Minutes of the Health Commission Meeting Tuesday, January 10, 2006 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 – left at 5:35 p.m. Commissioner Roma P. Guy, MSW, Vice President Commissioner James M. Illig Commissioner David J. Sanchez, Jr., Ph.D. Commissioner Donald E. Tarver, II, M.D. Commissioner John I. Umekubo, M.D. Absent: Commissioner Edward A. Chow, M.D. President Monfredini announced appointments to the Community Health Network Joint Conference Committee (CHN JCC). Commissioner David Sanchez will chair the CHN JCC, and Commissioner Tarver will serve the other member. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF DECEMBER 13, 2005 Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Tarver, Umekubo) approved the minutes from the December 13, 2005 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Illig chaired and Commissioner Sanchez and Commissioner Tarver attended. f the Budget Committee meeting. (3.1) PHP-Emergency Medical Services Agency – Request for approval to accept and expend, retroactively, a new grant from the California Emergency Medical Services Authority, in the amount of $240,860, to supplement on-call physician coverage for trauma services at San Francisco General Hospital Trauma Center, for the period of July 1, 2005 to June 30, 2006. (3.2) CBHS – Request for approval of a retroactive contract renewal with Lincoln Child Center, in the amount of $156,498, which includes a 12% contingency, to provide children’s 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 Ohlhoff Recovery Programs, in the amount of $376,583, which includes a 12% contingency, to provide behavioral health services to women and adolescents, for the period of July 1, 2005 through December 31, 2006 for a total contract amount of $632,659. (3.4) CBHS – Request for approval of a retroactive contract modification with Catholic Charities of San Francisco, in the amount of $86,375 per year, for 2 years, for new total contract value of $815,630, to provide supportive housing/mental health services to disabling HIV/AIDS homeless for the period of July 1, 2003 through June 30, 2007. (3.5) CBHS – Request for approval of a retroactive contract renewal with Regents of the University, in the amount of $345,610, which includes a 12% contingency, to provide program evaluation services for the Children’s System of Care for the period of September 30, 2005 through September 29, 2006. (3.6) CBHS – Request for approval of a retroactive contract renewal with Regents of the University of California, in the amount of $366,160, to provide crisis intervention & stabilization, clinical case management and linkage services for the period of July 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Tarver asked why the program was unable to meet its units of service. Edwin Batongbacal from CBHS said that the agency achieved 55% of its units of service in FY 03-04. DPH staff looked at the problem, which was mainly a result of staff turnover and the inability to recruit. The agency has achieved its FY 04-05 goals. (3.7) CBHS – Request for approval of a retroactive contract renewal with St. Vincent School for Boys, in the amount of $392,895/year, which includes a 12% contingency, to provide mental health outpatient services for the period of July 1, 2005 through June 30, 2007, for a total contract value of $785,790. Secretary’s note – Staff clarified that the contract is with Catholic Charities, with whom St. Vincent School for Boys has merged. (3.8) DPH-Environmental Health – Request for an approval of a new contract with Mission Economic Development Association, in the amount $73,538, which includes a 12% contingency, to provide fiscal management and business plan development services for the ongoing Day Labor Program, for the period of January 1, 2006 through September 29, 2006. Commissioners’ Comments Commissioner Illig ask Jenny Chacon from Environmental Health to convey to MEDA his concern about the number of people on the board. Ms. Chacon said MEDA now has only one vacancy, and MEDA staff is aware of the commissioner’s concerns. Commissioner Sanchez said that MEDA has provided years of service to the Mission community. He is pleased to see the Department looking at different pathways for approaching the day laborer population. The Mission Language Vocational Center is involved with day laborers as well. Ms. Chacon said they are working with Rosario Anaya. (3.9) AIDS Office-HIV Prevention – Request for approval of a retroactive new contract with UCSF-Stonewall Project, in the amount of $200,000, to provide HIV prevention services to men who have sex with men, for the period of July 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Illig asked if this contract is connected to the money for methamphetamine treatment that he read about in the Bay Area Reporter. Dr. Siever, UCSF Stonewall Project, said that this is a different contract. Magnet has two contracts with DPH, one with the AIDS Office and one with STD. Further, Stonewall Project has multiple programs with DPH. The programs referenced in the Bay Area Reporter are not related to this contract. Commissioner Tarver said he is going to advocate for expanded funding for the Magnet Program. (3.10) CBHS – Request for approval of a retroactive contract renewal with Mental Health Management, Inc. dba Canyon Manor, in the amount of $4,538,881 per year, which includes a 12% contingency, for a total two-year contract value of $9,077,761, to provide 24 hour locked mental health rehabilitation services for the period of July 1, 2005 through June 30, 2007. Secretary’s Note – Canyon Manor is a for profit organization, not a non-profit as noted in the Health Commission contract summary. Commissioners’ Comments Commissioner Illig expressed concern that one of the outcome objectives relates to number of patients returned to PES. Under what circumstances would patients return? Richard Evatz from Canyon Manor said that when patients become too acute for Canyon Manor’s level of care, they have to go to an acute level of care. Usually patients return to Canyon Manor. They have psychiatrists on staff, but are not licensed to provide acute care level of services. Commissioner Tarver said that L facilities are a vital part of the continuum of care but it behooves us to re-examine lengths of stay, costs, etc. He asked how Canyon Manor evaluates length of stay, discharge plans, etc. Mr. Stillwell said there has been a lot of pressure over the past years to move people from acute to subacute. So while subacute is expensive, it is much less costly than an acute hospital. That said, DPH staff continually look at the best place for these patients, and there is monthly utilization review. The nurse is out there every few weeks to evaluate whether patients can be discharged to the community, and there are on-going discussions with residential care facilities. Commissioner Tarver asked if the TCM project is involved in the UR meetings. Susie Reichert, Senior Administrative Analyst for Community Programs/Placement, said TCM is not done in the locked facilities. Ms. Garcia said that in December alone DPH staff moved 200 people from SFGH. Crestwood really assisted DPH in making this happen. As a result of the HMA Report, a Placement Committee is in place and is working on this issue. Commissioner Tarver requested Canyon Manor’s financials. Commissioner Illig recommended that this contract be approved for 15 months so that the Health Commission could review progress after one year. So the term of the contract is July 1, 2005 through September 30, 2006. (3.11) CBHS – Request for approval of a retroactive contract renewal with Regents of the University of California, in the amount of $719,765/yr, which includes a 12% contingency, to provide mental health and substance abuse services targeting low income, uninsured or underinsured clients with HIV/AIDS or disabling HIV for the period of July 1, 2005 through June 30, 2009 for a total contract value of $2,879,059. Commissioners’ Comments Commissioner Illig said this is the best set of outcome measures that he has seen in a long time. (3.12) CBHS – Request for approval of a retroactive contract renewal with Regents of the University of California, in the amount of $4,041,202, which includes a 12% contingency, to provide citywide case management mental health services targeting Psychiatric Emergency Services clients and County Jail inmates with mental illness, for the period of July 1, 2005 through June 30, 2007 for a total contract value of $8,082,404. (3.13) CBHS – Request for approval of a retroactive contract renewal with Crestwood Behavioral Health, Inc., in the amount of $6,500,000/year, which includes a 12% contingency, to provide 24 hour skilled nursing facility services for the period of July 1, 2005 through September 30, 2006, for a total contract value of $9,100,000. Secretary’s Note – Crestwood is a for profit organization, not a non-profit as noted in the Health Commission contract summary. Commissioners’ Comments Commissioner Tarver asked who often the patients are reviewed for discharge potential. Mr. Stillwell said there is a monthly utilization review, with special emphasis on improving the medical quality of these clients. Commissioner Tarver asked if the conservator is involved in the UR visits. Patricia Blum, Vice President of Crestwood Behavioral Health, said the conservator is there quarterly at a minimum. Commissioner Tarver asked that information regarding unduplicated clients and cost per unit. Commissioner Tarver said there should be other creative, clinical outcomes and treatment goals. (3.14) CBHS – Request for approval of a retroactive contract renewal with Progress Foundation, in the amount of $9,724,850, which includes a 12% contingency, to provide residential mental health services for the period of July 1, 2005 through June 30, 2006. Commissioners’ Comments Commissioner Illig asked Steve Fields, executive director of Progress, why the number of FTEs is being reduced. Mr Fields said the In-Reach shelter program was cut mid year, which resulted in a decrease of 3.25 FTEs. The other 1.0 FTE reduction is a mathematical error. Commissioner Illig was disturbed that three of the four objectives were not rated due lack of CBHS data. Mr. Fields said that there must be discussions with CBHS about how to measure what the Department and agency partners are trying to accomplish. CBHS only wants to include measures it can track and because CBHS’s system is basically a billing system, it cannot track many of the outcomes that Progress measure. This must change. Commissioner Illig asked if the agency has been paid under an interim agreement. Mr. Fields said the interim agreement