Minutes of the Health Commission Meeting Tuesday, July 1, 2003 at 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER The Commission was called to order by Commissioner Chow at 3:15 p.m. Present: Commissioner Edward A. Chow, M.D., President Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Ph.D. Commissioner John I. Umekubo, M.D. Absent:  Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Lee Ann Monfredini Commissioner Michael L. Penn, Jr., M.D., Ph.D. 2) APPROVAL OF THE MINUTES OF THE MEETING OF JUNE 17, 2003 Action Taken: The Commission (Chow, Parker, Sanchez, Umekubo) approved the Minutes of the June 17, 2003 meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Umekubo chaired, and Commissioners Sanchez and Parker attended, the Budget Committee meeting. (3.1) CBHS-Substance Abuse - Request for approval of a contract renewal with Center for Juvenile and Criminal Justice, in the amount of $249,250, to provide substance abuse recovery services targeting adult male parolees, for the period of July 1, 2003 through June 30, 2004. Deferred by request of the Department. Will be on a future agenda, within 30 to 60 days. (3.2) PHP-Housing and Urban Health - Request for approval of 20 contract renewals with the following contractors for a combined total of $9,680,022 for Housing and Urban Health (HUH) services commencing July 1, 2003. PHP-Housing & Urban Health - Request for approval of 20 contract renewals Contractor Program Description Unduplicated Clients Contract Term Total Funding Ark of Refuge, Inc. Ark House Transitional housing for LGBTQQ Youth 39 7/1/03-6/30/04 $300,815 Baker Places, Inc. Integrated Services Network Support services in 10 Single Room Occupancy (SRO) Hotels 522 7/1/03-6/30/04 $621,594 Baker Places, Inc. Star & Camelot Hotels Direct Access to Housing 117 3/1/03-6/30/04 $642,190 Baker Places, Inc. Emergency Hotels Emergency Housing N/A 7/1/03-6/30/04 $958,168 Caduceus Outreach Services Caduceus Outreach Services Psychiatric services linked to housing 80 7/1/03-6/30/05 $197,802 Catholic Charities Peter Claver Community Residential Care for homeless persons with HIV/AIDS 74 7/1/03-6/30/05 $863,458 Chinatown Community Development Corporation Chinatown SRO Collaborative Outreach, training, and advocacy services to SRO hotels 600 7/1/03-6/30/05 $500,000 Episcopal Community Services Canon Kip Community House Support services in a SRO hotel 113 7/1/03-6/30/04 $101,626 Episcopal Community Services Pacific Bay Inn Support services and property management in a master-leased SRO hotel 83 7/1/03-6/30/04 $960,981 Episcopal Community Services Rose Hotel Support services in a SRO hotel 83 7/1/03-6/30/04 $121,669 John Stewart Company Windsor, Star, Camelot & Le Nain Hotels Property Management services in master-leased SRO hotels 392 7/1/03-6/30/04 $832,464 Lutheran Social Services La Casa Mariposa & Mia House Transitional housing for women with children recovering from substance abuse and domestic violence 11 families 7/1/03-6/30/04 $177,860 Mission Housing Development Corp. Mission SRO Collaborative Outreach, training, and advocacy services to SRO hotels 480 7/1/03-6/30/05 $500,000 Page Street Guest House Broderick Street Adult Residential Care Facility Licensed Residential Care 36 7/1/03-6/30/04 $832,424 San Francisco AIDS Foundation South of Market Action Point Medication adherence program for homeless persons with HIV/AIDS 110 7/1/03-6/30/04 $232,605 San Francisco AIDS Foundation Full & Partial Subsidies Rent subsidies for persons with HIV/AIDS 124 7/1/03-6/30/05 $910,288 San Francisco Network Ministries Safe House Transitional housing for women 45 7/1/03-6/30/06 $147,516 Self Help for the Elderly Autumn Glow Residential Care Residential Care for elders with dementia 20 7/1/03-6/30/04 $117,278 Tenderloin AIDS Resource Center HIV/AIDS Emergency Housing Case management in Emergency Housing 260 3/1/03-6/30/04 $261,284 Tenderloin Housing Clinic Tenderloin SRO Collaborative Outreach, training, and advocacy services to SRO hotels 1,200 7/1/03-6/30/05 $400,000 Total 4,389 $9,680,022 Commissioners’ Comments: The Commission requested a follow-up to the Population Health and Prevention Joint Conference Committee. Action Taken: The Commission (Chow, Parker, Sanchez, Umekubo) approved the Budget Committee consent calendar. The Commission asked for a report to the Population Health and Prevention Joint Conference Committees on Item 3.2. