Before the Senate Finance community, topics include rural melt care and telehealth flexibilities. We are meeting today to discuss with senator becerra, the budget and the department of services. The budget comes down to a simple proposition, helping working families and the middle class get ahead. Reducing the federal deficit, they are not mutually exclusive. Today, we are committed to doing both. When it comes to health care, that means protecting medicare for the next generation by making sure that the wealthy pay their fair share in taxes, strengthening medicare, negotiating the cost of medication, and investing and priorities Like Mental Health care, and the health care workforce. Thats sharp contrast to the republican approach to the federal budget. Since the beginning of the year, there has basically been a demand for secret negotiations on unspecified cuts to specified programs wall hosting hostage the full faith and credit of the United States government. Budget chair Committee White house and the Budget Office to run the numbers, and its clear that republican promises to spare certain parts of the budget like Social Security, simply do not add up. Sparing essential lifelines for seniors, in addition to republican priorities means essentially zeroing out Everything Else in the federal budget. I would like to take a moment to address press reports. Some house members are considering proposals that cut earn benefits and medicare, or Social Security for those who are not yet at retirement age. I want to be clear. As long as i am chair of this committee, i will fight any effort to engage in intergenerational warfare. There are plenty of ideas that do not include forfeiting the benefits of current workers. Now, i am going to take a minute to talk about what that means in practical terms. Starting with medicaid. Contrary to pop contrary belief, medicaid acts as our countrys backstop for nursing home care, not medicare. Since my days as director of the i have been stunned at how many people still believe medicare leads in the effort to fund nursing home care. Thats just not accurate its. Medicaid. When the parents are in their 80s or 90s, and require medicaid is there to help cover the cost once they have gone through all of the hard earned Retirement Savings everything they did to try to plan for retirement while they were working. For public in 2017 by catering federal support and state Medicaid Programs, and giving states free reign to pare back benefits, that guaranteed backstop of nursing home care for seniors is ripped away. That means a return to distant times before the social safety net was created, when Older Americans who ran out of savings could not count on a Family Member or were consigned to a poor form. Nobody wants america to return to that way. Lets look for ways to Work Together and take on big challenges of our time. Rather than pursuing cuts that imperiled the countrys older people. Now, a couple of important priorities in the president s. Budget first the jugular of drugs. They have several proposals to that holds pharma accountable for years of high prices while lowering costs for seniors. That includes speeding up medicare negotiations, increasing the numbers of drugs, subject to negotiation. I strongly support this approach, especially as a center for medicare and Medicaid Services continues to steadily implement the laws that are already on the books. For example, last week the Biden Administration announced that the anti price gouging law that was written in this committee, in this room on a bipartisan basis in 2019 will lower cohen churns payments for 27 drinks in Medicare Part b. Part b pays for prescription, drugs that treat diseases like cancer and rematory arthritis administered in a physicians office. That includes humira. Folks, humira is exhibit a for why drug pricing reforms were needed in the first place. Important steps like these coinsurance reductions free vaccines, and the insulin cost cap and medicare are just the beginning of the big impacts of this law will have on Americans Health care costs. I want to make clear that ive said from the beginning thats when the federal government leads on Flagship Health reforms and medicare in key programs. That the private sector is going to follow, and that is exactly what is happening. Next, Mental Health, care very fitting since my has been of the cause. Last, congress the committee wrote black letter law and to move the country towards reality were all americans can get quality module health care, when and where they need it. I specially want to thank my partner here on the finance committee, senator crapo, at the beginning of 2021, we set on Mental Health clear, we are going to be ready on every single bill, every single one to make sure that we dance the cause of Mental Health needs, we were able to do that on the gun safety outlaw, weve improved Mental Health care in schools, funding for Community BehavioralHealth Centers. That, as i mentioned, senator coverage for therapists and medicare. New slots for psychiatrists, and senator crapo and i talk of often about this, and we intend to continue our Mental Health work in this congress again in a bipartisan way. One final point with respect to Mental Health care to clear off a little confusion. When it comes to Mental Health parity, the Congress Passed a landmark law in 2008, based on the proposition that physical and Mental Health would be treated equally. That, unfortunately does not happen today. 15 years after the law was written the Insurance Companies, the Big Insurance Companies are still finding ways to drag their feet on carrying out the parity law with respect to Mental Health. The challenge for the committee to stop the footdragging that is taking place under current law colleagues. Give americans what they thought they were getting in 2008. The president s budget takes important steps in that direction, and senator bennett, also is leading a way to put Mental Health care on a better footing. We are also pleased that the president s budget takes a big step when it comes to postpartum coverage for new mothers in medicaid, at the end of last Year Congress came together on a bipartisan basis to create an option for every state to cover postpartum care for new not theirs, 12 months. President s step budget to its credit takes annexed up to make that coverage available for the country. Finally, i want to say i think all of us had a chance over the last few days to read a stunning report about cracks in a Health Care System for disabled folks, it was reported on the washington post, we are going to need to develop smarter policies that provide Long Term Care options for families to get that is best for them. One option is offered by our colleagues from president ials censure senator casey based services. We are going to continue to promote that. So, this is all about making some Smart Investments in Better Health for the people of this country, consistent with showing that you can do that while reducing the federal law deficit. After senator crapo has a chance to make his opening remarks, i will introduce senator and we will get underway. Senator crapo,. Think you very much, i thank you senator for being here today. Before we begin, let me let you know that i have at this very time to be introducing a judicial nominee for an idaho district judge position. When i finish my remarks and i step out, i am not walking out on you. I will be back. Before i get to my prepared number marks. I do want to respond a little bit on the question about the debt ceiling negotiations. I want to make it very clear, the republicans are asking for negotiations on the debt ceiling process to add some fiscal restraint into the debt ceiling extension. I ask you, senator sarah to take back to the president might play that he engaged with us in negotiations. I want to make it clear. We are not talking about trying to produce benefits in medicare, or Social Security for our seniors. What we are talking about is reasonable reforms that can help us get some kind of fiscal response straight on our spiraling doubts. I encourage all of my colleagues in the senate, but particularly the president to engage with this in those kinds of negotiations. I want to start my formal remarks on the positive. You have testified before, and talked me privately about the fact that although we have our differences on a lot of policy areas, we want to fall in those areas where we can Work Together and we have found some last year. Last, year as senator wyden has already indicated, we came together on a bipartisan reform to produce common sense solutions, ranging from Mental Health improvements to comprehensive telehealth coverage for seniors and working families. Moreover, we accomplished all of this by reducing the deficit by billions of dollars. The administration and you, secretary mr. Work with us on this, and we have made good progress. I look forward to partnering with hhs as well as with my colleagues on both sides of the aisle to advance for the reforms like this and this congress to improve Health Care Access, affordability and choice for all americans. That being said, i do have concerns. With the budget that the president has put forward. Unfortunately, many of the proposals and the president s budget were indestructible to these kinds of additional ads that i have discussed. I have serious concerns with the focus on partisan policies that risk harming Health Care Access and affordability for both current and future patients. We talked about some of this yesterday. The budget central proposal for its would dramatically expand the size and scope of the bureaucratic government run Drug Pricing Program enacted last year in the i. R. A. Prior to that laws passage, my republican colleagues and i warned repeatedly that imposing sweeping price controls would prove disastrous for patients, biomedical research, and development, and domestic manufacturing jobs. Many of our fares have already come to pass. We pointed to the risk of higher lunch prices, and distorted pricing practices based on projections of validated by the nonpartisan congressional office. Sure enough, the wall street journal reported in january, and i quote, the impact in 2023 may actually be higher drug prices. We also expect concerns around live starving r d as the University Chicago would result in 135 fewer drug approvals and the next two decades, that figure would inevitably skyrocket under the budget proposed expansion. Already numerous manufacturers have signaled plans to table certain projects in light of uncertainty created by the i. R. A. In recent months weve also seen a russian of drug shortages. Even leading u. S. Food and Drug Administration officials have attributed to pricing dynamics. Doubling down on the price controls would exacerbate the laws most harmful consequences. Americans deserve better and more Affordable Access to Prescription Drugs, and we can find bipartisan results Oriented Solutions to advance that goal. Government price mandates, however are a step in the wrong direction. Ive also profound concerns, with the budgets bold claims of averting the medical trust funds looming insolvency largely through massive tax hikes and budget. This unbalanced approach does nothing to address medicare scott drivers. It would also punish the small job business and entrepreneurs who drive our economy. Unfortunately, the budget takes a similarly shortsighted approach to medicaid, reviving a number of rejected policies from past proposals, including hundreds of billions in new spending, tied to burdens of conditions and efforts to circumvent state leaders. The federal government should focus on supporting states, as they work to return medicaid to post pandemic normalcy. Rather than imposing new topdown mandates. Instead of turning to a one size fits all solution we should look to proven models for federal programs, such as Medicare Advantage. With skyhigh Patient Satisfaction rates. Medicare advantage shows that Consumer Choice and Market Forces can produce more benefits, and better outcomes, as we move forward i encourage or department to focus on our shared goals from cost cutting competition, to sustainable telehealth access, and other similar issues, rather than on these partisan priorities. I think you again for being here today, and i thank you mister chairman. I think my colleague, and my colleague and i are going to go back and forth about who said what when im just going to put into the record by unanimous consent that at this point, the House RepublicanStudy Committee proposals to cut medicaid and medicare, so specifically thats what we are talking, about so, secretary sarah, we welcome you, 25th secretary of the department of health and so Human Services. First latino to hold the office in the United States. You have dedicated your career to political service, most recently serving the attorney journal of california. Prior to, that he served 12 terms in congress, as a member of the house representatives, while serving in congress he was the first latino member of the committees on ways and means, he served as. On Social Security and Ranking Member of the subcommittee on health. Secretary we welcome you. I have appreciated the chance to work with you often over the years, and i appreciate your commitment advocating for the people served by the department of health and Human Services. Go ahead with your remarks. Chairman. , thank you for the invitation. A lot has happened in the year since i last spoke to you about budgets. More than 16 million americans have secured Health Insurance with the affordable her care act. Thats an alltime high. Altogether, more than 300 million americans now carry insurance to cover their health care nears, a show historic high as well. The president s new lower cost Prescription Drug law has kept insulin at 35 per month, and made preventative vaccines like the flu, covid and shingles vaccines, available for free under medicare moving forward this new law gives us the right to finally negotiate lower Prescription Drug prices for americans. Two capitol off, the Biden Harris Administration has safely and effectively executed the Largest AdultVaccine Program in u. S. History, achieving nearly 700 million shots in arms during the covid pandemics, without charge. The fy 2024 budget proposes 144 billion dollars and discretionary funding and 1. 