we would have no health care provider providing abortions past 18 weeks. a delay of this magnitude clearly impacts all wisconsin women seeking abortion care but it has particular affects on low income women who rely on public transportation and cannot afford an uncompensated travel time and work costs. these additional barrier maze be unsurmountable. the provider must also describe and dismay the image to the women. this is the most humiliating and degrading law that i have seen in wisconsin. it is certainly the government at its biggest and most intusive. women are not able to refuse an invasive vaginal ultrasound. physicians have no ability to taylor their medical care to the unique situation of the individual woman or adopt the best standard of care. the medical community also vocally opposed that restriction. they said the mandatory performance of an ultrasound before an abortion is not an accepted medical practice or standard of care. does not add to the quality or safety of the medical care being provide provided ultra sounds are being used as politi

more alcohol and medical services and they propose to add new providers. >> >> four medical providers, two dental providers and behavioral health staff. they will have multilanguage capacity and they provide in spanish and portuguese and will have additional languages available and will care for low income and vulnerable populations and based on medi-cal eligibility and necessity and their residents of those two zip codes will combliez about a third of the population of patients. this shows the patient population and the disparities that exist for the population they propose to serve so in the very left darker bar is the 94103 bar and then the 94102 zip code and orange is san francisco overall and the zip codes that conprize a third of the patient population and more individuals under 200% of poverty and 125% below poverty and likely to rely on food stamps and other funds. they are likely to have medi-cal or no insurance coverage and on par with the city is the diversity of these neighborhoods language other than english spoken at home and foreign born are on par with the diversity ac

providers buildings were nonexistent beneficiaries or services that were never provided, and providers to order unnecessary or in fact harmful procedures. the health care fraud and abuse control, a joint program under the direction of the attorney general and the secretary to health and human services department is a model for interagency cooperation and coordination. in fiscal year 2013 the hcfac program recovered a record for $.3 billion in health care fraud judgments and settlements. this is remarkable and i look forward to hearing from the assistant inspector general about how this was achieved and what can be done to strengthen the program going forward. i also think it's important to underscore what we heard that these bad actors represent a small fraction of all providers. investment go to a providers are not fraudsters under deeply dedicated to the care of their patients. given the size and complexity, the theme of medicare programs, overpayments are going to occur. cms must be vigilant in detecting and recouping them, but will many providers are entitled to have their claims a

and further providers as well. so we could take advantage of those types of cost savings while preserving quality. >> thank you. >> if i could ask you to suspend for just a moment, i wanted to take just a couple of the question that is tails nicely with a couple of questions we received in advance. and it has to do with the question of essential community providers. first of all, i want to make sure everybody knows what an essential community provider is. so i'd like one of our expert panelists to take a crack at that. but the aca requires plans to include substantial members of them, whatever they are. and they are particularly important to the lower and moderate income folks and isolated populations that catherine was talking about. how effective is the regulatory device, which i think is a threshold of saying that you need to have 20% of all the essential community providers with a change pending to raise that to 30%. is that the appropriate way to assure that folks can provide -- that they can find the provider

, distributors and logistics service providers. our success is due in no small part to the postal service and its wiin work with companies like newgistics to develop innovative solutions. more specifically we offer national integrated parcel delivery, postal delivery and return service for customers. we are able to ride cost-effective, reliable and convenient shipping solutions by working with the postal service for last mile delivery and for smile pick up. when newgistics was founded we did ourselves as a technology company. that would provide information retailers regarding the current packages. soon, however, we evolved into a returned logistics company handling returns to retailers making use of innovative technology. we concluded customers wanted them to return packages easily and retailers want to make their returns more efficient and cost-effective. thereforecost-effective. therefore, we developed a proprietary intelligence return solution making use of barcodes in our newgistics smart label. those barcodes provide a set of

