the medicaid funding is provided -- provided by the aca is set to expire this calendar year and the lack of a funding solution will be particularly harmful for american samoa as i know it will be for the other territories. i'd like to thank our witnesses for making the long trip to washington to testify before the committee today. welcome. each of your firsthand experiences will provide congress with an accurate assessment of the situation. aca's first allotment of funds became available in july of 2011, long before i and many of us here were elected to congress. those funds were only accessible after the normal annual allotment was exhausted. medicaid and chip payment and access commission, otherwise moan as mack pack published a fact sheet for american samoa which has a list for cal table of total medicaid spending from fy '11 to fy '17 taken from reported expenditures from the centers for medicare and medicaid expenditures. the annual expenditure is $30 million for that period. mr. chairman, i ask for unanimous consent to enter into the record a march 2019 mack pack report on medicaid

there's over 120 service providers at the event today, and they range anywhere from hygiene kits providedsics, 5% -- to prescription glasses and reading glasses, hearing tests, pet sitting, showers, medical services, flu shots, dental care, groceries, so many phenomenal service providers, and what makes it so unique is we ask that they provide that service today here it is an actual, tangible service people can leave with it. >> i am with the hearing and speech center of northern california, and we provide a variety of services including audiology, counselling, outreach, education, today we actually just do screening to see if someone has hearing loss. to follow updates when they come into the speech center and we do a full diagnostic hearing test, and we start the process of taking an impression of their year, deciding on which hearing aid will work best for them. if they have a smart phone, we make sure we get a smart phone that can connect to it, so they can stream phone calls, or use it for any other services that they need. >> san francisco has phenomenal social services to support p

we must provide it. thank you. >> hi, i am lauren babs, the director for planned parenthood of northern california. i want to thank our supporters that students for actually standing with us. we are looking for san francisco leadership to increase safety and security at our valencia health center. we have seen numerous abortion men sweep this country with one goal in mind. i direct challenge to roe v wade and to ultimately have the supreme court make abortion and act inaccessible in this country. we have seen 16 abortion bands in the last five months. because of this there has been volatile protester activity right in front of our health center. our patients come to us for judgment free care and they should not have a fear while getting that care. i commend all of the san francisco board of supervisors we have met with in the lap - past few months and their willingness to keep everyone in our community safe. thank you to the staff, as fpd, members of the attorney's office, city attorney's office and we s

community housing partnership is a housing provider. we support the budget justice coalition asked, and this is why. our residents are folks in poverty and people trying to get up out of poverty. we do a lot of work to support them to get there. all of these budget items, as requested by these community groups do that work helping people to address their pressing issues, and needs. hopefully rise up out of poverty and be self sufficient members of our community. behavioral health services, treatment services, all of the housing programs that we very much support and not only do our residents a benefit from the low income san franciscans across the board benefit from. particularly, we are also a member of the treatment on demand coalition, and within the e raff funding there are specific asks around increasing treatment programs. we very much support that. we are also a nonprofit, and we are trying to make sure that our workers, too, are provided with the same types of support so they are not left out of the picture. as a member of the s

the provider. >> if given, yep. there are lots of examples of, again, if you're out of network and you're forced to sign this sort of contract, there's no incentive for an insurance company to bring you into network. the insurance company is happy to have dr. smith in the town you're describing be out of network because they're getting him for in-network prices. that's what we want to avoid by putting them at a table together to work out a more appropriate contract. >> anyone else wishing to respond? >> i couldn't agree more on that one. if you talk about unintended consequences, again, we're all trying to get the patient out of the middle of this. and i think there's a consensus here. but the notion that some sort of a benchmark, a national rate, something that is an average would work in rural america i think is one of those unintended consequences you're referring to. that physician, that hospital should be negotiating with that insurer. should not be based on some number that somebody comes up with arbitrarily.

