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

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

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

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

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

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

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

>> 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

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

, 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

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

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

self-declare on the percentage of health service providers against the public service provider. so, for example, only count number of hospital beds or number of facilities and compare the faith-based christian health services against the government facilities. these figures are highly contentious. what the paper tries to impact is the numbers are very contentious contentious. there is a need to move away from this focus on the percentages of market share. the argument is basing your entire idea on whether or not they provide 20 or 25 or 30% of the health services is actually less important than the issues such as do they provide quality health care. do they emphasize health coverage to people who don't otherwise get access. do they provide a different kind of care that supports the season and make more resilient. so really the argument is moving away from those kind of figures of market share and looking at things such as utilization, satisfaction. we are trying to pull on what data there is on these other expects we consider to be more important. i'll just touch on a couple of

providers. providers not salaries within the v.a. is that correct?mmunity. and on a bipartisan basis, we are encouraging the v.a. to cooperate more with what you refer to as the community or non-v.a. providers. i think you're trying to change the culture of the v.a. so it's not a conspiracy to disappear the v.a. that's what i'm reading. >> that's why we changed the name from nan-v.a. care to care in the community. we in the v.a. own that care, even though it's in the community. >> relative to that i've seen others within v.a. health testifying before this committee that the concern, since you do own the care and are ultimately responsible for it, there need to be ways in which the contract providers are also accountable. that care is accountable. i've raised a number of times this issue of health records. you have centralized the billing and payment operations from the regional areas. and you are saying in your testimony, what i've heard, that centralization was -- had a lot to do with driving this shortfall. the misunderstanding that arose from what

it would leave women without the providers they know and the providers they trust. mr. president, i don't think women want the tea party making their health care decisions for them. but under this bill that's exactly what would happen, and that's why it's not going anywhere. so mr. president republicans can go ahead and try for the umteenth time to turn back the clock on women's health and score political points with their extreme base instead of working with us on the real challenges in country faces. we need to be creating jobs and growing our economy and actually expanding access to health care. we want them to know we're going to be right there as this comes to the floor fighting back to make sure women come before politics and not the other way around. we fought this battle before and again and again adds and again. battles that we all thought were mentmentsettled, that women thought they won decades ago keep coming back. and each time we've made it clear: we are not going away. they can put new spins on old ideas, they can try talking about it in different ways an

the serviced to be provided is to

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

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 francisco general so i'll be happy to answer any q

being built so we can provide cage frz the people that the cops will criminalize and arrest and you can't let that happen despite the regulations. >> thank you next speaker please. >> tom gillburty. i think another example of applause and redirection-so much of the energy for the police is having to deal with drugs, having to deal with mental illness on the street, homeless on the street. instead of jailing these people we need a alternative and for all of the other reasons everybody just said and continue to say, pause and redirection is needed instead of building more jail cells. thank you >> thank you next speaker please. >> hello my name is rilen tom and i just learned about this today, first of all i'm only 16. for myself to just learn about this today and see how huge this is, i want to discourage it because one thing is that you are encouraging people to be in jail. two, is right now i'm with the mental health board and we are doing a project about how teens are accessing mental helths services. the thing is, if you encourage this, like you are asking them to be in there. money sho

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

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

health insurance which is great about 20 percent provide reimbursement bktd i an employer reimburse employees and 20 percent provide the city option employers can choice one or any inspiration of those or other options to comply with the heartache ordinance about 20 percent as i said contribute to the city option who happened when a employer contribute the city once the contribution is made the funding is used to provide a benefit public benefit to the individual open who's on behalf of the contribution was made if the person is an uninsured they are provide with the training and experience that supports their participation in healthy san francisco if they're not an uninsured san franciscan perhaps they reside outside of san francisco their contribution goes into a medical reimbursement account in the amount that the employers contribution in 2018 some changes lows people to transfer their money in order to save up enough in their accounted to afford health insurance when open enrollment became available so, now to the detail of the city option modernization proposal today again her

