[gavel]. Chair fewer good morning, everyone. This is the july 17, 2019 regular meeting of the budget and finance committee. Im sandra lee fewer, chairman of the budget and finance committee. Im joined by supervisor Raphael Mandelman and aaron peskin, whos sitting in for supervisor stefani. Colleagues, can i have a motion to excuse supervisor stefani . Thank you. [gavel]. Chair fewer madam clerk, do you have any announcements . Clerk yes. [agenda item read]. Chair fewer thank you very much, madam clerk. Can you please call item number one. [agenda item read]. Chair fewer thank you very much, madam clerk. Colleagues, you might remember that this item was before us at the last budget and finance committee, and i requested it be continued so that we could get a b. L. A. Report. I think we have jim hendray before us from the San FranciscoPublic Utilities commission. Good afternoon, supervisors. I am james hendray from the San FranciscoPublic Utilities commission. We are here to talk about an ordinance introduced by mayor london breed. The goal is to ensure that San Francisco receives maximum value and timeliness to benefit from the energy program. This builds off of a number of resolutions and ordinances that the board of supervisors have task today significantly reduce Greenhouse Gas emissions from a variety of sources. These activities compliment activities going on by the state and the California AirResources Board as part of ab32, californias Global Warming solutions act. One of the main programs operated by the California AirResources Board is the lcfs, and the goal is to reduce Greenhouse Gas emissions intensity and emissions by 20 by 2030, and its progressively stricter standards to reduce emissions over time and creates an Incentive Program that those that exceeds the standards can receive credits which they can then sell. As usual, San Francisco is ahead of the curve, which is why were here today. We have a very symbiotic relationships with the p. U. C. Sfmta has been participating in the lpsc Program Since 2017, has received many credits, and we enters into an m. O. U. To submit proceeds from the credits by 50 . The ordinance before you today would allow the sfpuc which would be selling the credits to exceed the 1 million threshold. There are a variety of safeguards that are embedded in the program. Basically, the program is run by the its overseen by the California AirResources Board. Theyre the ones that basically register all the people who might be purchasing the credits, so we know who the market and buyers are. The credits are done through the air resource board, which basically kind of serves the central bank. Price data is publicly available, so we know what transactions are, where markets are going, have a sense of where to do it, and were looking at other safeguards on the p. U. C. Side in terms of structuring the bidding process to ensure that we get maximum value, and the bidding process will be overseen by the current planning group. As for the uses of the credit, the sfpuc plans to use a contract as it has done for similar programs to engage in a variety of program thats would reduce Greenhouse Gas emissions, so basically, were trying to sort of pay it forward, so were trying to do what we currently do, maintaining Greenhouse Gas resources so they still remain available. Sfmta has proposed to put their money into a variety of sustainability programs. Good morning, chair fewer, supervisor mandelman, supervisor peskin. Se Severin Campbell from the budget and legislative analysts office. Our analysis of the fiscal impact is there are currently 54,000 credits that have been accumulated to date based on current prices. The estimated revenue would be anywhere from 8. 6 million to 10 million. We consider this to be a policy matter for the board. If the board does approve the ordinance, we recommend that p. U. C. Report on the p. U. C. S protocols for selling these credits and report annually on the sale of the credits, including the amount of renew credits in the sfpuc. Chair fewer thank you very much. Lets open this up for Public Comment. Are there any members of the public that would like to comment on item number one . Seeing none, Public Comment is closed. [gavel]. Chair fewer colleagues, any comments or questions . I would like to take the recommendation of the b. L. A. . So id make a motion to accept the motions of the budget and legislative analyst. Thank you very much. [gavel]. Chair fewer id like to send this to the full board with a positive recommendation. Thank you very much. Thank you very much. Thank you. [gavel]. Chair fewer madam clerk, can you please call im going to take this a little bit out of order. Can i call item number three. Clerk yes. [agenda item read]. Okay. Good morning, chair chair fefe supervisors. Today, you have before you an ordinance approving the Health Service system plans and contribution rates for the calendar year 2020. The Health Service system agrees with the budget analysts report, so at this time, i wish to comment on the record, the key components of the cost changes. I can either take questions throughout or toward the end of my presentation. Its the preference of the chair. I am most grateful for the significance of this work and those involved. This increases the amount contributed by the employer and the employer toward retiree premiums. The survey here notes the amounts contributed by the employer for the employeeonly coverage for the medical plan. For plan year 2020, the rate is at 705. 