

cpmc has the last subacute care facility at the davis campus, and they plan to close down the facility when the last patient has passed. why isn't leaving open the subacute facility not only a requirement by a priority for cpmc? it sounds like they're going off a master agreement which was made over 2e7b years ago [inaudible], like, why can't we update that contract for the current situation we're living in? thank you. >> good morning, commissioners. my name is raquel rivera. in 2018, my sister, sandra rivera, was one of the 17 subacute skilled nursing

patients transferred to the davies campus when the other subacute campus was shutdown. she had spent over nine years at st. luke's. she was about to be transferred out of county. thankfully, the subacute families and the community were able to shame sutter in keeping them there. it is an agony for a person who must live with intensive airway support to have to live in a place that is far away from family and friends, yet in three years, we see this continuing to be repeated over and over again. in over three years, no progress. why can't cpmc do its share to

provide these beds. per the plan, the dave he's subacute s.n.f. -- davies subacute s.n.f. patients will be moved when the campus ceases care. a city so rich in resources are failing their own residents in this essential service, especially now with covid lung. thank you.

>> clerk: go ahead, caller. all right. we'll try the next caller. >> hello. can you hear me? >> clerk: yes, we certainly can. >> hello, health commissioners. my name is gloria rivera simpson. thank you again for having me. health commissioners, what else is it going to take to have these hospitals have hospitalized subacute beds here in san francisco? families have died over this. to have your loved ones transferred out of the city that they lived in for years, paid their taxes, voted, grew their businesses, made san francisco into what it is today. it's embarrassing, and it's so

wrong. these poor families have suffered long enough. the last time i saw the san francisco supervisors, my last words i said to them over three years, at some point, titanic is going to be like san francisco, where we'll drown. guess what? we drowned, we died, and there's covid. why can other counties have a hospital based subacute unit and the city of san francisco cannot? why can you house thousands of homeless people in san francisco but you cannot get 75 subacute beds? we are not people from the north county, from outside the city. we are people who put our blood and sweat into raising our families here, and you mean to tell me if we fall sick or become permanently ill, you

will abandon us. please don't make this a political gain. we don't have time, and please don't make this another subject on your agenda because this is not a subject, it's a life sentence. thank you. >> this is mark aaronson. i am an emeritus professor of law at u.c. hastings, and i work with san franciscans for housing, health care, and justice. we submitted a five-page outline to you before this commission hearing. right now, i want to make five points. first, cpmc, at the end of 2020, was serving fewer medi-cal and lower income san franciscans than in 2013, when it signed the d.a. two, cpmc uses every development, including the covid public health crisis as an opportunity to cutback

permanently on services that it views as not sufficiently revenue generating. three, as a result, while it has rebuilt a hospital on the st. luke's site, it has changed and is totally changing the former character of st. luke's hospital as a welcoming and integrated health and health care facility for low-income san franciscans into a hospital emphasizing high end tertiary and high end medical specialties. four, cpmc has not made any movement at its new van ness campus to serve the nearby low-income tenderloin community in a responsive way and has provided less than a bare minimum of support for meeting the d.a.s requirement to serve 1500 tenderloin medicare

residents. five, the city invests considerable time monitoring cpmcs compliance with the d.a. that time can also be used to investigate cpmcs performance in light of overall san francisco public health and health care concerns now and in the future so that cpmc does not continue to avoid and evade doing its fair share of meeting the public health and health care needs of all san franciscans, especially those who are low-income. thank you very much. >> clerk: thank you. that is your time. >> hi. can you hear me? >> clerk: yes, we can. >> yeah, my name is dr. teresa palmer. i work for san franciscans for housing, health care [inaudible]. health care in san francisco is broken and at the mercy of

corporate hospital behavior. cpmc and sutter pays attention to what generates revenue but does not -- the [inaudible] down services that the low-income communities surrounding its campuses needs. this is exemplified by its behavior concerning subacute nursing care and hospital nursing care in general. most of it has been shutdown, despite the need. san francisco is the only major city in the state and the only city with a level one trauma unit -- subacute unit that is accepting new patients. in 2017, protests about these frail residents being kicked out of county led to a sutter agreement, the remaining 17 being transferred to davies.

eight or less now live. many who have lived for years died in the first year due to this arbitrary and unnecessary [inaudible]. this was done to ensure sutter was generating as much revenue as it could. divesting these beds is and was a brutal bottom line decision. [inaudible] life dependent patients to transfer their beds out of county. beds should be located in a full hospital campus. sutter has not made any space for new subacute s.n.f. beds on any new campus. [inaudible]. >> clerk: thank you, ma'am.

that is your time. >> thank you. >> hi. my name is arnold wright, and i am a disabled client of cpmc davies medical center aquatic exercise class. i would like the commission to know that we're still here as seniors and disabled clients of cpmc, and we still need help with our mobility, and we desperately need to return to these aquatic exercise classes. without this program, many of us have no affordable or accessible choices to continue our care, and the most important point is the reduction of pain. that, i experience, and other members have shared with me, but the pain reduction from

these classes without the use of pain medication is paramount for seniors and disabled patients' quality of life. cpmc should be supporting this, but they have closed our aquatic exercise class, and it needs to be reinstated as a method of health care for those of us who so desperately need to strengthen our bodies after a stay-at-home period of isolation and access these services during the pandemic. it's necessary to maintain the level of care for low-income and community benefit for a historically underserved seniors and disabled patients who represent the pan pacific islanders, african american, latinx, asian, women, and other members who represent the population breakdown of our

city. please, please demand a change with their process. thank you. >> hi there. my name is blaine johnson, and i'm here to talk about the poor condition of the san jose guerrero park, and it's across the street from my house. i have a presentation prepared, if you can cue that up. i have a little bit of a lag, so i'm just going to assume that it's up there. >> clerk: it is. >> okay. great. so i'm speaking to you today because the park is part of the commitment of developments that cpmc made to the community. by the presentation and the photos that i'm going to show, i think you'll find that they're out of compliance on the project, and that the city is failing to maintain the space. next slide, please. so what's interesting about

this park is that it was once touted as a model of urban design. this converted an unsafe and busy intersection to a pedestrian plaza. it was featured in the new york times. next slide, please. it's no longer the media darling that it once was, so let's take a look. first of all, this was very poorly utilized public space, so in a city where space is at a premium, we're wasting our opportunities in this plaza. it's nothing but blank concrete and some dilapidated benches at this point. next slide. so i think during this pandemic, we can all agree that public space is more important than ever. next slide. i call 311 almost every day to ask for help. next slide. i've been reporting this

