services. for health 360 we serve about thousand people in our substance treatment program. 94% of the people who come into our residential treatment program sleep on the streets before they come into treatment. 45% of those people leave treatment without a place to go. we're feeding people into our system who don't have resources, don't have a place to go, can't get better. you can't get better when you're sleeping on the streets. please just make sure that you're really respecting the resource needs and process as opposed to jumping towards taking people civil liberties away. thank you. >> good morning interviews. i'm denny smith. i'm here with javier treatment on demand council. i'm here someone who's used all the services that we're discussing today about six years ago i was placed on opioid medication by a kaiser physici physician. when i came back, i found myself homeless and jobless and kaiser right before the aca enacted, discontinued my insurance care. i'm someone who's spent the last

postal service, the destruction of the u.s. postal service. in the first place, as you well know and you could explain better than i, the postal service is required to contribute these enormous amounts of money every year to the retirement and fund the pension system with -- in a matter of a few years that could be taken care of over the course of decades. and that is -- that is one measure that the republicans have done to try to destroy the postal service. second, we could have public banking. we could have the kind of banking services that the u.s. post office department had at one time in the 60s so poor people and people who have a hard time maintaining the kind of bank accounts and commercial banks could use the post office and the same way that they use these check cashing services and all sorts of ways. and the idea of simply eliminating days and the three or four days worth of postal delivery every week, this is not postal reform and this is not what the american people want. the american people admire the u.s. preels. mary is an outl

can do in those services. but for those who are willing, we do have some recommendations on how b.h.s. can address that. and the other thing we also wanted to point out, which is why fixing this sort of system issue is really important, is that 65.5% of p.e.s. clients during that year were struggling with a mental health diagnosis and substance abuse diagnosis and they have a higher recidivism rate. one of the things was to update the 2016 protocols that were already developed, so they recognized this was a problem. and we recommend some additional improvements to ensure that referrals are given to everyone who's discharged, and make sure that there are notifications to the b.h.s., like, county providers in advance of client discharges so they can make sure that transition takes place. and then, the second piece was making sure that intensive case management staffing is at a level that is adequate to transition these clients. the fourth finding which i think the city is well aware of is there's a cohort of adu

services. we have received multiple numerous notifications from neighbors from local people from businesses about their concern about this one individual. we know this that this individual presence and his behavior have impacted that whole neighborhood. immediately, as that came to our attention, we immediately looked at the background and found out more information. we deployed our engagement special to go out and meet and connect with this individual, to really understand what's going on and get as much information. we engaged with this individual and tried to about understand what the issues are and look at all these notifications coming and understand the patterns. through this process there was an event that occurred that this person was actually ended up being taken to psychiatric emergency services and was put on hold for 5151 psychiatric manufacture services. because this individual was identified in our high priority case review, which we have this robust process that we look at these

or a private service provider. almost all parents love their children and want to do well by their children. if they are given the resources and skills and training to raise children safely, that is what they want to do. finding a way to empower those families and do what they want to do anyway, those kids want to be with the biological families. they don't want to be eking away even if they are -- how do we equip these families to do what they want to do anyway? instead of passing judgment on what is happening and immediately traumatizing kids and parents by ruining them. >> i would second set. the one we talk with youth in care, they would always say you can help my mom. you could have served her differently. we're also excited about what congress and the administration did with family first and why this really is the change for states and communities and how they serve children and families. working and educating yourself on this opportunity and becoming involved and sort of supporting child welfare in the state

services. we wanted to look at our intensive case management because we agreed that this is an area that needs to be looked at. there's about 1400 intensive case management slots. to we need more slots? yes and no. yes and we've already acted on it. we're opening up 40 slots. we're opening 20 more slots for assisted outpatient treatment. then the hope is that by looking at our reviewing and doing utilization managements, we can open up more slots. if we need to do have more, i think we should. at this time, i think we're doing lot of things and we have a consultants to look at our intensive case management. we are reviewing that closely and what we have -- we took on performance improvement project to look at how people from intensive case management transition to outpatient. this is a project we took on and the state is monitoring on that to make sure there's handoff it people make the connection to intensive to a lower level. we received two innovative grants that i'm pleased to announce, one

