license provider and it is provided with other needed services. we are working with many others to improve prior authorization processes and by making it more electronic, we can further improve its effectiveness and efficiency. health insurance providers have invested billions of dollars to monitor, detector, and eliminate fraud. we are a founding member of the health care fraud prevention partnership which includes the federal government, stated as, -- state agencies, law enforcement, and health plans. has saved, the hfpb hundreds of millions of dollars through the detection and prevention of fraud. we are working with others to simplify operations without sacrificing quality. for example, through partnership with the council for affordable quality health care, our members collaborate with other stakeholders to develop standard rules for electronic transactions. because of this work, an increasing number of transactions are now electronic. however, there is more work to be done. a 2016 schq report estimated that more than 3 billion manual transac

current provider. if they're already connected, we're working on making sure that they're going to get back on notifications in place, and if they're not connected, specific things will be done to make sure the linkage happens, or the referral happens and we can work on the linkage on the back end. we have staff that can support the p.e.s. care, and we have humming bird that is on the campus that can do warm hand off from p.e.s. directly into humming bird to address the need when someone from p.e.s. so the notification's in place. however we do want to improve on our documentation of these discharge categories and making sure that these are reflective of exactly what's happening, and i believe with epic, when we roll epic out in our system, we can really track this much better, much more effective in a unified way. the last report that just recently was completed and shared is around the crisis intervention services which is the bridging of support services -- support with the police and department of

with providers that provide specialist opener treatment services. we also the grant program at sancho, medication, way medication-assisted treatment. those programs provide practical experience to have the ability to provide a didactic classroom style webinar, web-based training but then the ability within regions of the country where people can go and see this in practice. and we think that is a way to better assure that that practitioners will feel confident enough and able to use new skill set to provide care when americans needed. we also continue to support programs called experts. we also encourage primary care to continue -- >> how does that work now? in the schools, how can we identify the kids that have these issues. is a burden always going to be on the teacher? where to go next once they are diagnosed? i know it's very expensive. treatment centers and a lot of insurance companies do not cover -- >> the time of the gentleman has expired. >> even if they do the co-pays are so very high deductibles. i'm sorry. >> the time of the gentleman ha

as the affordable care act provides for the public. respondents reflect a large range of industry sectors, from hospitality and retail to manufacturing and technology to energy and others. three quarters of the respondents have over 10,000 employees. over 30% of the respondents have over 50,000 employees. let's begin with the evolving role of the employer. we asked employers what role they play in the organization. primarily a move to manage their health care costs or a broader organizational strategy? theirompanies view investments in health and well-being as an important element of their overall workforce strategy. that theiranies say health care strategy is an essential role in their ability to employ the most productive, engaged workforce possible and to boost business performance. state theloyers primary goal of their health care strategy is to manage their health care costs. as companies are taking this broader view of health and well-being, we are seeing employers play in extremely -- increasingly activist role in changing healt

this activity as hospitals or health systems acquiring other hospitals or provider practices or provider groups often flies under the radar. because at the local level rather than the national skill. we asked employers whether cost, quality and experience often referred to avenue the aaa were any better, the same or worse prior to consolidation. employers felt in most cases provider consolidation has not resulted in lower health care costs. it often results in higher costs. costs. employers mostly struggled to weigh in on the effect of consolidation on experience and quality which reflects the lack of data available on these critical performance indicators. as result of industry consolidation on national skill we asked employers their perspective on the impact proposed mergers between health plans and pharmacy benefit managers will have on the aaa over the next three to five years, giving them an opportunity to gain some traction. 26% of employers are optimistic if these mergers will have a positive impact on the aaa. the theory being given the fragmented delivery system, the vertical in

>> yes for adults and colder adults this is from a new r.f.p., however, the provider is a long-term providerand the contract is retroactive to july 1, 2018. and this -- we're requesting retroactive approval because the process for negotiating and awarding this contract was delayed, the r.f.p. process was more cumbersome than we expected. they did have a previous contract that expired december 31, 2017. but we had a short interim six-month contract so that the contractor -- supplier or uscf has not been paid during this period. i want to note that there's a minor change in the resolution and the resolution says that it's a five-year contract but it's actually a four-year contract. so you may want to amend that resolution. and then if you have any questions on the problematic aspects of the contract we have someone here that can answer questions about that. >> chair cohen: okay, where are they? it's always funny when people sit in the back of the chamber and it's like completely minute. come on down here. how are you? good morning to you. >> good morning, ma'am. i'm the program manager with th