we provided capability. we've provided support. we've provided training. at the end of the day, they have to fix this. >> they were successful to a degree that many of us didn't expect, and it was a decisive moment in the creation of a stabilized iraq. there's no doubt about it. we did a lot of things that supported them and gave them confidence. without putting large numbers of forces on the ground without leading in combat operations and conducting those operations do you think that providing embedded soldiers with the iraqi forces with communication systems with the ability to call in air strikes resupply, evacuation, those kind of things that an embedded american soldier provides and the confidence it provides could that be a positive factor in helping the iraqi forces to have the confidence necessary to get on the offensive and once again throw off these extremists? >> senator, it's been my experience that if we have americans with foreign militaries providing those capabilities that they do perform at a higher level, but there have to be other things

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.

we provide the strategy and support. we provide the funding. but ending veterans homelessness has to happen community by community. as i said, it's so much more than money. it's people like you who are committed to veterans and evidence-based strategies that work. another community strategy which is working is the mayor's challenge. phoenix, salt lake city, new orleans, have all reached major milestones the past year. in 2014, new orleans of course was the first major city to declare that they had ended veterans homelessness. houston recently announced that they have created a system that will help end and prevent homelessness now going forward. we expect many more cities to declare their results over the coming months. let me tell you, nobody has done more to help veterans homelessness than first lady michelle obama and the president. they have been there all along the way, provided the support and the leadership and the enthusiasm to get this done. partnership is one of our strategies that really works. we use the same principles in these par

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

from europe and other countries to provide us with protection.nd after the heinous massacre in the late 90s we still have 36 or 37 individuals mainly from the scandinavian countries providing some form of protection for our people in that city. these examples should be studied. the government abdicated its responsibility to provide protection. we need the security council to debate this issue seriously to provide us with protection. let me also add that we've been busy all day for the security council to pronounce itself on this issue to condemn this crime, and to resort to measures to stop it from recurring. we hope at any moment the security double will adapt a position to that effect, and it should be revealed to the international community. let me just share with you these two pictures of ali who was murdered and then burned alive. this is the second case in less than one year in which two palestinians children were torched to death. these terrorist crimes should not go unpunished. those who are responsible not only the terrorist settlers, bu

we have isis getting ahold and the iranians providing the taliban with weapons. is this a wise decision on your part to have a calendar base of american troops rather than a condition-based with drawl given your background and experience? i think you are probably well qualified to make that judgment? >> chairman i am aware of the consequences of the mission in afghanistan and i have a degree of personal commitment having spent time there. i can assure you if i am confirmed i will provide advice to the president to allow us to reach the desired end state and that is based on the conditions on the ground. >> other than a calendar base decision? >> my experience has been sometimes the assumptions you make don't obtain particularly with regard to time and that is certainly the case in afghanistan. >> thank you. in ukraine, it is obvious the russians continue their military build up. i was in eastern ukraine and watched the surveillance video made by the ukrainians showing the build up of russian forces inside ukraine. do you believe we should give the ukrainians coun

they will provide 4 work shops. these are 6 week workshops led my instructors who are certificated and the goal is to have 40 participants and 26 graduated from the workshops and they attend 4 out of the 6 sessions. the classerize 2 and a half hours long and the objective is to have the consumers at least 85 percent of them will be certify satisfied with the delivery from staff and volunteer and at least 28 percent will maintain or improve fitness level. also with at least 65 percent of the participants will be able to reduce risk if fall in fall prevention questions. >> any comment or questions from the commission? commissioner sims >> i didn't realize there were 16 different locations-14 locations. side question, is it difficult to attach the side chart to the proposal with multiple sites? >> we can offer that as nrfckz. we don't include it as part of the contract because site changes in terms of staff may change and it is more involved in terms of the contract modification process. that is the reason we don't inc

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

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