to order for the date of september 14, 2023. join me in the pledge. [pledge of allegiance] >> thank you, president scott.

roll call president scott. >> present. >> vice president hao. >> here. >> [laughter]. vice president hao is on her way. >> commissioner breslin. is here. supervisor dorsey. >> present. >> commissioner follansbee. >> present. >> and commissioner zvanski is absent. >> thank you. we have quorum. >> we will go to item number 3. general public comment. >> thank you, president skochlt item 3 is general public comment an town for the public to comment on a matter in the board's jurisdiction not on the agenda including requesting a board place a matter on a future agenda item. joy will read our instructions for anyone joining us online. health service board away public participation. there will be an opportunity for the general public it comment at the beginning and an opportunity on each item on the agenda.

in person comment be first and virtual. for anyone in person you can approach now. each speaker allowed 3 minutes unless the president deems time limits during the meeting. all ment concerning the item presented. a carroll miask questions but no obligation to answer. the health service board will hear 30 minutes of remote comment. remote ment for people received accommendation due to disability will not count territory will limit. call in by dialing 415-655-0001, access code: 2663 488 8763 ## >> then press pound you will enter the password and press pound. star 3 to be added to the queue you will hear, you have raised your hand.

wait to speak until you are called on. this is year time to speak you will be mute when your time is expired. click on the raised hand i conto be placed in the queue. whennure unmuted a request to unmute will appear. once you hear, vehicle caller you can speak. click on raised hand to lower your hand. measures encouraged to state clearly although remain unanimous. i will give you awe warning when you have 30 seconds. thank you to sfgovtv and media service for share thanksgiving meeting with the public. >> one moment as we check our public comment queue. >> our moderator can let us know if there is anyone in the queue at this time.

>> we have one caller in the queue. no caller enter public comment at this time. >> thank you. hearing no callers public ment is closed. >> another piece about setting something on the next agenda by a board member, item 3. >> right. anyone this is i general public comment on anything this is not currently on the agenda. or where a member or boarded member can request something be put on a future burden agenda. to be clear. >> for the november meeting i would like a discussion on the race of 2024, how the retirees are calculated pers charter i would like to get them here to understand that. i went over it myself and had a tough time understanding it.

>> let mow be clear. early retiree rates and how they are set by city charter provision sns >> right. >> okay. >> relis to the other rates, too. i skwt executive director to work with someone and so when we can insert that as agenda item. >> hello. >> yes. >> excuse me. i can't hear. so, yes, we will be happy to review the materials we put together and presented at this meeting and if there are additional questions we'll be happy the meetings are recorded we put the educational sessions

how he pets them on the board of education website they are available as a part of the board colors xhagz education i know it can be confusing. so i would appreciate if there are questions you have that we can 40 presentation we will be happy to do so. >> i'm clear that commissioner you said there would be additional people coming? >> i have in the asked anybody. the wait a minute for early retirees were unaffordable. >> i would ask. >> all right. there is a spread the word come next week if you want to talk about early retiree rates. next month. >> november. the november meeting. thank you. any other public comment? hearing none we will move to

item 4. >> thank you, agenda item 4 approval with possible modifications of the set forth an action item and presented by president scott. >> we are now dealing with the minutes of the last meeting for august 10th, 2023. i am ready to entertain a motion. >> so moved. >> moving for approval? >> correct. >> moved for the approval is there a second? >> second. >> properly moved and second this the minutes from the august 10th 2023 meeting be approved as distributed. is there board comment? ef edits. >> hearing 91. we will have public comment. public comment is open and instructionos web ex. and in person comment will be first and remote.

for those on the line press star 3 to be added to the queue. we're ready to vote. we'll have a roll call vote on the minutes of the prior meeting. >> a roll call starting with president scott. >> aye. >> vice president hao. >> aye >> commissioner breslin. >> aye >> supervisor dorsey. >> aye >> and commissioner follansbee. >> aye. >> item 5 the president's report. i have 91 for this month. s with this we will not have

public comment on my nonreport. item 6. >> vote to whether to cancel the meeting and will be presented by president scott. >> we have not had a meet nothing october that is the will opening of open enrollment i think our chief operating officer would mount a great revol with all the members of the team if we tried burden them with another activity during that time. it is hen a meeting we have cancelled.

we will now take public comment. thank you. public comment is open. instructions are displayed for thez on sfgovtv and web ex. for those watching web ex click on the raised hand icon we'll begin with in person. no one approached. we will move to remote public comment of the moderator will notify of callers in the queue at this time. >> we have no caller. >> no caller, public ment is closed >> with this we are now red to vote. >> roll call. >> roll call president scott

>> aye >> vice president hao. >> aye >> commissioner breslin. >> aye >> supervisor dorsey. >> aye >> and commissioner follansbee. >> aye. >> motion carries now to item 7 the director's report. >> thank you, number 7 the director's report a discussion item and presented by executive director abbie yant. >> good afternoon you see in the report the highlights i call out are the on going negotiations with united health care and the ucsf medical group continued to have a conversation. going back and forth. the -- communication within the medical group have been cleared up a bit. we have had one -- person who called united a week ago. no calls to member services. so -- it is -- clear that the we

are not having the disruption we were sprngs early on. but are monitor thanksgiving and continue to push each party to come to a good conconclusion on the negotiation. >> moving on, >> before you move on. >> yea. >> in the report itself, the next to the last line in the section on the united health care ucsf health network situation; it says united health care does have a contract in place with the university of san francisco. university california san francisco a typo on my part. >> is this ucsf or uc? hospital system? >> i can't -- the i believe they have contract in place with the other uc medical centers. and -- and they have one with

ucsf. >> so i would recommend we correct that to reflect whenever the current contract state is the uc hospital system and ucsf. then that's what should be there rather than uhc >> okay. noted. >> >> so the covid-19 vaccine well is a new vaccine available. and i will let doctor follansbee ment on this. the variant, there is an increase with people become ill. there is protection in the hospitalization special death rates are not elevated. and so we are back in a cautious state. you want to add to that? >> i would reiterate when you

said it is accurate. the -- file recommendations are initial low they were for people confusing. in line with who and initial low now the recommendations for everybody in the country if they are up in time for a vaccine 6 months completed the initial series of 2. and or 6 months after their last booster. if you had your last booster 3-4 months ago. wait a couple months until then. i suspect this is approved a couple days ago the medical centers don't have yet their supply. i went in yesterday to get my flu vac eastbound as kaiser they have the 23/24 flu vaccine available that is useful. if you don't want one time than i did not have the rsv or the

covid vaccine available. and so -- i'm sure all the health plans will send out instructions about when this is in the pharmacy ready to be distributed to the vaccine centers. am the confusion about rsv as well. i think this will be upcoming. flu is available now. i think for most people if you want to stagger any of this. usually we recommend in the west coast that people may be hold off on flu until the flu season reaches the west coast or begins to. but because of travel plans i took it now. but that's the bottom lineful don't go to the vaccine center tomorrow to get your corid vaccine or rsr until there are further instructions. >> thank you. >> on the healing equity and he diversity update it is childhood obesity and suicide

prevention month there are link in thes report. she prepared. check out the resources they are excellent source of information. >> i continue to sit on the health care advisory board's health care affordability board advisory mittedee, they meet next week. i don't have anything additional it report. board meeting in the left meeting continued discussion on the regulations for cost and market impact to you and total health care cost. very, everywhere complicated discussions with a lot of strong opinions this is how it is on a very fast track. the challenging decisions will be made senior than later. >> and the board will go on to set those targets up a year of

data collection special set targets and there will be finds for entities that don't meet the health care afford at target. >> our operations division continues to have some turn over. several people left the department for promotion opportunity within the city. and at least one for a job outside of the city. we are have a great partnership with human resources. a number of recruitments under way. things are moving forward. it is unfortunate this we had the resignationings. october is busy. but the team are rapid 3 bringing in people quickly as they can and turning them up to be available for calls the increase in call in october.

>> the i thank you is irrelevant all i need to highlight at this point. are there questions from the commission? >> questions from board members regarding the director's report? >> i have a ment about the diabetes. and a couple years ago we had more intense meeting on this. and at that time, cal purs approved all healing plans implemented diabetes prevention program. and i wonder if our health plans have this. this was a few years ago. ours should have i preventive diabetes plan. anything this there is care after you are sick but not much to prevent sick innocence this culture. gi will let the health plan speak but my impression we do and the manager of well being we have a contract for the diabetes

prevention with the ymca. i don't know if you want to add to that? >> are there health plan representatives that like to come forward it talk about diabetes prevention in your plan? yes, would you please identify yourself >> good upon afternoon denise rodriguez with kaiser. we have several years ago developed a per inship with san francisco i need an sdpupt see where that is. at this time i'm not sure. let me follow up and get back to you. get back to abbie yant on that. i want to say diabetes is a very big focus for our organization you imagine mag. prevention is key. we have alegality of program in kieztory identify and treat our members with diabetes or prediabetes. lots of education and nutrition classes and when somebody has

high blood sugar they are code. now the physician know this is this is a person who is on the cusp of having dieblgs. outside of additional program we do a lot with kaiser to manage that. >> all right. >> help to hear that. i wondered the other plans have it i was speaking to member who is prediabetic and doctor never referred them to a program. you would think this would be the first thing they dolled. this is outside of kaiserch >> within kaiser we automatic put someone in the program once you are identified with it. it is automatic. >> yea yoochlt are there other. other questions of the kaiser representative? are there other health plan representative this is want to speak to this topic. please? >> hi. excuse me.

good afternoon am tiffany gill with blue shield. we do have diabetes prevention program in our programs not sure if you are familiar. they are not something this somebody automatically gets put into a member does have to go and select a program. but we have several kind of an application based program where a member goes in and guess through criteria to choose which program they might want to join and a number of the applications are high acuity program applications. >> all right. >> thank you. >> questions? >> thank you. another health plan representative? >> yes. than i are all coming, good. [laughter] yes. >> i'm lori cumming with health net. we have several diabetes

prevention program in place a wellness platform, share care, offers opportunity for members to go on line and self manage if they have been identified but also from the pension stand point an audit a program if members are have over weight or they have a potential for diabetes, than i can go on and go through that program as well. >> all right. thank you. >> thank you. and -- >> one more. i'm monica, and i represent united health care medicare advantage pimented assure you for your medicare retirees we also have a diabetes prevention program in place. we have a program through optum and we are mining the data, looking for members that would

be eligible for this type of program. and we are sending out regular personalized communications to encourage female join. also if members are in care management, we will also try to really -- encourage people to join our programs. >> all right. >> questions for united health care? >> thank you. >> what brought this up congress the other night had a hearing and happened catch it on diabetes in this country and how prevalent it is. it is really a major problem in this country and hen for awhile. but -- it is -- nothing i happy to hear all plans will pay attention to. some of the people not go on their own unless their doctor says you should go here. they don't think to do this. you know. and of course there are people this don't get tested or have

year low physicals. it is i big problem. it is scare, really >> you know. >> thank you for your contribution >> president scott, when i gave report that one of our member services staff accepted a prosecute motional opportunity in the department this . is good. >> yea. rafael hudson was promoted to senior benefit analyst. i think this is excellent, she is a star perform and she got gained the promotion. >> pleased hear that. well is a promotional opportunity and glad he qualify exclude accepts and wish her well and continues to work within the system. thank you. >> anymoring comments or questions of the executive director? on her report? if not we are red for public comment >> thank you, president scott.

