Transcripts For SFGTV San Francisco Government Television 20160313

Roll call commissioner scott excused committing dribbling and supervisor farrell we have quorum item one action approval with modification of the minutes of the regular meeting of february 12, 2016, any corrections to the february 11th meeting with specifications. I move to approve second any Public Comments or discussions from the board seeing none, were ready to vote. All in favor, say i. I. Opposed . Okay that motion carries that item passes next item please decision item general Public Comment within the boards gentrifications not on tonight agenda any Public Comment . Next item please action 3 consent calendar with the approval of following previously discussed on february 11, 2016, city plan the Rate Stabilization reserve this was discussed during the last months meeting and was as opposed to be be rather than a than a discussion item is there any discussion from the board. So unless any discussion ill open this for a motion to approve. So moved. Second okay any Public Comment . Seeing none, were ready to vote all in favor, say i. I. Opposed . That item passes now were going to the rates and benefits next item, please. Item item 4 for the 2017 plan year ann hewitt. Good afternoon you should have before you the documents labeled the survey this is a number that has required from the charter we averaged the two populate county with the Committee Contribution efficient each one of their plans and take the average contribution by the 10 months populous county and average that that is the amount of money your required to support and an employee only cost if the city and county of San Francisco so page one is an explanation of that document it also give us i thought in 20122013 moved from the physical year july to a calendar year it outlines the briefing the adjustment on the subsequent graph is what and want to do it take you to page 2 is that up can you make it any bigger im not supposed to talk into that you guess so o cant see that that is page 2 of the document the 10 months policy lace los angeles is fresno i want to highlight two counties subdividing and santa clara those two county we have information on still a physical year six months oormd the data from the other 8 counties if you run your eye down the column on the explanation page they get an additional six months so what do we do we collect many data before i get to the final answer ill ask you to approve id like to you turn as an example to the first county this is on page 3 which is los angeles as you can see there is a applicant rally of plans for los angeles each other weve had the 216 and by which they support this were not interested in the premiums were interested in what 2ri contribute were taking you are costs and were saying well pay the city is going to support that with the 10 county down the 216 contributions for all those plans if theres a what we recollected average or theyve shifted or less rich benefit plan none that of that take into consideration we have in prior meeting at some point the contribution is up minimal but by, etc. , etc. We may decide to reengineer this at this point, were doing what is outlined specifically the chapter which is averaged all the numbers be vicinity of the weighed average by the distribution of the most or the plans designs therefore keeping the number less at some point in time well find out those programs not the city and county of San Francisco have reduced benefits therefore that allows them of them to shall believe lists their contribution and not dwrief a much higher in four weeks tan take on the reminder weve not changed best things your plans radio refresh so were to go to say you only have to pay half but the plans are less all the arguments can be put on the table not extermination but fuvent probability with that, for Los Angeles County the average is 627 plus up 4 about the 4 percent that is part of the exercise so you understand what it document is we old the highlevel summary benefits of los angeles couldnt for each the benefits we take the average this is the information is very interesting because you can go to my hss. Com and and their this with the sfoevengs that is a similar plan if you want to you can look at the premium in los angeles compared to the premium in Northern California under kaiser and theyre a your inferences we have a fairly well priced plan that is Better Benefits than month is of the county have we given you that document not yet but other xaernz more relevant to the continuous county this is a lot of interesting information it give us points as to how much they contribute and how were doing pretty well if you decide decide to use to information it is this particular public has have got r very good benefits at good priced levels we go through the next county which is San Diego County that happens to be i didnt know this was the second most populous county but there is an out liar for this exercise this time so santa clara is number 6 they have Valley Health medical they have health net and carrying hmo the rates went up high and he is contributions are up im pointing out the out liar county santa clara page 2 we look at this we run our fingers down the numbers and see that the one county that is the biggest county in terms of of change is santa clara county. What was santa clara last year. Well it is right here it was 83932 this years it was 783932 we forecasted it to be 78513 the department document. Santa clara has been higher. But if went way up this time and much more than before i was pivoting that it has been higher yes thats correct sdmilg sshg went up more than the afternoon at the end of the day if we do our averages and calculate the numbers i want to give credit to the people with happy holidays with the data and calculations together you know reviewed the numbers pea made sure in their correct at the end of the day 604 bus the 10 county assessment that i would like you to productive for 2013 and please be aware under the mou we use this for early retirees and even though the full value is not up to 65 unless there is questions id like to to be approved. Whats the number. 579124 the 2016 it is up. I move to approve. Second. On the survey. Any discussion from the board. Any. Seeing none, were ready to vote all in favor, say i. I. Opposed . That item passes. Next item please. Refuse blue shield flex Fund Medicare and ann hewitt. So similar since weve before flex opportunity it is Good Practice as requested by hss to review the data as we go into the development of the flex premium you took the premiums for active use and retirees as part of our robot he and a particular exercise present the data how it did for 2015 0 it he your honor, to page 2 of this document id like to review this and bring ousted expenses and explain the nature of what is the normal on month to month so well look at the scripser remembers inform blue shield in total there are 19 thousand plus a january and doesnt lose anyone in 19 plus this is uptick from the power year when you were the administration lien base of the hid tax 2. 4 million in admin costs that quite a bit of that or cac tax and on the the capitation one. 6 millions the medical the nonrestricted think cap its a our hospital as pournlt chaplains which you look at those those plans are not capitated they seem to have varied quietly youre at reflex to pay for those january is 8. 7 million and march it 15 million did are you have a bad mark or something happen there were or remember this was are still in negotiations between Sutter Health plan and Sutter Health systems excuse me. And Blue Cross Blue Shield so quite a bit of the payment were suspended until they finish that negotiation as of january so a lot of that suspended payment was paid by march so thats why you saw the 15 million it is not because of excess exposure as much as as much as as capturing open paying that get suspended because they were still in negotiations and good news they supplemented the disagreement okay. Then come into this in october and october the number is way down why did is that did that it goes down because of a systems conversion a lot of claims didnt get paid the october because they were converting the system so neither one of these are because of the excess inability of the actuary remarkably priced the produced but contract not only let me see is what is the net result of that exercise in looking at the experiences when you change the i dr and expense that the year you changed the refers an june 30th a physical year basis you see that one and 44,000 number there we changed the contingency refer the also ratio premiums clothed including the 8 million subsidize from the promised pledge of allegiance to keep it the premiums plus additional subsidize deficit by the full expenses was one and 2. 