: there hasr verma been concern raised about providers who haven't been screened, providers who have provided medications and appropriately. that's not just a medicaid issue. that's across all potential insurers as well. there are problems with efficiencies, fraud, and appropriate prescribing, but on balance these are programs that are essential for us to deal with this crisis. would you agree? verma: it's important for people to have access to treatment. chair atthank you, mr. our witnesses for being here and our witnesses for being here today. iministrator verma, appreciate your comments about the importance of protections for people with pre-existing conditions. a number of us are eager to hear in the upcoming conditions -- upcoming hearings on the supreme nomination of judge kavanaugh is for him to clarify his position, because he has written he perhaps doesn't believe it is constitutional to require coverage of those pre-existing conditions. it's one of the things i am waiting to hear through the confirmation process. but i wanted to turn to an issue i think many americans are c

they also provide transportation. they also provide meals. 7 days a week. a number of the non-profits are transferring to that because they are the only physician that now consistently cooks in that area, everything fresh. on the other side within your area is on lock which also has a large diverse population. plus we can name a number of other sites in this area. and two blocks away is the rodriguez early childhood education program on mission street which is over 70 years old which provides nutrition, training for staff and diabetes because of the student population there. the grandparents come in. the parents come in and it's all part of this communication and education. all i'm saying is within this two-mile area there's a number of unique resources that are now being linked with sfgh and others to provide some of these services, including choir system from u.c.s.f. etc. but i still haven't seen any discussion and or collaboration to utilize these services to enhance the ability to maintain these cultural services within the new parameter of the new st.

and i will do the work on that and provide the answers at the retreat. if not, by provide the questions to the city attorney prior to retreat so she can help answer those, although she is likely unable to attend it sounds like. any other questions for me? >> i just had a question. maybe you have some insight. what is the timeline on the new commissioner? >> a for the law enforcement seat? >> i have been told by mayor farrell's office that they are not technically not going to act on this during the end of his term, so probably something that will happen or i will start working on it again after july 11. >> question. did we find a venue for the retreat? >> not yet. do you have any ideas? >> not yet. >> i'll figure something out. but yeah, if you think of anything, let me know. i want light coming in and so that is a little challenging with a lot of our bar venues. and also having a projector and screen capability, but i'll figure it out. and is there any public comment on the director's report? no, all right, public comment is closeed. item four. report f

this activity of hospitals or health systems acquiring other hospitals or provider practicest or provider groups often flies. under the radar. because it happens at the localr level rather than a national scale. we asked employers whether cost, quality, and experience often referred to as the triple lane,y were any better, the same or worse prior to consolidation.fet employers fel fill in most cases provider consolidation has notnt resulted in lower health care costs. in fact, it often results in higher costs employers mostly struggled to weigh in on the effect of provider consolidation on consumer experience and quality, which reflects the lacd of data available on thesepeorma critical performance indicatorsw as we looked to industryale, consolidation on the national scale we asked employers theiryr on impact ofedgers manageed mergers between health plans and pharmacy benefit managers will have on the triple lane. over the next three to five years, giving them an opportunity to gain some traction. 26% of employed are optimistic. these markets will have a positive impac positivet. impact.

provide p.d. that's focused on closing the gaps for african american students, so specific professional development around closing gaps, provide p.d. on effective use of form ative data, so these are all strategies around professional capacity that we believe need to be in schools, especially our historically underserved schools. then you can see from the central office supports that will be provided for these schools, coordinate new teacher p.d. opportunities, provide p.d. for culturally and linguistically teaching practices. in the area of instructional guidance, some of the strategies that we want to put in place is to make sure that we have full literacy development around our literacy programs. you can see full math development -- professional development for our math core curriculum, so making sure that our teachers have a rich professional development around the curriculum models that we have in place but making sure that the p.d. is full and rich and gives them the skills that they need to

during that time, the program has provided more than 2,000 individual grief counseling sessions, provided trainin traid outreach to 3,900 individuals and served 5,000 residents in san francisco. in addition to the increase call volume, cesp has seen a shift in the types of calls it receives. callers are presenting with more complex emotional issues, including showing initial signs of mental health issues, as evidence by exhibiting symptoms such as delusional thoughts, paranoia, anxiety and depression. it could be relighted to increase in promotion and awareness of the program services through insurance companies, clinics and other community providers. to manage and properly serve clients in the community need, csp is looking to increase services, which includes increases in staffing, as follows with proposed contract modifications. the program will use additional funding to help pay for five friendship line councillors, part of their role is to support and manage the volunteer staff. the program will be using funds to cover the cost associated with training the volunteers. which is a corn

