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Healthy San Francisco

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Universal Health Care for all San Francisco Residents

Mayor Newsom announcing Healthy SF

The city of San Francisco was greatly troubled by the number of residents without healthcare and decided to do something about it. Rather than wait on the state or federal government, the City and County of San Francisco created Healthy San Francisco, universal health care for all San Francisco residents. While the program is unique to San Francisco in some respects, there are many aspects of the Healthy SF model that may be replicated in other communities. This is not a cookie cutter approach – factors that make HealthySF work in San Francisco may not necessarily be the same factors for other places.

“there are many aspects of the Healthy SF model that may be replicated in other communities”

The following is a list of frequently asked questions about the program, a brief summary of how San Francisco began the program and a few things to keep in mind when attempting to increase access to health care in your community, such as the program’s structure, and a list of stakeholders likely to be involved in the process.

FAQs

What is Healthy San Francisco?

Healthy San Francisco is a program created by the city of San Francisco that makes health care services accessible and affordable for uninsured residents. Healthy San Francisco offers a new way for San Francisco residents who do not have health insurance, to have basic and ongoing medical care.

Some services such as Vision, Dental, Acupuncture, and others are not included.

Healthy San Francisco is Not Health Insurance. Insurance is always a better choice because Healthy San Francisco has limited services and places you can go to get medical care. Participants in Healthy San Francisco are each assigned a Medical Home. A Medical Home (in most cases, a clinic) provides all basic health care services.

What services are included in Healthy San Francisco?

The following services are included with Healthy San Francisco:

Preventive and Routine Care
Specialty Care
Urgent Care (only at hospitals in your Medical Home Network)
Emergency Care (only at hospitals in your Medical Home Network)
Ambulance Services (within San Francisco)
Hospital Care
Alcohol and Drug Abuse Care
Laboratory Services and Tests
Mental Health Care
Family Planning
Durable Medical Equipment
Prescription Medicine

The following services are not included:

Dental Services
Acupuncture
Allergy testing and injections
Chiropractic
Cosmetic
Dental
Travel immunizations
Gastric by-pass surgery and services
Genetic testing and counseling
Infertility
Long-term care
Organ transplants
Sexual reassignment surgery
Non-emergency transportation
Vision

How much does it cost families?

The Healthy San Francisco Participant Fee is based on a “sliding scale.” This means that the program will cost participants more or less depending on their place on the Federal Poverty Level. Participants who earn less will pay less; participants who earn more will pay more. Examples of possible fees are below.

Household Size	Your Monthly Household Income
1	$0 – $904	$905 – $1,806	$1,807 – $2,708	$2,709 – $3,610	$3,611 – $4,515
2	$0 – $1,216	$1,217 – $2,430	$2,431 – $3,643	$3,644 – $4,857	$4,858 – $6,075
3	$0 – $1,527	$1,528 – $3,053	$3,054 – $4,578	$4,579 – $6,104	$6,105 – $7,630
4	$0 – $1,839	$1,840 – $3,676	$3,677 – $5,513	$5,514 – $7,350	$7,351 – $9,190
5	$0 – $2,151	$2,152 – $4,300	$4,301 – $6,448	$6,449 – $8,597	$8,598 – $10,750
Participant Fee Paid four times a year	$0	$60	$150	$300	$450

What is the impact on employers?

The San Francisco Health Care Security Ordinance requires medium and large-sized employers to spend a minimum amount per hour on healthcare for their employees who work in San Francisco.

The Employer Health Care Expenditure Rate Schedule is as follows:

Employer Health Care Expenditure Rate Schedule
	Business Size (Company-wide)	January 1, 2009	January 1, 2010
Large {	100+ Employees	$1.85/ hour	$1.96/ hour
Medium {	20-99 Employees	$1.23/ hour	$1.31/ hour
Small {	1-19 Employees	Not Applicable

The employee health service choices employers may elect to satisfy Health Care Security Ordinance requirements include:

Medical, dental, and/or vision insurance;
Reimbursing employees for their health expenses;
Various types of medical spending accounts or
The “City Option”, which includes Healthy San Francisco and Medical Reimbursement Accounts

Ensuring compliance of the employer minimum spending requirement will be the responsibility of the San Francisco Office of Labor Standards Enforcement (OLSE).