projects warrant the agency stepping in, as the power provider. and i know that particularly, some of the larger development projects, could easily fall, into that category, or it would make a lot of sense. the currently, as you know, excess hydroelectric power, generated at hetch, hetchy gets sold on the wholesale market at one quarter of the price that would be charged to a retail customer. so if we give the agency the ability to have more retail customer and there will be more revenue from the power and that can be reenvested in the agency's infrastructure including street lights. we are continuing the discussion with the staff with the particular of the language in the legislation and we have an open dialogue, and we want to make sure that the legislation is passed in the right form. and i know that the staff has proposed a few amendments, some of which were open to and others were not quite there and i am sure that we will continue to talk and so with that, i am happy to answer any questions. and i appreciate the time. >> commissioners? >> ye

the city will provide a capital infusion of approximately $2.5 million. that will be matched by a capital infusion from the school district of $3.5 million, used to refresh this now 20 some year old asset in terms of our occupancy in the building. much of the school district's contribution goes toward energy efficiency and sustainability of the asset. that's going to lower operating and utility costs, and the structure of the lease has the city responsible for those costs. so, that's why we see this as really a partnership agreement, each benefiting from the improvements made to the facility. there are two five-year extensions of term. those would be at 95% of fair market rent, which is described in the lease agreement, and there's also an early termination provision. after a period of 10 years six months in occupancy, just in case there is some other opportunity we desire to explore. while we don't suggest this is a class a asset, i do want to note that those rates ranging from $22 a foot to start and 28.50, you've seen me here before. you know what the

all of these conduct audits of medicare providers. each of these contractors have increased the number of claims being audited for payment accuracy in recent years. according to a 2013 gao study, the volume of post-payment claims reviews increased by 55% between 2011 and 2012. more audits means, obviously, more appeals. that is an inevitable result of the additional program integrity functions that we here in congress have asked cms to implement. congress has not provided omha with more funding for more judges to adjudicate claims, so when we wring our hands about the number of days that these providers have to wait, we have to wring our hands and look directly at ourselves. despite the sixfold increase in the number of appeals since 2006, the number of aljs at omha has remained relatively constant. in 2007 omha received 20,000 rac claims, in 2013 omha received 192,000 rac claims yet received no additional funding to handle this workload. i joined a number of any colleagues in sending a letter to the secretary of hhs citing concerns a

also one to provide a true partnership between us as a private company and the city. we [speaker not understood] has a long track record of doing very important civic buildings as well as housing, to work with us. and mr. updike's department. and have come up with a ken except tail plan that has been reviewed with city planning. the site divides the [speaker not understood] in half. the northern and eastern portion of the site basically would become a build to suit for the city of approximately 4 62,000 square feet. i'm going to walk you through the initial massing concept for that in a second ~. importantly, this portion of the site is contiguous to a building that the city already owns. it runs south van ness. so it really is literally and figuratively a consolidation of the city departments. one of the objective of the master plan we've been working on is to give the city a presence on van ness, and also to accommodate a programmatic requirement, very large well played -- something very hard to do. ~ anywhere in the city, but particularly this part of the town. and

provide abortions. each of those as a burden on the parties but i would suggest they differ. in the case of the employee subject to racial discrimination , even if they can get another job, that racial discrimination is a unique injury that you cannot remediless utility employers cannot discriminate on the basis of race. in the context of a conscience clause of the woman cannot get an abortion from a preferred provider, that surely is a significant burden on her, but we don't use that as trumping the conscience clause because she can get it through another mechanism. here all were really talking about is who is going to pay for a subsidy that the government prefers which is not about access to contraception but who will pay for the government's preferred subsidy. and in that context there are ample alternative ways to address burden's on third parties. >> it makes no difference. twenty fda-approved contraceptives, all of them covered by health care one case with three and another for. suppose contracept

