Commissioner sass . Present. We have a quorum oh, im so sorry, commissioner breslin, im so sorry. Were not trying to write anyone help. We need all the help we can get [laughter ]. That is exactly right. Thank you, secretary. With that, well go to discussion item 1. Item 1 discussion item opening remarks. President scott. Yes, would i like i would like to be sure that we all understand what this meeting is about today. There are a couple of features that are not customerary for meetings of this board. There will be no Public Comment unless after the closed session which is scheduled later for today. We have a hard stop on the forum at 4 00. At which time the board will go into closed session to her member appeal. After that well reconvene and go through protocol of whether we disclose or dont disclose and if those of you who are familiar with the sunshine ordinance understand why we do all of that. So that will be the time if there were any general comments on matters under the boards jurisdiction that we would receive those. So i just wanted to be sure that we all understand the protocol and ground rules for today. I would also like to talk a little bit about this forum. This is the third such time we have done this. We have tried to stepback from our daytoday operational and policy questions as a board, and Staff Members as well, to take a broader look into the field of health care, regarding issues that might be ultimately before this board before a decision. To say that were in a season in transition today particularly would be a vast understatement. We had to run the gauntlet so to speak to get into the building today because of what our democratic is and our country. For everything there is a season. I would put it to you, that we are approaching and will be entering into a season of policy change, its might impact the work of this board, and its purposes. But we are not we are not and i want to stress that in a season of change in our mission here, under the charter that we operate. Im reminded of a poem by the english poet im sorry, irish poet, William Butler yates. In the poem the second coming, which was written after the First World War in 1919, he said, things fall apart and the center does not hold. For many of you, that might be kind of where we are based on recent outcomes in the public arena. But i would prefer that we have a different image in our mind, as we undertake the work of this board, in fulfilling its mission to our members. Many of you have probably seen or heard of the image of the greek god in mythology by the name of cisifhis the king of cornith, through his own deceit and cleverness and the planing is of a man raleighing a huge boulder to the top of the hill. That is cisifhis. In rolling the stone to the hill, there was a penalty. He would get it to the top of the hill by night and in the morning it would be at the bottom of the hill and he was, again, to push it up the hill the next day. The lesson for this board in my view and for our staff is that the lesson is not one of endless work and drudgery fors us and not an image of endless labor and futility. I think the the message is one of work and purpose and hard work on behalf of the members of the Health Service system for whom we serve, and to provide ultimately affordable, quality care to those members. Our mission is endless. And we will have only moments of rest, pause and renewal for this board today to, take a stepback, take a breath and try to get a wider view and that is what this forum is dedicated to today. As we come back into regular session next month, well pick up the boulder and begin your journey together. With that i will now turn it back to the secretary and i think that our acting director, Deputy Director of operations, Mitchell Greggs has remarks as well. I just wanted to give a brief update on open enrollment, and that our full open enrollment report will be in the december boards regular meeting. That will have all of the details, but i just wanted to recognize the volume of work, the amount of work and the staff really stepping up to it. So we knew it would be a large open enrollment this year because of the plan changes and some of the new benefits that people are seeing and some changes that we have done within the plans. So we knew we would get a lot of calls and facetoface interactions. We have received over 10,000 calls, about 3,000 more than last year and we managed to keep all you have our servicelevels with that, too. We received 10,600 pieces of paper, open enrollment applications and that is anywhere from 3,0004,000 more than we typically do and were now at 90 of having those processed. Perhaps one of the biggest increases and one of our Biggest Challenges we wanted to do this year and get out there and communicate more and have more facetoface interactions with mills and we did it through the retiree sessions and flu clinicks with health fairs in parts of the city. So a good approximate number, we talked to about 6,000 people facetoface this year, that is almost triple what we have done in years past. Were also out there doing robo calls this year, specifically to the population that will move from blue shield and from the city plan coordinated benefit to the new city plan. And so we have done those specifically to those to help them know this is going to happen, the timing of what is going to happen as far as getting their new id cards and help our staff not get so many calls on january 1st and when people realize their benefits change and where . So we had really good responses about that and we had some really good responses about the Additional Services and additional Communication Services we put out there. Again, next month well have a lot of specific details in our usual presentation of open enrollment. Thank you. Thank you very much, deputy. Commissioner follansbee. I