approved at the state level a bill offers full medical despite the documented folks the bill has been reintroduced and in general health care financing issues will be medi-cal reimbursement this year marks the end of the increased medi-cal provider payments under the ac a in the governors budget that will be something to watch the ada realignment it they may or may not revisit it based on the parents we'll be watching that and the state is planning to do pilot for from me qualified health centers so the health centers we're interested in monitoring the development and on the federal level for disproportionate health care reforms in 2016 under the ac a some cuts that are slated to happen and the county health centers bumps were provided to the health centers that were due to expire in 2016 so commissioners you have before you a revolution approving the state and federal plan those plans went to the mayor's office this year early so the revised plans will be resubmitted. >> there's no public comment on this item. >> thank you, commissioners. >> i'm sorry it looks like someone has a comment. >> oh yes and this is deanna we've shared many of the priorities i want to bring to your attention to the issue you mentioned about the community health center funding issue it's a significant issue both for the clinic that are part of the thought consortium and part of the health department the owner because of the segregation but basically, if we fell off the cliff and not keep the level of funding we'll receive less funding than before the ac a so there's a big bump there's been new assess points out and new grant and back counsel to a level before the ac a was implement we don't know and the federal department is not saying how phil they'll do the cuts we know that overall it is 60 to 70 percent but how they'll take the cut for example they'll could choose i'll fight against it to fight the areas where they're the clinics and that's the only option if that hams f that will defund san francisco disproportionately they could effect the homeless program you know it's the root so we're you're going all of you to take part in some of the campaigns against the health center and the cliffs led by the association of the health centers we meet with the city lobbyist and discussed that state will took a concerted effort there's not a push people are not worried about it and it didn't happen until october there's not a great vehicle that gets it by congress it is an area of that big concern of ours. >> thank you health center cuts and all where is that in our presentation you spoke about is it under safety net carpool. >> it's at the end it's a federal issue it's the last slide or slide 11 i'll go up to it. >> oh, okay. >> it's the federal. >> it is it says to watch so, i mean is it many the documents that. >> it is part. >> those things are highlighted but you already have them as part of things and you've now summed and highlighted those are big items we have to keep a watch over. >> the protective or the health center is included in there in the federal plan and file number called out we wanted to do in the presentation to highlight the actual issues the plans are so board to cover anything and everything that comes larger budget concerns a lot of the various issues life's blood eir like the 2015 manner has unfunded and how we track that at the last meeting i was impressed on a personal level mr. wagner's sense that we've begun 63 quarters of positive earnings and positive krblgz sooner than later with the 1115 b and the prop 47 and others i support one hundred percent i wanted to make sure we have recycling and budget averaging plans in there while we support those make sure we look at the framework to support those commitments for me those are the right commitments so could you answer the first question position around the watch and what we're looking at in terms of what can be unfunded for a broader picture. >> those are noted action issues to watch because that's how we monitor them but for in general we do have internal department positions on who we support any of the measures but as a department we're not allowed to take an official position which the city can so the ac and the protective plan we tried to highlight how we will support issues or oppose issues and then in regards to our second question the a lot of the things like the ac pilots those are issues to watch because the starter if have a plan they've started something like a proposal that will need to get approved by the legislator and they'll implement the bills to make it happen those are things we need to follow throughout the year according or occasionally what happens we like a proposal but once it goes to the legislature it changes so we need to change our position so the protective plans allows us flexibility on what action to take. >> it's complicated the waiver it is so many different parts in the package we like 90 percent but 10 percent we're worried about you don't have to complicate it but how your approaching this as a c pack and agencies begin to lobby for us. >> we mentioned we have an 1115 internal group we meet twice a month the public health systems is taking the lead on the waiver specifically around the hospital financing portion of the waiver so greg wagner and valerie are both our key members of our internal group and we discuss the implementations all the time a lot of what wear concerned about the waiver is frankly more entities