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

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

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

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 pilot is due 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 workin

wired and wireless providers but when you look at just wired service for the home the number of providers drops down it is only one in certain areas but it's higher than that there are 4 or more in certain areas so it's not equally distributed across the city and we have a map showing the distribution in the report. we have many more choices for cellular wireless service but that has limitations the speeds offered are lower and caps on data use so you can't actually go onto the internet and use it freely for the whole month without incurring a higher fee and the devices at this time again all subject to change but right now a tablet or cell phone doesn't have the same functionality as a laptop or desktop computer and you can't apply for a job as easily on a cell phone or do your homework on a cell phone as as you can on your computer and in terms of of affordability certainly an issue for segments of the san francisco population these are rates as of last fall. they are subject to change but i imagine they are still in the ballpark and we're showing both the lowest speeds available and th

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

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 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

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

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

, 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

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

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

this will provide a powerful opportunity to assess strategies rigorously to see if they provide clinically valid information and better health outcomes for the american people. so in closing let me emphasize that the impact of the precision medicine initiative will extend far beyond the individuals who volunteered to participate. it will push the frontiers of discovery across the entire spectrum of biomedical research from basic science aimed at finding new therapeutic targets to translational science intent on moving research discoveries into practice for maximum public health benefit. given the size of the project and its real world nature evidence of improved health outcomes derived from this initiative will be attractive for immediate application across u.s. medical care. with sufficient resources and a strong sustained commitment of time, energy and ingenuity, the future of precision medicine appears very bright. we really look forward to working together to make stories like those of lily and carla a reality. that concludes my testimony. i look forward to answering your questions. >>

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

the last report va provided to vsos was dated march 31st, 2015. the american legion is concerned since the tpas are no longer required to provide that's daily metrics, va can easily lose track of the numbers. the american legion calls on congress to require them to continue reporting these daily metrics throughout the duration of the contract or explain how they will continue to track this information. in fiscal year 2014, va spent over $7 billion on non-va health care. many of the non-va purchase care programs are managed by different program offices and some of the services are handled outside of va claim fee processing system. va should streamline the model to incorporate all of va's non-va care programs into a single integrated purchase care model. congress should look into streamlining the non-va care statutory authorities. once congress gets a better sense of how the choice program will play out over the next couple of years, va's non-va care statutory authorities should be consolidated and rationalized incorporating lessons learned from the

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

that is about-there are 700 providers in town and this is a subset of those provider and that is staff to network. it is a strategy particularfry infant and toddlers and we connected all the vouchers were going to places where we invested the quality dollars so this was one of the strategies to make sure where we vend for vouchers. thathe low income kids get the benefit of the quality investment. we are look at data cyst mg integration for [inaudible] we want to use technology to find solutions to stream line their business practices. they are outdated and out moded and birdmsome. we are interested in [inaudible] they will all change next year as we come windup the plan so that is just for reference >> i think it is great to see that next year. thank you very much. supervisor yee >> 2 areas of concern i heard, one of them being the minimum wage impact and the [inaudible] it will cause. i'm not sure what the actual budget will look like in terms of trying to mitigate that impact. the other one would be in your circle it shows the pie chart shows that [inaudible] service 1 thousand infan

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

typically that's not a provider to provider because both providers cannot be paid for the same service but if you have a generalist with a specialist and they both do an exam, then they both can build. >> you have a general practice physician at rice county district number one at a specialist, both of them can build? >> if they are doing different services, yes. >> so that is not disincentive to a provider to make this happen? >> as long as you're in a state that allows for parity reimbursement. >> i will have to figure that out. finally, let me ask you to clarify for me when we talk about that reimbursement, does it matter who is providing the insurance, medicaid versus medicare versus private insurance? is the answer the same in all three setting? >> it's not and it depends on your state with the legislation allows for, and then medicare has geographic restrictions as well that we have heard. but in our state all public and private payers and mississippi medicaid included have a parity reimbursement for telehealth. same as in person. >> chairman blunt due out me to stop or asked one

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.

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

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

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

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

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

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

we also provide medical consultation to the people as well. all of this is free for the people in the northern virginia area d.c. maryland area. >> dr. nguyen in the coming years you'll be sponsoring a challenge. what kind of challenge? >> we plan to host more frequent dental cleanings across the board of northern virginia. the challenge here is because every state, virginia has a different guideline, maryland has a different guideline. so we do need attorney to help us legal advice to stay within the guideline and for the government of maryland from the state of maryland of virginia to give us more freedom in order to move there, expand across north virginia. >> dr. phan tell us about your elderly project. >> yes. help for tomorrow currently is evaluating the program that we can bring to them the services to the elderly in nursing home who could not have access to dental services. so we are very excited, but learn more about that. >> already. very exciting. very much needed. good dental care is important to our overall health. thank you so mu

and by the way of prevention, we provide short term rental assistance, and we provide legal representation and know your rights, sum seminars as well as weigh sift in move in costs for the emergency shelters to the affordable housing. and by way of access to houptsing, i want to highlight the importance of this program and that is that we provide the grants to cbos and they, help to shepherd the housing in secure families, through the city process for housing. and i think that it is helpful to have a guide through that process. in the fiscal year, 2014,/15, we reached, approximately 6,000 house holds through our eviction prevention investments we provided legal assistance as well as legal representation and we provided households with the tenant counseling, and we did provide 500 households with short term rental assistance and third and last category of the program is focuss on preserving the rent controlled buildings as well as these restricted affordable housing and this is geared toward current tenants and the first program that i want to highlight is the small sites program which has