graffiti for six months, and nothing has been done. it's filthy, and the city is not helping. next slide, and there's a pedestrian crossing that isn't even be used. next slide. if this were private property, the owner would be cited for blight. next slide. so my ask is for help, just to have somebody cleanup the park, and ask for permanent improvements. thank you. >> good morning, commissioners. my name is john avalos. former supervisor on the san francisco board of supervisors and one who had the privilege of voting for this development agreement with cpmc. i am now with the national union of health care workers, who represents workers at cathedral hill and davies medical center. and i'm talking today about the development agreement that i

had voted on and know some of the history around it. it was really looking at understanding cpmcs role in san francisco and what their interest is overall as teresa palmer, dr. palmer had mentioned. it's about revenue and the bottom line, and we knew we had to put the development agreement in place so we knew we had some standards in place, minimum standards for cpmc to meet. in doing so, we see that cpmc often obfuscates and doesn't present the true picture of what's happening and is often just toeing the line. our workers at cpmc and davies medical center were promised to get transportation benefits, and a majority of them have never received information pursuant to a transportation benefit.

looking at our data, it's about 1.7 million owed to workers for transportation benefits. many of these workers live in the north city and take b.a.r.t. also, their information is really flawed. they're looking at percentages of workers, but for our staff who are engaged in providing patient care, it's a quality of care that can be provided based on staffing levels. not percentages of local hires, but numbers of people who are available to take care of patients. we know now during the pandemic, when the patient care is greatly needed to meet the huge demand that's there, these staffing levels are insignificant to what is actually truly needed, and despite all of the efforts that are made with hiring hall and jewish employment services, there's not enough of them there. i think my time is up.

we are looking for better compliance overall. >> clerk: thank you. >> hi. this is sylvia aquino. can everybody hear me? >> clerk: yes, we can. >> all right. i work at cpmc -- actually, well, st. luke's from 2003 to van ness. i'm talking about two things. like mr. avalos, the transportation never addressed. i get evicted in san francisco. i lived there since 1982, and 2014, the owner of the house, they want to move in, so i cannot afford anything in san francisco, so i moved to east bay. for one thing, this pandemic hit, it cost me more than $400.

$400, and not including lyft or taxi to go to my work in san francisco. i take [inaudible] b.a.r.t., lyft, uber, whatever transportation because i don't have a car. and for one thing -- and they never give us information about regards to that transportation benefit. secondly, in regards to staffing, i noticed that it's been since 2008 recession, and they never addressed it. i've tried numerous times to speak with you guys, and now i'm working with [inaudible] and locally, there's nobody on the floor to take care of patients. that's how short it is, and

[inaudible] to hire more people, and i'm working for two people. i've got multiple injuries by doing [inaudible] to patients, and this is so sad that i have to be [inaudible] you folks about the cpmc, and they are so greedy, and not providing group services to the patients. >> clerk: thank you, ma'am. that is your -- >> why don't you do something about it? >> clerk: thank you. >> thank you. >> hello. can you hear me? >> clerk: yes, we can. >> okay. hello. my name is jessica ho, and i am the government and community manager for northeast medical services. as a community health center -- >> clerk: i'm going to interrupt you just for a second. if you could turn down the volume on your computer just to

eliminate the background noise. i have paused your time. >> oh, great. sorry about that. >> clerk: that's okay. >> as a community health center, we provide comprehensive health care services to approximately 65,000 patients across our 13 sites across the san francisco bay area, including the tenderloin. many of our patients receive medi-cal and prefer to be served in a language other than english. we have a strong relationship with cpmc. we've been operating in the tenderloin since 2017. we opened a clinic at 650 polk street in june 2020, as mentioned by gretchen, but prior to that, we operated a clinic at 518 ellis. of course, as you know, we have an nmso that contracts with over 4,500 tenants in the

tenderloin. during the covid-19 pandemic, we have been working with the community to open our clinic for vaccinations, and we have multiple sites of testing in the city, and we are committed to improving the lives of the underserved in the tenderloin. in summary, we believe that cpmc has met the requirements of the development agreement to provide care to at least 600 medi-cal recipients in the tenderloin, and we hope to continue to provide the best we can with our resources. thank you. >> hello. i'm the executive director of [inaudible] san francisco and also speaking for san franciscans for health care, jobs, and justice. i know the coalition has been here before, but i also want to step back and talk about what

the goal of what it was trying to provide, and that was care for low-income communities and communities of color. [inaudible] it should fulfill the d.a. in the purpose and spirit [inaudible] should be a community hospital. that's what is said earlier today, yet it transfers out its pediatric clinic last year. [inaudible] st. luke's, and now, cpmc has been rolling back on the very health care services that we worked so hard to save. [inaudible] and that's exactly it. what is the plan to address the shortfall? what is the plan to address the condition of bernal? [inaudible] it's very illustrative of issues here of compliance. [inaudible] the question is are people really providing the

subsidy if it's not providing the knowledge to workers to actually access the [inaudible] and i really hope the commission will investigate this situation and help the workers who should have received the subsidies of many years here. and as the other speaker said, they can cost them hundreds of dollars or a low wage worker that is providing health care in the city. [inaudible] the commission has played such an essential role, right? you know [inaudible] it's something that we've asked for, and i think that the commission has really helped us obtain in recent years. so let's [inaudible] to the workers, to the patients, and to our city.

