large providers provide the pipes that feed a lot of distribution. i think there's opportunity for both. simplify sayings and ease of the kust -- simplify sayings and the ease of customer experience. as complicated as the environment is, we'll need to see an ability to make it easier for customers to get what they want when they have it. some of the different products in the markets as well as some over the next couple of years, they aspire to do that. there's power on both ends of the spectrum. the weakest point is to be in the middle. if you are a programmer with not a lot of sway, you'll be a bit - it will be harder for you to negotiate what you need. if you are a distributor that is smaller and doesn't have scale, you'll be looked at as an acquisition target. we see a lot of that. >> i jotted down a couple of names, teuvo romeo, google chrome cast, rocuiii and there are others. are they nibbling away at small bits of eye ball share. are we talking about something that cumulative ly means a lot of people will watch a lot less black-wired televisio

we have 7 contracts providers. we issued request in february and received 7 and award 7 proposals mptd they are contractors in place so many will be a new contract for dos perhaps as a new or continuation [inaudible]s we believe that these contractors have done a great job in previous years so we are excited to keep these relationships going. across the 7 contract you'll see variation as the type of service. you will also see cost variations as each agency has different expenses related to staffing and infrastructure. we think that spreading the contracts among the 7 provide rbs and using in combination really leaves us best situated to meet the diverse needs of san franciscans. naturalization services themselves includes sect category of service such as english as a second language class, citizenship class, one to one assist squns legal services. there are a number of benefit to become a united states citizen. increased financial security and stability, family reunifiication and freedom of travel. moving to [inaud

the state runs the whole payroll system for the in-home supportive services providers. most recently they have tried to make changes with direct deposits for checks but it still takes by the time the consumer and the provider make the agreement they have to request a packet. they have to send it to the county and then to the state and approved and they send it in and time to get paid takes three to four weeks or more. if there are mistakes in there the process is sent back to the consumer and provider to complete so sometimes it's over two months to get a paycheck and that's a huge concern because no provider can work for that long with that uncertainty. only providers that have multiple commissioners already getting a paycheck with have the luxury to wait and the last thing i would say in the interest of providers and raising wages and benefits has been a goal for the public authority and trying to improve the work force and that has shown to be successful but also giving the consumers the voice to say this is the work force we want to support, but also we need to main

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

the service, the provider billed correctly and the provider was paid. one would argue that it was proper, but not f.a.r. kplients. >> should the obligation have been entered into in the first place? was that proper? >> it so, thank you again for your question, so was it proper? if it was, so proper -- i don't understand word proper. >> i'd lake to address that. and this is going on the appropriations, the appropriations area. so just if if funds are available, one we have the authority to contract. done improperly, but we do have the authority to contract for these services. funds are available. then they're proper. the paintyments are proper, from an appropriations and authorities. >> so let me ask this followup to mr. murray. have these actions have ratified? in other words has this been blessed by the va. i want to know whether you think this was appropriate or not. >> we know the office of inspector general recently reviewed unauthorized commitments and the purchase card program. for those that were identified to the oig, we did 100% review of that

provide services for employment and other programs as well. it is community based organization that has been around for quite a while. i believe about 40 years. >> thank you comment or questions? comment or questions from the public. hearing none, all in favor? opposed? thank you the motion carries. u, requesting authorization to modify grants with [inaudible] independent provider mode during the term july 2015 nob nub amount of 3, 194, 535 for a revised total grant not to exceed 217, 058, 315. i see megan isn't here [inaudible] motion to discus >> good afternoon commission ers. deputy director for dos . this is a modification of public support contract and as you know we have 22 thousand in [inaudible] public support has a variety of service that support the client and provider one of which is acting as employer of record and handling the health and dental plan. basically most of this is really because the cost of health and dental have increased so most of this modification will cover the increase in health and dental benefit that helps get

i should say all the home care providers including the i h ss independent provider and the home bridge providers and others one of the most confusing things one you might have so do is complete an i h ss time sheet they keep changing and getting worse so we have asked home bridge to add time sheet training to their curriculum and so this creates increasing the classes and costs associated with that increase in this modification as well so - we'll be requesting authorization to modify this grant with home bridge for a contract mold and provider skills development train from july 1st, 2015, to june 30th, 2016, for the additional amount of $4 million plus and i'll be happy to answer any questions you have. >> any questions. >> commissioner loo and i realize that fiscal year year 2016-2017 has the same amount as the current 2015-2016 so that means many probably you'll come back for more money. >> that's correct. >> maybe the needs are greatest. >> that's right. >> and we haven't addressed the needs of 2016-2017 yet because there has been a lot of fluctuation in past years so what we intend