want part of the waiver but the waiver part the amount of funding for the public hospitals we're the only ones that put up the non federal share they require the federal dollars and the state didn't put up a dollars donate one thing to make sure that we maintain at least the same level of funding and the second thing a lot of it is tied to metrics you've heard if you see the district program the system the repayment program those are the funding is tied to us achieving certain metrics we work with the clinical leads within the hospital to make sure those metrics mediated our purposes and meet our standards and connected to goals we want to chief at the hospitalities that's a long answer to our question i'm sorry we're integrated in the way we're responding to questions. >> i assume the project is complex you'll keep obvious posted. >> yes. >> if i could clarify for sure that's where i got trapped in the term watch it means monitor not an official protective position. >> those are items we're highlighting could it be easily said issues to be highlighted. >> commissioner chung. >> a couple of questions the first one under the communicable federal budget is there a reap why hiv i'd say and ryan white are two different bullet points. >> now it was just something. >> the second question really is because ryan white part b is more of you know it goes to the state and they create the policies and you know and they get to decide how that money is being utilized. >> what gets into the area i know there are states that are looking at to aid the dollars to you know support ac enrollment do we know if there's anything like that happening in california specifically. >> yeah. we know that the california office of aids uses ryan white to offer support to purchase insurance to undercover california and i don't know if there's other - >> so when we say we watch do i actually watch how know like those changes happen for instance like the utilitytion of this coming year like the ac and post medi-cal extensions. >> yeah. so actually what happens is by the end of the february all bills that are going to be introduced at the state legislator are introduced we flag them for you know this is a mopgs health bill, etc. and send it out to expert and get review back and depending on that review we sort of that's when we develop our internal position do we oppose or watch it the hiv programs are also on our list to watch and monitor so if there's anything to monitor through the legislation or the budget we definitely keep an eye on it. >> of course the bills passed we have to don't worry about that it is something the nuances. >> but last year there was definitely some interest in using the office of aids funding to support ac a implementation and this i image is still going on. >> okay. thank you. >> commissiioner sanchez. >> no, i just think that the department is we've done a comprehensive job and preparation and whereas our whereas you give us historical context property owner to when those issues were drafted in 2012 all of those involved in the perimeters this isn't the legislation of the advance of legislation if, in fact, we've generated those plans over the years and each the plans we might be at risk and keep them under radar you mentioned did you lobbyists or the cooperation with the state and federal bodies in essence we're saying carry on this dialog and oversight and we'll be prepared we a mechanism and we'll think it improve and did you say it and move forward so given the context and the fact that this staff has done a great job. >> i'll move for approval mr. chairman. >> i'll see if there's comments. >> may i ask one question regarding the prop 47 did they pass through the city, county general fund or through the department through the level of the area marking and the second follow-up question you're interested in asking that the funds could be used for supportive housing do you mean crisis additional housing or full service supported housing i wanted to know the level of housing our indicating. >> so the funding will be made available as grant and so i think the department will be able to apply or the county apply for the guatemala's or gravents it's unclear. >> oh so there's a granting action. >> right right now it's the board of - it's the one of the other corrections board at the state level that's going to - they convened their body related to the prop 34 of 47 this next year will see how to roll out the program and the saflgz won't be to 2016 that's an alleviation and commissioners i'll be meeting about the city attorney about the prop 47 we'll have to advocate for the subsidies for the mental health we may not be able to get the approval for the core cost of housing but this simply will insure that we advocated. >> at least on the service side and . >> meet the requirement. >> the release population or something connected to it. >> we're involved with the criminal justice system and provide most the mental health substances it's a key to come together would the district attorney. >> san francisco is seen as a leader in 12k3wr5g9 it's mental health services in a very forward thinking preventive way. >> we'll continue to work if that fashion. >> and part of our advocacy for prop 47 to mower whatever prelims is gone through so we're not eligible for the grants we want to make sure that didn't happen. >> in this i was wondering first of all on (inaudible) the federal (inaudible) he distributed well, what (inaudible). >> my concern is the federal you know conflict of interests doesn't come through i think that it is an important issue as the timeline is not so much american people protective issue but as we're moving into our budget this is an area we need to continue to work on ourselves it's an important public health. >> within the 3g9d area pb has come up and we're addressing that you'll see that in the budget coming. >> on the state protective plan i want to take angle exception i think in medi-cal provider pamphlets it talks about as opposing further reductions our position to encourage either the restoration of our 10 percent or even more i know this is perhaps unlivable but as a position of the city we should provide our furnisheds appropriately and the reduction of 10 percent shouldn't be a plea we're not objecting to it if f this make sense. >> i was going to see is last year a bill come out of the mayors budget and are not through the committee processes where the legislature trial court tried to correct that and we tried to make it happen. >> as a policy in here we shouldn't be on an okay we were at this level but advocating for a medi-cal rate to reimburse our provider. >> dr. we would like to say the disability that's an initiative we started here in san francisco 10 years ago we started working on how to get people involved with schizophrenia due to the fact their ability to bring all the paperwork the bureaucracy it gets ssi immediately to a patient and we have 6 months to back up the need and the requirement so i wanted to notice that marie martinez worked on this she made some incredible riderships with the region and federal and also h s a the instead of worked with us the santa clara county worked with us and it will be beneficial for many of the patient. >> has the results of the pilot come out. >> yes, we're waiting for the report. >> you're correct we should acknowledge it took a decade for the federal government to recognize for the entire population of schizophrenia. >> so that's a reimbursement issue i think this sort of within your long-term care by the way, because we took up the care issues we should be inclusive this is care we should be supportive of and it is a commission policy to try to advocate on that on behalf of. >> so what i was suggesting commissiioner sanchez has put forth a resolution and those issues should be part of the program. >> i so move mr. chairman. >> is there a second to that? you're addressing it and i want a second idea of fourth the medi-cal provider >> corrects those will be address into the state program and the motivations submitted back to the committee and was there a motion. >> a can i second it. >> discussion so because we're introducing new language do we have to like come back and vote next time. >> no, i believe that with the new language we're accepting this resolution with an addendum we would like to have those two items as part of the state program; is that correct. >> correct. >> i'm not - you say if you say okay. i is okay and the item before us is a resolution we can modify the resolution we're modifying it by addressing two areas that we're suggesting the proposed to the mayor's office on state legislation so we're approving this with the addendum of two other items correct we don't actually basis the perspective we pass what we believe the department would like; right? >> yes. i'm happy to edit that and provide to the commission. >> any further discussion? all in favor, say i. of the modified resolution all opposed the modified resolution has been accepted. >> thank you, commissioner. >> item 10 is other business. >> excellent work. >> the next item, please. >> next item is other business. >> okay. is there any other business in open session before us? if not we'll go on to the next item >> item 11 there were no joint conference meeting and item 12 is committee agenda setting. >> so we continue to remind your commissioners we're looking at topics at this point that will be placed on the planning meeting in what date was it. >> march 17th. >> march 17th. >> there will be a four hour public on session. >> it will take place from 2 to 6 clock 4 hours. >> contradict so you can schedule that, please. >> that was my reason for novelist you but if commissioners have items they will also building are appropriate for the planning session please let mark know. >> i'll sent out the information for the request and dates and items. >> okay. we'll proceeded to the next item and there's no public comment for any of the 3 other business and we're now in closed session commissioners and any public comment on the closed session. >> i've not received public comment. >> then a motion to go into closed session is in order. >> so moved and second. >> all in favor, say i. >> i. >> opposed? okay wire back in open section and a motion is in order whether to disclose or not disclose the decision in the closed session. >> most to no disclose a second. >> further discussion all in favor, say i. opposed we'll not disclosure the discussed in closed session there being no other items a motion for adjournment is in order. >> second. >> all in favor, say i. all opposed this meeting is adjourned thank you. >> all right. good afternoon. welcome welcome to the our special san francisco full board of supervisors meeting of january 7, 2015, i want to welcome everyone to the new year and hope everyone had a wonderful holiday season we have frank 1y0r7bd well, to our