the group endorsed the healthy aging model that's provided by the community services which provides a model that could be applied to various groups. provide for admittance to shelters where the clients go through a comprehensive needs assessment process. obviously, the availability of increased long-term, ongoing rent subsidies for seniors and persons with disabilities. as i mentioned previously, increased training for shelter and center staff, provide orientation sessions for shelter clients about case management, how to report. look at why seniors are moving out of s.r.o.s and utilizing shelters over navigation centers. the h.s.h. adult coordinated entry personnel resources hub. obviously greater access to assisted living facilities, skilled nursing and hospice. and universal case managers that could act as a team and work across the departments would be helpful. develop programs such as alcoholics anonymous and narcotics anonymous and other programs to address some of the behavioral needs. and that provides exclusive transportation because that often times becomes another problem.

you can't provide for the doctors if you don't provide an increase in the debt ceiling. you know that. we have to pay our bills and paying the doctors and making sure that they are protected includes doing the action that we're doing. join us in doing that. mr. brady: thank you. reclaiming my time. our colleagues have known for two years this debt ceiling was here. never passed a budget, never passed appropriations bill, let this crisis occur and built it time after time after time again when we could easily have come together. by the way, our democrat colleagues hold the house, they hold the senate, they hold the white house. they have the power to pass the debt ceiling and have had that time for the entire year. so to my democrat friends, you can try to sell this snake oil all you want but the truth of the matter is, you wrecked a bipartisan agreement for your debt ceiling crisis. that's what we're voting on today. republicans' support for health care providers. we won't allow them to be held hostage to this debt ceiling crisis. with that, i urge strong opposition to t

the only providers may be primary care providers, nurses, pharmacists. these providers are essential to rural families and there are times when specialty care is needed, and when there isn't a specialist close by, telehealth can help get patients to the medical care they need from a remote location, through the use of technology. telehealth services are also critical in nursing home facilities. in my state, we have strong programs designed to bring on-demand support into facilities to help avoid unnecessary emergency department transfers. by reducing unnecessary senior hospitalizations -- i should say my my reducing unnecessary senior hospitalizations act or the rush act would help facilitate more arrangements like we have in south dakota, allowing medical groups to collaborate with nursing homes to provide telehealth services through a medicare alternative payment model. i'm also pleased to support the bipartisan connect for health act, which aims to expand telehealth services through medicare and is supported by more than half of the united states sena

it provides more speed. the urgency on our streets and something we are trying to do for our community partners out of respect for hard work on the ground. we know they are working every day on the ground in the community and with the service providers. we will leave time for discussion. that is the last slide. we can turn back to you, chair williams. >> thank you so much. i am going to go to public comment. do we have any public comment? >> member of the public who wish to comment call 415-655-0001. if you haven't done so dial star 3 to speak. system prompt will indicate you have raised your hand. wait until you are up muted to comment. you have three minutes. checking the list now for hands raised. i do not see public comment. >> i am going to the committee discussion. i want to acknowledge the director thomas in rapid rehousing and support for rapid rehousing if we can extend that out. any members that have questions or comments. member friedenbach. you are muted. >> thank you for the presentation. a lot

>> there is a lack of data on some of these providers. just something you want to add on that any other data that we are getting? >> related to what ms. saunders brought up of those credit karma users, the credit karma survey participants, they did mention they fall behind payment 72% reported they had seen a hit to their credit. which is also pretty concerning rates. >> let me ask then, would it be helpful if you would legislation that would require the by now pay later and alternative financing methods to report their credit history to the credit rating agency? have these consumer patterns. ms. brody? >> i am sorry. >> ms. torres go ahead i'm sorry. i'm sorry that is a follow-up. we are urging the supervisory powers to collect data, to get a better understanding of what the consumer experience is among all of the users in this product. they are skewing it younger it might be consumers not as familiar with the credit system as other seasoned users might be. >> that is what california is doing? >> so california has licensed them so they a

their health care providers. that way veterans can talk to us about issues as it relates to anything. they know they can have that communication with their health care provider without fear of it being used in any other way. those are the two things we are focused on, alex. number one is how can we maintain our role as a trusted source of good, sound information inquiry -- including necessary warnings for veterans and also, how is it that we're going to make sure that veterans have every confidence in that context that we will not get between them and their health care providers? they'll get all the support they need including if they feel like they are getting pressure or recruited from somewhere else. great. turning to the issue of veteran suicide. that is especially pernicious. especially given the way that our community interacts with firearms. when it comes to choosing a lethal means for suicide, veterans overwhelmingly choose firearms because they are familiar with them and they are more likely john them. i