public comment is open. instructions are displays on the screen. in person comment will be first then remote public comment. for those on the line press star 3 to be added to the kwuchlt watching the meeting on web exclick on the raised hand to be place in the the queue to speak. in person ment? and no one approached. we will move to remote public comment. there are no callers at this time. >> thank you. moderator. hearing no further callers, public comment is closed. >> thank you. >> this being a discussion item will now move to item 8. >> thank you. president scott. item 8 financial report as of june 30, 2023. this is i discussion item and

presented by chief official officer, hussein. >> we welcome our chief financial officer. >> how are you. >> well, >> good. >> so just a brief update the year end report and -- in total our balance is stable 105 million. had a slight decrease due to off set by the settlement. and our net climbs for the access for flex fund access plus we are seeing higher claims. in total we think the net is [inaudible] higher than expected. we are seeing the medical team usa are higher the dental are lower than expected. the for pharmacy there is good news, we received 18. 9 million

this year, which is 48% higher than left year. and the reason for the change is mainly beginning in the 2022 plan year, we went to a model where we get 100 rebates passed back to us. opposed to 80% before then. that's one reason why we are seeing higher rebit in pharmacy >> and then other good news rates gone up. we had 2.3 million versus a million left year. on the trust fund it grew half a million. reason iss we do the strategic plan we reassess initiatives and aline them with the new strategic plan. our spending and use of this fiscal year was -- lower than we expected. >> for the general fund, we are at a plan and -- mainly due to

vacancies the other reasons are services from other departments. we had the land lord gave us a month rent holiday and other delays which accounts for most. we are ahead contributed to the city, [inaudible] >> we helped them. by having a surplus. >> and by helping the city with our surplus with you quantify how many millions of dollars that is? like a million. i will get the exact. >> a rough estimate. >> yea. so million five. >> thank you. >> i want this in the public record. long with the saving this is we had from the health plan renewals we are in excess of something like 8 million dollars. total.

if i recall natural this neighborhood. >> yea. a 23 year we had good rate in 23. >> all right. >> how is the audit prosecute seeding? audit is well. no issues so far. only potential issue i think the odd tors are look into is the impact the school district. where there is -- basically system issue this is school converting to the new system this has had an impact on the benefits. auditors are trying to gaze the impact. we thank you the impact is quite low. because we maintain a redundant system. only risk is our the corrections and the errors being brought to us time low or not that's when they try to gauge the magnitude of this impact. >> thank you.

>> are there other questions on the official report? >> hearing none we'll take public comment. why public ment is open. instructions are on the screen for those on sfgovtv and web ex. in person first then remote. on the line press star 3 now. for web ex click on the raised hand to be place in the the queue to speak. we'll begin with in person comment. no one approached. we will move to remote comment. our moderator will notify us of callers in the queue at this time. there are no callers. >> hearing no callers issue public comment is closed. >> thank you. item 9. >> thank you, president scott. item 9, health service system,

nounsment request for principle for medicare plans for 25 plan year a discussion item and presented by sfhsf. i want to emphasize what had is. we are announcing and discussing today dog an rfp for the medicare plans for plan year 2025. it is in the for next year. okay. it is in the 2024 it is 2025. with that, we will call upon our -- contract administration manager, michael. >> thank you, president school. thank you. micheal contract administration manager for san francisco health service. yes, i am going to announce our rfp for medicare plans for plan

year 2025. i will walk through quickly our assessment of other benefit plans. ghee in a brief history of our current medicare plans from there, i will discuss how we will be proceeding with this rfp that will include drivers and the schedule we see into next year. and that will be followed by a pause for board discussion. >> with that, as mention instead august meeting, we do this annual assessment. this is our duty to members to the city and to our department of we have assessed our benefit plans and a summary here on the slide. beginning with dental. we have determined due to the 3 year rate guarantee this was successful negotiated by our team that remember they will reconsider i dent will rfp next year during this same period. for the vision plan, again, due

to the 5 year premium guarantee, successful low negotiated by our team. we consider that again next year. and for our nonmedicare health plans take into consideration the results of the 2025 renewal process that will begin in december. we will look at the network pharmacy changes and electric at plan year 2023, clinical perform and health equity metrics. to be considered during the time period next year >> should be important to note this 2025 will be the first year after the rfp rate look for the ppo plan as a result of our 2020rfp. again. for our lifelong term disability, flexible spengd, volunteer benefit we will look at next year's consideration. now the medical plan a brief history united health care this

has been available to our members since 2016. there are 17,000 covered. for kaiser senior hmo plan available it all medicare eligible members. met california locations and available since before 1999. it also includes washington, oregon and hawaii locations since 20 upon 18. and again. just under the medicare population for united health, 14,000 covered lives. >> going this a brief history of the plans, not all the way back to when we started having the plans in the 80s, the uhc self insured city plan with prescription drugs changed to fully insured medicare advantage prescription drug plan effective january 1, 2016. all existing plan members migrateed the insured plan.

and this would be changed if than i lected otherwise during open enroll am. this was present in the miof 2016. how this process went before the board. we show it was successful. there were few errors in the process and had the administration handled. so for blue shield for existing 65 plus that was discontinue said in 2016. for members than i were shifted over unless they made an alternate determination during open enroll and want chose kaiser senior advantage plan. one minor note with this process, that is when we started the split family discussion as we and not presented earlier. split families discorrespond as of december 31st of left year. >> for the official announcement we will be issues a formal request for proposals for our hmo and ppo medicare plans for the 25 plan year. we present a summary of the

process. as well as the proposed scope before the board meeting in november ninth. in accordance with the board selection policy. will present a memorandum for a communication blackout at that time. and that will if begin the process for the rfp. i gallon in the exact time line of it with a later slide. i want to under listen the residential this was take into consideration by sfhsf leadership in relesing this rfp for medicare plans. address the improve am in network stability and coverage assure that for members forward in the future. we want to maintain a passive ppo offering for our members. we had a nationwide passive offering for those unfamiliar the simple way is that you will have the same reimbursement in network versus out this . is the least complicated option for

members and us. we want to evaluate multiple regional hmo plans you in we have one option the kaiser senior advantage. ensure we have in line with the strategic plan affordable and predictable rates year over year in the future. so we will look at multiple i don't remember rate capps, looks and that will be presented in our november ninth meeting. we want to ensuper continue top have transparency in our rating methodologies. we want to establish that we have already noted interest from leading medicare plans to responded. for many of you were here in late 21 and i have a slide so we show leaders have expressed interests or reached out to us. so we expect this to be successful rfp. finally, we want to evaluate

carriers approached inflation reduction act and how it affects our plans they are competitive we want to evaluate the plans head-to-head in the face of when we have seen market consolidation. and again, we have assess weed have the available internal resources sfhsf staff, leadership to conduct this rfp at this time. >> as mentioned on the left slide. we have the interest from largest carriers. many you will see in the footnotes responded the rfi or responded the rfa if we did an rfp they would responded. we are looking at interests from u nighted health care, humana. blue cross plan and blue shield plans. kaiser, and ci k na.

this will be the drastical defer present this in more detail in november high level will begin in november. tell end in mi-june. it is important to notice the reason why this ends mi-june opposed those of you present for nonmedicare plans, we have to wit for the final rules from cms the officials for those plans before we make a final determination. that does in the mean we have to wait and back load the process we can do this in 2 lines one with the nonofficial elements and with the official elements not much of a burden on our staff or on the evaluation panel matter experts we be retaining for this process. >> with that , i open up to board discussion for our announcement of the plan. >> before i call on members. can you give me a thumb nail description of how the rfp

versus the rfi process are different. >> great question. yes, this was on my sliced from the left meeting. again, the rfp a formal process result in contracts. rfi is exploring and does give more band width we know from the press we had members at the board present. again, as required by our board, the boards role will look at all recommendation and approving us going out to contract that will help in may or june of next year. that's how we divide this press >> we want to weigh in on the rfp process the november meeting is the time to get all of our concerns on the table? >> that's correct, president scott. thank you. i help my board colleagues are listening this next meeting is the time for you to get our

concerns on the table and ask they be included in the evaluation or questions or what have you. regarding the rfp. why all right y. that's correct >> are there questions from board members? >> excuse me you mention rfp for nonmedicare, when is this. >> consider this billsod the factors i out lined during this normal process. that will begin will start this in nooun june earlier. and tell go with the september meeting this time next year. jot health services does a sophisticated job looking at our data on demographics, health status with our plan members. i wonder if you expect this our enhanced data base will change the process or enhumans it how

that will be rowel in the to the information available to people -- plans interested in applying. >> i will call the critical members of our team, will be coalridge and the analytic's team we will leverage like the prior our number of not what you see in the demographics report butt data about our actual members. we want all perspective spondants to are insight in our member needs so they predict what the best response would be. this will be critical to how we do ensuring we present to the panel that address our members. why are there other questions? will and from the board? >> again, it is an rfp at the

next meeting scope, concerns, issues, requests, please bring them forward. all right. >> yes , sir. >> at this point we'll have public discussion on this topic. >> thank you, president scott. public comment is open. instructionsor the screen. >> there are no callers in the public comment queue at this time. hearing no callers, public ment is closed

>> thank you. >> michael and your team. and the hard work you are going to be doing on our behalf the next mont you prepare for the upon presentation in november. item 10 open enrollment this is a discussion item and be presented by ray plan an and will be well being manager. joy have been wonder when our chief operating officer hen doing for the last 3 months? i thought he had gone on vacation? was lounging in the caribbean or whatever. low and beholds we are back at open enrollment. we are. >> all right.

