Transcripts For SFGTV Health Service Board 20240712

Golf courses, acres and acres of land for the wealthy to sport while the poor are housed in tents and encampments. We need to change and we need this to be a real city solution. That means not concentrating it in one, two, three neighborhoods. That means around the city to all san franciscans that are committed to solving the problem and something they shrug off when they roll their eyes at San Francisco and how awful. No. Spread it around. Get it to places where people can spread out safely until we can build enough homes and actually get everyone off the streets for good. Thank you. Next speaker, please. Hello. My name is gail see crest. Resident of tenderloin. I was on eddy between larkin for 10 years. Now, i am on may son for the last year. All i have to say is whoever is working with this plan, it is not working, and i challenge just one of you to come spend one night in the tenderloin. Then go back to the drawing board. You dont know what you are talking about. It is so bad. It is getting worse and worse. I was out there today. That is all i have got to say. I challenge one of you to spend a night in the tenderloin and then talk to us. Thank you. Next speaker, please. I am with st. Francis homelessness challenge. I am the organizer. I want to ask for organizations to work as a team. I started organizing with people and interviewing people experiencing homelessness, working for safe villages. We need to organize with people experiencing homelessness. We need to collaborate with those individuals and work on a real plan as a team. Sfhc has two proposals, one before covid and one after covid that lays out a good plan on what we can do and work as a team. I just ask that we really come together and organize as a team and leave no organizations out. Thank you. Next speaker, please. This is lydia from st. Anthonys, dining room manager. I have been working at st. Anthonys for the past 15 years in the tenderloin. I will get micro for a second there. Is an operational aspect what is happening now is not succeeding. As an organization that has to Turnaround Services and completely redo how we serve people and double the amount of services we did overnight and we were able to do that. I am confused as to why the city continues to struggle with the simplicity of things like opening up 180 jones, creating a safe sleeping space with no garbage cans or toilets. There is an operational aspect that is not getting through. There are plans and studies, what we need is people to operationalize thing. I will talk about the water. The water is great. What came was 6foot pvc pipe with 8 spigots at two foot level. When you turn them on the water comes out. You cannot sanitize it. We had to buy equipment to supplement the water. Some of the basics of the Operational Plan has to improve. We want to be part of that conversation of putting this on the ground in a way that is operational. Thank you. Thank you for your comments. Next speaker, please. I am rob and one of the owneroperators and board member of code tenderloin. Listen to supervisor haney and nonprofits and take care of the most vulnerable by taking meaningful action in the tenderloin. The citys response to this crisis is a failure. It is telling in the meeting the city struggled to present a powerpoint about the plan let alone taking any action. These are infuriating. 350 people in hotel rooms that is great. It is a far cry from 1400 people turned away from shelters, many are in the tenderloin because free meals and social services are available. It already was providing services to the most vulnerable now that ha has exploided. People in tents line every sidewalk. It is impossible for residents and workers to move in their own backyard. We have heard plans and there is no action. I implore you to create more sleeping sites, b, communicate with the unhoused, close tenderloin streets so residents and workers can move around. E increase speed to hotel rooms, f reopen testing sites. G do all of this faster. In closing the situation represented a Public Health crisis before the pandemic now it is dangerous and a moral blight on the city. Take action. We can and must do better. Thank you very much. Next speaker, please. This is casey asbury, resident on hide street speaking on behalf of the demonstration gardens. There is a question and observations. An operation. How much of the dysfunction the neighbors are experiencing is related to d. P. W. Dysfunction . Now my observations. In our dozen Years Experience of working on building healthy green space downtown with neighbors, the mayors plan for the covid19 response has gaps. Success in mitigating the troubles will correlate to the inclusion of meaningful Decision Making and leadership from the residents of the neighborhood. Two. Emphasis on resources for healthy open spaces. The plan continues to treat this as containment zone versus a neighborhood with wide range of familieses, disables, concentrations of people with chronic illnesses. Sheltering in space requires access to nature, trees, parks, greens. This densely populated area has far less than its share. Safe sleeping villages put residents against each other for open air and trees and freedom of movement. Investment in resources for health and housing should be distributed through the city and not just in the tl. More investments in urban forest and open space cared for by our residents should be concentrated in the tl to create a healthy atmosphere for everyone. We cant keep allowing the neighborhood to be treated as a containment zone without investing in the things we need for dignity. Thank you. We need to take this opportunity to restructure and respond, especially in the vibrant part. The speakers time is expired. Next speaker, please. Thank you. I am amy fairway. I am the founder and director of Saint Francis homelessness challenge. I want to lift up the things i heard from al, robb, so many people. Thanks to matt haney for pushing for the neighborhood to really take this moment to end the crisis on our streets and reimagine how we can actually address these issues together with some best practices. Operationally i want to echo what was said from the st. Anthonys worker. 180 jones, as you know on this call if you live in the tenderloin, our organization tried to activate that site a year and a half ago working with emily and brandon was on a panel when he got into d. P. W. We were trying to work to activate it, and then it got blocked by emily cohen with the idea putting the 18 months 6. 8 million project there. We didnt want to stop the project. It is a case study of mismanagement. Lets be honest. For two months that site was blocked off and 50,000 was wasted on a Security Guard at 180 jones when our organization asked jesand emily and the mayor and the community and matt haney can we offer services there . I love the people that live there. We have organized with a lot of people in the tenderloin. We have organizing work and would like to build on that. That is what i would like moving forward. Cheryl davis you had mr. West come. Please protect your speakers and light bearers, cheryl. Mayor breed, have a come to jesus moment. Show me dont tell me. Do this altogether. Your time is expired. Next speaker, please. This is angela barren resident 500 ofarrell street street. I am astounded matt haney wasnt consulted on the tenderloin plan. Considering he lives here and walks through our neighborhood every day. We talk to him. There are some unique things that happen in the tenderloin that concern me when it comes to the plan. Outside of the presentation you showed i saw online specific blocks identified as blocks at higher risk. I am glad to see you are prioritizing things. I hope you understand when those blocks are targeted with plans and the plans usually call for Law Enforcement and relocation and cleaning. You are just moving or not you but the people in those spaces are moving into the untroubled spaces of the tenderloin. Now we have created a problem in another space, which leads me to a fine are problem that i feel like should be addressed and you really need to it has to be like a True Community ambassador to lead you into exactly what is going on. On the 500 block of ofarrell street, there are three properties that have hired a private security company. Now this gentleman has no problem coming out wearing his black mask and bulletproof vest and sunglasses and bulgelying Homeless People in tents properly socially distanting, following rules at the curb of the street, two old ladies. He bullies them across the street. Now they are across the street and two other Property Managers are bullying them. It is pushing the problem from one space to another. There has got to be a way to overcome that. You cant just like coral people to certain corners as the tenderloin with the plan. More outreach at an equal level might be more appropriate. Thank you. Before the next speaker. Just reminder. Public comment is the opportunity to speak to the members of the Public Safety and neighborhood services. Put remarks to all members of the committee. Next speaker, please. Good afternoon. This is delaware see more, a member of the tenderloin. For change in life i will be brief this afternoon. One thing is for the elc, for some reason the office is not getting the proper communication from what people at city hall and the Emergency Operations center are doing. We go to the Supervisors Office to get information about what is going on. They dont have information. Any supervisor district should have. I dont know what is going on and maybe you all know what is going on. We have to change. That makes no sense an at all for not disseminating information about daytoday operations to the supervisor. The supervisor is in charge of this community not elc. The Supervisors Office is in charge. Some of the youth. You have great slides, but a couple places criminal and drug activity was too close to homelessness. Those things are connected a hell of a lot and disconnected a hell of a lot. Being homeless did not mean drugs or criminality. Those should be in two different ways and not the same. Thank you. Have a great day. Next speaker, please. This is curtis. I am a long time tenderloin resident. I am calling in today. I am frustrated. We have been going to meetings, talking to the city, telling what we need for months now. They come up with the tenderloin plan and i am telling you i havent seen any real change or action. We are not asking for anything major, but they are not providing anything. You know, i have my unhoused neighbors on the street that are suffering as much as the rest of us. We are all victimized by a system not doing anything to help us. We feel completely abandoned. It is tragic because it doesnt have to be this way. Letting folks stay on the sidewalk in a tent is not a solution. That is not a good way to treat my neighbors. They deserve better than that. They have shelters but cant get them in it. Let the Community Organizations work with these folks. We can move those folks to the hotel rooms. Getting police to deal with this is only going to make matters worse. Why havent you been able to provide open space in the tenderloin for social distancing . They have been promising that but here we are, still none. I still cant get to the corner store. I am a high at risk person held hostage because it is not safe to travel. No room to social distance. It doesnt have to be like that. People are out on the streets. Your time is expired. Next speaker, please. I am a tenderloin activist. You know you arent going to threaten those. I think it is part of the strategy. Without anybody to vent frustration at, nobody can take the failure of the blame of the absolute failure for what is happening in the neighborhood. If anybody from the elc is listening in on this case, i am curious what you do in your job every day. What are you doing 8 hours every day . Everevery single week the neighborhood comes to you with questions, not difficult questions. You have no answers. Week after week you cant answer basic questions about what stations are working. Director carol, this notion that there has been a lot done for the neighborhood is insulting. Half the staff you have done in the neighborhood does not work. Two feet apart. Water everywhere. You just put a bathroom at the site. That took months to get people into. It is insanely frustrating. Open streets all over the city. Golden gate park. A month in the shelterinplace. That is not going to make this happen. The tenderloin has to protest to get a slow street. It is drivinglus. It is rational it is ridiculous. When it comes to this your time has expired. Next speaker, please. I am tom flores, 20 year resident of tenderloin, not member of any organization. Give perspective of life in the tenderloin. I will sherr share experiences. This morning walking dogs we were on the streets because sidewalks impassible. One person naked going through trash, one passed out with needle in arm, tents not separated, two incidents of few man fee fees sees. I have been hit in the head by two Homeless People with Mental Health. My husband was almost stabbed with a dirty syringe. We live in a third world city where nobody in city hall cares. I have not experienced any im im movement. These are not new but amplified with covid19. Iis this racial issue . Majority core in the neighborhood . Maybe both. Please help our residents to live a healthy normal life and treat the homeless with a level of humanity. It kills me to see the kids walking on these sidewalks and being outside is me mentality draining. What is the plan post covid. This is not new for us. Please, please, please help us. It is unbearable. Thank you. Thank you. Next speaker, please. I am cathy her nandez, tenderloin resident. I would like to express my discontent with the way that the public positions in office has handled the homelessness crisis in San Francisco. I feel there has been advocation of responsibility with various offices. It is infuriating watching the head of department of public works accused of bribery and scandals affecting our neighborhood and wellbeing. We dont have trash cans or restrooms that are needed to keep sanitary conditions in the tenderloin. That is all i have to say. Thank you for your time. Next speaker, please. I am kelly cutler. I am a resident and organizer of the coalition of homelessness. I was surprised to hear when i hear talk about such an increase in homelessness when really the reality is that we ar we are seg visible homelessness. The city is taking peoples tents or survival gear. That doesnt fix the problem. It is the lack of resources and lack of housing. Since shelterinplace i have asked numerous occasions where can people go . We are told where they cant go. But what is left out is where people can go. We do not have an answer for that. We are getting some of the areas where people can set up for safe sleep. It is a parking lot. We need to be doing more. The Community Process of involvement. We need past this idea that we can police our way out of this crisis. Supervisor man den man. You have been out to the encampment and you know the truth. There are no alternatives for people. That is what we need to get real about. We need an honest conversation about what the needs are and not try to hide it again. We need to respond like the crisis we are in. We have a crisis on top of a crisis. That is where we are right now. The city is failing to care for the must vulnerable in the community. It is a city of extreme wealth and resources. It is shameful and wrong. It has been going on for some years but also there is a pandemic. Your time is up. Next speaker, please. I am justin. I live on post street. I am not in the tenderloin but in the tender knob with the same issues of the tenderloin. I want to echo the frustrations of everyone else. The residents of this area i have been attacked with a metal pipe and chased into the building. Police never showed up. We had a trash fire a few weeks ago. They did get rid of the fire. Encampment remains. Behaviors encouraging the fire are still there. They were setting off fireworks launching three feet away from my neighbor who was pregnant. Above my living room for 20 minutes. We call police. They show up after people left. Adding restrooms doesnt help. We need people put into Scalable Solutions like camping sites outside of the city. Let people camp where they want is not a solution. Next speaker, please. Thank you. This is David Elliott lewis. I live on ellis street. Why ideas for improvement. The safe sleeping site and hotel spaces. I want to suggest to look at ways to make those more effective by engaging the guests or residents in helping to actually maintain their environment. If they are getting the benefit of services, hotel or safe sleeping village. Give them parttime assignments to keep the place clean and safe abwork off the benefit. There are a lot of benefits to work. It provides more longterm solution for helping unhoused with work assignments. To learn more about this. Saint francis website has ideas to engage unhoused residents in participation in their community. It should be a village wherever body participates. Again, visit st. Francis for ideas. I hope you will consider this to improve safe sleeping villages and i hope they are not temporary. Thank you for your time. DaviDavid Elliott lewis signing. Hello, i am steven tennis. I live at the bristol hotel. I worked for San Francisco collaborative and gl cbd. One thing that i heard her is that i dont think anybody, not just board of supervisors from the mayor on down, city hall knows what to do. If they did, how to implement it in a timely manner. If they did we wouldnt have what is existing here in the tl. I cant walk out the front door without seeing what everybody talked about. Tents, filth and people that dont care. With all of the tents, i think it would be an ideal area open and free of clutter. Another point is stop being so nice. We have got to start being aggressive. I dont mean mean or vindictive. When people dont care about where they are on the street, on the sidewalks in tents or not, they dont care. I think half the people dont because you can look and see that. That is unfortunate. We somewhere to get aggressive with how we deal with that. Nothing is working. I am 71 years old. I dont need an environment that will take my life and i am not alone. Sorry if i sound aggressive. If i dont sound politically correct. I am tired about it and tired about people not doing anything about it. That is all i have got to say. Thank you for your time. Thank you for your comments. Next speaker, please. Good afternoon. Especially matt haney. I especially appreciate the level of dedication you are showing to the people on the streets here. You do care about this. A few key points to bring to your attention. In my mind it is about producing the safe culture on the streets. I have come to know that the empty streets are dangerous and crowded are safe. There is no one on the streets it is risky. Crime can occur. What we have done is created an environment be exclusively encouraging criminals to be out. I as an old person cant be out on the streets, cant throw events, cant gather with friends. Police will be sent. Struggler the not the case. They are setting the culture for our streets. I dont like it and you dont like it. Give us an opportunity to change the culture. First provide sellin semipermant housing. I believe the tiny homes have demonstratorred this is the answer. We can have these in a few weeks to house every Single Person that is in the tenderloin in a new high rise dedicated to this purpose that the city owns, the city can reuse and reallocate and move around and store. These mobile housing resolution facilities are what we need in this moment, what we needed six months ago, five years ago and 20 years ago. We Center Housing projects with plenty of physical space. We need to create density in the tenderloin. We should be encouraging these. Your time is up. Next speaker, please. Even with the central city collaborative. I want to echo frustration about the disorganized city response. While i understand it can be difficult to coordinates specially in response to a crisis. I have to say that several months into this, the disorganization begins to look like indifference. You couldnt be blame residents for assuming there is indifference. Before this crisis it had deteriorated. Even what is done they felt like they were through constant neighborhood effort and agitation. Residents hav have enough on thr plate. San francisco must do better. Get it together and get the work done. Thank you. Christy. We have been ignored. Our solutions for safe sleeping sites at union square and other areas were over ruled. Our calls to move unhoused to hotels were rejected. It took months to get testing. It was high barrier testing that was performed by a private company data mining. It was performed by dph. It is not a plan if you dont have goals and timeline. That is an idea. It is exhausting to live like this. I am lucky. My heart breaks for my neighbors with children. My neighbors who are elderly, my neighbors with preexisting conditions and those living on the streets. Thanks. Thank you for your comment. Any further speakers on the queue . Mr. Chair, that completes the queue. I will close Public Comment. Supervisor haney. Thank you. I want to thank everyone who called in and i think what you all said was important for people to hear. There is a tremendous amount of rage and disappointment in the neighborhood, and somebody put it that they feel like they have been actively ignored. It does feel like it goes beyond indifference at this point. It feels like people are doing as much as