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tv   Historic Preservation Commission 6116  SFGTV  June 9, 2016 1:05pm-2:01pm PDT

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>> this meaning will come to order. please rise and join me in the pledge of allegiance. i pledge allegiance to the flag of the united states of america and to the republic for which it stands, one nation, under god, indivisible, with liberty and justice for all. now i will ask our secretary to call the roll. >>clerk: roll call. president scott,
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breslin excused; supervisor farrell excused, commissioner ferrigno, follansbee, commissioner sass excused. we have a quorum. >> we'll now proceed to item 1. >>clerk: item 1. approval with possible modifications of the minutes of meeting setforth below regular meeting of may 12, 2016. >> are there any questions or comments to the board on those minutes? i think it was a remarkable translation process to get it all down particularly with all the public comment. so i'm ready to entertain a motion. >> i move approval. >> second. >> is there any additional public comment? seeing none, public comment is closed. all in favor say,
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"aye". >> aye. >> any opposed? that motion carries unanimously. discussion item 2. >>clerk: item 2, discussion item, general public comment on matters within the board's jurisdiction not appearing on today's agenda. >> is there any additional public comment? seeing none, public comment is closed. we will now move to the rates and benefits committee. we are now the committee as a whole on rates and benefits. we will take up action item 3. item 3, action item. approve kaiser permanente senior advantage fully insured retiree rates and premium contributions for 2017 plan year. >> we have before you a presentation or powerpoint document that outlines the requested rate increase
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for the medicare advantage kaiser senior care product. we have it correctly stated as the 2017 kaiser permanente managed prescriptions retiree. this is the material. what we'll go through in our summary on page 3. that as a matter of practice for this product which covers seniors only 55 plus which is a cms program that creates a capitation amount determined by calculations by kaiser to cover the specific medicare members that this addresses. this is how it's done. instead of permitting claims, they get the medical management skill set to cover underneath that
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cost. this has been a very well received program over many many years and kaiser is of course a leading advantage program in the state of california. with that being said, as a matter of practice and necessity in order to have the rates correctly reviewed by the board of supervisors, we did an early release of the number. so kaiser allows us and there are kaiser representatives here if there are questions about that exercise. they allow us to have an early number. what does that mean? they don't know the early number. what they are going to get from cms from kaiser, so they give their best estimate to us. we agree to this practice, so at the end of the day when they finally know what they are going to get, we get a number. if we bill for 2016 or 2015,
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if we find out the number should have been more, then we add the difference to next year's rates. that's what this is all about. for 2017 the estimate they can give us at this point in time is $331. for 2016, it was determined after they received the final remission from cms, that the number should have been $9.76 higher. so we have to add those numbers together. so the billing rate is $340.76. i would like you to also see page 4 of this document. when we have rate cards for any of our products for retirees and medical retirees, we have numbers in addition to the pure premium. those numbers of vsp premium, our healthcare sustainability and then we
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have added best doctors. and very proactive second opinion that hopefully will allow us to manage medical care in the future. all of these have been reviewed by the board and accepted by the board. additionally, we are adding the $9.76. with that, i would like to turn your attention to page 5. page 5. >> may i raise a question? >> absolutely. what would kaiser assume the drivers to be in that negative variance? >> what would happen is we get a best estimate. >> i understand that. what caused the number to drive it? >> cms determines for the entire basket of people at the end of the year. once they get all the remissions in
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and figure out the judgement to the final request are, they say we can give you this amount of money. so, what turns out is they got less money than they expected to get. which means the rates should have been higher. we've been told through the last say 18 months that cms is rachting back money. to have this finally reconciled going forward, we are going to possibly be more short more often than not. this is not expected during this time. that helpful? >> that's fine. >> let me ask a question too. so the medicare advantage, what medicare returns the same for kaiser as it would be for blue shield? >> it's the amount of money
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that's area adjusted. >> it's the same for the blue shield people? >> when they look at it, it's an area based number with statistics relative to that population. if they are a higher risk or different set of people, you have a fact that is calculated. if blue shield needs to be a certain number, they determine you get that amount of money. if your other medicare advantage filer is in the exact same situation with a better set of risks, chances are they get less money that is well documented in architecture that they pay you. you don't get the exactly same amount of money. yes, sir? >> my understanding if kaiser docs forget to code their
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diabetes for the whole year, cms wouldn't have the diabetes. would the numbers be what they think the diabetics get for cms. a lot of this is diagnosis driven and the providers attempt to capture the diagnosis to make sure the reimbursements are maximize. >> the more money they get, the less they have to charge the purchaser. is that clear? it doesn't necessarily, well said, sir. you can look at it from different directions. it's an activity that requires very good documentation of diagnosis as was clearly spoken by the fine doctor and the risk. i know kaiser is best at collecting the data and make
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myselfing the reimbursement there is. period. i'm not selling you kaiser. they will be able to sustain a better set of numbers in terms of the what the city will have to pay for that population. >> is that a reasonable statement? >> yes. >> thank you. if kaiser can get an early estimate, why doesn't blue shield get an early estimate. >> we have it. >> why didn't we get that number. >> their's is the harder number. we haven't combined this number. >> we didn't know that last month what blue shield's medicare rate would be. >> yes, ma'am. but i have not provided it in this form at this point in time. >> okay. >> is that correct.