How do residents enroll in the program?

Enrollment for Healthy San Francisco occurs at over thirty sites across the city, including all primary care medical homes, San Francisco General Hospital, a centralized eligibility and enrollment unit within the Department of Public Health and at the offices of the program’s third-party administrator, the San Francisco Health Plan. Most participants may enroll at any site, subject to meeting eligibility requirements. For participants who are enrolling into HSF as a result or their employer’s selection of the City Option to meet required health care expenditures, their program enrollment occurs at the offices of the program’s third-party administrator (San Francisco Health Plan).

Applicants are assisted through the application process by an application assistor who has been trained in HSF eligibility rules and procedures. To facilitate enrollment, the Healthy San Francisco implemented One-e-App, a web-based, decentralized eligibility determination and enrollment system with built-in logic software to assess an applicant’s potential health coverage options. One-e-App screen and enrolls participants in Healthy San Francisco. One-e-App is the HSF system of record and provides the final determination for HSF eligibility. One-e-App enables participants to be screened for eligibility in a range of federal or state health coverage programs before enrolling in Healthy San Francisco, preserving limited local resources.

At the time of enrollment, eligible participants select their medical home from a list of clinics. Participants who are current patients at a particular clinic are able to retain this site as their medical home. Other participants can select primary care medical homes from sites open to accepting new patients according to their preferences — language, location, population focus, specialty area, etc.

Once enrolled, a participant’s coverage under Healthy San Francisco is effective for one year. At the end of the year, participants who continue to meet program eligibility criteria are re-certified based eligibility criteria.

What lawsuits has the city faced?

In November of 2006, the Golden Gate Restaurant Association (GGRA) filed a lawsuit challenging the Employer Spending Requirement (ESR) of the HCSO.
The following provides a brief chronology of events related to the lawsuit:

December 26, 2007: The parties filed Motions for Summary Judgment in July of 2007, and a hearing on these motions was held on November 2, 2007. The District Court’s written decision (PDF), which ruled that the ESR was invalid, was issued on December 26, 2007.
December 27, 2007: The City & County of SF files an Appeal and Emergency Motion for a Stay Pending Appeal, asking the Ninth Circuit Court of Appeals to allow the ESR to go into effect on January 2, 2008.
January 9, 2008: The Court of Appeals grants the City’s Motion for a Stay, which allows the ESR to go into effect, pending the City’s appeal of the District Court’s decision.
February 7, 2008: The GGRA files an application to the U.S. Supreme Court, seeking to lift the Court of Appeals’ ruling.
February 21, 2008: Justice Kennedy denies the GGRA’s application, and the ESR continues to be in effect pending the City’s appeal of the District Court’s decision.
April 17, 2008: Oral argument on the City’s appeal is heard by the Court of Appeals.
September 30, 2008: The Court of Appeals issues a decision reversing the District Court’s ruling and upholding the ESR of the HCSO.
October 2008: The GGRA requests en banc hearing by the Court of Appeals.
December 2008: The City & County files its response to the GGRA’s request.
March 9, 2009: The Court of Appeals denies the GGRA’s request for a rehearing en banc.
March 18, 2009: The GGRA files an emergency application to the U.S. Supreme Court, seeking to prevent the City from continuing to implement the ESR while GGRA prepares its appeal, which is due June 8, 2009.
March 30, 2009: Justice Kennedy denies the GGRA’s application, and the ESR continues to be in effect.
June 8, 2009: The GGRA files a petition with the U.S. Supreme Court, requesting the Court to rule on the legality of the ESR. The U.S. Supreme Court is anticipated to decide whether to hear the case by October or November of 2009.

The Court of Appeals’ September 30, 2008 decision upholding the ESR is now final, and the ESR continues to be in effect for all covered businesses.

How are services for the previously non-insured provided?

Service Utilization Data

The data indicate that utilization of health care services among HSF participants has decreased or remained relatively constant from fiscal year 2007-08 to the current fiscal year 2008-09 (annualized).