they have provided transaction in the past. [reading notes] the term of the contact -- contract is it pending approval. this allows counsel to develop knowledge on credits which is required to meet reporting obligations and provide consistent disclosure advice. the not to exceed amount is $148,950. that concludes my presentation. we also have janelle walker from bartley here if you have any other questions? >> thank you. do we have any speaker cards? >> no speaker cards. >> any member of the public like to address commission on this item? seeing none. public comment is closed. fellow commissioners, any questions or comments? >> no questions or comments. >> the only comment i have is i want to thank curls bartling for putting together a thoughtful proposal. i understand it was a unanimous decision by the seven panel members and the specific piece of mou is going to help provide consistency to the organization of van nuys and so forth. thank you. -- ocii and so forth. thank you. >> the only question i have i is -- does our small

i think it does provide accountability and does provide a public forum. it will slow down permits that are not covered by the public ordinance by six weeks approximately. i'm not saying that's a problem or not a problem. it's just another step we would have to have in the process. i would point out a lot of folks have brought to the local coordinator concerns of hsoc. if the commission decided they did not want h.s.h. to be involved and would not put a budget in there, i suppose that's the kind of leverage they'd have, but it wouldn't be over hsoc in general. and i think that's about it. we're not closed off to the idea of a commission. think there's still some outstanding problems with the way that it's written, and i think it should be an ordinance rather than a chart amendment, but i agree that supervisor haney is working very hard. with that, i'm happy for the opportunity to speak and answer any questions if they come up. >> chair fewer: thank you very much, director kosinski. supervisor haney? >> supervisor haney: yeah, thank you very much, director

brought to you by your cable or satellite provider. >> the trump administration is refusing to provide documents and other information to some house committees, the house oversight and reform subcommittee on government operations wanted information about the redevelopment of the fbi headquarters here in washington dc. subcommittee leaders said that's just one example. here's a look at that hearing where that issue was discussed. >> subcommittee will come to order. without objection, the chair is authorized to declare a recess for the committee at any time, this subcommittee is convening a hearing on the document production efforts on the office of personnel management, the federal bureau of investigation, and the general services administration in response to those committees and subcommittee document requests. i now recognize myself, for an opening statement. i want to thank the witnesses for being here, although i know there could be more comfortable hearings to attend. i regret we need to have this hearing. we are here because opm, the fbi, and gsa have not complied with the committ

this underfunding contributes to larger problems including lower provided rates and provider shortages. to correct this challenge i have introduced hr 2306, the puerto rico medicaid ask, which seeks to strengthen the medicaid program on the island by increasing the cap and removing a subsidiary fmap limitation. i'm also the regional cosponsor of hr 1354 the territories held in equity act. this was introduced by the congressman of the virgin islands that will face the problem for all tear five territories. those bills are under the jurisdiction of the energy and commerce committee and i will continue to work with my fellow delegates and the members of that committee to advocate for the advancement of those bills. i trust that today's testimony will help my colleagues understand the urgent need of action if we fail to act with the expediency that the situation requires, the provision of healthcare in all territories will be severely affected by far reach and repercussion for our nation. although i recognize that this is not the committee with jurisdiction, i would like to thank the vice

you can see, it doesn't provide much benefit for any of the neighbor, really, and it will provide much less appealing construction for the site. this building provides site lines to the street and a portion has been pulled back to really maximize the experience of the gas light building, the experience of the courtyard. you know, a lot of work to make sure this is a great compatible billion and benefits the entire block and the city as a whole. and we think that it's a great use of the site and we would ask you to uphold the project. thank you. >> counselor, are there any affordable units in this building? >> it's not required for an eight-unit project. thank you. >> thank you. mr. sanchez? >> thank you, scott sanchez, planning department. just on a couple of points, if i could have the overhead forwards. so we had public comment from the building at 1550. there's wheel a whole lot in between the two and that's the lot which is about 100 feet wide, which is wider than bucannon is. it's about the same width as bay street. so i think there is adequate separation between 1550 bay and the

we will provide residential counseling staff.ally, if emergency shelter is needed, huckleberry house will provide temporary safe home environment. as a native san franciscan myself, raising my daughters in this city, i am very proud to see this collaboration come together and very excited to work with this incredible group of people. i look forward to a future where we no longer need these services or these programs. when all of our children are safe, healthy, treated justly, and are well educated. but we have a lot of work to get there. by working together with the support from the california department of social services, i believe we can build a stronger community. thank you. [applause] >> thank you so much, doug and alia. in closing, i want to introduce the san francisco continuum team, the department of the status of women, just give a wave. huckleberry, youth and family services, family builders, west coast children's clinic, edgewood center for children and families, claire's house, learning for action, berkeley human righ