or a prearranged provider network. nine via providers also render care in va facilities under a contract arrangement or affiliation agreement with university medical schools. in fiscal year 2013 va spent almost $5 billion for non-be a provider medical care for more than 1 million veterans. as more veterans to seek care outside the va system it is important to ensure that non-va care is of the highest quality and it is reliable, accessible and efficient. three recent gao report identified numerous weaknesses in his management of its non-va medical care program and today i will focus on issues they reached result in this this area. in may 2013 gao reported that he does not collect data on wait times for veterans refer to non-va providers. therefore, be a cannot assure that veterans are receiving access to medical care that is comparable to veterans receiving care in the agency. also the emcees did not have automated systems capable of collecting data for all services and charges tied to a specific episode of care during

this provider has been doing the service for many many years. i have worked with them probably 20 years on this way back when i was in the community and they do a very good job. that is why usee a lot of the volume here. in addition to public education and educating professionals they work with director of adult protective services and other people who are really trying to move the issue of elder abuse response within the city. they are part of that effort as well so those are the things this grant pays for. >> any questions? >> happy to answer any questions >> commissioner sims >> the partners in the program are other government agency, other city agencies, da, police department. >> are you looking that forensic sentser or elder abuse prevention piece? you are right on those counts. i'll talk about those partnerships in just a minute >> i guess the question broadly that occurred to me is the function felt like a city employee function rather than a contractors function so i'm interested to understand why it would be a agency outside city govern

it's -- proper is an interesting question because if you establish the obligation, the provider providing service the provider billed correctly, and the provider was paid, one would argue that it was proper but not f.a.r. compliant. >> should the obligation have been entered into in the first place? was that proper? >> so thank you again for your question. so was it proper? proper. i'm struggling with the word proper. can i -- yes. can you -- >> i'd like to address that. and this is and this is going on the appropriations area. so -- if funds are available one, we have the authority to contract. done improperly but we do have the authority to contract for these services. funds are available then they are proper, the payments are proper. from an appropriations and authority. >> so let me ask this follow up question mr. murray. have these actions been ratified. has it been blessed by the va. we're concerned about what's happening here and we want to know what the basic question is whether this was proper or not. >> as we know the office of inspector general recently reviewed unauthorized co

the service, the provider billed correctly and the provider was paid.one would argue that it was proper, but not f.a.r. kplients. >> should the obligation have been entered into in the first place? was that proper? >> it so, thank you again for your question, so was it proper? if it was, so proper -- i don't understand word proper. >> i'd lake to address that. and this is going on the appropriations, the appropriations

second, our members are receiving health care that cannot be provided or only provided with great difficulty by other types of insurance plans. for example, health insurance plans do not routinely cover work-related health conditions, leaving such coverage to workers compensation insurance. however, workers compensation insurance presents coverage challenges to members because their 9/11 health conditions often first manifest after 9/11 many years later beyond the statute of limitations found in most state worker compensation laws. the world trade center health program serves a vital role in overcoming the difficulties that members might other wide experience in its absence. without the program, 9/11 responders and survivors might end up in limbo instead of in treatment. third, by providing evaluation and treatment for those most effected by 9/11 as a unified cohort, the program greatly aids not only the individual members but also the national understanding of the long-term health effects of 9/11, including its effects on children. the program helps us better prepare for the medical needs a

can you provide research provide by the zed rogua act? >> would be happy to. we are happy by the original drafters to provide money for the research into the health conditions that our members face. and as i mentioned before we've learned quite a bit from that research. and i'd like to highlight just one aspect of it. in additional to mental health andress and cancer research and autoimmune research and is the search on children who were at the time of 2001 attacks. there were a number of elementary schools and some in high school that were immediately impacted and we have a number of those projects that are going on now, about seven that are funded, and we're learning the effects on developmental issues in the children's population. to date, we've funded $88.5 million worth of research. and we have a significant body of research that is published in peer review journals. the world trade center registry alone has publishedé÷yky our pivotal papers in cancer auto immune diseases, asthma and other respiratory disorders have allowed us to provide better care, more