they can, but this is not what urgency looks like. What we have seen what urgency looking like in other areas of action we have taken as a city. We have seen what it looks like when we tell businesses they have to close and figure it out and stay home and yet it seems like the answers that this neighborhood is getting we are doing everything that we can. I have some specific questions and i want to make sure i know who is here. We have the director of d. P. W. Thank you for being here. Director carol is here. Thank you. Who else is here so we know so i dont ask questions not appropriate for folks here . Why dont i start with some of the things, some of the other departments we havent asked questions of yet. A question for m. T. A. One of the things you have heard a lot and we have been saying since the beginning the need for Additional Space for people to walk safely. The tenderloin was already the most dangerous neighborhood in the city as far as pedestrians walking safely. That is much more dangerous during this pandemic. On hide streety walk in the street. That is common in the streets. I know there was an announcement about a slow street on ellis. Next it was removed from the map. As we have seen streets all over the city being designated for slow streets, we only be have a single block in the tenderloin still which is on golden gate. What is the status of traffic flowing and created additional walking space in the tenderloin and how soon is this going to be done for m. T. A. . Thank you, supervisor haney. I am representing m. T. A. And our Pedestrian Safety program manager. We heard loud and clear for the last few years there is a Strong Demand for improved safety, Traffic Safety in the tenderloin. We are collaborating with Community Groups, many are here today. Just prior to the pandemic we started quick build efforts withspwithtwo streets for quickd leaven worth and golden gate. We have to ask ourselves we were Traffic Safety is critical. We need to be responsive to the eoc and to the playing that is to the p. L. A. Gue. We want to see where we are most helpful. The quick build continued to advance engagement was critical and we lacked Strong Community engagement through the pandemic. We are figuring out how to move foes forward. Like almost Everything Else we have done through covid19 it was trial and error. Slow streets evolved to a program that is best suited to low Traffic Volume in terms of cars, residential streets. We know the tenderloin doesnt have those streets. The solution of our typical slow street is not going to fly in the tenderloin. That doesnt make the needless important. It makes it more great. Our solutions have to be unique and cater to the tenderloin. The golden gate is a really interesting process. I believe the city came behind the Community Groups who understood their own needs. They asked the city for direct support on the temporal street closure. The street opens and closes as the Services Like Saint Anthonys use the street. Those cbos are the best eyes and ears on the street to make sure the space is maintained, cars are moving appropriately. Even a slow street allows for cars to access locally. What we saw on that very specific block with our cbos carrying water. While that is a model we want to replicate. We need to make sure we are partnering on the individual blocks to ian and maintain that is more work than our programming. We are starting that effort on. The slow Streets Program as originally conceived is not appropriate for the tenderloin. You and i with the director tumlin did do a walk. Your office specifically requested us to look at what we would consider not a full street closure but parking lanes and potentially travel lane closures to create more walking space. We modeled that in front of glide right now. That works as intended. That is good news for us. That is the kind of work we want to do. We want to use concrete blocks to bump out the walking space. That is something we are actively pursuing right now. The m. T. A. Is designing and engineering that kind of work on both jones and what we can do or sort of evolve on turk street on the eastwest version. We are working to procure the Critical Path to get that in place. It is not easy but it is something our teams are actively working on. Emails are flying back and forth today as i am at this hearing. Something to work with asoc to create Maintenance Agreement for whatever we do put in the street because when we put those concrete blocks in the street we pro conclude traditional street sweeping. We want the blocks to get the cleaning that is needed. That is our active plan. The hope is in the next few weeks to have designs. We need to work with Emergency Responders before we can declare victory on the designs. It is really important as we think about additional walking space that we work to ensure that fire has direct access to every pipe. That is a different Public Health issue. We want to respect their needs as Emergency Responders. We are hopeful to precure the k rail soon. You cant commit right now. I will work to get that answer as soon as possible. Sy hope i answered your questions to the best of my ability. Thank you. I just would flag something. I told the director this directly. As we think about the weighs in which the tender highway and neighborhoods feel they arent treated thtreated fairly theres all over the city. The highest need area for traffic and Pedestrian Safety was the tenderloin. There is wide recognition of that. But there was basically no action. We did one block on golden gate after st. Anthony came forward around changes on ellis. Not necessarily a question, but how are we in a place where three months in the pandemic the area we say identified as the highest need seems to me if you look at the map the least done for it. No way to interpret that, but we were skipped over because it was more complicated or because the solutions were different. It doesnt seem do you have any comment on how we get to a point like that . That is part of what the neighborhood is experiencing. It is hard for people to understand or process. Everybody says the tenderloin has high needs. They dont get even the basics other neighborhoods got. I speak on behalf of someone who worked a lot in the tenderloin. It is more complicated. That is not less visibility within the agency. The solutions are so much harder to work through and come by. You go to 41st avenue, a simple a frame with a simple sign. We wish that were the easy solution we could put out in the tenderloin. If i could do that today, i would. The sheer complexity makes it much harder for us to be as responsive as we would like to be. We can work harder after m. T. A. To make sure we are more responsive. My hope is that as we move the wheels and gears up that we are able to first get to a success and then repindicate that success. I want to really thank the Community Members who are constant and have participated in so many ways and elevated this issue. Work is thankless and i am grateful for their support. We have not met their goals and standards. I will strive to meet them in the coming months. I appreciate that. One of the things you have in the tenderloin to make it less comincomplicated. You have an organized community that is supportive and Solutions Oriented what they want to see happened. There is consensus in ways there arent in other neighborhoods in changes. This is true for every department. We are talking about the tenderloin because things are more complex that cannot be a reason why nothing happens. That should be the reason why we try harder with new solutions and dedicate more resources. We recognize that it is more complicated because needs are higher. As a result the response from the city is to say we cant do anything there now because it is complicated. It is extra frustrating pattern that existed before the pandemic. People are unset to see people are upset to see it continue. I appreciate the steps taken and i appreciate you coming to the neighborhood to spend time with residents and me and i hope we see changes happen sometime soon. I am going to jump from issue to issue. I am just observing. I think vice chair stephanie is chairing. It is your hearing. Do as you will until you hand it over to the vice chair to close. I have a few questions on each topic. I will continue. My next set of questions on testing. I want to thank everybody involved with the testing site and the Community Organizations as discussed. There were a lot of things that improved over time with it. We hope they are improved on the next time we do this. Just a question about the outcomes of the testing there. I have heard that the city because of who the provider was is prevented from accessing Critical Data like demographics and Housing Status and making it public, the rates are positive. Is that true . What is the status every treeing that status that we can retrieve that data . Understanding how sick we are and being able to use that for policy . I with prefer health to answer that question. I dont know the answers to that question. I am seeing if they are online. This is kelly for health. Ir have information about testing but not that specific question. I will get with the Testing Branch to try to get an update on whether we were able to get more specific information. While i have you here. In terms of other information that we are interested in. One of the things we feel needed here is a more ongoing permanent presence as well as on site testing liken campments and sros. Also anti body testing or the next level of the different testing needed in neighborhoods that are especially vulnerable. I think we have a call tomorrow to talk about planning a bit. Can you give an update on that . Sure. We are planning on doing testing starting next week. We will have a Public Health nurse team partnering with other partners with the outbreak management team. Did additionally with street medicine and eti wellness and the San Francisco Health Center and glide. The first day we will do outreach in education, informed consent around testing. Then day two we will do testing. With a team and then expect results on day three and four. Partners will work with us to track down the client to notify them of the results and work with them to come into the quarantine or if we support them if they choose to stay and do isolation on the streets. We will support them to do that. We are in the process of looking to try to find a site to do ongoing space for the community testing. Okay. Thank you. That is all on testing. We have follow up and i appreciate your work on this. There was mention of Community Ambassadors. How many are out there now and how many are added . This is an area where i heard a lot from the neighborhood where we just need a greater presence on the street to help with general safety, to help support social distancing, and as part of the plan there was talk of a new approach to Community Ambassadors. I am going to be candid. I havent seen them out there as long. I am a fan of the program. I havent seen the level of visibility around it. How many do we have out there and when . How many are we adding . We have 18. They are monday through thursday. The plan is to up to 25 to 32. That would expand the hours to monday through friday. They are all 10 hours. All 18 are in the tenderloin . Yes. Thank you. I want to ask a a bit more abot Public Safety in the neighborhood. I am guessing that sfpd is not here. Are we tracking any of the data around Public Safety indicators, criminal incidents, crimes as part of this plan . You are asking if we are tracking overall criminal related data . That has not been a component of it so far. That information is available to us. We are the areas in which we are working much more closely and really pushing to have better coordination with pd is around being able to Work Together as we go in especially as we help folks get off the street to be able to hold those areas once we get things cleared. My concern has been the fact that we have gotten quite a few, hundreds of people off the street and yet we are not seeing significant difference. Part of that is that coordination, obviously, needs to be much stronger together. Not just with pd but with d. P. W. And also a timing issue. That is why what i would say the second phase and recalibration how reapproach this going on which is underway now, it would have to coordinate closely with d. P. W. And with pd and the Community Ambassadors. We are able to move people, we are able to get in and clean, able to make modifications. Supervisor haney, to that point this evening there is a call at 5 00 to talk about that exact issue. It will involve public works, asoc and police. After we start to find shelter, rooms or space, sleeping sites for individuals, we want to maintain those areas. We are meeting this afternoon to talk about that exact process. Just so i am clear. It felt like different issues. My question is not about homelessness. It is about Public Safety and the fact that many people in our neighborhood are saying that they are walking on the streets and feeling in danger for the first time. Feeling a sense of victimization that is different and how that is part of the plan. I dont think that should be something that d. P. W. Is helping to lead. It sounds like what you are saying is once people experiencing homelessness are moved, how you prevent people from camping there. Your volume dropped off. What you are talking about is reencampment. Once the sidewalks are clear, and we will maintain that area. I think understand what you are saying. That is not what began the sentence with, but i think that will address it. Hopefully that will address the Public Safety concerns that the people of the tenderloin have. If we can keep those sidewalks clear, hopefully, that will make them feel safer. That is not necessarily a public works issue directly. Keeping the sidewalks clean and streets free of debris. That is something that i am obviously responsible for. Thank you. I appreciate that. I was going to comment that that is something we can and should add to the tracker. We can add categories of citations, arrests, whatever it might be and add to the tracker. That would be a good section to add. It is on that point and i recognize this is a complicated challenge. Anybody who lives or visits the tenderloin can see large groups of people congregating particularly around golden gate, mcallister andlar ken and other streets as well. I can name many engaging in drug dealing and drug use. Sometimes in groups of upwards of 100 during a time when we know that the covid19 can passthrough that type of grouping. It didnt seem like there was a lot in the plan discussing that and a lot of neighbors and businesses asked me about that. What sort of coordination between the various departmental bodies are being done about that specifically and the obvious dangers and risks associated with it . I dont really feel like i can speak for the Police Department with this. Obviously, they are part of it. We have tried to carve out, i believe in this plan. Although drug dealing and these things are part of it within the eoc. That is probably one part of the plan tha that is not something t we really can have jurisdiction over. I feel like we need pd to answer those specific questions. I do just want to say it is called out in the plan and it was in the slide. It seems that we should have something as part of this plan that is explicit about safety and that is about the connected but separate in some ways large groups of people congregating in the neighborhood, mostly in this instance i am describing related to the drug trade. The residents are going to say if you have a plan that doesnt acknowledge those things and talk about them and have solutions for them, you are missing a big part of what is happening. There are different views on what is going on work and all of that. We also cannot ignore it. That is not acceptable. It is missing a huge part of the experience people have in this neighborhood that affects their ability to walk down the street. Obviously the drug trade itself is deadly and kills people. With that. I have to respond where we have part of the Community Ambassador program also is not to do Law Enforcement but to be the eyes and ears on the street and a connection to the pd so that those things can be communicated quickly. That is one linkage. I am not sure if pd was invited to this hearing. Again, there is obvious linkage there and a lot of what i spoke about today, the ambassadors are there. Not to be interfering but to be eyes and ears and to help on a daily basis. Because people just dont live most of us in the tenderloin or not working there every day. That gives a way to communicate what those issues are as they come up, and that is part of the reason to flood the neighborhood with these folks. We are familiar with the neighborhood and can communicate to us. Where the issues are, flareups, where we have done intervention and it hasnt worked. To be clear, the sfpd, the Public Safety explicitly is not part of the eoc plan as you understand it . It is part of the plan. And i would say it is a unique part that really requires the pd to respond specifically to their strategies around how they are tactically approaching those issues. I am sorry they are not here to speak to it. I am not sure they were invited, supervisor. I would say that there is a Police Element to it, of course, and a lot of organizations who have ideas and solutions, other departments have ideas and solutions. The broader question of safety in the community is one that we see from the conversations and people organizing and protesting. People believe the police have a role and we need to rely on other types of intervention. There are a lot of people ready to do that. We are not doing that well when it comes to the situation in the tenderloin if at all. I just have two other areas of questions. I have kept people for a long time. I appreciate you all for answering these. D. P. W. One of the things that i have heard is that there are a lot more needs around cleanings as they relate to encampments because folks are out there for a long amount of time and dph has guidance to not move people and all of that. I support that. How are you approaching making sure that we are able to address the issues around sanitation and hygiene . Those are People Living out there and also for the broader neighborhood and businesses. I have heard from businesses that have been overwhelmed by the cleaning they have to do themselves that is way higher than normal. How are you approaching that in a way that is humane and effective and supporting businesses who may need more support as well . I will answer parts of that. First part regarding the tents. Originally we were asked not to move anyone because of the concerns about covid. As we learned more, with consultation from dph, we changed. We could ask people to move their tents temporarily while we would go in and clean. We have been doing that for several weeks. We have people temporarily move across the street, but we cant say you cant come back. We are doing that to try to clean a bit more. But you are right, supervisor. What happened in the past there was less people would build up less things because they were moving more frequently. Now because they are staying in the same location longer, there is more billion dollarsing up. I think that is what more building up. In the last couple weeks we had people move the tent to clean around it to address the specific issues regarding trash and things like that. With regard to Business Owners, what they are referring to is in front of sidewalks they have to do more. As a general matter, the Business Owner is responsible for cleaning their sidewalks. Public works we come in and to the extent there is feces or biohazard we will come in and steam clean the streets. I can understand the concern of the Business Owners. There is more on the sidewalk because of the activity. From a technical standpoint i am not making excuses. That is not really public works responsibility for the sidewalk. We do come in under certain areas. We are there every day, morning, even. We used to pick up the trash on the sidewalks. The Business Owners fell the same pressures that we are feeling regarding the amount of debris. The bad thing is we have had the broad problem in the city. The treatment seening there are other areas across the industry where we didnt go down the nice of the street. That is not so of an issue. In the tenderloin it is not as bad. That is causing a problem over the last several months. We have been in the shelterinplace. If there are cars on the curb line not moved because of the street sweeping and violations werent enforced, we cant get our sweepers on the curb line. The wind blows it to the Business Owners property. It comes together and we are trying to do more about that. Some of that is the Business Owners are seeing the brunt of not being able to get the sweepers to the curb, wind blows and the trash goes on their property. We can help them, and we are. Some of the things we have done some of the nonprofit partners, we had redirected some of the hand patrols from the soma area to the center loin to try to get more boots on the ground, if you will. That is helpful. That ask something that come up to me from residents and something for you to think about. The other thing i want to ask you about. I know we added some bathrooms and pit stops. Two things that come up with that. One is plans to add more . How are they along with the hand washing stations serviced. At least for a while we were hearing that they were often broken or missing certain supplies. I do think there are improvements on that in my experience. Could you speak