luke's and the new bernal mission campus is providing. all i'm saying is that i just hope that as these programs have been moved -- and you're saying that some already have been moved, that maybe you sort of reflect on, in about three months or six months, i think, if, in fact, we are servicing and providing the quality that we've had a strong tradition of in this city, not only in reference to our community, our patients, but also in reference to places like san francisco general and others who you've always been a partner with us whenever there's a crisis, and we'll work together. you know, all i'm saying is i would certainly take a look at is there any way we could, you know, not change, but perhaps -- you talked about a continuum of care and continuum of access. let's think about it, and the quality your institution has provided in the city for all these years. i would hope you would increase that quality and community involvement and think about these things as you get underway in your new flagship. >> so commissioner, thank you for

and a maximum that our providers are paid is only $14 an hour so it's extremely hard to get providers to come help us in the home. on top of that there is the issue of curb cuts and basic access in restaurants and businesses where we might have an access to the front door but we cannot access the bathroom or get to the basic areas and just recently i have been yelled at by business owners just for being in a wheelchair in their business because they don't want me there. and they don't want me asking for anything. so i bring this to your attention with the hope that this can be addressed. i have brought some of these issues to mofd's staff at last month's meeting and i hope for some follow-up and investigation into these crucial issues. thank you for your time. >> co-chair sehaux: thank you, zack. we're going to -- any other public comment at this time? >> no. >> co-chair sehaux: okay, thank you. we'll go ahead and close public comment and go to information item number 4 which is the co-chair report. and i just wanted to share some information. first of all senior and disability action

what we find in the past, supplemental payments to local providers who provide a lot of share, to meet their match and not necessarily because they had the highest level of care for medicaid recipients. this is important to clarify and insure payment. last is the audit that need to be done. seema verma mentioned audits, very important, glad they are resuming after a four year hiatus. the beneficiary eligibility determinations, managed care is my big concern. 36, $37 billion in proper payments. most of that is the for beneficiary eligibility determination, $500 million in managed-care. managed-care has grown over the years without a lot of good payment integrity and oversight processes in place. cms is planning to start that but state auditors are a tremendously untapped resource. two state auditors with us today have volunteered to come to the hearing, beth wood, auditor general from north carolina on the left right here, she is also the president of the state auditors association, the state opera from louisiana will be the next president taking over that association for state auditors

healthcare providers, small, rural providers, in my statement, have of the program for next year. because they have no idea if going to get the money. so i would like an answer from with f you starting commissioner rosenworcel. >> yes, senator. i recognize how important this to alaska. i am aware of difficulties and i can commit to you now that we resolve them as expeditiously as possible and make sure that we don't continue to have them going forward. commissioner carr? >> yes, sir, i'm aware of it, and i've been a voice inside pushing to make sure we can get to resolution and get stability going forward. you.hank commissioner o'reilly? >> yes, i agree with my point.ues on this exact >> and mr. chairman, again, my rustrations on this have exceeded almost any other issue i've worked on as a u.s. senator. your f it has come from office. >> senator, appreciate your concern. as you know we've had many about this.s >> too many. >> as have our staffs and i can i'm obviously weserve -- aware of the issue. >> this was stated, some version of that probably eight months ago. again, i've lo

and provide the i.t. and systems that provide for it. by having those groups closely aligned and working together, we think -- >> emily, do you think you can do this piece without legislative, without congressional approval? >> it's my understanding we can do the transfer without legislative approval, but i don't know -- i know our lawyers are still working at it, and i don't want to speak definitively, 100%, but it's our understanding we can make this happen. >> large part i think we can do this administratively. there are some things that our lawyers are taking a look at. there's certain authorities such as usa jobs, assessment authority. it's not a fee-for-service business. it's actually opm's responsibility to post all the jobs across the federal government. before there was usa jobs, people came to the basement of opm and went through the reams and reams of paper. >> i just want to make this point, this is what i don't want to have happen. i get mad at usa jobs as i already am, so it's a short trip.