[laughter]. welcome >> thank you, president scott and commissioners. upon ray, ceo for health service system and later in this presentationil joined by our well being manager and revowing the open enrollment plan for the 2024 plan year. >> this year open enrollment from monday october second through friday october the 27th. this 4 week period x. during this presentation i will run through the open enrollment time line. we will sdwhus is now for 2024. we dus the system updates this were necessary for all the plan changes. we'll walk you through the open enrollment plan for members. we will look at the then nares offered and then we review the health fair and food clinic calendar. planning for open enrollment

starts months before the october open enrollment period. you discussed an action that will take place for plan i don't remember 2025 and so open enroll am starts early. and we are reviewing the lessons learned and incorporating them for next plan year by our project manager, brian rodriguez he is a master this had 255 sprit, signments and time line that spans 9 pages. what you see on the screen is a simple version of this time line. by this time the board approves rate in june our contract team lead by michael and our consulting team spent hours on

the renewals for the next plan year. also by this time, our communication's team and ryan clubhouse have completed the layout and design of the open enroll am communication. we will talk about the activities for third and fourth quarter in the next upcoming slide. >> outside significant promotium increase this is impacted plans for 2024, there are actually few plan changes. for next year. the changes that we'll highlight in our open enrollment include introduction of the mommy pregnancy competence post partum care to blue shield members. the implementation of rx90 program for blue shield members the venals of getting i 90 day supply of maintenance medication in certain walk in pharmacy.

proposal to get a 90 day supply members would have to do this through mailorder. this prosecute voids the same benefit at walk in pharmacies. >> we will discuss the expansion of the delta dental mile away program this allows for clonings for members with 14 medical conditions and update the members on the updated plan limits for the. fsa plans. >> there will be minimal plan changes for 2024 this does in the money this there were not plenty of system updates this coalridge and the system and analystic team needed to make. the first significant change was the creation of a whole new set of plans for kaiser members that reside in southern california. currently, our systems combined the member in southern california and northern california plans into a single

file we then submit to kaiser who then on their side splits them, part based on the zip codes. however this , has lead to significant errors, discrepancies that we hope to solve by creation of the new benefit plan for our southern california kaiser members. >> second, >> i'm sorry can i ask a question. >> sure >> because when the kaiser doctor this was an issue for member this ismented retain northern california kaiser numbership and not allows to do this. does this mean if someone votes in palm springs but min tains i resident in sudden front they maintain the northern california membership without having to drop the primary care and you will this and steb now care team in southern california?

is this when this achieves? or is this the health plan? >> base said upon a member's residents than i are enrolled in either the southern or northern california kaiser region what this is solving is this just the transmission of those combined foils leads to the errors. and so based upon a member's resident than i would be funneled in the promote kaiser region. >> okay >> that's the way it was before. if they found you were outside the region you were sent it another kaiser system. the addition of oregon and washington and hawaii for medicare members was important. that does in the change that it rechannels them and makes finding the people more easily. is this it? >> that's correct >> does kaiser have a comment on

that? >> hi. good afternoon deb we kaiser. i wanted address when you were talking about. so, what rihas been stating here, there has been an wish the foil on sfhsf than i have in the had the ability to add the southern california contract id number. to identify members correct low in the system. they are doing a fix now where they are adding the southern california id record number. to help weapon this administration in terms of putting those members in the southern california contract. we had a work around on the back end. i think this doctor follansbee what you were talking about was the interregional members where they would have be -- in the

north. but having a northern california contract butmented to be seen in southern california men a residence there oui put them in the innerregional situation where they being still be seen in southern california but were in the necessary low in the southern california contract. were so far we have been doing a work around now we are fix the file to make sure they are appropriately policed into northern california contract or southern california contract. >> okay. i think, this that helps. i think this prescriptionally for members the issue is this if a member is in another kaiser and needs care for example a will be test. still requires some way for the northern california provider to get this order in the southern california or oregon or washington or hawaii system.

and this is not going to improve this at all? ; is that correct? that it is a really problem. i can tell you. right. of if depending where you live and where you would like to have the contract, we still have visiting member rights if you will. and so if you are northern california on the northern california contract and you are in southern california and you need to be seen there. all you do is call the travel line and they'll set you up in the southern california medical record number and you can be seen there. >> yea. >> thank you. that works well. it is just again it is more refind. that problem this was in the a problem. >> inspect my case. i have 2 kaiser numbers northern and southern. i had no problem accessing care as long as i am willing to be

seen if it is getting a blood test do in northern california that it is a problem this new contract will not them? >> all right. >> thank you. >> we test esa with helping it credit i retiree rate to help current and future retirees understand out of pocket costs for premiums this is as you know no easy task given the complexity of prop b. esa needed to modify our systems to collect, hold and trans mitt race and ethnicity for medicare members to comply with the mandate. >> one of the projects we are most excite body for this year is a new system to help calculate premium rates begin

this hsf for 4 groups with 75 union contracts and all the retirees, it is begin had tlmentd be some high level complexity this goes with our system. however, it will come to a prize to most to understand that and to manage this we have over 4 thousand rate this is we need to calculate. but had is probably more shock suggest this prior to this year, most of the rates were calculated by handled and with the help of finance analysts [inaudible]. this year hsf bruin the rate setting press using a ceqa server did the base program leverages every year to help set the rates going forward. however, this transification was a task for not only our esa team but finance staff and contract's

team. >> also working with human resources and the controller's office to provide employees with the option utilizing a preferred name different than the legal name. for members of our populations including those in our transgender community and alternate name a part of their identity. we are that he want this is moving forward. >> given the complexity involved in our program offerings rule and premiums, communications with members on what is important to them is no easy task example so next i gallon through communication plan. with having to notify over 70,000 families of open enroll am options a one size fits all approach december in the work. i handed jessica or director i couple of goal this is year. one, simple fight message members need to understand open enroll am cape acteds and 2,

reduce the paper used to community that message and jessica did responded. first, in past years send open enroll am letters to members with different rate tables and trust than i would figure out which applied to them this year we are sending them one of 87 different letters. that only have the rates this a play to them. so this has reduced complexity. gives another level of complexity on staff including jessica and rain. we are not sending booklets to active member this is year instead we'll include a link to a digital guide this is saving 2. 4 tons of paper and 19 thousand dollars in premium costs and saving in the postage we would need to utilize to send

the packages. >> so here are covers from the 2024 plan year benefit's guide. you see, all the communications for this year have a new look and foal from previous years. graphic designer ryan clouz used a design base and we do apologize on the footnote of the slide there is language that was not clear. when we were attempting to community is that prior to this year, we used to send out 4 separate, 3 separate guides for the city and coincident of san francisco employees. the municipal executive association employees and the superior court employees. so for 2024, we are combined all 3 of the groups to one single guide. so for 2024, we only have 4 separate guides that will be utilized.

and then -- weave did this because one of the piece of feedback we receive if employees is they didn't know which guide applied them. by combining the information in one guide tell be easy for them to find the information this pertains to them. a lot of the information provide in the the guide system redundant, anyway. this is the copy of the retire yee booklet cover in the self service instructions we reduced the number of step this is than i need go through to submit their open enroll am elections. we hope that reduce the need to call and ask for are assistance. the dates, two, when they need to do if than i want to change their current elections. it lists when current plans are

enroll in the what dependsants they cover and provides them with their costs will be for the upcoming year. for early retirees we are making sure we point out the increases will apply to some of them. here is a sample of what this year's envelopes will electric like. using the design. and in previous year we will be send out weekly oee mails starting with the left week of september it make sure our members are notified of their open enrollment responsibility. >> we willville a dedicated open enrollment website will be going on line soon. and the website will have a special event's calendar. this will be with only open

enroll am related events. so this will be separate from the general -- hsf calendar including other things relate to the wellness program. >> and this is just a listing of the various open enrollment organizers offer third degree year. a number of them about this for active and employees and retirees and some that are specific to either the active or retired popping lagz. i will turn it over to kerry our well being manager who will review the health fair and food clinic plans with you >> thank you very much. welcome. please, say your full name and your title. >> sure. good afternoon kerry, well being manager with hsf. i wanted to provide a ment in regards to the question this

came up around the diabetes prevention program to add had abbie was speaking to. we have been under work width ymca we provide a describes prevention program we used to offer it work site locations and the pandemic we turn third degree virtual. had a lot of success and since opened up 2 offer virtual come in person. we are working with michael and his team we will have an open rfp we hope it close in the next month. where we will look at our vend and reassessing and continuing on this program of the >> a quick update with this. just a moment in is beyond the health plan. this is -- our own internal program we are offering to employers. >> correct. >> absolutely >> family members domestic partners and spouses, retirees. >> thank you. >> for flu this year we are part mer in with kaiser.

kaiser pull nothing third party albertsons and safeway. we will run clinics starting september 27 through november 7. shorter period, left year we had a few late folk in thes game adding interested in providing a clinic at their location. our eligibility remains the same. for employees, retirees and spouses and domestic partners. and in addition to our flu we have done health service. we started bringing those become left year and pair our clinics with the benefit faris as limp 10 total we are off thanksgiving year. and a new site in the past which is the county fair building a new benefit there we will add wrchl can you puz for a moment. can we bring the slides.

in sync with your comments. >> thank you. >> this is why i think you are. >> thank you. >> we will offering 24 clinics one les then and there last year each year kwooe we look at where the volume of our vaccines are. and we have required minimums we need to meet. we assess those. we're reducing by 2 and adding back one we did 2 years ago. we will remain at 24 clinics at 23 locations. we doll 2 at the dem location to serve that population for 24 hour business needs. >> we have open and closed and restricted locations. as a reminder open locations are those that acsisz is easy to for combun don't need a badge to get n. city hall. 49 vaness. our location.

a few of those you don't need a specific badge access and restricted locations those employees have direct access top gain in that facility. i mentioned what is coming up rec and p county fir a benefit fair. offered a flu clinic and will will began this year. we are adding back will knoll. adding it become with extend efforts to improve our vaccination rates and something this is alls now this year is in the pedestrian, because kaiser used to facilitate our clinics anybody a mechanic gift their information sent upon and place in the their medical record. this will not be help thanksgiving year this is a message for us and trying to hone in every member will need to take a picture or image of their form. and then work with their medical provider or online tools to up load vakzinations on

vaccinationos line this is a number of locations we are going to offer, this does include our benefit fairs. >> the one thingil note is we don't offer flu vaccines at the airport they have their own clinic. we are offering 2 benefit firs at that location. i will wrap thumb we did have a request to get covid boosters at our locations. we did roach out to all 4 health plan and unfortunately, doctor follansbee there were changes we were unable to get the covid booster. questions? >> are there questions. >> thank you, to both of you this is finish fantastic to see change in open enroll am and a variety of issues.

i think there will be were questions people show up at the clinic about other vaccines. and unlike you know a certain good afternoonor running for a political office. where hurricanes are problems. we encourage that. i hope thank you will provide a fact sheet about rsv and covid vaccinations so members can get help trying to negotiate that and then encourage contact providers. and an opportunity to reenforce the message. >> yes, that's good we will had not considered rsv we can include this. additional low what i add is doctor wilson with the department of hr will be at a few locations as talking about

the covid booster as well to our members. this will be a nice add from educational stand point we'll have both of those. >> i have no stock in rsv. at all. if anyone access to media. they advertise is in the available. i suspect there is i get questions personally about this i assume there is alegality of issues out there because of the intense advertising. any, quos flu clint i think everic and cites and w appropriated for all of this? >> i have no questions. i want to thank you, kerry and rifor your hard work.

putting this together t. sounds them all of those will be done the preparation and plan thanksgiving went into it. thank you for the ways you electric out for our members. trying to get it completeod line. so can you do you have i target where you are getting better memberers better and better at this issue. you have a target for where you hope this year when percent involved less paperwork for hsh staff in terms of enter row. we don't have a specific target for this year. we are -- trying to make the system easier for members to take less steps. by far the vast majority of active employees do it online.

so we will evaluate how those the results of the changes n incorporate those in the plan for next year. one of the things we look at is -- whether or not you be the digital guides were successful or not and see how many requestings for paper to see whether this is something we want to transition retirees to. weep will be interested in hearing the data and retirees and early retiree and active employees. >> all right. on behalf of the board for those that you name in your report and the staff members not named that have brought you to this point we thank you for your diligence and work and leadership.