i'm excited to say we're providing now necessary funds for disconnected transitional youth this will sure that both funds will be placed for the next 25 years (clapping) so our young people low lead the effort in 25 years to reauthorize it i'm proud to say that kohlman has lead the coalition for the los last two years with many folks here today thank you for your service. in addition would like to an opportunity especially supervisor yee, supervisor avalos and supervisor kim and also supervisor mar and along with the 11 supervisors to make sure many this will be passed unanimously. as well as the mayor and the board of education that sometimes gets forgotten we thank you for your leadership. we're proud of the work we've done making a strong statement about a long term commitment. to our next generation of san francisco to make sure that all i say all i say all of our children and youth have an opportunity to call this city home. and lastly remember your child see is not just that woman's child the little boy who's commissioner sako placing in the middle school basketball court is ju

relay service providers. the order does not require delivery of 911 text messages ts that originate from wi-fi only locations or that are transmitted from devices that cannot access a cmos network. text providers have met this deadline for text have null, they will june 30, 2015, or six months a val i pieceof app request which, which ever is to implement text to 911 for that piece app. piece apps and covered text providers mutually agree to an alternative time frame without to obtain a waiver from the commission. the other provides for the commission to centralized data base through which piece apps may register and provide notice text ready.e the second report in order neutral technologically approach and does not mandate any particular model for to 911.ting text with respect to interdecked text providers, the -- interconnected text providers, networkat will choose a solution to deliver text to 911. thiscilitate the use of method the order requires that cmrs providers allow access to sms networks but does no

we are glad that we can remove that by providing a very clear feedback process. so, if you are a rider, this is something that is very important. if you are a rider and request a driver from uber app. you know who is picking you up and you know the car and license driver and that's a safety issue as well so you know you are getting into the right car. you are able to share your trip which is a big safety thing. once you enter the vehicle, there is a button that says "share my eta" and people can see where you are at all times. we have very fast and responsive customer service. customers are very pleased with our response time and feedback issues. and, we are also able to show you clearly the time of arrival to get to your destination. uber partners with many different types of vehicles. these are the models we have now. these are options at any price point. we want to be affordable and accessible to anyone. you may have heard these different options being referred to before. we have uber black which was our first model and this is a town car option. there is uber

our providers need to be solvent and provide care. i do not mean we need to protect them from fiscal distress. most of this discussion is about how to instill competition. what i mean by that is you should be transparent in your dealings. hold them to standards they simply cannot meet in a variety of ways. the provider -- and i believe in the marketplace being fair to providers being a winning strategy. i believe the provider system are the ultimate place in which consumers experience the health care system and a need to be able to function in a reasonable way. i do think pressure through competition is something these networks will generate. to that, butsed there are stories you hear about people believing they were in contracts and then them not being in contracts. broad contract law dealings with folks. meant. what i they need to be -- the need to know what they're getting into when they join a network. i am a person who is relatively flexible. set, you should knows the provider what you are getting into it. that is what i meant by

the firms the child care providers provided to us are the financial analysis and we received thoiz questioned and we need to review those and it will be part of our selection process to review those and it's not based on how many children they're serveing, but actually the amount of child care improvement based cost, they need to finance because the tenant improvements of the child care space are not included in our budget. . they need to finance those. >> the provider will develop the space. >> they'll develop the tenant improvement space. >> mm-hm. >> so although they get the subsidies and there's all kiebdz of subsidies to build out the space also from the city available, there's some element of it they're going to have to finance and will be using the market rate spots essentially to -- the cost over there to operate. that's my limited understanding of what i learned about child care in the last -- >> i'm impressed that we're actually becoming children friendly and i hope the idea came from our commission, our office. thank you. >> it did. >> that's very good. especially if we're adding u