whd you provide to commit to providing the communications relating to the development of this presentation soon? >> chairman comings, we've had discussions with your staff regarding the e-mail communications surrounding these draft reports put together. my understanding and could be mistaken but we'd asked for a date range of those e-mails and hadn't received that yet. >> i promise you we will get them immediately to you. so we'll get you that date range and you will work within that date range to get us what we want? >> we haven't put eyeballs on those e-mails yet, so we don't see any reason why we wouldn't be able to turn them over but we need to look at them first. >> the committee is specifically requesting your decision making the materials draft and final. we have words with the staff for the highest interest and will continue to do so. these documents are key to our investigation as we are trying to understand how the decisions were made, what factors were considered and who influenced the decision. have you agencies decided not to provide the committee with the documents, certain d

first, let me provide some context. as you know, when disasters occur, state and local entities are the first to respond. but when the magnitude of a disaster exceeds the state, territorial, tribal or local government's capabilities, fema may assist, including through awarding federal contracts however, a recent work has demonstrated that fema contracting needs improvement. for example, in a recently issued report, we found fema did not follow all contracting laws, regulations and procedures in awarding more than $30 million for two bronze star contracts for roof tarps and plastic sheeting. although expediting the contract award process may be necessary following major disasters, fema's missteps could have caused a qualified bidder to be eliminated from further consideration or, in the case of bronze star, an unqualified bidder receiving a federal contract. failure of the bronze star contracts delayed fema's process for delivering crucial supplies to help puerto rican residents protect their homes after hurricane maria.

the state of new york has created arbitration process where the physician provider or the provider in general can come to a decision about what they think is a fair rate to pay taken the patient out of it. that the federal government mandates that insurance company pays a certain rate than that is price-fixing. the providers will end up being paid less and less over time. did the networks which is in network payments will start to drop because there will be no reason for insurance companies to keep doctors in network. the out-of-network payment will be much less. >> was it ever hard to make a call to treat or not treat thinking how this patient is going to pay for. >> it has nothing to do with the way you take your patient's. i never looked at what type of insurance the they had. that is up to the business people. as a physician i can say for myself, probably 99.9 percent of physicians, whether or not people have healthcare coverage when you're treating them for emergency conditions, does not come into play at all. that is our job. that is what we signed up to do. that is what we want

temporary and housing would be provided. the department of hope weatherness and supportive housing generally has not seen an increase in the amount of emergency services required in the vicinity of navigation centres. calls for emergency services in the area are not expected to increase because of the availability of and connection to services through safe center programmes and staff caring for the clients. even if there were a small increase based on the needs of the population, it would not impact the calls in the area. calls would be at the site due to one location but this concentration would not constitute a significant effect. neighbors have expressed concern about an increase in noise from ambulance sirens. based on date provided by the department of emergency services, in the five months following opening of the civic centre, there were several priority 9-1-1 calls to the site, averaging 14 calls per month. this is far less than one per day and that, from the navigation center, with the highest call volumes. now thes

we provide the secretary. with respect to popularity, we provide the ranking of each product. >> i just want to give you an example. they create a better set of headphones. it is great for amazon. more people become amazon prime customers. instead of seeing the fruits of their success, this hard-working man discovered the road on a regular gopher product. because amazon controlled the platform, because of self- taught billing and demotes the entrepreneur to pay results which most people never see. how would anyone in light of the sequence of events, how would any entrepreneur invest in this type of environment where that can happen.>> our incentive is to help the sellers exceed. we know they would go elsewhere. they have many options. we apply the same criteria to both. we do not use their individual data. >> i am now turning to the google search for a moment. everyday people think they're getting the best most accurate results. for the products and services they are looking for. people are seeing results for