a service that's provided. some people go from personally lending a friend at no cost or they will say, well, i will give you 100 dollars, giving back 110 next week. no one does the math. it's just a simple fee. then you normalize it. and you say, well, i did that for a finder to, how about i start a business? and can you get into this space? applying the technology? one of the obligations to protect consumer privacy for a business in the space? >> it's probably not as easy as just creating a burger stand. there are more complications. and there are a lot of players in this space, i would say. and it does require adherence to federal law, state law, consumer protection laws, a whole host of regulations. it would require a tremendous amount of product design. capabilities and relationship with lending partners, with banks and to have those relationships with merchants, and going out and building a product to entice consumers to be able to use the product in a responsible manner. so there's a whole host of differ

tipping point is providing over $1 million to bipoch nonprofits in district 10 to provide services that go along with the emergency housing vouchers. the second priority is to reduce homelessness. and the third is to decrease the inflow into homelessness and then we're providing all participating households with application support and housing search and navigation support and services. and providing housing applicants with ongoing case supports as needed. the e.h.v.s program provides a unique opportunity to house people experiencing homelessness with these mainstream vouchers and it is really important to note that these vouchers did not come with any service vouchers so we spent time identifying them as dollars and moving things from other parts of budget to make sure that we're pairing things with the voucher to make sure that we can successfully house people and provide them with the services they need. to move successfully into that housing. and the last slide. i want to end the presentation here and i'm available for questions and also have my deputy directors hooer as well and th

but -- so you will note that what the service provider provided to r.d.a. is really what we've been talking about for the last six, eight, 12 months. we did have our review with the case chair and myself on october 8. and r.d.a. consulted with the dignity fund. that would make zoom meetings more accessible. case and the dignity fund are sending notices and links to surveys as they become available. we are all -- all the service providers at this point are assisting the participants in completing those surveys and sending out as much information as we can about, not only the surveys, but the community forums and the focus groups. then lastly, both case and the dignity fund coalition will provide updates and continue to promote the needs assessment process in the up coming meetings. the dignity fund meeting is scheduled for today from 2:30 to 4:00. and the case meeting is december 13th. this is 5:00. and that concludes my brief report. >> president knutzen: thank you, mr. gallagher. are there any questions from other commissioners about the report? hearing no

and we provide safety tips. we provide general assistance. since november, we have noticed -- we have received a noticeable increase in requests for safety escorts. mostly for school kids, seniors, and workers, both in the areas where there are large offices and businesses as well as small businesses. and especially in the mission, the bayview, chinatown, tenderloin and mid market areas. so this chart, relative to merchant businesses, there are check-ins. and this shows the documented interaction we've had with merchants in our current area since july of 2020. as you can see, that since businesses have started to reopen, we've increased the number of visits to them. and since july 2020, we have made 11,183 visit to small businesses. next slide. this shows the direct cause we have received from merchants. total since july 2020 is 417 with an uptick this year from may to september as businesses reopened. so the ambassador teams often provide merchants with their mobile numbers, because they receive complaints that they haven't been able to cont

you can't provide for the doctors if you don't provide an increase in the debt ceiling. you know that. we have to pay our bills and paying the doctors and making sure that they are protected includes doing the action that we're doing. join us in doing that. mr. brady: thank you. reclaiming my time. our colleagues have known for two years this debt ceiling was here. never passed a budget, never passed appropriations bill, let this crisis occur and built it time after time after time again when we could easily have come together. by the way, our democrat colleagues hold the house, they hold the senate, they hold the white house. they have the power to pass the debt ceiling and have had that time for the entire year. so to my democrat friends, you can try to sell this snake oil all you want but the truth of the matter is, you wrecked a bipartisan agreement for your debt ceiling crisis. that's what we're voting on today. republicans' support for health care providers. we won't allow them to be held hostage to this debt ceiling crisis. with that, i urge strong opposition to t

who wish to provide comment onnon-agenda items should call 415-655-0001 .enter access code 2490 734 357 . press the #followed by pound again and once you are on the call this á3 to submit your request to speak . it does not appear there are any members of thepublic who wish to comment on this item . >> .no request to speak i will submit publiccomment. please call the next item . >> next item of business is item 7, reports of the chair. >> chair: i just want to just publicly thank commissioner bycer. this is his last meeting with us. he is moving out of san francisco which is a requirement of this particular role here as commissioner and wanted to tell you , thank you so much. it has been such a joy and pleasure working with you . your heart and your passion and your smarts have really contributed to this commission. and i know i speak on behalf of the entire commission staff to see youleave . but we understand this is a wonderful opportunity for your growing family. and we could only supportthat . and wishyou all the best . i just want to touch my fellow co