26 loss ratio we were slightly over we actually spent more than we priced by 6. 4 million youll find out more as we go over the stabilization on page 3 we sort of do the aggregate period ero period whether up ticks and down ticks that Administration Number we noticed that number is going up that is 11 percent increase and capitation is 4 percent on page 4 and reviewing 4 percent and medical claims and from 2014 is not a great year nor claims has gone down and pharmacy everybody is occurring this problem with 9 c drives and drugs that went up 17 percent and we see we have a lot of money from pharmacy rebates and paid at this time no money out in 2015 for the aco and got money back if stoploss 2015 to we did okay which we look at accident expense is that higher than we wanted to be as of 2013 ill is have to say yes by into a period to period pricing point to experience and review point how do we do we did accurately youll talk about the last page briefing it outlines some of the points ive made and basically comes to the final synopsis we are 6 million plus to owe one short from where we would have been if everything was to perfection any questions at this time. So what years havent we lost money as acu. We lost no money in 2013 and thats the only year. Yeah. So how long would you recommend we gotten with the spends it didnt look like its turning around. Thats a very broad question commissioner commissioner president covington so has part of my responsibility reporting the cat id like to say i dont say an opinion ill say as we priced it and expected to turn out would i consider that tolerance up and down 5 percent i see that as adequate thats my personal opinion but beyond that i cant make a recommendation to continue this we last year if i may continue or want me to leave it last year, we did an example state fully insured with the renewals and going to flex funded and wrote me auto the expenses and cost we were insured they wanted an 11 percent increase we came up with 2 percent we didnt repeat that we didnt want to ring the bell every year by at this point we pointed out that we stated status quo then go ahead and bring it at risk and put it into trust a substantial amount of savings so we can fund it we have policies that allows us to recoup through the stabilization policy that is the best position with this is as presently being the case maybe the expenses last i think i permanent as an actuary vicinity from any other statement this is a good decision. Im curious from the director how the aclu are doing in general are they i was reading something on massachusetts back a few months they said half of theres dropped out im curious have the oil aco been successful in general. We need to separate the aco from neglect funding flex funding is a way it pay the bills the aco we manage the care and within blue shield the medical group is doing very, very well, thats the one that affiliates with the hospitals theyre doing well, they met their target well have to pay them they come in came in under what we predict we met that blue shield im available to answer any questions you may have the aco sutter hospital and they are doing burdened they did last quarter last quarter youll think that they didnt talk to each other but this quarter they implemented care coordinators in the outpatient and the pashlth setting we saw hospital beds down and a real engagement of the hospital surety had been unengaged with 3 kwaerlts last year and now engaged again so i dont remember the exact percentage agriculture not very much id like not to say but less than a couple of percentages. This is the first theyve been. Even. Their target. This is a large. So it surprised me a quarter ago i went in and said how unhappy they were not doing has promised and not pollutant but this meeting those numbers are great the fact it is like one of the things you shine a light on the people Pay Attention the fact that many quarterly were tell getting monthly reports to look at those dates and i think that keeping them on top of that and that they filled the positions patient coordinators and others working with the care coordinators the doctors and nurses are talking about and ive been terribly alone and forgotten in manhattan has consider coordinators is that are talking in terms of our population 0 active populations if the aco is small but the retirees population its much larger they need and they needs nor cooperation coordination the quality is better and in their close to their targets a summary of a long answer. Okay i have another question so is last year 2015 a stoploss reimbursement was nine hundred and 83 to tell us is that the stoploss paid part of that on page 3 of this report. Yeah. On page 3. So our stoploss are are we getting benefits that from the stoploss. Yeah. We must claim over one Million Dollars capped at maintenance in 2014 the stop also payments were within 4 of the trigger that was before we do to the expenses look at the total numbers there is a change in the stoploss reimbursement it is good as the program were for the fully imposed to every dollar we have a cap of maintenance the flex opportunity ratio yes, we do receive the reimbursements it was a matter of practice blue shield when we do invoicing it is automatically credited that used to be it was entitled but basically thirty day credit for the stoploss the cash comes back or net against the invoice in the next invoice period. Yes, maam. Okay. Yes, sir. Are we paying at a premium of some kind for the stop lost is that a cost. Yes. In our Administration Fees yes. You have a fee not large fir the stop lost payment we look at that when we determine the fee. By the premium is less than the recovery it operationally is that the ball park. Ill have to say ill have to look at it im not sure and supposed to know before i answer the question. Okay. So on the administration it went up by 11 percent is there a reason why 9 change of 11 percent. The Health Insurance tax they require and to let you you know that when they did the omni bus budget they postponed the excise tax but all of the mean that is embedded i dont remember it is quite a bit it is part of Administration Fees all the money will not be to the hss for the blue shield effects program for calendar year 2017 so youll not see that. In terms of number of drivers we have 9 thousand 19 thousand as of december 2015 what is the number in 2016 after question did. I actually dont have it is slightly less. We can ask on r one of the staff from last month. Those are all everybody. Yeah. Yeah, everybody. You know but in terms of. But not the sfpd. No, it is active. Can you find that. Okay. Any other discussions from the board. So any Public Comment . Dennis active and retired ferry want to go back one item because i didnt hear Public Comment called on that and we were talking about the 10 county survey i might have been mistaken he heard the actuary say this number is not used for active employees but only retirees. Because the 340u especially for the city pace 893 percent and employee pace 7 percent is didnt account. The survey it is based on the the premium this is a basis for which they work their mous off of. The mous for most of the mous is that whatever the premium the city pace 93 percent of premium and the employee pace 7 percent. Okay. Any other Public Comment . Okay now next item, please. Item 6 action item approve blue shield stabilizations refer ann hebt. Before the blue shield stabilization refer documents and did you need do photo. It is a deduction item. Sorry. This is a standard calculation required by policy that claims the policy that requires the amortization over a 3 year period of surpluses or diversifies that accommodated with the one year lag to be into the subtraction of the rates as surplus or addition if i have if for instance, a bathroom, in 2015 and you collected one Million Dollars and at the end of the day when you did the math you said i only need 94 millions you have 5 million of surplus that happened in 2016 the firefighter when 2017 the spates 2018 that 5 million on a premium by basis by employee counts will be taken away from the rates of 2018 thats the one year lag and how it works you do that over 3 years in 2017 for some reason that was referred you take the remaining 2 3rds balance from the 2018 rates and added that and memorialize that you get what the remaining amortized is so i thought that would be good to explain so everybody is on the on the same page and looking at the experience and add that is to the go forward balance okay with that said, lets turn to page 3 this is the basis of the calculations when we price this product for 2015 we expected to collect total tricks which is line of this is a breakdown of how those dollars were to be spent and estimates to be spent in 2015 we priced there product and said we need approximately a 4 percent rate increase we decided at this point by broad vote we said to keep the rates low especially for the active employees and brought to your attention 8. 