just want to thank the staff. I want to the first open forum, i think, for the season, which was in the library in the Conference Room and in the auditorium. It was packed with representatives from both health plans who articulately answered questions. I think for the first event i was quite impressed with the expertise, the satisfaction that was evident in the audience from people who came up to ask questions during the session and then came up afterwards and i want it congratulate the staff and the Health Care Representatives in their participation in the communication sessions. Thank you. I know that commissioner breslin and ia attended the retiree session for the city and county of San Francisco with over 500 people at that event with the flu clinic and our executive director was there as well. And presented part of the program. But again, i think there have been there was a commitment by both kaiser and particularly the broader new health plan, uhc, to really outreach during the course of this open enrollment. To me, it was very evident that they did that and more. I understand there is supposed to be another series or were engaged in other series of robo calls with retirees and so forth. So you may want to comment on that . Those are our last series of robo calls are happening right now. We do about 1500 to 2,000 a day, until we reach the full amount, which is approximately 9,000. We do that mainly because if we were to do all 9,000 robo calls at the same time, we would get more calls into our service center, as well as the plans Member Services phone numbers. So those are going on now and will be wrapped up early next week. Specifically were telling people about they get their confirmation newspaper partners when had he receive their new id cards and to give them numbers that they can Contact United Health Care if they want to ask questions about the new plan or find out if their doctors are already billing them for that plan. Again on behalf of the board for those Staff Memberses who are listening and i know some of the Management Team is present in the chamber, i want to express on behalf of the board, our profound thank you to the hard work that you have undertaken to process and support the open enrollment of our members. Its not uncharacteristic that you day in and day out do this type of work and we thank you for that. So with that, well move to discussion item no. 2. Item 2 discussion item. Review of the hss charter and administrative code sections. Erik rapoport. As erik approaches the podiums, i want to put a little bit of context why this is the leadoff activity for this forum. Over my tenure we have had numerous references to administrative and charter code sections, sometimes by the amendment of the plan documents and sometimes guidance coming from our counsel and others who might be bringing matters before the board. So i asked erik this spring to undertake a task, and that was to pull together in one document that could be clearly laidout what was applicable to the work of the board . Our role as commissioners . The scope of our work, the duties, et cetera, et cetera . And recognizing that this is a document for this date in time. There can always be additional tweaks and amendments, but we wanted to put this into one document. So that everyone would have access to it, and we wouldnt be living by the memory of myself, or other commissioners about what we thought might be there, but really this is what the guidance is. So i asked erik to do that. He was very diligent and we have the resulting document today, and well ask him to walk us through it at a highlevel. Yes, thank you very much, commissioner scott. That is exactly what i did. As you noted this document, i took off the american Legal Publishing website which has the update to day city charter and codes. So the website location is at the bottom of the document if you want to find it, especially going forward. As these charter sections and codes can be update. You type in american legal of publishing and hit on code library california, San Francisco, and then all of the San Francisco codes and charter sections will come up. And you can make sure you are relying on an uptodate version as compared to the version that is accurate as of today. So what this was, as i went through the charter and administrative code sections, and basically cut and paste all of the code and charter code sections that you felt were relevant for the Health Service board and i intend this more to be a reference document for the board to have all of these sections in one place. I will take a few moments to go through it at a highlevel and if you want me to speed up, let me know. We will. I can tell. So the first one and these are in order in the order as they appear in the charter and i put the admin code sections at the end. So just because something is earlier doesnt mean its any more important. Charter section 4. 1 02 lists the general powers and duties of city boards and commissions. This is also this is applicable to the Health Service board. You can read that when you have a chance. The one section that comes up on page 7 is last paragraph. We have had discussion about that. Which says that effectively each board or commission should work through the department head, regarding relative affairs of the department. However, nothing herein shall restrict the powers of the board or inquiry as provided in charter. As we previously discussed, those powers of hearing or inquiry that the board decisions make. And making reports, which we are doing every year, which is good. Section 4. 