>> hi. my name is [inaudible] montano, and i am the organizing director of senior and disability action. i'm also for san franciscans for housing, health care, and justice. you know, i'm calling because i believe this commission has the power to force this corporation into compliance with the culminated commitment, and also, that they are accountable to what they do with their workers. i'm listening to this, and i'm -- i cannot believe, you know, every year, when they have this -- this annual compliances statement, they picture themselves as being, like, heroes in the community, but they're not doing anything but cutting services and programs that are vital for san franciscans. so please think about the

families that have patients in subacute units, and the ones that will want their family members to stay in the city if they need to receive that service. think about that, and see how you can really gather some power from whatever places you can and make this corporation to comply, you know, to what they have committed in the past and they have not done, and they continue to not respect that. thank you. >> hello? >> clerk: go ahead, caller. >> hi. my name is elise gilbert, and

i'm a certified nurse mid wife at mission bernal campus, formerly known as st. luke's hospital. i've been working there since 2015. the maternal morbidity rates in the black and brown communities in the united states is dire. low-income and communities of color are at much greater risks of a lower outcome of patients during pregnancy [inaudible] our labor and delivery services at st. luke's was a warm community that our patients give birth at and were born at for generations, but the service was now moved across the city. there's no timeline for

transition back to bernal or even it will happen. cpmc is concentrating on making money and not on what's best for people during this time. thank you. >> hi, there. my name is emily pedauer, and i had the pleasure of giving birth at cpmc mission bernal campus. it was close to my home, and i felt safe and supported by the mid wife nursing team. i want to note that the closing of that campus was devastating and i did not feel comfortable giving birth at the van ness campus to my second child. it was unfortunate that i could not give birth to my second child at the place where my first child was born. i ended up choosing an out of hospital birth plan because i

did not feel my wishes to be honored. i urge the opening of bernal maternity and delivery unit [inaudible] thank you. >> hi. my name is nate pearl, and i'm a researcher for nuhw. we represent over 500 nursing assistants, food service workers, and technical workers at cpmc, some of whom have already spoke. i just wanted to call and support the comments of our labor community coalition and san franciscans for housing, health care, and justice, but i wanted to say that these people in these positions that cpmc are supposed to be hiring for, they've really moved the goal posts on the amount of hiring that they need to do. we know personally that they're not serious about doing this

hiring because they've proposed lower minimum rates than our current contract bargaining for these current positions. and what you should do about it, we urge these departments to do a real investigation of their compliance with this instead of relying on self-reported data from cpmc. we think you should do an investigation and get a full accounting not just of what the mode share is of the happy people who get to work, but who is getting the transportation benefits because the people are not, and if they are not, they get a full retroactive reimbursement because that's what they're owed. thank you very much.

>> hi. good morning. my name is jonathan gerase. i appreciate you taking the time for my comments. my comments are about the parklet. it appears that nothing is happening, and i'm just curious about what the neighborhood plan is. thank you. >> hi. i was just unmuted, but i spoke already before. thank you. >> clerk: oh, thank you. >> oh, i did my comment already. >> clerk: okay. thank you.

just making sure. a couple of these callers i jotted down didn't seem to make their call, but i'll give them -- go ahead, caller. okay. i am going to ask for anyone who has not yet spoken to please press star, three if they would like to provide their public comment at this time. last call for public comment. you need to press star, three. okay. seeing no additional requests to speak from members of the public, public comment -- i take that back. go ahead, caller.

>> hello. i'm nancy bohannon. i am an endocrinologist, and i've practiced in san francisco since i opened my office in 1976. i have cared for hundreds of people in the mission district. i was the only private endocrinologist in san francisco in the east for years. sutter has done the city a grave injustice by moving labor and delivery and pregnancy services to the other campus. this has really been very disruptive, as you've already heard, but sutter has a long

history of reducing services. one of the most lucrative services was the rehabilitation service, which they closed down as soon as they could and moved it over to another campus. they've closed the labor and delivery and moved it, which has been devastating for the community. they keep closing services [inaudible] and changing the nature of the care they are giving. we feel they should pay the fines of breaking the 2013 agreement, because they have not kept that agreement. they should return full services to the hospital and consistently support those services, but most important to me are the labor and delivery

services for these high at-risk pregnant diabetic patients. i recommend that the board of supervisors renew the agreement with sutter so that they cannot continue to abandon their responsibilities as outlined in the agreement. thank you. >> clerk: thank you, ma'am. that is your time. okay. final last call for public comment. you need to press star, three. okay. commissioners, seeing no additional requests to speak from members of the public, public comment is now closed, and this matter is now for your review and comment. >> jonas, should we start off or have the health commission begin? >> clerk: however -- i'm not sure it really matters. there's no vote here, so i think as previously mentioned, those who wish to make comment should enter their name in the chat function to everyone, and then, we can just call on people in the order that we

receive their request to speak. >> okay. great. i'll just go ahead and start, and for simplicity's reason, i'll go ahead and chime in on ken's report. myself, i was able to go ahead and fill out paperwork for residency here in san francisco. it makes less transportation, and i'd like to point out, i like your weight and fitness

rack in the background. it's nice to see that you're keeping in health, and you're not slouching. thanks, ken. i know that not only on the job sites, but especially in the offices, these projects are complex to build. they're not only intense on the job site, but it takes a lot of manpower and woman power in the offices, on the computers, working on all the c.a.d. and drawing systems, all the working people to engage these programs correctly. i know the diversity in the offices is at an all-time high, and i can't thank you enough, ken, for giving us updates on a yearly basis, and president bernal, would you like to chime in, as well? >> yes, and thank you, president koppel.

first, i would like to thank the san francisco health commission secretary mark morowicz as well as jonas ionin for your help, as well. this is our regular meeting, which we did not have the opportunity for -- there are a number of questions that we had with regard to medicare managed care, particularly with the labor and delivery unit, which had been raised by some of our callers already, centers for excellence, senior health, and chair care, and the cultural and linguistic appropriateness

and health care services. and i know that some of us will be raising these questions, and i will be, as well. so i wanted to thank the health department for the excellent work they did in preparing for this meeting. >> president koppel: commissioner tanner? >> commissioner tanner: thank you. just want to commend the staff for their great reporting and great overview and all the information that's provided. i think you noted some members of cpmc that are on the line. do we know their phone numbers, jonas, to unmute them and engage them with questions and things? >> clerk: commissioner tanner, yes.