expired December 31, 2005, and the delay in getting before the Health Commission has disturbed his cash flow, and this is upsetting. Commissioner Tarver asked why the contract was delayed. Mr. Fields does not know. Stephen. Banuelos, CBHS program manager, said CBHS is more behind than usual on contractors. (3.15) CBHS – Request for approval of a contract modification with Calvin Y. Louie, CPA dba Louie & Pak, LLP, in the amount of $6,191,325 per year, which includes a 12% contingency to provide fiscal intermediary services for the period of July 1, 2005 through December 31, 2006 for a total contract amount of $7,812,724. (3.16) CBHS – Request for approval of a retroactive renewal contract with the SAGE Project in the amount of $2,259,266, with an annual amount of $502,059, which includes a 12% contingency to provide outpatient mental health services for the period of July 1, 2005 through December 31, 2009, for a total contract amount of $2,530,377. Commissioners’ Comments Commissioner Illig encouraged SAGE to expand its board beyond six members. Commissioner Tarver has referred many patients to SAGE. It is a tremendous program. Action Taken: The Health Commission (Guy, Illig, Monfredini, Sanchez, Tarver, Umekubo) approved the Budget Committee Consent Calendar. For Item 3.10, the end of the contract was changed from June 30, 2007 to September 30, 2006. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. SFGH Summary of DHS/CMS Validation Survey On Monday, December 19th, a Department of Health Services (DHS) survey team, consisting of two RNs and 2 Pharmacists, appeared at SFGH to conduct an unannounced Centers for Medicare & Medicaid Services (CMS) Validation Survey. At the conclusion of the 4-day survey, five patient care issues were identified that required immediate correction: monitoring of patients on lithium; monitoring of diabetics on atypicals; IV admixture preparation outside of the pharmacy; procedure for addressing patients in clinical distress in acute psychiatry; and adding phenylephrine to the crash cart. The Interim Plan of Correction (POC) developed by the SFGH Executive Staff was accepted by CMS. SFGH was subject to daily visits by DHS until significant compliance with the Interim POC was demonstrated. On Tuesday, January 2, 2006, CMS/DHS abated the five patient care issues. It is expected that CMS/DHS will issue SFGH a full validation survey report that will contain additional findings. The Hospital Executive team has already identified action plans to address the additional findings. Medical Marijuana Program Moves to SFGHMC The Department began implementing the State Medical Marijuana Program (MMP) yesterday (January 9th) at San Francisco General Hospital. Staff processed 17 applications for the new MMP ID card. A number of patients seen at San Francisco General Hospital yesterday were familiar with the State Medical Marijuana Program and had obtained information and applications from the DPH and State MMP websites. News media (Channel 2, KCBS radio and KQED California Report) were on site to report on the new program. The MMP is located in the lobby of San Francisco General Hospital and operates Monday - Friday 1:00 - 4:00 p.m. The fee is $50 to process an MMP application ($25 for Medi-Cal). Patients must bring a letter from their doctor stating the patient has a medical condition where the use of medical marijuana is appropriate. Patients may designate one caregiver. The card, which is valid for one year, can be used in any county in California. San Francisco’s MCID's are valid in San Francisco county until the expiation date (up to 24 months). Proposition 63 Testimony A number of staff from Behavioral Health Services will testify before a panel review in Sacramento January 17th how the San Francisco Plan (Plan) intends to use the monies assigned for clinical services (Community Services and Supports [CSS]) under the Mental Health Services Act (Prop 63). The review panel is convened by the California Department of Mental Health (DMH) and is composed of consumers and professionals knowledgeable about county mental health services. Dr. Katz anticipates the hearing process will involve a series of requests for changes and clarifications before the panel recommends the Plan to Steve Mayberg, MD, Director of DMH. The monies will be released after Dr. Mayberg’s approval. DPH expects to receive over $5.3 million in new clinical services monies that will fund some administrative support and, if the Plan is approved as currently written, will include the following clinical services: The majority (51%) of CSS funding will provide Full Service Partnerships (FSP). FSP’s are case management with wrap-around services provided through a personal services coordinator, to accomplish "whatever it takes" to improve the client’s life in significant areas such as housing, health, relationships, education and employment. FSP programs will be funded by CBHS through MHSA with a combined total capacity to serve 122 to 153 individuals and their families across four age groups: children, youth & families; transition-age youth; adults; and older adults. A detailed breakdown of funding per age group is below. The remainder of CSS funding will be used for System Development to improve the service delivery system for all mental health clients and families. These efforts will include