Minutes of the Health Commission Meeting Tuesday, November 1, 2005 at 3:00 p.m. 101 GROVE STREET, ROOM 300 San Francisco, CA 94102 1) CALL TO ORDER Commissioner Monfredini called the meeting to order at 3:20 p.m. Present: Commissioner Lee Ann Monfredini, President Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Edward A. Chow, M.D. Commissioner James M. Illig Commissioner Donald E. Tarver, II, M.D. Commissioner David J. Sanchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. – arrived at 3:35 Commissioner Monfredini announced that the Health Commission’s newly reconstituted Population Health and Prevention Joint Conference Committee would hold its first meeting on Monday, November 21 at 9:00 a.m. Commissioner Guy will chair the committee, and Commissioner Tarver and Commissioner Monfredini will be members. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF OCTOBER 18, 2005 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver, Sanchez) approved the minutes of the October 18, 2005 Heath Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Illig chaired and Commissioner Chow and Commissioner Sanchez attended the Budget Committee meeting. Commissioner Illig said the Budget Committee will be conducting its business using a new format. At each meeting, certain contract approvals will be considered as a whole, and will not be presented and discussed separately. These contracts will be noted on the agenda, although if committee members or members of the public want to discuss any of these items, there is the ability to do so. The Budget Committee’s goal in doing this is to save time to focus on the larger contracts, and for the future to enable the Budget Committee to spend some time talking about other issues besides approval of contracts. (3.1) CBHS – Request for approval of a retroactive renewal contract with ValueOptions, Inc., in the amount of $100,000 per year, for a total contract amount of $336,000, to function as an administrative services organization providing out-of-county mental health placement services to minors, for the period of July 1, 2005 through June 30, 2008. (3.2) CBHS – Request for approval of a retroactive renewal contract with Boys and Girls Club of San Francisco, in the amount of $50,900, for a total amount of $57,008, which includes a 12% contingency, to provide Early and Periodic Screening, Diagnosis and Treatment mental health services, for the period of July 1, 2005 through June 30, 2006. (3.3) CBHS – Request for approval of a retroactive renewal contract with Children’s Council of San Francisco, in the amount of $174,943, for a total contract amount of $195,936, which includes a 12% contingency, to provide child care consultation services targeting center-based and family child care providers, for the period of July 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Chow made comments about all the contracts that are part of the High Quality Child Care Mental Health Consultation Initiative. This was not a criticism of the contractors but to better understand the coordination of the various contracts. Ms. Chan-Sew, Director of CBHS Children and Family Services, said that this is an interdepartmental partnership between DPH, the Department of Children, Youth and their Families, the First Five Commission and the Health Services Agency. Providers were selected through a RFP process. A number of providers were selected, including Children’s Council and SF Psychoanalytic Institute. Both have a long history of providing services. Ms. Chan-Sew gave the commissioners the 2003-2004 evaluation report. Commissioner Chow noted that the Children’s Council provides services to a number of Asians, and that they have staff to work with childcare centers in Visitacion Valley. Commissioner Chow would like the Joint Conference Committee to hear a comprehensive report on this initiative. He asked if this program is a model for other cities. Ms. Chan-Sew said the model is being implemented in cities across the country, but they are primarily funded through a single source. So the relationship with CalWorks is unique to San Francisco’s program. (3.4) CBHS – Request for approval of a retroactive renewal contract with Hamilton Family Center, in the amount of $86,375, for a total contract amount of $96,740, which includes a 12% contingency, to provide children’s mental health services, for the period of July 1, 2005 through June 30, 2006. (3.5) CBHS – Request for approval of a retroactive renewal contract with Huckleberry Youth Programs, in the amount of $153,000 for a total contract amount of $171,360, which includes a 12% contingency, to provide Early and Periodic Screening and Diagnosis and Treatment mental health services, for the period of July 1, 2005 through June 30, 2006. (3.6) CBHS – Request for approval of a retroactive renewal contract with Curry Senior Center, in the amount of $530,966 per year, for a total contract amount of $2,123,865, which includes a 12% contingency, to provide substance abuse treatment and mental health services, for the period of July 1, 2005 through June 30, 2009. (3.7) CBHS – Request for approval of a retroactive renewal contract with San Francisco Psychoanalytic Institute and Society, in the amount of $91,978 per year, for a total amount of $367,912, which includes a 12% contingency, to provide high-quality childcare mental health services, for the period of July 1, 2005 through June 30, 2009. (3.8) PHP-AIDS Office-HIV Health Services – Request for approval of a retroactive contract renewal with Baker Places, Inc., in the