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. DPH Budget Update In the early hours last Saturday, the Budget Committee voted to restore $13.5 million to DPH’s proposed budget for fiscal year 2003-04. The Committee restored funding for a number of community-based mental health, substance abuse and HIV/AIDS programs, as well as interpreter services at San Francisco General Hospital. This action returns funding for all of the service reductions proposed in the Department’s contingency budget, as well as some additional reductions proposed in the base budget. Attached is the Budget Committee’s Public Health Restorations list. (Attachment A). Tenderloin SRO Shooting On Saturday afternoon, a tenant at the Dalt Hotel, a single room occupancy hotel in the Tenderloin, shot and killed three other tenants of the hotel. The staff and tenants of two hotels were impacted: the Dalt Hotel (a Tenderloin Neighborhood Development Corporation hotel) where the violence occurred, and the Vincent (a DHS master leased hotel) where one of the victims worked as a desk clerk. DPH quickly responded by dispatching mental health crisis teams to the scene. In addition, several debriefings have been scheduled for this week for the staff of the Dalt Hotel, the Tenderloin Neighborhood Development Corporation, and the Vincent Hotel. Additionally, the child crisis unit will be offering specialized mental health services to children and families that were impacted by the violence. Planning for West Nile Virus On June 19th, the Environmental Health Section coordinated an inter-agency information sharing and training presentation on the West Nile Virus to City, State and private agencies. Twenty-four departments, agencies and institutions participated in the presentations provided by Jack Breslin and Senior Environmental Health Inspector Helen Zvernia. The purpose of the meeting was to inform our public and private partners that we are entering the mosquito-breeding season. As mosquitoes are the vectors that transmit the West Nile Virus, there will likely be a marked increase in the number of West Nile Virus human cases in California this summer and fall. Information on the control of mosquito breeding on properties controlled by these agencies was presented and discussed. Each participating department and agency will develop a mosquito control program by mid-July. These control plans will include identified breeding sites, control procedures and required resources. The Department of Public Health will be available to provide as needed assistance in conjunction with other City and State agencies in the development and implementation of these plans. Magnet Program Opens Today was the official opening of the MAGNET Program. Funded with a grant from Bristol-Myers Squibb matched by the Mayor's Office this program will provide sexual health services for gay men in a storefront in the Castro. In addition to offering HIV and STD testing as well as vaccinations to prevent hepatitis A and B, the program will use a number of innovative strategies, including recreational activities to help build community and thereby prevent disease. The Mayor attended the opening and Dr. Katz also had a chance to speak at their press conference this morning. Expanded access to 340B Drug pricing An agreement has been reached in negotiations with Rite Aide for the new outpatient prescription benefit. Beginning today, CHN will be able to take advantage of lower drug prices available under the federal 340B drug-pricing program for prescriptions dispensed to uninsured CHN patients through community-based pharmacies. As a result of this agreement, uninsured CHN patients will have the choice of the pharmacy associated with their primary care clinic, or the Outpatient Pharmacy at San Francisco General Hospital, from which to receive no-cost prescriptions. Patients are free to choose a non-associated pharmacy for services, but will not be eligible to receive CHN prescription benefits from these non-associated pharmacies. This new agreement expands the availability of prescription services to uninsured CHN patients while decreasing the Department’s expense for pharmaceuticals by approximately $1 million annually. COMMUNITY HEALTH NETWORK SAN FRANCISCO GENERAL HOSPITAL June 2003 (from 6/05/03 MEC and 6/18/03 JCC) 6/03 7/02 to 5/03 New Appointments 20 201   Reinstatements 0 3 Reappointments 22 319   Delinquencies: 0   Reappointment Denials: 0 Resigned/Retired: 9 128 Disciplinary Actions 0 Restriction/Limitation-Privileges 0 0 Deceased 0 1 Changes in Privileges   Additions 1 31   Voluntary Relinquishments 3 33   Proctorship Completed 7 172 Current Statistics - as of 6/1/03 Active Staff 420 Affiliate Professionals (non-physicians) 163 Courtesy Staff 498 Total Members 1,081 Application In Process 29 Applications Withdrawn Month of June 2003 1 18 (07/02 to 5/03) SFGH Reappointments in Process July 2003 to Oct. 2003 153 Commissioners’ Comments Commissioner Parker asked for additional information regarding the 7.5% that employees are giving back. He also asked, what effect, if any, will DPH see for the 13.5 million dollars that is being added back by the Board of Supervisors? Dr. Katz explained that the 13.5 million is going toward specific programs and agencies identified by the Board of Supervisors. The 7.5 percent relates to the amount that each employee in participating unions (which includes most of them and excepts the nurses’ union) agreed to pay toward retirement. In return, the staff in the participating unions receives 5 floating holidays as compensation. There is a cost to the Department in the case of those employees who need to be covered for the days they take off. As an example, there will always need to be a certain number of pharmacists working. When a pharmacist takes a holiday, the Department will need to pay another pharmacist to cover. This is a challenge, but a