strategies for reducing ethnic disparities and for outreach to seriously mentally ill or emotionally disturbed residents of San Francisco who are currently receiving little or no services. It is anticipated that the monies will be available by March, and services will be provided by a combination of civil service and community based organizations to be determined by an RFP process. Full Service Partnership (FSP) Age Group Funding Proposal Children Youth and Families: $120,000 will be used to serve 100 children and youth each year for three years in community-based violence and trauma recovery services, including a peer-support component for youth. $120,000 will be used in integrating psychiatric services within pediatric settings for early identification of mental health and psychiatric needs. $121,490 will be used to increase organizational and clinical capacity to specifically serve Lesbian, Gay, Bisexual, and Transgender, Asian/Pacific Island, indigenous, Latino and African American children and youth with culturally appropriate services. $80,000 will be used in school-based services including wellness centers. Transition-Age Youth: $152,835 will be used to integrate behavioral health services within primary care settings that serve transitional age youth. $200,000 will be used to provide supported services for housing, including co-op housing, independent living and board and care. $300,000 will be used to do outreach and engagement and to support youth-run and youth-developed services using the Youth Development Model. Adults: $131,490 will be used for supportive services for housing, including peer case management. $100,000 will be used for Vocational Rehabilitation. Through a partnership with the Department of Rehabilitation, this funding will expand to $400,000, as they will match $3 for each $1 of CSS money spent. $130,000 will be used to support a peer-run center that will include crisis drop-in and a 24-7 warm line. $80,000 will go to residential treatment. Older Adult: $180,000 will be used to support a senior recovery center that offers peer support and outreach. $300,000 will be used to provide supportive services for housing including peer case management. $172,835 will be used for mental health services in primary care settings, including dementia behavior management. Commissioners’ Comments Commissioner Illig asked if civil service would compete fairly with non-profits through the RFP process for Proposition 63 funds. Ms. Garcia said that the majority of the dollars are going to non-profits through an RFP process. Commissioner Tarver asked for an update on SFGH’s census. Ms. O’Connell said the censuses decreased in December. However today it is 331, with the greatest increase in Med Surg. Commissioner Guy conveyed the Commission’s appreciation of the staff work that was involved in the CMS survey. 5) MATERNAL AND CHILD HEALTH ANNUAL REPORT Twila Brown, Director, Maternal and Child Health (MCH) and Ellen Stein, M.D., MCH Medical Director, presented the MCH 2004-2005 Annual Report. The report provides program highlights, an overview of federally mandated MCH health status indicators, MCH integration of the DPH Strategic Plan and data analysis of the inequality in African American fetal infant health mortality. The MCH Program is a traditional public health program that implements four public health functions: assessment, policy development, quality assurance and access. MCH services are population based, prevention focused, systematic in approach and social justice infused. The MCH Section is primarily state and federal funded and is currently organized into five units with subsections: Children’s Medical Services; Maternal Child and Adolescent Health; Family Planning; Nutrition Services; and Public Health Nursing. Title V health status performance indicators and Bay Area data analysis is used to guide MCH program planning and priority setting, and to develop planning interventions to produce better health outcomes for fetal and infant births and to impact infant death, prenatal care, birth weights, breastfeeding, dental care, children living in foster care, etc. Health priorities for the San Francisco MCH population include reducing infant mortality in African Americans, increasing early entry into prenatal care to 90% and increasing preconception and interconception care, among others. Dr. Stein described the data analysis methods and findings around birth trends. The birth rate in San Francisco dropped significantly for all ethnicities except Whites. The change in birth rates was greatest in the Black and Hispanic populations. Dr. Stein described the Perinatal Periods of Risk (PPOR) model, which is used for reviewing infant mortality. Dr. Stein also described the Bay Area Data Collaborative (BADC), which uses regional birth data that has the statistical power to analyze ethnic disparities. PPOR Regional BADC data shows that the fetal infant mortality rate in the Black population was more than double that of Whites, Hispanic and Asian/PI. Data also shows that the greatest number of Black fetal/infant deaths occur during the preconceptional/maternal health period. Risk factors include access to health care, infection, stress and work, general state of health prior to pregnancy, injuries and abuse, family planning, nutrition, tobacco/alcohol/drug use and previous