amount of $104,679, which includes a 12% contingency, to provide residential detox and substance abuse services targeting poly-substance users or abusers with HIV disease, for the period of March 1, 2005 through March 31, 2006. Commissioners’ Comments Commissioner Illig asked why the contract was delayed. Ms. Long said that Baker was negotiating with the Department for a different rate, and the agency preferred to wait until these discussions were completed. Commissioner Illig asked Jonathan Vernick, executive director of Baker Places, if there are term limits for members of the Board of Directors. Mr. Vernick said that there is an annual election of all board members. So the term is one year, but this does not preclude people from serving more than one year. The bylaws say the number of members is not to exceed 15. Mr. Vernick said that his agency has been working closely with DPH around a number of financial issues and he is pleased to report that the financial condition has significantly improved. He also noted that while some of the issues that have come up are unique to Baker, many exist for all non-profits. When contractors do not get an increase, it means that programs will be cut. Commissioner Illig said that the Commission shares agencies’ concerns. (3.9) PHP-Community Health Promotion and Prevention – Request for approval to accept and expend retroactively a new two-year grant from DHHS, Substance Abuse Mental Health Services Administration, in the amount of $200,000, to support a project to prevent youth alcohol and substance use in the Bayview Hunters Point district, for the period of October 1, 2005 to June 30, 2007. (3.10) PHP-STD Prevention and Control Services – Request for approval to accept and expend retroactively a new four-year grant from the San Mateo Medical Center, in the amount of $360,000, to establish an HIV/AIDS Research Center in the Bay Area, for the period of July 1, 2005 to June 30, 2009. (3.11) CBHS – Request for approval of a retroactive renewal contract with Instituto Familiar de la Raza, Inc., in the amount of $1,956,642, which includes a 12% contingency, to provide mental health/substance abuse services, for the period of July 1, 2005 through June 30, 2006. Secretary’s Note - Sai Ling Chan Sew said the increase in staffing is 2, not 25. Commissioners’ Comments Commissioner Illig asked how the Board of Directors is doing. Estella Garcia, executive director of IFR, said the board is in the process of reviewing two new board members, one of whom they hope to have on board by January. One has extensive financial background and the other has a background in immigration law. (3.12) CBHS – Request for approval of a retroactive renewal contract with Richmond Area Multi-Services, Inc., in the amount of $2,800,380 per year for a total contract value of $5,600,759, which includes a 12% contingency, to provide mental health services, for the period of July 1, 2005 through June 30, 2007. Commissioners’ Comments Commissioner Chow asked if the child care consultation services are included in this contract. Ms. Chan-Sew said that this service is part of the contract, as well as the behavioral services that RAMS provides at the wellness centers. (3.13) CBHS – Request for approval of a retroactive renewal contract with Addiction Research and Treatment, Inc., in the amount of $5,103,038, for a total contract amount of $5,715,403, which includes a 12% contingency, to provide substance abuse treatment services, for the period of July 1, 2005 through June 30, 2006. Budget Committee Public Comment (taken at the Health Commission meeting) David Moulton said that Asian Inc. is a general partner of a residential building that is located next to the proposed methadone clinic. A number of children live in the building. In addition, a number of children would pass the site on their way to the Tenderloin School and there is a park across the street. Bella de Barres, project Manager of the site, said residents just moved into this building last December. It is a wonderful facility. The residents feel good about the street where they live. She did not receive a notice about the community meeting. She hopes that the project is not located here. Commissioners’ Comments (at the Health Commission meeting) Commissioner Monfredini asked the agency representative if there was a community meeting and how this was noticed. Evan Kletter, CEO of BAART, said the agency has begun the process of preparing to move from Geary Street to Turk. In preparation to that they held a community meeting. For the past two weeks there has been a sign posted at the new site announcing this hearing as an opportunity for anyone to comment on the proposed relocation. In preparation for the community meeting, he and his brother and sister canvassed the area around the site, asked security guards to post notices at their buildings. Commissioner Monfredini noted that people in methadone maintenance are in recovery and are trying to stay clear of their addiction. Commissioner Monfredini asked Mr. Kletter to keep in touch with the neighbors after the relocation happens to make sure that concerns are listened to and addressed. And that the clients are protected as well as the neighborhood. Mr. Kletter said they have a full time security guard and very strict protocols for their patients. They want to be a good neighbor. (3.14) CBHS – Request for approval of a retroactive renewal contract with Center on Juvenile and Criminal Justice, in the amount of $328,740 per year, for a total contract amount of $1,314,961, which