we do try to bring innovation to their care by providing -- let's say with pregnant patients, we provideentering, centering ises a new concept, being evidence-bears it. it shows essentially that you work with a group of patients instead of one patient, and their experiences can then be changed and they learn from the grouping. son stead of one-to-one doctor-patient ratio, you have large group where you can have a nice exchange and actually facilitates better customer services, and we care about our inmates and improves better outcomes, we have less preterm babies, and larger birth weights. so it's a good thing. lastly, hepatitis~c. that's the elephant in the room. enheight tis c is a very concerning illness. okay? it is surpassed -- it has surpassed h.i.v. as the largest cause of death or highest cause of death for viral illness as of 2007. our populations -- nationally, 17% or so, 17-point something percent of the inmates we have incarcerated have help tight -- hepatitis~c. in tennessee it's ten time the general population rate so 10% roughly. there's no vaccine available. not like hepa

and they run reports, and provide us with information to determine what is the over all impact. and are the over payments or under payments? and so that is just... >> why don't you apply it? >> we don't believe in extrapolating out to say, because we had a $5 error here that means that it is $5 million dollar error in the universe. >> why not? >> so it is just our they have done an analysis and determined that is not the process that we utilize and but we do work one on one... we do work one on one with the administrators to determine, the over all impact. and in the universe. so it does not mean that we stop at the sample, we work closely with them to determine, how many claims are affected. >> other questions, from commissioners? >> so, you know, sample of the claims, what percentage of that in the total universe? >> it is, we use an error of driven formula, to select our sample. and it is not a, we are not taking a percentage of over all universe of claims. >> understood, but what percentage of that 220, is two percent of the total universe, five percent? 20 in >> no, it is n

access is provide 55 front street and a ramp avenue shipley street under the confusion the project is seeking the planning code requirement for rear yard under section 34 and off-street parking and a special architecture feature under the articles. the project is located in the east selma neighborhood combination of residential and commercial uses. the transbay terminal is located 5 blocks east of the site and market street is located 3 blocks to the north. the recent completed project that is a 3 hundred and 82 square feet detriment is on the ned. it's bordered by a hotel along the full name frontage and a four story multiple family building along the shipley street it's bordered the fire department. we've received one hundred and 10 signatures and letters from 26 individuals neighborhood and community groups in support of the project the department has received one letter of opposition to the project. the commission has received the letters including those received after the publication after lookts looking at this the staff feels that's an appropriate project that adds homes to the

so we do a good job, i think, in providing and getting very creative and providing more and more services behind the wire. our challenges are, again, what i'd say is the grain of the inmate population. all states are experiencing inmates aging because they have longer sentences, longer confinements. and all of the illnesses that you experience and that the free world experiences with getting old, our population experiences. so all the mobility issues, you know, the cancer and all, we experience that. they have physical incapacity and immobility, progressive degenerative diseases. we have an increased concentration of chronic illness, and this is in the face of diminishing budgets, you know, for health care. and with that diminishing budget, we have to get very creative because there's increased liability associated with that funding decrease. we find that we have to establish protocols of who will get treated for certain diseases because of the treatments being so incredibly expensive. we have an increased mental health burden with dimension, depression, psychosis, disruptive behavior, an

out the provider is not there? >> right. >> i don't know that the model is going to spend a lot of time on that aspect. it is more going to be looking at it from the perspective of regulating the insurers and making sure they their plans they file with us are adequate and we are looking at it from that perspective rather than reaching out to providers and saying you may think you are in this one but you are not. that is probably not a step we would take. and that would be one of those areas where it is just not going to be in our wheel house to be going that far. >> in any of the comments you received from providers did you hear about this? is this something they were talking about? >> that is not one that i have seen yet. >> first let me clarify what i said about providers wasn't implying i am a supporter of being unfair to them. i do believe the system needs to be fair to providers. but one way in which consumers get a lot of information is from their providers. if they are not well-informed about the networks or

in addition, employers seek ways to move employees to quality providers, to providers that provide quality care and coordinated care. we asked employers -- are you going to be -- do you offer and employers -- employees to use knowers. we found about 15% of the respondents do have centers of excellence for transplant as well as other conditions. the ones that you hear most spineour orthopedic, surgery, knee surgery or heart conditions. about 30% are actually incentivize, meaning they may pay for your travels. in addition, about a quarter have networks with ace is. very few incentivize them. howre trying to learn effective the care is going to be. a lot the things we saw of interest in and we have seen employers implement as tele-health. the opportunity to call a dr. for minor health conditions that you may not be able to get into see her primary care doctor, you do not have time or they occur they areurs traditional physician is not available. it provides access to employees and steers them away from emergency room use. another area we have seen interest in is whether employers are going to