92. This represents an increase of 5. 04 from last year. The Health System serves employers from the city, the community college, the Unified School District as well as the superior court. The 4. 95 aggregate cost increase includes costs for all medical, vision, dental, and longterm Disability Insurance he greggate medical only cost for the increased Health System is 5. 7 while the city is only 5. 5 . This rates are within the National Range of 5. 5 to 6 . The Health System contracts with three medical insurance carriers. Kaiser permanente administrates a plan. The Health Service board approved after overall rate increase of 6. 5 for retirees and medicare retirees covered for could i sKaiser Permanente. Kaiser also provides medicare and premedicare retiree access to their facilities in california, oregon, and wash, which are also mentioned in the aggregate 5. 57 . A subset of current Infertility Services will be aligned with the cost share in 2020. Kaiser permanente senior advantage retirees have a rate increase of 11. 7 for members who live in california. As you may recall, Kaiser Permanente retirement rates decreased by 0. 2 last year. This rate reflects a reconciliation with the forecasted rather than the actual medicare reimbursement. The Health Services board also approved an enhancement for kaiser medicare plan where theres a transportation benefit for up to 24 oneway rides per year. This benefit is scheduled to take effect january 1, 2020. The Health Service board approved a 0. 9 increase for the trioh. M. O. Plan, and a 2. 3 increase for the h. M. O. Plan. The board also approved two plan Design Changes. One, members will have an improved access to receive vaccines at participating pharmacies, and secondly, the members will be able to access additional counseling without a specific disease diagnosis. The third medical plan is United Health care. United health care administers the p. P. O. City plan for active and early retirees as well as the Medicare Advantage p. P. O. For medicare retirees. The Health Service board approved a rate of 10 for active and early retirees, and the cost impact of one Design Change contributed to this increase. The Health Services board approved one Design Change for 2020, unites health care p. P. O. This reduced the outofpocket maximum, expected to have minimal Financial Impact to the plan which will benefit families using high levels of care. The United Health care p. P. O. Advantage has a rate increase of 16. 5 . There are no planned Design Changes. The 10 of this rate increase is due to the federal insurance tax. The rest of the increase is tax and utilization. We had a medical Second Opinion service and is going to allow this to expire in december. The health plans are now supporting the membership in seeking Second Opinions within their plans. The vision benefit, the basic vision benefit remains the same. There is a 4. 3 increase for the member contribution for the optional buyout v. S. P. Premier plan. We have multiple dental plans. There are some rate increases for the delta dental p. P. O. At 5. 3 . The board approved a 3 increase for the u. H. C. Delta h. M. O. Plan. For retiree dental, the board approved no rate change for the delta dental plan, but it approved two Design Changes. It will increase the cap from 60 to 50 , and the second is an increase in the annual deductible from 50 to 75. Life insurance is now provided by the hartford, who acquired the group life and disability business of aetna in 201. The Health Service board has approved an aggregate increase of 12. 4 for these products. The specific changes are listed at the 20 for basic life. Theres no rate increase changes for the childrens life insurance, accidental death and dismemberment services. So that concludes my remarks. Can i take any questions . Chair fewer yes. Lets hear from the b. L. A. First. The board of supervisors is being asked to approve the health, vision, and dental plan rates for 2027, to start in the year 2020. I wont repeat many of the things said today, but we do show the total cost to employees, employer, and retirees. Its going up by about 35 million from 757 million to 802 million. We do recommend approval. Chair fewer supervisors, any comments . I do have a question. We had questions around services for infertility treatments for singlefamily women. Actually, i think it is somewhat discriminatory, so can you tell me a little bit about that. Since we are talking about our contribution rates, i think we should be talking about the coverage and who is covered. Yes. As i stated at the last hearing, we are scheduled to present the staff recommendations to the Health Service board at their august meeting . Were still on track for doing that. We are in receipt of some data from all three plans. We are meeting with them regularly to discern what the services of this infertility benefit has been over the last two years. I dont have the recommendations available today for this hearing, but we hear the concern, and are trying to determine what what steps need to be taken to ensure that our membership has access either to the infertility benefit, or whether theyll need access to fertility service, where theyre not infertile from a medical diagnosis point of view, and perhaps they are in a lesbian relationship or a single person. So were looking at how theyre constructed and how the plans are doing them. There are some thirdparty vendors that are available to assist that have a lot of appeal on the surface of how