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>> i didn't know we had the blue shield medicare reimbursement rate. >> not yet. did we know this exact same amount of information from blue shield, please restate the question. >> yeah. i saw it said kaiser provided an early estimate but i don't remember you saying blue shield provided an early estimate of what the rates would be. that was my question. i don't remember seeing that last month. >> no. blue shield did not provide and early estimate of the retiree medicare rate. >> why not? >> that's not the way they present the numbers. from kaiser they presented an early estimate and the way they
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recoupe the money, they do say in november, the way the program is structured under blue shield, the calculation they provide is april or may. depending on the level of the calculation, we go into negotiations is their best and final. where kaiser has reserved the right to say we won't know a hard number until later in the year. and historically when they have been able to release a number in july, they release their best and final and then ask us to change it to the difference from the july number to the november number. but they have said in essence, we can technically do that. but when we ask for a much earlier number, they say we want to put this process in place. that's the way that works. >> so they put it on this
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process 3 years ago? >> yes. >> we had the question asked and answered, are there any other questions? >> we are on page 5. this is how we bill the rates in all cases. we take the premium from the vendor and add the 3 pieces and the final number. by the rules of the 10 counties, the lesser of the premium or the ten county. since the ten county was 604 $604. i can't remember what it was. the retiree person pays exactly nothing for the rate for
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their coverage under this program. and we go through the other calculations. the only other thing that applies to the retirees is the subsidy. it was developed to adjust the rate to early retirees. that being said, here are the set of numbers. if we go to the next page, we look at how this applies to the member 2-16 versus 2-17. the number that i will highlight is with the addition of the reconciliation, the retiree plus one will go up $12.88. three retirees will go $38.66 and non-medicare dependent. these are all the numbers. i have shared. we have gone through the exercise of
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the reconciliation. we have all on page 9 we have our foot notes for the items on the rate cards. if there are any more questions, i will make my recommendation. >> your recommendation is? >> please approve as presented. >> you heard the recommendation from the medical advantage plan for kaiser. the retiree renewal premiums and contributions. are you ready to vote. i would like to entertain a motion unless you have a question. >> i move to approve. >> second. >> it's been properly moved and seconded that we approve the rates as submitted by the actuary accepting the actuary's recommendation. is there a question from the
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board? public comment? public speaker: good afternoon, commissioners, clarence vonsky, retired city employees. the only thing that i really have a question about because i do appreciate neal's explanation of where the $9 came from and how it's being calculated. i think we are missing the rates that have the medicare member plus the non-medicare member. as i recall we would usually have the more of the rates that included that balance with other non-medicare members because otherwise these rates, they are very good and we can see them, but we really don't know the impact on those members that have dependents that are non-medicare. it would have been nice to see that also since i think it would go with this presentation and not the one we have seen before. and later i will express to you my other concerns about the blue shield rate and how they deal with
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it. that's the only thing i'm looking for here. thank you very much. >> i will ask the actuary to please come forward and answer that question. >> yes, i would like to answer that question and address that to claire. this is a family rate to assume two non-dependents. this is a same chart that we have presented as i have been so privileged to be your actuary. it's no less than or no more than. does that help? okay. >> we have a comment from a kaiser representative. >> hi.
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i want to add something. we are adding the rider. $50 co-pay per visit up to the combined 30 visits, with the chiral combined. it comes with that second benefit as well. the second benefit being added is what we call our silver and fit program. that provides a program for the participant to either join a participating gym that's part of the silver and fit network at no cost to them or receive a home fitness program package. if they don't want to go into the gym, they can get a fitness package for walking or pilates at their home.
