The prepters under the resolution for screening for type 2, that is doctor lawrence ng rather than kg and doctor eric [inaudible] is a l rath er than a j. Since they took the time to come thought we could identify that correctly. Yes, i apologize for my inaccuracy i have a problem reading these and they are doctors. That is the only correction i have. If there are no corrections all enfaiv say aye. Opposed . The minutes have been adopted. Thank you. Item 3, directors report. Good afternoon commissioners. Wanted to start off with the agreement for medicaid and medical regarding renewal of california [inaudible] waver. The currents waver provides 200 million to dph. This maintains [inaudible] smckted to decline in the out years mptd we have expected this now for many years ourselves so we are prepared to continue to plan for this potential decline. The two largest componentss are the successor to the District Program called prime and the uncompensated care pool. The prime care program is flat funded for years 1 through 3 and decline by 15 percent in year 4 and 5. The pool funding is man tained in [inaudible] based upon two studies on med kale access and compensated state care wide. The details of the studies are not known yet, they will determine future funding decisions for uncompensated years 25 in the waver. [inaudible] two biggest federal Funding Sources countnuity is good news. Oretd good new is the [inaudible] the demarmt is in the good possession to be successful at but it does intend to provide care for high risk population and off set [inaudible] it is a very complex program and trying to keep frac of this and it is a state wide, nation wide praess. Mayor gogo on to mayor lee announces 1. 2 Million Dollars supporting getting to zeer owith mac 8 fund. Getting to zero is focused on 34 pillars to acheechb the goals of goatic to zero. [inaudible] prep expaction, [inaudible] same day linkage and treatment for hiv diagnoses and retention of care. 1. 2 Million Dollar funding is leverages to increase the number of hiv positive patients to increase care. We announced the opening oaf our [inaudible] program in San Francisco and it began yesterday. Assisted outpatient treatment roughered [inaudible] Court Ordered out patient treatment with suvive mental illness. [inaudible] not engaged in care or deteariated condition and have a history of failing to comply with treatment. The person must be agadult tw serious mentsal illness and [inaudible] in the past 3 years over result in threats or acts of violent behavior to themselves. We anticipate there will be fewer than 100 people in San Francisco eligible each year but do anticipate many more who will call to determine whether or not their family members qualify and we are committed to those calling us to engage with them for service so that is a important outreach. This weekend i had a text from a person asking about the level in the hospital and referred them to the web list around that and i think again this is unusually in the past we couldnt engage as much with family members due to hipaa but this allows family members to get access to systems of care which they didnt have available before. Just to note that dens mechan tire is appoint today San FranciscoHealth Network dweckter of accountable care. Also we have a Health Care Foundation leadership fellowship z want to congratulate madonna vulensia and did she grimes and wanted to recognize him in the audience and i willjust to [inaudible] 2015 latino heritage celebration. We have people from planning and finance if you have additional 1115 waver questions. Commissions question to the director . I guess the question about the 1115because you just got this information, when would we have sort of a more comp rehensive evaluation and how it effects us in termsf othe ill ask [inaudible] may i break that into 2 parts, when does the Service Obligation become implementable and when do the financial obligations or the reimbursements occur . I assume there are different dates . The current waver expired october 31 and the agreement was reached at a high level last friday squu nounced saturday. The details are still yet to be worked out so they havent been affirmed between the state and cms. Cms granted a extension of the waver through december 31 and the new waver elements began jan 1 of 2016. Caph, California Association of Public Hospitals is working closely with the state to develop the detailoffs sth waver rks the special terms and conditions agreed upon by the kait and cms and [inaudible] myself represent the department at the boretd and will mead this week to talk more in detail about how the allocations will occur and what the details the study we would like to propose would be. That will be occurring in the next month and a half before 2016 . That is correct, all of that is done before 2016. We can get a more detailed report at the begin thofg year . Absolutely. Thank you. Any other questions, commissioners . If not was there public cominstant no Public Comment re quested. Item 4 is general Public Comment and notd received Public Comment requests. We should move on to item 5 is the finance and Planning Committee report. Mr. Chung good afternoon. The finance and Planning Committee met before this Commission Meeting and it was a short meeting for us today and what we were able to discuss and took action on is approve the contracts report and 4 new contracts that all added to the consent calendar for your approval. It chs a short meeting but we had a very kind of like deep discussion around like some the policy issues. One of the contracts on the contract report is relatively large like contract and it is likeit is a little over 92 Million Dollars for 5 years and so we had a lot of questions