>> i don't have the number of providers but it is in excess of 95-94% of all providers in the united states. it is the largest network by far of all of our competitors. the pharmacy piece of this alternative option is the existing plan. so nothing would change respect to the egg wip prescription drug plan should you elect this alternative. there are supporting programs moving onto slide six members will continue to have access to the nurse help line and life referral plan for personal financial and legal advise. there are other programs that they have today that would not be a part of this program programs like disease management and case management are not part of the supplement to medicare plan. similar to the status quo i would like to point out advantages and disadvantages to the supplement to medicare ppo first i will go through the advantages as i mentioned retirees would have access to not only our full california network but access to our national ppo through the blue shield and blue cross association. this may be an advantage or disadvantage but there is no medical group. it

providers. different payment reimbursement rates and requirements for authorization and different processes. it is thoroughly confusing. >> i understand it is. but are the veterans getting the care in the community? >> we are estimating in fiscal year '14 we'll see in the neighborhood of 21-23 million appointments for care in the community. that is up from about 16 and a half million in 2014. as i mentioned, there are a record number of veterans who are receiving authorizations for care in the community. 1.5 million over the last 12 months. a 36 increase over the prior period. >> is any of that in the mental health area? >> yes, ma'am, it is. >> what percentage? >> mental health has been a smaller percentage of care because often times veterans experience issues that va providers are potentially better positioned and more knowledgeable to be able to respond to. there is certainly mental health care out there but the vast majority is delivered inside the va. >> i am going to yield back my time an

spotting an irresistible opportunity captain lindsay sailed on the providence. there he enlisted the help of john brown, the respected merchant and statesmen who led the petition against the gaspee back in march. brown was from one of the most prominent families in the city. the ultimately helped found what we know today as brown university. brown and lindsay rallied new england patriots down on what is now the eastside of providence along the waterfront. refreshments, no doubt, were served. refreshed or not, the group resolved to end the menace in rhode island waters. that night, those readers -- raiders, led by what nick bunker called the maritime elite of providence, set out with blackened faces, long boats, and rode down the day. oars muffled to prevent detection. they make their way to the stranded gaspee and surrounded it. as daniel harrington recounted in a recent op-ed that he wrote in "the providence journal," "captain abraham spoke first for the rhode islanders, summoning d unningston. imd sheridan -- i am the sheriff of the county. there's a warrant t

providers. that has been pretty successful effort because they work very hard. >> we will take a short recess. we have two votes we will resume a the hearing immediately following the last vote. [inaudible conversations] [inaudible conversations] we will resume the hearing some members are making their way back from the last series of votes. thank you for your indulgence. are you prepared to begin with your line of questions? you are recognize. >> thank you for being here i was looking through emails that i just received from new hampshire. it is some good news. we have signed up an important partner of ours from the north country that is in a sparsely populated area to be part of the tories programmer want to reference that because we have talked a bit about the transition and how long it takes and vital part of that is to line up the private community partners and health care providers and in particular care for seniors and adults day care and home care. but looking forward we can all agree th

and a launch vehicle service provider. it will not cost tens of millions of dollars to incorporate any version of an ar-1. recall that we started with an understanding that the performance level coming out of either of these two engines will not match the rd-180, and we will be using a pair of engines to do that. >> let me stop you will. would the combined thrust of the two engines be comparable to the rd-180? >> yes, it will. in fact, it'll be larger than the two. >> okay. >> in addition to that, the rd-180 uses a very novel thrust vector control system to move the nozzle and steer the rocket. that's also a technology that does not exist in the united states. and, by the way one that we do not have an interest in developing. so there will be a new thrust vector control system to go along with that. so when we do all of that with the new performance point that's required and the new thrust levels that would need to be delivered, there will be software changes structures changes, there will be alterations to the pad to acco

in the annual report the providers must provide information regarding the following.ge of clients enrolled in all the public benefits for which they are entitled. the percentage of clients applying for the benefits. a full summary of the reasonable efforts made to help the client enroll in all the public benefits. if the clients are not enrolled in maximum public benefits, an explanation as to why a higher percentage of clients are not enroll. for hsa, the ordinance mandates that the agency creates -- they must share the work sheet publicly on the website. additionally, hsa will be required to conduct two already more -- or more audits. we as a board approve unanimously, this law will first help the city collect more accurate and appropriate data to better understand which clients in supportive house running utilizing public benefits and to what extent. public benefits help secure the most vulnerable in our communities and get them on a path towards self-sufficiency. they provide most basic needs. this legislation will help more seniors and families get their bents th