7 trillion dollars in mandatory funding for the hhs. It positions us to tackle the challenges we face including a crisis in future Public Health threats. It also phones operations and Mission Critical infrastructure needed to create a healthier america. Moving the two a Wellness Care system. An illness care system leaves our most vulnerable families behind, i wanna scare system invest in providing the full spectrum of health care to all americans. Illness care allows the price of Prescription Drugs to skyrocket. Wellness care starts by prescribing fruits, vegetables, an exercise. Food as medicine illness care requires you to get it a referral by your family physician to see a specialist for Mental Health services. Want to scare, it lets you get Mental Health care the moments you walk through the door of the Family Physicians office. Illness care forces hardworking americans to deplete their life savings, to get the Long Term Care they need wallace care invests early and Long Term Care like so our oldest American Adults and our americans with disabilities can thrive at home and in their communities. Our budget invests in Wellness Care. We invest more than 30 billion dollars to pay for the next Public Health crisis. This includes a billion dollars to replenish our nation Suit National stockpile. On Behavioral Health. Too many of our loved ones are dying from suicide or overdose. We encourage us access to crisis care. We grow the Behavioral Health workforce and we beef up Substance Use services. We are also gearing up to handle more than 6 million additional contacts from people who are experiencing a Mental Health crisis through 988, the three digit Suicide Prevention lifeline, which stood up last year. This budget covers 2 million adults left out by medicaid by their home states, and extends tax credits that make health care more affordable for millions of americans. They would also ensure that it expands postpartum coverage, for a new mom in our baby is here to stay. The president s budget is not only medicare for today seniors, but protects its strengths for the next generation. We also take care of our Family Members. Investing 600 billion dollars in, and 150 billion dollars to strengthen medicaid home and Community Based services. This budget funds the , and the title ten finally planning service. It delivers or commitments made as part of the National Strategy for hundred under nutrition and self. Important to me as a former attorney general, it bolsters our health care and enforcement work. The president s budget honors our responsibilities to ending with more than two billion dollars in new resources in 2024. Last year for the first time. You gave the Indian HealthService Advance appropriations providing the same protection against budget uncertainty that other Health Services received we hope to build on that progress this year. This budget reflects the precedents and our values and commitments. It helps begin to move from a nation focused on illness character one about Wellness Care, and most importantly it ensures health and wellness are within the reach for all americans. On behalf of the women and men of the department of health and Human Services, we look forward to working with, you and i thank you for having me today, secretary thank you. I will start them off with respect to the trust fund. Now, the president and democrats are committed to protecting what weve already called medicare guarantee. Medicare is not a voucher, its a guarantee of High Quality Health Care and americans have earned this benefit which each paycheck. With this benefit, the president is focused on making sure billionaires and the very wealthy pay their fair share, with strength and medicare as a negotiating authority, lower the price of more Prescription Drugs and extend medicare solvency for 25 years now, what we are hearing from the other side is giving a free pass to billionaires all these budgets work it out so that billionaires basically are left untouched now were seeing the full faith and credit of the United States being threatened, when i would like to do is make sure that you have a chance to make it clear what the differences are with respect to these issues. President s budget in my view does not cut medicare benefits by taking steps like raising the eligibility age, reducing access to care, or basically just handing everything over to a bunch of Big Insurance Companies is that factually correct . , [inaudible] the president made it very clear, he will not propose any budget that cuts benefits under medicare for the 67 Million People who pay account on medicare, into the millions more who are added every year. He would in fact increased benefits at the same time that hes strengthening the program for the future generations to come. Its a proposal that was due because so many president s have come before President Biden and never offered a proposal for 24 years in congress, i never saw congress try to tackle this in a serious way. Finally we have a president who says, heres how we do it, we cannot only strengthen medicare but we are not cutting benefits from for seniors in america. Lets move on to protect Prescription Drugs and the implementation of the Inflation Reduction Act. I think you heard me mention, right here in this room with senator. Thats where we locked in the first ever sets of financial penalties for price gouging in medicare. We saw the benefits of this this week with the reductions in cow insurance. Its going to be of help to millions of people that was done in 2019 in this room in a bipartisan way. We want to keep it that way. Cms is working on a tight timeline with respect to the drug pricing reforms theres a lot to do in advances of september 21 announcement of which ten drugs will be the first to go forward on the negotiation process. Last week as indicated was an important milestone with the release of the proposed medicare price negotiation in the guidance. This was in addition to the implementation and penalties for price gouging. You have an i have talked about that its so important that the Inflation Reduction Act guidelines are met and we ensure that the people who are participating in this program already and that the law delivers for seniors and. My first question to you, and you and i have talked about this. Is it possible for you to pay to commit to a timely release of the final negotiation guidance, which would come about this summer. Senator that is our goal we have never done this before, we thank you for the resources to try to do it right. We understand that september is a magical dates, when we announced the towns drugs that we will be part of the first negotiation, we will continue to work with you. I am committed to make sure that each and every member of the senate of the house has the information they need to see where were going. Because you are gracious and giving us the resources to staff up we hope to not only meet the deadlines, but hopefully beat them. We look forward to working with you really month by month. To meet this september deadline. You and i have talked about this before. This was an extraordinary victory for the millions of seniors who would stand and those pharmacy lines and felt like they were getting mugged. By the prices. Pharma protected this ban on negotiation. Like they were protecting the holy grail. Senator and so many others kept making the case. Of course you ought to negotiate. There are more than 50 million seniors on medicare. Who in the world does not negotiate . Last weeks announcements were very good with respect to price gouging with, respect to the list for negotiation. We are moving ahead to make sure this gets implemented. Tell me a little bit about what the American People can expect to be told as this goes forward and how it impacts them . Then i will yield to my colleagues. Mister chairman i believe we are not only going to be transparent with you and your colleagues, but with the American Public of how we are going about selecting those drugs. The process in which we are going to engage the manufacturers, in this we want them to be able to participate as much as possible in a public setting. So people can see how they behave in this process of negotiation. Whats the american let the American People see. Sunshine is the best disinfectant as they say, and we have no problem with that. Thank you. Senator stabenow will be next. Thank you very much, and welcome secretary. Ive been through so many Different Things that we could talk about that are so important and making a difference in peoples lives and thank you, thank the president for doing what you are doing. First, i do want to recognize i have a lot of friends and purple shirts here today from the alzheimers association, and we want to celebrate, not only i think over the years on Something Like a 700 increase in research, which is so critical and efforts, we have done since the book caregivers, and the next step is making sure that patients have the critical and urgent treatments that they need. I will be following up with you more on that. This is the moment to really build on that. I appreciate that they are all here with us. This week. Let me start also by saying that medicare and Social Security are Great American success stories. They were lifted a generation of seniors and people disabilities out of poverty. We certainly are not going to go backwards, at least the majority is not going to go backwards when the chairman talks about the House Republican study group budget which is one that has been lifted up as a Major Foundation for what the house is talking about, it raises the age of medicare to 70, that rages the age of Social Security to 70, i cannot imagine doing that, or privatizing the systems to move over to wall street or private Insurance Companies. I congratulate you, and i congratulate the president for going in a different direction, which is to strengthen medicare and to focus on the costs of Prescription Drugs and so on as we move things in the right direction for people. I have to talk about Mental Health. I have to talk about certified. Im so excited that this is something that we have done on a partisan basis. I see senator, we worked really hard together on the Safer Communities act, and the most strongest investment in Mental Health and Addiction Services literally in 50 years. Thats not an exaggeration, and so thank you for working on that as well as our chairman and Ranking Member who have been so pivotal and all of it. We are now, we have a demonstration project with ten states fully funded by a health care with clinics, quality clinics, 24 hour emergency services, we are now working on the next piece, they announced, has the process for identifying the next ten states, we want to get that all the way to 50. I would like you to elaborate a little bit more on your plans for this really transformative system, we are moving from grants, grants are good but its much better to have this be an integral part of our Health Care System with ongoing funded and support, support for staff, the work that this committee did in expanding medicare access to therapists and so on and the gma slots that psychiatrist at the end of the year really are important work that we have done. Could you expand a little bit on this program and vision around a Community Behavioral health. I have to begin by thanking you senator and others who championed this. Your fingerprints are all over this expansion of Community BehaviorHealth Centers, and thank god because we know that Mental Illness does not end at 5 00. It goes forward and at midnight, three in the morning you need to have someone you can turn to. Thats where the Certified Community have your Health Centers will be indispensable. The fact that we are trying to give them a permanent stream of funding, so that they are open all the time. This has a consistency. We know that folks who are going through a Mental Health, crisis they are looking for some stability. This helps add that at all hours, all days in the year and we are going to build on this to start on this project, a pilot, and now you see what is happening. Its great that we are also going to be able to help the states that start off in those projects, to expand as well because what a shame of the states that just took the lead, would be deprived of the chance to expand it. Thank you very much to you and your colleagues for what you have done. Im really thrilled that im in the president s budget, that he makes the