to those issues because they come up a lot . I am sorry. There is a big truck that drove by so i lost the audio on your question. We put in a lot of bathrooms in that area. Are there plans to add more . Since covid we added six additional bathrooms in the tenderloin. Those are all open 24 7 stations. The other thing we are trying to do and we are thinking about adding more specifically one in the polk alley that we are thinking about adding. One of the things that is an issue is just the access to more. We put in over 50 pit stops in the city. We have most of those concentrated in the tenderloin. A total of 11 in the tenderloin, and the additional pit stop stations to add is the problem. As we start to open up the bleaching site. The wealth of providing it is there. We are working trying to find the unit. We are not just not providing service. There is also a component of it. We did a big three firms to provide service. The hunter point family, msc, all of those guys have contracts. I think they are used across the city. These would be there with no bodies to provide the service. We are trying to not just provide the service. We are providing the service with them. You are right with your second question about the hand washing stations. That was a problem early. As far as us not being something for the public works to take on to make sure they were serviced. When we to assumed that it tooks some time to manage those. It is different than a bathroom. It was 24 7 monitoring. We would rather use those on the toilets. We have a way to provide the service. As a disconnect in the feedback we were getting in the Service Provider at first they were only contacting the vendor. If there was a problem with that unit. Now we asked them to contact the vendor and city. We are aware of it. It is something i can send a water truck to fill up if it needs basic supplies. It is a feedback change, if you will. I appreciate your attention to that. I think there is a change. Early on they were broken all of the time there. Is some positive changes. I do hope that is continued. We also through the calls on monday with the community we asked residents if you see a problem with any of those stations, report it to 311 as well. We are using that so we can be more and more responsive. We are paying for people to monitor and know about it from five different people as opposed to what they are doing there h. Thank you. Last set of questions here on homelessness. I would like to know more about the 350 people who were brought off the street and 300 people who are planned to be brought off the streets from the tenderloin. I will underscore we passed a law unanimously as board of supervisors which requires the city t to procure 8250 rooms. We are far from that. I think we are over 1,000 rooms occupied. Maybe we are in 1300 or so total occupied. In compliance with the law this board passed unanimously, we are the u. S. C far from that. The 350 people and 300 people what are the criteria used for these individuals . One of the areas we have had and challenges getting people off the streets quickly is that there was a very hard set of criteria where you had to be over 60 or have an underlying medical condition. Folks in late 50s approached me saying i have been waiting to get off the street and you cant. They skip over me. Are the criteria changed for the next set of 370 300 and whae the criteria for the 350 brought inside . I can answer the second part of the question. I can sort of answer first one. The cretiria has not changed. It is if same as the beginning. Over 60, which is younger than what fema has required. We will not get reimbursement for those between 60 to 65 who have underlying medical conditions. Or folks that were covid19 positive or exposed to someone covid19 positive. For the next group and for this next phase of the tenderloin. That criteria has not changed. However, the approach for identifying folks has changed. We are doing along with dph hot teams really they are working to do everything they can to identify and get these vulnerable folks to identify those who truly are vulnerable who have the underlying condition that may be they dont know about. Maybe they dont want to speak to it. It is not in their record of care that we have so far and they appear to be very vulnerable. That is why as we move to the next two weeks to bring people in working closely with providers who know these folks. A much more targeted and careful assessment of each and every person on the street so we can identify their vulnerabilities. I am not a clinician and this is not my background. What i hear everyone say is that much of the population is vulnerable and could fit the criteria. They arent necessarily dont have a medical record that shows that or maybe they are not in a place to recognize that in themselves. We are doing a lot with the city to really work with those. Not only the city but the people that serve who are outside that serve the population. The criteria hasnt changed. The approach to ensure everyone vulnerable is off the street. I need to remind everyone that we are doing this to save lives. We know who this disease affects the worst and who will die if they get this disease. Those are the folk eswe have to prioritize. We do think there are more vulnerable than i haded in the first go around. There is a lot of work going to making sure and taking a different using different strategies to help identify those folks. Thank you. To understand this. Right now you have to be either over 60 with an underlying medical condition and in coordinated entry to be brought to a hotel . No. Thathat is not necessarily true. You have to be within the system. I really would prefer that from dph i can speak to that. Robin cannedler with dph. You dont have to be in coordinated entry. You dont have to go through housing assessment. You do need to be in one of our city systems and preferably in the one system, in the hlh system to show you have been homeless in San Francisco since before april 1st is what they are saying. You had to have been here before april 1st. I want to underscore that because these are older and or people with underlying some conditions and were here before april 1st for those who say these are people from other places. With that said this leaves a lot of people out. What it is meant is for those saying there are a ton of People Living in the alley and other parts of the district who arent over 60 or with a medical can be to prove yet, they as kelly said they have nowhere else to go. There is not another place, not a safe sleeping site or hotel room for them. That is thousands of people in the neighborhood. I would say and i appreciate that we are focusing on the most vulnerable. It takes a lot of work for the hot team to do these assessments and find these elderly folks. We are leaving a lot of people outside with this model. I would recommend and say that, one, we should be thinking about broadening the criteria and thinking about involving cbos who work directly with the followings on the street to quickly assess people and get them determining their medical condition or hopefully ultimately broadening the criteria. This is going to guarantee there will be thousands of people on the tenderloin because it leaves people out. I appreciate we will have 300 more people in. That is important. It excludes the majority of people on the streets right now. I agree that we should get more and more people off the streets. I agree with mary ellen when we say we know the science of who is dying from the disease. I hesitate to expand the criteria before we have the beds to put people into. We need to focus on the most vulnerable right now. This is an hsa conversation. We had a set of hearings. If we have the beds is a selfimposed restriction that is flying in the face of a law we passed as a board that should require us to have the ad what amount of beds. We dont have to have that today. It is selfimposed. For the safe sleeping sites there is one in tenderloin with 16 tents and 21 individuals. Have h these individuals been assessed . What services are they receiving . Are they intended to be placed in a hotel or out there indefinitely . Are you talking about the fulton mall or 180 jones . 180 jones. Again, i hesitate to speak for hsh. I do know there are a lot of Outreach Services directed towards the folk from hsh and dph in terms of coordinated entry and covid assessments, Harm Reduction work and getting them into Substance Abuse treatment. There is outreach every day to those folks. I dont know. Mary ellen if you want to talk to the longevity of the site. The sites are not intended to be permanent. We are going to keep them in place for as long as we need them. The intention however a tent in a parking lot is not a great place to live. The intense is t they are to be temporary. While the site might be there for a while, the hope is that we are moving people to more appropriate level of care or housing, to robins point. Outreach is going on. Everyone is being contacted and assessed for all of the things robin mentioned regardless of where they are on the sidewalk or the safe sleep site. Or wherever they are in that system. Within hotels. The hotels are also even folks going to sick hotels are assessed for what is the next appropriate housing option for them. Are there other sites planned in the tenderloined, safe sleeping sites . There is fulton street. There are positive things happening there. Those are folks sleeping in that area. It was not something that was set up for people who were sleeping on the sidewalks orallies in the tenderloin. Are there sites set up for other than the 16 tents in 180 jones, people on alleys or sidewalks in the tenderloin right now . Yes. We are exploring about four our sites in the tenderloin. I am not trying to hide them. I dont have the addresses in front of me. I will share those with us. We estimate we will probably accommodate between 50 to 70 tents total with these sites. Supervisor, you know the neighborhood better than i do. There are not a lot of sites in the neighborhood. There are more, however, three or four more we are looking at for a total between 50 to 60. Again, they may be used as a way for us to kind of as we move through and as the folks that work with the Homeless People on the streets know they may be able to maybe someone is ready to move to the parking lot before a hotel. It helps to have the transition. We hope that fulton site will be used for more limited amount of time but longer than anticipated. I am going to wrap up. We could continue for hours. It doesnt seem like anybody else would want to do that other than me. I have other questions. I will ask you offline. I know that first before i make Closing Remarks supervisor walton and stefani i should open you to make statements . Thank you for the hearing. I dont have anything to add at this point. Supervisor walton. Repeat that. If you had anything to add before final comments . No. Thank you, supervisor haney. I want to thank everyone for coming to this hearing. I think that the folks who called in were very clear about our concerns are dissatisfaction, frustration, solutions we want to see. They have been widely shared since day one. I hope that we can challenge ourselves to do better by this neighborhood, even though it is complicated, it is hard, that is not a reason to be indifferent which is what it felt like for the residents and businesses and others who live and work in and experience the conditions in this neighborhood. I am sure we will have next steps to Work Together. I do hope we can make this plan something that is more transparent and accountable with clearer staffing and ways people can engage with it. I am disappointed we are leaving the hearing with some level of lack of clarity. There is no tenderloin dashboards or timeline. The staffs is murky. How people engage is best to join a committee, which i would love to share how people can do that or a working group. I think we can do better by this neighborhood and i also believe and other people said this many of these issues are not new issues. It shouldnt be something that you all alone, mary ellen should address on your own. We need longterm Sustainable Solutions to the challenges in the neighborhood. We cannot accept during this pandemic we move backwards and end up with greater challenges than we experienced before. This community worked too hard to make some level of progress to fall back. If we have learned anything during this pandemic that the issues of homelessness, dirty streets, issues of people not having safe areas to work, access to healthcare and social services or safety net is unacceptable and can never be acceptable as long as there is a threat of a pandemic. We cannot go back to the way things were or accept the way things are. I appreciate you, director carol. One of the things i really do believe you have very good intentions around this and have been doing your best. I dont believe you have been adequately supported and that this has not been a priority that it was in many ways proclaimed to be. The results speak for themselves, the opinions and experiences of the residents speak for themselves and i believe we can and should do better. I would like the opportunity first of all, to say you know that i am available 24 7 to you if there are concerns or confusion. I would like to address them. We want and have been and will continue to work with your office. You are right. I am very committed to this personally, but that matters that is the least important thing, frankly. There is a commitment and i can tell you from the eoc that this is a priority. Whatever resources are needed i am with this. We need more resources we will put it to this. That is why i brought it under the umbrella of the eoc. We have the resources of the city to put towards it. It is not acceptable where we are, and i, too, want to do better for the folks that live there and we will continue to strive to do that. I dont want to leave with an impression i am the only one here. There is all of the city departments involved and are committed as much as i am. We do want to continue both to continue the relationship with the community and Work Together, which is different than what i think the approach has been before covid, frankly. That is the Silver Lining in some ways. We would like to expand that. The public facing information is being worked on as we speak. There are people working right now. I am confident we will see a difference and i will eye hope to come back i hope to come back and maybe we can talk about the successes or maybe we dont have to have one because everyone is here. Again, my door is always open and i will work to take your very good recommendations around making the clarity around what we are doing and the timelines and the progress is more public. I appreciated hearing everyone, especially the Public Comments for People Living in the neighborhood. I listened to all of the comments and i hear you. Thank you. Thank you to all of the staff who stick around. We appreciate it. This is hard stuff, but our community and our residents deserve us to do the best we possibly can. Thank you, chair stefani and supervisor walton for your time. This is all about the tenderloin and district six but i hope it is an issue of city wide importance. Thank you. Supervisor haney would you like to continue to the call of the chair or file the hearing . I would like to continue it because director carol says the next one is going to be celebration. Maybe we wont need one. We will continue to the call of the chair. I will make that motion. Mr. Clerk please call the roll. Housekeeping because the house has changed. Vice chair stefani is presiding right now and chairman delman was absents at 1 55 p. M. Would you like to excuse chairman mandelman for the vote . Yes, i will make that motion. On the motion by vice chair stefani to exclusion chairman delman. Walton aye. Haney. Aye. Stefani. Aye. Three ayes. The motion passes. I would like to renew my motion to continue the hearing to the call of the chair. On the motion offered by vice chair stephanie to the call of the chair. Walton. Aye. Haney. Aye. Vis chair stefani. Aye. Mr. Clerk any more items before us today . There so no further business. Thank you. Then we are adjourned. Thank you. Taxes or marketplace changes that would have and impact over 2 of impact costs or revenue. The mappo plan includes the innovation benefits first introduced to the plan in 2019 that in support enrolled numbers all at additional planned premium for the 2021 planned year and so to address the commissioners question in the prior presentation. These include the Silver Sneakers Program, which is a gym membership which has 4,272 enrolled lives and just over 1500 of these actively participating during 2019. And the second is routine and posed discharge Transportation Service where 236 total trips have been taken so far in 2020 through late april by uhcmappop members and the third is a post discharge Meal Delivery of up to 84 meals consentin consecutiveld and so far in 2020 through late april, a total of 8,344 meals have been delivered and when setting the uhc premiums, we include the cost for the basic vision plan through vsp, which are unchanged from 2020 and the healthcare sustainability charge of 3 per retiree a month which is unchanged from 2020. Next slide. So with that, we show the rate cards being proposed for 2021 and each of these are contained for 2021 with distinct medicare dolcolumns for the city plannedp po blue shield access plus and trio. Next slide. These rate cards presented in this document reflect the full employer contributions for Retiree Medical coverage presently available to retired employees hired on january 9, 2009, retired persons who retired for disability and surviving spouses or surviving domestic partners who died in the line of duty. Retiree medical coverage but no employer contribution is available to retired employees hired on or after january 10t january 10th, 2009, at least five but less than ten years of credited service with the employers and coverage at 50 of the employer chartered contribution rate is available to retired employees after january 10, 2009 with greater than ten years but less than 15 years of credited service. The segment of retirees will receive the full employer chartered contribution for each medical plan and coverage as reflected in the following rate cards. Next slide. This rate card illustrates the total premium as weve discussed for the United Healthcare ma plan, as well as the mixed family situations, two in medicare, one plus nonmedicare and the right three columns of the page representing the nondifferent medicare plans that those dependents can enroll in and they include the vision plan premium for basic and the 3 sustainability fee and then, the allocation of the employer contributions in the middle of the page by coverage here to result in the final number of contributions and how those have changed from 2020 to 2021. This illustrates in a different way, the change in the monthly retiree contributions and the top part of the page, the monthly employer contributions in the middle part of the page and the monthly total cost rates at the bottom of the page. In all cases where there is an amount, all figures for medicare retirees are decreasing by 2. 9 with varying levels of increase or decrease depending on the plan, the nonmedicare dependent is enrolled in for the nonthree columns on the page. Next slide. So with that, ill present our recommendation. It is recommended the Health Service board accept the advantage ppo retiree 21 rate cards as presented today with a 422. 22 rate for the plan year representing a 2. 9 decrease and rate from the 2020 level and this recommendation comes with the understanding that the 2021 rates proposed by the United Healthcare are part of a twoyear rate gained proposal that is including the 427. 