>> any members of public who wish to provide to provide public comments on the consent agenda item should call 415-655-0001. and enter access code 2492-620- 4134. followed by the pound sign and then pound sign again. press star and then 3 to submit your request to speak. i'll allow a few moments. madame vice chair, it does not appear there is any member of the public wishing to comments on this item. >> thank you. hearing no request to speak by a member of the public, i will close public comment. i will turn to my fellow commissioners for their comments or questions. commissioner bycker, do you have any questions or comments? >> no commentses or questions. >> thank you. commissioner brackett? >> no questions. >> ok. given that we're in the world of boosters, does fully vaccinated mean inclusion of boosters or just the two-dose vaccination? >> thank you. great question. it is my understanding that it is tied to the first round of the boosters. the c.d.c., as i understand it, our public health director of the city has not verified a booster count as part of that protocol. so i'm happy to cl

tipping point is providing over $1 million to bipoch nonprofits in district 10 to provide services that go along with the emergency housing vouchers. the second priority is to reduce homelessness. and the third is to decrease the inflow into homelessness and then we're providing all participating households with application support and housing search and navigation support and services. and providing housing applicants with ongoing case supports as needed. the e.h.v.s program provides a unique opportunity to house people experiencing homelessness with these mainstream vouchers and it is really important to note that these vouchers did not come with any service vouchers so we spent time identifying them as dollars and moving things from other parts of budget to make sure that we're pairing things with the voucher to make sure that we can successfully house people and provide them with the services they need. to move successfully into that housing. and the last slide. i want to end the presentation here and i'm available for questions and also have my deputy directors hooer as well and th

they do provide access. i can't speak,000 they change the racial wealth gap. >> are there any studies that have shown a reduction in access to financial services, a reduction? >> the brookings institution is releasing a study in that regard later today that will talk about banks that have been leaving black neighborhood and how they has affected savings rates. i can motte speak to how fintech companies have changed that though. >> we don't know -- we don't have enough information yet to determine if the products are reducing racial disparities and access to financial services? >> i don't. i can speak to the banking part. how banks leaving have hurt black neighborhoods and communities. i can't speak specifically how fintech companies have helped. i believe they are but i can't provide particular data. >> that's the end of my questioning. thank you. >> the gentleman yields back. it's been a very, very good discussion and it was helpful having a mix of perspectives. i'd like to thank our witnesses if their test

in texas should provide in federal court. talk to our correspondent joininus now from washington. tell us what exactly this ruling means today. >> it is a minor victory for abortion rights providers because it removes a hurdle for them. the texas law was designed to prevent legal challenge. what normally happens when state legislates passed restrictions on abortion laws that are seen as unconstitutional, the federal courts step in and block those laws. the state of texas is not responsible for enforcing the law. it has passed that task to any ordinary citizen. ordinary citizens cannot be taken to federal court. this was the problem. the supreme court agreed this was unacceptable. they provided the narrow pathway for abortion clinics to take this to federal court and pursue their case there. however, they were disappointed the court did not block the law in the meantime. the conservative justices refused to grant the request that the lobby put on hold while the legal action was taken place. that was a big disappointment they s

the providers don't provide them. i don't think that would have any actual real world effect. >> can you go back to justice thomas' question. imagine those columns there are filled with the california civil code. let's take out those parts that don't deal with private people so we have property and torts and so forth. someone in your office says i've been reading that -- don't ask me why -- but i found 19 provisions here that i think are unconstitutional. let's go bring a case. now, if we accept your argument, i guess that person has a good point. i'm a little nervous. so far what you said to distinguish this one you said here texas purposely did this. boy, that raises a whole nother set of issues, as you know. you say they're not giving a good forum in the state to test out the constitutionality. and now i think about the california civil code or the procedure code or 15 other things. i don't know. is that the test? have you sat down and thought through what are the implications of the test, or is it that the federal

it would provide target red leaf to providers consistent with the original intent of the fund that we all voted for on march 27 of 2020. unfortunately, this bill includes a one-time procedural change to allow the senate to originate and pass a debt limit increase with only 51 votes. the medicare issue and the debt limit do not belong in the same room let alone in the same bill. protecting patients' access to care and helping health care providers during a public health emergency is a bipartisan issue. it deserves sincere congressional action. and it's time we work on that meaning. payment reform. i thank the gentleman from oklahoma and i yield back. the speaker pro tempore: the gentleman from texas yields back. the gentleman from oklahoma reserves. the gentlewoman from pennsylvania is recognized. ms. scanlon: thank you. i completely agree that protecting medicare from cuts is a bipartisan issue and we are happy to engage on that. unfortunately, there's a complaint about how this bill is coming up at this time, that's something that was pushed by republican leadership here in the house