and in that service, i provided service plans for the youth in support of the youth. unfortunately, it was blocked through the department of probation, and so ultimately, the youth would suffer because they didn't have a service plan provided that was referred by the attorneys and public defenders. we have the legal way from our politics but because it's hurting the youth ultimately. thank you very much. >> supervisor mandelman: thank you. next speaker. >> i was just looking around the room, and i see jack jackle and a whole host of people that didn't need to be there. i think everybody agrees juvenile justice, there's a problem there. i don't know if it can be fixed, and the only other alternative is to have it dismantled. i think if it would have been fixed, if it could have been fixed, it would have been. i think we had a good shot with willie brown's juvenile justice program. we gave it a shot skpr, and it didn't work. let's end it now. >> supervisor mandelman: thank you. next speaker. >> i was the clinician up at log cabin ranch for the last five years up until i

so, the whole provision of the rad service model, the word sup is really social service support. it is not the same kind of services. it is not intensive like that. that's why it is a one to 75 model. the contracts are going to housing developers and there was service providers as their partners because a lot of them don't do their own social services. when we put the rfp on the street we ask them to find service partners if they were not a service provider themselves. we require them as part of the policies and procedures to work closely with neighborhood agencies. particularly until senior disabled building. we -- in senior disabled building. we want them to be connected to different programs appropriate for them. some of the issues were they were isolated and didn't know how to get to those programs. we help to provide transportation to and from those programs to make sure they get there. staff will check in with staff on site at the different senior centers to see how those things are going. the intent is to provide connections to the local neighborhoods or groups if they hav

services. whatever the strategies may be, coordination with the tent of homelessness in support of housing. pin point those 2200 individuals and plan and strategy to reduce the cost to the system, 52% of the overall cost of emergency care is significant. then secondarily, one small piece is the last part. these out of county individuals and working in collaboration with the tent of homelessness. the other recommendations were more intensive care staffing, filling the staffing. those will be the two things if we can, file this report in this body. i'm asking that you follow-up with us. we'll is a follow-up hearing on this. >> thank you. >> supervisor safai: if we can just transition to ms. lisa pratt. >> i apologize that i have to keep our committee on time. we have another very lengthy hearing after this one. i have one slide. supervisors. i'm dr. lisa pratt i'm director of jailhouse. i appreciate the opportunity to dig deeper into thee complicated issues. the jail population represents nexus o

as the first weekdays service was coming out. we were having a difficult time meeting that service. that's when we started communicating to folks that they might see gaps. >> supervisor brown: no one in your agency knew that was coming before then? >> we understood that we would have challenges in filling all the service given the huge demand. i didn't appreciate the magnitude of that coupled with other things happening. our training folks based on. the general signup, the work that we were doing to familiarize operators with new equipment. i didn't have a good and clear picture. >> supervisor brown: there was no communication month before with your staff that said we're going to have a problem and an issue if the summer? >> we anticipated that we needed to ramp up. we didn't ramp up our hiring and training and getting existing operators back to work adequately as much as we could have. sometimes it's other projects that require us to substitute equipment. we can plan for and manage them better so that we can minimize the impacts. there will be disruption. we need to do better job o

in certain instances they're paid for a fee-for-service where an hourly rate is paid and for appeal services they perform. >> supervisor: describe to me the instances where they are paid when they recoup? >> generally speaking, there are instance where's regulation is passed down from a federal perspective or from federal regulators that counties or counties who are operating hospitals disagree with and instances where multiple hospitals have a similar issue or take on a similar case, what's created is called group appeals where the zuckerberg general hospital or hospitals in san francisco are able to participate as a group on an appeal case taken to the administrators and for those cases, it's difficult or the practice that it will receive a percentage for successful appeals. >> >> supervisor: thank you. mr. mario marino, please make your presentation. >> good morning, supervisors. first of all, i'd like to acknowledge the contract is brought to you late due to a staff absence during the time the contract was to have been continued. we've since then addressed staff fully primarily my hire.