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>> thank you. any other comment? questions. we have a motion and second. all in favor say, "aye". >> aye. >> any opposed? the motion carries unanimously. i would like to welcome our counsel at this time. would you please identify yourself. >> good morning, this is cecillia mangoba from the city attorney's office. welcome, glad to have you. our other attorney is engaged today. thank you for standing in for him. all right, we are now ready to move to the regular board agenda. and as she gets ready to leave, i would like to congratulate on her son's graduation this evening. congratulations. [ applause ]. >> the first board item is
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no. 4. >>clerk: item 4, discussion item. president's report. >> the action item i have about the city's charter sent to the members of the board by through our counsel. at another meeting we will have a kind of chronology of changes in the charter over the years that have currently brought the current documents to their current state. so this is the first in a couple of steps. this has been requested by the governance committee at its regular meeting and i thought by starting out what is covered in our work which is covered in these and looking back over time changes in the charter provisions that go through the board. that has impacted this
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board's work. that was slightly delayed not only with -- eric's absence today but there were no red line versions in the charter. he's going through an analysis to figure out what actually changed in the before document and the resulting after document. it's a little diceey. i haven't seen it, but that's what he's doing. but that will be presented at another meeting. i just wanted the board to be aware of that. secondly, i wanted to congratulate. i had the privilege of attending a luncheon yesterday with commissioner breslin, the san francisco county employees. i would like to thank the employees of the county of san
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francisco and congratulate the officers. we had a good time. i did commend them on their work and thanked them for their continued service on behalf of the retiree system. lastly, i would like to call attention to the board and i will ask the board to send it electronically. the california healthcare foundation. this is an annual study they do on employers across the state of california. it highlights a series of i think some people would say they are not very intuitive, they are kind of obvious trends in
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healthcare coverage in the state of california. i would encourage the commissioners to take time to read the link. there are several charts that accompany this information. but it does give a very good overview of the level of healthcare coverage across the state, what employers are doing, what co-pays, deductibles, increases we have seen over time and one of the whopping statistics for me was that since 2002, there has been a cumulative increase of 216%, 216% increase in the overall cost of healthcare to individuals. it's an astounding kind of thing to think it's been a little bit more of a decade but that's been the impact to the marketplace over time. there are a number of other
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statistics and highlights contained in the report and it's from the california healthcare foundation. it will be given to the board members by our secretary after this meeting. i commend it to you as a reading for the month of july if we act on the proposal today, you are not going to have a july meeting. so you can substitute that hours of work on that item. all right. we'll move on to the directors report. >>clerk: item 5, directors report. director? >> thank you. commissioners. i wanted to report on the personnel. month after month we have left a position vacant for
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attrition savings. attrition occurs when someone leaves a position and takes time to fill it. that's the main reason. because our staff is relatively stable, the average length of tenure is 8 years but it varies from 1 year to 37 years. we don't have a lot of attrition savings. we can't get credit for that so we've had to leave two positions vacant to achieve that for the budget. this year we just late late late yesterday afternoon got our budget from the board of supervisors budget analyst and they want to double our attrition savings which means we have to lay off two people or not fill two positions that we are currently have made offer letters to. there are also other additional budget cuts in the analyst
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recommendations. i'm not going to be specific about them because the negotiations aren't final and we don't want staff who are watching television to worry because hopefully we'll be able to save them. the proposals will result if they were implemented as proposed, would result in at least two lay offs. which is unheard of at this time when the mayor presented a balanced budget, we were successful in getting the mayor's approval for our budget that had already a 1.5% decrease over the 2 years. we had our initial call this morning after pamela spent hours reviewing it and review it with me last night and she worked on it again this morning. we had one discussion with the budget analyst staff and i'm sure we'll have more in order to
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avoid that. but, i request that the commissioners individually and the members in the audience send their e-mails to the finance committee saying that the health services is doing a good job, we've kept the rates low and met all of our member service goals and we have innovated in terms of wellness and volunteer benefits, and the other things, all database analysis, etc. it's essential we continue on this path. >> we avoided $20 million worth of cost to this party, is that not correct? >> yes. >> it would have been a cost to the city. >> yes. at any rate. you work all year so hard