we do have several members of cpmc staff prepared to answer questions from the commission. >> commissioner tanner: okay. i have a few questions. staff, if you have a response that you want to provide in addition or in lieu of cpmc, you know, sometimes it may be more appropriate for staff, so certainly open to who the most appropriate body is to respond. one of the things that we heard about and that was reported is the closure of the labor and delivery services, and so just -- and that there's no plan to reinstate that. i want to understand more about, you know, is that from staffing shortages? is it because of covid and things have changed? i was concerned because no notice was provided and no plans for reopening. i understand plans for reopening many things have come and gone during the pandemic, but if staff or cpmc can explain a little bit more about why that happened and what we can expect to see in the future with those services that may be

relocated or diminished due to the pandemic? >> this is gretchen polley from the department of public health. from the department perspective, we are committed to investigating the impact on patients and how cpmc is working to support patients during the reduction in services. so we have asked cpmc a number of questions to understand the impact and have requested that cpmc continue to work with us to continue the covid planning and to understand how the site might be restored in the future, but i will leave it to cpmc to discuss how the services have been changed and why. >> commissioner tanner: great. thank you, so perhaps cpmc would like to join us and

share, that would be helpful. >> clerk: yes. i've unmuted several people, so they should all be able to speak. >> commissioner tanner: okay. whoever wants to take it away. >> clerk: okay. and i've also unmuted warren brenner. >> hi. can you hear me now? >> clerk: yes, we can. >> commissioner tanner: yes. >> so thanks for the opportunity to speak to the health commission and planning commission. we actually haven't had an opportunity to speak to the health commission during this entire pandemic, which i think

is remarkable, and i want to begin by saying what a remarkable job that the hospitals and city have done during this pandemic. we had a call last night that without what we've done, a half a million more people who have died, and i think that's a tribute to the mayor, the department of health, and the workers in the public health care system did to keep the people of san francisco safe. one of the first things that we did when we heard about this pandemic, and its impending arrival was plan for the worst. some of you may remember that we were in discussions with the state to use the now closed pacific hospital, which we never had to do. but we also early on, didn't know the direction of the

pandemic, and we knew we needed to consolidate our services in anticipation of the worst, and i think we're seeing what we hope is the worst, but we don't know what will happen in the future. so one of the decisions that we made was consolidate the inpatient labor and delivery services at st. luke's to our mission bernal campus so that we could have one floor and the most space in case we, the city, needed access to more beds for covid patients. i remind everyone that we continue to provide services for pregnant women at mission bernal, and the fact that high risk women always were delivered at the van ness campus was mission bernal was intended to be a low risk delivery center, mostly

centering on mid wife delivered care. we have not closed that service permanently, we have closed it temporarily during the covid pandemic. i am constantly asked when we will reopen it, and i wish, like the rest of you, that i knew the answer to that question, because it's entirely dependent on the course of this pandemic. through the course of the pandemic, we have been surprised multiple times. i think none of us anticipate that omicron would be as devastating as it's been, even in a city like san francisco, which is so heavily vaccinated. we now have more patients in the hospital at cpmc than we've ever had before at any point during this pandemic, and we view our responsibility to the entire city to continue to provide the capacity to deal with whatever the pandemic throws at us. so that then answers, i hope, how we made the decisions on

the inpatient labor and delivery at mission bernal and what our plans are going forward. >> commissioner tanner: i think that does provide certainly insight into the rationale for the closure or temporary closure. what i would suggest to the department of public health and others is to identify what the criteria might be for it to reopen. certainly, we don't know perhaps [inaudible] i don't know, six -- >> clerk: commissioner tanner, i'm sorry to interrupt, but it seems as though you're -- commissioner tanner, i apologize for interrupting, but you're experiencing some technical difficulties. if you -- if you stop your video, sometimes at least we can get the audio. commissioner tanner?

commissioner tanner? can you hear us? are you still with us? >> commissioner tanner: is it improved now? >> clerk: yes. i've turned your video off, so we should be able to hear you, at least. >> commissioner tanner: yes, and i realized that my wifi was on the wrong network, i think. i was just saying, identify some criteria so we can understand -- what would need to happen during the course of the pandemic for those services to be restored or in this case know that the bed space that's been basically set aside to accommodate potential pandemic patients who need to isolate is not -- no longer needed. i think that might help with the public messaging. i did want to ask about the guerrero park, the commitments that have been made to improve that plaza, and the effort to improve it, and i think there's

concerns about time passing very quickly and needing not only to improve the design but where things are right now. can you give us an update on what to expect and when we can expect the update to be finalized? >> i'm sorry, commissioner. was that a question for staff or cpmc? >> commissioner tanner: i would say it's a question for cpmc unless staff is responsible for the design. is it our park and rec department responsible for the design or is it cpmc that's responsible for the design of the plaza? >> sure, i can respond to that. the design is being driven by cpmc. they're responsible for the design and carrying it through the design process. in terms of the timing, cpmc may be able to respond to that better.

>> commissioner tanner: okay. if cpmc can tell us what has occurred with regards to that park and when we might expect it to conclude. >> good morning, commissioners. [inaudible] with cpmc. can you hear me? >> commissioner tanner: yes. >> hi, yes, i can kind of provide a brief summary on the process of the park. we hired [inaudible] architects and our contractors on the design of the guerrero plaza project and had a number of iterations of design. we held five -- five workshops and neighborhood meetings that went back to 2017. we thought we were at a point where we had concluded design in -- at the end of 20 -- i'm

sorry, the meetings started in 2017 and concluded at the end of 2018. we submitted for a [inaudible] permit with the city in february of 2019. subsequent to that, we did have a number of comments from neighbors that came back that wanted to see substantial changes to the design, hardening the edges out of fear of cars barrelling into the park, driving up guerrero at the curb where guerrero and san jose serve -- split.

we hope to have a final approved permit sometime this year and are ready to proceed with construction thereafter, so in brief, that's where we are. if you have any questions, happy to field those. >> commissioner tanner: thank you for that feedback. i know that projects can certainly stretch on. it's certainly disappointing, though, to hear that it's taken this long, and the design's still not -- sounds like it's still not finalized. i understand there's some

concern why the design isn't even finalized yet. the design started in 2017, and here we are, five years later. >> yeah. i can't speak to the design issues, but there were issues raised by the neighbors about the plaza, both current and future space, and i think that, in combination of design changes, is why it has taken as long as it has, and i don't know if staff want to respond to that at all. >> commissioner tanner: miss purl, i don't know if you want to respond -- it sounds like there's some discussion as to who's going to maintain the park in perpetuity. do you want to respond?

>> that's been a major issue. one of the requirements of the development agreement is that it's on a small triangle of land, but the park cannot be built without a number of other agreements. at the time the agreement was signed, public works didn't anticipate maintaining those grounds as part of the d.a., but at the same time, the permit cannot be approved without those agreements, so we have been in the process of negotiating with cpmc in how to fund those additional improvements that are a necessary part of the park but that are not on the triangle designated in the development agreement, and we do have a

pathway fund those and construct those improvements and carry out long-term maintenance through improving. >> commissioner tanner: i just have one last topic regarding

the transportation, and we had some testimony here about workers understanding they may be entitled to subsidies. when i was reading the t.d.r. report, i couldn't understand if subsidies were part of it. it seems to be providing shuttles as well as providing spaces for alternative transportation like cars, bikes, walking, etc., but noting that many of the workers are shifting to east bay or not being san francisco residents. so cpmc, can you explain if there were to be subsidies provided to workers for t.d.m. or if that's not your understanding how the t.d.m. is going to be rolled out.