84 million was in pledge money the amount of money to hss trust by Blue Cross Blue Shield so it was to be applied to the active rates so what are we talking about we spent 8. 84 million subsidizing the rates this is common practice the Public Sector for the benefit the populous and from my prospective keeps blue shield as a program that allows excess and the chart requires the access to all providers if possible so the populous is covered with all the perimeters it is covered and establishes what we do okay yes, maam. Can i interrupt and point out the 6. 49901 is the same number on page 4 of the previous stack is those two decks are interrelated and, yes thank you for pointing out out director dodd so from the experience we presented the experience heres the summary of the experience you see we actually including the proposed loss 14 million plus dollars more than we collected but we were going to not collect 8,784,400 of that at the end of the day to adjust the things we need to add 6. 419 million. 491. Million dollars to the scaring forward ballots we have to add that and addss you know put those into the calculations and amortized that over 3 years we have a carrier forward that means those programs a sustainable in and of itself the best policy the 3 year amortization role rule is a good rule ive not changed my mind that is the sustainability in the program sustains itself big enough to do that it is great so with that being said page 2 and take the Carry Forward amount and if i can find out that sorry excuse me. Prior to that as of last year, we had that discussion going through 2014 the remaining amount of money was 8 million plus we add the Carry Forward and new have 15 million 15 plus Million Dollars that we have a charge beginning the rates of a gordons basis is for 2017 were to go add for the cell phones for the actives early retirees we are going dont add this money to the rates so to might be 30 here a 50 were adding the money and collecting that and bring that into the trust and so this is the amount of money to am intents through the rates what will be the remaining to be amortized for the next set of rates gordons or in that year base 10 million plus with that said, i want to point out a couple of things so we were trying to the best of the ability if my please silence all Electronic Devices to keep blue shield an active participate for 2014 we raised the blue shield rates 11 points 5 percent so for all Good Intention not subsidizing blue shield rates and for 2016 we have raised the rates substantially the chances are fairly good well see some of the money more than likely i can see generate surplus. 2016 and the 10 million balance should go down with that said, you know as matter of policy and practice i have to go to the recommendations go which is that we bring the 5 million plus into the am i reading the right number yep we bring that into the 2017 rates i recommend that we follow peel bring this number into the rates i need you to. Questions from the board. This blue shield stabilization refers separate in the city. Yes, maam. This big pool and so much for the dental; right . Yes. 80 theyre all you a separate. All right. Everybody is selfsustained for the program. I move to approve our actuaries recommendation and any discussion from the board. Any Public Comment . Seeing none, were ready to vote. All in favor, say i. I. Opposed . That item passes next item, please. Item 7 action item presentation oneself Opportunity Program Reinsurance Company stop lost ann hewitt. Okay this is my grand finale this is a document as a matter of fiduciary responsibility correction financial actions that we bring to the board every year should we add additional reassurance to the program as it exists or adequately covered for access losses this document is our explanation as to where why we feel at that at this time not necessary to add outside reassurance to any of the selffunded program ill refer the documents where are we thats the trust with the city plan the United Health care and dental plan and there can be the situations is uncommon a dental plan causes excess losses and a way to cap the we are with the blue shields flex fund program weve outlined the clean stabilization the next part of document explains how outdoor reshiners works i dont want to paying pay in any claim im selffund for whatever the configuration we met a premium they pay everything this did insurance do i have to pay that i have x amount of money youre a Public Entity you dont generate revenue is you want to make sure this fine board are we adequately covered when things go the wrong drieks has this happened the Public Sector absolutely as time we have a process ill go to in a few seconds do we need to purchase additional insurance we explained that is how it works and we say you have two policies which i could read you have two policies the contingency a board stated policy not the system is followed independent this do this and that you have a contingency that policy says an independent outside actuary to be myself or anyone and that actuary will calculate based on we have to approve we want to number on the ballot sheet that says if we have cash sitting the trust to cover excess lost 40 million not bank and i dont if you went over that you have all this money with the 99 percent confidence you have requested your actuary and presently hold the contingency refers for all 3 programs it is having a very good programming practice so as the flex plan as written by the state of california to a premium plan you have to have the Million Dollars covered anything over Million Dollars is covered you have a what they call max loibltd english liquidate blue shield pays when we decided that we went through the contingency refers you have limited to no exposure on the city plan our exposure is primarily medicare there is no real ability you know to side to worry about excess exposure you have full contingency refers that is fully fund with that said, you can pay the insured but told on the contingency reserves he applaud you if you do generate and loss in excess of the premium you have to 3 stabilization reserve not not surplus how to deelevate the rule is the rule it is presented fully discussions no record but we followed the policy those are two rules that cover the excess loss for the long term sustainability of the program all that is said in close is that it is 100 percent and that is one i know im being a little bit dramatic im 100 percent on the side of no additional reinsures you dont your policies are great and coffer all the exposure so its proven at this time youve not requested the actuary to have additional insurance for new programs. Yes, maam. Im not understanding something we presenting have stoploss insurance. A contingency refers reserve you basically hold. There was a stoploss number 5 we got reimbursed for. You have for the neglect fund program youre required to have a stoploss at a Million Dollars plus thats how it is required by the state of california that you have to take that in order to write that as a minimum premium product. That didnt go away. No. Yrm not very much. We havent had a stoploss. Not the United Health care no stoploss. I feel were taking something away. No nothing thats it. And the stoploss on the flex time funds from the contingency reserve now pay the premium yes, sir. It seems like there would be been helpful to point out on the deck we have stoploss protection on the flex opportunity the first slide suggests there, there are 3 programs and your remdz no stoploss beyond the stoploss coverage we already have. Yes. Fully noted, sir absolutely understood. Ill be curious to find out what the premium is. The future. Yes. Or the next meeting. Okay. When he rate well absolutely review the stoploss deck. Well be receiving reviewing that administrative line that went opt out last year because of the 2 point something Million Dollars in hid tax and look at that Administration Line and it is in that line that the stoploss for the flex plan is built in. Yeah. In the april that was presented for blue shield that itemized it i have it we presented it every time and yes, sir. I move we approve your recommendation not