Pres of actually elevating quality to the Network Level so rather than looking at it at each individual section, you will see it up a Larger NetworkDepartment Level. We will be coming to you, the commission, at the Department Level to really present what we are doing in terms of clinical quality, what are the measures, the metrics, and so you will see them. It will not only be those who sit on those panels, but the entire commission will be able to see the full picture of clinical quality. Those will be coming from the network side and we will also incorporate those components of quality that exist. When will those be appealed . In january we hopefully hopefully we will be coming to you within the next six months with a quality report from a Network Department level perspective. Thank you very much for your report. Thank you very much. Have a good evening. Commissioners, the next item is a resolution approving the San Francisco department of Public Health 2020 state and federal legislative plans i have both the resolution on the presentation just for you to know to stay on. Thank you. Good afternoon, commissioners i am the director of the office of policy and planning. Today we will be providing you with an overview of the departments 2020 state and federal legislative platform, as well as a summary of some of the actions that we are taking in 2019 that were taking taken in 2019. Im here with max was a Health Planner in the office who i will be sharing this presentation with. As was mentioned, you have a copy of the resolution before you that approves our platform your consideration today. As i mentioned, well be providing you with some backgrounds on the purpose and the development of the plan, a summary of the actions that happened in 2019, as well as a highlevel overview of the state and federal plans. We prepared two plans. One federal and one state. These platforms are aligned with d. P. H. s priorities and missions and serve as guides for monitoring bills of Budget Proposals and identifying any issues that might come up during the course of the year that may need some city action. The plans are informed using input from Department Leadership , subject Matter Experts throughout the organization, as well as many professional associations that several d. P. H. Staff are members of. The plans are intended to cover a broad range of issues that are important to the department. Additionally, they might serve as helpful tools for staff who are representing the department on other associations when it comes to representing what our position is. Every year we present the plan to the Health Commission annually for your approval. After which the plans are sent to the Mayors Office for review and then they incorporate the plans into a larger city wide legislative plan. I also wanted you to know that if the commission has any additional feedback or input, we are happy to incorporate those thoughts in today. This is a little hard to read up here, but how do we advance positions as we already City Department . There is a process that we have to go through. This starts with the plans which are the ones i just talked about as issues come up and are introduced at the state level or the federal level, typically d. P. H. Staff work with leadership within their division to analyse and review what potential impacts are. Then that policy or proposal will come to the office of policy and planning for review. We may also reach out to other organizations, other City Departments if necessary before developing a specific proposal. And then afterwards, this advances onto the Mayors Office of legislative affairs. When it comes to state legislation, they can meet a monthly meeting that has seven members, seven voting members that are representatives of the board, the Mayors Office, city attorney, and the Controllers Office who approves official positions by any City Department after we receive approval from the office of legislative affairs and that committee, we may engage in advocacy. Typically this is in the form of a comment letter that we can share with the legislature. I also wanted to note that the city contracts with state and from dural lobbyists who will work on behalf of the department and federal lobbyists. We could also provide expert testimony if needed in sacramento. Or provide Technical Support under the high Priority Issues for the department. On the right side, i wanted to note the nature of state and federal process that requires us to be responsive. We are often, you know, coordinating with partners outside of departments such as our associations, the Mayors Office and other City Departments and the City Attorneys Office. Looking back on 2019, we monitored around 100 bills that were relevant to the Health Departments mission or function we officially took positions on 22 bills. Six of which were signed into law by governor newsom, two which were vetoed and 14 which are currently held. They come back as two year bills this year. Some of the key issues included Behavioral Health. Substance use Disorder Treatment this year we sponsored a bill that would have expanded medication assisted Treatment Options were individuals in the jail. Unfortunately this was held this year and it may come back in 2020. We continue to support a bill on Overdose Prevention programs, conservatorship conservatorship was another key issue. We support it along with the Mayors Office which was a followup bill to 1045, which is the new housing conservatorship law, which grates a pathway for conservatorship for individuals who are high users of systems as well and also have Mental Health and Substance Use needs. Another bill that we supported this year was a. B. 1544 which would have permanently authorized our local e. M. S. Agency to transport patients to alternative setting such as a recovery centre. We expect this issue to come back again in 2020. And finally we supported a few prosals that are related to the integration of Mental Health and Substance Use funding for sameday billing when individuals are seen at a primary care setting and Workforce Development really had to introduce loan forgiveness for individuals are practising with the county Mental Health plan. Other key issues this year were related to h. I. V. Prevention. We supported s. B. 159 which is a bill that passed and allows for emphasis to dispense drugs. It also prevents Insurance Companies from requiring prior authorization. Maternal childhood and analysing health. We supported the pregnancy in childhood and childbirth act which recognizes maternal morbidity and births are highest among africanamerican mothers across the state. This requires hospitals, primary care clinics and other centres to implement implicit bias trainings. I will talk about the medical eligibility and Expansion Proposal on the next slide and longterm care. There are efforts of the state to expand these systems, which would allow medical beneficiaries to be placed in care homes in lieu of more costly nursing facilities. This year the governor was able to advance several healthcare proposals. The first was already mentioned in the opening remarks around expansion of medical to undocumented adults aged 19 to 25. There was additional expansions for coverage california premium support for individuals between 40600 of federal between 400 and 600 federal policy poverty level. This is going to require all californians to have insurance or they can potentially face a penalty of up to a minimum of 695 per addled. This year, the government also issued an executive order with the goal of controlling Prescription Drug costs. There are two key proposals in this executive order. One is the transition of Pharmacy Services for medical managedcare to free service. Would you expect this proposal to reduce savings for Public Healthcare systems. The executive order also included a goal