>> this is warren brennan again. we let every members know that our subsidies include public service for transportation. i'm chagrinned to learn that some of our staff don't know about them, and we'll make a stronger effort to do so, but again, i was surprised that the union isn't providing their members with information of a benefit that they have. >> commissioner tanner: i'm hoping that more staffers and workers can be aware of the services and the benefits they have. do you happen to know what the nature of those benefits are, just for those listening, they can understand what's accessible to them right now? >> i wouldn't answer that off the top of my head, but there's substantial subsidies for clipper® cards and things like

that. >> commissioner tanner: all right. great. thank you. those are my questions. >> president koppel: commissioner diamond? >> commissioner diamond: thank you. first, i want to thank staff from both departments for their incredible work putting together the very, very detailed analysis that was provided to us in this hearing. i. i had two questions related to the report. one is directed to d.p.h.

staff, and one is directed to cpmc staff. all of the questions about the subacute facilities really raised the question in my mind about the spectrum of services that, as a city, we need to have available to our older adults. as i understand it, the terms of acute is used broadly, generally, to refer to people on ventilators, but we also have long-term s.n.f. that's needed for older adults that are confined to their beds for other reasons. there's short-term s.n.f., which is short-term rehab, and under a totally different license, assisted living, and for purposes of this discussion, in the frail category. while this may seem like a discussion that's under the jurisdiction of d.p.h., it raises its head at the planning commission most recently in the

form of board and care facilities and the position of the city to retain board and care facilities and reports that we have received that indicated that they're not financially viable without significant subsidies which are not currently available. so if d.p.h. staff could take a moment and talk about the gaps between what cpmc is required to do under the d.a., which really just focuses on subacute and all the rest of the services i just identified that are critically important for our aging population? where is this addressed? what's the plan? where is this talked about? how do we as planning commissioners stay informed? it's a broad subject, and i don't want you to dive deep into it, but if you could give us an overview not only on sort of what the status is of the

efforts to find other subacute beds as the number diminishes at cpmc but what i understand to be a shortage of not only subacute, but short-term s.n.f. beds, long-term s.n.f. beds, and others? >> thank you, commissioner diamond, for the question. we are working with all of our partners in the city to understand how we can bring more care beds on-line. these are efforts started in 2021, delayed because of the pandemic, and there are two primary interventions where we're actively working with chinese hospital and another long-term care facility so understand how we can bring beds on-line at those two facilities, so that is an on going process. cpmc has been engaged as one of the hospital partners in these

conversations, but as mentioned earlier, cpmc is not yet committed to any specific activities that they will support for care beds. kind of stepping back, looking globally at the issue of needing more long-term care beds and other types of beds for older adults, part of that is addressed in the city's health care service master plan, and that is done in conjunction with the city's long-term care plan, looking at gaps in services and how we can bridge the gap. i and my colleague work on that particular plan, and we're happy to provide more information to the planning commission on that health care services master plan. >> commissioner diamond: i had the opportunity to review the health care services master plan a number of years ago, and what i'm interested in is not only the planning efforts but

the actuality of the implementation of the planning of beds. where are we, what's our goal, how forward towards the goal are we, and what are we doing to actually incentivize the providers of these services which i know are so dependent on government funding in many respects, and the problem is clearly compounded by shortage of labor, back breaking labor, and the need for nurses. all of these problems come together, resulting in the shortage of beds, so it would be, i think, useful and perhaps as a planning commission information item, you know, in the near term, d.p.h. could present to the planning commission sort of where you are on these subjects. so i would just put that out there as a request to planning department staff and d.p.h. staff to see if it would be possible to have a report and

an information session sometime in the next couple of months. my other question is for cpmc. i noted that the t.d.m. patents had fallen off during the pandemic, the public transportation, and the concern that people might have had in taking public transportation to get to the hospital, and i'm curious about what efforts cpmc might take to move people back towards accomplishing the goal, and if there are -- if there's work going on with m.t.a. about

the timing or particular lines of service? i know that the hours of staff are quite different from most workers, so if cpmc could give us an update on what measures they think are necessary to get us closer to the goal? >> commissioner diamond, it's warren brenner again. first, i want to thank you for your interest in our geriatric population. we view that as an essential part of what we do at cpmc, and i want to assure you we have a dedicated geriatric care center at, and we view it as an incredibly important part of our services that we provide at

mission bernal. as far as transportation, everybody is aware that we built the new hospital at geary and van ness in anticipation of it being a major transportation hub in san francisco, and i'm literally sitting out, looking at van ness and geary as we're speaking now, and the rapid transit systems on both of those streets are not yet fully operational or close to operational. that will be an enormous help for those to get to work at our campus, which is the largest of our campuses. but i share your concern, the decline in the use of public transportation during covid, people getting used to and relying on private cars and other sorts of transportation, uber and lyft, is going to be something that every employer in the city is going to have to deal with once public transportation is back, fully operational, and we'll do a big

push. hospitals are a unique situation because we're open 24-7, and on weekends, and our transportation is less good, and even when it's at its most robust. we have a substantial part of our population that unfortunately has to take cars to work, given the high cost of living in san francisco. so i appreciate the concerns we share. >> commissioner diamond: thank you very much. those are my questions. >> president koppel: president bernal? >> thank you, president koppel. first of all, i'd like to thank dr. browner for his response to san francisco's department of

public health's response to covid-19. it would not be possible without the dedicated work of mayor breed, d.p.h., and the people of san francisco. i would also like to underscore to dr. browner that he and cpmc are welcome at any time to address the commission, and please reach out if you feel the need to do so, particularly as we return to in-person or hybrid meetings in march of this year. i did have some questions in regards to the answers that you provided particularly with regards to the labor and delivery at mission bernal campus. my questions focused on being accessibility. i know you addressed purpose to

maintain covid ready ability on that floor. what efforts are being made or what's your assessment of patients who had been seen at the labor and delivery unit at mission bernal, that their needs are met and they're aware of the availability of services at the van ness campus or have they somehow been lost in terms of the cpmc system and, you know, understanding some of the neighborhood characters for each facility, are they getting the services that they need in a way that is culturally and linguistically appropriate. >> yes, i'll take that. again, i want to emphasize that the prenatal care for the moms at mission bernal continues to take place at mission bernal,