transit service, as well as the ferry service. those are the three main drivers as it relates to the height or the level of the toll. there are other costs as it relates to administration, and the affordability program now does have a financial impact that we are proposing. it has a financial impact as stated in one of the slides of approximately $3 million a year for the $300 a month stipend that we are proposing. >> i look at it a little differently. i look at it as we will be raising less for the operational cost for the shuttle and we will have to find other revenue sources to cover that gap if it is not coming through the toll. i don't see it as an expense. i view it as less revenue for these three options. so then the rest of the capital infrastructure is fully funded. >> yes. the capital construction for what you see on this chart here, we have the southgate realignment, the westside bridges and major ones they are. they are funded by the developer or by state and federal funds which some match from the developer and other

as we bring these services to the official city functions, i think it's essential that pretrial services be under a civil authority. senate bill 1054, which was signed by the governor in september, granted the city and county of san francisco an extension to maintain the current, separate, nonprofit funding operations until january of 2023. i heavy some brief nonsubstantive amendments that i have circulated. you should have them in front of you. first, i'd like to add "whereas clause to read as follows, september 30, s.b. 1054 was enacted that granted the city and county the ability to contract with the nonprofit entity performing pretrial services to provide continuity and sufficient time to transition the entity's employees to public employment." and i would like to amend the first resolved clause on page 2 line 6 to reflect senate bill 1045, "resolved that the board of supervisors reiterates the city and county of san francisco's authority under 1054 to allow san francisco pretrial services agency to continue operating in its current form as an independent, nonprofit organization." i

by service. and it gives the physician the flexibility to coordinate with both medical, social services and also interact more completely with the patient potentially outside of the context of an office visit. but i also think we're paying for primary care wrong by paying for it within the fee schedule and paying on a per-visit basis would go further in trying to pay on more of a block basis for those services. this would probably require a beneficiary to have a designated relationship with a by mare care physician -- primary care physician, and i think in the long run that's probably not a bad thing to happen. now, a lot of the motivation in the conversation today was about documentation. and here again, joe gets credit, took the point that i was going to make, but that's fine, i'm okay with it. [laughter] joe said, well, you know, if you're interested in burden -- i think this is the point he was making -- what about this whole mips situation. as you guys, as was explained but just a quick prim

we did focus heavily on making sure that service was on those routes, and that we weren't missing service, but we continue to need to look at new ways to enhance on-time performance. and then finally, as i discussed ,, we reduced our preventable collisions by 5% and we will continue to focus on collision reduction. moving forward, i plan to take the month of december to reflect on our progress and learn. we will also invite more feedback from the folks closest to the work. i often think that they really have the best ideas, and we also have some actions that we didn't complete. they will roll forward with the idea that the next cycle would begin in january and carious through march -- and carry us through march. in that period, we will be doing a two month closure of the tee line. the scale of that construction is smaller than twin peaks, but we are very actively taking the lessons from twin peaks and making sure we apply them to the project so we really minimize systemwide impacts while still providing really excellent service for our tee line customers. in the next 90 days, i think our

different service levels. it's one of the amendments that came out of committee. the e.i.r. and the transportation obligation call for a 10-minute build-out. so muni service is going to be funded the way that new muni service associated with development is funded everywhere else, which is increased general fund revenues. but i mention it here because it's robust service levels that we need to help muni achieve, which is a less than 5-minute frequency. it's rapid. and it is and will be needed. and we will need to work with m.t.a. to make sure that's achieved. we have done a number of oute outreach this fall and we brought an initial concept to committee in october. the committee directed us to go back and do some more work, some outreach, and then presented a revised proposal to the committee at the end of november, november 27. we've also been briefing the tida board in parallel. some of the things we heard were concerns about affordability. some businesses concerned about the ability to attract and retain wor

department of health and human services. she first served as an associate director for the childcare bureau and then as an associate commissioner for the children's bureau where she oversaw a $7.2 billion budget and 130 employees responsible for all child abuse prevention, foster care and adoption programs delivered by state, local and tribal authorities. cal pin is an alumni of the hill. she's served as a congressional staffer, the lead one for the income security and family support sub-committee of the house ways and means committee. she worked with members of congress there and with others on passing legislation effecting programs including child welfare, childcare and a temporary assistance for needy families, known as tanf programs. >> thank you very much. good morning. my name is christine calpin and i'm the director of public policy at casey family programs. and i'm pleased to be here with my colleagues and welcome the opportunity today to introduce you to casey family programs and describe our vision for supporting c