to expand the states bulk purchasing program, which would essentially allow us to collectively purchase drugs for the state to lower drug prices. The other key issues that i know you heard a little bit about from our Behavioral Health division earlier or in the fall of 2019 is california advancing medical which is the states process to renew its current waivers with the federal government. There will be a lot of attention and focus on that this year. And finally the governor is planning to release his budget this friday, so we will be monitoring that and we will provide the commission with an update regarding this proposal. I will hand it to max to talk about some of the federal issues on the platform. My name is max and i am a Healthcare Program planner with the policy planning office. For this section of the presentation i will provide a brief overview of the federal issues that we monitored during and were engaged in and provide an overview of the departments proposed 2020 state and federal platforms. This past year, the federal administration engaged in various actions to undermine before able care act, immigration protections, womens rights and lgbtq rights. Many of these issues have been ongoing from the previous several years and we will continue to monitor these into 2020 as they progress through the court system or through the rulemaking process and a more complete overview of these issues are available in the table that was provided to you. At the start of 2019, your appeal of the individual mandate became effective. The california new statelevel individual mandate and also the affordability initiatives are projected to help protect the state from impacts from this repeal. In addition to the mandates, other efforts were made to weaken aca related a form reforms including an ongoing challenge to the constitutional legitimacy of the aca. The federal administration also continue to undermine the health and safety of our San Francisco immigrant communities with attempts to change charge rules which govern how the use of Public Benefits could impact immigrants or individuals with immigration status. In august of 2019, the state attorney, in coordination with Human Services agency of the department of public Public Health office in the Mayors Office, filed a legal challenge to the newly finalized public charge rule. Fortunately in october of 2019 following that challenge, the board indefinitely delayed his limitation of that rule and is continuing to make its way through the courts now. If the rule does go into effect, it could significantly impact immigrants use of publicly assisted programs like medical. At the department has developed Public Awareness materials informing residents that they are welcome at all city clinics and hospitals regardless of their immigration or insurance status. This past year the administration also implemented new restrictions on title x Family Planning grant plan. These restrictions would restrict clinicians and other clinical staff from being able to provide a complete and unbiased Reproductive Health information and a full range of services to their patients. Last year, the departments funding planning coordinator provided an update on the Health Commission on these changes in the following august. These changes officially went into effect, at which time the department withdrew from the grant program. The departments maternal child and adolescent Health Section is committed to could tuning to provide Financial Support to the Family Planning program, which had administered the grand. Before withdrawing from the grant program, the program had worked with the City Attorneys Office to provide official comment on the rule and provide testimony in a lawsuit filed by the california state attorney general. The board of supervisors also provided a resolution by opposing these regulations. Finally, the federal administration implement the changes that would allow providers to refused to provide services, but they have a religious or moral or religious objection to like abortion or gender reassignment surgery. These changes are referred to as conscience rights in healthcare, and under these changes, federal funding would be taken away from the state from state to do not comply. D. P. H. Formally submitted written comments to the rules citing concerns with the rules discriminatory effects in the California Attorney general and San FranciscoCity Attorneys Office filed lawsuits against this rule. In november of last year, a judge blocked these changes from taking effect. So next i will provide an overview of the departments state and legislative platforms for 2020. For the developed of this years plans, we worked with leadership and experts from across the department to review the platforms to identify emerging policy issues and areas covered in the platforms are not too different from last year. Modifications have been made based on the issues that the department is likely to engage in. This includes a new section on expanding policy goals for longterm care, as well as furthering Behavioral Health integration. For the 2020 platform, we organized legislative issues based on their intersections to the two additions to the San FranciscoHealth Network and the population addition. Issues are categorized under one division based on who is likely the lead on the issue and to we would first reach out to better understand impacts of the policy those issues both impact both divisions and we will work with experts from across the department to understand the implications of the policy and weigh in on those issues. Rather than reviewing the entire platform, we will highlight several state policies that the department expects to focus on in the upcoming year. Medical and healthcare reform will be significant issues as the state engages in the cal aim initiative. This will impact many different parts of the departments Healthcare Delivery system. We will want to monitor proposals to ensure that Adequate Funding continues to be provided for Public Hospitals in the Health System and that there is continuity in the whole person care system under the condition of longterm care that continues to be a pressing issue in San Francisco and across the stage. We continue to experience issues of Residential Care facility closures and these facilities offer supportive residential living for individuals who no longer live independently. In order to stabilize and prevent the further loss of these facilities, we will support proposals to increase funding to prevent the further loss of these facilities. I like to discuss the department s 2020 legislative platform. Commissioner ciao, thank you for your feedback. I want to note it has been incorporated into this years plans. We added language to support proposals to comprehensively fund hepatitis b services such as education, treatment, screening, and vaccination. If also added a new subsection within the Public Health care section stating that the department will support proposals to ensure that emergency programs and planning are inclusive of the needs of vulnerable populations including those with access to functional needs, those with disabilities, those unable to be selfsufficient for 72 hours following an emergency, as well as other groups that may be disproportionately impacted during an emergency. Given the broader categorization of federal issues, they are not organized by Department Division on this platform. As i mentioned earlier, the department is expected to monitor many of the same issues from the previous years. These include ongoing issues around a. C. A. Healthrelated reforms, immigration issues like public charge, and proposed changes propose changes to patient privacy. Because of our distance from the federal level, will continue to work closely with professional organizations like California Association of