pregnancy outcomes. Medical model approaches to perinatal inequities have not been effective. Non-randomized trials were either weak or unable to be sustained. Randomized trials showed no benefit. San Francisco has developed a different model. Response: Supporting Change Black Infant Health Program/Fetal Infant Mortality Review Committee/PPOR CenteringPregnancy Consortium –combines an empowering medical model with community groups and services; develop local peer-support systems; sharing best practices; develop Bay Area-specific new materials; comparing medical outcomes on a county, regional and state level. Preconception Care Bay Area Data Collaborative Universal Home Visiting Public Health Nursing Intervention Seven Principles. Challenges Decreasing Revenue at national, state and local levels. Universal Home Visiting – program sustainability; weekend PHN visits, non-invasive jaundice screening. Nursing Shortage Black Infant Health Sustainability Dental Access Pregnant Women – dental disease contributes to prematurity. Professional outreach and education. Many doctors will not accept these women. Children – pediatrician applied fluoride Service Integration, particularly around nursing services. Ms. Brown showed a video of the Black Infant Health Program. Commissioners’ Comments Commissioner Guy said the Population Health and Prevention Joint Conference Committee heard this presentation and was impressed with the methods through with MCH has identified the areas of need and developed appropriate interventions. She also appreciates the genuine health status model, rather than a clinical model. Evaluations show that this model works. The work pinpoints the problem of health disparities and shows how DPH’s response could help address these disparities. Commissioner Tarver said this is a great example within DPH about using best practices that have been developed elsewhere as well as internally. Have there been any thoughts of developing programs or outreaching to girls who are of pre-pregnancy age? Dr. Stein said that preconceptional health must to be provided to women of all ages. Ms. Brown said the preconceptional program is a life health model. Commissioner Sanchez congratulated MCH for the Bay Area Data Collaborative, which provides the ability to generate the data needed to validate interventions, best practices, etc. Each county has a community foundation, and Commissioner Sanchez urged the collaborative to make similar presentations to these foundations. Commissioner Umekubo commented that the infant mortality rates are used to gauge health care systems’ effectiveness. He is curious about how San Francisco compares nationally. Dr. Stein said they would have to look at the national health indicators to develop an appropriate comparison. 6) STATE AND FEDERAL LEGISLATIVE REPORT Scott Boule, Deputy Director, Office of Policy and Planning, presented the State and Federal Legislative Report. The priority that the Office of Policy and Planning places on legislative advocacy flows from the Department’s Strategic Plan. Office of Policy and Planning works within the City’s system to undertake direct advocacy, coalition work and the development of a two-year State Legislative Plan. Mr. Boule highlighted areas of interest. Federal Overview Record Deficits – 2005 deficit is the third largest ever. Non-defense discretionary spending is a small portion. Republican emphasis on spending cuts, particularly of entitlement programs – Medicaid cuts; HHS cuts. DPH really felt the impact of the HHS cuts, due to lack of earmarks. Additional tax cuts proposed Medicaid will continue to be on the chopping block. Ryan White CARE Act Reauthorization Program authorization expired in September 2005. This is not unusual, but puts program in a vulnerable position. Bush Administration did develop reauthorization principles, which are harmful to both San Francisco and California. The extent to which the principles will be in the final bill is unclear No legislation has been introduced yet. Mayor Newsom submitted a letter in August 2005. “Listening Sessions” are being held later this month. Medicare Prescription Drug Benefit Shift to private plans – Medicare Advantages vs. PDPs; varying formularies and cost sharing Impact on Dual Eligibles – the majority of DPH patients fall into this category. Patients now get drugs through Medicare instead of Medi-Cal. There are cost sharing requirements. New challenges for AIDS Drug Assistance Program (ADAP), including new cost sharing. State Overview Improving budget situation Impact of the special election Few bills signed into law Medi-Cal Hospital Financing Waiver Implementing legislation signed in October, implementing a five-year waiver; includes a hold harmless provision. Unresolved issues remain: new reimbursement mechanism (Certified Public Expenditures); funding in years 3, 4 and 5; coverage initiative; managed care expansion. Proposition 63 Behvioral Health Innovations Task Force – appointed by Mayor, met seven times from May to August 2005. Disappointing award for clinical services expansion. DPH has met with the Department of Mental Health and the Oversight Commission around this issue, and has prepared a plan in the event additional funding is obtained. State Medical Cannabis Card State card replaces the DPH card program. The program moved from 101 Grove to