1 03 has additional rules and regulations for how boards and commissions work and note in section a1, this is the rule that requires ten days public notice, if you are going to change a board policy or rule as compared to the usual 72hours required under the brown act. Further down on page 9 this is the section that states that unless otherwise required by the charter, its it requires a majority vote for Board Members to make as decision to vote on any decision. And further down in the middle of the page right above paragraph c, it requires members to vote yes or no, and you can abstain unless there is a separate vote by the board allowing members to abstain. It lists the current composition of the board. And the terms of service on page 10. And on page 11, lists the specific Health Service board powers. These are in addition to the powers or limitations of charter section 4. 102, 103 and 104. Specifically, the key power or responsibility of the board is to put health plans into effect as set forth in chapter section a422, which well get to in a minute and section 5 authorizes the board to act on member appeals, and this is where the 60day requirement comes from. That the board those hear a member appeal within 60 days. The next one is just background, charter section 12202 is the basic provision for membership in the Health Service system, which is members of the Health Service system shall consist of all officers and permanent employees of the city and county, unified school district, Community College district and such other officers, employees and dependents and retirees as provided by ordinance. That ordinance is administrative code 16700, which is at the end and well get to. So the entire list of all eligible Health Service board is administrative code 16700. Charter section 12203 affirms that the Health Service system is a trust fund administered by the board in accordance with provisions of the charter solely for the benefit of the active and retired members of the Health Service system and their covered dependents. So the charter is broken into two parts. They have the numbered section and for some reason they have set up a separate appendix. So i dont want to say substantive. But those related to the Health Service system are in the appendix. Its somewhat duplicative in the charter section says the Health System is hereby established and contains a religious exception, which i dont think i have had questions about in last 15 years. Charter section a421 allows for planned residents and i dont think that has happened to my knowledge. If i have a question on page 13 . Yes. A421. Subject to the requirements of state law and budgetary fiscal provisions the Health Service board is authorize by twothirds vote of the entire membership of. The Health Service board to adopt plan i believe its a major ity of the vote, although it wasnt changed in this section apparently. This i think is a section related to San Francisco residents. And so i dont think this provision is operative. I can take a look at historical nature of it. I think you are referring to the next section, which is a422. For members. Yes, for members you are correct that the board has the power to adopt plans for a majority vote for members, but we still have that three fourths requirement. Plans shall not become effective until approved by ordinance of the board of supervisors adopted by a 3 4th of its members requirement. What is the difference in residents . And members . Again, what i want to do is just go through these provisions. There are a series of historical provisions that i havent looked into and if you have specific questions i can take a look at that and get back to you. Im reading that section as authorizing i assume, with board of supervisors approval, they ever wanted to create a health plan for San Francisco residents, that there seems to be some Charter Authority for doing that. Again, no one has asked me about that since i have been general counselor over ten years. Maybe that is the ground rule, if we can just note questions. I put it in there. Well note questions and then well have followup. I have said on other times were not trying to boil the ocean today and answer every issue. so noted. Well come back if we have to have some followup. Okay. Thank you, erik. My understanding this is more of a review. Yes. And in terms of actually providing legal advice, im probably going to need more time to go back and look and that is one section i really havent spent much time on. Okay. There may be some historical understanding too, that we can consult. Yes, correct. Thank you. And that third paragraph of charter section a422 requires the actuarial report and rates and benefits package that is submitted to the board of supervisors every year. A423 sets up the schedule for approving plans, and the process for calculating the 10county amount, which is referred it in the charter as the average con striction. That con striction. Contribution. Other expenses with obtaining and disseminating information regarding plan benefits and costs, the investment of such fund or funds as may be established, including travel and transportation costs. Member Wellness Programs, actuarial expenses, and expenses incured to reduce health care costs. So these are the allowable expenses on the top of page 16 that can come out of the trust fund. Otherwise, it has to come out of the administrative budget that isa proved by approved by the board of supervisors every year. There is an historical sense of specificity and charter section a425 is another historical section and if people have questions if they could ask me later. A426 regarding member choice within the system. Were now on page 17 . At the top of page 18, im moving quickly. Okay. Minor change in prop c regarding member selection. So now members have the right to select a duly licensed physician who is made available through Health Service system plans. That change was made to allow at some point if the Health Service board wants to adopt a national hmo plan and the idea is that they would be able to do that with that change. So now im going to