Transcripts For SFGTV Health Commission 11717 20170120 : vim

Good afternoon the commission will control to order and the secretary will call the roll. Commissioner chow. Present. Commissioner loyce. Present. Commissioner sanchez. Present. Commissioner pating. Present. Approval of the minutes of january 3rd, 2017. The minutes are before you for approval. I heard a motion for approval. Is there a second, please . Second. Are there any corrections . I would like to make one correction, if i could . First i would in the page 5, after the formal report of the director, then i would have a space in between for after the item on the faces for the future, and as you do, you have a paragraph, but it looks like it belongs to the previous topic and i think i might put in there a topic called the tom waddell incident. Or something . Yes. I see, commissioner. I can add a line, too, so it breaks up the space. If you could do that . Then under the last page, page 8, i think the intent that commissioner singer was reporting on item 11, which was the sf general joint Conference Committee report was that they deferred the medical staff report action items, because it was felt there should be a physician to review the medically oriented rather than myself being specifically mentioned there. Oh, sure, im happy to make that change. The issue there being that there were medicallyoriented issues, but no physicians at that time on the j cc from the commission. So i think that would be clearer. Those are the two corrections i would make. Any other itemss or corrections to the minutes . If not, were prepare for the vote. If there are no objections to the correctionings all in favor of the minutes with the corrections please say aye . Aye. All those opposed . Before we go on to that item, i would like to ask if we had mentioned in the minutes that we were going to have an addendum into the annual report as a followup has that yet been done or sent that off to the board and mayor . } commissioner chung needed to submit an updated bioand didnt do that until thursday of last week and i havent received the final annual report and i will pass along via email when that occurs and cover letter and i will talk to you commissioner chow before i submit under your name. You worked out the wording, that commissioner pating was suggesting. My understanding that commissioner pating was happy to use the wording from the postcard that director garcia had. I hadnt seen the final, but im assuming it would look as commissioner pating requested and let it all see it. So you will do the followup on that for us . Yes, sir, and i will communicate with each of you and let you know its done. Thank you. Go on to the next item, please. Sure, item 3 is the directors report. The directors report, director garcia, please. Good afternoon, commissioners. I wanted to start by announcing that our new director of Behavioral Health services is here with us in the audience. He started with us as many of you know he will be the leader of our whole Behavioral Health service through the city and county of San Francisco and he will be managing the health plan and drug medical organized delivery systems. Mr. Bassari comes from rams, the richmond area multiservices. He was the executive director there for 14 years. And while at rams, he was very successful at directing older adult Behavioral Health and with peerbased wellness and Recovery Services and peer training and ran the Vocational Services we funded through that organization. Prior to rams, gabos served as director of operations in the ucsf department of psychiatry at San Francisco General Hospital where he over saw the intensive Outpatient Service programs. So i think he comes with Incredible Knowledge and experience, and hell be working right back in the same areas that he left ucsf at in terms of working on this side of the road. So i really want to welcome him and if you would like to come up and say a few words to the commissioners . Surely. This time on behalf of the commission, we welcome you, please. Good afternoon. Thanks for the warm welcome. I had a really wonderful welcome earlier today at the community Behavioral Health services and various management and the directors. Im really excited and pleased to be in this position and looking forward to doing really amazing work with everyone else that is really smart and hardworking and with the same focus. Having worked in a Community Setting for years i can bring that perspective and also having worked at the hospital and with the department of Public Health and all of that with serving our consumers with Behavioral Health and substance issues and telling people this is really the beginning of a great start and looking forward to what is ahead and any questions that you have, im very pleased and thank you for the honor to be in this position. We would just like to give you and round of applause of welcome. [applause] [applause] welcome again thank you. Policy director is here and state of california governors proposed budget for 20172018 was rolled out last week. Ill have her come up after my report to give you details. We have a lot of organizing efforts going on and activities going on by our federal representatives in the city. We had an event at zuckerberg last weekend and this last weekend there was activity at city hall. And the department is getting prepared with the rest of the city for potential more of those types of activities on the 20th. So nancy pelosi was in the area and jackie lee and Barbara Spear and also Nancy Pelosis office, i think is planning