SFGH. Statewide implementation began in August. Delayed implementation – Board of Supervisors Resolution regarding protecting confidentiality. San Francisco’s approach protects confidentiality. Mr. Boule noted that the Legislative Report includes a summary of the health-related bills that were enacted in 2005, as well as a status report on bills that are tracked by the Department of Public Health. He noted a few of these bills, including AB 228 (Koretz), AB 547 (Berg), AB 417 (Aghazarian) and AB 1768 (Leno). Looking Ahead Federal – covering the uninsured; reauthorization of Ryan White, which is a critical DPH priority; additional spending cuts; implementation of the Medicare Drug Benefit. State – infrastructure bond/seismic safety. DPH’s priority is to make sure there is money for San Francisco General Hospital; Medi-Cal waiver for assisted living services; mobile methadone treatment; unresolved issued in the hospital financing waiver; and continuing to push for fair allocation of funds under Proposition 63. Commissioners’ Comments Commissioner Monfredini asked if confidence is justified in terms of Ryan White reauthorization. Mr. Boule said that we could be confident that reauthorization legislation will move forward, but San Francisco has a lot to worry about. San Francisco needs a hold harmless provision. Undoubtedly there will be an increase in the amount that San Francisco’s annual allocation can be reduced. Commissioner Monfredini asked Mr. Boule for his initial reaction to the Governor’s budget. Mr. Boule said that with regard to the state budget, there is not a lot of new money for health. But one of DPH’s priorities is the infrastructure bond. Commissioner Illig said the Ryan White CARE fund had two parts: formula and supplemental. The hold harmless agreement relates to the formula allocation. He is concerned that over the past few years, San Francisco’s supplemental requests have not been as successful as in the past. There are other troubling recommendations, including the requirement that 75 percent of funding go for core services, with no definition of core services. Commissioner Illig recommended that the Health Services Planning Council present its priorities to the Population Health and Prevention Joint Conference Committee. Mr. Boule said that the key factor in San Francisco’s supplemental applications the shrinking amount of money that is available nationwide for supplementals, not necessarily inadequate applications. Dr. Katz added that some of the recent supplemental problems have been political problems. Commissioner Illig asked if the Department should consider name-based reporting. Dr. Katz said this is a policy decision for the Health Commission. As of now, the Health Commission’s current policy about name-based reporting stands. Commissioner Illig asked if there has been success with the long-term care waiver. Mr. Boule said Assemblymember Yee put forth legislation that would have allowed a supportive housing waiver to move forward. This is stalled, and the legislation is being reworked. Commissioner Umekubo said one of the insidious components of the Medi-Cal waiver is the reduction in physician fees, and the Department should keep an eye on this. Mr. Boule said there was a 4.4% reduction in physician services under Medicare, but there is a proposal to reverse this. Congress has not yet voted on the proposal. Commissioner Tarver asked if DPH has a directory of contracts with private hospitals. Mr. Boule will follow up with the Contracts Office. Commissioner Tarver asked the status of funding for the Trauma Recovery Program. Mr. Boule said that unfortunately the Governor vetoed this legislation. Assemblymember Leno has committed to reintroducing legislation in 2006. Commissioner Guy added that the Department anticipated the reduction in CARE funds, and discussions around the integration of HIV/AIDS services into Primary Care and Community Behavioral Health should continue. There is going to be less money. Commissioner Guy asked that the Health Commission be kept apprised of legislative activity around both universal health care and prescription drug access. Commissioner Tarver looks forward to the Joint Conference Committee discussion around the integration of HIV/AIDS services. 7) APPROVAL OF A REVENUE SUPPLEMENTAL APPROPRIATION FOR SAN FRANCISCO GENERAL AND LAGUNA HONDA HOSPITALS Gregg Sass, Chief Financial Officer, said the Department is requesting approval of a revenue supplemental appropriation of $10.259 million for expenditures that exceed budget at San Francisco General and Laguna Honda Hospitals. No general funds are requested. Revenues at San Francisco General are expected to exceed budget by $8.596 million. Revenues at Laguna Honda Hospital are expected to exceed budget by $10 million. Surplus revenues at San Francisco General Hospital primarily consist of higher than expected revenues for Medi-Cal as a result of Medi-Cal reform. Surplus revenues at Laguna Honda Hospital are due to a large increase in the Medi-Cal base per diem rates. The increased revenue from the base per diem may be partially offset by a corresponding reduction in supplemental payments (DP/NF). The revenue increase is a conservative estimate of the net effect of the increase and the offsetting reduction. The supplemental will fund thee areas: $4.486 million unfavorable