certified Community BehavioralHealth Clinics prominence, its so critical. I have to say this was a major bipartisan accomplishments, and while he is no longer in the senate. My partner was integral to this. So, shout out to senator, as well. I think my colleague its a very hectic day up here, as you know on wednesdays at this point. The next three in order of in order of parents are. Thank you very, much mister chairman and i think i will say, with alzheimers as senator stabenow mention, we have a number of our alzheimer friends here with us today. The fda has accelerated approval pathway has provided a lifeline for countless americans advancing access to safe and effective medicine for cancer, rare diseases, hiv and other conditions like alzheimers, years before these treatments could otherwise come to the market. Unfortunately, this administration has taken unprecedented steps to erode this pathway. , they are deterring lifesaving innovation and fling access to care. This troubling trend began with cms coverage restrictions for an entire class of alzheimers their piece. It seems to set and continue Clinical Evidence model, which would slash payments for treatments that rely on accelerated approval, secretary, i recently read a letter urging the administration to abandon this misguided model, giving the potential for slower and slower pipelines for new medicines for seniors among other serious conditions. I also wrote about the grave implications of the alzheimers coverage decision. How does your department ensure to remain a robust and viable option for innovators, and most importantly for patients . You have touched on something very important for me, having my father, my inlaws, my father in law and mother in law, dementia, last, years last months of life. It was very tough, my father died my. Home we cared for him, same with my motherinlaw and fatherinlaw, my wife and her siblings cared for them. This is tough. Dementia, all of us, not just the patient, we want to be there. We are fortunate that in america we are coming up with new innovative treatments, and we are doing everything we can to accelerate them. I give you the evidence of the covid vaccine. No one expected that the gravity vaccine would come out so quickly. Whether its alzheimers covid, hepatitis c. We are moving and we want to be there and we will look for every innovative approach to make sure that when we can put as safe and effective drug in front of the American People, and then also determine whether we are covering by medicare. I understand the heads that commitment. The accelerated model that you had adopted or are looking to adopt, and pursue is going in exactly the opposite direction. I encourage you to revisit this model. Let me move on to Medicare Advantage. Cms recently released their annual advanced notice which included some significant changes to the Medicare Advantage risk model for the upcoming pit process. We have heard concerns from providers, patience, and plans that these changes will disproportionately impact most vulnerable and may beneficiaries. Including those with low incomes, or chronic conditions. Mister secretary, does the Administration Plan to address these concerns in its final im a rule . Senator, thank you for the question. Nearly half of all seniors who have medicare use the medicare managed care model. This is critically important. We are actually going to make sure that the final gavel falls on this, it will not only move us in the right direction with more efficiency, but it will also protect every Medicare Beneficiary for seniors and disabled seniors who use the program. I encourage you to look at this carefully, conduct an Impact Analysis to determine how the model you are currently considering changes would affect different groups of beneficiaries. I think you will find that once again, these proposals are going in the wrong direction. Let me move on to one more we can agree on. Thats on telehealth. As the budget request mentions. My colleagues and i came together last year to advance a crucial twoyear extension of wide ranging flexibilities, including for Medicare Beneficiaries. Without further action, however, these policies will expire at the end of 2024, creating a coverage cliff for tens of millions of seniors across the country. Secretary, i realized this requires congress to get engaged and involved. But from the administrations perspective, how should telehealth coverage look at the longer term . Can you commit to working with congress to develop Meaningful Solutions that will protect access well beyond access next year. Senator this was crucial, we will work with you because we do not want those statutory flexibilities to expire. But we are going to need your help. Thank you for the leadership you have demonstrated over the past on this one. We want to make sure that everyone has broadband that will make telehealth work. We want to make sure that everyone can use a doctor, wherever that doctor is located that requires the states to work with, us to make sure we might be across state borders. We want to make sure that if you are in Rural America or, in cities intercity america, you dont have to worry that you dont have a way to get to the doctor, you will have access to telehealth. Encourages as strongly as you can to get that legislatively done. I know secretary wyden and us are working together on this, and i just want some strong support from the administration. Thank you senator crapo, and you are right we are working together on a number of these issues, i just want very quickly before we go to senator, grassley to say that we very much appreciate having alzheimers advocates in the house today. My mother was enchanting house in palo alto for years and years on and with alzheimers and they were one of the countries and continue to be one of the countrys leading institutions from Dementia Care on alzheimers. You are hearing this from all of us here up here that we are committed to working with you. The other point i wanted to mention involves the medicine for the drugs. That is, i have a very strong supporter of accelerated approval for these very exciting new drugs for alzheimers. My colleague are still trying to persuade my mother not to retire, is leading the cause. Its just a very important to remember what was agreed to originally. That was, when you have accelerated approval, so we can make sure we are keeping our commitments to these patients, it would be followed up by the Drug Companies presenting evidence. Of progress with respect to how the drugs are working patients. And working with patients. That was part of the accelerated pathway in 1992. I want all the folks who are doing this wonderful work advocating for patients. We are going to support you we are going to look for research they are going to look for new medicines, the accelerated approval as part of it. The pharmaceutical companies have agreed after the drug is approved, to continue to furnish evidence of its progress. Thats very important, youll remember that is what dr. Calibrate with will newark considering his nomination. Thank you very much, and thank you. To thank, you first of all very quickly it i started the hearing aid or is senator warren and i sponsored, i also want to thank you for enabling the transition continues because 65,000 iowans are benefiting for and many of these people are farmers, and Small Business owners. Letting them continue has beeneyed by a partisan priority in president obama, trump and now biden. I hope hhs allows them to continue in the future beyond 2024. Now let me go to my first question the organ procurement and transplantation, network. I have been looking into this network, a long long period of time. The problems have gotten worse. Thousands of patients are dying every year. Billions of taxpayers dollars are wasted. Because of gross mismanagement, the system is rife with fraud, waste, and abuse, corruption and even criminality. This committee has received credible allegations regarding the United Network for organ sharing, relating that organization threatening whistleblowers including even and caregivers, simply put this is beyond unacceptable, these efforts appear to be part of an attempt to cover up failures and competition for government contracts. The question to, you i hope that you can commit to investigating all instances of whistle blower retaliation and harassments. With the hhs commit to harassment. Would the h h s commit to removing anyone involved in that Improper Conduct from any involvement in organ procurement in transportation leadership and committees. If you dont agree with me, why not . Senator grassley, first, thank you for the work youve done. As you mentioned, this is taken a long time. Think of youve committed to. It on the whistleblower question, we are absolutely committed to working with you to ensure that if there is a play made about a particular operation, we dive right into it to find out whats going on. Let me give you more important news. Today we are announcing that hhs, that we are going to look put forward a modernization issue, which will do a number of things that i think youre gonna like. One, will call for competition, and who becomes a contractor for these organ procurement, a transplant services. It will no longer be Just One Company the way its been for, what 40 years . So thats one big change that will occur. Secondly, we will require transparency. They have to start sharing their data. They cant hide, as you just said, behind this confidentiality, and say we cant show you what has gone on, because it is confidential. We are gonna require far more data transparency. Again. This follows all the work youve done. And then finally, we are going to try and upgrade the i. T. System. Which as you can imagine, with these contractors, never having changed, everything gets stale. So does the i. T. We are going to update the i. T. , so we can be officiant with those organs that we receive. So we can get them to someone, instead of having them ultimately be discarded because they didnt get used in time. Those are things where announcing today. And in the president s budget, it calls for resources, so we can implement this. Were absolutely gonna call on you for your help to try and move this forward, get your input, but again, much of what we are announcing today, is resulting of the work youve done over the year. Thank you for your initiative, i want to turn to rural health care. I want to thank the administration for implementing the new and voluntary rural Emergency Hospital program. You ive worked for three or four years to get past. Another Rural Hospital Program you may not know so much about is the Rural Community hospital demonstration. It extends the financial viability of 26 small rural hospitals in 11 different states, five in iowa, the program has taken up, it has taken up to 30 hospitals. But cms is currently under utilizing the program. Congress has authorized the program for several more years, while there is interest in rural hospital participating cms has told me that they have no interest in filling the four additional slots. I realize that you may not know about this program. Do you think that we should be do you think we should be under utilizing costeffective Rural Hospital Programs like the Rural Community hospital demonstration . Senator i am familiar with the program. And we are making a concerted effort in Rural America to inject life into some of these facilities. Because as you know very well, too many of them are closing. And they are not being replaced. When they are being replaced, their first being gutted by essential services they used to provide. We have dedicated services into Rural Community hospitals. But were gonna try and do more. We certainly will take your lead on some of these initiatives. Because we know that those of you who go back home every day and have to deal with those providers know exactly what they need, and where they need to go. We look forward to working with you. Secretary, thank you. While youre in the room, let me thank senator grassley for working in such a bipartisan way to improve this system with respect to organs and organ procurement. Yesterday there was, in my view, a big victory for families across the country, who have been finding for more effective organ procurement the administration indicating they work with us to have more competition in this unos contact. This committees fault on a bipartisan basis there hasnt been enough competition for the contract, and meeting expectation waiting for transplant. I want to thank my colleagues on both sides of the aisle, senator grassley in particular has been at this for years. Senator menendez is next. Thank you mister chairman. Before i go to my question, i want to say, i want to echo your comments as someone whose mother had a tenyearlong goodbye with alzheimers. We have a moral, as well as an economic imperative to and alzheimers in our time. I hope the budget will reflect that as well. Mister secretary, for years communities across the country have struggled to fill major, for a growing crisis exasperated by the pandemic. I have long championed legislation to advance address the shortage by increasing the number of education slots. Based on my legislation, congress authorized the creation of 1000 new medicare funded. Of 2021. In our hunt specific Eligibility Criteria for distributing these laws. However, the kingdom of cms, the final