so they're providing more than just the cleaning. but i want to say for purposes of disclosure -- first of all, i'm proud of the fact that i think the tlcbd is, perhaps, one of the, if not the most progressive benefit district in the nation. tou.that's not an accident. there was a lot of intentionality around thinking about and stretching the plan of what cbd can mean in a community. and servings as a low income sro resident of the tenderloin on the board, i would like to think i played some small part in moving them along. but the truth is, they've been work wig community organizations robustly to try to think about and envision what cbd can mean for the whole community. so i really appreciate their effort and i hope you can support them. thank you. >> next speaker. >> good afternoon. i'm dale seymour from the tenderloin. i've been here 35 years. i've have two businesses that total about 15 years. so i'm familiar with the tlcbd. you know, they're just a tailly organization. daily organization. the good thing, these folks are tenderl

user should look out for fees though often sending money to friends is free of charge but many providers make a profit on other transactions charges 5 percent on international money transfers for instance that can become costly in the long run. so here's a checklist for finding that your wallet that's best for your needs what countries and currencies doesn't work and how can i top it up what payment options do i have and what does the option i use most cost and as always it's also important to look out for your security and personal data. expert julie martin some basic advice for choosing the right provider look for multiple factor authentication look for making sure that there is a backup. and make sure that they are warning you about how you should and shouldn't be interfacing with the technology. whether or not my money is safe depends on how i keep it leaving my wallet is probably a bad idea using 1234 as a password for my wallet also not the best but providers need to maintain security standards to. technically speaking most do you want to buy serious providers are well protected th

>> yeah, it has been provided. >> okay, ma'am.s provided as part of the packet which is uploaded to the website and is public information. >> second. >> ma'am, you are out of order. until they are asked a question. >> i assume all of those lots have been subdivided, and required a variance? >> um. yes, looking out the parcel map there are um, it is the nature of the block to have smaller lot development. >> the property line between the subdivided lots do not match up, is not also correct? >> well, that was -- the subject property was a subject of effort previous variance granted by the zoning administrator. >> i understand that, i'm saying that subdivision compared to the one next to it, that the rear property lines do not line up, is that correct? >> they do not. that is correct. they do not line up. i do not have the previous variance in front of me. i am not sure. >> okay. >> ms. arnold, i am in support of the project. i think it is a sensitive project. the only thing i would like to ask is that since this particular small blo

the service that we are expected to provide. on the last slide, i would like to conclude by saying, we are glad to be here today. we're looking forward to public comment and anything that the community has to say about the m.o.u. i will be here until the very end. i will be taking notes so that i can take in everything that has been said, circle back with the department internally, and then go back to the school district next month and finalize the document. we are also in the process of updating our department bulletin because of 96 c. and the change in questioning of young people. we need to update our policy. of course, you saw that we are working on our know your rights brochure. we have added language there, and then last, we will be working on department general orders 7.01, which is our approximate leaf 14 page policy on how to deal with juvenile crime, juvenile victims, to reflect all the recent changes in the city ordinances and the laws, and things of that nature. this concludes my presentation. >> thank you commander

all providers should be required to provide key information about their service. we do all those things. we're a good player in that realm. and in protecting neutrality on the net is so important. i don't think it's productive to consider this issue as part of stelar. >> all right. so senator smith said that broadcasters, i think you said, represent about 12 cents of the overall cable bill. is that right? where do you get that number and -- >> it's a number that's not difficult to calculate. we follow it fairly regularly as an association. >> and mr. thun, what do you say about that? >> i'm not sure. i wish they were that low -- >> this is the overall cable bill, right? >> yeah, our numbers are significantly higher than that. i don't have the exact number in front of me. i can tell you, the number of 12 cents is dwarfed by what we pay overall for retransmission. >> $12.16 as a subscriber. as of march the 31st right off my p & l. >> that's for retrans? >> four stations. >> what do you pay for other stations? >> >> $62.12. 79% of my cable programming, 79% is program