on doing more of these types of Community Meetings. I wanted to let you know that the Electronic Health record has the request for proposal for new lyndon b. Electronic Health Record was published today and out in the public. We were about two weeks behind in terms of publication and details to work out with the City Attorney and the Mayors Office with rfps. We have been attending and visiting with board of supervisors regarding the ucsf Research Building that comes before the full board in the next couple of weeks and so we have been having oneto one meetings with the board and also there have been two Community Meetings that our staff have attended as well. And just to end this, we just would like to let you know our traumainformed systems training continues to expand and we have done a lot of work and this is going on around the country, cities like philadelphia, the state of maine, are implementing systemwide trauma informed system initiatives like the department. We have a new training coming up on january 26th for staff two things about hr and one of the outcomes we had with lead is our staff taking the lead process to really another level of trying to continue to improve our services in two areas that Human Resources have been working on to create standard work for employee separation and ensuring that they turn in their keys and that were managing their i. T. Systems and also family leave. So using those models of standardized work i think is proving to be very successful to the department. So just wanted to acknowledge Human Resources work on both of those areas. I will end my report there and if colleen could come up and give us highlights of the governors budget, i think than any questions, commissioners may have . Good afternoon, commissioners. Colleen chawla. As the directors report indicates, the governor released its january budget last week. Its 179. 5 billion dollar overall statewide budget. And he is projecting a deficit of 1. 6 billion due to declining revenues. The budget however holds health and Human Services at about the same level. And retains a lot of the progress that has been made in the past, for instance it continues coverage for undocumented children under medical and provides for a bond for under the mental Health Services act, no place like home bond. It also proposes to back fill funding decreases in the Childrens Health Insurance Program and its basically a relatively stable budget for the health and Human Services area. In addition, it includes revenues, borrows from future revenues to establish the adult youth Cannabis Program statewide, which of course the department of Public Health will be involved in locally, establishing those regulations. One thing just to be clear about the governors budget he made clear in his statements it doesnt anticipate any changes to the aca, making any kind of guesstimates isnt so helpful. So it assumes that the law as it is in place now will continue through this budget year, the 1718 year and should there be any proposals that impact the aca and uptake of covered california in the coming year he will amend his budget and the budget process all together the governor introduces his budget in january and legislature debates its budget later in the year, later in the spring and a may revise a may revision to the governors budget is introduced after may 15th. This is just sort of the opening of the discussion for the year. Im happy to answer any questions that you might have . Questions from the commissioners . I had one question, which was there was discussion from the cma that the governors budget was actually then taking or either reducing again medical reimbursement. So i dont see that as listed here as one of the initiatives. Yes. So it doesnt reduce medical reimbursement, but i think there was some desire on part of the medical association that some of the revenues under the two initiatives that allocate revenues to medical would result in an increase in reimbursement, but it did not and i know its been one of the criticisms of the governors budget it doesnt increase medical reimbursement. There was an increase . There were two Ballot Initiatives that dedicated revenues to medical, and the governor used them to avoid reductions in Services Given the declining revenues in the state overall versus to increase reimbursement. Thank you. Commissioner loyce . Thank you for your report, colleen and im very, very interested to hear what the budget looks like as a result of the may revise, and particularly in light of the fact we may know more about the incoming president s decisions around Affordable Care act and i would be interested in what is being said and how it impacts both the state of california and city of San Francisco. Well bring that back to you. Commissioner pating. Related to that, could you just maybe explain how changes in federal medicaid rates, if there are any in the future, would then effect medical reimbursement, and then the state budget . So just in terms of the timetables of federal budget making regarding medicaid medical, the state, and then what rolls through . Okay. So the federal government provides a matching rate for states based on the state income. So right now our california has the lowest matching rate federal to state. So 50 state, 50 federal. But its an entitlement program. So its dependent on the parameters that the state creates to allow medicaid to operate in state. So the federal government doesnt set rates. It instead says this is for whatever expenditures you may make, well match it with the federal dollar