rule for 2022, and again in 2023 included additional criteria, not specified in the law. This additional location, specific prioritization, unfairly disadvantages states who have few geographic or population age psas. As a result, in new jersey, and other states were completely, completely shut out from obtaining these critical residency positions. The cia of 2021 clearly specialize that the specialty shall, not may, but shall distribute up to 200 residency positions each year, and shall distribute not less than 10 of the residency positions to each of four specified or providers. Thats a lot, thats what the Congress Intent was. I resisted cms last year. They failed to address this issue. Can i have your commitment to work with me to revise the methodology used to distribute future residents positions, so we follow congresss intent of law. And states are not totally shut out of this program . Senator first thank you very much for the work youve done on medical education, you absolutely have michalyn to work with you on this. Thank you. Im concerned that the proposed advanced notice Medicare Advantage rate announcement will create further health disparities, for the 640,000 Medicare Advantage beneficiaries in puerto rico. As you know, puerto rico seniors overwhelmingly depend on the ema program, with an emmy penetration rate of 94 among beneficiaries eligible for Medicare Parts a and b. The proposed changes could impose the largest here two year reduction in federal Health Funding to puerto rico at change. I just harmful not only to the moles vulnerable beneficiaries, but to the islands Health Care System and economy. One that we have been working towards, and improving. This is going to set them back. Further, the ema programming in puerto rico supports health access, inequity, by filling gaps in care resulting from the islands exclusion from many of the federal health benefits. Im concerned these changes could undermine progress weve made to address disparities on the island, including recent funding gains achieved for the Medicaid Program, which i thought for. What is the administrations plan to ensure any proposed changes are not magnifying disparities, and reducing Services Provided by beneficiaries on the, on to our United States citizens. Senator, thank you for the question. As weve mentioned earlier, one 67 Million People count on medicare, about half of them count on it within the managed care program of medicare. We have to make sure we get it right, we are in the process of reviewing all the comments we received, based on that advance notice. And what the president said, is we will guarantee, that there will be no cuts to the benefits under medicare in this proposal that the providers will see in most cases, an increase, a substantial increase in some cases, to the monies they are receiving reimbursement money they are receiving. With all due respect, this is in a broader context. Youve got to look at puerto rico specifically, in the disproportionate way it gets affected. So im worried, that while were talking broadly, the effect in puerto rico, for the three and a half million United States citizens, is disproportionate. So im gonna follow up with a letter regarding Medicare Advantage in puerto rico. Urging you to address anomalies in the right formula to mitigate funding disparities for the island. Finally, last month, the New York Times published a disturbing report on the use, the illegal use of migrant child labor by several major companies. Some as young as 13 year old are unaccompanied minors who came to the United States, placed responses by the office of refugee resettlement. Often made to work long hours, in hazardous conditions. What are we doing to make sure that that does not happen again . Senator, like you, i have three daughters. Children are children. We should treat every child in america the way that we would expect to have our children cheated treated. It is a serious issue when someone claims that a child is being forced to work, especially in dangerous conditions. We take very seriously our role in that, at hhs, to make sure that while we have custody of a child, and remember, we receive custody of these unaccompanied migrant kids from the department of Homeland Security. When we do, we are obligated to provide them with the care, that you would expect for a child. While the process of trying to find them a suitable setting to live in. Because a large congregate care setting is not the most ideal for any child. So we go through the process of trying to look for a sponsor. We go through a vetting process, where we that all potential sponsors. And by the way, almost all, about 90 of those sponsors end up being a Family Member, an immediate Family Member. And so what we try to do, is make sure that when we do finally place that child in the hands of a sponsor, that they will receive the care that theyre supposed to. What were finding is that oftentimes, a lot of these children are now being employed, and i hope that we go aggressively. You, we, all aggressive at any employer that would think that it is right to allow a 12 or 13 year old to working conditions that arent even safe for adults. And that is where we have to go to make sure that we are not failing children, thats why we announced that in a joint effort, the department of labor, and the department of health and Human Services will work to try and make sure that we can do what we can within our jurisdiction to avoid that happening. At hhs, that means trying to get sites from d. O. L. , if they know of a particular individual who is seeking to be a sponsor, who may be engaged in the practice of using, or employing, or allowing kids to be employed, in ways that are detrimental to them. We are gonna try and do the best we can to make sure that we have that fight early, so that no sponsor like that would ever pass our vetting process. Thank you. I thank my colleague, i want my colleague to know, i appreciate his leadership. I especially want to help with that last point that you made. This is outrageous, that companies are exploiting 12 year olds. In order to make a quick buck. Taking advantage of these kids. Its outrageous. I look forward to with thing working with you, and following your lead. Senator cornyn. Last year, died of drug overdoses, including 71,000 roughly from synthetic opioids like fentanyl. Do you believe we have a Public Health crisis when it comes to these overdoses deaths . Absolutely, absolutely. One reason why we have this Public Health crisis, which you and i both recognize is such, is because we have lost control of our southern border. We have seen millions of people show up, some claiming asylum, some being placed, like unaccompanied children, through your offices, with sponsors in the interior. And of course, the asylum system now, which essentially is a free pass into the the interior of the United States, a due to the backlog in Immigration Court system, many of these cases will never be reached, assuming people actually show up for their Immigration Court hearing in the future, with very little consequences. As you know, title 42, which is the Public Health title that was implemented because of covid, it will expire in may. I would like for you to tell us what the administrations plan is, to deal with this Public Health crisis, and this humanitarian crisis caused by the lack of any control of our border. Senator, i will try and concentrate my comment on the work that were doing at hhs. And ill let my colleagues speak to the work that they are doing for example, department of Homeland Security, and others on other aspects of this. Id like to know what the plan is. I sioux muse been consulted and collaborated on that plan. But so far we have not seen anything that is credible in terms of dealing with this. And as bad as it is now, which is never been worse, when it comes to the flow of drugs and people across our border. It will get worse if title 42 expires, and there is not an adequate plan put in its place to deal with both the flow of drugs and people. And to your point, because we are having to work under a very broken immigration system as you mentioned these are the things that happen. I know for example, the department of Homeland Security has tried to move the asylum process in a way that lets us get to these cases quicker, and adjudicate them, that way we can move through that process. In terms of hhs, we continue to try and be prepared. We do not know who will cross that border as a child who is unaccompanied. And when we have to be ready to secure them from dhs, within 72 hours, so they can be an appropriate setting. So what we are doing is preparing whatever the eventual outcome is, to make sure that we respect the rights of any child to receive care that is essential. We are going to continue to do that at hhs. Mister secretary, i will just give you one persons opinion. I think the Biden Administration has completely dropped the ball when it comes to the border. Unfortunately, we have seen all of these deaths. I recently went to a high school right outside of austin, we are i live. Ive talked to the parents of lost young people, who thought they were taking something relatively innocuous, but it was laced with fentanyl. And as you know, the cartels use industrial type pill presses, to make what looks like a normal for pharmaceutical product. But in fact is tainted with federal. Which as you know, is extraordinarily powerful. And small amounts can kill. I want to just say the one thing i would congratulate the biden ministration on, is their commitment to implement the bipartisan Safer Communities act. Senator stabenowator tillis acknowledgment one of the most important parts of that bill, that senator murphy and i were involved in, and actually all of our colleagues were involved in. Not in one way or the other, but we made the single largest investment in Community BasedMental Health care in american history. And i think that is something that we are all going to be very proud of. And we will address a huge unmet need. The last thing i want to say, in a few seconds i have, is just ask for your help. Senator menendez talked about the workforce shortages, nowhere is that more apparent than in the Mental Health and physical Health Delivery systems. We tend to focus like through a soda straw on reimbursement rates, because the federal government is trying to figure out, how do we cut Health Care Costs, make it more affordable, but we have a confluence of problems when it comes to recruiting, and retaining health care professionals. We have erosion of the standards for providing those professional services through scope of practice issues. I would like to ask whether you would be willing to work with us. The chairman and Ranking Member obviously set the agenda in working on all of these issues as part of the same problem, as opposed to dealing just with the reimbursement issues and isolation. Senator, we look forward to hearing from your staff so we can follow up with you. This is absolutely something the president has asked us to follow and work on, the president does dedicate money to workforce expansion, and development, and also resilience. So we look forward to working with you on this. Thank you. Senator cornyn, thank you again for your leadership. Your ongoing leadership on these Mental Health issues. I think that there is some more opportunities, particularly through Public Private partnerships. In our part of the world, connie bomber has funded Behavioral Health studies at the university of oregon. I think it will be a model for the country to get more workers. Chairman, as you know, it was a product mainly of this committee, the finance committee that made that possible as part of a bipartisan board of Safer Communities act. So thank you for your leadership, as well as that of senator crapo. I think that is a big deal. To be continued, you are absolutely right. Next is senator cardin. Thank you mister chairman. Secretary becerra, thank, you it is good to see you. I want to underpoint a point of grassley in regards to organ transplant issues. The reform of the optn process will save lives. We lose 17 americans every day waiting organ transplant. This is an urgent issue, i just thank you for your response, and the actions that you are taking. I want to turn to an issue of drug shortages. The wealthiest nation in the world that spends the most of any nation on drugs, yet we have important drugs that are in shortage supply here. According to an american side society of health systems, pharmacists, 160 drugs were added in 2022 to the drug shortage list. 48 were in sterile injections, making a total of 295 active drug shortages here in the United States. These are not, these are drugs that are critically important to health care, summer in cancer treatments, and other areas, the president s budget feels with extending expiration date, which i think is important, senator collins and i have introduced legislation on that, to deal with disclosure. How do you intend to mitigate this challenge that we have in this country . You know senator, im glad youve raised this point. Whether it was the issue of infant formula, or the issue of the winter flu, we are seeing that in so many cases, the industries that we count on to provide us effective medications, are not ready for disruptions for a broadside. Thats because we have gone into a system where these industries, to save money, and