in kind fte they're providing funding this is they're in take and coordination staff member i mention this dos loves that when agencies are are ready to help and support those programs means getting more services to the client thank you. >> may i have a motion for discussion. >> second thank you one observation and that is hundred and 50 thousands of this contract is coming from federal fund. >> yes. >> that's a good thing and secondly the workers will be providing this emergency short term care. >> uh-huh. >> are they going to be held to the seem standards as ssi has to meet worker is one full-time employee she's been about the agency for 10 years she's familiar with the program and maintains a nursing assistant licensing and able to renew that through training of self-help. >> any comments or questions from the commission any questions or comments from the public increase hearing none call the question all in favor say i. any opposed the motion carries thank you item i requesting authorization to renew the grant with national council on angling for provision of the san francisco con

plus plus a 10 percent contingency for a total not to exceed hundred and $73,000 plus the purpose to provide emergency short term homemaker and personal care services to eligible 57b8d individuals the grant will be funded through county general funds. >> hello, again commissioners as you stated the item is a new 3 year home care for seniors program the program itself as described sends out a person to complete the caregiver services open a short term basis the types of services provided fall under 3 personal care services and a shower services typically the clients most uncommon this program utilized by clients that have an application pend for state funding ssi services to cover that bridge and sometimes the clients running home from hospital or rehab facilities need short term health at the home and some referrals come in from clients need an occasional clean up around the house the provider is self-help for the elderly the current contractor we're awarding this contract as they were selected by the rfp process 634 was issued this past march i did the program monitoring for self-help in 20

they provide 60% 07% of the jobs in sanford cisco, and they provide it locally, and they are not going to offshore their jobs any time. i am not an opponent of cleaning up the tenderloin. i love the tenderloin. i love what is right now. i recognize we have a diversity of books that live there and people do not want to see open drug dealing. i do not have a problem with people lit think -- people out on the street socializing. i think that is good. that to me is more -- you know it is part of the character of the neighborhood. i get to represent one of the most exciting and dynamic districts in the city. it is where change is happening, so i think it is exciting in terms of how we can model what it means to be a smart growth neighborhood, how we can use transit and housing effectively to serve our city and also to do a lot of the new green policies that we have developed over the last 10 years. >> the meeting will come

one line in our belief that referenced the business relationship of our client to the third party provider where you couldn't easily get reporting? and i wasn't sure what that meant >> fly whole is an organization in which taxi drivers place the day's within each taxicab to measure certainly activities like service calls it is an organization that i can show you e-mails my client the information was not from the american taxi but verbal from fly whole my client did several requests to report the data for the first time we're being told by the sfmta brief there was some reporting so that information is never recorded or addressed to my client before reading the sfmta brief. >> but fly whole is paid by our client for the services. >> there's a contractual relationship to provide the data but that information was provided directly to sfmta for the needs the manner in which it is verifiable but we didn't have this information prior to read sfmta's brief. >> that is more subjective why did our client enter into a contractual agreement with the same manufacture. >> measures it was a measure done

those are a total of 5 providers. one of the things in terms of the policy issues kw response strategies that we are working on, we manage san francisco pilot that allows us to have a higher state reimbursement rate. the state has a single rate throughout the state which is a problem for us because our cost of care and i have a sloyd to show the rate disparity for title 5 contractors. it is our number 1 policy problem because as we try to support those providers if the state isn't paying their fair share it is a problem. it is a problem for them to keep their doors open let alone provide quality care. that is a big challenge. we have this pilot that allows us to pay a slightly higher state rate and that pilotdue to sunset. it also allows us for families to stay in eligibility for subsidy longer. the state medium income ceiling for eligibility is 43.200 and the pilot rate allows them to stay in the subsidy for 53 thousand. that is for a family of 3 and it changes depend on the size of the family. we also are working on