Service Utilization	FY 2007-08 Actual	FY 2008-09 Annualized
Average visits per participant per year	3.93	3.05
Outpatient laboratory services per participant per year	1.47	1.10
Outpatient radiology services per participant per year	0.55	0.41
Surgical procedures (inpatient & outpatient) per participant per year	0.19	0.15
Average number of prescriptions per participant per year	8.75	6.45
Hospital admissions per 1,000 participants(1)	28.2	18.4
Number of hospital days per 1,000 participants(2)	103	61
Average length of stay – hospitalization(3)	3.64	3.34
ED visits per 1,000 participants	175	128
Urgent care visits per 1,000 participants	134	131
Average mental health visits per participant (CBHS data only)	1.53	1.33
Average substance abuse visits per participant (CBHS data only)	0.60	0.56

1) Fiscal year 2008-09 data is for July 2008 – September 2008 only.

2) Fiscal year 2008-09 data is for July 2008 – September 2008 only.

3) Fiscal year 2008-09 data is for July 2008 – September 2008 only.

One key goal of HSF is to provide participants with a usual source of care (i.e., primary care medical home) in the hope that this will reduce episodic care, reduce emergency department and urgent care visits and reduce avoidable emergency department visits. The data indicates that 7.3% of the ED visits to date were avoidable which is lower (14.8%) in comparison to San Francisco Health Plan data for adults Medi-Cal recipients.

What features of HealthySF can be replicated in my community?

The key generalizable features of HSF that could be replicated are:

Focus on primary care home to reduce duplication and improve coordination
Centralized eligibility system to maximize public entitlement and increase coordination of benefits
Centralized system of record creates accountability and comprehensive database for planning & evaluation purposes
Non-insurance (care) model that can potentially result in lower costs and leverage federal/state funds for localities
Establishment of predictable, affordable participation fees; may not be viewed as charity by participants
Shared financial responsibility (public, participant, employer)
Public-private partnership maximizes available resources

What other healthcare programs can we consider?

California counties may be able to re-examine indigent care programs to ensure that they emphasize a medical home, comprehensive services, etc. and maximize charity care services by non-profit hospitals.

Process

1. Decide the approach

In 2006, Mayor Gavin Newsom created a Universal Healthcare Council (UHC) to develop a plan to provide access to health care for San Francisco’s uninsured adults. The council estimated 60,000 uninsured adults lived in San Francisco but some were receiving care from one of the many non-profit clinics in the City.

Identify the number of uninsured residents in your community and determine how they get treated. Assemble a task force with members from the city/county government, health department, chamber of commerce, and private and public clinics. Your health department may be another place to start if they are well resourced. They have some resources that will prove beneficial later on in the process. They will also be a major stakeholder and should be considered in all steps along the way.

Determine if the health care infrastructure and delivery system you need is already in place. San Francisco had 27 non-profit clinics that were already providing health care for the uninsured. Gather information about the number of providers (i.e. hospitals, public clinics, private clinicians) in your area, their business model, who they serve, and their operating levels. A strong infrastructure is necessary before program details can be finalized.

2. Study your options

San Francisco created a program that would make it easier for a large number of uninsured adults to received care at their nearest clinic. Instead of providing health insurance, the City focused on increasing access to subsidized care. The program is funded through public funding, federal funding, participation fees, and employer fees established through ordinance.

After identifying the target population, determine if your community is better suited to provide access to care or health insurance. Have an actuarial analysis developed to estimate the cost of providing health insurance to uninsured population in your community. Consult previous studies performed on your community by the local health department or outside agencies. If financially possible, conduct a study to determine the best option for your community with the help of your local health department and/or an outside agency. Determining the best option for your community will also depend on the resources different parts of the local, state, and federal government are willing to provide to administer the program.