and evaluation of services. bob has talked about one notion to redefine services based on time. there are many other ways that this could be addressed, but this is the opportunity. this is the perfect moment to think about the consequences of what we have done before, and the what we do is enter medicaid payment data. in addition, we all looked at reported death rates, and we cluster death rates according to groups of specialties. but it turns out i'm not even alone. many specialties are cognitively intense and make significant issues with the workforce. let's take a look at the slides here. one moment please. what you will see here are pairs of maps. we will look at the first map. this is a dense area from mississippi into ohio. this is where the id doppler's are. there are massive areas in this country with no infectious disease physicians that all. this is diabetes and all the complications of diabetes. then you can say maybe this is the way that doctors distinguish themselves. your are the ophthalmologists a

etiquette services and figural health services, long-term services and support and law requires integration of plans what is integration what should it look like? should be single entity? so they offer the services for tumor plans and even if plans are one and the same? what are the challenges to creating if we can, single pathway point of medication to the point of medication especially for the duels? the question who wants to start? >> i think that's a huge question. you know -- one of the things with integration vacation coordination which is critical and much easier to do it if you have the panels position in your panel and you have the relation in your network and relation with them. if your eight -- plan you want to also have the health benefits for dual eligibles. talking people who are in both programs and health benefits as well for both coordinate so trying to do it loosely across organizations is difficult. then i think the thing is capturing the medical savings because at the end of the day that's where this has had. to show the services when they are provided result in a return

, to the end of their service.his is overdue. and it needs to be monitored. it needs to be assessed so that we as the committee in a bipartisan way can make it happen. in closing, i'm extremely proud of the bipartisan work and i'm looking forward to the 116th congress and i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from tennessee reserves. the gentleman from california. mr. takano: mr. speaker, i'd like to yield two minutes to my good friend, the gentlewoman from maine, ms. pingree. the speaker pro tempore: the gentlelady from maine is recognized for two minutes. ms. pingree: thank you, mr. speaker. and thank you to my good friend from california for yielding the time. i rise in support of the veterans benefit and transition act of 2018. frankly, it's always a good feeling to be able to speak for commonsense legislation put together in a bipartisan fashion for the good of america's veterans. in particular, i welcome the inclusion of section 504, the vetera

, behavioral health services, long-term services and support -- the law requires integration of thoseplans. what should integration look like? can that be a single entity, can two or more plans sufficiently coordinate to offer these services even if the plans aren't one and the same? what are the challenges to creating if we can a single pathway, point of communication -- especially for the doers? big question. who wants to start? all right -- you are next but you can go. >> i think it's a huge question. i think it's one of those things with integration that -- with communication and coordination it's critical and it's much easier to do if you actually have the panel of physician -- you have the person's physician in your panel, right? or in your network and you have the relationship with them yourself. if you are a plan providing long-term services and supports you also want to have the health benefits that are dual eligible, talking about people in both programs. you want to be able to have the health benefits as well and the ability to coordinate so you are trying to do it loosely

up dates on self-service. presentation by mitchell griggs. >> mitchell griggs, chief operating officer at the health service system. in this time every year, we take a moment to -- just to brief you on the successes and the numbers and statistics of what happened during open enrollment in october. and i believe i started in september telling you some of the things going on this year. so just wanted to highlight what was unique benefit wise for this open enrollment. one very big thing is we started self-service or e benefits for the first time. this is people being able to log in to a computer and do their enrollments instead of paper as they've been doing for the past decades. another initiative we did was a communication or photography, member engagement through our communications and trying to do some things to get people to read our benefit materials or to read our e-mails. and so i think some of these things were very successful, as you will see in the numbers that we're going to talk about. so on page one

but it doesn't have to be military service. it could be more of a peace corps service. had parents who opened up barbecue rib straublets right here in the state of texas. desoto? anybody live here locally? duncanville. we had a couple of them. shirey's eat shop. anyway, just from watching them, i'm curious if we have reached a point now where it's helpful to people to have skin in the game. because when you're running a business, ownership is huge. you don't want, as you say, a bevy of employees who don't want to be there but you also don't want a lot. of people who don't take ownership of the work they do, no matter how much they want to be there. i wonder if there's room for that? i'm curious on your thoughts. >> as a leader -- leader, future leaders looking to go into the service, the ability to influence and empower people that are around issue what is absolutely needed in the foregoing future. you're right, we were in professions where some people didn't agree with why we were there. when i was in afghanistan i had soldiers ask me, sir, why are we even here? really