to have any more stoploss insurance. Second. Been seconded. Any other discussion any Public Comment . Seeing none, were now ready to vote all in favor, say i. I. Opposed . That item passes. Next speaker, please. Item 8 discussion item educational presentation value based insurance design ann hebt and Allen Thompson in front of you a brief power point by the deck value based insurance i was asked to bring this for you to cancer and Additional Research around this topic to let us know that today as an introduction just to give you a bit of backward what is valley based design it minimized or eliminations High Value Services and independence the Patient Population with chronic condition High Value Services that are identified through the high based evidence and the costs effective therapy for a Patient Group to lower the outofpocket reducing the barriers for members that needs Chronic Care Services valley based Insurance Company focuses on increasing the quality rather than lowering costs so the health plan is for the service to their Health Rather than the confident of the services being produced in considering the valley based shiners 3 key areas services, condition and participation so under service you may increase or decrease the level of for everyone that used a particular service and unpresumed to be innocent services not used for example, coverage for centers of excellence to incentivize people with surgeon needs to use a center of excellence for quality under condition based decrease the cost sharing for the specific condition and the cost shares eliminate the High Value Services that improve the outcomes for diabetes and they receive free office visit to their diabetic needs and for consideration it could be cost sharing participation in specific programs with recommend treatment for example, participating in a Tobacco Program you may receive tobacco medications that reduced with no copay with this background we went two or three medical carriers and asked for the valley based insurance theyre having in place or are considering for the future so beginning with kaiser in the 3 key areas under service they use external and internal centers of excellence and use competent care with the multi provider handbooks on care for various population condition banks examples for kaiser which is built both theory coverage and the registery for chronic conditions and might want worker and outreach efforts to population and counseling support and low copays to treat chronic conditions as far as the participation they have the Health Programs and incentives and my Health Manager on online resource i was told with information to support members on page 4 for knitted health care the Cancer Center and a premium for to assist members 0 who need guidelines and member in health plans for the benefits Lower Services provided costs under the condition based program Martin Luther king programs and a variety of conditions that addresses that are listed on page 34 and the other programs in terms of participation basis programs healthy pregnancy a clinic Weight Management that is cost it to the employer and lastly for blue shield their vaulting a number of valley based insurance for 2017 but none are currently offered in 2016 so looking at the options their currently explorer for the participation looking at incentives like the financial reimbursement based on the number of tasks and looking at the Service Based on on the ppo for the low costs providers and their bundle payments for certain conditions focusing on cancer and blue shields will negotiate treatments at the health costs out of system that concludes my presentation. Education think valley based design any questions. Yeah. I when i look at the first slide it focuses on increasing or decreasing share of costs or copays had i look at the items i dont see a connection with copays or cost of service i i mean those they seem Like Services included the way they provide but no impact on the member in terms of changes in copays if im reading this wring the examples dont fit the example am i miss reading and you make an excellent point the design if can mean a variety of things depending on who youre speaking to our prospective of valley based design i outlined on page 2 we ask the same questions to the carriers this is their responses and their framework what is theyre doing and the activities so, yes you hit on an interesting point to basically this is a promotional this is why were so great and not reducing the members costs that was what the question was that appears that way to me. Thanks. Other questions i can direct. Yes. I think i want emphasis what ann said about the valley design varying from vendor to vendor western having trouble with diabetics picking up their insulin and using their insulin because the copays were so high we might ask our vendors to waive the copays to improve experience we havent found any tweaks we could improve compliance so the vendors have implemented disease specific management and with the Educational Programs a different way of designing it but are places the country copays for meds for chronic illnesses much higher campos than we charge were at 5 for generic and 15 for brands and kaiser about 20 for generic and 25 for brand in blue shield im not sure that is accurate but were low for our costs they were higher it with incentivizes the copays. I imagine youll end up slightly higher copays because then at the end of the day the total costs of serving the population is not changed but shifting where the funding comes from. Higher premiums. Higher premiums. Other questions discussions . Thank you thank you any Public Comment on this item seeing none, now were going back to the regular Board Meeting next item, please. Item 9 discussion president s report. Vice president limb i dont have any report and the president has from report either he couldnt make it to this meeting per diem seeing none, next item, please. Item 10 discussion drortsz director dodd. You have my report in front of you id like to highlight a couple of things you recall weve talked about the 1095 forms and most employees should have gotten them im not sure the employees got them well instructed people not to send them in with their tax but keep them as prove the health plans sent forms to the irs so everyone has prove they have Health Care Coverage with over 55 thousand forms our call volume and assistance increased gridlock youll see that think is chart actually 51 thousand i apologize it wasnt a horrible increase bus over our thirty second waste time that is remark weve gone live with state of california salesforce it will give us a tracking mechanism to see who spoke to the member last and weve logged think 2200 member cases so this is not a whole new system that you are benefit analysts are using it highlights the testing that had to go in for mailing out the 1095 forms doing the analysts do more the deck and ill appoint that our privacy officer marina did this for all of us we are in compliance with hipaa and finance submitted internal documents to the Controllers Office as part of audits wife exceeded the content management youll recall the two improvements customer and the electronic data wear now prepared to move on with digitizes all the material weve selected a candidate to assist in communication theyre going through the final processes right now and were trying to get a timeline eventually happens this is kind of a downtime but once the open enrollment stats in april and may and june most of the times is taken up more and more were trial to parse out what we can get done before the the open enrollment in terms of in your inpatient a epa report summarizes the epa we brought on the two new staff towards the end of the year one of the exciting things we celebrated our champions we have a champion appreciation that supervisor farrell came to and people were impressed we drew down the director and the board of supervisors and kaiser was very generous with prizes and made yogurt for everyone that is a healthy celebration no cake. Just youth i dont get. Right i dont get and granola. We have over 200 champions and the care and feeding of 200 volunteers and keeping them excited about trying to get people to eat rights shouldnt be taken lightly theyre well teacher taken care of by they are wellness staff weve altered two classes to have access to improvement activities so this is more work for them but the says is only so big we said okay startled to lunch and yogurt or whatever it is we also met with mayors the resources and the controller so talk about a citywide ergonomics wellness and working with Workers Compensation how to improve our prevention