Once the structure and funding are set, develop the program model. Determine the population for which services will be provided, decide if dental or emergency room services will be provided along with regular care, and contact providers that will deliver services to population. Determine eligibility requirements, maximum enrollment, how population will be enrolled into program, and estimate the cost of providing program services (both care and administration). Finally, estimate revenues available to cover costs and assign participant fees that may be needed to cover any outstanding expenses. Participant fees may be determined using a sliding scale that assesses an individual’s ability to pay based on their income and employment situation.

3. Discuss with stakeholders

After developing the program model, reach out to your community and hold meetings between health departments, elected officials, clinics, and funders. Involve the care providers in the conversation as soon as possible. They will have input on the services they provide and at what capacity. Some clinics may only want to serve specific communities because of requirements set forth by their funders. Private clinics may be interested in discussing payment options for their services. The parties providing care and paying for care should be clear by the end of the meetings.

4. Identify sponsor, introduce legislation, and build support

San Francisco’s Universal Healthcare Council presented its recommendations for the development Healthy San Francisco in June of 2006. Shortly thereafter, Supervisor Tom Ammiano incorporated the program into his Worker Health Care Security Ordinance. The ordinance created an Employer Spending Requirement enforced by the Office of Labor Standards Enforcement and requires the Department of Public Health to implement Healthy San Francisco. The Employer Spending Requirement requires Covered Employers to spend a minimum amount of money on Health Care Expenditures for their covered employees. Legislation may be required in your community if you are implementing employer spending requirements to help pay for the program.

5. Implement

Ensure broad-based oversight group created to provide community input. Patient input will be one of the fastest forms of feedback in the programs start-up stage. Phase implementation given complexity of effort. This allows for program to make modifications as needed. The program will not maximize efficiencies overnight. Clearly communicate planning and implementation strategy with the community and the care providers. This helps manage expectations of participants, providers, the public, and other interested parties. Perform community outreach for your program and use clinics, community organizations, schools, churches, and other popular places for your targeted community to deliver the message.

6. Monitor and Evaluation

Your health department may have the most resources to monitor the program. A monitoring group may be created if your heath department lacks the resources necessary to monitor the program. The monitoring group may be similar to the health council in size and participant diversity. Make measuring success easier by choosing only significant metrics that will measure different aspects of the program.

Stakeholders

Department of Public Health
Kaiser Permanente
Non-profit clinics
Private clinics

Ordinance

REGULATIONS IMPLEMENTING HEALTHY SAN FRANCISCO AND MEDICAL REIMBURSEMENT ACCOUNT PROVISIONS OF THE

SAN FRANCISCO HEALTH CARE SECURITY ORDINANCE

1. Purpose

(a) The purpose of these Regulations is to implement Chapter 14, Sections 14.2 and 14.4 of the San Francisco Administrative Code, the San Francisco Health Care Security Ordinance (“HCSO” or “Ordinance”) which authorizes the Department of Public Health (“DPH”) to: (i) create and administer a program to provide health care services to San Francisco’s uninsured residents; and (ii) establish and maintain Medical Reimbursement Accounts for non-residents who work in San Francisco and other qualified individuals.

(b) The program referenced in subsection (a)(i) above is identified in the Ordinance as the “Health Access Program.” However, DPH has determined that the name “Health Access Program” creates confusion among San Francisco residents because of its similarity to other programs. Accordingly, the program shall be named “Healthy San Francisco,” and is hereinafter referred to in these regulations as “Healthy San Francisco.”

(c) The Healthy San Francisco program will fulfill the City and County of San Francisco’s obligation to provide services to indigent persons in need of medically necessary services as required by California Welfare and Institutions Code Section 17000. The Regulations in no way shall be construed as an expansion of the City and County of San Francisco’s existing obligations to provide health care under any California and/or federal law.

2. Definitions

(a) Applicant. Any person who applies to participate in the Healthy San Francisco program or the Medical Reimbursement Account program.

(b) Application. The form developed by DPH to determine applicant eligibility for Healthy San Francisco.

(d) Clinical Site or Clinical Setting. Any licensed facility that provides health services.

(e) Covered Employee. Any person that meets the definition provided in Section 14.1(b)(2) of the Administrative Code and Regulation 3 of the Office of Labor Standards and Enforcement’s Regulations Implementing the Employer Spending Requirement of the San Francisco Health Care Security Ordinance.