includes a 12% contingency, to provide substance abuse supportive living services, for the period of July 1, 2005 through June 30, 2009. Secretary’s note – Mr. Stillwell said the term of the contract is being changed from four years to one year. So the term of the contract will be July 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Illig asked if the agency plans to expand its Board of Directors. Dan Macallair, executive director of CJCJ, said the agency has undergone a difficult transition over the last three years. He maintained a consistent board through that transition. Over the next year he hopes to seat additional board members, with a goal of nine high-quality members. The board is diverse and represents San Francisco’s communities quite well. (3.15) CBHS – Request for approval of a retroactive renewal contract with Haight Ashbury Free Clinics, Inc., in the amount of $4,913,647 to provide behavioral health services, for the period of Commissioners’ Comments Commissioner Chow asked what steps have been taken to stabilize the Glide outpatient program. Ben Eiland, HAFC program manager, substance abuse treatment services, said that Glide has been able to reestablish itself in providing units of service. Last year the units of service started to slip. There have been historic problems with this program. They are on target for the first quarter of the fiscal year for the units of services. Mr. Stillwell said that on a good day HAFC is a still a world-class organization. They have had considerable challenges in their financial condition for the past two years. Last spring they had a substantial change in administration. The contract is monitored closely to ensure that there is consistency in services. There are still some concerns about the agency. Commissioner Illig asked about the financial status. John Eckstrom, executive director of HAFC, said that the agency’s financial situation is in the same as it has been. They are controlling costs, but past debt is eating away at the margins. The fundraising plan is going more slowly than anticipated, but they recently retained a fundraising consultant. The board has been restructured since the last time he was before the Health Commission. They have become much more active with fundraising in the past eight weeks. Commissioner Sanchez asked the agency to provide more information about the past debt. Is there a specific timeline for repaying debt, and can this be renegotiated? Mr. Sass, DPH CFO, said much of the debt is the difference between the payments that were made to HAFC for Jail Psychiatric services and the costs that were incurred for 04-05. DPH must recover the overpayment, but he is working with the agency to design a repayment schedule. Mr. Sass said that HAFC has not exhausted all their options yet. Mr. Eckstrum said that they have the debt to the city, accounts payable debt and other factors. (3.16) PHP-AIDS Office-HIV Health Services – Request for approval of a retroactive contract renewal with Haight Ashbury Free Clinics, Inc., in the amount of $105,325, which includes a 12% contingency to provide Complementary Therapy Services to individuals who have HIV/AIDS and reside in San Francisco for the period of July 1, 2005 through June 30, 2006. (3.17) PHP-AIDS Office-HIV Health Services – Request for approval of a retroactive contract renewal with the Latino Commission, in the amount of $280,000, which includes a 12% contingency, to provide residential substance abuse treatment services to adult HIV positive monolingual Spanish-speaking substance abusers, for the period of March 1, 2005 through June 30, 2006. Commissioner Illig announced that the Health Department is sponsoring two forums for non-profits regarding governance. These forums are scheduled for November 16th and 21st, both at 5:30, in the Health Commission chamber. Action Taken: The Commission approved the Budget Committee Consent Calendar. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. State of the City Mayor Newsom delivered his annual State of the City address last week. This year’s speech highlighted numerous key public health accomplishments. Leading the list of accomplishments was the expansion of the Healthy Kids program to 19-24-year-olds, moving San Francisco one step closer to being the first City in the country to offer universal health care. The Mayor also called for expanding the Department’s primary care clinic hours to provide increased access for our patients. We applaud the Mayor’s leadership and thank him for his commitment to public health. BioWatch Alert On Saturday, October 30th, environmental detectors in the San Jose area detected a weak signal for Francisella tularensis (Tularemia or Rabbit Fever). These detectors are part of the national Biowatch Program. Detectors are located in most counties of the Bay Area, including San Francisco. No other detectors have registered F. tularensis. There have been no recent cases of tularemia in animals or humans in the Bay Area. There have been multiple conference calls this week with federal, state and local agencies to discuss surveillance, intelligence, notification and communications, and the consensus is that this incident was most likely an environmental contaminant, rather than the result of a terrorist release. Yesterday, DPH sent out a Health Alert to all San Francisco clinicians, asking them to consider Tularemia in ill patients that present to SF hospitals and clinics and to alert us for any suspicious cases. Most other Bay Area Counties sent out alerts as well. Santa