of workrelated injuries in terms of my activities ill highlight excuse me. The ill recall over the past 3 years talking about the women firefighters having a higher rate of Breast Cancer than the average woman they finished collecting the samples 80 firefighters and 80 Office Workers and theyve began to compare the results that was a meeting the scientists so hard to track the chemical compounds but it was really exciting and the women firefighters made a Youtube Video you can watch yourself how to be safe after leaving a fire and theyre really excited about this this is something that mr. Change the health and wellbeing the firefighters throughout the country and all in San Francisco as hss i also drafts testimony we were notified on just last week when rates were out on february 19th cms is changing the reimbursements the pharmaceutical management plan. Retirees and so i quickly respond and submitted testimony by the deadline that was last friday and well see those actual rates outs on april 4th i in terms of transparency interest there were there was a very Important Supreme Court ruling it was a 6 to 2 ruling having an extra justice might not made a difference but a setback the states cant require data to be on a selfinsured plan not require the data be submitted to a statewide database so watch that for future forevers on, on transparency on our part and thats all the other thing that we have been tracking along with the department of the environment the pharmaceutical dispositive what happens when you dont finish our bottle of ohio chlorine or whatever what do we do with those medications its been a Long Time Coming but put out regulation and ive been with work the department of environment and hopefully submitting testimony that will will you those to be disposed of safely and environmentally safely and keeping them out of the hands of people that dont need them public works the throughout the department disposal thing was subtleties by the board of supervisors are working other than that, supervisor president london breed in particular as have pharmaceutical disposal days the issue of narcotics are a problem you had to count them and say who our receiving them from and gauntsdz and the Police Departments got involved this is an issue particularly. Kaiser because cms and walgreens are putting them in box but we had to adopt the state standard this is it for the disposal weve taken some steps but not solved the narcotics step any other questions any Public Comment . Good afternoon, everyone. Commissioners i just want to make a couple of comments wards to the report one the tns participation of maefshth o subtle there is very well received our people are excited and increasing the number of retirees that are taking part in activities walking and experiencing and were trying to now gets more information to provide times for classes that more of our retirees will be entitled to come to 1145 we had a meeting a wellness coach and nutrition everyone got up and experienced and margaret came forward with the program and her participation is helping our population specifically thank you for that, yes and ask that continue it is important the other they know one of the message that i quality of life to the members when they encounter difficulties with services this question call Health Service and let would whoever answers the phone know theyre having a problem of kaiser or blue shield or knitted health care and the feedback eave received lastly we call and say wear still having a difficulty and were being told why not call kaiser or blue shield we did that but thought you time to know not really click and members have saying call Health Service with the performance levels that need to be met and as along the Health Service doesnt know about the difficulties they dont know y were for the feeling whoever is taking the information is not taking not i thought id bring that up ive had good discussions we are working on getting many of that roved it is frustrating members are encouraged to call and they dont get the response they anticipate but thank you and probable the wellness thing is the best thing since life spread. The retirees thank you very much Herbert Wiener this is a short not in the past, when i had difficulty with reimbursements to the medical provider i have to call the board of supervisors and their aid has to get onless horn with the Health Services we never wanted to come to this level again and have to do everything to prevent it i think that the Service Delivery as improved but they need to be addressed we dont want to come down to the level even the aids of the board of supervisors having trouble so and then to the nightmare please end this. Any other thank you next item, please. And item 11 deduction item hss Financial Reporting as of january 31st, 2016, panel 11. Pamela chief Financial Officer as of the captains through december 31st actually excuse me. Sorry i have too many papers on any plat plate the directions for this period of time would indicate for the trust as of 6 30, 2016 our fund balance will be 78. 2 million which is about 3 million better than we report for december the reasons for this city plan is continuing to have better claims inheritance and therefore the use of the fund balance is reduced by with an Million Dollars the blue shields flex plan we raised the rates in 2016 to make up for the 2014 deficit and continuation of the pharmacy redebates e debates e beats to offset the rates for the rates in 2015 so we have while an increase of 1. 2 million oh the selfinsured dental plan right now 3 housing unit 4 million increase and continue to have a favorable a claims experience the selfinsured dental plan same as the prior report interests remains the same of 3. 4 million and forfeitures we have budgeted to transfer over the general funds but those are determined at the end of the fiscal year and performance guarantees we are still looking at an increase as of over so with the performance guarantees there are always lagging so we just received some funding that recent for the plan year 2014 the Health Care Sustainability funds were projecting a surplus of about 85 million at the end of this current fiscal year the prior month we recorded im sorry 84 thousand laughter plus dollars and the prior month we reported thirty thousand and then pharmacy rebates weve received at an amount if blue shield we are right now having 2 million the bank and project a total ends of 2. 4 million forfeitures were waiting. The final results from the run out period and for the general fund right now, were projecting no savings to give back to the Mayors Office and is Controllers Office we have been told to use the ends of here on behalf of the appellant any of the current savings for items like starting hiring part Time Staffing for this east ends project and purchasing economic equipment and doing the best we can with the expenses and anticipation of settling the budget at the similar value as we had to go into with the reduction. Any questions. Any questions from the board. May be one on the Health Care Sustainability fund is it possible to have a diversities at the end of the year or are we locked into the Funds Available we could have a surplus we can break even but unless we have a carrier a balance going into the year it sounds like in this case were going to end up with an 84,000 surplus in addition to what we collect once we get to zero and couldnt have a net deficit in that fund limited to the amount that goes in. We cant spend more than we actually have thats correct. Any other questions. Any the questions. Thank you any Public Comment . Seeing none, next item please a 12 health plan issues if any. Any health plan issues or network. Hi good afternoon blue shield of california ambassador i wanted to just make the board aware of a small change in your policy around hepatitis c blue shield has a requirement around qualification for some of the more expensive hepatitis c medications and we recently revised our guidelines to align with the American Association for the studies of Liver Disease and the Infectious Disease society of american it racks you are guidelines a little bit so those who may have been denied access to hepatitis c medication due to medical net for example, in their own awe symptomatic and didnt qualify theyll quality for that medication and those who were notified we notified members their qualification was denied we have retroactively gone back and notified them to contact their doctor and again apply for that particular Prescription Drug just information i wanted to make the board aware. So it has been defined. Yeah. In december noifdz. Fewer thirty so