22 per member, per month rate quo quotation for the 2022 year. Its for the 2021 year plan only, but we want to acknowledge that the United Healthcare proposal also includes this second year, twoyear guarantee. Mr. Clark, i need to make a quick announcement. President breslin is trying to get back in the meeting via the phone line and having technical difficulties and ill pass the responsibilities of the chair to Vice President until president breslin can return. Ok, thank you very much and this is Vice President and ill be taking over as acting chair until president breslin returns. They can open up for the discussion of questions from the Board Members. Hello . Karen . Hello . We can hear you, yes, youre on the phone line. In the meantime, any questions from the Board Members for mr. Clark . I know we have approved some the rate guarantees and other scenarios and is this something from your standpoint that youre seeing across the public and private sectors . There are a lot of things that can happen between one though, now and 22 and i understand this number within the control of the health plan, but is this something that is new, different or timely in this respect . Yeah, thank you for the question. In this particular instance, this is not something that commonly see with Medicare Advantage plans. Typically, its a oneyear renewal circumstance and especially in this case, with an early renewal before the final cms subsidy rates are set, but United Healthcare did come to us, acknowledging the likelihood of lower claim exposure in 2020 to the covid19 pandemic and the suppression of healthcare thats been resulting overall. And obviously that could not have been foreseen at the time they developed their 2020 rates last year and so, in an approach to their underwriting proposal, we had significant discussion about the amounts that were being applied for use for the future renewals for 2021 and downtow2022 as well as the infon presented earlier on a slide in this deck. And so in the end, it did result in a more favorable rate renewal than would have occurred otherwise with just a straight somewhat just typical underwriting proposed by United Healthcare and so, because of being able to achieve a lower rate than would have otherwise been in the case in 2021 and lock in a relatively modest increase for 2022, lead us to recommend this twoyear renewal approach for United Healthcare. Again, it seems like theres an upside to it and i can appreciate to it. Obviously, the down side is that a part of the diminished access to healthcare will be diminished access to screening for Health Problems that may go undetected, colonoscopies and Artery Disease and on the one hand, im impressed with the shortterm benefit, but a little concerned about the health of our members in the long term with these kinds of programs and done to try to catch up with the deficit in Healthcare Services that have been postponed during the pandemic. Yeah, if i may, i will ask United Healthcare representatives to speak about expectations for the rest of the year for members, how theyre encouraging members to see their primary care physicians so that information can be captured as a part of the cms process for star ratings and the house call programs and so if i may call on United Healthcare representative to speak about that. Hi, commissioners. This is shannon hoss with United Healthcare and yes, we are continuing to reach our membership to encourage them to take advantage of virtual visits as much as possible and then as the different states start opening up for inperson Healthcare Services, we will be doing communication campaigns out to the memberships to encourage them to continue to get their preventative screens as much as possible. And so i just had a discussion with jessica yesterday about continuing those communication campaigns. Through the chair, this is commissioner scott. What is the medicare star rating of the plan that we have . 4. 5 stars. Thank you. Youre welcome. Any other questions . Karen, are you back online . Is president breslin back on the line . I can see her on a phone line. Can you hear me . I can, but can you hear me . Yes, we can. Oh, you can, i didnt know you could. Great, ok. My power went out here. And it isnt even fire season yet. [ laughter ] so i missed a lot of this because i trying to fool around with this stuff, but last year, you know, they came United Healthcare came with a 17 raise, as we know, and you say the majority of that was a hit tax, but 8 was a hit tax and 9 was what their increase would have been without hit tax and so, then again, it looks like 9 this year except for some of the other things you mentioned. And im wondering about this post discharge meals. How did they go from 1,344 two last year, to 1,344 this year . And what is the percentage of usage for these meals, because i think we should be looking closely at these things to see where the money is really going. So we can take that offline and present those back to you. And assuming they say on all of these meals, two meals a day, usually, and i was looking at meals after safeway and what they would be and probably the most 54 or something. And so, were paying were paying 1. 75 for the meals a month and like the last time, the utilization was ridiculous. We should be looking at these things and seeing, are we getting our moneys worth . Theres other ways to get meals, maybe, besides this and basically the meals in plastic than you microwave them and nothing health cree abou healthd im just questioning this whole meal issue. Thank you for the clarity. For clarity, the 1. 75 is the kps charge ill review in the next presentation and this year United Healthcare is including the added benefits i discussed earlier at no additional planned cost. So our members are not payed 1. 75 per month for healthcare . Thats correct. Theyre paying zero for these meals . Thats correct. Its included in the plan. I looked at the agenda for june 2019 and looks like our members are paying a little over a dollars per member per month for the meals and so, when i do some sort of quick calculations, which i know have lost, we paid for this year, i think weve paid Something Like 65,000 for the number of meals delivered and i have to go back, to figure out how many meals weve delivered. So the additional rate increase, we did indicate that into last years rate interest. It was a little over a 1. 04 per member, per month and am i remembering that correctly . Yes, it was 1. 01 in 2019, when it was introduced, correct. So were not even paying the dollar now . Thats correct. So were paying zero and how did that happen . So its not accounted for in the rate once so once we did the initial implementation for 2019, its just included in the plan now and its not an additional charge. It was into the total rate . Correct. So then you are paying it, right, in the long run . Ill come back with some Additional Information on how its absorbed into the rate. Its no longer a charge. Were not charging as a part of thofthe premium for those meal deliveries. So im curious about the 1,344 bursts of last year. When you say two, i dont think that was our overall there were 125 meals across two individuals. Versus 1,344 this year, i guess. Correct. Ok. And i dont know what percentage that would be. Im not sure, too, was the end on. I dont think that was the 2020 end of year number. That was 2019 yeartodate as we made the rating presentation for 2020. And the meals have to be prescribed. Its not the option of the patient being released from the hospital. It has to be prescribed as a part of the treatment, am i understanding that correctly . Its not necessarily a prescription. The case manager that is working with the patient just needs to recommend that they get post discharged meals or transportation and then they can take advantage of that benefit. And so this is commissioner scott. Ithis is where i have a question only of you, but also in the upcoming presentation. At the time a person is being discharged from the hospital, there are a number of discharge plan activities that are executed by hospital staff, by social work folks, so on and so on. There are a number of offices that get involved in that and my essential question is, who at that level is oriented or knows how this is being handled by our member who happens to be covered under your plan or under kps plan . For United Healthcare clinical case manager is assigned, when a member is inpatient is working directly with that member and they would be the ones making the recommendation. I see. And this is at the bedside of the person and their Family Member if theres an accountable Family Member, they would be aware of this . It would likely be by phone, not necessarily inperson. I see. Thank you. This is commissioner falls. Number one, karen, i did a simple calculation based on the number of meals delivered through late april and what last years new rate for these meals, per member, per month, ongoing and built into the current new rate and were paying about 48. 70, i think, per meal. 48 . [ laughter ] thats my calculation based on the number of our members enrolled in this United Healthcare Medicare Advantage program and the number of meals delivered and the rate from last year. I can guarantee that the rate that were being offered includes this. Its just not a change in benefit. And then to get back to the second question and the comment, the second observation and a comment, as someone who discharged lots of patients over my medical care, there are discharged instructions, people with heart problems and low sodium diets and its in the health plans advantage unti noo discourage habits that might prompt readmission within 30 days, because part of the Medicare Advantage rating includes readmissions. And so dietary recommendations that can be implemented into, in fact, meals so that for a person on Heart Failure, i would hope the meals provided are low sodium meals following the diets recommendations. Its an advantage to the patient and health plan and decrease the readmission risk for that member if they got and took their meals as provided and didnt supplement them with salty potato chips or hamburgers. So again, its a twoway street and my calculation, i guess im wrong, were paying fairly dearly for this but it would be a benefit to the members to be offered meals that are consistent with the recommendations of their medical team. Correct, the moms meals does offer different diet plans for various conditions, Heart Failure and low sodium being within ooneof those. The reasons this is discussed today is because there were strong evidence that these meals do make a the difference, but they are noting in the patients overall wellbeing and yes, the studies were done in relation to readmission rates which were exorbitantly high. This is a big piece of that. As fragments of our Healthcare System is, this is a huge challenge and boils down to as Commission Scott was saying, in the hands of the case manager that is actually doing the discharge, are they able to connect the patients with these types of acute Care Services and i think youve heard from shannon how united approached this and youll have an opportunity to hear how kaiser approached it. Theyre similar and different, but at the end of the day, if theyre able to systematically able to change the way we manage acute care, it will make a difference in the welfare of our population. That assumes everybody has a microwave, right . My experience with the programs is when they dont have one, they get one and i imagine those programs have faced the challenges as well, is looking to ways to improve. I mean, we could work with shannon, with kaiser to see what the satisfaction is around these meals. That would be a reasonable thing to ask. I cant imagine these meals would keep anybody healthy but better than not having anything to heat but 48 a meal is ridiculous. Thats the uptick rates that we had at that time, and so it is encouraging to see that keep in mind the target population here is hospitalized patients and as the number of people get hospitalized, it goes down. Theres not you cant really think about it, even though we typically pay for these on a per member, per month and its not a service thats readily available to every member because the target population is the sicker of the population. Its the people discharged from the hospital, basically, right . Yes. I think the point that the director is making, we would have to look at the number of individuals that are admitted to the hospital per year and i think out of our total membership, there isnt a significant percentage of individuals who are actually admitted since so much care these days is outpatient and more people are taking advantage of preventative care. So i think the population were talking about is a small one, but its usually with very acute problems or chronic problems that require that kind of hospitalization and the postcare. Ive tested the meals on wheels as they were distributed not to one of our members but to a retiree in another county who was being served by meals on wheels for that and the meals were actually quite good. And i was totally impressed with them. And so i think maybe we do need to have some kind of rating as to the quality of the meals and what is being distributed and if the individual is unable to have meals prepared for themselves and theyre on restricted diets, it needs to be controlled somehow and they need to be fed, because many of the folks will have caregivers at home and not able to do their own care themselves, i think. Ii want to point out that number one, this is a vulnerable population and sodium intake, for example, could put someone into Heart Failure and these meals should serve as a good template, whether theyre palitible or not, but people should be able to make them palitible with other spices and whatever. And im certainly not advocating that we take the 48 per meal and just hand it to our post discharged patients and say, here, you have 150 a day to buy food wherever you go, because there is benefit not only to the Members Health to get ongoing instruction in appropriate dietary, you know, meal preparations and planning and whatever. But also, if we can help decrease the readmission rates, then rates go down for everybody, because those calculated again into the following years rates, assuming that its not a rate guarantee. Good point. Ithink we need to look at the statistics that now we have over 18 him meals distributed, i think the cost of the meal has probably gone down significantly. Although, i dont know what you used for your numbers, doctor. I just used the what the minutes of june 2019 listed as cost of odding thi adding this. Now that its a benefit, im sure its ruled in. In. I dont have access to uhcs calculations for providing these meals. I know what we reimbursed across the board last month. We can do a report out on how these programs are working in the fall. Madam president , this is commissioner scott. All of my power is out here and so maybe ill just let commissioner fong speak to run the meeting because i cant mute or unmute or anything here. Then through the president and acting chair, i would like to offer the following motion, that we accept the actuarys recommendations as outlined on page 25 of the presentation, which includes the rate cards that are included in todays presentation. Thank you. Do i hear a second . Second. The motion has been made and seconded. I would like now to open up the phone lines for Public Comment. Natalie . Thank you. Put were goinwere going to had pause for members on the phone line and members watching catch up and i will start that 30second pause at 30 minutes and then well open up the lines. Can we show that page 25 . Because that doesnt match my printedout copy either. Im sorry. Anthony, any way to go back to page 25 . Is that the recommendation page . Yes. Thank you. Claire, for my own personal preference has been to open up my ipad at the same time and so i have access to the slides independent of the projected page. Because i agree with you that it is difficult with you to refer back to previous slides under the current formatting. Thank you, doctor. This is actually page 16 in the items that i printed out, the attachments that were given to us and i havent figured out how to use that ipad yet but i appreciate the comment because ill spend more time trying to learn that. Excuse the interruption for the meeting. Thank you. Thank you, commissioners. Moderator, can you please open up the phone line for the first caller. Operator you have two questions remaining. Im Herbert Winer and i was wondering at the point of clarification, did we do item 10 already . This is item 11 and i just want clarification on that. Yes, mr. Winer, we did it before the break and we started with item 11 after our ten manufacture minute break. Ok. And one question i have is, this plan seems very comprehensive and im a member of United Health. And my concern is we only have two plans, United Health and kaiser. And i would like to see the city plan restored for retirees. Otherwise. I have no comment on what is proposed and i disagree with the competition, the orders to keep the rates down and to provide very good service for retired and active members. Mr. Win winer, is that all yu need to say or anything else . Thats all i have to say. Thank you for your comment. Its noted. Moderator, will you please open up the lines for the next caller, please. You have one question remaining. This is fred sanchez, the president of protectourbenefits and i echo some of the same comments mr. Winer just said. I would love to see a return of the city plan. I mean, the comment was made earlier about the two choices of flexibility. The best way to do that would be to get as much providers bidding on the Health Service system and so, when we have that rft done, hopefully it will be so attractive, we will get multiple providers that arent providing services now and the they will e in. Interesting stuff because of the shortterm visits down and i share the concern that later on we might have a case of more dramatic patients coming in becausandthen well have a dramc increase in rates and thats a real concern. Speaking on the meals, if it really does mean less readmissions, that sounds like a good thing and its kind of like paying it forward like the silver sneakers, keeping people in better shape so that their need for admissions for various medical issues become lessen. Thats the thing that if they track over time and if we can get more providers, we would like that and we would like to see possibly the city plan coming back for the retirees. Im very concerned about the early retirees. Their rate increases over the last few years has been so substantial that its hard for that group. They need more providers. Thank you for everything that you guys do. Thank you, mr. Sanchez. Moderator, will you open up the call line for the next caller, please. You have zero questions remaining. Vice president , that concludes Public Comment on this item. So i think that were ready to go ahead and vote on the motion thats on the table for this. Would all members signify by saying aye and any opposition . It passes unanimously. We can move on to the next item. Yes, item number 12 is the review and approval of the kaiser senior advantage medicare fully ensured retiree rates and premium contributions for california, and this is for plan year 2021 and this presentation is done bymike clark from aon. Well review the senior advantage or kpsa, fully ensured retiree rates for the 2021 plan year in california. Next slide. Wool start with our recommendation and then an introduction to todays discussion, provide commentary on the kpsa 2021 rates, including Program Writer considerations, presenting monthly cards for two scenarios, including a comparison of 2021 versus 2020 rates. Closed with a recommendation. And as with prior presentations, we have appendix slides i will not review but are there for reference. Next slide. It is recommended that the Health Service board accept the kpsa medicare hmo retiree rate cards as presented under the post discharge Meal Delivery writers scenario which would include the adoption of a new post discharge Meal Delivery writer as described in this presentation for kpsa in 2021 and this would result in a 5. 0 reduction in kpsa per member, per rate. Next slide. And so well start our commentary and introduction to this presentation. Next slide. Well comment that as we reviewed earlier, theres 13,463 medicare eligible retirees enrolled in the kpsa plan and since a request by shsf, kaiser provided an early estimate for the following years and kpsa member retiree rates to be used in rate care development. Next slide. After our 12. 2 rate increase from 2019 to 2020, the premium rate before considering the addition of a post discharge meal differrery program is decreasing by 5. 5 from 2020 to 2021 and it would be a decrease including post meal discharge delivery program. The rate also includes an enhancement of the Transportation Services rider that was added for the 2020 planned year as wheelchair and gurney transport will now be included with program fees increasing for this, as well as a fee for the existing silver and fit Fitness Program. You see the pages where ill review it later in the presentation, the rate cards for both scenarios. Next slide. The derivation including all three programs, includes an added post discharge Meal Delivery writer if approved is shown here starting with the 2020 precms reconciliation, kaiser medicare member premium rate and the change in the yeartoyear medicare reconciliation was favorable and favorable underwriting adjustment from 20 to 21 and it added for th the innovation includes the enhanced benefit, included in the premium rate if all three are included in the program of 347. 37 and the sum released before the 2021 final approval that we reviewed earlier today. Next slide. The proposed rate adjusted for prior years cms reconciliation variances is an estimate since kaiser has not received that final approval from cms for the 2021 rate. Given its an estimate, kaiser will reconcile any differences between the 2021 rate provided today and the ultimate final 2021 rate next spring. And this difference will be applied to the 2022 rates. Since its a risk rated for the medicare population, the final rate could be higher or lower than estimated applied. Although the desire is to be as close to the initial estimate as possible. They cannot project the final rate, nor predict the ultimate variance between the initial and final rates at this time. Next slide. Both the medicare reconciliation adjustment and trend are favorable for 2021 as we discussed earlier and as a reminder, when we set our total kpsa premiums and rate cards, we include the vsp basic plan, vision premiums and the sfhs healthcare Sustainable Health charge. Next slide. Now well go into a conversation on the Program Writers. Next slide. And in recent years, as weve discussed today, medicare have been encouraged to provide support for Members Around the Healthcare Services they obtained. Three programs were discussed for the 2021 plan year which represent a mix of programs already in the plan this year, as well as an enhancement in new program consideration. So youll see as we talk about each of these, well discuss the continuation consideration of silver and fit for fitness, the enhancement consideration for the Transportation Service and new consideration for the post hospital discharge meal differrery service. Next slide. And the silver and fit program is an exercise and Healthy Aging program which is similar to the Silver Sneakers Program we discussed earlier than the united plan. They provide a Fitness Program and the 2021 premium charge for silver and fit is 2. 