Clara County Health Department is doing active surveillance for Tularemia in hospitals and clinics close to the detector. Surveillance will continue until November 13, the end of the incubation period for this disease. Rabid Bats Dr. Susan Fernyak hosted a press conference yesterday with staff from Animal Care & Control to raise public awareness about the problem of rabid bats in San Francisco. There have been six rabid bats within the last two years in the City, necessitating post exposure prophylaxis for 12 individuals. The press conference focused on the need to prevent bats from entering houses and the importance of avoiding contact with bats, especially if the bats are having difficulty flying which could indicate rabies infection. Animal Care & Control responds to nearly 60 episodes of bats inside dwellings each year. DPH tests approximately 75 animals each year for possible rabies infection. In a case of ironic timing, the most recent case of a positive rabid bat in San Francisco was confirmed yesterday, just after the press conference. Coverage of the rabid bat press conference was carried by a number of TV, radio and newspapers in both the mainstream and ethnic media outlets. Mental Health As a result of the recent tragedy that culminated in the death of three children off Pier 37, DPH staff appeared in both local and national interviews about mental health in general and schizophrenia in specific. Dr. Bob Okin, Dr. Bob Cabaj and Dr. Irene Sung were called on to respond to the increased interest in dealing with mental health consumers and their families. The Department is fortunate to have the expertise in staff that can serve as spokespeople for mental health during these tragic events. Annals of Internal Medicine Dr. Katz attached to the Director’s Report an article from the Annals of Internal Medicine entitled, “Clinical Decision Making during Public Health Emergencies: Ethnical Considerations.” He had the privilege of working on this piece with Dr. Bernard Lo, from the Division of General Internal Medicine at UCSF. Commissioners’ Comments Commissioner Monfredini was very saddened by the tragic death of the three children last week due to their mother’s mental illness. Commissioner Illig asked Dr. Katz if the Mayor’s Office has followed up with him on the plans to expand universal healthcare. Dr. Katz said yes, and that the Mayor is fully committed to expanding the Healthy Kids Program. He sees expanding primary care clinic hours as one way to expand access. With regard to the audit, Dr. Katz has been told that the Mayor was speaking specifically about primary care. Mayor Newsom sees the recent success with the restructuring of Tom Waddell as a model, and is interested in understanding how many patients are seen in each clinic, what the productivity numbers are and where opportunities are. Commissioner Illig wants to make sure that the Mayor is aware about the cost of these initiatives with the hopes that these initiatives are funded through an addition to the budget. Commissioner Sanchez said that the Mayor spoke at the Mission Language and Vocational School dinner and reaffirmed the excellence of our primary care model and the importance of these services. 5) APPROVAL OF SAN FRANCISCO GENERAL HOSPITAL MEDICAL STAFF BYLAWS Andre Campbell, M.D., SFGHMC Chief of Staff, presented the revisions to the San Francisco General Hospital Medical Staff bylaws. The revisions were discussed and approved by the Medical Executive Committee and approved by tally of votes by the active Medial Staff via e-mail poll dispatched September 8, 2005. Dr. Campbell highlighted three of the changes. There were changes to the specification of visiting privileges to state that the visiting privileges are granted for a specified period of time, and that the Chief of Staff shall inform the Governing Body when visiting privileges were granted for a patient care need that could not be met by a member of the medical staff. Another change is to proctoring duration. In the past it was not recognized that it could take more than two years to complete proctoring for a rarely performed procedure. The change to this section is to acknowledge that proctoring is dependent on the number of cases, not length of time. The last change Dr. Campbell highlighted was the elimination of the Diagnostic Services Committee and creation of the Clinical Care Committee. This change came out of a medical staff retreat. The Committee’s goal is to look at services provided by different specialties and try to streamline the operations and make things more efficient. Commissioners’ Comments Commissioner Chow asked that change from “his/her” and “he/she” to “their” not be made at this time, so that staff can ensure that it is indeed necessary. Dr. Campbell said that this could be done. Commissioner Illig asked if the medical staff includes other medical professionals, for example providers of complementary therapies. Hiroshi Tokubo, Director of Quality Management, said that the are privileges for physicians to practice alternative therapies, but alternative providers are not part of the medical staff. Commissioner Umekubo added that often time acupuncture is performed by physicians who have been credentialed to do this. Action Taken: The Commission approved the Medical Staff Bylaws, with the exception of the change from “his/her” and “he/she” to “their.” 