we vote to elect whether to disclose any or all discussion on item 12 held in closed session, including a vote on whether to assert the attorney client privilege with regard to item 12, san francisco administrative code. section 67.10 action motion not to disclose any items in closed session. second. yeah. okay many members of the public, they'd like to make public comment regarding line item 13. please approach the podium. i'm seeing none on the motion. commissioner walker, how do you vote? yes mr. walker is. yes. commissioner benedicto? yes. mr. benedicto

is. yes. commissioner yanez. yes. mr. yanez is. yes. commissioner burns. yes. commissioner burn is yes. commissioner yee. yes. commissioner yee is yes. you have five yeses. fine. item 14, an adjournment. all right. all right. are adjourned.

going 90 charlie. go ahead. we moved to san francisco in 1982. we came from the philippines. i have three kids nathan, jessica and iva. i was really young. when i had neat, i turned 19. and then two weeks later, he was born. so when he was fine, i used to watch cops all the time. all the time and so he would watch with me. he had his little handcuffs and his little toy walkie talkie. and then whenever the theme song came on, he would walk around and he just thought he was the baddest little thing. i think he was in kindergarten at sheridan because he and i attended the same elementary school there was an officer bill. he would just be like mom officer bill was there then one day, he said, mom, i touched his

gun. and he was just so happy about it. everything happened at five minutes. i would say everything. happened at 4 to 5 years old. it's like one of those goals to where you just you can't you can't just let go. high school. i think you know everybody kind of strays. he was just riding the wave. and i mean, he graduated. thank god. one day i think he was about 20 or 21. he told me, he said mom. i want to be a cop or a firefighter, i said. no you're going to be a firefighter. but that's really not what he wanted to do. his words were i want to make a difference. and that was a really proud moment for me when he said that my dad was a cop in the philippines for 20 years. i think a lot of that played a role into his becoming

a cop. my dad was really happy about it. my mom. she was kind of worried, but i just figured i can't stop him. he can make his own decisions. stu. i just want to say what's up? how you doing? good. good. no i'm trying to look good for us to looking good for us to so when he was in the police academy, mind you this kid was not a very studious kid. but i've never seen him want something so bad when he was home. he'd be in his room studying the codes. he really fought for it. hi. what's your name? i'm nate. nate is great with kids, and he would give them hugs or give them stickers. i think that that's a positive influence on the kids, and then the people around you see it. once he makes that connection

with people and they trust him that foundation that respect people look at you and see your actions more than your words and so that i think will reach people more than anything. you could say you later, brother. thank you. all right, see you. it's a really hard job. i know you. you see a lot of the negative for me. i would not put myself through that if i didn't care. you know, you have to be the right kind of person. you have to have the right heart to want to do that. when people ask me if you know what my son does , um, i just tell him he's a cop , and i just feel like i'm beaming with pride. i always told him when he was young that he would do something great. and so to see it. it's i have a moment. i'm very proud of him.

>> >> (indiscernible) faces transformed san francisco street and sidewalks. local business communities are more resilient and our neighborhood centers on more vibrant ask lively. sidewalks and parking lanes can be used for outdoor seating, dining, merchandising and other community activities. we're counting on operators of shared spaces to ensure their sites are accessible for all and safe. hello, san francisco. i love it when i can cross the street in our beauty city and not worry whether car can see me and i want me and my grandma to be

safe when we do. we all want to be safe. that's why our city is making sure curb areas near street corners are clear of parked cars and any other structures, so that people driving vehicles, people walking, and people biking can all see each other at the intersection. if cars are parked which are too close to the crosswalk, drivers can't see who is about to cross the street. it's a proven way to prevent traffic crashes. which have way too much crashes and fatalities in our city. these updates to the shared spaces program will help to ensure safety and accessibility for everyone so we can all enjoy these public spaces. more information is available at sf dot gov slash shared

[music] my name is husheem anderson a lieutenant with the san francisco fire department born and raised in san francisco, grew up in western addition. both my parents worked for the city. my dad was a custodian with san francisco school district and mom a muni driver. when i grew up in san francisco i never thought of the fire service as a career. not because i didn't want to be a firefighter, i just didn't know anything about it and it was literally the experience of trying to figure what i was going to do with the next part of my life where i decided to go to city college and take a couple classes. that is when i discovered there was actually a fire science program program emt program and paramedic program. if it wasn't for that opportunity to get the

education training and meet several mentors that are some of my grood friends today, i don't think i ever would are have pursued this career. i was interested in becoming a paramedic so i did work experience at the ems division when it was actually in the presidio, completed that program, did my paramedic internship at the same time i volunteered with san francisco fire reserve and able to learn a lot of hands on skills associated with becoming a firefighter. san francisco went through a period of 7 years without hiring, so we hired about a 130 people off of the 2001 test which is the first fire test that and ever sat for, so i took that test, did pretty well on it test, interviewed, didn't do as well as i liked so they hired 130 people off that list and didn't hire again for another

7 years, so here i was training to do a job where i was really excited, but there were no jobs after 911 so things slowed down and once the fire department started hiring again i was in the second class hired full time in 2012. because of the experience i had here at city college, it was always really important for me to be able to give back. so, when i got to the fire department, i didn't have a college degree, and in order to teach at a community college you need a college degree, so quhile i while working as a firefighter i got my degree from saint mary college so i got a bachelor degree. i teach firefighter 1 and 2 curriculum for the program at the college. after i promoted to lieutenant, then i applied to be a instructor down at the training

academy because i always loved to teach. my past experience is really helpful in terms of how i'm able to break down information and pass it alodge to brand new firefighters. so, for myself, i didn't know very many people of color who worked in the san francisco fire department. as african american working in this department i always felt a obligation to be that example, to provide a roadmap for folks who look like me, who come from communities that i came from to make sure they have the same opportunities. now as a san francisco firefighter i can tell you if you work hard, you get along with people, you will be welcomed into this department but we can also do a better job of representation. to me as a company officer when i'm on the fire engine or truck it is so helpful to have a rig where members can relate to the public we respond to.

to me that cultural diversity of the members on our fire engines, on the ladder trucks is important because if we can do a better job of representing the community that we are serving, i think we do a better job of relating to the community that we are serving, and to me that is something that is really important. 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 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