. >> uh-huh and where you provide services to the caregiver is there a route. >> with the ad c r.c. yes. the respite the family member can drop off their member and the trainings and educational component my understanding when i spoke with patty they do a lot of individual counseling is the wrong word but a lot of attention for the family members around problem solving or support of taking care of of their loved i need help finding service abc it helps to find the services for the individuals that's the resource part of the program we're not just sending some place to a center if you need more around assistance a that's available. >> so if a caregiver needs respite do they use their own agency to the alzheimer's agency where they have 14 days of care. >> this is a little bit different my understanding this is different than family caregiver alliance so what ad c r.c. the loved one is brought to the center, however any days that's recess activist put the carve could a facilitate whatever needs to be done. >> yeah. yeah. >> any other questions. >> okay hearing none i'll call for the v

green: it seems the patients provide a great deal of understanding from the doctors and providers in the program. how do you think this affects the patient outcomes? dr. howard: without doubt. the providers that i first met in august of 2002, when i became first involved in this program are the very same providers that i see now in june of 2015. their dedication to this population has been worthy of note. mr. green: so the doctor-patient relationship is important, because of the continuation of the program. dr. howard: the trust that our members have to the providers that we are fortunate to have cannot be duplicated anywhere else. mr. green: do you think continuing the program is so important to ensuring the same level of knowledge and expertise? dr. howard: very definitely. our providers have a wealth of clinical information that other providers would take them years to develop. mr. green: ok. thank you, mr. chairman. i yield back my time. mr. pitts: the chair thanks the gentleman. now recognize the vice chairman of the subcommittee, the gentleman from kentucky, mr. guthrie, five m

providers who are not in the ppo network should somebody have a direct need to see a provider we will try to recruit them number two as a fall back, they will have coverageage they don't have today. >> questions? >> there are a lot of things not covered under network. specifically preventive care there say whole list of them >> yes that say a good point >> what do you do all of that out of network none of those would be covered >> correct to the degree they will could covered by medicare they would have coverage there we as a blue shield policy ppo plans do not cover preventive care with nonparticipating providers >> that is no different than today is that correct? >> well today we don't cover anything for non-- >> just for a point of education i'm trying cocompare and contract >> that care would not covered. >> it would not be covered at all >> correct. >> is the mills peninsula group in paloalto a part of this group. >> yes they are >> mills peninsula. >> pal low alto >> yes they're in our ppo >> those are the two not covered before for the seniors >> correct >> they will be now >>

has failed to provide more clarity. businesses need know how to comply and to plan and put things in place and f.d.a.'s failure to provide clarity has made it impossible for those things to happen. we will hear from the stakeholders and i hope we can discuss solutions to the problem and i yield the balance of my time to cathy mrs. mcmorris rodgers. mrs. mcmorris rodgers: i thank the chairmen for their attention to this issue, and ms. loretta sanchez. our joint efforts to clarify these regulations and represent the needs of america's small business owners are critical. i thank chairman upton and the 40 bipartisan members who have agreed to co-sponsor. h.r. 2017 is simple. clarify the intent of this nearly 400-page regulation so businesses can comply with it and consumers can have access to helpful calorie information. my staff and i have met with stakeholders and other member offices on all sides of this issue more than 20 times and asked how we can improve this legislation. something that we have heard again and again i

providers. different payment reimbursement rates and requirements for authorization and different processes. it is thoroughly confusing. >> i understand it is. but are the veterans getting the care in the community? >> we are estimating in fiscal year '14 we'll see in the neighborhood of 21-23 million appointments for care in the community. that is up from about 16 and a half million in 2014. as i mentioned, there are a record number of veterans who are receiving authorizations for care in the community. 1.5 million over the last 12 months. a 36 increase over the prior period. >> is any of that in the mental healthier? >> yes, ma'am, it is. >> what percentage? >> mental health has been a smaller percentage of care because often times veterans experience issues that va providers are potentially better positioned and more knowledgeable to be able to respond to. there is certainly mental health care out there but the vast majority is delivered inside the va. >> i am going to yield back my time and

serving 6 hundred low income families that will have provider programs those provides the family to move them out of poverty like the families i serve i grasp in a low income immigrant my mom moved us to the united states my mom was a seam stressed ass as a result i grew up in the factory i slept there and after many years of struggling and faces again domestic violence my mom applied for assistance i grew up with gangs and high crime and drugs and received medal and food stamps my mom didn't speak english and like any kid's i see at the age of 7 i have to help my family navigate and translate i felt the embarrassment of the frustration of those services and saw the benefits the benefits not only help to keep us alive but provides water my mom skills to help her gain confidence in here life i sat with my mom in classes sponsored by the welfare department i remember here sense of pride and accomplishment something that had been anything's throughout my choold liquor store i remember the sense of pride as a summer youth worker my first exposure of the no point services program it was