theyre entitled to save money, have gone towards a supply chain methodology, that essentially says, we will keep inventory, only the stock that we need immediately. If all of a sudden you have a major increase in demand, you cant meet, it or something happens with the manufacture who has to go down because, there is an issue of safety, or cleanliness, all of a sudden the supply goes down. Theyre not ready to meet the need, and so what we have done is we have begun to do more surveillance over how these private Sector Industries are handling their supply. We dont regulate that supply, but we want to have more eyes on it. So we can make sure theyre preparing for that broad side that may come. Were also trying to make sure we help them mitigate any supply chain interruption. So if they get some of their material for their product, from overseas, some country, we want to make sure theres not gonna be a disruption, whether politically based, or supply based, that keeps them from being able to produce. So we work with you, because this is a big issue. We saw for the pharmaceutical industry how they manipulated markets for profits for insulin. The same thing is happening on less expensive drugs, where theyre changing their production capacities in order to maximize their profits. Which we understand, but since we are the largest payer for the services, it seems to me we can have a stronger impact on their decisionmaking. We look forward to work with you all that. As you know, oral health is closely tied to physical health. The final calendar 23 fiscal fee schedule role expanded dental services tied to medically necessary conditions, which means that the services will now be covered under Medicare Beneficiaries. Thats a step in the right direction. As you and i know, we have major gaps in both the medicaid and Medicare Programs, in regards to coverage for oral health, and dental services. Particularly in the underserved communities. They are particularly vulnerable. Which steps do you intend to take in order to deal with the access to Oral Health Care in america, particularly in underserved communities . As you said, one of the first house we took is to try and make sure that where we had authority, we expanded access to dental Care Services, to focus on medicaid. We have made the effort, with your support, to try and expand coverage within medicaid for dental services, more directly, we count on many respects on our Community Health centers, who are able to use some funding they get to expand services, including dental health. We are gonna try to do everything we can within the authority we have to expand access. We know infection related to your dental situation can ultimately impact your overall health. You know the story of demonetize driver. A young man from your state of maryland, who died, because a tooth ache, which parents did not have the money to have him go see a dentist, became an abscess, and then an infection, before you knew, it he was dead. Its one of the best investments we can make, you get great returns. Let me just say in conclusion, hepatitis c, thank you for your efforts there, we need to identify those that have hebetated, see montes are there, it saves lives. And it saves costs. I appreciate the initiative in your budget, i would how congress would work on budget rules, which would encourage that type of services to deal with diseases. Were backing up that hope. Senator bennett is next. Thank you for coming back, thank you for your service. As you know, congress acted in a bipartisan way that address Surprise Medical Bills through the no surprise act in 2020, i worked with senators do cassidy and hassan on that. We built a big broad bipartisan we hope to ensure level Playing Field between providers and insurance as they resolve payment disputes. Through the dispute process we set up, both parties were supposed to provide information specified in statue. The arbitration that is required to take this information, and weight it equally. But we have heard a lot about how the implementation has been challenged, and to be completely plain and simple about, it mister secretary, we believe the administration is not implementing the legislation as intended. We are seeing lawsuit after lawsuit, from providers, insurance isnt responding in a timely manner, sometimes not at all. Even when the payment determinations are won by providers, players still dont pay providers after the statutory deadline. It is a big mess. Cms is frozen, and unfrozen in the process over the last few months, which has led to significant reduction in cash flow, leading providers on the hook for tens of thousands of disputes. While patients are still technically protected, these implementation challenges harm every single patient, because they dont know whether providers are actually gonna be there to provide the services that they need. So we have got to get this back on track. I just want to know that im willing to work with you and others to get this in the right place. In the budget, hhs requested another 500 million to implement this bill. But i dont see evidence that it has gone well, or right by congressional intent. Can you give me your assessment of what has gone wrong, and how you intend to reduce the backlog and legally implement this bill . First, thank you senator for your work in helping us have this critical law passed. Secondly, i dont think you or i knew what it was going to come. Let me ask for your help, im gonna plead for your help. We are receiving more than ten times the number of claims that anyone ever expected. And these arbitrators, that are supposed to go through these claims, theyre swamped. And remember, they dont get paid unless they adjudicate the claims. What were finding is that theres way too many, i would say matt vast majority. But way too many are frivolous. Because there is no cost to file a claim. So everyone is just filing all sorts of claims. These arbitrators are trying to figure out what cases to handle. Thats whats backing down the system. It will tell you this, were saying charitable awe. We are not letting patients get caught in this food fight between provider of care, in the Insurance Company that has to pay for the care. Were making sure patients are not getting the bills in the mail, saying you owe this money. Its gonna be between the provider, and the insurer. What were trying to do is have a system that works, so i plead with, you in your colleagues. Help us make sure that we get to the legitimate cases, so provider whos looking for real payment, or an insurer who saying, hey youre asking for too much, we can adjudicate that claim. Well, lets have another question i want to ask. But i think we have, i dont know, whose fault it, is but we have a system that doesnt work, i think. So i certainly will help, the volunteer, hassan, cassidy, id ask you to volunteer to figure in how we can Work Together to do it. Im writing names down. Well you should only write my name down three times. Ill try and get the other folks. I want to, i want to, say, again thank you for your leadership. Just a few months ago, the chairman of the cdc put out their latest youth Mental Health report. It continued what i heard across colorado, over the past few years. We have a youth Mental Health epidemic in america. A Mental Health crisis in america. According to the cdc report, 40 of High School Students felt so sad or hopeless last year that they could engage in regular activities for at least two weeks. I was saying to myself the other day, when i get a call from colorado, that somebody the age my daughter has died, i no longer asked, was it a, car accident, or was it leukemia, the question is, was it a, was it, was it suicide, or was it fentanyl, or was it, you know, a gun. And by the way, when i was the superintendent of Public School, we never asked that question, just 15 years ago. Tell us the truth, for seniors, one in five Medicare Beneficiaries have a Mental Health condition among latino seniors, that goes up to nearly one in three. I know weve done a lot in this community on Mental Health. We gotta do more, im glad the hhs just budget calls for Medicare Advantage and investing in the Mental Health, into primary care. This is why i introduced with chairman wyden. The middle Health Care Act for americans. Our bill would require for Medicare Advantage plans, and increased reimbursement across programs for integrated care. I am extremely grateful coming to the end of my question, i know matter town, out of time. Im extremely grateful to your staff are working with us to draft that bill. I just want to ask you, as we continue to work on, it whether he would be willing to work with us on, it because im sure youre detecting the same trends and Mental Health that we, are and maybe with just five seconds,. Yes. Thank you, mister. Chairman thank you, senator, for your leadership on this, it takes your breath away what some of these gaps in eugene, oregon, for example, a young person has a problem in school, and they have a major breakdown, there is literally no treatment for them at that time. So youre doing an incredibly important work. I appreciate it. Senator lankford is next. Thank you. Good to see you again. I had a parent that was in my office today, as you can, imagine the parent said they came here to do research and background. When they bring questions they bring different kinds of. Questions their particular child had a Health Care Issue and are asking me about the toxic drugs. They went through several different proposals that were out there, but then they asked a very specific point, a well educated question about pharmacy benefit managers. And they said, what is being done . Because that seems to be a black hole. All im reading and seeing you are very perceptive to be able to go through the different aspects on that. He talked a lot about drug policy, but theres nothing about pbms in some of the proposals in your budget piece, seeing as we work with them directly, i want to talk about some of that as well. But for the pbms in particular, they are not even mentioned, once what is the plan at this point . What is the deal with drug pricing and the pbms . Senator, thank, you it may not be as directly included within the budget, but the administration is working on pbms, because we know more and more there is a growing concern that the middleman in the process of getting in drugs for manufacturer to patients they are skipping off a good deal of the money that is being generated. And what we want is for consumers to get the drug at the lowest price possible. I will tell you that most of these issues will likely end up in court, as you can expect, but were going to try to move to make sure that if there is a middleman that is going through the process of making sure a drug is getting through the manufacturer to the patient, that its done. Efficiently and we could use your help. We would be glad to work with the administration on that, we will find bipartisan support to deal with. This basic elements of, transparency pbms are very where the pricing, is where the money, actually owes or even the standards for evaluation. Different pharmacies are valued at different. Ways they dont even know the evaluation sometimes. Getting some synchronization, weve made those recommendations to your team, wed love to do work on. That we would love to work on. That if i could continue on the same team, this issue is becoming more and more important where the drug will be released, out there is a generic drug that is released later in competition, but according to the pbms, and the original manufacturer, it is put on a branded tier. Meaning that the patient at the pharmacy counter is paying the more expensive rate, rather than the generic rate for their pharmaceutical. It also becomes an issue for medicare as well. That is not an issue that you brought up on, this but its a really big issue. We need to be able to address this, this whole issue of where a new generic drug comes, out whether it is, it can help us get to settling this issue for the prices. We will follow up with this. Thank. You i want to send talk about something senator menendez brought up. Its the children in custody that have come across the border, the unaccompanied minors. The New York Times published this report that was pretty horrific about labor, but its not new, to some extent, trying to be able to figure at how we can actually manage this. The times actually identified that there is a stat, 85,000 children that hhs loss immediate contact with once they were placed in sponsorship. Thats my first question, is that number accurate. . Once they do the vetting, places in sponsors, do you know where they are . Even for those first 30 days . And then when you get to day 31, do we know where they are, and if i can push a little farther, if they dont show up for their first hearing, is someone from hhs checking on them . At that, point they are lost. Senator, every week i get briefed by my team, sometimes two or three times a week, on the situation with the unaccompanied migrant kids and where we stand. Ive never heard that number, 85,000. I dont know where it comes from, and i cant attest, but i would say that it doesnt sound at all to be realistic. And what we do is we try to follow up as best we can with these kids. Congress has given us certain authorities, our authorities and the moment we have found a suitable sponsor to place that child with. We