the ordinance before us today will provide them amnesty under the code. it will consider them to be legal nonconforming businesses and allow them to remain in the building as long as they file the appropriate legislation. i'm also actively to protect light manufacturing spaces. light manufacturing provide working class san franciscans with working class jobs. the mission is one of the few places where p.d.r. zones existed, and we must protect these spaces. prior to active space building, there was a long history of this property of arts and manufacturing uses, so the planning commission imposed restrictions when it approved active space in 2004. the owner of the active space signed a notice of special restriction in october 2004, where he committed to make p.d.r. use of the building, including a prediction of both office and residential purposes at the building. it the city attorney is pursuing a separate enforcement process with the owner, but i wanted to provide you today with the full context of the situation we are solving for. once again, it is both

today china is the largest provider of official export credit, providing an estimated $39 billion in medium and lon long-term export financing, more than the next three combined. the administration looks forward to working with this committee and congress to reauthorize xm so that the united states is fully able to act as a market-oriented counter weight to china and other nations that use export and trade-related financing in increasingly strategic and predatory ways with long-term consequences to u.s. economic and national security. as i previously testified, the united states will not unilaterally disarm. in closing, i again want to thank president trump for his support. the president told me that the world needs to -- and i quote -- see more products stamped with those four beautiful words, made in the usa, close quote. america's workers need congress to reauthorize xm to help make this happen. i look forward to your questions. >> thank you very much, chairman reed. as we've already both mentioned, we've heard a lot about china. we've heard from the president, members of his seni

so i think that they are not providing the services they were actually providing before. just saying they really don't care. and they are transferring the accountability to somewhere else i heard that they were trying to contract, you know, older places to do some classes on diabetes. but i think it's beyond that. it's not just education, but also the service that is provided. so like i said, you know, my family we have high incidence of diabetes and i know it's common in the latinos, like myself. and the filipinos and some blacks also. and we tend to be on the low income side. so it's not profitable for them. and i think it goes back to how come they run as a non-profit, when they're not providing, you know, for low-income. thank you. >> thank you. >> any other public comment? it is now in the hands of commissioners to raise any questions for clarification with regard to the cpmc update, as provided for us. so, commissioners. >> commissioner green. >> i wonder if any information -- how does volume relate to, number one, unique patients, what the actual conserve is, you c

in the revised motion that you provided, with us, recently.fstreet freight loading section, page 31-32, are those numbers correct? should i be more specific? >> i see an extra zero. that is a typo. [laughter] >> also, seeking an exception for six of the required, to 11, isn't it? eleven of the required number? >> for retail? the micro retail? oh, for the loading? i would have to check my plans again. >> check that, then also whether it is exception for six or is it an exception for three? >> okay. >> on the page before, whether it is providing less than 50% or is that something else, depending on your number, okay? >> were you going to wait for an answer? just to clarify there is a provision in the code that allows them to do substitute spacious -- spaces which they are doing to offset. >> understand, but that number still does not match up. okay? >> we can certainly make the corrections to the motion if the commission is so inclined to make sure either the errors that are in the inspection are corrected on comply with the code. >> it's an inc

and page 6, line 26, strike operator and provide mobile provider. mr. city attorney, i would assume you would require a one-week continuance, and if you would propose a continuance, i would propose one week. >> chair fewer: okay. that was a mouthful? yes. >> supervisor mandelman: yes. i would like to thank you for your work that one would think was not remotely possible. this is the first serious possibility about doing something for the increase of congestion of t.n.c.s in our streets for 15 years, so thank you for doing this. >> supervisor peskin: thank you, supervisor. >> chair fewer: yeah. i would like to say although this is a tax regulation, this is by no means regulating the business at all. so i think we're going to have some of the same issues in ability to regulate the industry. i think it's a good first step. having said that, let's open this up for public comment. i'm wondering if there's anyone that would like to come on up on item 17. everyone has two minutes. >> good morning -- afternoon. i'm here to represent mothers out front san franci

they will be provided up 50% of ami.in addition to the three units, the project sponsor has volunteered to contribute one additional unit to the inclusionary affordable housing program. as based on the conversation for the community members. the project includes an addition of approximately 27,017 square-foot of office. office uses within the umu zoning district are subject to the vertical controls of her office uses which is not allowed office uses on the ground floor and limits the number of stories permitted based on the number of stories of the building. based on this, the project is allowed a maximum of one floor of designated office base in the existing three story building. the existing building has three floors of office base including the ground floor. as of october 2018 there is approximately nine and a 4,000 gross square feet of it small cab office development space. planning codes action 803.9f allows building with 5-7 ways to have two floors of office, the project is permitted to floors of additional office.