provider to deliver services under choice. we then designed a network map that we're now in the process of constructing together. and over the next 90 days from behavioral health to primary care to specialty care, we will rack and stack the network to meet the demands that can't otherwise be met by the medical center in dallas. that is being repeated between the area and the pacific as we seek to do our part to mature the operations of choice. it's a privilege to serve in support of those that serve this country. it's an honor to serve the veterans from the states that are represented by half of the members of this committee. and mr. chairman, i look forward to taking questions after my colleague donna hoffmeyer is finished with her remarks. >> thank you. ms. hoffmeyer? >> members of the committee. i appreciate the opportunity to testify on health net's administration of the veterans choice program. health net is proud to be one of the longest serving health care administrators. we are dedicated to ensuring our nation's vetera

a lot of companies want to provide both. they want to provide new services. the cable company has an incentive to favor its own favorite product, it bundled service. i think law enforcement is going to have to make sure there is no on their benefit to cable through this consolidation. host: do you see those concerns? got something -- harold: not at all. most american consumers have wires coming into their home. it is not that they are getting video services all -- video services over all three but they have the option of getting services over at least two which is the cable and telephone company. they still exist, they are not doing very well. in addition there are wireless options and wireless speeds are increasing. lots of americans, particularly young americans, have cut the wire. they don't have a cable subscription and they don't have a telephone wire subscription. they are purely wireless. and they get the broadband they want. these are not broadband illiterate people. they are quite broadband sophisticated. and you have new companies coming online to c

typically it's not a provider to provider because both providers cannot be paid for the same service. if you have a generalist with a specialist and they both do an exam, then they both can bill. >> you have a general practice physician at rice county hospital district number 1 and a specialist at the k.u. medical center. both of them can bill? >> if they're doing different services, yes. >> so there is no disincentive to a provider to make this happen? >> as long as you're in a state that allows for parity reimbursement. >> i'll have to figure that out. and finally, let me ask you to clarify for me when we talk about that reimbursement does it matter who the payor -- who is providing the insurance medicaid versus medicare versus private insurance. is your answer the same in all three settings? >> it's not and it depends on your state and what the legislation allows for and then medicare has geographic restrictions as well that we've heard. in our state, all public and private payers in mississippi medicare have a parity reimbursement for telehealth. same as in person. >> chairman, do

we provided drop in services for the parents in the community at the community center. the coordination of services were with -- we had a meeting with city agencies facilitied by dcyf to figure out the next strategies in support of the children we also had a mental health provider conference where we asked and invited treatment providers across the city to see how we could support and provide mental health services to these children and their families and as a department met with the principals and the wellness coordinators to talk about what had happened over the summer and identify signs and symptoms they should look for and as we all know the children were probably going to seek the services through the school district and the follow up services and provided since then there has been coordination with park and rec and they sent over 80 people up to the camp and provided individual trauma focussed counselor and there has also been two groups for those kids that witnessed the homicide. we also have offered a grief group at our wellness center and increased our behavior

providing services in another state. so the congress has provided funding through our telehealth programs for the licensure and teleportability program. we with the state and provincial psychology boards. we're trying to work with licensing boards so that say a psychologist was practicing in missouri but was providing services in another state, rather than having to complete two completely different licensure applications, they could adopt a common licensure. so it makes it easier for somebody to practice across those state lines but it still protects patient safety this terms of the licensing and credentialing for that provider. that's one way we're trying to get at it. we've been investing in telehealth for a number of years. i think we now have improved access to care. i think one of the challenges is finding out which applications have the best clinical outcomes. so the evidence base for telehealth could be expanded. so one of the things we did this past year is put money into a teleemergency evidence-based program.

typically it's not a provider to provider because both providers cannot be paid for the same service. if you have a generalist with a specialist and they both do ab exam, then they both can bill. >> you have a general practice physician at rice county district hospital one and specialist, both of them can bill? >> if they are doing different services, yes. >> so there is no disincentive -- >> as long as you're in a state that allows parity reimbursement reimbursement. >> when we talk about that reimbursement, does it matter who's providing medicaid versus medicare ver vus private insurance? is there the same in all three settings? >> it's not and depends on your state and what the legislation allows for and medicare has geographic restrictions as well. in our state, all public and private players have a parody re reparity reimbursement. >> do you want me to stop or ask one more? mr. stover or mr. walters, how does it work in missouri as far as medicare versus medicaid versus private pay for telehealth or mr. stover how does it work in our state? >> we invested in telehealth, the geogr