(f) Covered Employer. An employer that meets the definition as set forth in Section 14.1(b)(3) and its inclusive subparts of the Administrative Code and Regulation 2 of the Office of Labor Standards and Enforcement’s Regulations Implementing the Employer Spending Requirement of the San Francisco Health Care Security Ordinance.

(g) Federal Poverty Level. Level determined by the “Poverty Guidelines for the 48 Contiguous States and the District of Columbia” as contained in the Annual Update of the HHS Poverty Guidelines developed by the United States Department of Health and Human Services as published in the Federal Register.

(h) Healthy San Francisco Participant. Any uninsured San Francisco resident who fulfills all Healthy San Francisco eligibility provisions and is enrolled in the program.

(i) Health Services. Those services provided through the Healthy San Francisco program which a Participant will receive to treat a health or medical condition, promote health and/or prevent disease.

(j) Household Income. The total annual income of all family members in a household.

(k) Medical Home. The clinical site or clinical setting in which a Participant receives preventive and primary care services.

(l) Medical Reimbursement Account. An account established and maintained by DPH or its vendor from which eligible individuals may receive reimbursement for out-of-pocket medical expenses.

(m) Ordinance. The San Francisco Health Care Security Ordinance adopted by San Francisco Board of Supervisors as Ordinance 218-06, inclusive of any future and subsequent amendments.

(n) Participation Fee: A quarterly amount that Participants in Healthy San Francisco must pay to remain eligible for care under the program.

(o) Point-of-Service Fees: The amount(s) a Participant must pay for specific services at the time services are obtained.

(p) Provider: A California licensed health plan, hospital, clinic or clinician contracted to deliver health services to program Participants.

(q) Third-Party Administrator. A vendor or other entity that DPH enters into a contract with to perform specified administrative functions on behalf of the program.

3. Healthy San Francisco Program Eligibility

(a) An eligible Participant is any person who:

Pregnancy-Related Medi-Cal (Omnibus Budget Reconciliation Act);
Pregnancy-Related Medi-Cal (Presumptive Eligibility);
AIM Access for Infants and Mothers;
Omnibus Budget Reconciliation Act Medi-Cal (non-pregnancy and emergency only);
Family PACT (Planning, Access, Care, Treatment);
Breast and Cervical Cancer Treatment Program (California-only); and
Cancer Detection Program.

(ii) is between the ages of 18 and 64 years old, or is an emancipated minor, or a minor not living in the home of a birth or adoptive parent, a legal guardian, caretaker relative, foster parent, or stepparent, and is applying for coverage on his or her own behalf;

(iii) has been without employer-based or individually-purchased health insurance for 90 days from the date of application for Healthy San Francisco eligibility, or has lost employer-based health care coverage within 90 days of date of application due to a change in employment status, or who has lost COBRA coverage within 90 days of date of application;

(iv) is ineligible for California and/or federally-funded health insurance or assistance programs, provided that the applicant’s eligibility for the following programs shall not make the applicant ineligible for Healthy San Francisco:

(b) Neither employment status, immigration status nor the existence of pre-existing health conditions shall be used to exclude a person from eligibility for Healthy San Francisco.

(c) DPH will develop an application for participation in Healthy San Francisco and a process for obtaining a Medical Reimbursement Account for potential participants.

(d) The Healthy San Francisco application will collect information from the applicant necessary to determine program eligibility and eligibility for any subsidies for participation in the program, including, but not limited to name, address, household income, and employment status.

(e) An eligible Participant shall be enrolled for participation into the Healthy San Francisco program if he/she submits a completed application, fulfills the eligibility requirements and pays the required participation fees as established by DPH.

(f) DPH shall, from time to time, require participants to re-establish eligibility for participation in Healthy San Francisco.

4. Healthy San Francisco Program Fees

(a) Healthy San Francisco will have two fee components for its Participants: “participation fees” and “point-of-service fees.” These fees shall be based on Participant income which is measured with reference to the Federal Poverty Level.