let me provide background on daca and who is eligible. two years ago this week, on august 15, 2012, u.s. citizenship and immigration services began accepting requests for daca. daca was created for individuals who, at the federal government's discretion, were deemed low priority for removal from the united states and thereby met several criteria. they had to be under 31 when the program began. they had to have come to the united states before their 16th birthday. they needed to have been here continuously present in the united states since 2007. this is why none of the children on the border could qualify. they need to either be in school, have completed school, or served in the armed forces. importantly, they need to not have any serious criminal history. as an act of discretion, daca recipients are not gaining legal status and did not have a pathway to citizenship, but for the nearly 600,000 who are in the program, what they get is a two-year renewable reprieve from deportation and the ability to work lawfully in the united states. the

it's providers that come from the population we serve. we do have -- we have -- given a lot of client vs history of substance abuse disorder or a conflict with the law so we have a fair number of our staff members are former consumers. we probably have a higher number than other organizations of consumers and we have a continued commitment to do that so by increasing services we add the opportunity for consumers to be employed in our service. in terms of how we measure that we do keep data -- demographic data on the staff and where they came and by what path they came to us, so we would be able to report on that and if you're interested in a change we could benchmark that today and operate as usual and look at it when we come back a year from now and these are the changes that happened as a result of us occupying the site. >> right. but in this particular marketplace currently that we're in is that a challenge to find culturally competent providers? i mean what is the marketplace -- >> it is a challenge because we are dependent on public

the whistleblower statements i provided to the committee were provided to the o.i.g.and are more relevant to the committee than many may realize. i urge additional review of the statements. in addition to providing specific examples of whistleblower harassment to the committee, i hope my testimony provides some insight into three key issues in v. -- three issues v.a. management fails to address. reckless waste of federal funds and causing greater backlog of enrollment applications for the sole purpose of achieving performance goals. why there is resistance to implementing proper and effective processing and reporting systems and the source of the resistance as addressed previously by dr. draper during her testimony and the need to remove ineffective managers and the critical need for the v.a. management accountability act to be fully implemented. thank you for this opportunity. i look forward to your questions. >> thank you very much, mr. davis. if you would, explain a little bit further the information you who ded to rock neighbors, was deta -- detailed from the whit

we're providing services to several thousand students.we provide in the wheaten area mostly anit's all around the county. there's mental health services, case management to connect people to community resources and help them where there's poverty and connect to the resources that they know that affecting their mental health. most of our services relate to early intervention and prevention because it's spectrum. >> talk. you would about stigma and do you see it diminishing? and particular by are are young people seeking help and reaching out? >> it's a mixed bag. stigma has been with us for a long time. we seen signs that it's changing, cases or incidents where children will bring children to people and ask them to look at their friend because they're not feeling well. weave got a lot more to do towards education. but also to make them aware that there are things that they can do to prevent themselves from becoming mentally ill, to do things to take care of mental illness along the way. our hope is that they will the decrease the sigma fur

there's a lot of small providers. i know you've heard all this and we appreciate it, and i agree with my colleagues. i want fairness. is because you're a big provider, i don't think a big hospital system should have to wait and be penalized in this fashion, but what's critical in a rural and front just like mine in new mexico, that means an entire community and a place like a gallop where in my district, in torrance county, there are not any providers. there aren't any durable medical equipment providers, there are no small oncology providers, none. zero access. we don't even have the right tools or strategy to re-create these practices. so i'm interested as a result of understanding now the situation between how they are adjudicated, what you're initiatives are, how you're trying to many these cases. i appreciate the weekly meeting, but i would encourage you to go back to ms. tavenner and the secretary and clear at least some of these comments, i think it seems like -- we've got a problem on the front and. so we do w

