§ 14.2. SAN FRANCISCO HEALTH ACCESS PROGRAM.

(a) The San Francisco Department of Public Health shall administer the Health Access Program, comprised of Healthy San Francisco and Medical Reimbursement Accounts. The Department shall determine eligibility and benefits under each program component to maximize participants' overall access to Health Care Services.

(b) Under Healthy San Francisco, eligible uninsured San Francisco residents may obtain health care from a network consisting of San Francisco General Hospital and the Department of Public Health's clinics, and other community non-profit and private providers that meet the program's quality and other criteria for participation. Healthy San Francisco is not an insurance plan for Healthy San Francisco participants.

(c) Healthy San Francisco shall be open to eligible, uninsured San Francisco residents. Eligibility criteria shall be established by the Department of Public Health, but no person shall be excluded from Healthy San Francisco based on employment or immigration status or a pre-existing condition.

(d) Healthy San Francisco may be funded from a variety of sources, including health care expenditures by Covered Employers pursuant to Section 14.3, from individuals, and from the City. Funding from the City shall prioritize services for low and moderate income persons, with costs based on Healthy San Francisco participants' ability to pay.

(e) Healthy San Francisco shall use the "Medical Home" model in which a primary care physician, nurse practitioner, or physician assistant develop and direct a plan of care for each Healthy San Francisco participant, coordinate referrals for testing and specialty services, and monitor management of chronic conditions and diseases. Healthy San Francisco participants shall be assigned to a primary care physician, nurse practitioner, or physician assistant.

(f) Healthy San Francisco shall provide medical services with an emphasis on wellness, preventive care and innovative service delivery. The program shall provide medical services for the prevention, diagnosis, and treatment of medical conditions, excluding vision, dental, infertility, and cosmetic services. The Department of Public Health may further define the services to be provided, except that such services must, at a minimum, include: professional medical services by doctors, nurse practitioners, physician assistants, and other licensed health care providers, including preventive, primary, diagnostic and specialty services; inpatient and outpatient hospital services, including acute inpatient mental health services; diagnostic and laboratory services, including therapeutic radiological services; prescription drugs, excluding drugs for excluded services; home health care; and emergency care provided in San Francisco by contracted providers, including emergency medical transportation if needed.

(g) The Department of Public Health shall also be authorized to use payments made to the City by Covered Employers to satisfy their Health Care Expenditure requirements as set forth in Section 14.3 to establish and maintain Medical Reimbursement Accounts from which eligible Covered Employees may obtain reimbursement of Health Care Expenditures in the amount and under the terms set by the Department of Public Health.

(h) The Department of Public Health may coordinate with a third party vendor to administer program operations, including enrollment, tracking service utilization, billing, and communication with the participants.

(i) The City Controller shall ensure that any Health Care Expenditures made by a Covered Employer to the City pursuant to Section 14.3 are kept separate and apart from general funds and shall limit use of the expenditures to support the Health Access Program.

(j) In accordance with the guiding principles and key findings of the 2013 Universal Healthcare Council Final Report, the Department of Public Health shall develop a plan to ensure that Employer Health Care Expenditures made to the City pursuant to Section 14.3 can be used to maximize enrollment in health insurance through Covered California and include possible options for incenting employers to provide quality, affordable health insurance directly to employees. This plan shall be presented to the Health Commission no later than August 1, 2015, so that it may be considered and approved by the Health Commission and by the Board of Supervisors in time for full implementation beginning in the 2016 Covered California plan year. Unless and until the plan is approved by the Board of Supervisors, the Department of Public Health shall continue to administer the Health Access Program, which includes Healthy San Francisco and Medical Reimbursement Accounts, in a manner that is consistent with the guiding principles and key findings of the 2013 Universal Healthcare Council Final Report.

(Added by Ord. 218-06, File No. 051919, App. 8/4/2006; amended by Ord. 69-07, File No. 070255, App. 4/2/2007; Ord. , File No. 140317, App. 6/26/2014, Eff. 7/26/2014)