and i think we are going tohave like have a presentation later on hopefully somewhere in the beginning of the year to really look at the history of that specific program on how they bundle the services that not necessarily directly contract would department of Public Health and looking at the efficiency the programs and what kind of like qualative indicators we have for those like programs. We look forward to that discussion. With that said, we have some consent calendar items for you to all approve. Any questions to the chair of the finance committee at this point before we go tothe consent calendar . I believe on your consent calendar you have the contracts report but was that not modify today a 2 Year Contract . That is correct. That is one thing we didit was originally a 5 Year Contract and after the discussion you know, like we have approved provisional 2 Year Contract and the rest would be coming back to us with the presentations and the discussions, so hopefully sometime next year. Just to know that is the health right 360 contract for 92 Million Dollars . Commissioner singer. I think it is now for 34, 600, 00 because it is only 2 years. I the one thing that is different is the one contract is modified to a shorter term. Are there any extractions flaum consent calendar . Seeing none we are prepared to vote on the consenlt calendar. All in favor aaye. Opposed . The consent calendar sudopted there isnt Public Comment on finance committee or consent calendar. Item 7 is compliance and [inaudible] update. Hi commissioners. Maria martinez and drecktder of office of compliance and chief integ rity officer. Some i know and some i dont, i have been here in 18 years. I will present to you the new office. We have worked together for about 6 months now and introduce you to the department, what our purpose is, what we have found out and hope to accomplish and answer any questions you might have about the compliance and privacy. Last year your well aware of the southerland breach we had that was complex and wide spread and involved technology and really showed us that we need today think differently and broadly about our security of our information and as we implemented aca and the new laws about coffin fudential, we looked at privacy and Compliance Department wide. We had people who addressed compliance and privacy in the department but they are in separate siloed in the Department Working very hard, these are individuals who carried a lot of responsibility for both of these functions and now we bring them all together into 1 umbrella. What i will talk about is all thesethis. I wont go through all of it. I give the idea of the scope of the work we are doing and what we found out and where are going. I will give the bad new. First of all, what is compliance . Compliance is regulated by a number of federal, state and local legislations mostly boils down to are we preventing illegal and unethical conduct in our workplace and make sure the people who where working in the department are allowed to work here if they have certain kinds of criminal background they are not allowed to work on site. To make sure that there is a place where people and staff can call to report violations, it is called the wistal blower program. Ultimately reduce the financial risk and loss we haveill talk more about that as we move aheadbasically we are trying to implement best practices to make sure we ethics and integrity in the workplace. That is our purpose for compliance. Privacy, we all heard about hipaa. There are many many laws and legislations and Institution Codes that regulate who can tom to whom, how they can talk to each other and we are bound to implement these rules and regulations. They are very complex and as a department that is very diverse we have hospitals to residential programs out in the boondocks. How you handle confuditionaltyi have 2 or 3 things a day that stump the panel and have to find out about them. The goal of privacy is to protect the con fudentionalty of the pakess and make sure the department is in a place we dont have to pay fines for breaching of the confudentionalty. In addition the goal is to make sure that the protected Health Information gets to people in such a way that helps them change and improve what we do so we are also making sure that data gets where it should go to help us make decisions about the care and services that we provide. This is the department, i wont go through of iti work very closely with quality manenment, Human Resources, and it. I work with bill a lot on it security and i probably see our city attorneys talk to them much more than you would hope i have to talk to them. We organized in 2 different ways. We havewe are trying to get to the place where the people who are located on site at the hospitalon one side you see institutional care and primary care and the other side Behavioral Health, ambultory care and population helts. We are trying to get it so the folks located there are focused on preventing things from going wrong and that means doing Risk Assessment and audit and corrective action plan wg the administrators in those areas. Over in the hospital we have magy [inaudible] and jill account in the 2 institutions who have been carrying the load of privacy for those 2 big institutions and we also havemy god, i lost your name. Evon yescarrying the whole load for compliance in the hospitals so we hope to fill position there. On this side we have [inaudible] who is carrying the compliance and i have been carrying the privacy for the rest the institution there. In the middle we have a new staff who have been barbara is really adept at mubing people around and moved good people to knh in and help us look at whistle blowers, breaches complaint and that