can you describe what that is and what services this provides? this is a policy affiliated self-helpaffiliate credit organization based in durham. access toamilies credit. we have provided $6 billion to nonprofits and small businesses. this has gone on in about five or six states, including with -- wisconsin, florida, and california. the 80'st unions in had a legacy of redlining with african-americans in the region. our ceo started the credit union in response to that. we are grateful for the policy into theing input perspective of what products work and the threat to financial stability and what would directly compromise that. >> good, positive action. underscore i would the importance of the issue of these lending practices as a barrier to retirement. recognize this serves as a barrier to savings. employers have increasingly or trying to help people address problems where they are caught up in payday loans, sort of a cycle. , and reallyembers many more of them have this, but one of our members established a not-for-profit trust to provide emerg

but the reality is whatever health care plan you're providing to your contract workers, you're also providing to all of your other employees. you can't give this group a favored health plan and a lower level health plan to everybody else. so if the standard provides -- mandates a really expensive plan, you've got to come up with the money somehow for the rest of your employees. some employees, most of -- others might have ten or 20% of their employees working on the contract, so that is the struggle that we face. that is why we support the proposed recommendations and hope that you will approve them today. thank you. >> thank you. next speaker, please. >> carl kramer, san francisco living wage coalition. three points i want to bring up with the health commission. point number one, as you heard, there was strong concerns from labor and worker advocacy organizations that the $45 copayment for primary care provider visits deterred low-income workers from seeking checkups and preventative care. the study by the san francisco department of public health office of policy and planning, called san fr

so it's exactly why we're trying to provide them some stabilization.oing this almost 11 years ago really looking at how to work with the residential care facilities in both ways. one, to provide them dollars to serve clients with higher needs and also to help them to cover their costs that ssfai doesn't always cover. because the increases don't match the cost of doing business. >> all right, thank you. [applause] >> we think over 50 thousand permanent residents in san francisco eligible for citizenship by lack information and resources so really the project is not about citizenship but really academy our immigrant community. >> making sure they're a part of what we do in san francisco the san francisco pathway to citizenship initiative a unique part of just between the city and then our 5 local foundations and community safe organizations and it really is an effort to get as many of the legal permanent residents in the san francisco since 2013 we started reaching the san francisco bay area residents and 10 thousand people into through 22 working groups

third, we working to optimize how we use state provided claims and provided it in a program integrity efforts. for the first time as of last month every state, d.c. and puerto rico are now submitting data on the programs to the transfer medicaid statistical information systems. we are now shifting from sub the collecting the data to using advanced analytics and other innovative solution to improve data and maximize the potential program accountability and integrity purposes. moving forward we must continue to bolster our existing efforts and optimize the use of data to drive better health outcomes and improve efforts. medicaid is to find the program to the product am appropriate spending threatened its sustainability. but as long as the program remains an open ended entitlement enters a 90% match rate for the expansion population, states have an incentive to find new ways to draw down federal dollars. cms will need to continually adapt and adjust oversight policies. ultimately, we need to work together to consider structural changes to medicaid programs that would control spending at

the supplements that they provided. those are gone. so, i am highly suspect of anything cpmc does because they really are not into to long-term care for any san francisco an and i want you to be aware of that. it's always a double-edged sword. so i am highly suspect of this proposal. and i'm really thinking public accountability is needed where cpmc is because they will never do the right thing by anybody. thank you. >> thank you. >> do you want to indicate the reason for this management transfer and if in fact a representative of the foundation were here? how the foundation fill the gaps of what happens as you transfer these programs. >> thank you, very much. this is dr. elizabeth bellardo the chief executive officer of the medical foundations and she will comment as well. let me just start by reminding everybody here that contrary to what you just heard, we have a tremendous long-term commitment every single person in san francisco. has manifest by the fact we will soon be opening two hospitals to serve the people of san francisco fo

we also provide both pre-nd post exposure prophylactics for hiv prevention we also provide a range ofomen's reproductive health services including contraception, emergency contraception. sometimes known as plan b. pap smears and [inaudible]. we are was entirely [inaudible]people will come as soon as were open even a little before opening. weight buries a lip it could be the first person here at your in and out within a few minutes. there are some days we do have a pretty considerable weight. in general, people can just walk right in and register with her front desk seen that day. >> my name is yvonne piper on the nurse practitioner here at sf city clinic. he was the first time i came to city clinic was a little intimidated. the first time i got treated for [inaudible]. i walked up to the redline and was greeted with a warm welcome i'm chad redden and anna client of city clinic >> even has had an std clinic since all the way back to 1911. at that time, the clinic was founded to provide std diagnosis treatment for sex workers. there's been a big increase in std rates after the earthquak