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and you get a blow like this which means an unpleasant month as well as july. i wanted to point that out. >> that is from the finance committee? >> mark farrell is the chair and of course he will support us. will someone with an iphone look? >> we'll research that. we'll say the names publically and tell them how to e-mail city hall and get a hold of everyone. >> i believe it's mark and scott wiener, last year it was jane kim and scott wiener; and london breed participates as chair of the board. thank you for asking that question. i meant to look it up before i came. i will meet with either them or their staff which i have in years before. >> so how is this information going
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to be disseminated back to us then? >> we will articulate here at the meeting but we'll ask to distribute the names to the supervisors and the e-mails and phone numbers to be able to either call or write or otherwise camp out with them. >> okay, thank you. >> otherwise the map of providing testimony is to sit through an all day public hearing. i believe it's not this friday, but next friday where every single issue that's going before them is heard. it's quite a laborious -- so, anyway, i appreciate your support especially since we took the mayor's cuts and approved the budget and now we are being cut more. so, i wanted to point that out and also wanted to point out that we have
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begun administering this, the employee engagement survey at the committee meeting. we are taking a survey in a matter thatten insures employees responses are confidential and not disclosed and the employees anonymity is protected. some responses might yield information about the respondent or other privacy information including supervisors. we want to make clear that we are doing this confidentially. and that's in an effort to have everyone participate. if they were to be made public, we shouldn't both undertaking this survey because people don't want to have their responses public. they have assured anonymity. >> may i say something? on
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behalf of the board, i would request from each and every staff member to please complete the survey. it's an effort by the management team of the system to get a better understanding of what can be done to help engage and respond to your needs. that can only be done if you participate. so, on behalf of myself, principally, but i think i speak for the other commissioners, we are asking each and everyone of you to please participate. >> through the chair? >> yes. >> is it just for active members, the additional services, right, that are in the survey? >> you are talking about the volunteer benefits survey. we are talking about the staff engagement survey. >> that's no. 7. >> it's been in my personnel report. >> okay, we'll talk about volunteer benefits in a minute. the other thing is we will be presenting the results of
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the engagement survey at the august board meeting. we'll have a report. in terms of operations. you have in your packet. as usual we've met all of our customer service goals even though our in person assistance continues to grow, but people keep retiring. but that's nice because they just come from downstairs into our office. we did an active survey on voluntary benefits. it's in your packet. as of june 1st, 2500, employees have responded. we are happy to offer those benefits. more and more employees are asking for voluntary benefits.
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it varies from paycheck to paycheck. >> can i ask something about the volunteer benefits? >> sure. >> how much is it going to cost us? >> it cost us nothing. >> how does that work? >> we are doing it through the employment benefits district, they are doing our mea benefits. it cost just a little on payroll lines. there are lines for colonial and flack and you name it. whenever that leaves, they are making adjustments. who is making money on this are the insurance companies. they are vetting rates so there is a place to go and
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complain. if there are idiosyncracies, the payroll departments will clean them up. hopefully this will reduce the number of payroll lines than there are. it will be easier. >> but no extra staff time? >> no extra staff time. it really is a great benefit. i wanted to draw attention to the data analytics report that's in with the packet. this is the first time we've had a dashboard on the medicare retirees since the third quarter of 2010. now that our data base is up and running, we can't do it all ourselves, but we can design the report and feed in the request and get it back and present
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it. i think it's an example of the benefit of the database and you have information on who the retirees are. kaiser has 45% of the medical retirees. >> their average age is 72.6. >> blue shield, 69.3. at least it's what it says on the slide. you are right. 79.1. i apologize. ful >> city plans average ages 75.2. >> this tells us about the admits per 2,000 members, the average length of stay and it does that by vendors so you can see on page 9 the
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average length of stay for medi-cal retirees for blue shield is 6 days, then 4 days and kaiser 2 days. similar impatient dates per thousand, again blue shield is the highest. interestingly kaiser is the second highest. we also found this in our care organizations. what we need to look at is what are the readmission rates and then city plan is 5 days. an 8-day length of stay is a long time in the hospital. procedures per 1,000. this is an example script per member per month how many prescriptions and those have all decreased from 2.11, to
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2.55. i just wanted to draw your attention to the work of the data analytics department. it's very exciting. other things that are happening is we are building the new enterprise management. you heard us talk about the ecm. we've now got the equipment and building the processes to begin to scan all of those hundreds of thousands of records that we have in our record room and off site storage. we acquired new copiers that will save us money in printing cost. we are doing an actual enrollment process, management effort to really keep track of dates and times and hopefully reduce the stress that occurs since we are getting ready for open enrollment. in terms of finance, you will hear from the