beneficiaries rugged inhabitants of the total patients are by rural providers than in urban provided making these organizations particularly sensitive to changes in medicare payment policy. at cms were taken a number of steps to improve services. first we create numerous opportunities for rural stakeholders to engage with cms jimmy choo we understand their concerns and challenges. cms has rural health coordinators at each of our regional offices who meet monthly with central office staff and with representatives from the hrsa office to discuss emerging issues. cms offers regular rural health open-door forums to provide current information on cms programs, answer questions on guard about the emerging rural health issues. we are trying to remove regulatory barriers for rural health providers. last year seen as reform medicare medic regulation that we didn't fight as an acidic obsolete or excessively burdensome which was a providers nearly $3.3.2 billion over the next five years. this include specific provisions target of reducing burdens on rural health care providers. for example, a k

we have provided woefully inadequate support for our transition-age youth and when we do not provide that support, we end up causing other problems. it is not like it disappears. these are our youth, who are here in our community, and we need to make sure we are providing services for them. yesterday, we had a hearing on the dcyf budget, and i was very disappointed with one aspect of the budget, particularly the alt and backs were being eliminated -- that all add-backs were being eliminated on a number of different subjects. i do not agree with that. i am in discussions with dcyf, and i am is hopeful we will be able to work something out. my predecessor was always committed to making sure funding occurred, and i will continue to do that, so you have an ally in me. the budget is the most eminent issue, and we do have a structural budget deficit in the city so we need to deal, of course, with the short-term balancing our budget in a way that does not decimate city services that people rely on but also to address our long- term structural budget deficit, and that means implementing some

our proposed primary care on haven has 6 primary care providers in a family medication and pedestrian asterisks we provide x rays and mammograph and labs that have one-stop shop care not have to go elsewhere to receive those are services and we'll plan on bringing in specialists depending on what the patient needs are we'll have expanded hours and welcome drop in and open on weekends we accept more or most private and pun health care plans and medi-cal and medicare patients are welcome you've heard on the recital spates our institute they include the eco friendly pursuits for mind, body, and spirit we'll have jewelry and body care pursuits that tie san francisco health products that is important with our painter we have a institute with heath and healing products the muni and 49 lines and bart stalgsz makes it easily assessable by public transportation in 2013, the department of public health published a master plan and they identified van ness and the 20th street neighborhood as a mel underserved area that was one the criteria when we were looking for where we wanted to put a clinic

of budgets swings so it is hard to judge how much money and how much services they'll be able to provide we're going to use that as a base to build from and hopefully increase that actual performance. >> thank you. any questions or comments any comments or questions from the public hearing none. > all in favor, say i. > >> any opposed thank you the motion carries thank you, rose and cherlyn. >> the next item on the agenda g request authorization to enter into a new contract with national council on crime and diligence so provide the structured decision making for the adult protective services during in a 2015 in the maturely of $124,000 plus plus a 10 percent contingency not to exceed hundred and $36,000 plus and it looks like sherry reign will be doing this presentation yes, i'm giving jason is a break i want to thank kim and jason for getting this contract through our contractor was this was a tough one and he did a great job of making that happen we wanted it for acquit some time adult calls come ♪ the intact line our staff takes the calls and passes them on to adult protective servic

providing the services. >> it also states qualified health care provider under distinction two as defined. >> i think that language might be taken out with a new version it says of barer or cosmetologist for instance a massage of our face not considered a massage for a dpw permit for . >> so i guess when the commission heard the legislation the last meeting i think it was under the understanding that on page 19 line 191 states the permit shall be required under the services provide by a health care provider that is defined under the definitions of on page 7 line one as under the regulations of division two of the california business code so i just - so is it how i read this is it those liquor an acupuncture it is an accessory use not required by the depending upon to get a establishment permit but not listed in the planning code as one the exempted entities they'll be required to go through the conditional use even though they'll be seen from the planning code as a massage establishment. >> correct. >> okay. >> but we in terms of the that health care provider piece i believe this is likel