instead, it provides a blueprint for how c.b.p. should use its current budget and the $4.6 billion in emergency funding we recently passed to address the humanitarian crisis. second, the myth that my bill will make it more difficult for c.b.p. to prevent human trafficking. my bill specifically allows for c.b.p. to separate a child from an adult if, quote, such an arrangement poses a safety or security concern, unquote. such as an -- in instances of suspected human trafficking. furthermore, my bill requires c.b.p. personnel to receive training on indicators of child sexual exploitation and abuse. third, the myth that my bill requires medical specialists onsite at all times. that's simply not true. it is simply false. my bill only requires a licensed health provider, like a nurse, a physician's assistant, an e.m.t. or paramedic, to conduct health screenings. and it empowers c.b.p. to call in an emergency care provider to help with emergency triage decisions. that's it. and the emergency care providers can include those specialists. b

also not the best but providers need to maintain security standards to. technically speaking most do you want to buy sirius provider well protected the data reason crypted and stored on secure service it's recommended to use the wallets which have been checked by at least 2 i.t. security companies one risk remains humans passwords need to be protected and you want to use are a popular target for phishing attacks which enable criminals access to what this digital wants. this is the power and the danger of mobile banking you are your own bank and if you have bad security practices you lose your phone or something happens then you are the one who is going to suffer the consequences of that like online banking most do you want to use 2 factor authentication for example password and fingerprint what if a transfer feels as though some providers have accommodating rules similar to a bank but that is not a given equal it usually circumvents the middlemen making a profit and if there is no longer an intermediary there who is making money off of you. then you have

today, i will provide a brief answer. i will show the downside of our heavily marketed system, inflated prices, and lack of access, were all evident by 1960, the first year the u.s. health care system was declared to be in crisis. that crisis led to the federal government getting involved, ostensibly to correct for market failures. it did not work. the key take away point is this. policymakers who want to turn back the clock to some version of government free medicine need to look carefully at what the system was like before 1965, and why it did not work. why did the u.s. go the route of such heavily market eyes health care system? ized health care system? in the colonial era, guild regulation of medicine did not survive the transfer to the new world. colonialism encouraged the motto, every man his own doctor and the forerunners of today's physicians faced competition from alternative healers. you could call yourself a doctor and the association could do nothing about that. you could make drugs in a barrel and claimed the

provider from support services without. i agree with helen's comment about that being a self-fulfilling problem. if you don't have an address you cannot get a home care provider. if you don't have a home care provider, you cannot get to in shelter. that's crazy. the other idea, that scott said something earlier, some people cannot handle congregate setting, i am paraphrasing. as far as people with severe disabilities. that is ridiculous. a lot of shelters do not have adequate areas for wheelchairs and people with disabilities. also, this might shock everyone in this room, there is something called guidry. many people, in shelters are extremely bigoted. the staff does nothing about it. i witnessed an african-american being kicked out of the shelter because the color of their skin was upsetting people in the shelter. the shelter staff will just agree with the majority. if the majority is upset about a person with severe disabilities, who has a site seeing dog, or has a different skin color than people. they will get kicked ou

so look up china, if they're providing the same type of services that we're providing for china, andu'll see a multibillion-dollar difference. and about libya and the middle east, that's big mistake of $180 billion cash money on pallets given to libya, which is a terrorist country, and that's one of the biggest mistakes that the obama administration made in their presidency, giving cash money to that country. >> chair fewer: thank you, mr. wright. any other public comment? public comment is closed. i'd like to make a motion to move this forward to the full board with a positive recommendation. [gavel]. >> chair fewer: and madam clerk, could you please call the next item. [agenda item read]. >> chair fewer: thank you very much. and we have mr. juan ibarra. >> thank you, supervisors. my name is juan ibarra. i'm the acting director for the mental health services act in the san francisco department of health. i'm here to present our fiscal year 19-20 services act annual update. so to provide an overview of mhsa, this was enacted into law in 2005, and it's a 1% tax on personal incomes ove