and the state then determines what delivery mechanisms like managed care, that theyll create and what reimbursement rates that theyll create. Its not a federal government rate and actually california has pretty low reimbursement, somewhere like 48 out of 50 states per member reimbursement so pretty low as set by the state. So if the federal government decides to match at a lower rate, would we be on the same cycle, for example . I guess the question is the federal government considering 1718 budgets or are they two years ahead . Because its an entitlement, the way that they have structured it now is they cant reduce funding. They can reduce elbility for or they can reduce the matching rate. So before the aca, our matching rate was 50 50. With the new expanded population, the 138 of poverty single adults, that matching rate is goes down to 90 10, 90 federal government and 10 state and that expansion is under discussion about whether its part of repeals its since its part of the aca and that is of the part of the aca impacting medicaid being discussed as part of the repeal. So either they rescind it and say they are not going to pay any of that 138 for single adults or they could say that they would like us to pick it up at normal matching rate and wouldnt pay 90 , but pay 50 and it would be up to the state to decide if they could cover the 50 . Or more likely how to work with counties to cover that 50 . So its kind of a cascading effect, depending on what the federal government does. This could all take effect 1718, that soon . Because we still have the fiveyear implementation of the original aca phasein; right . With 100 and 100 and drop down to 90 and so forth . Would that have to phaseout . We dont know. I guess i was wondering could there be changes in the federal reimbursement rate as early as middle of next year is the question . I think its theoretical possible to do it that quickly. The other thing they are considering at federallevel is bloc grants and to give state and allocation based on the number of medical eligibles in state and overall funding would be reduced to states for medicaid. Thank you very much. Any other questions either of ms. Chawla or the director. With report to the Race Ethnicity Data Collection parameters, i assume both medical and San Francisco and does it include lgbtq and finally adding to the medical data systems . Its been added with us in particular transgender communities. We have a couple of providers who have been really entrenched and alice chen and susan. I would hope that we can continue to nudge the state to look at the issue statewide. We worked very closely with supervisor wiener on this. We started it and he did . Some legislation and he is now at the state and already let me know that is something that hell take to the state as well. I expect hell do some legislation. Thank you very much. Any other questions . Ill note there is no Public Comment for this item. Okay. Well move on to the next item, please. Item 4 is general Public Comment and i have not received any requests. So we can move on to item 5, report back from the community and Public Health committee. The community and Public Health Committee Heard two reports today, one the update on the mental Health Services act. Every year there is an annual update submitted to the state and every three years, which is this coming up year next there will be a 3year plan revision that will be updated. And the mental Health Services act was enacted in 2005 and maybe our commissioners remember that it taxed 1 of personal income tax of individuals over 1 million, and california has more millionaires than we thought. So this is actually very large fund for mental Health Services in the state. It has five areas, Community Supports and services, innovation, prevention, workforce education and training and capital facilitiess and technology. And for these services San Francisco has been receiving on average over the last five years about 25 30 million plus or minus as the number of tax revenues coming in has varied statewide. I would like to say when we heard their report from the committee, we have been very impressed with the extent of mhsa services in San Francisco. San francisco has always been a statewide leader in Behavioral Health and wanted to comment on three programs in particular for recovery oriented Treatment Service and philosoph physwas full service partnerships, clients that are severely mentally ill that requires whatever it takes services. We have been 1051 clients in this full service program. And the statistics were that it had 85 drop in arrests and clients in this program have a 76 drop in Mental Health and substanceabuse emergencies and 70 reduction in school suspensions. And this is also being implemented alongside assisted outpatient treatment, which we heard last time as well. Two other programs to highlight were the early psychosis program, which is a novel innovation for assisting individuals to prevent and and to provide early treatment for schizophrenia. There has been about 80 clients served with 30 reduction in inpatient episodes. I would just like to say that in general our dollars from mhsa have been used across our system and its almost too hard in a brief thumbnail to oversee the number of programs that we have. But we have been very impressed with the spending on peertopeer services, increasing access, particularly also increasing Behavioral Healthcare in our primary care clinicks and moving towards innovation. The two last items were the prevention and Early Intervention programs and the