we cant know how many they were. A view small percentage but a border assess Going Forward. Thank you. Thank you. Any other from the folks seeing none, any Public Comment . Secondhand smoke next item please. Item 13 opportunity to place items on further agendas. Okay any items for the board for the next month meeting . Nothing . Any Public Comment . Seeing none, next item please item 14 discussion opportunities for the public to comment within the boards jurisdiction okay our previous president commissioners this is your last chance. Your last chance. Okay. Seeing none this meeting is good monering, welc Rule Committee meeting of march 10, 2016. Im katy tang and to the right is malia cohen and the right is eric mar. We would like to thank sf gov tv [inaudible] herb and [inaudible] josh alexander. Any announcements . Please silence all cell phones and Electronic Devices [inaudible] submit today the clerk. Items will appear on the march 22, march [inaudible] thank you very much. Will you please call item one, hearing appoint one mb tern to childcare planning and advisory council. There is one seat. Thank you, if we can have mrs. Candice wong. Good morning, my name is candice wong. Im currently the applying for reappointment to districtly advisory council. I have experience on [inaudible] business side and [inaudible] working at the low Income Investment fund of california director Child Development program. I have been there for 10 years so continue to serve the city in the capacity of Early Childhood education and proud the work we have done over the last 2 decades and love to continue to serve the city in that capacity. I brink both the perspective of running programs but business perspectives and how we support the minority owned businesses. Im also a proud resident of district 4 and happy to answer questions you may have. Sure can you tell a little about the things childcare Planning Advisory Council has worked on in the past year and also what do you anticipate for the year coming up ahead . One the major things we are working on and supporting office of [inaudible] developing the 5 year plan for Early Education in the city. That is in process. I also sit on that council. The process with hopefully should be done in the next month or two, approved by the board of supervisors, within that planning we do a variety of things look from 0 to 5 and look on the [inaudible] of the programs and quality of the policeman and access ability for families. [inaudible] the next phase is how to look at the 05 continuum and how do we do that to make sure our kids are ready for kindergarten and continue to 024. I also sit on the council with the mayor and superintendent around the city wide planning for 024 in that plan and that is also a 5 year plan. [inaudible] office of ece on the advisory committee, so i think the few areas around quality and how we coordinate with the state and make sure the state is accessing all the federal and state resources we can, how do we use the local dollars to leverage. Planning for the infrastructure so there is the business side of education and facility size as the city grows, how do we make sure we have adequate facilities to serve the kids in the growing population so we worked on a variety of issues, infant and toddler and preschool. [inaudible] i know there is also a lot of talk in terms of salaries and really how it is we are supporting the providers in a lot of the childcare setting and making sure they are able to attract and recruit quality people and retain them as well and that is a challenge here in San Francisco. Is that something that [inaudible] or through childcare Planning Advisory Council that you will be tackling that issue . That is a major issue for our city. Just like finding k12 teachers we have a big issue around [inaudible] teachers so that will be a major issue. The wages and benefit issue is a whole package. I know supervisor you are away y aware of that how we attract the quality teachers we need in the city and especially in the area of Early Education so that is actually one of the highest Priority Issues we will tackle in the next few years. Thank you. Supervisor mar. I just wanted to thank candice, mrs. Wong for years at work really helping to stabilize Community Based childcare and working on wages issues with sf cares to many other programs and with supervisor yee developing into a Amazing Organization that helps build capacity throughout the city. I want to say that think her involvement on the commission is critical given the budgetary experience how to support the capacity of smaller Community Based businesses and organizations as she stated. Knowing directly how the low Income Investment fund helps smaller family run Childcare Centers and other places, stabilizing them whether in the sun set or richmond is critical work. i want to ask at the city level and having Adequate Funding stream frz preschool for all is a great example of your leadership over the years thank you supervisor. Early education for all. Thank you, it looks like that is all the questions and comment we have so at this time ill open up itm 1 to Public Comment . Anyone who wishes to speak on item one, please come up. Good morning rules committee and supervisor tang and supervisor cohen and mar. [singing]. These dreams go on in the first five, every second youre alive, theyre a good guide. Thank you very much. Alright, any other members of the public who wish to speak on item 1 . Seeing none Public Comment is closed. I think mrs. Wong is a wonderful incredible represent on the counsel and glad district 3 ipointsed her and glad supervisor paskin is glad he would like her to continue the role so happy to support her. We vamotion and second by supervisor cohen and without objection congratulations mrs. Wong is appointed to sheet 3 of of childcare advisory council. Item 2 conforming the [inaudible] Oversight Board termseneding january 24, 2020 i see we have mrs. Sesay and mr. Lee so if you would like to come up and make a presentation. [inaudible] nadia sesay [inaudible] Public Finance and delighted and honored to be honored to the Oversight Board. I work frd the city over 17 years, kind of scary. Im in my role as Public Finance director and manage the cities [inaudible] debt obligation is over 3 billion dollars in outstanding debt and work closely with Capital Planning and special projects directed by the mayor and board of supervisors. I have bij on the committee since tent 12 after the disillusion of the Redevelopment Agency and [inaudible] get all the successor agencies and [inaudible] we were also able to all the [inaudible] completed and [inaudible] all the funds back and got a state finding of completion. We are also successful receiving final and [inaudible] of 3 project areas, the ship yard and transbay and mission day. We also have been able to achieve [inaudible] on the long range Property Management plan. We moved from semiannual approval and issues [inaudible] we also continue to maintain a oversight role as well as new obligation and the Oversight Board is also charged with reviewing and approving issuances as well as properties that are under the successor agencies jurisdiction. My expertise i bring to the table is debt issuance and [inaudible] so there is a huge level of debt issuance required to issue debt not to just deliver on the infrastructure but Affordable Housing. The housing isnt under the Oversight Board [inaudible] i am thrilled and honored and love to stay on the committee. Great, thank you very much. Maybe if you can tell us a little abouti understand a lot of the work is probably very much ongoing because they are long term projects but what do you anticipate to be some of the major issues or challenges for the upcoming year . I should acknowledge that we have been able to overcome a lot of the issues when disillusion came about we had a challenge of issuance of bonds for housing and we didnt have clarity on transbay for issuance of bonds in transbay. Most preently recently the state approved legislation that allowed to issue that so in terms of Going Forward the challenge will be on [inaudible] with development or Cost Increases with infrastructure, the [inaudible] already executed so have the ability to issue that on their behalf. It could be [inaudible] we have a recession or not, but in terms of the project and develops we have partnerships with we dont anticipate there to be a issue. What could potentially be something we will have to observe in the long run is the timing of when Development Comes on line so there is enough [inaudible] with housing as needed. Most importantly it is probably timing of when Development Comes on line but