(ii) Point-of-service fees shall be assessed on a sliding scale based on a Participant’s Federal Poverty Level when a Participant receives services at a clinical site or clinical setting.

(iii) Any person with an annual household income between 0% and 500% of the Federal Poverty Level shall be eligible for a subsidy for the participation fee, to be determined by DPH.

(b) Non-payment of the participation fee by the program Participant can result in cancellation of enrollment from the Healthy San Francisco program.

5. Healthy San Francisco Services

(a) The program shall provide health services for the treatment of medical conditions with an emphasis on wellness, preventive, and primary care. Services include: professional services by clinicians (i.e., doctors, nurse practitioners, physician assistants, and other licensed health care providers) including preventive, primary, diagnostic, and specialty services; inpatient and outpatient hospital services; diagnostic and laboratory services, including therapeutic radiological services; behavioral health services, including mental health and substance abuse services; prescription drugs, excluding drugs for excluded services; home health care; urgent care; and emergency care provided in San Francisco.

(b) The following is a non-exclusive list of services that shall not be provided by Healthy San Francisco program:

(ii) Allergy Testing and Injections;

(iii) Audiology (including hearing aids);

(iv) Chiropractic;

(v) Cosmetic;

(vi) Dental;

(vii) Gastric By-Pass Surgery and Services;

(viii) Genetic Testing and Counseling;

(ix) Infertility;

(x) Long-Term Care;

(xi) Organ Transplants;

(xii) Sexual Reassignment Surgery;

(xiii) Transportation: Non-urgent; and

(xiv) Vision.

(c) Healthy San Francisco does not cover any services, including emergency services, provided outside the City and County of San Francisco.

6. Healthy San Francisco Service Provision and Delivery Network

(a) Each Participant shall have a designated clinical site or clinical setting that shall serve as his/her primary care medical home. The primary care medical home shall coordinate a Participant’s access to services in the program, monitor management of medical conditions and provide continuity of care.

(ii) Participants may request a medical home change during their pre-determined program recertification and re-enrollment process.

(iii) Participants may make requests to change their primary care provider (i.e., a physician, nurse practitioner or physician assistant) within their medical home.

(b) The network of providers delivering services to program Participants shall be confined to licensed providers who have a physical location and practice in the City and who have entered into agreements and/or contracts with DPH and/or its Third-Party Administrator to provide services under this program.

(c) Healthy San Francisco shall not cover or reimburse payment for services delivered to program Participants by providers that have not entered into agreements and/or contracts with DPH and/or its Third-Party Administrator to provide services to Participants under this program.

7. Covered Employee Participation Rules

(a) Covered Employers who chose to satisfy the Employer Spending Requirement under the Ordinance by making payments to the City shall deliver the payments to DPH’s Third Party Administrator. Payments shall be made consistent with the provisions of Section 14.3(a) of the Administrative Code and Regulation 6 of the Office of Labor Standards and Enforcement’s Regulations Implementing the Employer Spending Requirement of the San Francisco Health Care Security Ordinance.

(b) Along with its payments, the Covered Employer shall provide to DPH’s Third-Party Administrator: (i) the name of the Covered Employee, (ii) the amount paid per Covered Employee and (iii) other information as needed by DPH to determine whether the Covered Employee is eligible for participation in Healthy San Francisco or for the establishment of a Medical Reimbursement Account. DPH or its Third-Party Administrator shall provide Covered Employers with a form upon which they may provide this information along with their payments.

(c) DPH’s Third-Party Administrator will use the information provided by the Covered Employer pursuant to subsection 7(b) above to determine whether the payment made on behalf of a Covered Employee shall be used to fund the Covered Employee’s participation in Healthy San Francisco or to establish a Medical Reimbursement Account for the Covered Employee.

(d) Covered Employees on whose behalf a payment has been made to satisfy the Employer Spending Requirement shall be notified by their Covered Employer that such a payment has been made in accordance with Regulation 7.1 of the Office of Labor Standards and Enforcement’s Regulations Implementing the Employer Spending Requirement of the San Francisco Health Care Security Ordinance.