variance in Personal Services and Fringe Benefits due to high patient volume General Hospital; $2.915 million unfavorable variance due to need to retrofit a chiller than can no longer be repaired; $2.858 million unfavorable variance at Laguna Honda Hospital primary as a result of changes in staffing necessitated by a recent licensing survey at Laguna Honda. Public Comment Sam Alicia Duke spoke on behalf of a community fund that could be funded through the excess revenues. This would be a good step in increasing community resources to help disabled and elderly individuals live in the community. Tomorrow is the grand opening of Eugene Coleman Community House. We need more of these developments throughout the city. Norma Sattan, Planning for Elders in the Central City, said they would like the Health Commission to consider using some of this excess money to create a community fund to provide more home and community-based long-term care services. Marie Jobling, co-chair of the Long-term Care Coordinating Council, said nobody should be at Laguna Honda Hospital or any other institution because of lack of community resources. The barrier is the development of alternatives, and this money provides a rare opportunity. If these revenues were put in a community trust fund, the Health Commission would be able to promote community alternatives without taking the money from someone else. She asked that the Health Commission consider for action at a future meeting the creation of a community fund. Elizabeth Zirker, Protection and Advocacy, supports the idea of using supplemental revenues to establish a community fund. San Francisco has made great efforts to comply with the Olmstead Act, but is not yet in compliance. San Francisco can take this opportunity to be creative to supplement adult day health, expand TCM, etc. This is an opportunity separate from the discussion around the Laguna Honda Hospital rebuild. Meg Cooch, Planning for Elders in the Central City, said the time is now for the Health Commission to act for alternatives to institutional care. Here is some unallocated money that can be directed into community-based services. The Long Term Care Coordinating Council has a plan toward which this money could be allocated. Tricia Webb said she is a living example of a person who lives in the community with services. She is independent. She does not have to depend on being institutionalized to get the services she needs. More people need these services, and this money should be put toward long-term care. Commissioners’ Comments Commissioner Monfredini asked Mr. Sass to clarify that the supplemental appropriation before the Health Commission is to fund overexpenditures due to cost of doing business at San Francisco General Hospital and Laguna Honda Hospital. Mr. Sass said that is correct. Commissioner Illig said this is an important opportunity that the Health Commission needs to move on. When the Controller came forward to the Health Commission in May with his report on Laguna Honda Hospital, one of the options was using the savings from operating a smaller LHH to create a community trust fund. This money is a windfall and provides an opportunity to start a community fund now. He recommends that the President refer this issue to one of the joint conference committees and come back to the Health Commission in the near future to consider creating a special fund with $7 million in excess revenues. If the Health Commission does not appropriate this money now, it will be used later for other things. Dr. Katz said what is before the Commission today is a supplemental to cover overexpenditures at SFGH and LHH. It is in the province of the Commission to recommend to the Board of Supervisors that they appropriate the remaining revenues differently. He supports the suggestion to refer this issue to a joint conference committee. Commissioner Tarver wants the Health Commission to have a role in setting priorities for how any excess money is spent, including the creation of a trust fund for Laguna Honda Hospital. Commissioner Sanchez said he supports the supplemental appropriation, and also supports further discussion around additional revenues. Commissioner Guy supports the discussion about the community trust fund taking place at the Community Health Network Joint Conference Committee (CHN JCC), primarily because this committee has a broader overview of the policy issues the Health Commission wants to examine and has members from across the Department. This does not preclude a presentation to the Laguna Honda Hospital Joint Conference Committee as well. In addition, several community members were de-linking the idea of the community trust fund from Laguna Honda, which is another reason she thinks the initial discussion should take place at the CHN JCC. Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Tarver, Umekubo) approved the $10.259 million revenue supplemental appropriation. The issue regarding the creation of a long-term care community trust fund was referred to the Community Health Network Joint Conference Committee for consideration and reported back to the Health Commission within 60 days. 8) PUBLIC COMMENT/OTHER BUSINESS None. 9) ADJOURNMENT The meeting was adjourned at 5:45 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 noted 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.