the [inaudible] is already pledged to the development and center a agreement from department of finances that have those allowable contracts. Great, thank you. Colleagues any questions, comments . Okay, seeing none well move on to mr. Olson lee. Good morning supervisors. My name is olson lee and a current member of the Oversight Board and director of office of housing and commune tee development and work between the Mayors Office and Redevelopment Agency for dwix 26 years. Prior to my position at the Mayors Office i was the depsty director at the Redevelopment Agency and assisted in many redevelopment plans that are implemented now through the office of Community Investment and infrasfruckture. I ran the Affordable Housing plan through the Redevelopment Agency. [inaudible] we received the completed housing projects of ocii so my role on the Oversight Board is to insure that process goes smoothly, that ocii is implementing the enforceable obligations appropriately and as one of the questions of the work for the futures, there is still a lot of work to be done. Still a lot of Affordable Housing to be done. With the passage of sb 107, with the assistance of the state delegation, Affordable Housing received additional funds from prior redevelopment project areas to help complete many enforceable obligations in transbay and mission day and candle stick point and look forward to the opportunity to provide guidance on the implementation of the work of ocii. Thank you and then just the same question but from your perspective, what do you see as the major challenges or issues you will work on the next year . I think the major issuers are figuring how to implement sb 107. [inaudible] i think the other major question will be some of the transfers of the former ocii property, one being yerba buena gardens and the governing structure for that in the future. Thank you. Seeing no questions or comments thank you very much and well open up item 2 to Public Comment. [single] [inaudible] i hope you have good oversight. Maybe im a open book because i make the items right, but i sure hope that you pake a good board member this time. For your good look with the [inaudible] thank you very much. I didnt think you could come up with a song for that. Colleagues ill close Public Comment, there is no one else for item 2. Supervisor mar. I like to move we reappoint two incredibly experienced people for our city to seats 1 nadia susay and seat 2 olson lee. Thank you. Second by supervisor cohen and we are lucky to have you in our city and family. With that, without objection that is confirmed. If we can call item 3. Item number 3 is hearing to consider 22 members terms ending [inaudible] assessment appeal board 3. There are two applicants we have two applicants for seat 2 and seat 5. I believe mrs. Nelson said she could not appear today. Is mrs. Bryant here . Great, please come on up. Good morning supervisors mar, tang and cohen. I have been in San Francisco for 52 years [inaudible] and i have diversifyed experience in the [inaudible] for 15 years i was in the trust division with [inaudible] doing trust accounting and also real estate. [inaudible] for the individual banks. As a tax accountant i was doing the taxes foremost in the Tax Department before [inaudible] for doing the trust division. [inaudible] i was doing the actual [inaudible] beginning from the application until the conveyance of the property. I also have experience [inaudible] taking classes with city college working [inaudible] i did an appraisal on a Single Family residents in Mountain Spring and [inaudible] which i had from the [inaudible] and i also have done the private trust with other conservativeship and also a conservative for the city listed here in San Francisco but i didnt do the [inaudible] i would be happy to join this group and based on [inaudible] and based on the facts and do the research for it and hopefully this is [inaudible] and i hope to be with this board [inaudible] and thank you very much for your time. Thank you for your presentation and think you answered the question i was going ask you which is how you would approach the role and i was looking for someone for this role and body on facts, making sure everything is done fairly, transparently in concert with all the other members with the assessment appeals board so glad you brought that up on your own. Supervisor mar i want to thank you for meeting with my office and your long time Neighborhood Work in potrero hill and bruno heights. Your volunteer with various neighborhood association. It says something about your professional work as a appraising which you meet the minimum qualifications but [inaudible] pg e Energy Audits to open space work with open Space Committee and involvement with lots of Different Community organizations, i really find that tremendously commendable besides you meeting the minimum qualification. Your expertise and work as a appraising makes you well qualified for this seat so im proud to support you. Supervisor cohen. Ill be supporting mrs. Bryant as well. Just a question so you are able to make all the meetings for the assessment appeals board . [inaudible] i would like to be able to [inaudible] be able to work with people and im pretty good with that. Im very good with the public and communicate and dont have no issue for [inaudible] i mean my question is, are you going to be able to atened all the meetings . Are you going to be able to attend all the meetings . Yes i know there are quorum issues so want to make sure i did have a question because im also involved with the commissioner [inaudible] also [inaudible] but that is one hour once a week. Alright. Okay, thank you very much for your presentation and interest in serving. At this time well open up item 3 to Public Comment. Any members who wish to speak on item 3 . [singing] [inaudible] hope you do good good with all your dealing [inaudible] in the sky keep on [inaudible] good luck and [inaudible] thank you very much. Any other members of the public on item 3 . Seeing none Public Comment is closed. At this time we have a nomination . I would like it nake a nomination to move Kristine Nielsen to seat 2 and mrs. Bryant to seat 5. Second by supervisor mar, take that without objection. Congratulations. Can we resend that and send forward as a committee report. We take that without objection as a committee report. Now item 4. Item 4 is hearing to consider appointing to the Food Security task force, there is one seat and one applicant thank you, if we cani apologize if i mispronounce your name [inaudible] good morning board of supervisors. Im honored to be nominated for the Food Security task force. My name is [inaudible] and im the Nutrition Services director with the mu turnl child and adolescent helths program with department of Public Health. I haveas sth Nutrition Service director i oversee the Supplemental Nutrition Program for women and children known as wic and oversee the work for snap ed program known as [inaudible] here in San Francisco that provides Nutrition Education to cal fresh [inaudible] also in my career i have worked with vulnerable populations, specifically women infrant and children at most risk for nutrition issues and being a part of the task force i have attended several meetings so far. I think i bring a voice for our most [inaudible] folks within the community and really bring up not only food issues but also issues as they relate to nutrition and health, so you know, that is something that i passionately believe in and really have worked for my career. If you have any questions you mentioned the focus you would like to bring to the task force if appointed particularly regarding nutrition and health, can you expand on that a bit . Yes, currently there are a lot of projects involving nutrition, providing meals whether it is through cal fresh or delivered meals and there isnt a big focus on women infant and children. [inaudible] i do a lot of work related to Breast Feeding and there is a different dimension to Food Security piece because you really dont see it as a Food Security issue when it come tooz infants but it is a critical piece that first year and it is something i really feel that needs to be brought to the table and that is something i plan to work on. Thank you. Glad you mentioned that. I think that is incredibly important. Supervisor mar. I want to say mrs. Rein is extremely qualified and love the passion toened hunger and your work within the department of Public Health for food Stamp Education to maximize people qualifying for Food Assistance and the work with wic. You didnt mention [inaudible] that is how i connect with the folks that i have worked with. You