thank you. are this questions and comments. we will take public comment. thank you. president scott. public comment is open. instructions are displayed on the screen. in person comment will be first then remote comment. click on the raised hand queue to speak. we will begin with in person comment. good afternoon. dennis kruger retire exclude act ever firefighters and spouse. i like what they are doing. consolidating short and easy to understand booklets. i have one question regarding consol down to what members

individual low have. the omgsz pgzs what they can choose. vision issue dentsal another medicare plan will those be included in the simple forms or will people have to inquire beyond the booklet? >> all right. >> chief operating officer. >> so. as i spoke to you earlier the open enroll am packet will list had their current benefit elections are and who than i are covered dependants are and the promotium costs for the visible plans. visible to them. in addition there is know open enroll am booklet in the refire department guide a 16 page book that goes through options retired members have for making

benefit elections for the upcoming plan year. employees will have that similar version of that 16 ping open booklet that is visible to them but will be online. and available through link or qr code this will take thome that place. medical, vision, dents yam when have you all of the benefit in one place. >> the open enroll am booklet for retirees does include all options available to them. medical, dental and vision and active employees gwen their guide will include all available plans to that employer group the board knows that employers offer the suite of benefit and otherses we offer medical or dental and so their guide will be present want to this member. >> thank you. >> are there other questions --

from in the room? you in would. >> yes. thank you move to our remote comment. we have 2 in the loip and zero in the queue. why thank you. hearing no callers. public meant is closed. >> again, thank you, ray, kerry and team for when you have done. >> public comment is you in closed. >> thank you. >> we will move to our next item. which is i recess. mind can comprehend only what the end will endure. so we will take 10 minutes. and by my light, that means

2026. 2526 will be back here to reconvene. clear clear

now convene the health service boofrmd i asked secretary call the roll >> next. starting with president scott. >> present. why vice president hao. >> present >> commissioner breslin. why here >> supervisor dorsey >> here. >> commissioner follows bee. >> front. >> we have quorum. we will pick up on the agenda with item 11. >> thank you, president scott. item 11 approval of vision to the health service system rowel and section 125 cafeteria plan

2024 an action item and presented boy sfhsf ray. >> good afternoon. ray, chief operating officer for hsf. every year we review healing service system rowel and cafeteria plan did you want to determine when changes need to be made for the up something plan year and bring them to you for approval. first i will walk you through the substantive changes we are requesting to be made to the plan rules. in section, 3 we are updating the list of eligible boards and commissions who are able it participate in hsf benefits. added members of homelessness oversight commission and removed the concourse authority. >> and in section b5 reinserted

the section relating it subsidy for surviving departments which was deleted after 2011 but is -- referenced elsewhere in the rowels. we believe it was dloeted because most of the sentence in the section, peerless where in the rules. we believe having it in one space it make its easy for the members to understand. >> b4 we attempt to claire fight application of section fret 56 of the california labor code applies to surviving departments of safety members. who die in the line of duty. >> we add a new section c five state this is in compliance with now requirementless we will be asking members medicare eli didn't believe members to provide race and ethnicity data. >> cms request thanksgiving did

thea to identify the deparity in quality of care and target quality improve am interventions to achieve equity >> section d, updating the language to better clarify the look back period for status of registers domestic partners when this is if someone is i registered as a domestic per in and qualityified for irs benefits, if than i term nit this per in any time during the year they are disqualityified from those irs benefits for the entire year. we changing the language to better claire foil that look back period. >> section i nile, we added language to out line the opportunity members have to enroll until the coverage under special enroll am prosecute visions out lined in the healing insurance and accountability act.

i need to point this there is an error in this section of our changes version of the document. and section i1b regarding special enrollments for new departments states for children enrolled due to birth, adoption, foster or legal guardianship members request enroll am within 60 days. this should read 30 days. it is for coverage change related child's eligibility for premium assistance that is requires to allow a 60 day enroll am window. we apologize for this error. for those other situations it should read 30 days. >> section f alus for this board so there are a couple thing in f

this we are propose to change it it is to grant flexibility in the future should the board wish to either have an open enroll am period this is shorter then and there 3-4 weeks and also to allow for active enrollment. currently in the plan rowels the plan rowels prescribed for a passive open enrollment for all benefits except for sf, if a member does in the take action this their elections from one year will roll over to the next year. academyive enroll am require members to go in and make an election for the next plan year. and again other currently, we believe that the reasons there is i passive open enrecommend am in the member rowels because >> is less administrative burden

and it is easier on the members. however, as we have seen, member don't take an active engage am in most case fist than i don't vice president to make a plan change in the future if we introduce a new plan wield like members to make an active engagement in deciding which plans most effective for them and families begin the new line up of plans. and so we do think that this board miwant to prescribe an active open enrollment in the future should we add new plans or manage of that nature. this would not require an active open enroll am it is allows to you designate a future as an active open enrollment this plan year. similarly, in the rules the rowels require a 3-for you week open enroll am period and when we see during open enrollment is

this there is massive interests at the latter end of open enroll am. currently, we have a 4 week open, our call volume sfieks the last 2 weeks. pep if they are given a 4 week period they take that 4 week to make a decision and so we do think that if there is any significant change in a future plan year it may make sense to make mull pull shorter periods so this we are more effectively to divvy the calls up over the open enroll am period we give to those members if we do 2 week for active or 2 weeks for retirees that will better enable you to spled the calls that come in moreenly through that total 4 week period of time. these are just options that the board would have in the future. not dictating this we change the

length. it allows for the future flexibility. >> can i ask a question i hear about this -- option. it does in the mean the health system will change or implement this. but fihear it correct low the changes would in the happen without the board approving not something jen ritted within hss so of on your behalf or something the board would need to understand the residential for shortening the period? >> that is the way we wrote the rule this it state its gives the board the flexibility to dictate either abactive enroll am or shortening that length. this makes sense the other 2, you talked about the new plan offered, does this allow for then a sort of short period of

time open enroll am. members miwant to switch plans. in the midst of the calendar year? is this had this is allowing? or means that there is a new plan option for this person the next cycle, this were implemented that i they would be required make a decision to stick with the old benefit plan than i had or and reviewed the now new one >> incorrect than i are prescribing changes to open enroll ament assuming it would be effective for the beginning of the plan year and an active open enrollment declared for open enroll am preceding that mr. president year. it would require a member to make an like either relecting their current plan or change to a now plan should this be the member's desire.

>> okay. >> moving on section m3. we removed believe that this language was in place when the city had its own self funded plan. the city pleasant and required members to notify hss if than i had secondary insurance outside our system. we don't have the method or the need to collect this information. so we are removing that section. >> buffer go on. are there other questions on the rowels changes? continue >> that concludes the proposed changes to the member rules. now i gallon on to the cafeteria plan for year 2024. and section 4.6, similar to the

change in the member rules adding a section to notify members of their hipa special enrollment rights. in section b 3, we are making the necessary changes to update the fsa limits for 2024. and section b3 also removing a section so section b3a e-2 requires members hired mid year to able to allow a prorated election of the annual that year's maximum. we are we don't administer to this rowel. if someone is hireod july first than i contribute the fullanual max to the plan. there is no rules that would probability us from allowing a member to make the full election. so we are proposing to remove this provision.

and then in section d for you quo are updating the flexible credit available through members of the city and county in superior court. any questions on the cafeteria planned document for changes. why if there are 91 i'm willing to entertain a motion regarding this item. >> i move that we approve the proposed policy changes for the second the calf tear why plan document plan year 2024 and also for the rules for plan year 2024. >> is there a second? >> second >> properly moved and seconded this we approve the proposed policy changes for the health system service health service

system plan rules for year 24 are and for the cafeteria plan for plan year 24 as described. are there questions from board members. we take public meant. why thank you, president scott i will read our instructions for those members joined after the break inform person comment be first then virtual. each allowed 3 minutes to comment unless the president deems new time limits. all comment med concerning the item presented. i call are may ask questions but no obligation to engage with the caller. the board will hear up to 30 minutes of remote ment for each item. remote comment from people received accommendation due to disability will not count toward this limit. member of public attending via phone dial 415-655-0001, access

code: 2663 488 8763 ##. you will be prompted enter the web near password 1145 and press star 3 and you will hear the prompt, you have raised your hand. wait to speak until the host callos you. when your line has been unmute third degree is your time to speak you will be muted. for those watching the meeting on web ex click on the raised hand i conto peek. that will appear next to your name when you are un muted in the system a request to unmute will appear select un. i will give you i warning when you are 30 seconds remaining and

then i will thank you and you will be placeod mute >> we look to our moderator to see if there are callers in the queue for item 11. stlr zero callers in the queue. >> hearing no callers, public ment is now closed >> we have a roll call vote. starting with president scott. >> aye. >> vice president hao. >> aye >> commissioner breslin. >> aye. >> supervisor dorsey. >> aye. >> commissionering follansbee. >> aye >> we'll move to item 12. >> which is identified board education it it is education but burden but for members of public. we have been on a bit of an odyssey since left year to provide background information on a variety of topics will be

discussed during this presently anticipation and thome this will provide context to the workings of the board, issues that are present in the market place and other force this are out there shaping health care policy. with this. we decided to let our lead on i break from presenting from you. at the rate and benefits i'm glad to be here speaking with you today. president skol scott said this is part of board education series. one we had left month and 2 additional in november and december. today is the market and health system review. i could spend all day talkingil not make you sit here all day. i will try to give you the

highlights and kudos to hss the board and the work you is don date. and the looking ahead at the future modules. >> looking at of 4 part series last among you heard from mike and cfo hussein about the over view and out line. today the market and health system ino vague. november benefit design bench americaing and december will be future state opportunity. before i dive in to the slide i will do a bit of stage seth here. so, we had predictable trait when is we were looking at health care costs. and benefits. and anchor our work on our decisions. hell study groekt and bye-byes growth in i stable w force and organizations could today in the

midst of a new environment >> the organizations and members. >> we will speak about 5 of them so you see that -- not the in any authority just for ease of speak throughout slides the first the expectancy. and natural and in terms of in person hybrid work and expectation coming out of the pandemic employers the expectations speciallying employees with life experience and in the work/life responsibles. where individual health and well being declined and sppth mental health and e megz will well being i key for many and health

service board and hss. seen a spot light shining on diversity, equity competence inclusion and health equity. we are seeing a decline in well being. over all and as well in communities of -- female of color exterioring xhengzs within that characteristic of us individuals. cost pressure for health care benefits mound mounting one way to manage this in the pedestrian but roached a point affordable concerns are real. and if there is hope and that is the market innovation this isk cell ritting. we have new solutions from start ups and in tour market players focussing on impactable problems. >> would you paudz for a moment >> yes. >> i had a question about the data which is interesting but

i'm sorry. was it a broad survey of public, private. for and nonprofits? i don't know what the denominator was? >> yes. the statistics on slide 5? >> all of. >> iel. these are from a variety of resources. that are in tien print at the bottom. but you know upon met life survey. common wealth, so these are significant and sizeable surveys we are referencing. i don't have the specific deenemy narrators. >> okay. since we have a population we are entered in government employees. you know >> correct. >> as well in terms of our own needs are. >> i don't believe we do the surveys ourselves? >> correct. those are -- broad based national multiple types and industries employers to give

this brood sweep. >> i find interesting and under 152% change yens for better benefits. used to issue a leading indicator it was machine that he cause people to change jobs. and that has changed the past decade or 2. that is benefit's driven more then and there money. and also bad super vision is a viver. we will not talk about this today. >> thank you. page 6 dive in each of these i don't want to leave you throughout with challenges and no solutions. this is in the hs circumstance specific this is a broad based look at what employers do in the world to address different dimensions. we note a now actions under each in terms of prevalent and e

merging and note this hss did a lot of work within all of the categories around mental health and well being and the strategy planning,rousing stigma through the forum and the work this come out of this. family forming. high performance net works the first is employee experience navigation highlights today rescue niedzing there are other pos this is go in the employee experience it is creating personal experience its driveway the right care, time and place focus on high quality. so we noted earlier the w force is shifting and we are having a competition for talents. and health care coverage is more and more a big component of this contract that employees have with employers. navigation is a technique used to engage and support members and employees in troetsing that

personalized responsibles of part is a reflection of coming out of the erof consumerism high dedeckable plan and putting individual in thes seat of consumers like you go on amazon and buy to buy heck. we seen a bit of shift out of that mentality and to the adoption of high touch navigation. and we have seen thanks to the pandemic increase use. digital tools. the tipping point of efficient use of the digital tools. >> examples of the approach within where you are population would be shield concierge and accolade on the ppo plan. this is brilliant. almost key this if consumers can't navigate their system why does it exist?

i'm sorry, you know apoloies toicize are i look to get the flu vaccine i not wot website once i found this yes, i can walk in the to the center. being in the find gwen to find out the hours when i went i found out they were closed between 12:30 and 1:30 for lunch gave me an opportunity to shop. this it is so simple. a lot about covid but not rsv. navigation needs to be proactive in terms of all the whether complex or simple and without this you know the what are we doing, fringely, thank you very much for this slide. >> you are welcome. thank you for comments. >> as we go intont next slide. mental health and well being. we are seeing trends lead by dig

tell solutions for access and out come. so -- we discussed for those. you at the mental health forum the continuum of emo well being. it suspect health and well and be unwell or in between. so with this we see a continuum of care. and that's what the 4 categories are peek to. online self direct care such as calm and other meditation tools. e ap and work/life. have on sight as well as 24/7. therapy tool and blended care with in person and virtual. care and treatment, via net w providers in the health plan.

