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

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

this is why it provides networks of clinics and providers trained to treat these diseases and ensures that providers and survivors bear no out-of-pocket costs associated with these particular health conditions and it provides monitoring and treatment services for more than 71,000 responders and survivors. they reside in every state and in 429 of the 435 congressional districts. if some of you don't know, the law is named for james zadroga, a new jersey hero who responded on 9/11 and spent hundreds of hours digging through debris and died in 2006 from respiratory failure after exposure to toxic dust at the world trade center site. like him, thousands of people from all over the country came to the aid of the country and those at ground zero and those responders and survivors should not be abandoned, and i hope we can expand the program without delay. i only have 30 seconds left for mr. engel, but i apologize and i yield to him. >> thank you for yielding and let me agree with everything you said. in the aftermath of september 11th, it is estimated that up to 400,000 americans were expos

>> we would be able to provide appropriate services. currently in county jail 4 we have inmates housed there with melthal illness and there is no appropriate place to see these individuals. we rin competition with attorneys for private interview rooms. the aufsh space is probably 3 by 4 for the mental helthd staff that work there which includes housing of equipment, computers phones and regular supplies so it greatly improved the ability to provide services. >> thank you very much. this is consistent with what i heard when we is ask questions about this. to supervisor wieners point, building a jail isn't anything any of us spare to but the fact we have 850 brisqunt the building needs to go, i think we all watched during katrina what happened to prisoners incarcerated in facilities that were not safe or adequate and know our friends at the da's office deal with situations daily none of us would like to deal with. talking about environmental has zardss. 850 bryant needs to go. we need some measure of continuing jail facilities. i think we

the thought being i would get online and search my provider online and search my provider and see how many claims he was responsible for, the cost of that provider. the media picked up on this, and a lot of it was gotcha journalism. so my provider is the most costly provider because they prescribed the most costly drugs, for example. that's not necessarily helpful to a consumer. i could turn that around and say, my provider does the most hip replacements, and therefore, is an expert at doing hip replacements. so we need to put this data into context. the second thing that we know consumers really value is this cost quality equation. in other words the value equation. right now, we don't have very good measures of quality. so the information that could be presented on some of these health plan comparison websites just simply haven't available. we're just measuring the wrong things and things that consumers don't find necessarily helpful. most of the measures used are measures of underused, did i perform the mammography on the preventive screen, did i do some of those preventive measure

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

rooftops is is different type of service we need to attach to those poles at this level in order to provide the extra data capacity that is why you heard council for verizon an over and under this is under it is about capacitate so with that said, i want to straighten out it needs to be replaced to consultant in this with the geo95 a regulation by the department of public works it requires the facing requirements between everything on a utility pole in other words to meet those safety driven specifications in order to meet those the pole needs to be increased in height by 4 feet and it here on behalf of the appellant you should know that extra net is a 12 copy we're a co-owner the reason we're attaching to the light poles no other poles in the neighborhood to attach to some people in the audience have called out attached to street lights no medal street lights that is not an underground district an overhead utility district with only those poles and are, in fact, the least intrusive installations on a utility pole when we're working on street light pole we can do more awe authentically plea

are there providers providing them with an interpreter? >> i want to make sure i understand the question. so you're saying at the site of care where we have sort of limitations or constraints in terms of english speak you know, what are the support capabilities to ensure that the physician is engaging with the patient? >> in the language the patient prefers, they have an interpreter. part of this was the state of washington for its medicaid program, they have a state wide interpreter program where every provider can -- that's medicaid covered can get on and say next wednesday, i need someone in russian to speak russian at 10:00. i need someone in mandarin at 11:00. i need someone in spanish at 3:00. >> i can't speak to sort of what the health plan is doing specifically in that venue. i'm not sure if anyone else can speak to that. i think that hospital systems and providers probably have a response thato that. being careful how does health plan intersect with that relationship. we want to make sure, which is where you're going, we reduce th

the serviced to be provided is to

providers. i think you are trying to change the culture, so that there is not this enmity -- not a conspiracy to disappear. that is where i am reading. >> that is why we changed the name to care in the community. we in the v.a. own that care even though it is in the community. >> i have seen others within the the a health testify before the committee the concerns that you do own the care, you are responsible for it -- there need to be ways in which the contractor and the providers are also accountable. that that care is accountable. i have raise a number of times this issue of health records. you have centralized the billing and payment from the regional areas. you are saying in your testimony from what i've heard that centralization had a lot to do with driving the shortfall. the misunderstanding that arose from what you knew from the regional billing to the centralized billing. is that somewhat accurate? >> the requirement in the choice act to centralize the accounting and billing and administ