what remedies could be provided in those cases if they were allowed to proceed? >> an individual could receive come for example, an injunction preventing the bring of enforcement action or by bring a lawsuit by a plaintiff who seeks to do so. now of course as discussed earlier to justice barrett that would only provide relief against that one individual but the more important part here is that eventually those cases be decide on stare decisis ground by appellate courts would prevent follow-on cases to some extent but in terms of really you get declarations basically, a declaration, and application of an individual or i misspoke or become an injunction sorry. a declaration that in s.b.-8 claimed by that individual against the protected conduct would violate state law, , fedel law, whatever the claimant be. >> and one final point. why wouldn't, i think i've alluded to this before and asked this before. why wouldn't these private individuals be considered private attorneys general? because so much seems to be one thing that seems rather implicit on the other side is

it's a service that's provided. now, some people go from personally lending a friend at no cost or say i'll give you $100, you give me back $110 next week, and no one does the math. it's just a simple fee. then you formalize it and go from i did that for a friend or two, maybe i'll just start a business. how does someone get into this business? do you have talaunch a bank, can you get into this space just applying the technology, and what are the obligations to protect consumer privacy if you do setup a business in this space? >> i would say it's -- a little bit more complications and there are a lot of players in this space already i would say. and it does require you to be adherent to federal laws, state laws, state consumer protection laws, a whole host of regulations that are there to protect consumers. so it would require, you know, a tremendous amount of product design, the capability of relationships to have with lending partners, banks and others and have that relationship with merchants and going out and bu

one surface to provide for attacks. that is the best practice. we were there prior -- >> you highlighted the testimony -- the u.s. water treatment facility, industrial control system and incentive used as a part of the treatment process. the concern is the water system including treatments -- what are your concerns in this area? >> the threats to the water infrastructure is real and comes from the same challenges other sectors including the reliance on the legacy systems that are not only outdated but the vendors that actually created them. these include workforce issues, having appropriate staff within very small organizations that reach these facilities to be able to respond in fact in the case of the february attack according to reports there was an official there was monitoring and was able to see the efforts as it happened the reality is there needs to be more that is done and we are encouraged by the fact to establish the expectation of the specific agencies and the environmental protection agency is that for the

it talks about law enforcement providing services as requested. individuals have to put together a security plan. has to be approved by the sheriff's department -- [indiscernible]. >> supervisor safai: -- and for the police department, same thing. so i feel very confident this has been vetted legally, and in no way, shape, or form, is this about trying to have a private security force there. and in talking to the individuals or the working group, they will tell you that they always prioritize everything. this is only overtime. this is not impacting day services by the sheriff. this is only overtime, and we put language in here at the request of the human resources department to ensure people aren't putting in for time off or sick time and not getting additional pay. that's why we put in here 90 days later for the sheriff to bring back a security plan so it would not impact the day operations of the department. so that's why we put in the amendment that you see under 10-a.6 on page 7 that talks about within 90 days of the effective date of this cha

as we are now and on my and would be a healthcare provider and then a specialist on the other end. we have seen an explosion in the use of telehealth during the period of the pandemic. march 2020 there were about 2500 telehealth appointments per day and one year later , march 2021 there were 45000 telehealth appointments per day that is ago massive expansion and the good news is it allows us to meet our veterans where they are t including the rural communities and allows them to have the expertise. i was in kansas with senator e moran very early in my tenure and i was talking to a veteran who is talking about the mental health care he was receiving. and he made the point because of telehealth he could gettt access to a mental health care professional and manhattan and it wasn't manhattan kansas but new york city. that is the beauty of telehealth because we have concentrations of healthcare providers and that vehicle allows us to bring it directly to our veterans wherever they are. there is a major challenge in all of this which is beyond our control which is access to 5g for access

the third is the relationship that we have with community providers. congress enacted something called the mission act several years ago. the mission act sets certain limits that says for example if a veteran cannot get access to her primary care physician within 20 days he can be referred to community care. the veteran can't get access to a specialist within 28 days he can be referred to community care or at the veteran has the particular a long drive to get access to care in the va system he can be referred to the community providers in his community. those are the three ways we do this alex. we are looking at this really hard right now for a lot of different reasons looking at access for rural veterans and we have been looking at it because of questions of vaccinations. in this case we brought the covid vaccine to those communities through our mobile units. we are also looking at this because we are taking a hard look at our infrastructure, our physical infrastructure across the country for a requirement that congress put on this in what we call the