>> in terms of health equity. per of knowing or thinking about health equity acknowledging the member journey. so there are verse point in thes health care ecosystem we need to consider health equity competislide is looking to show that all the various touch points health equity should be considered. the next page you will give you examples. understanding the current challenges really per of informing the future. so -- we must understand this there are many depositions and intersections to be considered. for example lgbt members have greater need for health care and the focus mental health vendors or provide and getting those 2 together. for race and ethnicity. health status boy race and

ethnicity various. influencing per ins to evaluate equity in terms of guide lines and care management programs. and critical to the future. and in terms of age, focused on family building has been significant over the years and has been building. and we are seeing looking forward benefits toward health based issues based on age and need such as men because. seeing i growing -- space look to address men pause. in terms of affordable andarc sesz to care. pressures come to us through rates and benefit's cycle temperature is looking to get us to think differently. in terms of furthermoracy you look the biosimilars as a special prop to provide high qualm medications and lower costs. through mental health it statute

e ap and digital support tool. chronic care, perhaps low or not cost medications and care and navigation and on primary chairman virtual primary care or hybrid with virtual in person and population focused access. >> in terms of market innovation i love this slide. it is. so virtual care are look to compete with health system. we seen activity in the pace and vendors come and go. but they planted the seeds for new innovation. you know we seen amazon get in this space and may be familiar with the partnership with cost plus drug company the virtual ecosystem is expand and continues to chink as new

vendors enter. we see traditional carriers get nothing space through building in house tool and resources or per inning with the venders. >> in terms of integration assistance rising costs are creating growing competition. and consolidation. the rapid growth in virtual and hybrid care health system move to compete and address the rising cost of the health workforce. state of consolidation focusos market power. limited data to show improve examine don't see the negotiations of low are prices passed on individualsor experience the future stage would focus advance primary care foundation. to drive care to high quality provide, the optimal play-offs

service and intgritting support for those with chronic care needs. >> in addition on this navigation and data operatability key to the success of the model. >> pharmacy, so in terms of vertical integration seen consolidation 80% of prescription volume within the 3 largest bbm's this is reinvigorated carve in and out pharmacy. new partnership catharsis challenging traditional players the amazon and cost plus drug company combination. focusing on the future will see more bio[inaudible] market with the biosimilar first model to provide high quality. low cost and of course the biden administration released the top 10 drugs lists.

champion is the cms contract and negotiating 10 drugs which a new concept for them. and i wanted to note that that list of 10 drugs has come out the pricing will not be effective until 2026. it is expect third degree this will address the top 10 drs. 3.for you billion pid and out of pocket expenses for individuals which is 9 million americans there will be additional drugs to add to the list. why can you pause and identify the 3 largest pharmacy benefit managers. >> some know will have it cope mow honest. express group, cvs and optum.

>> okay. part of the united health group >> okay. thank you y. in terms of hss with strategic plan the one we had and the one we built, a lot ofarctivity has been helping around innovations i want to give kudos to the team for that. you have been a leader in consideration and adoption of many of concepts we spoke about. and on the slide i out lines of the initiative this is hss has taken and will continue to bring ideas and the healing service board. with this i will thank you for your time and see you in november on the other 2 items and i will welcome questions or comments. thank you for this presentation. i think it is very are puff a large amount of information it one vehicle.

when you talk about innovation people say what is this? and you come it's it in a variety of ways here in terms of the scriptors and laying out information. thank you for your work on this. are there questions from the board members on any of the topics? >> this pointful beyond the interjections we made during the presentation i should say >> i continuing is again an excellent over vow. the bottom line this is irrelevant big accident and getting bigger. when you electric at all this, you see people jockeying to getting bigger business the amount of dollars is staggering when we pay and get from all of this innovation. it is amazing i know that cost per publish for medicare patients remain stable the left 10 years it is a surprise, lots

of people and something that is a positive for alost competition. and competition remains the name of the game. i don't think anyone would complain about decrease of services over the 10 years the cost is stable. i think that systems can w but this is -- foal we are a drop of water in i big ocean. our own way we can cope with all of this. >> are there other questions or comments from the board? >> if not we take public comment on this item at this time. >> thank you, president scott. public comment is open. instructions are on the screen for those watching on sfgovtv and web ex. in person first then remote comment. press star 3 to be added to the queue. for those watching on web ex

click on the raisad hand. we will begin with in person public comment. no one approached. am we will move to remote comment. well are 2 callers zero in the queue. >> thank you. no further callers public comment is closed >> all right. thank you. we will move to item then. we had a number of interjections welcomed from planned representatives if there is something specific that you wanted bring to the attention of the board and the public. we call on you at this time. it was an admission in one of the presentation about kaiser's urjen care centers another opportunity for people to get

direct service. and as a new part of the delivery of service boy that health plan. that's in the presentation was over looked we did not say timented call this out. >> i think this for all the venders interesting to see a map of how where upon the contracts are. with in person health care. for urgent care. this is -- we are concern body the high utilization of emergency rooms for nonemergency room care. and so i know this you know all of the health plans deal with this how than i get their contracted medical groups to provide urgent care on holidays, weekend and after hours. men of them are developing condition transacts with the free standing system whether it is pharmacy based or one medical. interesting to hear from plans

about this. and how you are strug explicwhat is being done to get the right care in the right place at the right time after hours and children in particular. after hours is -- across the board. >> thank you. >> other comments from board members? >> no comments from -- yes. >> director yant. >> i like to ask kaiser to comment on the situation this got play in the press not to put you in the hot seat. board should know before they come become in november this there will be more in the press about them than i are putting together a campaign. can you comment, please? >> good afternoon denise rodriguez with kaiser. so, talks continued to occur and negotiations. we had our 7th session. we had 6 and now 7 sessions.

and that was in san francisco september 6-8. there was new proposals maedz i thank you is standard negotiation. we support the bargaining process. and are committed to finding a resolution before the contract ends the end of the month. other than that is correct another place to get updates is www.. k p. org/labor. up to the minute updates on had is help nothing negotiations. is there anything else executive eighteen yant. >> xha employee population the negotiations are affecting? >> the great question it is coalition of unions this are represent in i variety of unions. i will follow up and give you a list this lists them out there are self and i don't want to misstate it. >> thank you i will sends this to you executive director. >> thank you. i want to give it in context we

near a period of time labor unions in many sectors are -- feeling the need to be allowed in request. and the alternative workires as an example i do expect we hear quite a bit about this negotiations as well as others i want the board to realize the point that we are at the city san francisco is going in negotiations with bulk of their labor unions in january. i'm sure that -- whatever kaiser settleos will impact that. so, you know there is a lot going of i want you to know we are aware and following and plans are keeping us informed. >> thank you >> thank you j. for your update. >> hopeful low when i come become the next meet nothing november i will be settled. >> this is our hope as well.

>> thank you. >> all right. with that, there is public comment buzz we had public comment comment on this item. myself and others. so we will have public ment on this item. item then. >> thank you, president scott. public comment is open instructions on the screen for on sfgovtv. in personnel first and then remote. for those on the line press star 3. for those watching on web ex click on raised hand to be placed in the queue to speak. we'll begin with in person comment. now remote public comment. >> board secretary there are 2 callers on the line zero enter the queue at this time. >> thank you, hearing no callers public comment is closed.

>> with that. this meeting of the board is adjourned. clear clear i'm anthony i'm owner of scoop

ice cream in the bayview. >> the environment sit down environment to enjoy a bananasplit. root beer floot. shake, et cetera . just creating that environment for people to come and enjoy. they can experience this is cultural driven. we pretty much replicate what our culture means in the bayview. >> a back story me and my siplings my aunt took us out for ice cream all the time. spend hours eating ice cream and talking and catching up with friends and family of came with an idea. why don't you bring the ice cream shop back has not been one here in a time since the 90's. i thought it would be good to bring something back to a community where i grew up and something with me in business

community. my fate is the apple pie flavor made from french cashew milk it is vegan. homemade cashew milk and cocoa nut milk. apples upon cinnamon and nutmeg and create a great desert. my great grand mother made it from scratch. made ice cream for kids in the neighborhood and made different flavors. sugar free and dairy free. got passion to do it being here in the community and from my family. the san francisco music hall of fame is a living breathing world that's all

encompassing about music. [music playing] it tries to do everything to create a music theme. music themes don't really exist anymore. it is $7, the tour is two floors, (inaudible) so, each one of these frames that you see here, you can-you are and look into the story of that act, band, entertainment and their contributions to music. affordability

is what we are all about. creative support. we are dedicated to the working musician. we are also dedicated to breaking some big big acts. we like to make the stories around here. ultimately legends. i didn't - >> sound familiar do you keep on getting up there's an easier way. >> of course there's easier way get rid of of mosquito they breed whatever

this is water no water no mosquito mosquito feed on good blood the eggs hatch and stay near the waters san francisco to breathe and the adult underlying mosquito waits on the as many until it's sexuality hardens water pools in any areas and creates places you'll not normally think of budget and any container that holds water and hidden in bushes or else were dump the water and do it over soil not into a drain the larva can continue growing in the pooled water is sewage disthe first of its kind the area if the sewage is two extreme have a licensed plumber assist water

pools in rain gutters and snaking and cleaning out the water when keep the water from pooling and keep in mind that mosquito breed in other waters like catch balgsz and construction barriers interest crawl spaces with clmg is an issue you may have is week to cause the water to collect this is an sour of mosquito so for buildings just fix the clean air act drains and catch basins can be mosquito ground it will eliminate it as a possible location keep shrubbery and growths estimated any water to can be seen and eliminated birdbath and fountains and uncovered hot tubs mosquito breed but it is difficult to dump the water out of a hot top

can't dump the water adding mosquito finish rids the source of mosquito there are also traditionally methods to protect you installing screens on windows and doors and using a mosquito net and politically aau planet take the time to do the things we've mentioned to eliminate standing water and make sure that mosquito are not a problem on your property remember no water no mosquito

>> (indiscernible) i just know it. excuse me boys, but does anybody have sun block to block this skin from the sun? >> yes. that's right, i need to get my (indiscernible) >> many of us last summer (indiscernible) reapplying sun screen is like getting the second dose of mpox vaccine. >> wait, two doses- (indiscernible) >> isn't it too late to get my second dose? >> girl, it is like sun screen, never too late to put more sun screen on. >> that's right, i need to get my second dose of mpox vaccine before the summer starts. >> let's (indiscernible) 21201 to find the closest location to get the vaccine or go to sf.gov/mpox.