try to do some followup, but neither the child nor the sponsors actually obligated to follow up with us. And we make every effort to follow up with them as best we can. But the first 30 days, there is the followup thats actually happening, there but if they dont show up for the first hearing, there is no followup at that point . Is that correct . The followup for purposes of the immigration proceeding would be, i believe, through the department of Homeland Security. Okay. Well, at this, point no one is following up. There are some assumptions that are made there that if an unaccompanied minor has been placed in a home and they dont show up for hearings, no one seems to be checking on them to be able to figure out if theyre still at the same address, they were dropped off at, what are they doing . Where the next showing . Up i also understand that you have called for an audit before we got it in february, my understanding is the audit concludes next week. Is that something that we could get a copy of as well . To be able to see next week once its finished . Let me make sure, senator, when we have that audit finished, if we are able to share publicly the results of that. I believe we can probably share most of the information because most of the process that we use is public, what were trying to do is make sure that our checks on vetting or catching anyone who should not be considered a suitable sponsor, and our audit is for the purpose of making sure that our background checks are fulfilling that mission. I dont know why there wouldnt be a good reason that you can share with this committee, and even if we were seeing it just locked in with this committee, and it wasnt publicly, released theres no reason the audit cant be released. There are issues of privacy for the children. I get, that but its probably not kids names in the report. But thank. You senator lankford, thank you for bringing up the pharmaceutical benefit managers, what we all know is pbms. We are going to be having a hearing next thursday in this committee on specifically them. It is a result of senator creighton and i having a number of conversations about it. Im gonna let my colleague ask their questions. This conversation will continue. I hope next remember can come next. Thursday thank you, senator. Thank you for the dialogue before the meeting. We were concerned that people at hhs are working. So let me put this picture up. This is a picture taken at 10 40 a. M. Last monday, i dont hhs headquarters. It is like empty, then we could have pictures of other parking lots that are similarly empty. So you know, wow, the buildings, theres no cars, the buildings are empty, so we just appropriated three but first, tell me this, can you give a breakdown of how many fulltime employees are at their desk in one of these buildings every day . Senator, when you take a look at the workforce at hhs, we are close to 90,000 throughout the country, and working in various parts of the country, some here in headquarters, by the, way and headquarters we have i have limited time. So this may be misleading. Tell, me what percent of the employees are at their desk fulltime on any given day . I dont mean to be rude, just limited time. I appreciate. That our folks are working fulltime. But how many are at their desk as opposed to at home . Or someplace else . A coffee shop . Whatever we make sure we care about that theyre performing and delivering, that doesnt answer my question. Because i know the best practices now, in many, industries is to bring people back. And so is it 5 . Is a 10 . Is it 1 . How many folks are actually sitting at their desk in the government building when they are working fulltime every day . We have folks who, as they work fulltime, its not a clearly, sir, you dont want to answer that question. I dont mean to be rude, but that begs the answer may not be flattering. When cms put out a request for employees, as regards to the complex drug negotiations that were a recent bill. The posting offers generous telework policy what is generous telework policy mean . If somebody hired in that program, how many days a month will they be expected to actually be in a government building as opposed to wherever they wish to be . Senator, that depends on the work, or some people have never left a job, even during the height. Im not speaking about leaving the job, im talking about being at their desk. A percent . Anecdotes are not data. We are limiting the scope of what we do. We have investigators who never said it desks. Somebody who traditionally would have been at their desk . Depending on the work they had to be performs, sometimes they may be in the field, sometimes theyre at office. For the record, obviously it doesnt seem that youre prepared to answer that question. For the record can you give us a percent of the actual workers who are fulltime who would be expected to be at the, desk not an expecter in louisiana, but someone. Else if you can give that for the record. We could, followup senator. Kenny agency provide us vpn data or some other measure of accountability that shows that the people truly are working from home . We can certainly show you that they are performing. The fact that 700 million were invited to the arms of americans. Do you have the vpn data. We saw the vpn data that showed double digit numbers of employees were not turning on their vpn every day. So that suggests they were not accessing emails, for example. Is that data still being collected . Can you show those results . I can get back to you on that. If you live in the d. C. , area you have to work differential. So you get a little bit. More your cost of living is more. So as someone who is in this building with an empty parking lot, is someone in that building not knowing where they are currently working, are they still getting a cost of living adjustment as if theyre working in washington d. C. . I have to tell, you senator, that is not the headquarters of the hhs department. It is cms headquarters. Oh, okay. What we can get back to you on. That as i, said we have been coming in day and day out. Performing day in day out. Lets assume, because ive heard from people within the agency that in reality, people are only required to come in one day out of the month. And this has been something we have heard from cdc along those, lines but have also heard from somebody who is working at cms. I assume you have a Global Policy because of the same union negotiating for all of hhs. So it seems to me as if this is the same policy wherever you are. My question, is if you are working from home consistently, and originally you are based in d. C. , are you still getting the cost of living adjustment even though we frankly dont know you might be flying in one day a month but living in West Virginia . Again, sir, im not familiar with the statistic that youre throwing out that says but is their cost of living adjustment for people who are taking advantage of generous telework . You are certainly a cost of living adjustments for folks who work in high cost areas. Even if they are telework . If they are performing their work, they are entitled to receive a cost of living adjustment if they work in a high cost living area. When you to find work in a high cost living area, do you mean telework . They are vpn could show them in d. C. , but they could be in West Virginia, so are they getting paid as if theyre living physically and showing up every day and parking in that parking lot every day in the d. C. Area . You would have to take a look at the particular Job Description to find out what type of work is done and where theyre located to make that determination. I yield. I thank my, colleague next is senator hassan. Thank, you mister chair, Ranking Member crapo for having this hearing. And thank you mister secretary, for being here. I want to start with a discussion of state opioid response grants. I was really pleased with the departments proposed budget includes two billion dollars for state opioid response grants. These grants, which i have worked since 2017 to secure and expand, they really helped my state significantly improve our response to the federal crisis. Last, year you and i discussed programs impact in New Hampshire, New Hampshire has been really hard hit by the fentanyl crisis in particular. We discuss the importance of continuity of funding. It helps states plan and avoid drastic cuts. And just before the, hearing you are talking about a program in rochester, New Hampshire, called hope on haven, hill which focuses on Treatment Recovery in transition for pregnant moms and parenting moms who have Substance Use disorder. The continuity of funding has been really critical for them to be able to develop that program and really help these women turned their lives around. And help them get better. In last decembers appropriations, bill congress acted on a bipartisan basis to acquire hhs to, and this is a, quote prevent unusually large funding changes from here to. Year i know from our past conversations that you understand and share this really important goal. How does hhs plan to implement this statutory requirement to prevent your twoyear funding state opioid response grants for states like New Hampshire . Senator, i have to say thank, you these are your babies. These grants, you championed, them you made it possible for us to actually get money into communities who need to deal with opioids. And youre saving lives, to thank you for that. The president has followed your lead. He is calling for two billion dollars in investment, that should help a lot of these agencies that are administering the funds to get services to folks who are trying to get off of opioids away to know that theyre going to have a consistent and hopefully permanent stream of support because the last thing you need is to be there one day, but not the next. So the work that you are all doing is not only helping us to institutionalize these programs and but also, we want to make sure that it stays consistent, so that we dont have one day having the resources to do, it and next to you have to close down all the shops. So we will work with you on. That i appreciate. That i really just want to make sure that your staff in mind continue to work on this, its everything from certainty and predictability for patients, as well as being able to recruit people into the work for us to do this work. So i look forward to working with you and your staff on that. Now, i want to turn to discuss title ten Family Planning funding. I want to thank you for including robust funding for maternal and Reproductive Health departments budget, including doubling funding for title ten Family Planning to 512 million. Along with senator warren, im leading a letter to appropriators echoing that request. Title ten is the only federal program dedicated to providing Family Planning. And its historically been a program thats under funded, but we all know that in light of the supreme courts decision last year, to restrict reproductive freedom, this is a program that is more essential than ever. Can you speak to the importance of congress appropriating this essential title ten Family Planning funding . I want to ask you omar, question if you could be a little bit brief. Family planning hasnt received a boost in funding in eight years. It is time. We know how essential it is. It is not just funding for one type of, care it is funding for Family Planning services. Indispensable, president s budget recognizes, it we look forward to working with you to get that across the finish line so we can actually expand services so we can get help to the communities that need them. Its essential for a woman capacity for Self Determination and dignity. I appreciate it very much. I want to turn to another issue, which is the and 80 active implementation. At the end of last, year the mainstream Addiction Treatment act, and 80, which i lead with senator murkowski, was signed into law. This Health Care Providers which prevent them from a critical treatment of action for people struggling with fentanyl and other opioids. I know that even the administration are strongly behind this new law and, i want to thank you for yours work to support it. Can you please speak to the importance of these changes and what hhs is doing now in coordination with other agencies to expand access to morphine by ensuring that Health Care Providers know about these changes . Senator, where do i start . Medication treatment is critical because its one of the ways you save a life. If you give morphine to an individual before you od, you saved a life. If you remove the barriers that keep a physician from participating in a program to be able to prescribe a lifesaving drug, you have saved your life. And we were able to really remove the ex waiver cap, we were able to make it more likely that a sub physician will want to participate in this program and not find themselves subjected to Lauren Forsman oversight as if they were encouraging drug use, what we did was, we liberated the system to actually treat drug addiction, and take away the stigma. So we look forward to working with you on. That i look forward to it too, and im overtime, but one of the critical things here could be making sure that we work with Law Enforcement as well as Health Care Providers to stop it in pharmacies and make sure primary care physicians another primary prescribe arrears know that they can prescribe this lifesaving