is a investigative units. I have a planner here, kim nob nub who is able to help me do all of the policy and planning. It is very complicated and i hope to have someone help do the data trading. This is a very big piece of what we do and will grow and grow and grow and that is how we take the data and match with Human Service agency or dcys. We are trading data so it is very complex and the thing that wakes me up in the midolf the night in terms of how we do that. Hr i have arleana win who does the whistle blowers in hr and well talk about that because all most every whistle blower involved employee conduct. I will share a little about thrie areas, one is whit whistle blower complaints and privacy. Some of this is tough to look at. We had 80 whistle blower complaints that kim through the Controllers Office or us. Half are Human Resource related and other half having to do with fraud and abuse of the 65 that are closed, about half were not substantiateed so it is important to know that. The other half were substantiateed in hole and resulted ichb corrective action plans with whatever department we worked with and ultimately for 5 employees it impacted their status here in the department. In terms of privacy breaches we anticipate there is a little less than 500 thousand dollars that assigned this last fiscal year but it takes 2 or 3 years to receive a fine. For example, we got a fine last week for 3 years ago, so it takes a while for the feds to catch up with us. 13 breaches we reported in 3 quarters of them were due to people taking phi off the work place, put it in the usb or laptop and put it in the car and going to the supermarket and while they are gone somebody is stealing it. I put in the packet you see a notice i sent out that said you may not do it and have to have approval so we are trying to mitigate that in the future. Three were intentional and unozerized a woman came into the Emergency Department percentinating a medical student. We had a social worker who looked opperson who was hospitalized and you know the cybercase where we are up to like 66 thousand documents that were stolen. Each of those docunts had to be looked by magy and her staff to determine what left. Just a huge huge project and impacting many many people. We are still working on that. We anticipate the fines to be millions there. In terms of compliance that would be for bills that went forward to whom ever pays us and between chona and evon either finding out in the audits or informed a bill that went forward needs to be repaid. It is all most 10 Million Dollar frz the last fiscal year including some of the Behavioral Health programs and adult clinic. They are here if you want to ask more questions. In terms of where we are going, we are putting a lot of work into the types of efforts to change behavior through knowledge and that would be through our training. Laguna and General Hospital have a good rate of getting the staff and making sure they are doing their training. Community ambultory care is not doing quite as well so we will focus on improving the way in which peoplesupervisors know when their staff havent completed the training. We are also looking at the training itself to make sure we are conveying how to act or handle protective Health Information opposed to being able to type out hipaa correctly which very few people can do. In terms of communication we have one hotline number so people can call toll free whether tay have a whistle blower complaint or concern about a breach or question, it all comes into one place. General hospital has been doing a privacy [inaudible] i have seen it for years, but we have taken that on and been able to push that out to the rest of the department. Fast facts i put examples in the packet where woo have a corner and discuss things come up up to get that out. Lagoona honda has a Good Practice of acknowledging Good Behavior for privacy and complianceo hope to implement that as well. Policies it is important they are easy to read and understand. In terms of data breach, our two institutions have 15 days to be notified of a breach, investigate and be able to report back to the federal state government, so any time you have a large groobreach we need to be able to kick into a incident command and so we are we have a guide that was created by magy and jill and other people who have worked on privacy and now we need to implement that. In terms of sharing data, we will create a data sharing guv rns committee where it isnt just me getting a request and trying to decide if that is appropriate to have it and the best way to get it. We will create a structure where we look at requests and Research Requests for evaluation and improve care coordination and that is very complicated. Mou and [inaudible] is very complex and hope to be able to hire someone shoon to help with that. Data security, privacy looks who should look at it and data [inaudible] this is where i work with it. We have over the past few months created a [inaudible] we have stations now where our contractors have to sign that they are in fact in compliance with privacy, security and compliance. Data security, privacy and compliance. Not only do they sign it but also the chairman of the board will have to do that. We created new forms and user agreements. We looked at who is using our system and who should be off of it, how often should passwords be changed so this is work it is workic le safely and squur securely. The challenges are hiring. 5 3 4 f1budgeted posit we are moving to new emi so we have staff working with it to help codeify preventing privacy and compliance issues before they happen. In terms of legislation we have spent a lot of time on 42 cfr part 2 which is a problem with sharing substense abuse