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finance committee. but again we'll emphasize that we have cut 1.5% this year and next year and the budget was approved by the mayor with no additional cuts. then we have to be vigilant about not having further cuts from the board of supervisors. our annual external audit kickoff occurred. in our 2015 post audit by the controllers offices yield no material weaknesses. beyond that, we are in good shape. the other thing i wanted to, in terms of wellness, let me highlight. >> can i just? >> yeah. >> i think we've seen in the past sort of a comparison of medicare plan benefits for the different plans. so i'm wondering if enrollees get an opportunity to see a dashboard of some of these other things? because
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their pharmacy cost depend upon whether the drug is generic or not. their inpatient days varies per plan. some of them look fairly modest and different until you look at the number of days.. i'm wondering if that is somewhat of a goal, at some point when you are fully staff. i don't know if people ask about this. but it's the next logical attention for a consumer who want to know what they are buying. and what the potential risk maybe. how many inpatient days might there be while making the choice. >> and what are the most common diagnosis for those days. >> i'm not asking for it. >> but if the board wants us to consider doing a forum on compare and contrast. >> that's something possibly we can take up as part of the educational effort, but also some of this information, i know it's
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posted as part of your director's report but there is also a notion of being more activity around this data and reports going forward. if that is the date to be true, it would say to me that we are going to have a link on the website so members can go into and review. >> this is a very good time to suggest that since we are looking at redoing the website. >> as more of these are being developed, you may want to plan on a link there. i know as part of your report, marina comes in and gives us a report, but they don't necessarily sit out alone and that can be a value as pointed out. >> great suggestion. >> all right. i particularly appreciated the wellness thank you letter that was submitted by one of our members and it's also part of our report. >> about colorful choices?
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>> right. >> i want to highlight the wellness the eapa counseling services have reached the highest level in 2016 during the month of may. the addition of the counselor and having them do workshops on-site at different departments have really engaged employees and made them realize. again, the national literature shows that in all industries there is this depression in moral in every employer, i guess probably unless you work for google where they have free food and everything else. commissioner breslin in particular has been concerned about nutrition and diabetes all along. i'm excited to report that the recruitment for the diabetes prevention program research study that we are doing with kaiser that kaiser is leaving is we
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have already enrolled 200 employees and we plan to roll that out formally in june and july. probably one of three employees develop diabetes. this is before you get diabetes. if we can teach them nutritional and behaviors would improve the diabetes situation. this directive came from this board of anticipation of trying to keep people healthy. i just wanted to underscore on the part of what i did. review the budget materials, but i wanted to just say that our chief financial officer and her
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staff labor over the budget for hours and hours and they redo the numbers. everything is as tight as a sealed tuna can. our numbers, you can't question them and we are really lucky to have such good finance staff especially at this time of year. i can feel confident when i get a report that all i have to do is read into the microphone at the board of supervisors meeting. that concludes my report. >> would you highlight the rates? >> i apologize. yes. we revised the rates and benefits calendar to add a rates and benefits meeting on tuesday, june 21st, from 12-2. it will allow five members to be in attendance as opposed to just four. it also is giving extra time
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for the actuary to look at what alternatives there are or what can be reexamined and renegotiated because of the retiree rates from blue shield and uacn and ppo and city plans came so high. they are still working on trying to figure out, is this formula the best and who is disrupted in the formula. all of those alternatives will be presented on june 21st. >> all right. >> so, at the april, when we talked about the best doctors and at that time they said whoever presented said they would have the final rates for consideration at a meeting. when will that be? will that be at
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the next meeting? they said at the time this may not be the final rate. >> i understand it is the final rate. >> i'm not sure. i looked at my notes. >> you are asking about the best doctors rate? >> right. they said for the future we'll obtain the final rates for consideration. i didn't know if that was going to be part of -- >> can you speak into the microphone? >> yes, sorry. the final rates for best doctors. the $1.40 is the final rate. >> that is in the active rates that we approved. >> i saw that. i didn't know it was ever approved. okay. >> any other questions? >> that includes the outreach, the extra amount for the outreach. >> any other questions about
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the directors report, is there any additional public comment? seeing none, public comment is closed. we'll proceed to the next item >>clerk: item 6, discussion item. hss financial reporting as of april 30, 2016, and fy 2016-2017 and fy 2017-17 mayor's budget report for hss. >> on director levin, i would like to commend on the report and would ask you to thank them all for the work they do day in and day out. >> thank you. good afternoon, chief financial officer. the financial report you have before