and we take -- as their delivery date approaches, we take them on a tour of the van ness campus and how to access us, as we do with all of the 5,000 patients each year. it's not an ideal solution, but it's a solution that allows us to anticipate a future potential problem with covid that none of us have seen coming. some of you actually know that i have trained as an epidemiologist, so you would think i would be in a good position to anticipate the curve balls that this pandemic has thrown us. i certainly would never have predicted that, two years in, we would be in the thick of it once again, and i've learned

not to make predictions about when we're going to be able to get out of it. there's nothing that would make me happier than to see this pandemic end and life get back to normal, but i think our efforts for moms, we're enabling them at our van ness campus, which has substantial capacity for it. >> thank you, dr. browner. >> commissioner chow? >> thank you, president bernal. can you hear me? is it -- oh, i guess i have to turn this down. okay. >> we can hear you, dr. chow.

>> okay. now i can't hear you. >> you're good to go, dr. chow. everything's okay. >> oh, okay. thank you. and i want to also echo president bernal's thanks to everybody and then add, also, our thanks to the hospital council and all the various bodies that have been cooperating, including cpmc. and having a background of being on this project, even before it was built, and even before the d.a. was written, i'm really encouraged that so much progress has been made in the various reports, and i thank the department, both departments in actually creating reports that are not just voluminous but very filled with information that allows us to understand in the course of this near -- understand, in the

course of this near eight-plus years, the progress being made. and that includes our own department which helped summarize the issues very well that we are all looking at. obviously, the project is to help deliver health care for this community. and some of the questions that were asked, i wanted to give credit for cpmc for helping to respond, although i'm not sure that i appreciate the 16,000 lines of health care information, patients that cpmc cared for in 2020. i did find out that cpmc indicated to us that the

[inaudible] i'm always calling it mission, but i'll -- st. luke's, but i'll have to learn to calling it mission bernal. i was a little surprised about my question first, to cpmc before i finish my comments are, in regards to davies therapy pool, maybe dr. browner, you can help us, and what's happening there. we understand there's maintenance, and there is some questions if there will be a pool returning and how to do rehab units without a pool? >> yeah, so i'm not an expert on in-patient rehab. i know that the pool had very poor ventilation and lots of

leaking and was not considered to be -- we didn't consider it to be something we could keep up with during covid. as far as i know, most acute rehab facilities don't actually have swimming pools. most rehab is done without having that kind of facility. we were lucky that we had one. >> is -- dr. brenner, i'm not sure if you were finished, but with those problems at the pool, was cpmc intending not to have the pool anymore? >> ed, if i can call you ed because i've known you for so long, i've got to tell you, it hasn't risen to the list of things that have crossed my desk for decisions about. there's so much else going on about.

i'd be remiss if i said i was fully up to speed about what's going on with the pool. we're dealing with lots of other stuff, as i'm sure you appreciate. >> i understand, and i'm sure that's one of the comments that i was trying to make, that our department can work with you in terms of something that was brought to you or we need to have a better understanding of, understanding that, obviously, pools do need to be refurbed or closed permanently. i think we need to see if that is a service that would rise to the level of acute. likewise, i understand that cpmc has felt that having opened the covid unit in place

of the o.b. was -- and i understand your answer to the questions, but would trying to keep a capacity for unexpected changes, again, in covid, but i'm wondering if the city then changed the state of emergency, would that be some sort of a signal that says you could bring back the o.b. cases, and i guess, secondly, about o.b. itself, are the patients being given a tour of van ness and knowing how to get there before their day of delivery? >> yeah, and maybe you didn't hear me before, but we do make sure that all the women that get their prenatal care at mission bernal are familiar with van ness and how to access it when it comes time to have

their baby. >> okay. very good. would the lifting of the state of emergency or any changes that the department could say they would bring o.b. back or is that something that the department might need to talk with you? what might be those changes that, then, the department might say we -- i don't know how many beds there are, but that it would be okay to bring o.b. back because of a decreasing covid capacity? >> you're anticipating the end of the pandemic, so that would be the criteria -- we have the situation that san francisco is ahead of the curve, both in

terms of what's happening with omicron and also with our very high vaccination boosting rate. we do serve as a referral for the rest of the sutter health care system and many other hospitals in northern california that are further behind us both in omicron and vaccination, and we'd have to take into account those responsibilities, as well, but let me assure you i am very much looking to the end of this pandemic, at least as anybody else on this call. it has really complicated all of our lives, you know, immensely. >> thank you. along that line, and as an epidemiologist, do you not feel that we may be in a different sort of a state of it being

endemic as opposed to pandemic and things will eventually get back to normal? >> this is a deeper discussion, but i think if we were an island, that that would probably be true, but the concern is that the virus is still in our world, and it's hardly endemic in africa or much of asia or even south america, so i'd be hesitant to stay we are going to get to endemicity as quickly as we would than if we were by ourselves. >> no, i appreciate that, you

know, your approach to that. if i could change the topic to concerning the tenderloin. as you know, the mayor did declare an emergency for all the issues in the tenderloin. is cpmc part of working together with the d.p.h. and maybe other facilities? i know that st. francis has sort of an outreach in the tenderloin in order to assist the people in the tenderloin in the opioid crisis? >> yeah, we're located not very far from the tenderloin and often receive overdoses and other incidents of health that occur in the tenderloin as well as working with d.p.h. to try to figure out what to do about it.