much easier challenge than DPH had anticipated. The Department will only back-fill when it is necessary. RNs are not included because their union did not participate, but LVNs, CNs and Pharmacists are included. Commissioner Umekubo expressed his happiness with the additional money added back to the Department by the Board Supervisors, and recognized the advocacy done by Dr. Katz, staff and public. Commissioner Umekubo asked about the status of the MHRF. Dr. Katz explained that the MHRF would remain open for one year as a locked psychiatric facility. The union is paying for the cost of keeping the facility open. There is a requirement that Dr. Katz chair a blue-ribbon committee to study how to keep the MHRF open and the needs of the community, and the first meeting has already been planned. Commissioner Umekubo asked about the 340B pricing, how many pharmacies are involved? In the new model, each clinic is tied to one particular Rite Aid. The Rite Aid is in the neighborhood of the clinic. Patients will now be limited to two choices (SFGH or Rite Aid). Commissioner Chow pointed out that the Commissioners received a packet from Sharon Kotabe that explains this new arrangement in greater detail. There has been a request that there be additional presentation to the Joint Conference Committee to describe the impact, especially because the identified Rite Aid is not always very close to the patient’s clinic. Commissioner Chow noted the tragedy at the SRO Hotel this week. Though it was not a Department-run SRO, it brings up a concern of the Department to keep its housing units as safe as possible. In today’s meeting, Marc Trotz was helpful in explaining how the Housing and Urban Health office does this. Commissioner Parker asked if the Department set geographic criteria when choosing pharmacies for participation in the 340B program. Dr. Katz said the Rite Aid closest to each clinic was chosen. When the Department originally went out to bid on this contract, there were almost no bids because of the complexity of administering the program. The Department is advocating for a less complex system. Commissioner Edward Chow presented a Department of Public Health Certificate of Honor to Kathleen Becker for twenty years of service in the Department. Jimmy Loyce accepted on Ms. Becker’s behalf. 5) HIPAA COMPLIANCE UPDATE Dennis Scott, Chief Compliance Officer, presented this update on HIPAA compliance as of July 1, 2003. He provided the following summary of compliance as of 6/30/2003: HIPAA Area 12/31/02 06/30/03 Other Dept Coordination 95% 95% Privacy 43% 99% Data Security 44% 67% Business Associates 15% 94% Transactions & Code Sets 55% 78% Project Status - Other City Department Coordination Significant Developments With the passage of the Privacy compliance deadline (04/16/03), we have received numerous calls from other City Departments and the City Attorney’s Office regarding coverage under the HIPAA Privacy Rule DPH provided a HIPAA training session to the Department of Aging and Adult Services, and we are providing consultation on their compliance program DPH is working with the City Attorney’s Office to develop a list of HIPAA covered and exempt departments We are encouraging other departments to adopt a “compelling argument” test to determine if they are covered under HIPAA Status of Implementation Efforts - 95% Completed We have completed the “outreach” phase of our project plan Our implementation effort is driven by the decisions of other City departments and our project plan expands with additional requests for consultation Compliance Risk Factors The application of HIPAA to other City/County services outside of health care is evolving The greatest points of exposure will come from an adverse ruling of a judicial or administrative body to include parts of the City under HIPAA that are currently not covered Privacy Significant Developments Implemented DPH-wide Privacy Policy and Notice of Privacy Practices by mandated deadline (4/16/03) Compliance Manual updated with Privacy Policy Notice of Privacy Practices available in targeted languages on 4/16/03 Privacy and operations training completed for DPH staff on 4/13/03 Privacy “hotline” implemented 4/13/03 Status of Implementation Efforts - 99% Completed Compliance due 4/16/03 DPH has completed the implementation phase of our project plan DPH is currently performing post-implementation review to determine points of additional training We will provide additional training On authorizing the disclosure of protected health information To staff in public health surveillance, disease prevention and control activities on the HIPAA Public Health exemption We are also integrating our privacy policy with our security remediation efforts Compliance Risk Factors Privacy remediation has been completed within the mandated deadline Our compliance risk has evolved from “milestone” to “breach” risk Risk of unlawful disclosure of PHI of one of our patients/customers Data Security Significant Developments Final rule published Compliance due by 4/21/05 Status of Implementation Efforts - 67% Completed Currently meeting project timelines Draft GAP Analysis