they could help our members feel more welcome and comfortable, so were trying to figure it outaou and are commid to putting all the recommendations before the Health Service board at their august meeting. Chair fewer because we know if these services are available to heterosexual couples, then actually these benefits should be accessible to single women or just others. Well, the medical services a woman may be infertile, and she may not be able to conceive in a normal sexual relationship as a heterosexual couple would, so having Assistive Services for Reproductive Technology plan thats not covered under the plan because its not a medical diagnosis. Chair fewer but i understand if heterosexual couples were having a hard time receiving, they would just wait a year, and all the benefits accessible to them without any conditions at all. That is all old school thinking, and that is not necessarily true. Chair fewer it is true that it is a person who maybe as a single woman in her 40s and not ovulating as often and not able to be pregnant, then wouldnt that be also considered a medical condition . Yes, if that ovulation was considered a medical condition . Chair fewer if there was a low egg count. Yes. Those are diagnostic procedures that would lead to a diagnosis of infertility. Chair fewer and then, would single woman be eligible for that . Yes. Chair fewer okay. And all the benefits yes. Chair fewer okay. Currently . Yes. Chair fewer another concern, it seems that pharmaceuticals, other prescriptions that are more expensive, when you buy them through our Insurance Plan versus outofpocket, ive seen comparisons where theres 1,000 difference. So why is it that are people covered, for example, under blue shield would pay more for prescriptions using the medical plan versus just paying outofpocket . We have opportunistic pharmacies that are taking advantage of that plan. We were not aware of that previously, so we are in conversation with the pharmacies on how to best manage the situation. Because these pharmacies are popping up, or these pharmaceutical services are out there. There certainly is news to this certainly is news to me, so its something that we have to find out how to grapple with. If you are Contracting Services with a pharmacy, you are paying whatever that price is. If youre buying it from a pharmacy that is one of our contracted, its a negotiated price. So thats why this can occur, so as i said, it was brought to our attention, and we need to understand who are how prevalent that market practice is. Chair fewer so i think thats my question, how prevalent is that because just from this one example, i think we can agree that its rather alarming that we have the assumption that we are covered under a medical plan, that our pharmaceuticals would be less expensive, quite frankly, than outofpocket, but there are instances when its not. So you have no idea how far this extends or if this is something that is at a level to be very alarming or that or have you done any analysis . Yeah, i wouldnt be able to speculate on that at this time, but its alarming, and it is worth the attention that we need to spend on it. Chair fewer okay. Thank you very much. Lets open this up for Public Comment. Any members of the public who would like to comment on item number three . Seeing none, Public Comment is now closed. [gavel]. Supervisor mandelman yeah, ill move this forward to the full board with a positive recommendation. Chair fewer yeah. I think we can take that without objection. Thank you very much. [gavel]. Chair fewer madam clerk, can we go back and read item 2, please. [agenda item read]. Chair fewer thank you very much. Okay. This was also presented last week as an item, and now, were coming back, i believe, with some language amended to actually institute a labor harmony agreement. So do we have julia dawson here . Chair, members of the budget and finance committee, before i go into my brief presentation on the agreement, i do want to say that we are proposing to make a small change to the agreement that you are currently considering for approval . We are proposing to add a clause under section 512, new section k, and were submitting copies of that new section for your review. And we are also submitting a copy of the contract as amended by this new section. And this new section would promote labor harmony between j. C. Decaux and any of their potential partners who would be sourcing attendant services. Supervisor fewer thank you very much. So with your approval, im going to go ahead and do a brief presentation on the agreement. Chair fewer thank you. Linda, can we have the projector. So you can see this is the newly designed toilet for our program and existing agreement. This current agreement was signed in 1998. It currently offers 28 a. D. A. Accessible public toilets and has 114 total kiosks at this point in time. 24 are advertising and 69 are new stand. There have been 13. 5 million flushes in these facilities since the agreement was started, and we had about 825,000 flushes last year. So the new in the new agreement, were proposing to replace the toilets and kiosks with uptodate technology and a more contemporary and cutting edge design. It is time for a refresh of this equipment. We will continue through this new program to provide safe, attractive and easier to use amenities. Theyll be lighter in color overall and have some light inside, which is not like the new one. Under this agreement, j. C. Decaux would be responsible for staffing at 11