i think all of the hospitals in the city would really appreciate an occasion to talk about the effect that the pandemic is having in the city. they are dramatically affecting our ability to provide care to other folks in the city, and all the hospitals are very much engaged in trying to help figure out what to do about this problem. it is worse, i think, than many people release. >> well, i -- no, that's -- thank you, and i'm sure that we'll be looking forward to partnering with you and others in the hospital community. but being that the hospital is to close to the community and part of the response that the

d.a. was seeing was to try to improve the health of the tenderloin with the new hospital, then this would be a potential, while not within the d.a. that would show a continued interest in that area. along that line, st. anthony and cpmc does not seem to be moving very far. meanwhile, the nems relationship is very commendable does fulfill at least the asian community part of that since nearly 90% of nems' patients are asian. but it says in your report back to us, you've been training

st. anthony's and their leadership -- your staff, that is. not you personally. i know how busy you are -- but that you actually continue to try to work with st. anthony's, and that's been going on for, what? four-plus years, and then, that's not going to work. is there a new strategy to reach more people in the community than what nems is able to reach? >> let me just say a couple of things, and then, i'm going to call on my staff. we realize that although st. anthony's is located in the tenderloin, it hasn't -- it's undergone a lot of change in leadership. we've also been working with healthright 360, and then, i'm

going to ask kate whelan to talk about our other programs in the tenderloin. >> yeah, so that was a ban that healthright 360 has supported mobile care, primary care to help vulnerable communities in the tenderloin. we also have an investment in the tenderloin. we've given grants to g.l.i.d.e. and also partnered with g.l.i.d.e. for a number of vaccine works during the pandemic. we've also, which i think is part of the report development agreement is, you know, reported safe passage to make

sure that residents in the tennerloin are able to move safely in their neighborhood, and then, we've also provide movement safely on the streets, and that's in addition to the partnership and the care that we provide in the tenderloin. i'm going to turn it over to emily to talk about sort of the history with st. anthony's and where that stands. >> yeah, thank you, commissioner chow. emily webb. i just wanted to add onto the community partership. we work diligently with the clinical association to try to make that feasible, but it just wasn't going to be financially feasible, which you may recall.

technically, according to the development agreement, it says very clearly that we are he ae ae -- that we're allowed to meet our tenderloin agreement in our partnership with nems. we wanted to work in the spirit of the agreement, and we've forged that partnership. we've done outreach and conducted due diligence, but i think there's personal choice in assigning a primary care provider, and there are a number of providers in the tenderloin, including large d.p.h. clinics that do significantly large outreach efforts.

another thing is a change in the executive director and administration, but nems has several other providers in the tenderloin private practice, both family care and pediatric providers, and they represent significant care, about in that 4500 number, and focusing only on st. anthony's only really looks at one piece of our partnership and investment in the tenderloin. >> no, thank you, and i do appreciate you looking, as we are, in the spirit of how to reach the tenderloin as opposed to just simply having the

number of beds that the d.a. calls for, and i think that our future reports might be able to outline that you've made the number in the strictest sense with nems, that aside from st. anthony's, there are these other options that you are providing to the community, which i think would be very helpful to understand the work that you're doing in the community down there. and i think one of the questions that i asked, how many people in the zip codes were using cpmc van ness campus, and it seems to be quite considerable in 2019 and 2020, so i want to give that

consideration to the commission, so thank you for that. so i'll just conclude by just sort of suggesting some areas i thought might be of important for future consideration. in the o.b. services, to try to understand how the patients, you know, are accepting the transfer to van ness, especially that it sounds like, from dr. browner, it'll be some time before they determine how long they'll need the covid beds and updating their system. so i think it would be nice that the patients could also give input into how well or could have some suggestions of how to improve the transfer process from prenatal care at

mission bernal and then delivery at van ness. i know this can be done, and it was done fairly successfully with chinese hospital, so again, i think the way you would measure that would be to find outpatient satisfaction, and we all might even learn more about it, then, and how to improve the service. i think secondly, on the cultural competency, i really appreciate the information that you gave on the demographics, and it showed that it was quite responsive. again, here, i think the recipients, to get an opinion as to how well that went, would also be able to tell how your vendors or interpreters are really doing on-site. so perhaps getting some input on that, and perhaps you also get it directly through surveys that you get through patients

being discharged. if not, it might be a question that should be on the discharge if they received interpreter services so that you could be able to understand also how well it's being received, is it useful, and any areas of improvement that could come out of that type of input. i know that you had said that you really don't have patient input on the services. there is a portion of the class starts that to which you said you were infusing cultural competency into the various operating departments and all, but i didn't actually see information on that, and perhaps we can get information on that at our next report. lastly, just to encourage that we continue to work on subacute care. i know we've been struggling with that issue for many, many

years, and really appreciate the work that you all did in helping to sponsor the last report that came out of the hospital console, but now i think that we're on the verge of actually getting some beds, it may be an issue that cpmc might see where they can contribute more beds or actually help contribute to these -- sustaining of this, perhaps by way of how many patients would come from the system. whenever it may be, i would hope that you can work with the department on this, also, as it looks like we have at least made some progress in spite of the pandemic in looking for subacute beds here in san francisco. so that actually concludes my remarks. my thanks to everybody, again, for the fine work they did in putting together the two years

of reports. i feel that we're sort of caught up now, finally, and sutter's roll in the city is more clearly defined and that they have built out a bigger system than when we were just at them at the pacific campus only. we will look forward to their continued operation and improvement of the health of our residents. thank you. >> commissioner imperial? >> commissioner imperial: first, i want to thank commissioner chow for very detailed requests and also questioning to the cpmc. one -- and i would echo commissioner chow regarding his outreach in the tenderloin area. one thing that is -- one thing that is the outreach in the tenderloin where the medical

enrollees are behind in the cpmc, and i would echo commissioner chow in terms of doing more outreach that is just beyond the -- i do think, however, we keep cpmc in forging the partnership with st. anthony's, but it's still important to keep more partnerships in that area and not just the medical service providers. i would also make comment about the guerrero park completion, and it looks like these are things in discussions, and i would like to hear the cpmc actually, since this project is being delayed now, in terms of their commitment, and i think i would like to hear, probably in the next year, in the next reporting, in terms of finalizing design, and also part of the discussion should be also the maintenance of the park. i would like the cpmc make this

kind of commitment in this guerrero park completion, and also, i would echo other commissioners and all of their concerns about the subacute services beds that it looks like has been an issue for many years. and yes, i understand that we are still in pandemic, but the planning for it, for the subacute services should not be delayed and should not be -- should actually be more urgent in this time. so those are my comments, and i do appreciate every commissioners that made comments here, and looking forward to cpmc to see [inaudible] commitments in these areas of concern that still haven't been met yet. thank you. >> president koppel: commissioner moore? >> vice president moore: i'd like to echo thank you to the

health commission, in particular, the succinct summary of commissioner chow. i'd like to thank staff, and i'd also like to thank cpmc. this is probably one of the most difficult times to deliver a cohesive reporting because in every aspect of health care, life has been upended in a way that none of us predicted, and all of your charts and tables leave a lot of questions open. for planning commissioners, i think commissioner tanner, commissioner diamond, and commissioner imperial touched on those things that are of most important competence to us, and that is the land use of the park, and the urgency for getting the park done, understanding all of the things that may be in the way that may have delayed this, and helping the city get this done as quickly as possible.