thank you for your service, rest in peace, mr. president. mr. williams: next is the gentleman who represents a very large district in texas, congressman will hurd. mr. hurd: i want to thank my friend and colleague for arranging this conversation. i want to join my colleagues and omourning nation as we continue to honor the legacy of president george h.w. bush, a giant of a man we should all aspire to be. he's also a man of integrity who focused on his family and faith. he was a loving and caring husband, father, grandfather, and great grandfather who treated his friends and his foes with kindness, humility and respect. i will be forever grateful that he fell in love with texas a&m university, my alma mater, because that's where i had the opportunity of meeting and becoming friends with the late president. he encouraged me to join the c.i.a. and had a lasting impact on me and many of my peers to answer the call to service and work toward causes greater than ourselves. i will be forever grateful for him instilling this spirit in me. 41 was the epi

services at the u.s. capitol, national cathedral.es right after this short break. g . you don't need to go anywhere dad, this is your home. the best home to be in is your own. home instead offers personalized in-home services for your loved ones. home instead senior care. to us, it's personal. home instead senior care. opportunity is everywhere. like here. where you can explore the world knowing you can always find your way home. ♪ ♪ ♪ this holiday season, families near you need your help. visit redcross.org now to donate. - (phone ringing)a phones offers - big button,ecialized phones... and volume-enhanced phones., get details on this state program. call or visit and accessoriesphones for your mobile phone. like this device to increase volume on your cell phone. - ( phone ringing ) - get details on this state program call or visit >>> hello, everyone. i'm kate bolduan joining you from washington today where the nation's capital and the nation prepare to honor the life and legacy of the 41st president, president george h.w. bush. min

health services. as you begin to go into your presentation, i am going to frame the presentation with a question. how do we measure the efficacy of the program? and how long are these contracts for? is there a performance-based aspect -- aspect in them, you can make a presentation hopefully you'll be able to answer these questions. thank you. >> afternoon. i am a d.b.h. budget director. i'm here to report on our discretionary spending programs. specifically we are here to report on two initiatives under this spending plan. the first is the mental health services for the homes of 335,000. we are in the process of reviewing our current outreach program and we are finalizing the details of the vendor. our goal is to have 335,000 of ongoing services to be delivered in shelters to include coordinated and integrated services to support behavioral health recovery, outreach and engagement, assessment and case management, referral and linkage and crisis intervention for homeless adults and families. i think th

with medicare fee for service it's us running a government program. in a crowd like this we have to call it out. we are running a government insured system and the rate system, it's being set around the conference system which is why the extent to which we could lick to medicare advantage as examples of how things kind of should work, the better. we will have a interesting discussion over the next 5-10 years because medicare advantage has always been a smaller portion of medicare then medicare fee for service is dominated which is now changing. for up to i think, a third of beneficiaries are in medicare advantage. if it keeps growing at this rate with seniors who age in or are used to having a comprehensive medicare like advantage rather than the different 1960s fee for service benefit, they choose that kind of plan, there's a day where we will have majority medicare advantage where it is the dominant part of the medicare system and will have to rethink this whole mental frame where fee-for-service leads to medicare advantage to follow. maybe we need

we provided the service. what i was trained to do, you go out there and you treat these people you want them to be treated. you give them the same service you desire. that's what we did. we got through that. i went through having guns but pulled on you. i didn't report that you have big piece of glass in front of you. i'm going on 28 years. if we can restore that family back, then we can restore the service. i wanted to share that with you. >> supervisor brown: thank you. >> terrence hall again secretary of treasury. when i was up last time -- >> supervisor kim: because you already spoken, you can't speak public comment. i will close public comment first and then if anyone wants to bring you back up for questions -- are there any other members that like to speak. public comment is now closed. i have a warning. we have one more item. we are going to lose quorum at 2:00 p.m. supervisor brown. >> supervisor brown: anybody have anything before we close up? >> supervisor kim: what i will say briefly, i appreciate