80 per member, per minute or 452,000 total, which is a passthrough of the program cost through the organization that operates silver and fit, American Specialty Health. In terms of utilization for the 2019 plan year, there were 1,185 members enrolled in the gym membership and 125 members enrolled in the home Fitness Program. So in total, approximately 10 of total kpsa plan members elect to enroll in the silver and fit program. Next slide. As background in the Transportation Service discussion, the Health Service board approved transportation benefit enhancement to both medicare plans recently, the United Healthcare plan of 2019 and kpsa for the 2020 plan. This provides Transportation Services at no cost to the member up to 24 oneway rides annually, as well as a post discharge after a hospital stay ends within a 50mile distance limit per trip. Presently, the kpsa transportation rider does not accommodate participation of a member in a wheelchair or gurney during the ride. They must be moved into a seat and the vehicle presently for transport, where the wheelchair, for instance, can be tucked into the van, but the passenger would not be riding in the wheelchair in the van. Next slide. But for the 2021 plan year, kpsa is preparing to accommodate the transportation of a member in a wheelchair or gurney to allow for the transportation rider fee and the kpsa rate would increase from the current 2. 75 per member, per month, to a proposed 3. 87 per member, per month in 2021 and this represents an nursincrease of 181,000 annual. For the first three months, there were 47 rides and ill verbally update that for the first month dates, there have been 63 rides delivered to kpsa members through the existings transportation rider. So again, 63 rides now through the first four months of 2020. And pricing is based on these utilization assumptions from ktsa derived from kaisers observations for these services and other kaiser planned geographies and expect 5 of members for medical appointment rides and 3 for total members for post discharge rides. And there is a small additional amount within the pricing to cover administration and Information Technology support for the program. Next slide. In the new consideration for post discharge Meal Delivery, if you recall 2019, this was added as we discussed earlier today for the United Healthcare plan. For 2021, kpsa has the ability to offer a Meal Delivery service which is not offered in kpsa today. Up to 84 homedelivered meals following a hospitalization, when referred to by a clinical staff member includes three meals per day, limited to one utilization. All meals are ordered in succession immediately following an inpatient hospitalization and cannot be spread throughout the course of the year and the cost for the meal as benefit for kpsa members is 1. 75 per member, per month, for 380,000 total. The pricing assumes the 3 utilization of total numbers for post discharge Meal Delivery on the experience of the vendor, moms meals with other plans and there is also a small additional amount in pricing to cover administration and Information Technology support. Next slide. please stand by . Just as a reminder that the rate cards are for those with full contributions, and there are other cards for those with other coverage or contribution, depending on active or retiree. So this illustrates the difference between 2020 plan year retiree contributions under each of the two scenarios that were presenting today. The top set of figures are the status quo contribution. That is if the Meal Delivery rider is not offered into the kpsa plan versus the retiree contributions in the bottom table for 2021 if the Meal Delivery rider is included. You will see that the retiree only contribution is zero throughout, so no impact there. For those covering Family Members, theres a small differential in retiree contribution between status quo and the Meal Delivery contributions. This card shows the Meal Delivery rider scenario, building on the total cost items in the upper part of the exhibit. The employer contribution in the middle part of the exhibit, and the final member contribution and the change in member contribution in the lower part of the exhibit shown in this chart for the three medicare only tiers, medicare retiree only, plus one, and plus two or more. We have appendix in the exhibits that capture mixed medicare family rate tiers to exhibit the impact of retiree contributions in the appendix, as well. Next slide. This shows the change in retiree contributions and contributions and rates under the status quo scenario. Next slide. And then, we have two pages, starting with the rate card if the Meal Delivery rider is offered, and the next slide is the change in rates for contributions if the Meal Delivery rider is offered. So well go to the recommendation page. It is recommended that the Health Service board accept the kpsa medicare h. M. O. Retiree rate cards as presented today under the post delivery rider as presented in todays presentation that would result in a 5. 0 reduction in kpsa per month member rate. Vice president follansbee, i turn to you. Vice president follansbee okay. Thank you very much. Id like to open this segment up to questions and comments from commissioners. Commissioner scott this is commissioner scott. I dont know if theres a plan representative on from kaiser, but its regarding the wheelchair costs, and have you or has kaiser contracted with a different vendor to provide wheelchairtype of transportation versus the vendor that you currently had or how is that working and why is there this expansion of costs of 181,000 . Thank you, commissioner scott. Kay kessler with Kaiser Permanente. We are continuing to contract with the same vendor, and weve been working with diligently with them. I know that weve had many discussions over the past yea,s maybe longer, about adding this benefit. And based on the usage that weve seen with this type of transportation in other regions and some of our other business lines, we determined that this would be the correct rate to include the gurney and wheelchair transport. Its a specialized type of transport. Commissioner scott but its adding 181,000 to the cost . Yeah, i believe and i dont have the page in front of me. Mike, i think its 1 commissioner scott 1. 75 or something. Thats correct. It is adding that to the total cost. And i think, commissioner scott, when we had talked about this in previous meetings, i believe weve always been very transparent that the cost would change if we did add the wheelchair gurney van service to this item. I know that it was an important part of the benefit. We did not have it in place to start, so the total cost that you saw for 2020 did not have that included in there. In an effort to really get this in place to start the benefits in 2020 while working towards this for 2021, and so i believe, though, from a total cost standpoint, this would be fairly comparable to what you would see in the marketplace to this type of a benefit. Vice president follansbee any follow up question, commissioner scott . Commissioner scott thank you. President breslin id like to ask, if i could, the wheelchair and the gurney, is that customary for people that provide transportation vendors that provide that . Ill ask my colleague, julie brady, to comment on im not sure if we have data on how common it is that we use those services. Julie, do you have that information with you today . Hi, this is julie brady. I do not have that information with me today. We can go back and ask Member Services for that information. President breslin im sure curious because many people say they get you out of the chair and put you in the regular chair and store your wheelchair. They dont put a whole gurney in a back, so if you have to put a whole gurney in a van or something, thats a whole different thing. Youre right. It absolutely is. Thats a specialized type of transportation, and it really is based on the needs. There are some cases where people cannot get out of the wheelchair and have that put into the trunk, and so it was important for us, and i know important for the board to have the complete benefit added for 2021, and were pleased to be able to do that. President breslin so youre anticipating 3 utilization for the meals . Yeah, thats what were using as our figures and what for working with the and we have the same provider that u. H. C. Does, and so based on information from them and what theyve seen from other health plans, thats how weve developed the rates. Important to note, this is a new benefit for us for 2021, so were using that information. Obviously, as we move forward, well be able to assess what our own utilization is and what the cost should be in the future. When i see these utilization figures and what they cost, it just seems like i just dont know how sometimes we can justify adding these benefits for such small usage, when everybodys paying for them and very few people are using them. I dont know. It just kind of [inaudible] president breslin its 10 , which i guess would be about 1300 people or so using them. Its quite a few, i suppose. Just, president breslin i didnt mean to discuss you. President breslin no, go ahead. The discussion that we were having previously about the meal service, it was a good discussion. This was a service that we looked forward to provide, and we look forward on reporting out to the board on what the usage of this is and how people like having specialized meals upon discharge. And also, we want to continue, should you continue with these benefits, all three of them, moving forward, its important to continue to work with executive director yant and her team, and weve had a lot of discussions about this, about how we can continue to make sure that communication is out there and getting retirees to use the benefits that are out there for them. They serve a purpose and theyre very important. President breslin and another question that came up, you get reimbursed for medicare for these benefits . We actually dont. I know that it can be very confusing. We can be allowed to offer these benefits, but they do not reimburse us any additional money when we offer these benefits. President breslin well, i think the big problem is excuse me. I think the big problem is with Medicare Advantage problems is lock of transparency because we lack of transparency because we dont know how much these vendors are getting reimbursed. Mike, correct me if i am wrong, but we dont know how much they get reimbursed from kaiser, from kaiser or United Health care. I know they look at a lot of things, but theres a lot of upcoding that goes on today. I know that for sure in United Health care, and so just maybe you can shed some light, if you think you know about these cases and how much theyre getting upcoded. Yeah. I can comment on what i see. United health care, we are provided with an underwriting sheet that lays out the total expected costs as well as what is expected to be reimbursed by c. M. S. Into the plan that produces the net rate that you approved earlier in this meeting. While we dont have exactly what the c. M. S. Is created in the United Health plan, we know what the estimated costs are on the estimated gross costs. Miss kessler, i would ask you to comment from the kaiser perspective. Yeah. Ill have my colleague, yolanda, comment on that, if you wouldnt mind, on the c. M. S. Reimbursement and setting our rates. Hi. This is marina from United Health care. So i would say the process was very similar to how mike described for United Health care, u. H. C. We go through a process where we get some preliminary notices from c. M. S. Regarding what they are looking at as far as anticipating reimbursements throughout the year, and as mike mentioned, we dont get that final notice of what reimbursements are going to be, really, until the fall late summer or fall. And then, we take that information which has a really similar process which calculates the expected reimbursements and then what our expected costs are based on the benefits that we are offering. What might be different between Kaiser Permanente and some of the other plans is that we do not experience greater use actually claims and developing rates. Were using the reimbursement as the basis, and then, the other benefits that we are offering that built up the Community Rate for the medicare plan. President breslin yeah, i understand that theres a rate, but if you present to medicare, thats an individual that has all these other health plans, and they reimburse you a lot more for that, and we have no idea how many people that could have been done with, and we have no way of knowing what you get for all of these actual individuals, right . Yeah, thats correct. They do do a risk adjustment based on how c. M. S. Looks at our overall population to determine the reimbursement that they supply to Kaiser Permanente, and we do include those assumptions in our Rate Development for the actual rates. And then thats presented to mike, correct, lorena . Yeah, thats correct, and then, if theres more information, we can help develop. President breslin is mike able to see how youre reimbursed maybe 500 people youre getting a lot more money for than some other 500 . Is that based on your book of business and not our specific population . Thats correct. President breslin but theres an update now, and medicare followed suit. But karen, if im understanding what the representative from kaiser just said this is commissioner scott, they are not looking at individuals, theyre looking at their whole book of business. Were not specialized in their population or predefined, were part of their whole book of business, and that is what they are presenting to medicare for reimbursement, not individuallybased claims. Its a communityrated process. Were rated as a community. Were not individually or, in our own right, evaluated on that basis. Vice president follansbee and this is commissioner follansbee. I can reiterate that, that that is, in fact, the case. I also want to be careful that no members of our board accuse either individual providers or health plans of upcoding. That is fraud. That is definitely fraud, and i can definitely excuse me. Let me take a quick drink of water and having been investigated for fraud by the state when i was accepting medicaid and found that i was not fraudulently billing, i know that d. H. S. Is very concerned about fraud, and as you alluded to, karen, they have actually gone after systems for fraudulent billing, so i dont think we should be in a position of accusing either u. H. C. Or kaiser of upcoding fraudulently, which is kind of the concern you were saying. My point is benefits are hard to approve once you take away them. Im a little concerned when we approve moms meals for u. H. C. A year ago, the price was 1. 01 per member per month, and kaisers going to charge us 1. 75. And i dont know what u. H. C. Now pays, but thats a huge increase in meals and with the same vendor. I dont quite understand what the difference is in services that will be provided to the Different Health plans. Likewise, were being now asked to subsidize silver and sick, and we have high utilization. 10 of our members, which i think is fantastic, but im wondering if kaiser has data because of the division of the research or whatever that shows in fact they have to charge more because its not really in our interest for members to be silver and fit; why were being charged for something in this cycle that we werent charged for in the other cycles. Yeah, kay kessler. Let me address the silver and fit and then well address the meals and the pricing. Silver and fit is what is charged by American Specialty Health to us, and we had, when we originally implemented this, as a special arrangement, you know, as starting out with the new benefit, we had offered that we would cover the cost for the first two years. We expanded that last year because the rate increase was so high already because of the reconciliation from the previous year, but we were very clear that we would need to begin charging for this. Again, were not reimbursed for. It is something that we pay directly to American Specialty Health, and its not based just on the rate usage of San Francisco. Again, its something that the members had asked for and wanted to be a part of this. And then, let me answer the meals and ill see what followup questions you have. The meals piece, when you look at it again, we worked with moms meals to look at what their experience has been with other health plans, but remembering that were an integrated delivery system, have the ability within our hospitals especially to make sure that this is really integrated with that discharge planning, we actually believe that usage may be slightly higher. Now well have to see. Again, this is a new benefit, but when our actuaries look at that, there may be a difference in pricing, but i have no idea what the cost of moms meals is for this year. Commissioner scott so to this point this is commissioner scott of discharge planning, i go back to my prior question of u. H. C. So how does that work with you folks . Again, youve got many people touching that person as theyre leaving the hospital, so how do you get kind of that prescription for this particular service to that individual . Yeah, no, great question. Julie, if you could walkthrough the process. Youve been great in putting this together in how our nurses will walkthrough the discharge orders with the discharge nurse . Yeah. Itll be part of our paperwork. The member will receive a call from the vendor. The vendor will figure out what kind of meals they want to be charged for, what kind of meals they want, and where they want them delivered to. So if they want the meals delivered to their daughters home, they can have them delivered there. If there is a special meal they need, thatll be able to be figured out. All of this will be figured into the discharge plan and customized for the member. Commissioner scott thank you. Sure. Vice president follansbee i just have one other question in that i remember very distinctly our concerns when the transportation benefit was added, that we were concerned about wheelchair access because Public Transportation allows anyone being transported in San Francisco through through muni to have wheelchair access. I dont think that we were necessarily addressing gurney access, but we now are being asked to cover both wheelchair and gurney. Do you have some estimate about how many the gurney portion of this contributes to this surcharge and how awere gurney patients being transported before and to what costs were they being subjected if this was not a benefit . Yeah, great question. I know that me and julie, we mentioned earlier, well have to go back for some of those numbers. I dont know, julie, if you can comment on the wheelchair, the van, gurney, it comes kind of as a specialized vehicle. Just julie, i dont want to assume, so if you could comment, and if we need to get back to commissioner follansbee, we can. Yeah, i think we might have to get back to him. I do know that they sort of do work hand and hand, but well have to go back to the vendor to find out about that. So we will follow up with the numbers, the percent, because it sounds like, just to be clear, you want to understand the percentage of the time that its actually gurney transportation since the conversation had been very much about wheelchair and van usage. Vice president follansbee yes, in part, because i think we realize given some of the stresses of our municipal transportation system, some users were having to change buses several times, stresses over scheduling, and it was really that population, the wheelchair users that seemed to be accommodated by Public Transportation when possible, but all of the benefits of the transportation rider werent being extended to them. The gurney rider, that didnt extend to them. They were never subject to delays or Public Transportation riders. Not that im trying to deny gurney patients transportation. Yeah, absolutely, and let us get you that information. I dont want to makeup numbers in any way, but i do believe that it is a combination to having both but not necessarily the focus on gurneys. Well get you the information. Commissioner zvanski this is commissioner zvanski. In working with some of my retired patients a few years ago who were kaiser patients, i learned a couple of things. One, not everybody has a wheelchair who folds into the trunk. Some of our members have electric wheelchairs or other devices, and so a van that drives up to take them has a ramp so that they can drive up that ramp and into the van and remain in their electric wheelchair or cart or whatever it is. So thats very different than the standard type cab or car that would come to pick up someone who doesnt need a wheelchair or is a wheelchair user with a chair that can fold up into the trunk. I dont know that theres a different charge for that, i just know that it was a different type of transportation. Lastly, when one of my colleagues was being sent from the Rehabilitation Center where kaiser placed him and needed to go back to kaiser for various tests and other appointments, it was an ambulance that was sent, and the member was charged separately for the ambulance ride both to and from his appointments as other kaiser facilities. He was in pacifica, so he was going to south city and San Francisco for different appointments, and he was charged the ambulance rate because i guess they transported him on a gurney and not on a wheelchair even though he was pretty ambulatory. It occurs to me