>> thank you for the information (indiscernible) >> excuse me boys, do you mind checking please? >> sure. >> that doesn't look like a sun burn, you might want to getd it checked out. >> what do you mean clecked out? >> checked out. i was told if i got my second m pox vaccine i would have less severe symptoms. (indiscernible) >> maybe i schedule the second dose just to be safe from mpox. >> most vackeens offer you a level of protections, just like sun block. sometimes you need to reapply for more protection. the m pox vaccine is based on two shots several weeks apart to provide the strongest level of protection. visit sf.gov/mpox to get yours.

>> thank you boys for that reminder! make sure your are fully vaccinated for m pox this summer. text summer vibes to 21201, to get [♪♪♪]

>> my family's starts in mexico in a small town. my parents are from a very, very small town. so small, that my dad's brother is married to one of my mom's sisters. it's that small. a lot of folks from that town are here in the city. like most immigrant families, my parents wanted a better life for us. my dad came out here first. i think i was almost two-years-old when he sent for us. my mom and myself came out here. we moved to san francisco early on. in the mission district and moved out to daily city and bounced back to san francisco. we lived across the street from the ups building. for me, when my earliest memories were the big brown

trucks driving up and down the street keeping us awake at night. when i was seven-years-old and i'm in charge of making sure we get on the bus on time to get to school. i have to make sure that we do our homework. it's a lot of responsibility for a kid. the weekends were always for family. we used to get together and whether we used to go watch a movie at the new mission theater and then afterwards going to kentucky fried chicken. that was big for us. we get kentucky fried chicken on sunday. whoa! go crazy! so for me, home is having something where you are all together. whether it's just together for dinner or whether it's together for breakfast or sharing a special moment at the holidays. whether it's thanksgiving or christmas or birthdays. that is home. being so close to berkley and oakland and san francisco,

there's a line. here you don't see a line. even though you see someone that's different from you, they're equal. you've always seen that. a rainbow of colors, a ryan bow of personalities. when you think about it you are supposed to be protecting the kids. they have dreams. they have aspirations. they have goals. and you are take that away from them. right now, the price is a hard fight. they're determined. i mean, these kids, you have to applaud them. their heart is in the right place. there's hope. i mean, out here with the things changing everyday, you just hope the next administration makes a change that makes things right. right now there's a lot of changes on a lot of different levels. the only thing you hope for is for the future of these young kids and young folks that are getting into politics to make the right move and for the folks who can't speak. >> dy mind motion.

>> even though we have a lot of fighters, there's a lot of voice less folks and their voiceless less folks and their voiceless >> i'm rebecca and i'm a violinist and violin teacher. i was born here in san francisco to a family of cellists, professional cellists, so i grew up surrounded by a bunch of musical rehearsals an lessons. all types of activities happened in my house. i began playing piano when i was 4. i really enjoyed musical

activities in general. so when i was 10, i began studying violin in san francisco. and from there, i pretty much never stopped and went on to study in college as well. that's the only thing i've ever known is to have music playing all the time, whether it is someone actually playing next to you or someone listening to a recording. i think that i actually originally wanted to play flute and we didn't have a flute. it's always been a way of life. i didn't know that it could be any other way. >> could you give me an e over here. great. when you teach and you're seeing a student who has a problem, you have to think on your feet to solve that problem. and that same kind of of thinking that you do to fix it applies to your own practice as well. so if i'm teaching a student and they are having a hard time

getting a certain note, they can't find the right note. and i have to think of a digestible way to explain it to them. ee, d, d, e. >> yes. then, when i go on to do my own practice for a performance, those words are echoing back in my head. okay. why am i missing this? i just told somebody that they needed to do this. maybe i should try the same thing. i feel a lot of pressure when i'm teaching young kids. you might think that there is less pressure if they are going on to study music or in college that it is more relaxing. i actually find that the opposite is true. if i know i'm sending a high school student to some great music program, they're going to get so much more instruction. what i have told them is only the beginning. if i am teaching a student who i

know is going to completely change gears when they go to college and they never will pick up a violin again there is so much that i need to tell them. in plain violin, it is so difficult. there is so much more information to give. every day i think, oh, my gosh. i haven't gotten to this technique or we haven't studies they meese and they have so much more to do. we only have 45 minute week. i have taught a few students in some capacity who has gone on to study music. that feels anaysing. >> it is incredible to watch how they grow. somebody can make amazing project from you know, age 15 to 17 if they put their mind to it. >> i think i have 18 students now. these more than i've had in the

past. i'm hoping to build up more of a studio. there will be a pee ono, lots of bookshelves and lots of great music. the students will come to my house and take their lessons there. my schedule changes a lot on a day-to-day basis and that kind of keeps it exciting. think that music is just my favorite thing that there is, whether it's listening to it or playing it or teaching it. all that really matters to me is that i'm surrounded by the sounds, so i'm going top keep doing what i'm doing to keep my life in that direction.

>> good morning i call the tjpa meeting of september 14, 2023 to order. i am receive mandelman. san francisco city hall. members may attend in person, watch on channel 78, 28 or 99. or the sfgov.org website to stream the live meeting.

call the roll >> i would like to note this chair gee is absent. thank you, vice chair mandelman for presiding. we welcome new sfmta jonathan sitting in and note this director baptiste will be absent due to scheduling conflict. directors,il call roll. director emeltansy. >> forbes. >> present. >> director lipkin. why present. >> director ruiz. >> present. >> director seyed. >> present. >> vice chair mandelman. >> present. next item. >> item 3 is communication. we would like to note the process for the public. members of the public may

comment on the meeting during comment period in person or remote the line is a courtesy and availability may be disrupted due to technical difficulties or otherwise. in person comment first. remote comment taken after. the public call in line is agenda dialing instructions scrolling on the bottom of the screen on sfgovtv. are there communications? >> i will check for public ment in the room. i will check online. >> seeing none online i will proceed to the next item. director item 4 is board director's new and old business,

i'm not aware. item 5 is the executive director's want and director adam van de water will present the item. >> good morning. welcome director ruiz and happy transit month. last month our chief financial offer returned to the city of richmond to serve their director of finance. team developed a plan to continue the business at the agency and item 10 today relates to this as we seek a person to nil vacancy. at the transit center the dream force is this week the sales force conference our neighbor and seen an increase in riders and customers at the center including large party reservations within the building. east cut commune benefit district received feed wang from neighborhood largest employers than i are bringing employees

back to the office. post labor day. we are seeing a pick up in activity in the neighborhood and welcome that. september is transit month. we have partnered with organizers, nice stickers from ac transit. find the area. the san francisco transit rider in the bay area are -- planning a number of upon events to highlight the roll transportation has in bringing communities closer including our transit search. providing the bay area system include to the center with an opportunity to win a tour of our facility. including the train box. the transit activities are the week of september 25. tabling event at sales force park on wednesday, september 27th and partnering with kaiser to host a forum. thrive with transit on wednesday september 20 and in front of

their space by shaw alley. >> we will join cal trin they host emu block party on saturday the 23rd. this follows their successful event in san jose that brought 4500 to see their new electric trains. invite the public to pip in the fun transit month activities happen nothing and near the sales force transit center. >> in addition we provide our daily free offering of activities and facility's operation's director will cover this in his report. including news of the lose termination agreement with doing business as the show group. and the 2 suite space 13 and 37 on the ground floor, we will share more on our plans to inn gauge our community and identify the highest and best use of the spaces >> on the dtx we veterans the

downtown riextension the portal protect the federal transit investment grant program. this week i joined director alfonso rodriguez in l.a. with michelle here today as we participated in the fta transit construction rounds tibl than i are hosting to discuss delivery and best practice. a great opportunity to meet, limited partership and discuss worrying sponsors with fta and delivering transit investments and got a chance to tower the under construction l.a. metro purple line to santa monica and hear from projects doing heavy urban you should ground rail. and hudson tunnel and the new york metro and l.a. regional connector. these were good opportunity to establish connections and learn if their challenges of delivering the projects the left

several years. >> matching funds continue to be our focus to advance the project. which on the local level includes county transportation authority board passage of an additional prospect k and l allocation of funds. 4.6 million dollars on first,ed are first read this tuesday. renalinginally we cord nay with the metro transportation commission on an update to the major project advancement policy they started discussions yesterday at the september programming and allocation's committee prior to expected commission action in october. we are continuing discussion asking them to prioritize funds to meet mile stones as we complete the new starts process. >> than i are considering an update to the bipartisan infrastructure law program. awarded 50% of projects that mtc endorsed. asked for their consideration to endorse the perral for megaand

chrisy funding programs we have submitted applications for. our project recognized a contender for funding sources and like the advocacy and support since their 2 projects for the funds did not pursue funding for this cycle's time line. which allocation of funds nothing fitsical 26 and, wards expected the fall and early next year. lastsly, thank the state for 60 million dollars commitment of funds to the project. and your consideration of item 12 today allows them to take the team the master agreement to the california transportation commission in october. to keep the project development efforts moving forward. upon happy to answer questions you may have before our facility prescription's report and this concludes my portion of the report today.

>> good morning vice chair mandelman and directors i'm the facility director and happy to be with you here today. okay. 4 popular programs the left month we have drum circle you see here. roof top jazz, yoga and of course our lovely family programs liked to ler tuesday. and director veteran van mention third degree month is transit among we are celebrating by riding transit. and i'm looking forward to the bart hunt this is wore having throughout the bay area and at transit center we will have food

pop ups in the park. performance. informational tabling from our per ins and getting the word out about how important it is this ride transit. >> for park programming attendance, we seeing here is one year graph attendance and the important take away we are trending up by 24% when compared with last year. performances on the 18th we have tiera by pinnia and celebration of hispanic heritage month. and on the 24th of september, we have an alison wonderland quest this takes you throughout the park. looks like a fun event for everybody to come out and enjoy the park with their family. and then in on the eighth we have another mask quest.

i think the theme is different. up and keeping it exciting and showing how diverse our events issue the post ballet on october 15th. the drag shows and musical performance and of course, halloween silent disco. for visit trends. become a nerd when it come to data again. i like it. especially when i see positive data. had we see from place are ai is using cell phone data to show activity around the center. we are seeing a 48% increase when compared to left year. averaging 116,000 people per mont. which is up. and our average dwell time may seem small rain by 3 minutes. which is enough time to grb a coffee or another beverage.