there is concerns about t.d.m. management, staff using public transportation, and the need of people to drive their own cars. the questions that were posed by the public leave me still a bit uncomfortable because out of the many public comments, the human factor of disappointment is what i heard from most people who spoke. many of the people who have spoke have done so over the years we had multiple locations at our updates of cpmc and their compliance program spoke again today on a number of issues that, in their perception, have not been diminished. i am referring to the professor, i am referring to mr. avalos, and people whose

names i don't know, nurses, patients, etc., and i have not heard many positive comments. i am not taking sides, but the echo of those comments still raise money questions that i think should remain on the table so that we continue to improve how people are perceiving cpmcs compliance and as the recipients of care in the system, i would like to hear where people are praising and in reference of each other about what they're doing opposed to what they're not doing. today, i heard less of what's being done than what's not being done, and although i saw the charts, i think commissioner chow very

succinctly voiced challenges. i myself am not in the medical field so i listened attentively to what was being said, and i urge all of us to continue to work toward solutions that we can, in the end, can hear, as a recipient of public services and health care, in the end, can say that cpmc is doing a fabulous job. i wish that for all of us. thank you. >> clerk: okay. if there are no further questions or comments from members of the commission, this public hearing is now closed. >> president koppel: we're adjourned. >> clerk: thank you. >> thanks, everyone. >> thank you, everyone. stay safe and healthy. >> vice president moore: thank you much.

>> after my fire in my apartment and losing everything, the red cross gave us a list of agencies in the city to reach out to and i signed up for the below-market rate program. i got my certificate and started applying and won the housing lottery. [♪♪♪]

>> the current lottery program began in 2016. but there have been lot rows that have happened for affordable housing in the city for much longer than that. it was -- there was no standard practice. for non-profit organizations that were providing affordable housing with low in the city, they all did their lotteries on their own. private developers that include in their buildings affordable units, those are the city we've been monitoring for some time since 1992. we did it with something like this. where people were given circus tickets. we game into 291st century in 2016 and started doing electronic lotteries. at the same time, we started electronic applications systems. called dalia. the lottery is completely free.

you can apply two ways. you can submit a paper application, which you can download from the listing itself. if you apply online, it will take five minutes. you can make it easier creating an account. to get to dalia, you log on to housing.sfgov.org. >> i have lived in san francisco for almost 42 years. i was born here in the hayes valley. >> i applied for the san francisco affordable housing lottery three times. >> since 2016, we've had about 265 electronic lotteries and almost 2,000 people have got their home through the lottery system. if you go into the listing, you can actually just press lottery results and you put in your

lottery number and it will tell you exactly how you ranked. >> for some people, signing up for it was going to be a challenge. there is a digital divide here and especially when you are trying to help low and very low income people. so we began providing digital assistance for folks to go in and get help. >> along with the income and the residency requirements, we also required someone who is trying to buy the home to be a first time home buyer and there's also an educational component that consists of an orientation that they need to attend, a first-time home buyer workshop and a one-on-one counseling session with the housing councilor. >> sometimes we have to go through 10 applicants before

they shouldn't be discouraged if they have a low lottery number. they still might get a value for an available, affordable housing unit. >> we have a variety of lottery programs. the four that you will most often see are what we call c.o.p., the certificate of preference program, the dthp which is the displaced penance housing preference program. the neighborhood resident housing program and the live worth preference. >> i moved in my new home february 25th and 2019. the neighborhood preference program really helped me achieve that goal and that dream was with eventually wind up staying in san francisco. >> the next steps, after finding out how well you did in the lottery and especially if you ranked really well you will be contacted by the leasing agent. you have to submit those document and income and asset

qualify and you have to pass the credit and rental screening and the background and when you qualify for the unit, you can chose the unit and hopefully sign that lease. all city sponsored affordable housing comes through the system and has an electronic lottery. every week there's a listing on dalia. something that people can apply for. >> it's a bit hard to predict how long it will take for someone to be able to move into a unit. let's say the lottery has happened. several factors go into that and mainly how many units are in the project, right. and how well you ranked and what preference bucket you were in. >> this particular building was brand new and really this is the one that i wanted out of everything i applied for. in my mind, i was like how am i going to win this? i did and when you get that

notice that you won, it's like at first, it's surreal and you don't believe it and it sinks in, yeah, it happened. >> some of our buildings are pretty spectacular. they have key less entry now. they have a court yard where they play movies during the weekends, they have another master kitchen and space where people can throw parties. >> mayor breed has a plan for over 10,000 new units between now and 2025. we will start construction on about 2,000 new units just in 2020. >> we also have a very big portfolio like over 25,000 units across the city. and life happens to people. people move. so we have a very large number of rerentals and resales of

units every year. >> best thing about working for the affordable housing program is that we know that we're making a difference and we actually see that difference on a day-to-day basis. >> being back in the neighborhood i grew up in, it's a wonderful experience. >> it's a long process to get through. well worth it when you get to the other side. i could not be happier. [♪♪♪]

i'm nicole and lindsey, i like the fresh air. when we sign up, it's always so gratifying. we want to be here. so i'm very excite ied to be here today. >> your volunteerism is appreciated most definitely. >> last year we were able to do 6,000 hours volunteering.

without that we can't survive. volunteering is really important because we can't do this. it's important to understand and a concept of learning how to take care of this park. we have almost a 160 acres in the district 10 area. >> it's fun to come out here. >> we have a park. it's better to take some of the stuff off the fences so people can look at the park. >> the street, every time, our friends. >> i think everybody should give back. we are very

fortunate. we are successful with the company and it's time to give back. it's a great place for us. the weather is nice. no rain. beautiful san francisco. >> it's a great way to be able to have fun and give back and walk away with a great feeling. for more opportunities we have volunteering every single day of the week. get in touch with the parks and recreation center so come

>> good morning p.welcome to the january 14th. meeting of the youth, young adult and families commission. we are joined by supervisor safai and member melgar. our clerk is erica major. any announcements? >> yes. minutes will reflect this is a areremote meeting. we invite public participation in the following ways. public comment is available on each item on the agenda. through sfgovtv they are streaming the number on the screen. each speaker is allowed two minutes to speak. comments to speak duringhe