medication. Thank you, i look forward to continuing to work with you. Thank you. And thank you for your, work senator, especially on title ten. Enormously Important Program and has not come up yet. Today senator, johnson you are. Next thank you. Welcome. Do you believe it is important that we understand how the coronavirus originated . Absolutely. Is there somebody in your agency or department that is spearheading the investigation to determine . That we have done a number of initiatives to try to move forward there. Including having our oig take a closer look. So youre saying its oig . Is there somebody in the department outside the Inspector General that is spearheading . This we are also doing a scrub, were all trying to get as much information. The difficulty is that were not getting a lot of cooperation from some of the sources externally. Lets talk about lack of cooperation, i would say the same things true in terms of cooperation of the agencies. Do you believe the public has a right to know how the agencies are spending their money and how they are operating . The public does have a right to know, yes. Theres two primary methods for that. You have foia, freedom of information act requests, you also have congressional oversight. Would you agree that it is generally subjected to more redactions than congressional oversight would be . I wouldnt say that. We do have to be careful what goes into the public domain. We are respecting confidentiality and privacy. I understand. There is some exceptions that are very explicit out there. A lot of the make sense, but i would argue, and many people, do the congressional oversight is not subject to the same redactions, strictly when you have security clearances and we deal with classified information that is appropriately redacted under foia. Let me give you an example, we requested these documents, by the way, in june of 2021, under a request, court ordered, 4000 pages of different documents, primarily emails, from Anthony Fauci, they were produced under the foia. In september 2020, one we had five members of homeland governmental, affairs they were asking for those same pages unredacted. There is a law that says you shall turn it over to us. In september 2020, when we started working with hhs to produce those documents to accommodate the process, we narrowed 400,000 4000 pages down to 400 to get those things unredacted. They werent handed over, to us what we did was we were allowed to read them 50 pages at a time in a reading room and take notes. Some productions we did get, for example, we got this document. This was dated february 4th, between Anthony Fauci, jamie farrar, the welcome company, and Francis Collins, you see the redactions here. This is the same document produced under foia without the redactions. So now we know what was redacted, and this was redacted, by the, way under be for, which is trade secrets. One thing that was redacted was Anthony Fauci saying question, mark serial passage and h two transgender mice. They were humanized mice. Theyre talking about Francis Collins remains a very real possibility of accidental lab passage in animals that can give by cans. He said anything, its a 60 40 he thinks its 50 50. This is february 4th. There is nothing to do with trade secrets in that reduction. Another example, this is february, second this is when they were saying they funded this dangerous research. Now there and to cover up mode. Here is what we got, in our production, the head of the redactions. This is what waser released under foia. Now, this was released under the b five exception, which is privileged information within or between agencies. Again, this is with jamie ferraro, the welcome trust. So we had redactions with privileged information that didnt apply, and we still had it redacted. I dont have time to get into that. This is completely inappropriate. By the, way you have produced 350 pages to us in the reading room. For over a year we have been asking for the last 50 pages. This is what the 50 pages look like. Now, again, i would argue congressional oversight should not be subject to the same redactions that were applied under foyer requests. Im asking, you will you commit today to provide our oversight, senator paul is on this, now again, we had five members of Homeland SecurityGovernmental Affairs under a law that says you shall provide. This will you commit to providing the last 50 pages of communication between Anthony Fauci, Francis Collins, jaime farrar, as it relates to the origin of the coronavirus . Will you commit to that . Senator, i absolutely will commit to make sure we follow up with you on your request to get some of that information. Again, this is in compliance with the law that you receive the information. I dont know what particular statute with regards to disclosure was applied here, but you are absolutely entitled to the information, that by, law a member of the senator of the house again, youre not complying with the law because your redacting things, for, example under to the brit process communication outside of the agencies with the welcome trust. , again these reductions are not complying with the law. So i will appreciate a followup, i expect to see the unredacted 50 pages very soon. We can comply with the loss, but we will follow up with you. Thank, you senator johnson. Next is senator cortez thank, you always great to see you. I want to touch on Medicare Advantage. Seniors in my state rely on Medicare Advantage to access affordable High Quality Health Care. I often hear from nevadans how vitally important this program is to supporting the health of them and their loved ones. Thats why i have been a long supporter of Medicare Advantage. I am proud to have led the annual bipartisan letter. I believe the rough 57 senators. My colleagues that signed on to the letter urged the administration to preserve and strengthen the program. Last week i spoke with cms administrator, brooke was, sure about the proposed updates for the program for 2024 and what it means for nevadans. I will reiterate, today, mister secretary, any efforts to address overpayments and Medicare Advantage should support program integrity. And preserve the sustainability of the entire Medicare Program without just droppeding access, without increasing cost, or jeopardizing the quality of care. As you moved to finalize 2024, policies i urge you to prioritize a program with improvements that benefit patients and deliver value to seniors and taxpayers, so i just want to start with that. Secondly, i to notice all the purple here in the room. Thank you to the alzheimers associations, everybody who advocates. Its something that ive dealt with in my family with my grandmother. So appreciate your advocacy over the years. Thank, you you always have a supporter with me. Secretary, let me talk about the commercial Prescription Drug inflation rebates. Last, year as you well, now we passed historic drug pricing policies in the Inflation Reduction Act. This law is already working to lower drug costs for our seniors, with medicare, importantly, the inflation penalizes Drug Companies for raising prices faster than inflation. However, as it stands, today these companies are only held accountable for hiking drug prices in the Medicare Program. That is why im introducing a bill to extend the inflation rebate penalty to include drugs used by people with private commercial insurance. My billmpo will ensure that in about a families, as well as our seniors, are no longer squeezed by Drug Companies outrageous price hikes. Secretary becerra, im glad to see the goals of my bill reflected in the president s budget proposal. How would the inflation rebate penalty for the commercial Market Impact drug prices for patients at the pharmacy counter as well as health care pairs like employers and unions . Senator, first, thank you for that effort. We want to think in any way we can and help. We know what happens if you dont take insulin. Those were only applied to people on medicare, 67 million americans on medicare. Today, the three leading manufacturers of insulin said they were gonna drop their price of insulin for those who arent on medicare. So that was in the private insurance market. You see what happens when you introduce competition into this. The prices go down. Now everybody has to compete to get your business. You bill, i, suspect would do the same thing. It would introduce that competition in the private insurance sector. So it would compliment what we do in medicare. And at the end result, you would drop the price for a whole lot of americans who arent on medicare. Thank, you i appreciate. That let me just add that my commercial Prescription Drug inflation rebate bill has the potential to generate significant savings for the federal government. In, fact cbo projected that a similar provision would save 34 billion dollars over ten years. So i thank you. Let me jump to something very quickly here. Mental health, ive heard my colleagues talking about, this as you well know, this is such an important issue for me as well. I support my colleagues on both sides of the aisle for working to address. This and i appreciate the support for the Crisis Services in the budget proposal, around Mental Health, and the funding 23 bill. Our fiscal year 23 funding bill. The significant expansion in funding for 998, the new suicide crisis lifeline has helped communities manage, increased demand, and call volume since the line went live last summer. I, know i talk to my folks in about all the time about this. On this committee, we are very focused on what comes next. What happens when someone in crisis dials the line and needs somebody to come help. Or somewhere to go for that treatment. I was proud, with the, chairman to pass increased funding for it 998. In crisis care through mobile units in the december bill. We have more work to do. So my question for you is, in your view, what is the biggest challenge to improving crisis care coordination when were talking Mental Health support thats needed across the country . Senator, workforce. We need to hire more folks, pay them decent wages so they will stay in the field because right now, we know that health care has a shortage of workers, period. Mental health is even worse. And if we really want to say to somebody, call 998, youre going to get real help, we have to make sure that there really will be real help at the end of that call. I look forward to working with, you im hearing the same thing in my, state and across the country. So thank you. Thank you. I thank my colleague for questions. Especially the point about mma Medicare Advantage. We work closely with this committee and chairman casey, who puts in a lot of effort on this. Just a quick word. I believe oregon, nevada and minnesota, they have the highest percentage of Senior Citizens in mma. Thats in the entire country. And having spent a lot of time in these precincts with my days working with seniors, ive come to the conclusion that unfortunately not all Medicare Advantage is created equal. There has been some very good mma, there has been some not so good and we are going to work closely with our colleagues to make sure we get the former, and help less of the, latter her points are very well taken. We are going to work closely with the administration to make sure that we recognize that kind of distinction. Next is senator tell us. Before i make comments and questions, i want to recognize the alzheimers association. You are all in my office in North Carolina delegation, was in my office yesterday. My staff have been meeting with them. I looked at my stuff and, said are there any priorities that you have discussed that we dont support . They said the answer is no. We support them all. Including a Dear Colleague letter for funding for nih. So you can kind of my support. But the reason i did that is because i wanted to talk with him about something that should be on your agenda. And it relates to research, and it relates to Prescription Drug pricing. And i will get to that in a minute. I want to use a few examples. I know we have had some members talk about the great advances secretary becerra and the Inflation Reduction Act. Based on patterns that im seeing in the industry, you could call it the investment reduction act. Mr. , chairman i have three documents that, without objection, i would like to submit to the record. Without objection. Two are related to eli lilly, one to another player in the pharmaceutical space. We have made Business Decisions to drop small Molecule Research and other, things because the time that they would need to recover the investment they anticipate, it is not there, and you can expect small Molecule Research. You can expect productions in a drug that were trying to expand, you can see the effects of not getting well intended policy right. And mr. Becerra, secretary, congressman becerra, i think the work that you did on a bipartisan basis, whether it was 21st century cures bill, or even more importantly, the heat you took from your side of the aisle to get trade promotion authority, it tells me youre a person who likes to get to a positive. And a productive. And the only reason the primary reason i didnt support her confirmation in fold associate is the position youve taken on rights. Im not going to have enough time to get to many questions, but i think it needs to be said, and i believe were going about it the wrong way. In terms of the haircut that needs