that when we talk about gurney transport, it is this transportation versus ambulance, even a b. L. S. Ambulance, which is lower cost versus some of the other Transportation Options now available through Transportation Companies that contract with kaiser or other places. And those are just my observations for whatever theyre worth. Thank you. Commissioner scott this is commissioner scott. If theres no other comment, i am prepared to make a motion. Vice president follansbee go ahead. Commissioner scott i move that we take the suggestion of our actuary of the rate cards with the proviso that we will monitor the recommendation throughout the year. Second. Vice president follansbee now, well open it up to Public Comment. Clerk thank you, Vice President follansbee. One more time, were going to wait 30 second to allow those of us at home who are watching the feed on sfgtv to catch up to where we are. The 30 seconds will start now. All right, moderator, can we please have you open up the phone lines to see if theres any callers remaining. Operator you have one question remaining. Hello. My name is richard rossman, and about the transportation, when i had a Family Members discharged from a kaiser facility, we got the exact opposite information, saying that the gurney and wheelchair would be free, but if they can walk, kaiser wouldnt pay for it, so i dont this was in february. Second, since kaisers saving money on not building a new building in oakland, and they give money to the warriors and the san jose sharks, maybe they should use that money to build another post acute a post care facility so kaiser can be in charge of the patients post recovery, which i think they should be from the time of the surgery until the time they go home and not pass the buck to third parties. And lastly oh, the other thing is that i found out kaiser has an ombudsman. I never knew about that. I found out about that almost accidentally, and this notice should be placed in the hospital rooms and sent to our members, and this ombudsman has been helping me in my ongoing saga with kaiser. And i find the person very neutral, and i dont know why kaiser doesnt advertise this service. And finally, when after the rate study period, i hope Health Service board and kaiser can work on setting up an advisory committee. I think it would be good for our members with kaiser so we can meet and try to work out some of these problems that keep popping up. Thank you. Clerk thank you, mr. Rossman. Moderator, will you see if any other callers are on the line . Operator you have zero questions remaining. Clerk Vice President follansbee, this concludes Public Comment. Vice president follansbee thank you very much. So i now call for a vote on this item as proposed. All those in favor . All those opposed . Okay. It passes unanimously. Thank you very much. We can move onto item number 13. Clerk item 13 is a review and approval of Kaiser Permanentes multiregion retiree plan rates and premium contributions for plan year 2021. This is presented by mike clarke from aon. Commissioner scott excuse me. This is commissioner scott. I wanted to have through the president or acting chair, i wanted to have placed in the record that were going to monitor periodically these supplement c Supplemental Benefits that exist with u. H. C. That we now have with kaiser, so id just like to have that on record and get some sense of cost throughout the plan year. So im asking director yant to make note of that. Yes, ive noted that. Thank you, commissioner scott. Vice president follansbee thank you, as well. Commissioner scott im sorry to have interrupted. Vice president follansbee no problem. Move on now to item number 13. Mike clarke, aon, and my last presentation today will be to review the Kaiser Permanente 2021 multistate regional rates for early retirees and medicare retirees. Ill start with introduction, move quickly to the commentary on the rate actions, and move to the rate cards, to the recommendation for the board today. Next slide. Staff recommends that the Health Service board accept the kaiser multistate region plan premiums that are shown in the resulting rate cards and best material. It demonstrates current membership enrolled in each plan along with the total proposed kaiser rate actions from 2020 to 2021, the total expected annual premium for all three regions for this plans, approximately 942,000. You can see the distribution of covered lives across early retirees and dependents as well as medicare retirees and dependents and the rate change actions being proposed today. Increases for the washington region that are at or slightly below national trends, and decreases for the rates in northwest and hawaii regions. Next slide. In 2018, sfhss introduced a new set of kaiser plans for retirees living in certain geographies where kaiser plans are available. They are available in Washington State, the northwest, which is primarily the vancouver, washington and portland, oregon area, and hawaii. Next slide. The overall average rate changes that we reviewed earlier are 1. 7 decrease for early retirees and 0. 7 decrease for medicare retirees. When we set the total premiums, we also include the cost for the v. S. P. Basic vision plan premiums and the fhsb sustainability plan charge. And just a reminder that these rates are set early in the process, so any reconciliation to ultimate final 2021 rates will occur next spring. Next slide. And just a reminder that the rate cards in this document are for those who earn full employer contributions for Retiree Medical coverage based on the criteria listed on this page. There are also alternative levels of employer contributions or coverage with no employer contributions, depending on the retirees scenario. Next slide. So with that, we show the rate cards for starting with washington, the rates of the contributions similar to the format looked at earlier. Next slide. Here, you see the changes in rates focusing on the monthly retiree contribution changes at the top of the exhibit for early retirees on the left side, medicare retirees on the left side. Youll notice there is no required contribution for retirees and early retiree coverage and medicare only retiree coverage for any of the contribution plans. Next slide. These are the rate cards for the Northwest Region. Next slide. And the change in rates for the Northwest Region plans early retirees and medicare retirees. Next slide, and we finish with the rate card. Next slide, and the changes in rates. Next slide. So we go with our recommendation that the Health Service board approve the kaiser permanent say 2021 premium plan rates and regional rates for early retirees and medicare retirees. Vice president follansbee . Vice president follansbee mike, thank you very much. Lets open up the item for questions, comments from Board Members. Commissioner scott this is commissioner scott. In light of this extensive discussion we had on retiree supplement, what im talking about in terms of the enhancements, do these same programs apply to our retirees in this in these other regions . Id like to defer that question to a kaiser representative, please. Hi. Kate kessler, Kaiser Permanente. They do not all apply to the other regions. Julia, i want to confirm that that is correct. Yes. This is julie brady with Kaiser Permanente. Yes. Currently, these services are only offered in california. We are looking at expanding, but the regional footprint is much smaller than california. President breslin i just have an observation. Washington is, like, 1,940 a month for a family. Thats 23,000 a year. You know, i dont know who can afford that. That is really something, and the northwest is also really expensive. Im curious why hawaii would be so much less since hawaii is very expensive to live. They have a very high cost of living there, and im curious why hawaii would be so much less. Sorry. I was trying to get off mute. So i dont know the reason that the rate is so much different in hawaii, and im wondering if, lorena, if you have the information. I know these are very small early retiree populations. Many times, these are manually rated, and its not based on utilization at all, and its very much based on the rate usage in this area. I wonder if you can comment further. We would have to take this back and look at some Additional Information, but in general, it is manually rated and based off of the demographics, but there may be a different demographic between the members in washington than we have in hawaii, but wed have to look at that closer for you. Very small populations, as you saw, so they could be very different from one another. President breslin well, hawaii is 25 and washington is 16, so it couldnt be that much different. But very different people, so we dont know what the population is yet. President breslin this is something i think we should be looking at for the early retirees with dependents because im sure theres going to be more with all the things going on. Its getting almost unaffordable with them, and the same with blue shield in San Francisco. Its also in the bay area. Its, like, 16,000 a year or more. I dont know. Talk about that more later when you talk about the r. F. P. I look at these figures. I dont know that would be a quarter of peoples salary or more of some peoples salary. Yeah. The employer contributions from the city charter do provide for the full employer contribution for the retiree coverages only for these plans, both early retirees and medicare retirees. There is an employer contribution for the first dependent for the city charter, but the second and subsequent dependents receive no incremental contribution per the city charter. President breslin im talking about the employee and retiree and family, which may be one child in the house or something. Thats what the problem is. The Single Person in all categories is not that high across the board, but but that particular group is really, really vulnerable. Commissioner zvanski this is commissioner zvanski. Can i ask a question, as well im sorry, karen. Are you done . President breslin yes, i am. Commissioner zvanski id like to know first of all why if im not understanding, why the rates for washington overall are so much higher than every other place, and my understanding from actually coworkers who were from hawaii and went back to hawaii when they retired was that hawaii has that kaiser is sort of the state of hawaii plan or sort of the state coverage that is offered to everybody. So i would expect that whatever we contract would be probably rated with that group and would be a lot less, and i dont know if im understanding correctly, with all of these outofarea people, that they are all being rated individually, and so that means that in hawaii we would not get whatever the hawaii rates might be with the state of hawaii, but were being charged a separate rating based on the individuals that we have there, and id like clarification of that. But i do want to know why Washington State is so much higher than anywhere else. Yeah. So i will commissioner zvanski, ill comment on the hawaii rate as far as the estate plan, and this has nothing to do with the rate. The state of hawaii offers Kaiser Permanente as an option, and of course theyre rated according to their utilization, and thats a completely separate plan. And so we can get Additional Information on the details of the rating for hawaii versus the Washington State area. Again, these are each very small populations that are typically manually rated from for each of those areas, and we can certainly get Additional Information for you. And i do know the kaiser actuary shared with me before the meeting that specifically for Washington State, there was the recent acquisition that kaiser made of the cooperative Health Program in Washington State, and so there were some underwriting methodology changes for the 2021 plan year that drove that 6. 3 increase in the early retiree rate in the Washington State program, so the onetime adjustments, now that the underwriting is fully under kaiser and kaiser owned, so we would expect per the what the individual shared with me before the meeting that there would be a stabilization of that increase Going Forward before this oneyear adjustment in the underwriting. Commissioner scott through the chair, this is commissioner scott. To michael mike, at this point you did say these plans were Community Rated, all three . Thats correct. Commissioner scott so its not that theyre looking at our utilization per se and then coming up with a rate, theyre looking at their book of business or whole community, and were a part of that, correct . Correct, and certainly happy to ask the kaiser underwriter to speak of demographic adjustments or anything else that may happen within the Community Rating environment. Commissioner scott okay. Thank you. Yeah, absolutely. Go ahead, lorena, if you would like to comment on that piece of it. Yeah, so for these small populations, they would be manually rated, and so none of their utilization or experience would be included in the pricing of the rates because it would just be too volatile. One person going into a hospital in a population of 15 members could skew the utilization experiences or what it would look like. These are small populations, and theyre based on the demographics of a retiree population. So, for instance, if, in washington, you know, the population had an average age of 64 whereas in hawaii, it had an average age of 55, then you would see a difference in what that demographic factor would be. It would also be, to your point, president breslin, is that the mix and so one of the things that well take back and look at is exactly how many families, how many subscriber only contracts we have, and then how that is impacting the rates because that can also have an impact in implications and development to the rates, as well. Commissioner scott so for the record, maybe one of the things that he we h things we need to and this is to director yant maybe get some information on the group rating and individual rating processes, and we can have our actuary weighin on that as we go to an education session later this year. Vice president follansbee any other questions or comments from the commissioners . If not, ill entertain a motion regarding this recommendation. President breslin did we have Public Comment . Vice president follansbee until we have a motion thats passed, i cant have for Public Comment. Once i do, ill ask for Public Comment. Commissioner scott this is commissioner scott. I move we accept the recommendation of the actuary as outlined in his presentation and summarized on page 24 with the underlying rate cards for the kaiser plans that are in multistate regions. Second. Vice president follansbee okay. Its been moved and seconded that we approve that recommendation. Now well open it up for Public Comment. Clerk thank you. Another reminder that were going to wait 30 seconds for the public to catch up to where we are now. That 30 seconds will start now. Commissioner zvanski while were waiting, this is commissioner zvanski, seeing that we now have, i guess its two more categories of retirees, the january 9, 2009, and the january and then Going Forward, the january 10 hires, and i know it adds to the rate cards, but im used to seeing rate cards that had about five different options on them, on one specific card way back before it was aon hewitt, but it would be nice to see those rates, as well, so that we could have rate cards that show us what those retirees are costing and what they would be paying outofpocket and compared to the previous year. I would really appreciate it. And lastly, i just want to understand with mike that these individuals that are being rated in the multistate, you said they were getting the full the full, i guess, supplement, so this is the tencounty theyre not getting the difference between the tencounty map and the full cost of the plan as we have in our other Medicare Advantage plans that are then passed on through employee plus one and family rate, correct . Yeah, the employer contributions are developed, you know, first for the single tier based on looking at the plan costs, as well as the other features of the formula, and then, the subsidy contribution applies to that first dependent. Commissioner zvanski right, right. So what im seeing in the rate cards that thats the difference between the two costs, and its not the full tencounty amount, it looks like. Based on the calculations, thats correct. Commissioner zvanski thank you. Clerk thank you, and i just want to remind you, commissioners, the reason we have a 30second pause so the people at home who are experiencing a delay in presentations can actually catch up before to hear presentations before we move into Public Comment. So i would request that we use that 30 seconds for silence. Moderators, can you please open up the call line for me . Operator you have zero questions remaining. Clerk Vice President follansbee, that concludes Public Comment for this item. Vice president follansbee so id like to go ahead and open up this item for a vote. All in favor of the recommendation and to approve the Kaiser Permanente 2021 multistate regional rates for early retirees and medicare, please signify by saying aye. Anyone opposed . Its unanimous. Thank you very much. This concludes the rates and benefits section of the meeting. We now open up the meeting to the regular meeting. Id like to remind the Board Members that and the public that number one, we have three very important items, one of which is an action item, but wed like to see if we can move through the rest of this agenda, including the action item, in the time we have remaining. So im going to call for item number 14. Clerk yes, no problem. Item 14 is the directors report. This report is given by abbie yant, the executive director. Good afternoon, commissioners. Thank you very much. Due to the lateness of the hour, i wont spend a lot of time going over the directors report in your packet. I anticipate there may be some questions about a few of those items, so i just wanted to highlight in the report that the Health Service system continues to operate in a virtual environment very much like we are today and do not have any plans of opening to the public any time soon. Were preparing our health and safety plan to be submitted to the City Administrators Office which outlines under very restrictive guidelines how we mail out some additional personnel into the office on very specific focuses and schedules. All persons will have to selfcertify as to their wellness, where they anyone whos ill will not be allowed to report in to work. Many more details on that, should anyone need that, they can talk to mitchell or myself. The also, i acknowledge the we have on our ongoing Strategic Plan for the Health Service system, addressing the social determinants of health. We talked a little bit about that through the transportation and yield discussions that were quite robust, though we do need to have a conversation about the impact of race on health and health outcomes, and we will be doing that again in the second half of the year where were looking more closely at our data and how we can support our members whose health is related to their rates and how we may be able to Work Together to improve the health of our membership. I also want to ask, after several years of postponing the decision, that we will proceed with doing a competitive bid for our medical plans, and that is officially, as of today, this is the Public Notice that we will be doing that. We have included in the directors report a memorandum to that effect admonishing each of the commissioners and advising on what your communications cannot be can and cannot be with anyone who we are currently doing business with or who is potentially bidding on the plans. I will note that we should call that a blackout notice, being se sensitive to the situation that exist in all of our communications. I reworded that to a communications notice. The impact of covid on our membership and being seen through the plan claim utilization is just now starting to come in, and we hope, again, in future months, to be able to report back to you, as you. As i think all of you are aware, San Francisco as well as the bay area has done a good job in suppressing the wave of the covid, but as things open up, there may be outbreaks and clusters of covid that occur, and so the Health System is certainly more ready than it had been to accommodate the care needs of persons infected with the covid virus. But at this point, the problem has, at least as we understand it, has been an underutilization which has been spoken to several times today. As we continue to get these measures to work with our health plans, we will be reporting back to this board. I did want to move into the quickly into the fact that we do have some folks that are going to be able to retire this year, and so i just wanted to recognize of our staff that came to the city from blue shield in 1991 and has really carried a great institutional memory and has been a stalwart advisor in our Member Services area. We wish her well. Shes had nearly 30 years of service and has been a pleasant woman to work with. Anabelle perr began her career in 1980 at the school district, and then she moved around a bit and ended up in City Services where she is a member benefit analyst. She has a lot of compassion for our members, as well, and has been a stalwart member of Member Services. With that, i would like to say i wish both of these women well in retirement, and we will be looking to fill those positions in order to serve our membership. I also wanted to acknowledge the work that we continue to do in i think really important ways of collaborating with Public Safety agencies, with the health department, with the department of Human Resources and many others in bringing wellbeing with a focus on Mental Health to the workforce today. It certainly has been an issue for us that weve wanted to delve into deeply for several years now, and the crisis has afforded us the opportunity to really dig deeply into Mental Health issues and bring tools and work closely with these with many departments, so with him beings, like many of us in this new covid world, has been incredibly adaptive and creating in finding new ways to work with our partners throughout the city. So i think with that, ill close, cause many of the other things smile way have been mentioned in this lengthy meeting today. Let me just pause there and see if there are any questions or comments from the commission. I just got a message that someone was trying to call in on 13, and they said there was no Public Comment, so please check the line. She said there were a couple other people in line to get on, too. Clerk yes. Were they pushing onezero to get added to the queue . President breslin i dont know. It just said there was no Public Comment. Vice president follansbee no, no, that item is closed. President breslin no, i was just saying that they were trying to get in. Maybe something was wrong with the system. I have a couple of questions about the r. F. P. Its going to be for actives only and early retirees, not kaiser, of course, but what ive heard is i know you had the focused group, and a lot of members saying they want more choices more choices besides blue shield, and maybe blue shield and somebody else because without any competition for blue shield, prices can do whatever they want to do there. More choice and more competition is always good. Also, the city plan, in order to make that viable again, youre going to have to open it up to all members. It just doesnt seem right to separate our members for these different plans. I looked around at the ten counties, all the ten almost all except two didnt have a p. P. O. , and some of them had two p. P. O. S for sure. And then, i noticed the county with the fewest selections, which was santa clara, was the highest across county. So it just seems that we need more choices, not just to take away one and get another one. More choices. And then, early retiree with family death, they need to find something it seems they need to find something more affordable for that group because its just getting unaffordable, especially with blue shield. And the city plan isnt working either, because of the medicare people being taken out of there. And then, i dont know if the board did the board personally weighin on this r. F. P. And what they would like to see or was it just the focus group . This is commissioner zvanski. I have a question, as well, through the chair. Vice president follansbee wait. Were still waiting for a response to that question. You were muted, i believe. No, ive been actively listening to this board for 2. 