we haven't provided flexibility. the worst nightmare for veterans and currently experiencing in el paso, they are unable to get access to see somebody and 34% of the veterans could not see a provider at all for mental health care access, whether 16 days, 60 days 34% could not get in. i want to make sure that we go back and look at those numbers and make sure they reflect the reality as veterans are experiencing. >> i would suggest we do that. let's get our numbers and your numbers together and understand the basis of your research and the basis of our numbers and see if we can sort through it. we have work to do in el paso, you and i and others have been working on that. we know that. >> we've submitted a proposal a pilot project to you and i thank you for reviewing it so quickly would love to work with you going forward to implement that or a better idea if you got one but we've been at the bottom the of the barrel and that translates into care deferred, care denied, suffering on the part of veterans and veteran sui

provider?want to comment, to, to ensure you're not replacing a sole source provider with a difference sole source provider?meight want to comment, to, to ensure you're not replacing a sole source provider with a difference sole source provider?want to comment, to, to ensure you're not replacing a sole source provider with a difference sole source provider? >> the approach is to find one that will be available for the capabilities in the future. we're going down the path so we can have that new rocket. whether vulcan or the atlas we're going down that path. and we have a much more -- much healthier industrial base now spacex is certified for an element of the capabilities now. so we have spacex out there. so we have capability aies out there if we can take advantage of all of those schl systems. that's what our approach is trying do. >> we initiated this in earnest last august with requests for information from industry and we've been work with them very very closely. and the rocket propulsion s

been put out twice there were no responses so our department went off to seek a group that could provide this service and that's before you on the consent calendar also lastly on this consent calendar is hundred and 27 plus dollars if the university of california san francisco medical center and as it is stated this is for consultation of electronic records work with the sf g h not just that but the entire electronic records requirements it is a very complex - we have a very complex series of means and the universities experts will be able to upon our contracting with them to tell us h how they could meet the need and meet a 10 year cost analyze it is to determine whether the ethics system can work for us as the department is looking at several of the contractors and so this is before you also in future at our consent calendar lastly as our processes is in the third quarter dpw financial report to have copies of this we are at this point ahead of the budget by $28 million much of that was related to increased revenues from our medi-cal business and also reduced costs over at san francisc

real estate contracted with third party expert in providing relocation services and they will provide a relocation plan for us and assist with implementing that relocation plan for the businesses that would be effected as a result of the purchase for this site. secondly, to expand on jessie's comments, our normal course of operations we would enter into good faiths and negotiation with property owners after a project has its sequa compliance in hand so we are concerned about the timelines to produce the final acquisitions if the sequa compliance issue was delayed. we do not have a lot of time after receiving the notice of award from the bureau to complete our acquisitions and secure site control, which is a requirement post notice of the award process. i hope that is helpful. >> okay, if there is no further comments from any other city department, i will open it up to public comment for those--supervisor kim you have questions? >> yes, i have a few question s for the project sponsors. maybe i'll address my first set to mr. updike on the sro units. it is my understanding we are not pro

and edge edge providers interacting it would seem to follow logically if they edge providers actingn the consumer way why shouldn't the fcc have the jurisdiction to extend those same rules to edge providers and more brief look at the internet standard it's not clear to me why the fcc should limit its focus on internet service providers. you could easily see a dominant edge provider engaging in other conduct so that's part of the uncertainty that unfortunately fcc opened up and i hope we don't follow that. >> thank you both and i yield back the balance of my time or it's. >> a chair recognizes the gentleman from illinois mr. rush for five minutes. >> i want to thank you chairman i want to thank you and the ranking member for today's hearing. commissioner pai welcome both of you to today's hearing. it's so nice to see you once again. mr. chairman i want to bring up one of the most egregious matters under consideration under the ftc and i'm referring to the prison phonecall rates. understand the fcc is poised to make a ruling on in-state phone rates for prison phonecalls. that said mr.

and again san francisco has been at the first and foremost of providing prep the rest of the country is following behind some more slowly than others but we can completely will change the face of epidemic and people that benefit the most from prep are linked to services if they deserve to take prep and measure the impact does it have a positive impact are we seeing break to tell us in preparing or resistance we know of one case of a person denied life insurance because he was on preparing we want to minimize the cases of denial for preparing the rapid committee is rapid initiative for hiv diagnoses we have been doing linkage to care when i talk about that we get people into care but lose them quickly we lose them because they're not really linked immediately if that if you diagnose someone in a clinical setting but we'll try to get you into care but at all r call those 5 numbers they can easing easily be lost to care there was a pilot program it has been highly successful people find is successful as soon as people are diagnosed to get them to a provider to get them not only the medi