(e) DPH or its Third-Party Administrator shall inform Covered Employees where they may go to be screened for enrollment in Healthy San Francisco and/or establishment of Medical Reimbursement Accounts.

(f) A Covered Employee on whose behalf payment has been made to DPH must, in order to participate in Healthy San Francisco, meet program eligibility requirements and enroll in Healthy San Francisco.

(ii) Payments by the Covered Employer shall entitle the Covered Employee to a discounted Participation Fee for six months from the date of enrollment. After six months from the date of enrollment, and every six months thereafter, DPH or its Third-Party Administrator shall determine whether the Participant’s Covered Employer has continued payments on the Participant’s behalf in the preceding six months. If the Covered Employer has continued to make such payments, the Participant shall remain eligible for a discounted Participation Fee for the following six months. If DPH or its Third-Party Administrator determines that the Covered Employer has not made payments on the Participant’s behalf for the preceding six months, the Participant may remain enrolled in Healthy San Francisco by paying a non-discounted Participation Fee.

(g) A Covered Employee that does not meet the program eligibility requirements for participation in Healthy San Francisco but wishes to benefit from the payment made on his/her behalf by a Covered Employer, the Covered Employee may sign up for a Medical Reimbursement Account to be established and maintained by DPH’s Third Party Administrator. Any funds collected on behalf of a Covered Employee during the calendar year shall be forfeited if the Covered Employee does not sign up for a Medical Reimbursement Account by July 1 of the subsequent calendar year. Any forfeited funds shall be used by DPH to fund the programs described in these regulations.

(ii) Any administrative fees charged to the City to establish and maintain the Covered Employee’s Medical Reimbursement Account shall be deducted from the balance amount in that Covered Employee’s Medical Reimbursement Account.

(iii) A Covered Employee must use the money deposited into the Medical Reimbursement Account within a designated period of time as determined by DPH.

8. Public Information on Healthy San Francisco

(a) DPH shall make available to the public all information necessary to facilitate participation in the programs authorized by the Ordinance.

(b) Written program materials for applicants and participants will be offered, at a minimum in the following languages: Chinese, English and Spanish.

(c) DPH will maintain a program website and ensure that access to program information is available through the 311 System operated by the City.

9. Healthy San Francisco Administration

(a) DPH is responsible for the overall administration of the Healthy San Francisco and Medical Reimbursement Account programs. Its responsibilities include, but are not limited to: overseeing overall program development and implementation; defining program goals, design and policy objectives; ensuring adequate financing and evaluating the program’s effectiveness.

(b) DPH may enter into a vendor/contract relationship with a Third-Party Administrator and/or other entities to perform to specific administrative or programmatic functions needed to appropriately operate and maintain the program.

10. Reporting

(a) DPH shall make annual reports to the San Francisco Health Commission on the status of the Healthy San Francisco and Medical Reimbursement Account programs.

(b) DPH shall comply with Section 14.4(f) of the Administrative Code with respect to Healthy San Francisco and Medical Reimbursement Account program reports to the San Francisco Board of Supervisors.

Toolkit

Download Healthy SF Toolkit in pdf format
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3 Responses to “Healthy San Francisco”

Gavin Newsom: Sharing Innovative Solutions to America’s Problems | Twitmerlin - News, Celebs Gossip, Social Media says:

February 23, 2010 at 6:18 pm

[...] weeks and months ahead. The site currently features a number of San Francisco policies, including Healthy San Francisco, our plastic bag ban, San Francisco Promise, JobsNow and our open data [...]
London The » Gavin Newsom: Sharing Innovative Solutions to America’s Problems says:

February 23, 2010 at 7:21 pm

[...] weeks and months ahead. The site currently features a number of San Francisco policies, including Healthy San Francisco, our plastic bag ban, San Francisco Promise, JobsNow and our open data [...]
Gavin Newsom: Sharing Innovative Solutions to America’s Problems « Read NEWS says:

February 23, 2010 at 8:16 pm

[...] weeks and months ahead. The site currently features a number of San Francisco policies, including Healthy San Francisco, our plastic bag ban, San Francisco Promise, JobsNow and our open data [...]