5 years, karen, and weve had a number of sessions dedicated specifically to this. So i did hear what youre saying. I would like the one comment that i would like to make, though, is we are not including in this competitive bid the medicare business. It would be too much for us to be able to take that on, and the disruption to the entire population would be almost impossible to manage. So we are focused this year on the medical plans for the active and early retiree populations. President breslin so no p. P. O. In sight for the medicare population . Were not addressing the medicare populations this time around. Vice president follansbee commissioner zvanski, you had a question or a comment . Commissioner zvanski yes, thank you, dr. Follansbee, i do. I hate to admit this, but in the boxes that i have at home from previous r. F. P. S, god knows why i saved them, or even brought them home i guess they were delivered or whatever. The r. F. P. S that went out previously always included the medicare, and it was only during dr. Dodds administration that somehow blue shield was given the exemption of carving out medicare business, and that somehow that then became a different kind of structure, and i dont recall it. I dont know i really dont know if i was on the board at the time or it was after, but that was the first time that any of the vendors that provided Health Benefits was allowed to carve out medicare, the medicare population. And so im just pointing out that i think it was the charter language that required us to include also that any vendor that did business with us had to provide coverage across the board which included medicare. And maybe it was changed in prop c. I dont know, but i think we need to check the charter on that issue to make sure that we are in compliance with that r. F. P. Abbie, i hear you absolutely that this would be rather overwhelming for the staff, and its not my intent to add that, but i just want us to have a consistent policy with consideration to everyone and that were not out of compliance with our charter r. F. P. Thank you. President breslin i just wanted to make another comment on the health and safety issue. My hope is that we can get back to a normal inperson Board Meetings in the near future and not a year from now, im hoping, because it is much more difficult for members to weighin on these meetings, and someone called in to the board of supervisors the other day and was really describing how difficult it was for them because they had a bit of a handicap. And like i said, some peoples dont even have computers. So i know that you dont even have control over that, but im hoping that this isnt going to be another 12 months for that sort of thing. Yeah. I do know that we will be drewingdre introducing a different platform for doing these meetings. Is that webex that were exploring . Yeah, were looking at different options. Commissioner scott this is commissioner scott. I would recommend that you also include go to meeting in that list of possible vendors, but i wanted to raise a question about the Steering Committee, abbie, on the social determinants of health. It is my hope as youre working through this process that we will have some early engagement by this board in looking at the some of the stuff the Steering Committee will be looking at so we are in sort of a parallel track in terms of taking a wider view of this issue as we are considering various policies per medical plan designs, etc. , Going Forward. I recognize that youre in the early phases of this, but im hoping that theres some interactivity with the board around this issue so that that will feedback to the Steering Committee and vice versa. Much appreciated. Thank you. President breslin when youre talking about other types of meetings, youre not talking about inperson . Commissioner scott no, im talking about other president breslin im asking abbie about the other types of meetings. Commissioner scott i understand that. I thought we were finished about that topic. I was talking about another topic, social determinants. President breslin i understand that. I think i can handle that. One is we will work under whatever the city standard is for public meetings. I understand the options are changing, and well let you know more when we know more. Be aware that we may be doing Something Different in august, and i have not heard any discussion about no longer doing virtual public meetings. When i do, i will be sure to let you know. And then, on the social determinants of health Steering Committee, its kind of a different meeting. Commissioner scott, because were developing we have wanted to do this when we got sort of diverted with covid, but we hired derek and marina, and then, youve met leticia, our other facilitator, and carrie and beshears on the wellbeing team, particularly challenged with Mental Health and the different issues that relate to Mental Health and how services are accessed and delivered. And then, marina, of course, being our data guru and myself as sort of leading off this exploration as how we look at social determinants of health because one of the things that is not written a lot about in any of the Major Research on social determinants is the impact of work as a determinant of health, and so we are looking Robert Johnson has recently let out a request for proposals to look at that very issue, so theres a lot going on that were just trying to get our hands around what kind of approaches or what our universe might be, and so certainly to involve and have conversations with yourself and other Board Members will be very appropriate. Vice president follansbee i have one other comment, and then im going to close this item, and that is that the comment about transitioning to medicare, Social Security in their processes that they handle backlog, i appreciate that we are going to adhere to the members rules, i wonder in august if we could have a report of denials of members who werent able to transition to medicare for one reason or another compared to other years . Because i am quite nervous about the communications that have come from the federal government agencies, not just the h. H. S. Over this period of time. So i want to make sure that we havent denied members access transition to medicare. If we could do that in august or september. Yeah, we could take a look at that because it is an issue on a regular basis, let alone in the covid world, so would be happy to take a look at that, and certainly at how we look at helping people transition to retirement is something we looked at thats a big area of concern. Fran frankly, its something that nobody looks at, and then, they see it, and they have a lot of questions. Vice president follansbee so if there are no other comments or questions from the board, id like to open this up for Public Comment. We will respect the 30second rule before we go to Public Comment. We have two other important items, so if we can keep mindful of the time and the fact that we have two important issues, as well, to issue, one of which is an action item, so im going to turn this over to open this up for Public Comment. Commissioner zvanski dr. Follansbee, this is clare zvanski. I just have one important question. In monitoring the retirement board, there was a new order from the Mayors Office that their office is staying closed for a full year, and im wondering if Health Service has received any kind of further direction from the Mayors Office, and if this would be the place to include that . And also, i just noticed how they have their Board Meeting rooms where two staff people and the president of the commission were actually in their Board Meeting rooms while they were doing the virtual meeting, so i dont know if thats an option for us to consider in the future. But im most concerned about the Mayors Office statement and that office being closed for a year because theres so much that Health Service does with regard to retirement and vice versa. Thank you. And now, im quiet. Commissioner hao this is commissioner hao. I would really appreciate it if our colleagues would help us move along with the agenda. The hour is really late. Thank you. Clerk thank you, commissioners. Were going to start the 30 seconds now, and for those on the phone lines, please press onezero to be add to the queue. If you are listening on the conference line, you will not be added to the queue until you press onezero. The 30 seconds starts now. Thank you. Okay. Moderator, will you please open up the Public Comment line for the first caller . Operator you have zero questions remaining. Clerk Vice President follansbee, that concludes Public Comment for the directors report. Vice president follansbee thank you very much. Well close this item and move onto item number 15 then. Clerk yes. Item 15. The San Francisco Health Service system revised fiscal year 2020 through 2021 and fiscal year 2021 through 2022 proposed general Fund Administration budget. This presentation is done by pamela levin, the chief financial officer. Vice president follansbee before we begin, i just want to remind the Board Members that this is a critically important issue that we are about to hear, so we need to devote our attention to pamela. The discussion from the Mayors Office seems to change periodically, and so this is a moving target, and the success of our Health Service system relies on our ability to meet the financial constraints but also meet the demand for services which will only increase in these periods of stress, so pamela, please proceed. Good afternoon. Pamela levin, chief financial officer, Health Service system. The item before you is the revised proposed general Fund Administration budget for 2021 and 2122 for your approval. I want to note that this differs from the one that was originally sent to you because of some changes in the direction from the Mayors Office that occurred early this week. Next slide. The city now faces a deficit of 1. 7 billion over the budget horizon due to losses associated with the pandemic. For comparison, the twoyear deficit in february is 420 million. A recovery is not expected for four years. In may, the mayor issued revised budget instructions to try to close that deficit. Departments are now required to submit a revised budget with mandatory Budget Reductions. For 2021, the planned mandatory Budget Reduction is 10 , and for 2021, the mandatory Budget Reduction is 15 . In addition, departments are required to submit a 5 contingency plan for 2021 totaling 180,325, but this may not be implemented. It depends on if the budget projections, if they worsen. As further reductions, we are to stream line positions, consolidate b consolidate costs. Departments are to determine which serves are to be delivered in person or if they can be delivered remotely and to look at increasingly how technology can be used to provide services online. Page 2 next slide. So when we looked at the budget, we tried to do everything we could to balance it with the mandatory and make the mandatory guidelines and also maintain our position authority. Initially because there was a hiring freeze that started in march, the only positions that were critical to the operations would be approved by the mayor to fill. What we needed to do is rather than having positions actually eliminated, we increased our atrition for those positions that we knew we wouldnt be able to fill. Thisll be a combination of the natural occurring attrition because people are leaving or retiring, and the attrition because we wont be able to fill positions because of the freeze. Next slide. This slide shows the 2021 revised budget side by side with the Budget Approved in february before the pandemic. As you can see, the reduction targets are being met by increasing attrition and decreasing nonpersonal services while maintaining the increased funding levels that we requested in february as much as possible. Funding for materials and supplies is increasing at the same level as requested in february, and no reductions are proposed for work orders. The reduction that you do see in the line for onsite activities and a reduction in the line for contracts, we moved the funding because we knew that its unlikely that well be able to do inperson activities in 2021, so this funding will be rolled in and be able to use it for additional mental Health Programs. Were also cutting more than whats required in the first year so that we can partially fund the expanded Employee Assistance programs that we added in april that consisted of a 247 e. A. P. And a direct responder Mental Health application. Next slide. When it came time for the contingency plan, we looked at areas that would be occurring in 2021. Since the budget would not be approved until october, and all the expenses have to be approved by june, that reduction partial reduction of the grants is on the contingenci contingency plan. In addition, the instructors for rec and park is cut for 2021 because we do not think that inperson classes will be possible due to social distancing requirements. Next slide. This slide shows the 202122 proposed budget side by side with the budget that was approved by the board in february. In order to meet the mandatory reductions, attrition is increased like in the prior years. Funding for nonpersonal services is reduced, again, while trying to retain the increases that were proposed in february as much as possible. Materials and supplies are increased at a much lower level than what was approved in february. Funding for the work orders for the Fitness Instructors is reduced by 37 , with the anticipation of some inperson classes being possible in february 2122, and we have also reduced the work order with the City Attorneys Office to reflect the prior years expenditure levels. Finally, the main proposed budget will be released to the board of supervisors on august 1. The budget hearings are in august, and the board will approve the budget in september, and the mayor will sign the budget on october 1. This budget is extremely difficult to put together, and its going to be quite a challenge to negotiate with the Mayors Office and the board budget analyst because of, you know, the fact that were not in the office and there are expenses that may be viewed as being discretionary, that we may differ in that viewpoint. Ill be glad to answer any questions. Vice president follansbee so are there any questions for pamela levin . Commissioner scott this is commissioner scott. Pamela, i want to say that i commend you and your team for what i know has been a difficult week or more in putting this information together. I think that you have identified, based on my Prior Experience with some of the budgets that we submitted, areas where reductions could be made. While painful, but if its under a mandatory framework, we hope theyll have minimal impact while continuing to support our members as well as continuing to do the ongoing business of the system. So thank you for what youve done, and to the degree, as was said earlier in the meeting, that if, indeed, there is some level of interfaces that we as individual Board Members can support you and abbie as we go forward with this process, i would stand ready to do that, so thank you. One last thing id like to point out as i mentioned in the beginning, there is a recovery down the road. Theyre expecting it will be in four years. It may be a little longer, and at that point in time, wed still have the positions that we could fill, although, you know, were in all of us are in kind of a a new way of looking at our work and but still providing the Necessary Service to our members. Vice president follansbee are there other comments . Id just like to also thank you very much for this report and also remind those the public but also our Board Members that this time will be increasingly stressful for all San Francisco employees, and weve already seen some evidence of some members of some departments sort of not being very supportive of members of other departments, and therell be increased stress for those employees who are continuing to work and trying in good faith to handle their jobs, and that includes our own hss staff. And so this is not a time for us to pull back on the Mental Health options that we can do to support other departments and other employees of the city and county of San Francisco as well as our other contracted employers. Any other comments . So ill i guess this is an action item. Do we need to approve the report as youve submitted it or whats the action that we need . The action is to approve the budget as submitted for the department to submit the budget to the Mayors Office tomorrow. Commissioner scott commissioner follansbee, ill make the following motion this is commissioner scott. I move that we accept and instruct the departmental c. F. O. That we accept the budget as proposed and forward this to the appropriate city authorities. Commissioner hao this is commissioner hao. I second that motion. Vice president follansbee so its been approved and seconded that we approve the current budget as outlined by pamela levin today to be forwarded to the Mayors Office tomorrow. I would now like to halt conversation from the Board Members and open up the line for Public Comment. Clerk thank you very much, Vice President follansbee. Were going to put a 30second pause on conversation for people at home watching this meeting to catch up to what we have just discussed. That 30 seconds starts now, and i want to remind callers, if you are dialing in, please press onezero to shabe added the queue. Thank you. Clerk okay. Moderator, can you open up the line for Public Comment . Operator you have no questions remaining. Clerk okay. Commissioner follansbee, Public Comment is closed. Vice president follansbee okay. On the motion to move the budget to the Mayors Office, all in favor . Opposed . Lets go into item 16. Clerk item 16 is the infert willi infertility benefit status update for blue shield of california, presented by shawn lovering. I would be remiss if i did not think, on behalf of did not thank, on behalf of blue shield, natalie, for all of her work and support. We are going to miss you. Next slide. Next slide. So were here today to give you an update on our efforts around infertility. It was brought to our attention last year that there were some issues, and were going to bring to your attention that we can fix things. [inaudible] when they added the Custom Benefits that you see on the right. Next slide. So we did a ton of research when this was brought to our attention, and we identified the following areas where we had gaps. Benefit authorization and identification process. We understand that infertility is a prepersonalize very personalized and very difficult process to go through, so we had to adjust our authorization timelines to better fit the challenges