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you today summarize the revenues of the trust and general fund through april 30, 2016. we are projecting the trust will have a balance of $78.1 million on january 30, 2016. this is only $300,000 less than what i reported last month. has to the result of some ups and downs. the balance is from city plan due to unfavorable claims experience. blue shield $500,000 is due to unfavorable claim experiences. there were increases to the fund balance from delta dental to $100,000 due to favorable claim experiences and then we received $300,000 for the
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forfeiture for the healthcare dollars. we also distributed a copy of the pages from the mayor's proposing budget. they look for those of you that have the black and white, they look a whole lot better in color. basically we had proposed, they did extend a couple of limited duration positions and we ended up taking the cut, but had some return in for that. as catherine mentioned or director dod mentioned that it was preliminary and they could work with us
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i hope that's true. we had a long discussion today about what we can and can't do and every effort is being made to ensure that we keep the department as a whole if we can. i know that's part of the director's concern and we are tight in our staffing levels and we can't afford to either have to keep two more positions vacant than we already have or make cuts to the rest of the staff. so that has been and will be clearly communicated to the budget analyst. i have looked into -- the budget committee, supervisor
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farrell, supervisor katie tang and norman yee and then supervisor kim and supervisor wiener are the temporary members that join during this budget process. >> all right. thank you. so again i'm requesting the secretary to send the names to the board members e-mail and phone numbers so that we might engage in the process. is that all from you, director levine? great. moving right an along. is there any public comment? >> claire savssky. >> i would like to commend pamela
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levine for her incredible work and also her staff's work. it's just amazing and we really do appreciate all the angst that goes through it and the hours and the efforts. it's just phenomenal. with regard to the battle now before the board of supervisors, it sounds like we did okay with the mayor's office, but now we are dealing with the board of supervisors cuts and looking to supervisor farrell to really take the lead on this and helping us out. we will send an e-mail blast to the members and ask them to send a letter to the committee. you have been part of what we are doing at the retirement board with regards to our benefits. if they would like us to mobilize and show up at city hall, i'm sure we can put out the call and get that kind of
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turnout at city hall so they understand they can't mess with our delivery of health services as well as the retirees coalition. we are being quite activist in our old age and are here to support every effort that health services goes through and especially through back up pamela and also catherine in their efforts to really fight for our benefits. so whatever we can do, let us know and thank you very much. >> thank you. >> mr. chairman, on the next item. i realize i didn't update you on the legislation. >> all right. this is to go back to the director's report to include a discussion of the legislative items, please. >> ght, sb 932 was a bill that pretty much prevented anti-contracting within the health systems had been pulled from the agenda of the state
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legislative committee because there was a concern from san francisco general hospital and the san francisco health network that it might apply negatively to them. the legislation was amended shortly after that committee meeting and i met with ppa and the staff and they in fact withdrew their opposition, but unfortunately the bill did not get out of the second policy committee. so it's dead for the purposes of this legislative year. if there is a special session, it might be reintroduced, so we may do it again. the other bill sb 1010 from the same author and it's still alive and well. they are trying to add transparency to pharmaceutical pricing. it requires to convoluted mechanism
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that pharma report to employers when there is going to be an increase of more than so% of pharmaceutical cost or a 1 prescription is going to cost more than $10,000 for the course of that prescription. and then the employees have to report to the department of insurance and the department of managed care that this is happening. it doesn't do anything, it just shines the light in pharmacy cost. >> the remedy as we all know is to have cmms in the marketing of negotiating their rights. but i'm not going to say that again. go right ahead. >> on the state level this is a step again to say pharma and it's not okay in california . that went to the legislative committee yesterday and marina actually represented
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us there. i presume they approved it and the bill is still alive. it has a very small financial impact. it will probably pass through the state legislature and the budget committee and go on to the assembly. i will keep you informed. i apologize. >> thank you for those updates. >> i saw this in the packet and i did a bit of reading as well because this is an issue that concerns everyone in this room. the sb 1010 has wide support including the california medical association, etc. and to be distinguished from a resolution in the november ballot to tie it into a complicated formula with the va medical center, that is different from this and we need to kind of watch that which is much more controversial with a lot of interest groups being very nc