committee providers,

benjamin lindsay failing to providence. they yield to inspection by gaspee. captain lindsay refused. despite warning shots fired. steered his ship toward the co-. right over the shallow waters. they shot over the shallows. the gaspee ran aground and stuck firm. the british ship and her crew was caught. stranded in a falling tide. they would need to wait many hours for a rising tide. according to nick bunker come as might fell the gaspee crew turned in, leaving only one person on the deck. spotting an irresistible opportunity captain lindsay sailed on the providence. there he enlisted the help of john brown who had led that petition against the gaspee back in march. brown was from one of the most prominent families in the city. he ultimately found what he hopes to be the browns university. down in what is known as the east side of providence along the weather -- along the waterfront. refreshments were served. the group resolved to end the menace in rhode island waters. those graders, led by what to nick bunker called for maritime elite providence set out with

hearing none moving on the new business we begin with a request authorization to provide a 10 percent contingency amount in the contract authority approved by the commission for each contract welcome david >> director the contracts and facilities currently we've been fortunate over the loose several years received many add backs during the budget that's the good news we're in for the united states us times this is a backlog in getting them certified did add backs are granted late in the budget seeing none, season we've come to you with our renewable you wills and it details modifies the contract we have to come back for a second round of modifications in working with the city attorney we've come up what a contingent amount all the grants and agreement you'll see from this point forward will contain a ten percent contingency amount will be infected should is it be finalized by the board of the mayor's office of budget and we'll make the investment we already have the contingent authority from this body this laws us to get the contracts certified and have a cost of businesses implement

but this represents some of the support we can provide for families we have been providing this it checks out personally to support pamlies this is a way to institutionalize that need and provide support for families at aggrieving time trying to ensure the families get the right for burial. >> garcia are we the pry mar department overseeing the youth and silence? >> it's city-wide process. you need the workforce programs so it's a city-wide effort under diane olidadecha we provide intervention outreach and mental health services for the families who do get impacted we have our own dph teams that does a first assessment then there is an entire city team go tout to the family it's a citywide effort what we do is get to the root causes of these issueses and get people to jobs and education today in fact there was a graduation of people coming out of the intervention program so it's a significant role. >> in terms of police and implement the development we're just a part this is why it's in our budget >> partover the issue is the contract is with us the uc wrap around project is a contract th

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

, providing transparency and providing access to people that can help whether it's a cass inspector or an consultant. there is a tremendous need for people on the ground to provide technical assistance which is the worse word for [inaudible] individual consulting and that 101 kind of guidance so please note that for the state of california we are deeply invested in our small business community. we want to know what we can do on the state level to help small business thrive and succeed and to me this information needs to to be shared so they can understand what some of the best practices are so that's all. >> well, we have created on this time agenda that we shared to learn more about what small businesses interested in and looking for and we have to open up the phone lines for any questions or comments as well as in the audience to share any ideas and thoughts that they may have. we have a number of our commissioners that have joined us and we will be hearing from them shortly, but we definitely look forward to any comments or thoughts from those on the phone. do we have any calls at t

so with the cuts over time, and the state budget, our providers, both are contractor providers they mighthear referred to as our title five group, and all are providers who accept children who are using vouchers whether those vouchers are funded with state funds, federal funds, or city funds, are struggling. so we are likely to see slow increases at the state level in terms of increases both in the standard reimbursement rate for contractor providers. read 5% last year. we learned. another 5% this year and also increases the voucher rate. we are committed to keeping our city funded subsidies at the same level of those increases in the voucher area so for our axis program for homeless families, for our city childcare program, which funds subsidies for infants and toddlers and for subsidies directed to our families who are in the child welfare system. we want to keep those vouchers at the same rate of increase as the state vouchers. so, with that, i will take comments.. i also want to say that we received a budget analyst report that we are not in agreement at this time with the finance. >>

who is the policy analyst and dennis salazar who is the mediation and outreach two trial attorneys provide the 12u7b89 reviews and they prosecuted 9 officers and the commission case and the in 2014 we had fairly sustained report that exceeded 25 pages the work of the investigators as well as the attorneys moving to policy work and policy recommendations is an area that marianne works on it was a robust year for policy work and that's why we are advocating so strongly for an additional attorney on our staff to assist in the policy work and to assist in areas such a the customer satisfaction survey and in general report writing and the policy work that ms. marianne gaeblgd with the police department to complete the video and detecting and overcoming language barriers and provided train on language assess and work 0 the general order children of arrested parents and to complete the training video with the department and san francisco police department and community advocates policy recommendations made included the department 6.09 to require the police officer to provide the transmitted prote