of the 3 providers 2 are bilingual [inaudible] of the visiting providers they are about 70 percent bilingual and spanish so it is not true we are not providing bilingual services to patients who need them and it is true the quality of the care we provide is first rate and invite you to come down and see that first hand. we are extremely proud of how we are doing to help patient manage gestational and other forms of dediabetes. we knhimented to look at cultural and lick wisticly appropriate services. as i think you real aiz, those standards are not as spinge as many of the other standards hospitals live up to and hofep by engaging in nationally recognized expercent figure how to do better. in this city which is one of the most diverse cities in the u.s., it is our oubigation to take the lead >> i would simply say i agree with i think how lieu jurado kwibeed the issue in the letter and hope that we can continue to work on this together on this. >> any other questions for me? >> on the-going beyond the diabetes in termoffs a process around the mix at saint lukes if you can talk about that >> as

meeting sheryl from aging comments talk about the hubs created in san francisco and the services provided it was a very welcomed discussion we've - we're in the midstream of the postcards campaign we delivered 3 thousand postcards to the mayor with the letter we've had from the department of aging a few months ago and we're in the period of the supervisors to talk with their dissatisfy and deliver the postcards to them and to give the direct number we've been asked to come back to talk with kate howard of the mayor's office for the dollars we're going to have a boarder discussion that's tomorrow i want to invite out to a rally on the steps of city hall today it came up suddenly a combination serving the elderly for the disability advocates we're doing a rally about fair share for fair care the need for serves and care for the seniors with disability at city hall today hopefully, this meeting will be done and you'll walk downstairs not that we planned it that way. >> and then on monday our case meeting the regiment 3 to 5 on open hand may 11 and mary will do a presentation on bio metrics t

a primary goal is provide training. we work with all the candidate who are san francisco residence we also pay particular attention to those from the priority neighborhood discussed earlier. we are happy to partner with cpmc and work with the other collaborative community bases organizations to allow more san francisco residence the opportunity to apply sfr the first source and also entry level positions at cpmc. thank you >> thank you very much . [inaudible] doctor ty nob noc >> good afternoon supervisor. joe [inaudible] acting director for positive resource center. [inaudible] i'm here representing the organization. we are one of the 4 organizations received funding from san francisco foundation and proud to enter into this partnership with cpmc to provide job readyness training interesting in becoming competitive can dts for infrelevel position. received funding for job readyness program designed to assist disabled low income job seekers in china town [inaudible] limited employment histgy occupational skills due to h

provided was dated march 31, 2015. the american legion is concerned that since the tba is no longer required to provide these metrics va can lose track of the numbers. the american legion calls on congress to require va to report these daily metrics throughout the duration of the contract or explain how they will continue to track this information. in fiscal year 2014 v.a. spent over $7 billion on non-va health care. many of the non-v.a. purchased care programs managed by different program officers and v.a. central office in some of these services are handled outside of processing systems. v.a. current purchase models incorporate all of va's non-v.a. care programs into a single integrated purchased care model. congress should look into streamlining non-v.a. care statutory authority. one gets a better sense of how the choice program of play out over the next couple of years. v.a. 90 care statutory -- should be consolidated and rationalize incorporated lessons learned from the v.a. choice program. thank you and again mr.

ñ of services provide lease sale or transfer.ission is required to hold a public hearing and this is the first of two hearings. the hospital may present information and respond and the health commission may make findings about whether the services will have a detrimental impact on the healthcare services in san francisco. the health commission received notice from st. mary's medical center earlier in march. they intend to close skilled nursing facility on june 21, 2015. the school nursing unit has 32 licensed bed. majority of patients are covered by medicare and 13% of their patients were covered by private insurance and 7% by med cal. this closure there will be an elimination of services at st. mary's. st. mary's indicated that changes in healthcare reimbursment and ongoing losses of unit as reasons for their closure. to provide you with background in the memo that you received it contains information about san francisco population. the grass that you see shows the population over the age of 65 in san francisco, california and t