know, i have a 8 year old son and he definitely inspires me and through that i can really see how difficult it can be. I mean, i have been blessed with [inaudible] in my life and the participants we are serving may not be there and still taking care of these children so yeah, the passion goes to a different level when the mother [inaudible] i know that with tarry oly and Food Task Force members focused on seniors and people with disabilities, the children and families issue is really critical as well and know the School Districts and [inaudible] are working but i think you bring a lot of valuable expertise. Your work with immigrant communities and food and hunger is another great area, but im happy you will be joining the task force. Thank you very much. So, i dont see any other questions or comments so at this time ill open up item 4 to Public Comment. [singing] [inaudible] security food task. They are taking away your ham burger and i hope [inaudible] security, food, task, security, food, task, supervisor mar we are going to fix that big mac. Thank you very much. Any other members of the public, we are closing Public Comment for item 4. We have a motion and with a nob nub i move we epoint [inaudible] to seat 10 on the Food Security Task Force Second by supervisor cohen. [inaudible] yes. Alright, thank you. Without objection, congratulations. Item 5 item 5 hearing to consider the Quarterly Reports of the Shelter Monitoring Committee. Alright, thank you. I think that we have some representatives to present on this item today. Good morning, my name is jonathan bunoto and chair the Shelter Monitoring Committee appointed last year by the local homeless coordinating board and just became chair a couple mointh uzago so bear with me, not completely familiar with the Quarterly Report and this is my first time here. So, with regards to the Quarterly Report, and thewe did 20 site visits this First Quarter of the year and what were looking for are issues such as the facilities cleaned, bathrooms stocked recollect adequate bedding, storage, adequate meals, signage and ada accommodation and reasonability information. There are 43 total complaints during the quarter and that is consistent with Previous Year where we were averaging around 40 complaints per quarter and a break down of the types of complaints, 81 percent were staff related issues, fallowed by facility and access issues, 9 percent. Health and hygiene, 8 percent. Ada, 1. 8 percent. So that is a summary of the Quarterly Report. Do you have any questions regarding the Quarterly Report . Um, thank you. I just wanted toi had a chance to read through it before hand so you mentioned the number of complaints for the quarter was consistent. It looked like a very High Percentage in terms of complaints that are staff related, is that also across the board across the various reporting periods . Ill let howard answer because he has been doing the Quarterly Reports. Good morning, supervisor, howard chen, policy analyst on the staff. What we have seen is typically there is a pattern of complaint about staff being the Biggest Issue with client complaint. And can you elberate a bit on what that entails . Sure, the staff category is one of the broadest categories of complaints we take and that can range from staff not having id badges to potentially using disrespectful language while speaking to clients and it can be something as serious as non maintaining a safe environment. The staff category is very broad so as a result you receive a lot of complaint in that category. Have there been anything done to address that issue then, especially such a overwhelming percentage of complaints are based on that category . When clients come in and file complaints with our office, what we do is we track the names of the staff being named and the complaint and if the new trend with specific staff receiving a unusual amounts of complaints, what we do is send that information over to the contract monitor, but from what we have seen so far, there havent been that many individual staff that continuously we see complaint. It is different staff receiving complaints from different clients. Okay. Thank you. I had a question, mr. Chin, it looks like next door is the site of 25 complaints and im wondering and looking at the narrative ofcould you just explainit seems like that is where some of the concentrated complaints are and how that was resolved . So, next door is one the largest shelters in the city system and so as a result we do see they typically receive a more complaints than some of the smaller sites. That would also be true for [inaudible] south and providence as those are some very large sites and typically they do receive more client complaints. One was no smoking sign not posted in spanish, howare smoking complaints a common type of complaint at a number of the shelter . There isnt a complaint we receive a lot of. For that particular instance i cant recall the exact details of that complaint but that isnt something that typically comes up very often thank you. Maybe that was from a site visit where we observed there want a no smoking sign in spanish because they are required to have all the signs in spanish and english. Alright. Thank you. Any other questions from Committee Members . Seeing none i just look forward to continue working with the shelter monering committee, Human Services agency and of course providers as well in term thofz policy regarding people involved in Domestic Violence incidence so thank hsa helping work on that in the past wreer changing that policy so hope we can continue making improvements on that. I also thank hsa for their support and assistance as well as you, supervisor tang and the board of supervisors for passing the resolution back in december. There is a additional item which i wanted to bring to your attention and that is the Shelter Monitoring Committee has some legislation recommendations and one of them has to do with the standser of care number 12 which is there should be two clean sheets and some [inaudible] they dont have laundry facilities, so the recommendation that we are making is that they be aloud to substitute a clean blanket for a clean sheet and not get written up at violating a standard of care item. And the second recommendation we are making has to do with the board of supervisors seat 1. Currently this seat has to be sfiled by someone who is homeless person or homeless 3 years prior to appointment living a homeless child or the recommendation is living a homeless child under the age of 18. It is issue for the committee to find candidates who are currently homeless with their homeless child, not to find but to keep them because if you a homeless and trying to care for a child it is very difficult to be going on all the shelter inspections we do each month and it is difficult to attend the Committee Meeting and any subCommittee Meetings, so we would like to recommend that this be changed to somebody who has lived with a homeless child under the age of 18 at some point within the candidates life time. We believe it will make it easier to keep someone in this position. It is currently unfilled on the committee. And the third recommendation is that the terms of each committee officer, they are two years, but we ask that they be staggered so half rupointed on a even year and half are appointed on a odd year so we can have consistency in the committee with experience. Thank you, if you have any questions thank you. And so just in terms of the 3 recommendations sound good to me. I just wonder does Department Staff want to weigh in on this and let us know their thoughts . Did you mean the staff from dph or hsa . Either one we [inaudible] shelter monitoring officers quarterly so we work through these changes and agreement with all of them. Great. Just for the record [inaudible] sorry. Great. [inaudible] howard chin, policy analyst. [inaudible] assistant to dweckter of health will coordinate with dpa and hsa. He is out of town but can forward questions or concerns over to him. Thank you. Colleagues any questions or comment . That thank you so much for your work and Department Staff. Well open up item 5 to Public Comment. I think mr. Walter left. No members of the public for item 5. This was a hearing so if we have a motion to file this hearing. So moved thank you. Second by supervisor cohen. The hearing is filed mptd mr. Clerk we have any other items before us . No more items, madam chair. Okay thank you. Meeting is adjourned. [meeting adjourned] please silence your mobile devices that may sound off, when you are speaking before the commission, if you care to state your name no the record. I would like to take roll. Wolfin