military support, providing more weapons. united states provided a lot of weapons, and they have scattered out into the hands of the gangs or people who should not have them. another big sort of struc wealthauses inequality. wealth has been concentrated among the rich and is squeezing the poor into higher levels of poverty. just very few opportunities for -- >> you can follow all of this online at www.c-span.org. we will take you to a discussion on immigration, and particularly on the executive order issued by president obama as --12, known as finally, as you have also seen, we are recording and lives streaming -- live streaming, so please be sure to use the microphones at both sides of the room. to formally begin, it is my pleasure to introduce a veteran executive here at -- who runs our government performance apartment -- department to provide us with a welcome. [applause] and welcomernoon, to the pew charitable trust. i am pleased to welcome you to that panel discussion we will have today. is a nonpartisan organization, es

there are providers that are more efficient than other providers. if you knew that, wouldn't it make sense to try and construct a network that focused folks on those providers that you thought were more efficient? that ends up being an advantage of having a narrow and in that case probably more of a value network. there's other reasons why these narrower networks are good. you can -- if you can concentrate enrollment amongst fewer providers, it facilitates engagement and it may reduce administrative costs. so i think i can make a pretty strong case why there's some merit for these types of things. but that said, and you'll now realize i'm an economist because i'm about to say on the other hand -- [laughter] there's a lot of legitimate reasons to be concerned about these types of products. host importantly, people need access to good doctors, they need access to convenient doctors, they need access to their. doctors. and we very much want to have people have that opportunity. the problem is, in general, you choose your plan before you get ill. so it'

no more technical decisions for patients and providers alike. we're not going to have observational status trying to figure out what the best policy is in addressing it. >> thank you for the question and for all of the work that you do for the state of wisconsin. i think it is very complicated. i think as hospitalists, we're trying to figure out exactly how we fit into that payment model. going forward, i think, you know, i'm from a small town in wisconsin, as well. i think if we could get back to thinking about these are medicare patients. they've worked their whole lives. and what is the right thing to do for them? e think we're going to find those solutions. >> i am concerned about the impact. yet, within the medicare system itself, we've seen payments come down dramatically in recent years. >> the cost-shifting in the orb ser vags status is considerable. and we know that some people really do not have the must be to pay for the nursing home cost care out-of pocket and then they go home. medicare is not paying for the nursing home, so we've h

i will provide you a break down of the areas. >> right. and i am aware that you do provide this on and ongoing basis and a snapshot on a individual month, but as we have noted a at the pointed over a concern period of time it would be interesting to look at that trend and see what the issues are. >> i am happy to provide you that information. >> thank you, commissioner dejesus? >> thank you. i am really glad to hear that when you are going to the naco? >> yes, they are going to talk about the militaryization, and i just want to say, you know, we have a civilian police force, and they keep people use at para military attorney loosely, but we have a civil police force and i noticed that the obama administration and the department of justice are going to investigate where they are giving left over equipment like tanks to the police departments and the police departments are rolling it out against the civilians which is shocking to see and then to understand that we are, and the federal government is actually handing out lmilitary equipment, i

provided with all the contributions that our city has been given but all the great programs and want to make sure that all the families that deserve our support get it in a way in which to in fact, and here heard from parent to have a more efficient system and let's not have me find out when my kids are in the teens there are so many great programs we've got to get a system that i think this is reflected in this initiative to have families analyst it easier and to increase it at the time not only when the city is plentiful but when the city wants to enjoy more investments and i'm happy to join the entire board of supervisors the elected officials and tom who started a lot of this back in the days when he was supervisor i give him credit along with applicant working together they're pushing hard to make sure we have the best programs and we have the opportunity to have this conversation with the public this november. we're going to have the best children enrichment programs in the world here in san francisco. raids our families here and get our kids in the public schools? going to be