to allocate all those funds and you know with us we take a lot of time to work with the community providers to strategy allergies the best way to get the money out the don't worry about we've deny that we haven't had time to analyze the effectiveness to see if we get more funding. >> last week, i was with the coalition of agencies on the rally are as on city hall not only planning for the senior and disability action on third street and many of the centers they're saying that in san francisco we're only serve half of the seminars that need the home delivered meals and fraction that needs accident home delivered groceries we're starting to address more of the population in need in the rest of this fiscal year and leading into negotiation. >> yeah. we'll looked at the effectiveness of the program we have a strong planning unit they're looking at this issue we're mindful we have limited dollars and the network serving the aging of folks is a credible balance and nutrition is an important part but without the services it is hard to keep folks adams home safely we have to look at that as a syste

we provide those devices. the cost about $350 and can be repurposed when one veteran is finished with it. the cost of using a device like that are about $1600 a year. when i talk about cost savings i did not translate that days of care for hospital admission into savings. patients last year had a 54% decrease in bed days of care. they had a 32% decrease in the number of admissions. it is important to know the devices do not exist alone. they are part of a system. for us, we have home telehealth coordinators. for about every 100, we have one care coordinator. for every 100 veterans enrolled, it needs to be the right population. people have published about this data. we have inquiries from all over the world. some of the problems people in other countries have experienced is not having the care coordinator available or electing the wrong group of patients. there are four disease conditions for which this is helpful. congestive heart failure means the heart is not functioning as strongly or effectively as it used

, which is the local provider. no it is complicated. sometimes out of fear we cover so much that we do not accomplish the goal. i appreciate you raising that testimony in my last question will be of sloan. you talking about you wanted more flexibility. >> yes, sir. >> put some meat on that poem. >> at the top of the list is flexibility around the determination of hardship for veterans to be able to have access to choice care. the way the law is written it is restricted to geographic barriers i believe is the language that is in the bill. we want to open that aperture giving us more flexibility to extend care. >> open that to be a type of illness. >> a type of illness distance. there could be an instance where veteran delivers -- lives within 40 miles of the center that does not deliver the care. >> i will interrupt you, and i apologize. you want the ability to exercise judgment. >> yes, sir. >> the chance to exercise judgment in terms of the 60 day authorization. >> yes, sir. >> there ought to be ways we can accomp

to provide this kind of care. we have about 12.7% of our patients engaged in clinical video telehealth. there is a large opportunity for expansion. we are working down the barriers that we see in expanding this as an option. someone wrote in the mid-1990's that the biggest barriers to the extension of telehealth are not the technologies. they are the administrative burdens. what we often refer to is the fact that our nation has a health care system that is excellent, but it is a bricks and mortar based health care system. there is not a system of hospitals. it is our goal to get to the point where the care can be provided timely. not clunky. it will be easy for the provider and the veteran to be able to have that care. senator blumenthal: you said 12 to 20%? dr. mccarthy: i said 12.7%. senator blumenthal: thank you for your excellent work. senator collins: senator cotton. senator cotton: dr. mccarthy, i would like to continue along the lines that the senator is discussing. in a state like arkansas, we face a coupl

if you are participating providers. those things need to be blended together so that we don't have disincentive to participate in one program versus another. >> fair enough. >> and the reimbursement rates need to be the same. 700 million transferred 400 million. i don't have a problem with that by the way. the questions i have is this is a miracle drug. when you anticipate those costs to flatten out so you aren't going to need those kinds of dollars? >> i think the conversation that needs to be held at this house committee and the appropriators has to do with the requirement that we managed great i would tell you our thought, the va's thought is we should be talking about a requirement where veterans that are hep c positively manage that number two functional zero by the end of 2018. that is what i think the requirement should the. so what we need to do with step back from that and lay out a plan that says this is what would be required in order to manage that requirement so we are not back-and-forth. the first time we

hundred and 50 units to people that can do better in the community for the many years providing over 6 hundred and 90 units for individuals ill living living with hiv we've talked about the medical respite and the green center was a program we started over 10 years ago in looking at how to manage those with alcoholicism and provided them an opportunity for deintoxicating and trying to get them into other levels of care and treatment and part of the homeless outreach team is successful to provide them with emergency stabilization beds inform gaining their benefits and stable listing while we wait for permanent housing with over 2 hundred and 87 units a lot of the discussion i've heard it today as well in terms of working with diversities and our ability to bring diverse populations into our workforce and we began this last year with had over a year of working internally to work on black african-american health inches initiative one is health and humiliate train we've trained over hundred and 50 staff and we'll continue to provide the ability to have a conversation been race and it's i