>> regards to mta ridership an increase when compared to left year the data citywide. we do see a slight dip in july. but one hypothesis may be due to people more comfortable traveling. summer brick and this kind of thing. >> with regards to ac transit. similar trend to sfmta. we are showing a 24% increase and again a bit of a dip in july. so really looking forward to seat august numbers. more than anything i'm excited seat september numbers. most people know a lot of folks coming become to work post labor day and got dream force now. that will be interesting to see where we max out with regards to ridership and activity in general.

for retail leasing updates. mody formerly vibe. they are delayed a bit but trucking language i bit. getting their kitchen exhaust installd and interior finance they're not far out, still looking for them to activate may be november/december. we got beer bottle submitted plans to put a kiosk in the grand hall. grit to activate that space and cap our that foot traffic on the ground floor. director van de water mentioned a lease termination agreement with the show group. to terminate their lose on the roof top park and the ground floors. now we are focusing on activating this space especially in the roof. working with the community partners and of course, working

with our are real estate professionals to find a long-term tenant this really fits the p and compliments the public access and use of the park. so, want to be clear there. we are look for the right fit. all, we got juice bar. who is -- look to star construction in the next several months with pokey house on a slower trajectory. i want to make sure i show love to the concern tenants open and operating and make sure we flag them but otherwise, that's the end of my report. let me know if you have any questions! >> thank you. i wanted to share to add upon a bit on the ac transit ride areship story. anyone interested we are going

through the realign study looking how ridership has changed and still changing. on our website there is a new report publish third degree shares both ridership sum row and each line individually. love this. excited see that a few of the trans bay roots have higher productivity then and there inspect 2019. just a handful but it is great to see riders coming become to the transbay rots. >> thank you for saying that. >> director, there has been new fleet that has been launched for ac transit lifely new bus i had the chance to ride here. >> wonderful. we have new double deck are mci's and my complaint is there are too many rideros my root for them to put the bus in service. it hen great to see them out serving transbay and hearing positive feedback from our on

our school roots. kids are excited since the bus are doing double duty and school pick ups. >> double decker. >> pun intended. >> so >> thank you very much. >> great. thank you. we will check for public ment in the room. none in the room i will check online. >> no public comment online proceed to your next item. >> directors item 6 the cav update and chair bryan larkin is here to address you >> good morning vice chair

mandelman and other board members i'm brian larkin chair of the tjpa, our meeting this past tuesday the 12th. our brief agenda included the usual staff report. downtown work plan update and facility prescription's update. the staff report on the activities since the august meeting included when will go on for transit month. among the things she mentioned was a transit block party at fourth and king on the 23rd. and one of our cac members anthony said there was a lot scheduled at the same time at this same location so it could be crowded sdpt tjpa staff plan

accordingly. and ana harvey the work plan update. eric shotmy are asked whether tjpa, rm3 funding request would be affected by the mtc rating of the project. in asking this question demonstrated a thorough understanding of the funding process and i will [inaudible]. i asked about the relocation process planning. and my take away from that was that that process endeavour is more intensive then and there i imagined press intensive than i would have imagined. facilitying prescriptions and natasha patterson asked about transit commercial sxruns new ups of rental space. the other brian shaw and eric

made observations on street scape surrounding the center. there has been changes in just what is open expect not. but they want to know they made observations. >> other than public ment and i review general public ment and review request for upcoming meeting topics, that was it for this month. >> thank you, chair larkin. comments. >> i look forward to seeing you in october. >> all right. >> public comment. >> i will check for public comment in the room. >> and -- seeing no public comment in the room i will check on line. no public comment online, next

item >> thank you. why directors item 7 is public comment. an opportunity for the members to address the authority on matters not on today's calendaril check for upon comment in the room. we have public comment. >> good morning this ask jim pattic are patrick and company i want to address the policy for the project labor agreement. this policy and this policy of this board to pay the highest price for labor. the highest price for labor. how can you possible low bid a 2-4 billion dollars project where you agreed to pay the highest price. you are shooting yourself in the foot. and i think it is in the right.

you only have the opportunity to -- contractor has an opportunity to bid on risk and profit. he has labor fixed. what are you doing. makes no sense. so -- i agree, i think you should redot policy and rethink that thing from top to bottom. >> i argued for this a long time and i continue to argue for it because i think it is good public policy. thank you. >> thank you. check to see if there is additional ment in the room. seeing none i will check on line. >> all right there is in other member of the public wish to dress you under this item this concludes the item.

>> directors item 8 is the consent calendar all matters are considered to be routine and acted upon by a single vote there will be no separate discussion unless the board or public requests. then the matter will be remove friday consent and considered separately. and -- directors i have not received an indication well is a member of the board or public wishing to have items considered sprit low and well is in public comment. >> all right. i will -- proceed with calling consent. i will call the consent, item 8.1 is approve happening minutes

of august 10, 23 meeting. it.2, authorization the executive director to execute an amendment to master service agreement with ever bridge for notification system, software, compensation up to 4 pon, 500 over 3 years a.3 authorizing the executive director to execute a third amendment with the agreement for commercial retail space in suite 123 on the transit center and 8.4 authorizing the executive director to execute a second amendment to the lose agreements with den bow a california corporation for 2 commercial retail space suites 125 and 129, and suite 119 juice bar on the first floor of the transit center. >> do i have a first to move the item? >> thank you.

director forbes. a second. >> seconded by director lip consistently directorsilical the vote. >> director forbes. >> aye. >> director lipkin. >> aye. >> director ruiz. >> aye. >> director seyed. >> aye >> director mandelman. >> aye. >> director this is item the consent calendar is approved. >> directors item 9 approving the applicant to serve a mfbt tjpa citizen's advisory committee to fill the vac an seat bicycle advocate seat. willie magis. >> good morning directors as noted the add viseow matters of interest relating to the trans bay perform felony members

representative constate wensys representative the groups and impacted by the program of last july hunter stanford in the bicycle advocate seat resigned result nothing an opening. staff determined there were qualified candidates from the 2 similar 23 recruitment cycles and 5 of them and we are recommending one before you today. josalin thompson to fill the bicycle advocate seat. she is actually here if you would like to hear from her. >> that would be great. >> good morning i'm josalin thompson i'm honored to be considered and here to answer questions if you have any. >> thank you. >> comments or questions other than thanks and gratitude. >> looks like we have no

questions. >> all right. i will check for public ment in the room. seeing no public meant in the room i will check on line. no public comment on line. and i will go ahead and call the vote. do i have a first to move the item? >> i will make a motion. >> thank you, director ruiz. second? i will second. >> and second by director seyed. >> go head and call the vote. director forbes. >> aye. >> director lipkin. >> aye. >> director ruiz. >> aye. >> director seyed. >> aye >> vice chair mandelman. >> aye. >> directors, item 9 is approved. proceed to the next item >> please. >> all right, directors, item 10 is adopting a resolution

appoints araceli harris finance manager 2 as an extra help retired anew tan imminent special project work, oversight during a critical time as we fill several finance positions gonzalez, chief of staff is here to address you. >> hi. directors. the item before you is a requirement by cal purs retired and i will stop there and give our gratitude to her for considering to come become and assist the agency. and share her knowledge and expertise with the staff. with that, are there questions? looks like not. >> >> thank you. all right. no questions from directors i will check for public comment.

no public meant admit room, i will check on line. >> seeing none online. do i have a first to move the item. joy will make a motion. >> we have a first by director forbes. >> second by director lipkinful thank you. i will call the vote. director forbes. >> aye. >> director lipkin. >> aye. >> director ruiz. >> aye. >> director seyed. >> aye >> vice chair mandelman. >> aye. >> item 10 appointing retired anunt is approved. >> directors, item 11 is authorizing the executive director to execute amendment 5 to the professional services agreement with a law firm seyfarth shaw to provide service

for baseline construction close out increasing the total amount by 4.1 million not to exceed 20 million in amending the fiscal 23 similar 24 budget reallocate to oshg camidate the legal services with in change to the total amount of the fiscal rear budget or the over all program budget. dennis, senior construction manager is here to address you. jury room good morning directors i appreciate the opportunity to present thisef you. in support item 11 we also have in attendance ron almeida the director of design and construction of phase one and then we have in the back row greg, shaw's counsel representative. usually mike is here but greg is

fill figure as we close out phase one construction the item before you brought forth with full recommend agsz from the tjpa staff to continue the professional service as we continue to try it close out phase one. no questions. >> okay. seeing no questions or comments i will check the room for public comment. >> we have a member in the room withhold like to comment. >> thank you. this is jim patrick with patrick and company. i would like to see a list of the items which are yet resolved. to be resolved. allocating 20 million dollars? to get them resolved. i don't know i question this. but there is in the enough

information to digest relative to evaluate whether this is a good idea. thank you. >> thank you. >> no other public comment in the room i will check online. no public ment online. i will go ahead and call the vote. i have a first to move the item? i will make a motion. thank you direct lipkin. a second? >> second. >> second boy director ruiz i will call the vote. director forbes. >> aye. >> director lipkin. >> aye. >> director ruiz. >> aye. >> director seyed. >> aye. >> vice chair mandelman. >> aye. >> item 12 is approved proceed to the next item? >> please, do.

>> item 11 is approved. >> item 12 authorizing an executive director execute a master agreement and program supplement with the california department of transportation cal trans and associated resolution to enable the program anding allocation up to 60 million dollars in state transit and intercity rail capitol program funds. we have mary prior financial consultant here to present the item. >> good morning, i'm mary prior with nwc partner this is item is to approve a master agreement with cal-trans alufor thefully of funds of the 60 million in tircp funds that was allocated to tjpa in april. the california transportation commission or c pc is expected to program the 60 million at the next meeting october and allocate 15 opinion 5 million at that meeting with budget of the

funds to be allocated fiscal year 25. if you have questions, i'm happy to answer. >> director lipkin >> not a question but a comment that i'm excited to see this move forward it is important the state is a contributor this is an important step to use state funds to advance the work. i'm supportive. >> i imagine we'll hear in the next item about our gap in the work we are doing to close that. still significant. thank you for your work >> and your report. >> all right. there are no other comments or questions. i will check the room for public

comment. seeing no public ment in the room i will check on line. seeing no public comment on line i will proceed to call the vote for this item >> do i have a first to move it. >> make a motion. >> motion by director forbes and do i have a second? >> so moved. >> thank you, and second by director seyed. i will go ahead and call the vote. director forbes. >> aye. >> director lipkin. >> yes. >> director ruiz. >> aye. >> director seyed. >> aye. >> vice chair mandelman. >> aye. >> this item is approved. proceed to the next item? >> thank you. >> item 13, san francisco peninsula rail program steering update and stats of the downtown rail extension/portal, work plan schedule.