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

arena there's a couple of good articles recently regarding the warriors community foundation and i'm provided you with information this morning requesting that the warriors and the city leaders include in their proposals providing education for our kids i teach in san francisco public schools and also at the juvenile hall where the high school program there is a woodside learning center i'm requesting the warriors work in partnership with the county schools which includes a facility out in la honeyed in the snuz they've struggled about how to utility that property it has tremendous potential i provided you a brief description of the woodside learning center and rather than i gave an article on the golf maintenance and training program at juvenile many have to go to a group home for a year increase a lot of facilities on the east coast that trains kids in a high school program so there's also just recently started at the glen eagle glove course some of the ideas are the proposal has been speaking about where the warriors and all professional supporters have a trurls influence on those kids wit

we work on technologies, best practices, and provide market guidance. we have laboratories that vet solutions that we list on our website. all of our information is free. our mission is to educate empower, and protect. now, our end game strategy is to devalue the data so it's useless in the hands of the bad guys. we have three technologies that will allow us to do so. emv at the point of sale. point-to-point encryption, and tokens. when bundled and implemented properly, the data becomes useless, and there's no reason to break in. that's why the counsel supports adoption of emv in the u.s. through organizations such as the emv migration form and other standards that support emv today and other worldwide markets. emv chip is not a silver bullet. additional controls are needed to protect the integrity of payments on line and in other channels. this includes encryption tamper resistant devices, malware protection, network monitoring and more, all vital parts of the pci standards. effective security requires more than just standards for standards without sup

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

on may 1st, va sent to congress a legislative proposal providing major improvements to use provider agreements for the purchase of community care. we request your support. lastly, we are requesting flexibility in one other area of veteran care, hepatitis c treatment. you are all familiar with the impact of this new generation of drugs. veterans that have been hep c positive for years have a cure within reach with minimal side effects. because of the newness of these drugs, there was no funding in the budget or appropriation. we moved $688 million from care in the community anticipating the shift in cost to choice to fund treatment for veterans with these new drugs. it was the right thing to do but it wasn't enough. we're requesting flexibility to make this cure available to veterans between now and the end of the fiscal year. so, we are improving access to care, notwithstanding the reported wait times that you see. that means we still have work to do on wait times but we are improving access to care. we're committed to making choice work and have very specific actions to do just that and we ne

which provides $140.5 billion for health and human services and included allocation in the governor'sng includes proposal that could increase access to medical. the may revision does not make significant adjustments to public health funding and renewal or medical providers rates. it is expected to have a neutral impact and legislation will hold another meeting to finalize the budget in mid-june. >> i wanted to nouns a -- announce a proposal to include $6 million to provide on going support for respite beds for chronic medical needs. this residue pit program will include a program for clients that cannot be adequately served in the homeless shelter system for individuals who amide be otherwise on the street using emergency services. this expansion of medical respite is the next step of series for solutions to the city's homeless population and to provide needed mental health and services and getting homeless individuals the support they need earlier and helping to avoid crisis that can cause harm and great expense. also included in the $28 million proposal that the mayor released last

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 --

if there is not a network provider, you can set up an engagement with an individual provider to deliver services under choice. we then design a network map we are under the process of constructing together. 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 otherwise cannot be met by the va medical center in dallas. that is being repeated across our entire 28 state area and the pacific as we seek to do our part to mature the operations of choice. it is a privilege to serve in support of those who serve this country. it is an honor to serve the veterans from the states represented by half the members of this committee. mr. chairman, i look forward to taking questions after my colleague is finished with her remarks. >> thank you. >> i appreciate the opportunity to testify on the health net imagination of the veterans choice program. health net is proud to be one of the longest-serving -- we are dedicated to ensuring our nations' veterans have prompt access to needed healthcare services and believe th

the proposed change provides no guarantee this will provide safer patient care. additionally lpns with little or no psychiatric experience are taking the place of psychiatrists during intake and assessments. taking care of patients and providing excellent care has a lot to do with providing basics and using a lot of common sense. for example, when patients are asked what is important to them, you will hear simple straight forward common sense questions. such as -- will i be admitted quickly? is the room clean? is there a bathroom in the room? does the call button work? does someone answer and arrive quickly when i need them? does everyone speak so i can understand them? if i need help to eat, will somebody be there to help me? do my doctors and nurses spend time explaining things so i can understand what is happening? unfortunately patients surveys indicate none of the above questions are being answered very well in the va although the crisis last year did focus on access to care, this is but one small piece of the total package. getting timely initial access is

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