providers. they treat veterans in community hospitals and doctors offices using either a fee for service arrangement or a prearranged provider network. nonvaf providers also render care in v.a. facilities under a contract arrangement or affiliation with university medical schools. in fiscal year 2013 v.a. spent almost $5 billion for nonvaf providing medical care for more than 1 million veterans. as more veterans seek care outside of the v.a. system it is important to make sure that v.a. care is of quality and reliable and sufficient. three recent reports acknowledged weakness of the nonv.a. medical care program and todayly focus on issue v.a. needs to resolve in this area. in may of 2013, g.a. reports that v.a. does not collect data on wait time referred to nonv.a. providers and v.a. cannot assure that veterans are receivek access to medical care comparable to care at v.a. mc's and also they do not have automatic systems capable of collecting data for all services and charges tied to a specific

at the same time we have providers in the district, mental health providers that v.a. has contracted with and yet we're not utilizing them to the extent that they can be utilized and pushing our veterans to those contracts. and thirdly i would say that triwest i think is very committed to administering the choice program. they have indicated that they plan on hiring lots and lots of folks to do a better job of providing the choice program. so all of these issues that i'm raising right now are sort of fighting against each other. we're going to need resources for the choice program and in order to increase and enhance the program and we wouldn't want triwest to hire a lot of people and then tell them sorry. we have to push more people to the people we have already contracted with and my veterans in ventura county are not receiving the services and beginning to feel this dilemma. so i'm not sure that i have a question -- i'm not sure i have a question except to say i thank you for your leadership. i do believe if you weren't asking the hard questions your issue around th

services, to be blunt the embassy can't provide on the economy to provide, it has to provide for itself. >> of the 5,000 how many are military personnel? >> right now of the 5,000 the number is pretty small. that number is likely to increase over the out years because as the military mission changes, there will be a security cooperation office that will eventually be part of the embassy that will oversee the assistance we provide the afghan national security forces. those decisions are being made right now. >> just a guess. you told me there 5,000 total. 100, 200, 300? just guess wildly. >> maybe 100. >> we have almost 5,000 civilian personnel that we anticipate having in afghanistan? is that the deal? >> you're combining what's the case right now and what will be the case over time. over time, that percentage will be a larger number because of the cooperation of the security office. >> okay. okay. then we have a question for, i guess -- i'm running out of time. well, was a risk assessment done at the kabul site and if it wasn't, why not? that's the final question. >> risk assessments a

, 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

>> sir, we can provide that. what i can tell you is it's the smaller portion that are direct hire u.s. staff who are doing what we think of as the work of diplomacy. the larger portion are the people necessary to support the staff given the very unique circumstances in kabul whether that's the security staff or the life support staff especially as the military mission draws down and we lose some of the services that the department of defense has provided and need to provide for ourselves. services, to be blunt, the embassy can't rely on the economy to provide it has to provide for itself. >> of the 5,000, how many are military personnel? >> right now of the 5,000, the number is pretty small. that number is likely to increase over the out years because as the military mission changes, there will be a security cooperation office that will eventually be part of the embassy that will oversee the assistance we provide the afghan national security forces. those decisions are being made right now. i can't really tell yo

them to provide a report to the i oc to invite both groups to provide their annual report we provide a longitudinal pathway there are suggestions at looking at the graduation and dropout rates pend approval by the board the participants will joining file with the board to get court approval and staff immediately begins the implements during the summer for the requirement that's all i have thank you very much for your attention. >> i have no public speaker cards for this item commissioner fewer we've come a long way with the plan you know i think even the time i've been in the district we have come a long way i wanted to say in the monitoring and could we get the comparison data in our immersion program ofes o and logical told you loans studies so that we can compare within a program e os and els their academic progress to have that for a long ranger we're hoping to eliminate the gap we only compare some and also i think you're going to monitor by rates and programs probably for fiscalness that's great and other monitoring might be how many stay within the pathway all through high sch

that we can provide in this country as they have earned. i think one of the frustrations that i've had on this committee is that we have, as a committee i have been here 6 1/2 years and we keep providing more and more and more money and then we have the v.a. come back for more money and we see things like thing about in aurora. we beat that horse to death. moves that cost hundreds of thousands of dollars. i think of a billion dollars goes wasted at aurora that could have provided v.a. veterans healthcare. i don't know where it went. we had a failed system between d.o.d. and v.a. that spent $1 billion trying to get -- way before you got here, to try to integrate two healthcare records, vanished, the money's gone. that's a waste that i see and no way on this earth would you have allowed that to happen at your shop when you were -- in no way would i have allowed that to happen when i was the mayor of johnson city, tennessee, where i was or in my own practice, i couldn't have survived doing that and what's happened is that both sides of the ais

it's not just provider directories. it's also formularies and that's another important piece for folks not undergoing care, how to make sure that plan they're going into and understand that responsible is a what drugs are covered. maryland d.c., they moved and with integrated provider directory systems that i think have been successful so far. and other states have followed suit. on the formulary side last year we did kind of a sampling of the state based marketplaces. it was still very difficult during open enrollment to find the links for the formularies actually pull up the formularies in many of the state's marketplaces. >> peter? >> i think it's right, when you we look at consumers choosing plans, about 30% care about finding a doctor. 10 or 50% care about drug. these are chronically ill individual. the vast majority don't but for those who do they care a lot about. covered california people can link to each plan's formulary. we look forward to having a consolidated formulary directory. it's not going to be in 2016