it provided what economists call "a public good"-- a good that has to be provided collectively or notall. i'm speaking of the flood control and navigation improvements made possible by the tva dams. these improvements were in the interests of society but they would not have been in the interests of private businesses. the benefit of flood and navigaon control was spread over the entire region and not limited to a few paying customers. flood controprotects thousands of people in the region and thousands more who may move in afr the dams are built. whether thousands or millions of people enjoy this benefit the cost of providing it is unchanged. the problem with a public good like this is that it's extremely difficult to charge private consumers for benefits they receive. my neighbor decides to pay for flood control but i do not. there is no way in which i can be excluded from the benefit of his flood control just as i can't be excluded from the benefits of a nationwide polio vaccine program, or national defense. invasions of flood waters or foreign armies can be handled only in one way-

us data or won't provide us data and not work with the vendor we can only do so much but rather have the vehicles 28 or 29 total to move to a dispatch company that works where taxicab drivers get calls and provide service we don't have much more to add i've provided data if you have questions the gentleman is here to answer questions for the cat that is provided. >> can you speak to the argument your regulations are unfairly burdensome on smaller buzzeds businesses and this regulation we set the number because that was our belief that in order to obtain a again measure for instance if you have a dispatch with two vehicles but one thousand calls in a month that's just as unreeblt i'm calling a taxi company i'm sorry we can't because our only two are occupied we are trying to figure out we're assuming calls all over san francisco many, many calls we're looking at a number that allows that company to service as many calls and as it can take throughout the city to pick up those vehicles so, yes that impacts a to vehicle dispatch equip we don't have anything like that if they receive 5 th

we provided some of the technical expertise. that capability in india today is quite sophisticated, quite a advanced. the recent super cyclone was the l tremendousos reflection of india'simal i capabilities because the loss of life was minimal in a, you know c category five super cyclone. that capability was on display in nepal as part of india's response to the earthquake. and the united states can feel proud for the role that it has played around the region in investing in disaster response capabilities. there's more to be done in trying to foster more regional t coordination andhe advanced planning of regional responses, by the fact that there are -- experi there is so much capability in tries the region today and the tha experiences of many of these countries in their own earthquakes is something that we have a direct hand. >> very heartening to hear. thank you all so much. mr. chairman thank you so much just for your gray shousness.- i really appreciate it. f >> thank you very much.statemen i just want to start out with --

at's where a so-called community benefits have provided for through the participation agreements those owner participation agreements provided for a very robust affordable housing that housing program a total of 6 thousand 4 hundred units for mission bay north and south 28 percent affordable or 18 hundred in total are provided in two ways each the development agreement are particular you saw how we provide in the different methodology in hunters point but is private developer is former southern pacific railroad they do not land very valuable in san francisco only 7 by 7 and inclusionary unit fast forward in 2014 how have we done through the inclusionary units and through the land donated to ocii we've produced over 11 hundred units out of the 18 hundred we're 2/3rd's of what there and is market rate as you can see is moving forward and certainly ucsf and is hospital and other job generating uses so once we're ready land becomes available and this particular piece of land on third street 1153 planning block 3 etc. on third street on the corner eco line we're posed and ready and part of

still provide a broad range of ancillary was services. maybe they have expanded their telehealth. maybe they expanded the clinic hours so they're not just open 9:00 to 5:00. and the community seems okay. in other cases there is a definite gap when a hospital closes, specifically around emergency services. but with the 34 hospitals that have closed since 2013, that is an uptick from the previous two years. what is interesting is the same number of hospitals have closed in urban areas, but i think as you know, when a hospital closes in a rural area it's a little different than when it closes in an urban area. so this is going to be a real priority for us from a research perspective over the next couple years. and we'll certainly work with our colleagues at cns and across the department to better understand and see what other resources can be brought to bear. >> mr. morris i'd be interested in knowing the research outcome of what happens to a community following a hospital closure, but i also would encourage for that research or -- for resea