it provides water to several counties. reason the sfpuc opposes the plan is because it has a contractual plan with modesto to follow their lead on in-stream flows. sfpuc gave up its right to think and act in accordance with the values of constituents. a recent public opinion opinion found that 93% of san francisc n franciscans conserved water during a drought and 94% said they would conserve if it benefited the environment. 21% only if it enabled more development. three times as many people said they would be more likely to blend groundwater with drinking water if it benefited the environment versus enabling more development. 97% supported measures to protect san francisco bay and 92% restoration of the twalamy river. and 88% for affordable housing and 68% for market rate housing. support for more office space was low at 40%. another reason the sfpuc opposes the bay delta plan is because it's planning for a massive amount of development. plan bay area prepared bye-bye area metro forecast 4.3 million new jobs and 2 million

it's important we are able to conduct risk assessments and provide the tools that have been provided at the state level so we will continue working with dhs and would love to the system of congress. >> mr. hatch, you want to follow. >> was i agree. the best way the federal government can help is to provide assistance to resources, consulting, as well as dedicated unpredictable funding so that we can identify with our needs how much we will be able to meet the states financially. >> the first two years i was your i served on homeland security, i was amazed at how many times wrote on a daily basis that there are attempts from the russians for cyber hacking, that is nonstop in fact, it was all the way back in 2012 when i believe a former presidential candidate pointed at the concern expressed the geopolitical threat that rush is. mr. hicks, question for you. what advice does the election assistance commission from your and we can provide the state and local officials when evaluating vendors for cybersecurity? >> we operate under the voluntary system. if a vendor wants to submit a system

he makes the case and provides the way to get to zero debt. yes. no debt. i have even seen that work with a number of couples. finally, nonprofit organizations of all sizes and missions are active in promoting financial literacy. a study by the consumer financial protection bureau estimated that in 2012 alone, nonprofits spend more than $472 million in direct financial literacy services. ? but what of the federal role -- but what of the federal role? 2003, i cosponsored legislation that was largely adopted in the credit transactions act. creating the financial literacy and education commission. we will talk about that more later. it was created to develop a national strategy on financial literacy efforts and promote private and state and local efforts. unfortunately, despite significant progress, in coronation and building of partnerships, significant overlap and ineffective resources -- resource allocation persists. a fact that has not gone unnoticed by the current administration. that is why i am looking forward to introducing current u.s. treasurer has b

generally these services are provided less than 24 hours. participants attend a certain number of days, and generally participants also payout of pocket as this level of care is not reimbursed by health insurance. these levels of care also offer recess piet for families and their caregivers, and they're licensed by the california department of health and social services. the program on the rite indicates adult day programs in san francisco. there are ten programs in total. three who serve adults with did he shen shall or alzheimers, and one that serves adults who are vehemently disabled. in addition the department of ageing and adult services provide some assistance for adults with dementia or alzheimer's. so while cpmc has been working together with the institute on ageing on this planned change, currently, the institute on ageing has not identified a new location for the day program, and so the impact of this change is uncertain? we know there are a limited number of adult day programs in san francisco that serve adults with dementia or al

so it's exactly why we're trying to provide them some stabilization. we started doing this almost 11 years ago really looking at how to work with the residential care facilities in both ways. one, to provide them dollars to serve clients with higher needs and also to help them to cover their costs that ssfai doesn't always cover. because the increases don't match the cost of doing business. >> all right, thank you. [applause]you. >> today, i wanted to kickoff and welcome you to the first every family well forum (clapping.) >> compromising is carmen chu currently which this of the family forum we put this event dough went to a lot of community meetings and we're he and she about families worries and troubles aaron planning for the future and ahsha safai for buying a home and college and retirement and for many of the seniors how to passing on their prompts to their kids. >> the family forum benefits throughout san francisco i'm supervisor norman yee representing district 7 people are homeowners fritter buyers and they don't thinks the planning. >> what

provided by chinese companies z.t.e. and hallway, due to the concern that they represent security risks and have violated u.s. sanctions. the provision would also ban the use of video surveillance equipment from several chinese companies due to concerns about security risks and infringement of intellectual rights. this will place a ban on some telecommunications provides and include a direction that government agencies shall prioritize available funding to enable these providers to replace the equipment they have procured from chinese companies. i'm also particularly pleased that the conference agreement includes a senate floor amendment that i authored to ensure that as we proceed to develop nuclear weapons, the congress is in a position to provide vigorous oversight to any such request. given the powerful nature-these weapons, it is essential that we maintain our oversight on this matter. it also includes language to ensure that that we can maintain the plutonium pits. los alamos is the center of producing plutonium an