6) DEPARTMENT OF PUBLIC HEALTH ANNUAL REPORT Scott Boule, Deputy Director, Office of Policy and Planning, presented the Department of Public Health’s FY 2004-05 Annual Report. This report summarizes some of the Department’s major accomplishments from the past year, including the revision of the Strategic Plan. The report is structured to show readers how the Department is configured, the characteristics of the population it serves and what activities the Department does to fulfill its mission to protect and promote the health of all San Franciscans. Mr. Boule presented demographic information about the population served by DPH, including information on gender, ethnicity, age, income and insurance status. He also reviewed the DPH structure, which includes the Community Health Network and Population Health and Prevention, and reviewed the four Strategic Plan goals. The Annual Report described myriad programs throughout the Department in the context of which Strategic Plan goal and objective it was designed to further. Mr. Boule’s presentation highlighted a few examples: Upgrading Primary Care Facilities Working with other safety net providers to improve diabetes care Expanding access to primary care for patients of all ages Expanding health insurance coverage for young adults Making neighborhoods more walkable Improving working conditions for day laborers Expanded hours at the Urgent Care Clinic Improving access to eye care with the “Eye Van” HIV/AIDs Centers of Excellence Increasing the number of supportive housing units available Providing partner notification through the Internet Making TB screening more efficient and more accurate Updating SFUSD’s TB screening policy The FY 2004-2005 Annual Report is available on line at www.sfdph.org, through the “Get Reports and Data” link. Commissioners’ Comments Commissioner Illig is concerned about the number of Dr. Katz’s direct reports. Did he have this many before the budget cuts? Dr. Katz said the budget cuts increased his direct report. He is also concerned about the PHP/CHN distinction. For example, the AIDS Office provides direct services, but is considered part of PHP. Dr. Katz said that the HMA report recommends that the Department form itself as a delivery system, with a Chief Operating Officer (COO) to operate the system. This is similar to what the CHN was meant to be. It had two main limitations, the first being that Community Behavioral Health Services was not included. The second is that the dual structure was created during a time of tension when people thought the hospital overruns negatively impacted mental health and substance abuse. There has been a vision change to embrace the goal of a delivery system. The COO would be in charge of this system, and nothing else in the Department. Dr. Katz added that AIDS has a huge impact on the delivery system, but the AIDS Office itself does not provide direct services. Commissioner Illig asked what would be the difference between the COO and the long-term care director. Dr. Katz said the COO would be responsible for the flow of patients throughout the system, not just long-term care. The long-term care director would be specific to long-term care with a substantial knowledge base and a focus on long-term care planning. Commissioner Illig said this is an excellent report. He appreciates the simple descriptions of the Department’s programs. He looks forward to using the Annual Report as tool to plan for special Budget Committee presentations. He suggested that the Health Commission should consider having joint meetings with other bodies that govern long-term care. Commissioner Guy said this is an excellent report, and she wants to maximize the Commission’s use of it. Annual reports serve many different purposes, and it is important that the points in the plan are connected to the Strategic Plan. The Strategic Plan is a tool of accountability for the Health Commission, and a living document. The work of the Joint Conference Committees should be linked to the areas of the Strategic Plan on a regular basis, not just annually. Commissioner Umekubo said he was struck by the increased revenue collections over the past six years, and asked if the Department has reached its max. Dr. Katz said that in the current fiscal year the Department is exceeding its revenue target. Commissioner Umekubo asked the status of cuts to the Medicaid program. Dr. Katz said the Department is safe for next year, but we could see a significant drop in revenues two or three years from now. He will keep the Commission informed. Commissioner Tarver said the annual report did not reflect the impact of the budget reductions and position eliminations. With regard to the Strategic Plan, there is the opportunity for more specific objective outcomes. Ms. Kronenberg said that there are specific outcome objectives, but these were not included in the Annual Report due to length. She is happy to share this with the Commissioners. Commissioner Tarver asked where the planning takes place to prioritize services and restorations, in anticipation of a time when there is not a deficit. Ms. Kronenberg said the steering committee that was formed as a result of the HMA report is looking forward to doing this type of planning. Commissioner Sanchez lauded staff for an excellent report, and reinforced the point that core CHN administrative staff was lost during budget cuts, and it is critical that this be restored. Commissioner Chow said the Department has done an excellent job creating a document that incorporates a number of reports that were previously reported separately. The report gives the Department and the Commission the ability to prioritize. He is very pleased that the Department has stayed