proposed by receiving infertility treatments to extend those. [please stand by]. As i mentioned before, we pulled all the previous denials for inFertility Services, rereviewed them. We also created access for members to a dedicated internal subject Matter Expert for assistance in navigating the matter with our patients. We have put in an endtoend process and oversight for every infertility request that comes in. In addition, we have created a more friendly overview of the Fertility Services available to sfhss members and put that on the sfhss microsite. Next slide. Access to meds. This, as you know, was an area that was brought up to be very difficult to navigate. [please stand by] so that the members have additional options when it comes to getting their fertility meds that are allows them to use their insurance and is easy to access and timely for them. We anticipate that these new contracts should be in place by november and we certainly will come back and update you on that item at the november Board Meeting. Are there any questions around what we identified, what we have corrected . And Going Forward how this will work for members . Lets open up the discussion now to the members of the board. Any comments or questions . This is commissioner. And looking at this presentation i see only one picture that points out a nonheterosexual couple. I think in your materials it would be nice to have a few more depictions of alternate family groups so that its not quite as heterosexual oriented. I think that is especially important for a number of members of our Health Services system membership. Thank you. Thank you, thats a point well taken. And on the on the website the information that we uploaded there we have certainly were focused on making it extremely culturally compassionate for all members. So if you take a look at that i think that you will find that we did achieve that. Other questions or comments . I have a couple. One is that, you know, its pretty i think that you covered from the beginning of the of this benefit in the beginning of 2018, so we had more than a 30 denial rate which looks to me, except for the few individuals that were not covered benefits were reversed. Over the two years now, 2 1 2 years, you know, thats a long time for people who are trying to undergo fertility. And i dont know that its not germane for what youre doing for future, but theres a significant fallout for the individuals who were inappropriately denied coverage. Im just kind of curious to know if you can maybe in three months or so to provide some followup information to those 58 individuals who were denied the service inappropriately. The way that i understand your presentation. The other thing is that the pharmacy benefit item is still very real and the information that we have been provided by obstenostensibly from a member o resourced this considerably, is that like a lot of pharmacy benefit systems or companies, that theres a very complex interrelationship between these companies and the providers. The pharmacy is now been brought out by express scripts. Express scripts is now a subsidy of cigna insurance. And i think that theres some concern that maybe cvs or walgreens are trying to buy it, but theres now cigna. And so my understanding now is that the decisions and the relationships and the reimbursement and the price setting now is under the auspices, frankly, of another Insurance Company cigna. So i think that this is opening up a hornets nest in terms of pricing for all of these specialty drugs. I know that they specialize in drugs that have to be administered intravenously, and it can be administered by the members themselves. But there may be other drugs. So i point this out because this is an issue not resolved for this benefit and i think that it deserves our look at it more carefully for all of our contracts that involve this kind of a pharmacy benefit company, a forprofit company, where our members are paying outrageous amounts of money for drugs that are accessible to them in other ways. Yes, thank you. And i think that is exactly why, you know, we are seeking additional contracts with other providers at this time. You know, the way that the benefit is currently set up, the drugs are paid under the medical plan and not the pharmacy plan. Because the fact that there are injectable drugs. But for infertilities theyre paid under the medical plan. So we are working with our partner, cvs, to secure additional providers and access for members and looking at reaching out to different specialty pharmacies in San Francisco to secure contracts with them to have additional opportunities for members. I think that its important that the members have, you know, other options to for when they go to access their drugs. And so that is a point well taken. Thank you. Just, again, to reiterate some of the points that have been made in multiple discussions, about the competition may be a good thing in this regard. Yes. I think that youre right. So other comments from any of the other commissioners . If not, id like to go to the period of silence where we open up to comments from our members. Thank you very much. At this point everyone at home who is watching and or on the conference line, please be sure to press 1, 0 after you have dialed into the conference line to ensure that youre put into the queue. We will start the 30 seconds of pause right now. Moderator, please up the public line for the callers. You have zero questions remaining. Clerk that concludes Public Comment on this item. Thank you very much. I believe that this concludes the discussion on this item. The agenda is that everyone had access to to eliminate some of the items that we normally have during the open times with comments on the health plans and other items. So with that its been a long meeting and ill entertain a motion to adjourn. Mr. Scott i wanted to thank the doctor for taking over for me. This is commissioner scott. I would thank karen and you for the way that youve conducted this meeting today. And with that i move that we adjourn. Second. May i remind my members that a motion is not required for adjournment. The chair merely indicates that the motion that the meeting is adjourned and thats all. You dont need a second either. Thank you very much, but i wanted everyones concurrence with this. [laughter]. Thats the spirit that i offered it, commissioner. Thank you very much. Thank you for all of your presentations and the meeting is now adjourned. It. Shop dine in the 49 promotes local businesses and challenges resident to do their shop dine in the 49 within the 49 square miles of San Francisco by supporting local services in the neighborhood we help San Francisco remain unique successful and vibrant so were will you shop dine in the 49 chinatown has to be one the best unique shopping areas in San Francisco that is color fulfill and safe each vegetation and seafood and find everything in chinatown the walk shop in chinatown welcome to jason dessert im the fifth generation of candy in San Francisco still that serves 2000 district in the chinatown in the past it was the tradition and my family was the royal chef in the pot pals thats why we learned this stuff and moved from here to have dragon candy i want people to know that is art we will explain a walk and they cant walk in and out it is different techniques from stir frying to smoking to steaming and they do show of. Beer a royalty for the age berry up to now not people know that especially the toughest they think this is i really appreciate they love this art. From the cantonese to the hypomania and we have hot pots we have all of the cuisines of china in our chinatown you dont have to go far. Small business is important to our neighborhood because if we really make a lot of people lives better more people get a job here not just a big firm. You dont have to go anywhere else we have pocketed of great neighborhoods haul have all have their own uniqueness. San francisco has to all the annual celebration of hardly strictly bluegrass is always a hit now completing itself 12 year of music in the incredible golden gate park. This is just the best park to come to. Its safe. Its wonderful and such a fun time of the year. There is every kind of music you can imagine and can Wander Around and go from one stage to another and just have fun. 81 bands and six stages and no admission. This is hardly strictly bluegrass. I love music and peace. I think it represents what is great about the bay area. Everyone is here for the music and the experience. This is why i live here. The culture out here is amazing. Its San Francisco. This is a legacy of the old warren hel ment and receive necessary funding for ten years after his death. There is a legacy that started and its cool and hes done Something Wonderful for the city and were all grateful. Hopefully we will keep this thing going on for years and years to come. I went through a lot of struggles in my life, and i am blessed to be part of this. I am familiar with what people are going through to relate and empathy and compassion to their struggle so they can see i came out of the struggle, it gives them hope to come up and do something positive. I am a Community Ambassador. We work a lot with homeless, visitors, a lot of people in the area. What i like doing is posting up at hotspots to let people see visibility. They ask you questions, ask you directions, they might have a question about what services are available. Checking in, you guys. Wellness check. We walk by to see any individual, you know may be sitting on the sidewalk, we make sure they are okay, alive. You never know. Somebody might walk by and they are laying there for hours. You never know if they are alive. We let them know we are in the area and we are here to promote safety, and if they have somebody that is, you know, hanging around that they dont want to call the police on, they dont have to call the police. They can call us. We can direct them to the services they might need. We do the three one one to keep the city neighborhoods clean. There are people dumping, waste on the ground and needles on the ground. It is unsafe for children and adults to commute through the streets. When we see them we take a picture dispatch to 311. They give us a tracking number and they come later on to pick it up. We take pride. When we come back later in the day and we see the loose trash or debris is picked up it makes you feel good about what you are doing. It makes you feel did about escorting kids and having them feel safe walking to the play area and back. The stuff we do as ambassadors makes us feel proud to help keep the city clean, helping the residents. You can see the Community Ambassadors. I used to be on the streets. I didnt think i could become a Community Ambassador. It was too far out there for me to grab, you know. Doing this job makes me feel good. Because i came from where a lot of them are, homeless and on the street, i feel like i can give them hope because i was once there. I am not afraid to tell them i used to be here. I used to be like this, you know. I have compassion for people that are on the streets like the homeless and people that are caught up with their addiction because now, i feel like i can give them hope. It reminds you every day of where i used to be and where i am at now. Right before the game starts, if im still on the field, i look around, and i just take a deep breath because it is so exciting and magical, not knowing what the season holds holds is very, very exciting. It was fastpaced, stressful, but the good kind of stressful, high energy. There was a crowd to entertain, it was overwhelming in a good way, and i really, really enjoyed it. I continued working for the grizzlies for the 20122013 season, and out of happenstance, the same job opened up for the San Francisco giants. I applied, not knowing if i would get it, but i would kick myself if i didnt apply. I was so nervous, i never lived anywhere outside of fridays know, andfridays fresno, and i got an interview. And then, i got a second interview, and i got more nervous because know the thought of leaving fresno and my family and friends was scary, but this opportunity was on the other side. But i had to try, and lo and behold, i got the job, and my first day was january 14, 2014. Every game day was a puzzle, and i have to figure out how to put the pieces together. I have two features that are 30 seconds long or a minute and a 30 feature. Its fun to put that altogetl r together and then lay that out in a way that is entertaining for the fans. A lucky seat there and there, and then, some lucky games that include players. And then ill talk to lucille, can you take the shirt gun to the bleachers. I just organize it from top to bottom, and its just fun for me. Something, we dont know how its going to go, and it can be a huge hit, but youve got to try it. Or if it fails, you just wont do it again. Or you tweak it. When that all pans out, you go oh, we did that. We did that as a team. I have a great team. We all gel well together. It keeps the show going. The fans are here to see the teams, but also to be entertained, and thats our job. I have wonderful female role models that i look up to here at the giants, and theyve been great mentors for me, so i aspire to be like them one day. Renelle is the best. Shes all about women in the workforce, shes always in our corner. [applause] i enjoy how progressive the giants are. We have had the longer running until they secure day. Weve been doing lgbt night longer than most teams. I enjoy that i work for an organization who supports that and is all inclusive. That means a lot to me, and i wouldnt have it any other way. I wasnt sure i was going to get this job, but i went for it, and i got it, and my first season, we won a world series even if we hadnt have won or gone all the way, i still would have learned. Ive grown more in the past four years professionally than i think ive grown in my entire adult life, so its been eye opening and a wonderful learning i love teaching. It is such an exhilarating experience when people began to feel their own creativity. This really is a place where all people can come and take a class and fill part of the community. This is very enriching as an artist. A lot of folks take these classes and take their digital imagery and turn it into negatives. There are not many black and white darkrooms available anymore. That is a really big draw. This is a signature piece. This is the bill largest darkroom in the u. S. There are a lot of people that want to get into that dark room. I think it is the heart of this place. You feel it when you come in. The people who just started taking pictures, so this is really an intersection for many generations of photographers and this is a great place to learn because if you need people from different areas and also everyone who works here is working in photography. We get to build the community here. This is different. First of all, this is a great location. It is in a lesspopulated area. Of lot of people come here just so that they can participate in this program. It is a great opportunity for people who have a little bit of photographic experience. The people have a lot, they can really come together and share a love and a passion. We offer everything from traditional black and white darkrooms to learning how to process your first roll of film. We offer classes and workshops in digital camera, digital printing. We offer classes basically in the shooting, ton the town at night, treasure island. There is a way for the programs exploring everyone who would like to spend the day on this program. Hello, my name is jennifer. My name is simone. We are going on a field trip to take pictures up the hill. Cmon, cmon, cmon. Actually, i have been here a lot. I have never looked closely enough to see everything. Now, i get to take pictures. We want to try to get them to be more creative with it. We let them to be free with them but at the same time, we give them a little bit of direction. You can focus in here. That was cool. If you see that . Behind the city, behind the houses, behind those hills. The see any more hills . These kids are wonderful. They get to explore, they get to see different things. We let them explore a little bit. They get their best. If their parents ever ask, we can learn they can say that they learned about the depth of field or the rule of thirds or that the shadows can give a good contrast. Some of the things they come up with are fantastic. That is what were trying to encourage. These kids can bring up the creativity and also the love for photography. A lot of people come into my classes and they dont feel like they really are creative and through the process of working and showing them and giving them some tips and ideas. This is kind of the best kept secret. You should come on and take a class. We have orientations on most saturdays. This is a really wonderful location and is the real jewel to the community. Ready to develop your photography skills . The Harvey Milk Photo Center focuses on adult classes. And saturday workshops expose youth and adults to photography classes. Hi, youre watching coping with covid19. Today im going to the grocery store. Now, im not an authority about the virus. Im just showing you what im personally doing. To find out the most definitive and uptodate information about the pandemic, i highly recommend the f. A. Q. Available at sf. Gov. Im taking a list and before i leave i put a sanitizing wind and pair of gloves into a plastic bag. Im wearing a mask and taking the smallest number of items with me. Just my car key, credit card, i. D. And the batching im not taking my phone with me. Even if i use it to pay, i either have to touch the p. I. N. Pad or sign the screen anyway. Im concerned about crosscontamination. I dont want to transfer the virus from my gloves to the phone and then to my face. Whin i get out of the car, i put on my gloves and get a grocery cart. The essential workers at my store are doing a great job. Theyre sanitizing every cart and limiting the number of shoppers. Having a cart can help you protect your space. In this store, there are two new science on the floor. Ones directional to encourage everyone to take the same route around the store. The second is to remind shoppers to maintain a safe distance from each other. When im done shopping and ready to pay, i stand in line at least six feet from the shopper in front of me. After unloading my car at check out, i go past the cashier and pack my own bags. That is one less person touching my groceries and less of a burden on the stores employees. I thank the cashier and leave the store. On my drive home, im careful not to touch my face. I leave my outside shoes on the porch and as soon as i get through the door, i wash my hands for at least 20 seconds. Next, i wipe down my debit card, i. D. And car key. And then i wipe down the front doorknob, clean the sink taps and wash my hands again. I wash my vegetables in cold water and remove the package aing from my proteins and other items. I leave the nonperishables in my garage for a few days unless i need them immediately. My refrigerated items get a quick winddown to be on the safe side and, of course, i wacker my hands again. Heres a quick recap of my visit to the grocery store. That is it for this episode. I hope you found it helpful. Shop and dine the 49 challenges residents to do theyre shopping with the 49ers of San Francisco by supporting the Services Within the feigned we help San Francisco remain unique and successful and rib rant where will you shop the shop and dine the 49 im e jonl i provide sweets square feet potpie and peach cobbler and i started my business this is my baby i started out of high home and he would back for friends and coworkers theyll tell you hoa you need to open up a shop at the time he move forward book to the bayview and i thinks the t line was up i need have a shop on third street i live in bayview and i wanted to have my shop here in bayview a quality dessert shot shop in my neighborhood in any business is different everybody is in small banishes there are homemade recess pesz and ingredients from scratch we shop local because we have someone that is here in your city or your neighborhood that is provide you with is service with Quality Ingredients and quality products and need to be know that person the person behind the products it is not like okay. Who im nicole and lindsey, i like the fresh air. When we sign up, its always so gratifying. We want to be here. So im very excite ied to be here today. Your volunteerism is appreciated most definitely. Last year we were able to do 6,000 hours volunteering. Without that we cant survive. Volunteering is really important because we cant do this. Its important to understand and a concept of learning how to take care of this park. We have almost a 160 acres in the district 10 area. Its fun to come out here. We have a park. Its better to take some of the stuff off the fences so people can look at the park. The street, every time, our friends. I think everybody should give back. We are very fortunate. We are successful with the company and its time to give back. Its a great place for us. The weather is nice. No rain. Beautiful San Francisco. Its a great way to be able to have fun and give back and walk away with a great feeling. For more opportunities we have volunteering every single day of the week. Get in touch with the parks and Recreation Center so come good morning. The meeting will come to order. I am afnay el mandelman. We are joined by supervisor stefani and walton. Our clerk is john carroll. Thank you sfgovtv for staffing this meeting and operations and it for lending support for this meeting and for everything you all do to keep us going smoothly