there is an update and the status of the schedule. why good morning. happy to be here on transit month. for me every day is a happy transit month. i hope everyone will ride transit. every day, every day. [laughter]. transit. >> anyways, really do appreciate a couple of shout outs for our event fourth and king. we're excite body it. any time we get to shut down a street in san francisco to celebrate transit and some of our accomplishments, it is we hope for the same type of turn out if not more than we did in san jose. i want to thank director van de water project direct rodriguez for attending the construction round table. you know as we novemberigate the fta press, it the be important

it learn lessons from others as opposed potential low starting from. there is experience the project can pull from. important it do so and certainly will build our kitchen cap net that way of folks we can call and again as we novemberigate the press and get in what is the extension of an operating rail line. that will need to operate throughout the course of construction. i bit of complexity involved. to appropriated remarks after aproposaling mile stone in august the proust financial plan and the request to enters engineering, tjpa and the portal have the 6 partner agencies supporting the prp. continue to collaborate to advance the program while we anticipate the outcome of the fta review of supporting documents in the perral's risk assessment and readiness reports

to advance to engineering. will finalize a project rate and favorable will admit the project to engineering and a sick capitol grant dollars amount is established reflecting the funding participation subject it an execution of a full funding grant agreement w. this completed will recommend the project at the end of this year for funding in the next white house budget recommendation. and consideration by congress for the federal fiscal year 2025. left month we received a presentation on the past to baseline budget and schedule. had a productive conversation on procurement and funding in advance of future discussions on this specifics of the procurement process as it progresses. this board's consideration of a base line budget and schedule in november. genetics ip mt continues to be engaged and inlet august and early september on items relate today vertical circulation and

scope deferral. prosecute curement preparation. governors work to probably a memorandum of understanding and contract packaging this concluded my and ana harvey for engineering will provide a look ahead of project items appearing before the board in the coming months. >> she is behind me. i got it. [laughter]. >> that was tricky of you [laughter]. was not intentional. why good morning vice chair mandelman and directors. this okay. this month's look ahead for your consideration guess from the month of october until february of 2024. coming before your attention next month will be 2 action items and one information item. the first action item will be an amendment to the existing enabling works site planning mem

recentliedum of agreement an agreement we have with cal trin it fund their -- do you need me to? sorry about this. um -- an agreement with caltrain found their design and project management oversight of on going design work for the work this needs to take place for the portal in the caltrain fourth and king rail yard. second item before you is a conflict of interest policy related to procurement. and for information as there will be several presentationos this leading toward january and information item on construction procurement. follow thanksgivingville a jam packed november with 3 action items and one information. the budget and schedule, which executive director referenced a contract delivery prop an action item will build upon the

procurement item you will hear in october making recommendations for slight adjustments to packaging as we advanced those since the project delivery analysis study. the rm3 funding requests referenced in the cac report and information for your consideration as we begin steps forward potential low commencing our right-of-way program next year the draft relocation and impact study plan. for information for your consideration. this will commence a public ment period. and then following had in december the reelection will come back as final incorporating comments out of the period. for your consideration as an action in december. you will be seeing the successor mou the mem recentliedum of understanding amongst the 6 per in agencies that will succeed

the existing dtx rail program-mou. going in the new year, subject to funding as all of these are, the construction procure am will be advanced for your consideration as an action item. and then in february the award of the project management construction management contract. and with this i will take questions about your jam packed schedule in the next 5 months. >> yes. i have a couple. is the conflict of interest policy for us the directors or who is it for that you are creating? gi will refer to you deb are miller. >> thank you for the question. director. the it is an organizational conflict of interest policy, which many of the member agencies have adoptd and it is specific to anticipating the progressive design build form of construction contract.

so intended give guidance to potential bidders on the pdp condition tract. >> i see. thank you. >> piggybacking if helpful, because we have, lot of procurement now we have had to update ours. really electric to find a balance of not conflicting people out for small business opportunity. if it is helpful to connect with legal timeteam i'm happy to put you in touch. gi appreciate that. we have been looking at your policy. [laughter] thank you. >> this is all important work and i do want to ask a bit how to budgetary gap closing over the next year. is it going to be we got this gap and this gap and then we don't got this gap?

or is there something the commissioners should looking at or markers of -- whether, is this going to be like things are looking good or bad? or a moment where it is happening or not? >> thank you for the question, vice chair. a couple comments first on progressive design build the conference in los angeles there was discussion of modernizing construction managedologies and project delivery from the line bid and design bid build to construction manager at risk and progressive design build movement in that direction. what you see here on the action items before you some of them are conflict of interest policy, statements of mou's. big ones in november time frame and wore anticipating with our work with the transit administration that

wield be given a project rating around the october time frame. and recall we need a medium or higher rating. we have been trending modium high there are availables this the project management oversight consultant and financial consultants will review to make this determination we will get this in october. this will allow you to come to you in november to adopt a final base line budget and schedule. this will look a lot like what was approved here in august with some minor modifications. we think. but what that does is it sets the max process for the federal participation and the project. so, with the inclusion of the fti capitol grant and committed funds we are 78% funded. we are making great frog gets this to construction this last 22% is reline on external grant

sources and other sources. follow we adopt a base line budget in november, it starts the clock to identify the sources or runt risk of ~esque ligz from years of delay. i want you to be appropriated and oui the provide had information you require to get you red for this decision in november. because having this project rating, enter in the engineering increases our likelihood of receiving the guarantee, wards, which we rely of it does put us in a position we need to accrue the funds recapping that federal share. well is a decision point ahead this we have been working toward. and the november time line will be a point upon where we want to make sure you have the information to make that decision. >> we are not tow point of closing i gap because are not sure, we hope the indicator in november we'll figure out are we

actually at 78% fund and you know is this a shot at doing this or not? and then there is a year of work to figure out how to close this gentleman. >> all of this is in service of the accelerated work schedule i grant agreement in the spring of 2025. this is a decision for the board in november. it gives us time until spring of 25 it, line the sources. as presented. there are a number of opportunity on the list we need to evaluate their likelihood of closing the last 22% again. >> okay. all right. director forbes. >> what will be the bench marks during this period once we make the decision and there is the need to close that gap? are you thinking through bench marks of performance?

or i think the vice chair is asking a good question. how do we know if we are on track or not during that close the gap period? >> there will be a number of decisions. one of which is whether we are award the applications we submitted throughin are city rail and transit capitol programs, the first 2 are fra federal rail administration grants we should here from the end of the calendar year. megathe third hear from next year an indication of progress on this front. the metro transportation commission has had success with their major project advancement policy coordinate the region will revisit prioritization as part of that process in november time frame. and as mentioned, we are the only application in the region for megafunds and hope to get their support as part of this process. there will be indicators over

the coming months simultaneous come after the november time line. we doll our best to out line those so you know what is manage when. should we proceed in november and we would proceed toward the execution of the federal transit administration will not sign a full funding grant agreement without the required match. the november time frame to be clear, is to look in the federal participation, which is a dollar amount. a percentage of the cost. projects delays subject to ~esque ligz and go up over time that percentage would shrink because the dollar value capped and the over all value would grow. we're not commit to delivering the protect. and fully fund nothing november when we are doing is capping that federal share. there are other federal sources.

for cap this is federal share. >> thank you. director forbes for putting i finer point on my question. it does sound the and terrible bench americas to close the 22% as we hope that is when we are trying to close, may become clearer witness we know it is i 22% gap we not know until november. sounds like there is a giant bench america in november. and if we make it through this door, then we will look for more clarity around what else is there? >> if you could, director van de water in your director's report very simple low say this is where we are securedi unsured and this is the current status. just so we are aware each time and we and the public are clear. thank you. >> absolutely. as we present in the the past

and start increase the kayedence of we look at funds in categories, committed, on hand and require no action on. those budgeted this don't need additional action but still out there potential low in time and those that are planned. or applications and others. there are some sources this are budgeted but on royals activity which is suffering from high interest rate environment and push in the the 40 prior to previous estimations. >> sounds like good bucket this is is i key risk areas. so keeping us updated and aware will be critical. >> thank you. >> a donald quality to this conversation. known, known, unknown. >> unknown. >> yea.

adam, the city has pursued before and it was difficult but is there an opportunity to pursue federal legislation to get existing local match that is spent now counted towards the match for the cig? if you could get this, if, a big, if, it was difficult 15 yearsue burglar allows to you push out the cig clock you are collecting this match but not fixed on this federal potential contribution is this a legislatedive strategy you are considering to help with this gap closure? >> yes, thank you for raising this. of the federal transit administration did grant the inclusion of train box exextend tour in 2010 to the total of 729 million dollars, 400 from oura funds and the reminder from local sources as a match toward

phase 2. appreciate your comment this was a hard faust victory for the project. we one of the challenges of the project and we hell this beg your pardon of including the trin box, it is difficult to segment a tunnel with existing trin becomes we get there or don't. there are limited have you engineering opportunity we hope to bring to you in the coming months reduce the scope and the cost. but a matter of getting from the operating railroad and to the transit ternity to link the providers. this is fixed distance and fixed cost. thank you. everybody >> thank you. >> all right. public ment time. il check the room for public comment. no public comment i will check

on line. we have a mfbt public withhold like to provide comment. am can you let them in. good morning, vice chair mandelman [inaudible] the first thing i like to bring to your attention that the item in the packet is broken. so there is in way for members of public to review the material if there was any other then and there the on the slide was presented to you. with regard to the gap. there are 2 ways to address this problem. you can either look for more money. or you can take a look at the scoping this fit the current

[inaudible]. including engineering and by -- mr. van de water or through the incorporation of other projects such as the tx and [inaudible] stops and you might think what not necessarily [inaudible] there are different ways to not just design, construct and [inaudible]. potential -- thank you. >> thank you. caller. check for additional public ment on line. >> seeing no public comment this concludes public ment for this item. >> we'll make sure our links work >> yes, we'll check this out. >> directors this concludes you were agenda for today. >> we are adjourned.

>> thank you, >> thank you. >> clear clear complaints and

not (indiscernible) that concludes today's overview. thank you for your time. >> what happens after a complaint is submitted? when dpa receives a complaint, the first step is it to assign it to a investigator. if the complainant provides contact information, they receive a letter telling them

knoo they assigned investigator will be. if the complaint is submitted anonymously they will not receive further contact from dp. >> what happens when dpa finds a police miscucktd? >> the dpa find misconduct, meaning sustain a complaint, the next step is to determine how serious the misconduct is and what discipline the dpa will request (indiscernible) the dpa does not itself impose discipline and can only recommend discipline in a sustained case. >> what happens if a complaint turninize to a chief nonnob >> if the dpa decides to recommend 10 days suspension or less, the chief of police is the final determner of both whether misconduct

occurred, and if the chief agrees misconduct occurred, what the disciplineitary penalty will be. in those cases if the chief disagreewise dpa, the case is over and dpa does not have any recourse. if the chief decides that misconduct occurred, and to impose discipline, an officer has a right to a hearing before that decision is final. >> what happens if a dpa complaint turns into a commission level case? >> if the dpa determines a 11 day suspension all the way up to termination is the appropriate outcome for a misconduct case, a trial is held in front of the police commission. normally, one commissioner presides over the trial, then the entire commission will read the transcript and vote. if the commission determines misconduct occurs,

then the commission also determines what the penalty will be. if you are stopped by a police officer you should follow the officer direction, keep calm, keep still, and do not make sudden movements do not reach for anything, especially in your pockets, keep your hands visible at all times. you have the right to remain silent. this means you do not have to say anything. tell the officer i want to remain silnts. you have a right to a attorney. tell the officer i would like a attorney. if you are arrested do not talk about your case or immigration status to anyone other then your attorney. do not sign anything without your attorney. do not lie to law enforcement officers and if you are property are being searched make sure i do not consent to the search. do not challenge the officer, you can file a complaint about police services later, if you are not comfortable speaking english you can ask for a

bilingual officer who speaks your language and also ask for a interprerererererererere >> good afternoon an announcement for asl viewers due to the importance of showing videos we ask our asl viewers use the link in the description of the live stream. for viewers withhold like to town hall meeting translated click on the web x link in the live stream and click the icon in the bottom left corner select your language.