network for north beach and russian hill we've worked tireless for those this the greatest way to provide ever increasing need for capacity and the demands for wireless from cell phones watches ipads and so on and so forth doubling every year and verizon is scrambling to find those facilities this is the least impact we're able to use an existing structure essentially pitting telephone equipment on the telephone pole the department has addressed the appeal points and bring your attention with respect to the historic review the facility is a block away from the crooked street it makes it clear the location explicit qualify that requires additional review of it did the standard would be whether this is significantly detracts from the authentic nature of the structure we your this smaller than a telephone pole the box are 10 by 17 inches high smaller than two pieces of paper put together can't possibly detract of this is a historic structure there is concern about the impairing views and the standard it must significantly impair the building landmark, park or other structure that is the poin

my employees really, truly value the investment education provided to them specifically providing investment recommendation and various asset classes. this information allows them to make informed investment decisions and many of my employees could not afford to pay for this investment education separately and might be discouraged from investing in the plan at all if my company did not provide this benefit. and third, the best interest contract exemption will increase the cost of services to small businesses. and possibly eliminate access. there's some question about whether advisers to small business plans are even able to use the exemption. even assuming that they are, there are certain to be additional costs associated with these changes. as a business owner who relies on outside professionals to help me manage my plan any additional costs imposed by the regulation will be pass theed on to me. in conclusion, i'm very concerned that the proposal will not achieve the department's goals of better protecting workers and retirees but will, instead, make it harder for small business employers a

they have already provided support to over 800 mothers and their babies. hardest period for a new mother is until the baby reaches 18 months old. research shows that a mother who hasupport during thi perio is less likely to abandon her baby. mothers are provided with food, accommodation, and whatever their babies need free of sinc the aim is to help them become self-supporting individuals, they are responsible for taking care of their babies and the housework. they also receive vocational training, such as sewing or computer skills. as work options for women are limited in astana, the idea is for them to acquire skills that will help them fine wo. find work. >> sairash is 30 years old. she come from a town that is about four hours by train from astana. she was working as a cleaner in the capital, but was alone and at the end of her tether when she gave birth to her baby. the father who had promised to marry her had come to astana to work. he pretended to be single when, in fact, he had a wife back in the country. >> translator: i met her at a maternity hos

we provide needed help to victims of disasters. but our reason for being, our very reason for being, at the very core of what it means to have an army is to win and to win decisively in ground combat against the enemies of our country so american citizens can enjoy life liberty and the pursuit of happiness. and every year 120,000 of america's sons and daughters raise their right hand to they can the oath to serve in the united states army. in return, we make the commitment to develop them as soldiers, leaders and importantly as citizens. these soldiers are the core of the all-volunteer army made up of the active nation guard and the reserve. we are a total army. we are in fact one army. we are america's army. and all of us come from the people. right now, we have the most skilled and combat experience army in the nation's history. but in this time of increasing instability and increasing uncertainty throughout the global we must face and solve significant challenges. i pledge to be a steward on behalf of the american taxpayer we re

clean lynnens and provide multiple blankets which are provided and laundered every day, but the standard of care, sheets so the committee does due diligence and rights it up. we don't have the ability to fund sheets and blanket service so that is sth way we try to kaess this things. i'm pleased the committee meets with dph and human services meets with the committee roughly quarterly just to try to explore these details in a more productive way. but i wanted to make sure you werea weir individual complaints were reported in a timely fashion and there is a response mechanism which doesn't come out in the reports when you see them >> there are 2 departments in dph- >> hsa is the entity that funds the shelter system including resource centers and adult and family shelters. dph is the funder of the staff position for the shelter monitoring commit jealso fund [inaudible] such as behavioral health roving and case management and adult shelter system so it is joint partnership. the primary funding is from dph >> what do you see is possible to help streg strengthen the understanding of what is ne

the question is what are we going to provide for our children? and when you look at research, making sure that people have the best medical care, making sure that we take advantage of innovation and make sure we open the door for jobs, good jobs, jobs here in the united states that have impact all over the world, it's all connected. it's all connected to what we're trying to do here today. you all have contributed greatly to our discussion. we're going to take what you said and use it in every way we can. we'll probably be calling on you again trying to get your advice seeking your advice because we want the best minds and we have them sitting in front of us. we also of course thank speaker gingrich for his contributions and thank you very much as we march forward trying to make a difference. my mom used to say in my time and in my space i will make a difference with god's grace. thank you very much. >> thank you. >> c-span gives you the best access to congress. live coverage of the u.s. house. congressional hearings and news conferences. every m