Completed Remediation project tasks in progress Integration of security remediation with privacy policy is major current theme HIPAA Security policies and procedures under development Compliance Risk Factors Currently no known risks to meeting compliance deadlines Business Associates Significant Developments New HIPAA Exhibits have been implemented for contracts Privacy training completed for vendor contractors Status of Implementation Efforts - 94% Completed Compliance no later than 4/15/04 based on annual renewal process of contract Currently meeting project timelines All vendor contracts are currently being revised with HIPAA language at renewal New vendor contracts include HIPAA language as part of the standard contract Compliance Risk Factors No known risk factors All vendor contracts will be compliant by the mandated deadline (4/15/04) Transactions and Code Sets Significant Developments Medi-Cal and Short-Doyle Medi-Cal will not convert to the required national billing codes by the mandated deadline (10/16/03) The State’s published local to national code conversion project plan extends to 2006 The State has announced an extended grace period for receipt of outdated codes Most Medicare intermediaries have initiated testing Status of Implementation Efforts - 78% Completed Compliance due 10/16/03 TCS is currently the major focus of the DPH HIPAA implementation effort TCS implementation responsibility has been assumed by the operating departments, with project management by the Compliance Division Physical Health systems vendors on target to meet compliance date Behavioral Health systems compliance complicated by State’s delay in moving to national codes Compliance Risk Factors DPH will not be in compliance by the HIPAA mandated deadlines for certain behavioral health billing codes due to State delays Commissioners’ Comments: Commissioner Parker commended the report, and noted the complexity of the subject. He reviewed the major points of the report. He summarized HIPAA as being primarily about regulating what can and cannot be shared in the health care setting. Dennis Scott said that HIPAA does not really change practices in this regard significantly in California because aggressive privacy laws already exist. It does require each covered entity to have a privacy policy, develop it and communicate it. Commissioner Umekubo asked what this unfunded mandate would cost the Department. Dennis Scott noted that his office costs $600,000 to maintain. There has not been an analysis beyond this to look at the other costs involved. Commissioner Umekubo asked what has been the biggest challenge. Mr. Scott said that it was the development of a Department wide privacy policy. It was difficult to create one that works equally well in all of the Department’s settings. It took longer than anticipated, but the final result was successful. Commissioner Sanchez thanked Mr. Scott for an excellent update. He asked about how the behavioral health model that the Department is newly adopting will impact HIPAA compliance. Mr. Scott noted that the State level still has 2 different departments (Substance Abuse and Mental Health) where we will have one, which will raise challenges mostly in coding. Commissioner Chow asked that there be an update on HIPAA Compliance after the next major deadline in October (10/16/03) to the Community Health Network Joint Conference Committee and then an update to the full Health Commission in six months. Commissioner Chow asked if there is one clearinghouse where providers and others can go to make sense of the implications of HIPAA? Mr. Scott said that there is a state office of HIPAA implementation, and they have done a reasonably good job of helping counties. This has been a good source of information and sharing of interpretations. CMS conference calls have provided important information. However, there is no one clearinghouse. Mr. Scott said that through all of the directives at the end of the day the Department has to do what’s reasonable as we are in the business of providing effective health care. Commissioner Parker asked if we could project the overall impact on health care costs factoring in the cost to design, implement and maintain HIPAA. Mr. Scott said that there has been controversy in this area. Mr. Scott said estimates determining how much it would cost health care entities to provide health care after HIPAA do not necessarily apply to public system. Commissioner Chow asked Dr. Katz for his perspective on HIPAA costs. Dr. Katz noted that it is hard to break out cost accurately, because it’s imbedded throughout the system. The Department will continue to spend $600,000 for staffing the HIPAA compliance office and this will stay the same in the foreseeable future. Dr. Katz also noted that he believes Mr. Scott was correct to point out that the Department exists to provide effective public health services. Dr. Katz said that he appreciates Mr. Scott and the work he and his staff have done. 6) PUBLIC COMMENTS There were no public comments. 7) ADJOURNMENT The meeting was adjourned at 5:55 p.m. Frances Culp, Acting Executive Secretary to the Health Commission