together, rather than breaking up and creating an Authority, as was done in other jurisdictions. The San Francisco Department of Public Health has the potential to be the public health model for the nation. The Annual Report and Strategic Plan would not be possible without a unified system. Commissioner Monfredini said this is a working, interactive report. Many annual reports are put on a shelf, but this is not the case at DPH. Ours is an ongoing planning tool. 7) PROPOSITION 99 UPDATE Jeffrey Leong, AB 75 Coordinator, gave a status report on the AB 75 Project. The AB 75 Project began with the passage of Proposition 99 in 1988. This created the state Cigarette and Tobacco Products Surtax Fund to conduct anti-tobacco use campaigns, fund tobacco use research and pay for health services for the uninsured, through the California Healthcare for Indigents Program (CHIP). SFGH receives funding through this program for indigent medical services. In FY 05-06, the allocation is $1.2 million. The program also reimburses private hospitals and physicians for uncompensated medical care provided to uninsured adults and children. For FY 05-06, this amount is $500,000. Proposition 99 also requires the City to provide and/or pay for follow-up treatment services to CHDP-screened children. And through MICRS, it requires submission to the state of an annual data report on all medically indigent patients seen by SFGH and DPH. Today, there are additional revenues for indigent care including SB 12/Maddy, Emergency Medical Services Appropriation and local general funds. The total revenues for this program are $4.26 million. The mission of the AB 75 Project is to provide access to health care, promote health and well-being and prevent serious illness and disability for indigent families and individuals through the funding of health services, and by partnering and advocacy for care. The goals of the projects include: To effectively administer state and local grant funds To pay providers in a accurate and timely manner for the provision of emergency, obstetric and pediatric services to indigent San Franciscans To insure that CHDP-screened children receive follow-up treatment services at no cost to the families To submit accurate and complete indigent care data to the state. Mr. Leong described the County Hospital Program, which pays for uncompensated care provided by San Francisco private hospitals to persons who are medically indigent or uninsured, and the Physician Program, which pays for uncompensated care provided by San Francisco physicians. The Hospital program currently is used to pay for large dollar amount inpatient stays for medically indigent at CPMC, Chinese, St. Mary’s, St. Francis, UCSF and St. Luke’s hospital. For the physicians program, more than 90 percent of paid services are in hospital emergency rooms, including CPMC, St. Francis, St. Mary’s, UCSF, St. Luke’s and SFGH. Funds are allocated between community physicians (80 percent) and UCSF at SFGH physicians (20 percent). Mr. Leong described new program initiatives: Conduct program review/audits to assure compliance with program policies and procedures. Expand dental provider network to provide better access for CHDP-screened children requiring follow-up treatment Advocate for children’s health insurance coverage and use of existing insurance sources, such as Healthy Families and Healthy Kids Develop mechanisms for general assistance and homeless populations to have greater access to medical care, including reimbursement of services in hospital emergency rooms. Commissioners’ Comments Commissioner Chow asked what the program’s administrative overhead cost is. Mr. Leong said it is a little less than 10 percent. He added that the Department successfully reduced the Americhoice contract by 25 percent. Commissioner Chow thinks it would be worth opening a dialogue with Chinese Hospital to see if they could participate in the program. Mr. Leong will do so. Commissioner Illig asked if AB 75 has an allocation formula. Mr. Leong said that for the hospital program, there is a formula based on uncompensated care. Mr. Illig said it does not seem right to pass through money to private hospitals that are not doing enough charity care. He suggested a charity care threshold to be eligible to participate in the program. Dr. Katz said this would require state legislation. Commissioner Tarver asked if the hospital’s decision to seek reimbursement under this program is voluntary. Mr. Leong said yes, and hospitals choose which patients they want to apply to the CHIPs account. 8) PUBLIC COMMENT/OTHER BUSINESS There was no public comment. With regard to Other Business, the Commission set a hearing regarding the future of St. Luke’s Hospital, including the impact of the elimination of outpatient mental health services, for the November 15, 2005 Health Commission meeting. 9) ADJOURNMENT The meeting was adjourned at 6:15 p.m. Michele M. Seaton, Executive Secretary to the Health Commission Health Commission meeting minutes are approved by the Commission at the next regularly scheduled Health Commission meeting. Any changes or corrections to these minutes will be reflected in the minutes of the next meeting. Any written summaries of 150 words or less that are provided by persons who spoke at public comment are attached. The written summaries are prepared by members of the public, the opinions and representations are those of the author, and the City does not represent or warrant the correctness of any factual representations and is not responsible for the content.