state programs that are providing funding. when it comes to prohibitions, estate can't discriminate on status or use. you cannot say a person can be catholic and you also can't say that a person can't take communion. i also think when it comes to subsidy programs, there you can't discriminate on status. you can't stay there we have a playground program, you're not eligible for religious as subsidy with a specific purpose and it excludes purposes that are contrary with the government and directly advance religion. that is the one category a real issue what do you say to those by excluding someone whose religious from a state program in creating a feeling of exclusion were told that your school is in good enough and you can go to the bangor christian or the religious school. i think the strike there would be how comes i can't to public extents. in the taxpayers why your money is being used to go to a school that teaches boys are better than girls and actively discriminates against protective classes. that is the second i want to

, what is the capacity, community by community, neighborhood by neighborhood, provider by provider, and a sense of urgency and alacrity of getting these things in place because it seems like we're waiting to do things, but all we do is wait, and we keep getting told that things are happening, things are being discussed, options are being considered, but it seems like -- and i'm trying to be as charitable as possible here, understanding that there's a pandemic, but it seems to be focused on motion rather than movement, and i really have to appeal to all the department representatives here to feel the pain here because providers who are closest to individuals, families, adults, young people have to tell people every day why things are not happening. we are the ones charged with that responsibility; that we have to explain to people, i thought there was a whole lot of money coming down from the federal level or i saw the federal government talking about all this money that was available, and wasn't there this prop c thing that was available. we have to explain this to people, and it's gall

do have two private partners, we are the largest provider.the years leading up to covid, we'd seen increase in call volume on annual basis without increase in ambulance staffing since 2015. and this really resulted in a number of operational issues for us. including response time and increasing occurrence of medic to follow, which means there is no medic available, no ambulance available in the city of 911 system. so in late 2019, we began working on a staffing analysis with the controller's office and mayor's office to take a look at proper resource levels and then, of course, covid happened. and we had, you know, those efforts were put aside to concentrate on the response to the pandemic. but covid brought on a whole new set of tests for us and the 911 ambulance system. so, because the system is currently facing some unprecedented challenges and as a result has had to incorporate never before used measures to assist with demands on a daily basis, such as authorizing d.o.s. ambulances. you know, we bear the brunt of the challenges and the 91

it's not intended to provide broadest range of possible choices, it's intend to provide substitute for public education. >> whynd isn't it treating peope neutrally to tell them where all citizens without respect to your religion and so to all the schools part of the are equal without respect to the religion whether you are secular, catholic, jewish, what have you. he will all be treated equally. isn't that the neutral position? religion does not affect your qualification for a particular public benefit. your religion or lack of religion doesn't affect your qualifications in our society. >> as your question pointed out, it certainly couldn't distinguish among religions, i couldn't providean funds to the catholic school -- >> to stop you there, i think the lesson of some of the u cas, discriminating against all religions versus secular itself a discrimination that's odious to the constitution at least in certain content. >> i think that's about it, the question is whether to decline to find religious instruction while funding secular instructionuc is the border of determination. >> there

we are very eager to work with states and providers and some of the health plans that provide a lot of dental coverage to think about ways to both measure that level of access and to think together about how to address that. reimbursement will always come up as an issue but there are things beyond reimbursement that can get us into that as well. alan: i hope you'll forgive me for peppering you with topic after topic but i'm going to add yet another, which is vaccines, particularly around covid. here we are. you're responsible for the program that covers the largest share of children in the country. we have vaccines approved down to age 5. medicaid serves a particularly vulnerable population. we have a vaccine for children program. i realize responsibility for covid is spread around the federal government in different parts of h.h.s. but when you sit in your seat and think about the risks for the children that medicaid and chip serve, what is the role of cmcs in promoting access to vaccine, any other sources of support for young children, and although we have -- daniel: it's an integrat

that the state invest in increasing the abortion provider network across the state. that insurers also folks have access to providers and health care professionals that are culturally sensitive, and represent patients they are saying. kristen: i see that one recommendation for you is to provide scholarships to medical students willing to do abortions, in anticipation of a greater need. but does california have the money to pay for this? whether it is training, scholarships, travel, lodging, does it? jessica: yeah, we think it does. the state is projecting a surplus of funds in this next fiscal year. and we think that this is an absolutely necessary use of those funds. honestly, we don't have much of a choice. as a reproductive freedom state, which california has proclaimed itself as, we have a duty to ever california patients as well as those seeking abortion in other states, to center bodily autonomy and center the needs they have. people have a right to choose if, when and how they want to become parents and start their families. and of other states are going to ba