to be done to get prescription prices lower, and not at a point in time, not expensive, other research thats necessary. I tell everybody in the industry. I believe there is a hair cut coming. I havent heard any member talk about who needs to be on the barbershop. I think it needs to be pharma, i think it needs to be the pharmacy benefit managers. It needs to be the insurers. Medical, the medical profession, the perception, the pharmacy, the fda, the legal community. If youre really going to fix the fundamental problems with drug pricing. And look people in the eye and, say you are doing not just something to claim victory, as it was done with the i. R. A. , but something that is sustainable. Every single one of them need to be there all a part of value chain. They all need to be at the table. We need to get it right. Because you may be able to correct me if im, wrong i havent seen a single successful sustainable solution to this, or at least part of the solution, except when passed something not too long ago. Mister chairman, id like to submit for the record and oped that, with this it was written by senators by and dull in 2002 that said we never intended for their legislation to become weaponized. Without objection. The nih has recently just rejected the imposing price controls based on, price now, we have a work group thats going to consider price as one of the ways that we go about getting down on this industry. If we do it, we are going to have a longer window for work that has been done for alzheimers. Ive got a vested interest in. That i was a parttime caregiver to my grandmother. Ive got a vested interest in broader research. Ive got to potentially deadly one incurable, one curable disease in my body. One is prostate cancer, the other is wagners gray yellow mess. Prostate cancer has a lot of promise. Provided that its within that window. Wagners is a rare disease, it is not going to be something that were going to see a cure for particularly if we dont get this right,. And incentivize the private sector to invest in things that they may have to walk away from, after a billion dollars an investment. I told the alzheimers association, please study up on the attacks, on intellectual property protections, take a look at what the administration has done, trips, waivers and other, things really threatening the return on investment that these companies have to make. Please make sure that that is part of your pitch when you come to these members of congress and expect them to produce a Prescription DrugPricing Strategy that they can look even the eye and say, it is going to produce year over year results. Thank you for being. Here senator tell us, thank you for your point with regards to the nature of how pharmaceuticals particularly, as it relates to the regulatory system, have a breakdown in every step of the way. Thats what senator grassley and i found in our mid research report, if anybodys having trouble sleeping, tonight you can go through the scores and scores of footnotes, and it starts with, farm up but it is the pbms, it is the circular,s its, distributors mister chair, its the fda to. We learned so much from covid. We figured out how we can accelerate approvals under him urgency use operations. The fact that we have those snap backs, postpandemic, after theyve been proven to, work it means, to me, that were not learning some of the good things youre your point is correct. Senator warren, than senator blackburn. Thank you very, much mister chairman. I also want to say, welcome to the alzheimers association. I wore my alzheimers purple today. We have a very active group in massachusetts, i want to say special thank you to all of the advocacy you do on behalf of so many people we have lost to a terrible disease. So thank you. I want to talk today also about Medicare Advantage. Every february the federal agency that runs the Medicare Program releases a report outlining how Medicare Advantage, or am, a insurers are gonna be paid for the following year. Emily is a program that allows private insurance plans to offer medicare benefits, now, taxpayers pay these Insurance Companies a set amount per beneficiary, and this amount to go up if the beneficiary is sicker. The more diagnosis codes that beneficiaries have, the higher the payment. And whatever ensures dont spend on care, they actually get to keep. These companies have built entire businesses around making beneficiaries look as sick as possible, and unsurprisingly, government watchdogs have discovered widespread abuse. This year, cms, they made a few updates to ensure that the governments payments more accurately reflect what actually cost to pay for the care for beneficiaries in this program. In, response the Insurance Industry has kicked into overdrive, sending an army of lobbyists to claim that the changes will hurt medicare. So lets go through this. Lets start with the basics, mister secretary, under your proposal, will total payments to insurance plans that run Medicare Advantage, will they go up or down . Total payments will go. Up so they will go up. Cms is proposing to increase payments to m. A. Plants next year. In other, words the Insurance Companies, overall, are going to get more taxpayer dollars, not fewer. But Insurance Companies want a lot more taxpayer dollars. Not just a little more. So they are kicking and screaming, and they even shelled out millions of dollars for a primetime Super Bowl Ad opposing the proposal. Now, these Medicare Advantage companies are also peddling industry funded studies that claim medicare premiums would go up. And benefits would be cut if your proposal is finalized. Mister secretary, are those claims accurate . We know they are, not benefits or not cut. Okay. So, numerous experts agree with hhss assessment. When Medicare Advantage was, created the Insurance Companies argued that they could provide better care for the federal government at lower cost. But for years now, and a plans have been using a long list of tricks and games to take advantage of loopholes in the governments payment rules, to squeeze literally hundreds of billions of extra dollars out of the program. Researchers at the Kaiser Family foundation found the Profit Margins four and a plans are double those for other kinds of insurance. In other, words because of lax rules, running Medicare Advantage plans is a lot lot more profitable than running other types of insurance plans. The Insurance Companies dont want the party to end. So, mister secretary, are they private Insurance Companies that run Medicare Advantage, are they actually delivering health care for seniors at a lower cost than traditional Medicare Program run by the federal government . The numbers show that it costs more to provide care to seniors in medicare through the managed medicaid Advantage Program them through the Traditional Program called fee for service. The cheaper way to do this is actually just to run people through the Medicare Program . Not to say theyres arent some brokers that work with Medicare Advantage, but overall, thats what the data shows . Yes, were talking overall. So if you lump everyone whos in the Medicare Advantage program, the manage care, Program Within medicare, those who are in the traditional Medicare Program called fee for service, the beneficiary cost is higher under managed care, over what we call Medicare Advantage. Exactly the reverse of what they promised they would deliver. They said handed over to, us we will do this cheaper. In, fact according to the medicare payment advisory commission, which is the independent Congressional Agency that studies medicare, the private Insurance Companies running mma have never delivered health care at a lower cost than traditional medicare in the entire history of the program. So, i just want to say, i urge cms to finalize this proposal. I cant get an ad on the super bowl, but i hope that having you at this hearing will have some influence on this. It is important to take the steps to strengthen medicare. I also want to, say i dont think its enough. Cms needs to double down on its efforts to crack down on industry abuses in the mma program. I stand ready to work with you and to help you do that to ensure that Medicare Beneficiaries get the care that they have rightly earned. Thank you, mister secretary. Thank you, senator warren. Senator blackburn . Thank, you mister chairman. And mister secretary, thank you for being here. I am so grateful that we have the alzheimers volunteers here. We have a great group in tennessee. And i there they are back. There we love to see them. Mister secretary, the budget that you brought to, us it is full of things that get in the way of research. It would prevent new drugs and therapies from coming to market. It would weaken those ip protections. And this would expand big government, and its something that does cost us some concern. I want to return to the issue of telework. I know that senator cassidy discussed this with you. Adding to the list of how many hhs employees are working, telework, i would like you to identify the essential and non essential components of that list of those that are teleworking. I also would like to look at you and your team personally, when you look at telework, how many days have you spent in california . During covid19 . Thank you, senator, for your question. With regards to my status, i know that requests have been made for my schedule, we will try to provide as much information. I think it would be great if we were able to get the schedule for you, your security, detail and the record expense reports so that we can see how much. The reason this is important is because you are overseeing an agency that is the equivalent of a tenth of our nations gdp, and i think that it is vital that you be on site overseeing that department. So can you even ballpark how long you were in california . And how often you are absent . I dont get to california very often. When i, do it is usually because i am doing work and travel. During the pandemic. I think its important that during the pandemic you are there. I want to read this back to you. 2019, talking about the border crisis, you said to president trump, and i quote, to say that its an emergency and then within 24 hours having said it, go off to florida to your maralago resort, when you think there is a National Emergency, i think all the evidence, including what donald trump says and does, proves this is no National Emergency and, quote. By your own standard, you would equate covid to not being a National Emergency if you are spending those hours in california and being absent from the headquarters . It is time to get people back to work. Faithbased organizations, we have 8000 faithbased organizations across the country that are irreplaceable members of the nations Child Welfare system. Senator, we are going to do some bipartisan work at Judiciary Committee on these issues. Tennessee, relies heavily on faithbased agencies for Services Like foster care, adoption, child different child and family services. And the recruitment of those adoptive families. Now, under your leadership, one of the first actions that we utica was to rescind waivers issued by the Previous Administration which allowed faithbased groups to place children in families that are in accordance with their sincerely help but their religious beliefs. The president s budget composes to gender identity discrimination by penalizing foster care and adoption providers for operating in accordance with their tenants of faith. So, with nearly 400,000 children in the foster care system, would you not agree that placing those kids in loving homes is a greater priority then advancing and agenda . Senator, thank you for the question. There is no doubt that being able to place and a child who is in foster care in a loving home should be our top priority. We want to be sure that thats always possible. We want to make sure laws are not violated. Okay, lets do, this lets have you submit how many potential foster and adoptive homes would be forced out of the system, if the president s budget was put into effect on that issue. I want to go back, i know senator menendez talked to you about the office of refugee resettlement. And this department is responsible for the care and placement of unaccompanied children who come across the u. S. Border. Correct . Yes. And are you aware of the recent New York Times article that really reported on a large number of unaccompanied children who are being placed with exploitative sponsors and working long hours and dangerous conditions . Im aware of the fact that a number of children have been reported to be working in ways that are violating our law. But im not aware of the situation you mentioned about being placed in exploitative circumstances, so if you could clarify that. I will be happy to, mr. , chairman i love to submit that article for the record. Without objection. Thats wonderful, thank you for that, now, the agency the times reported that under the biden presidency, the agency cannot find 85,000 children. And the agency lost contact with a third of the Migrant Children that are coming into the country. So i would like to know what youre doing to find the children . And what youre doing to make certain that these children are not being trafficked . First, those statistics that you mention, as i said previously in regards to another question by one of your colleagues, those are unfamiliar to me. I have no idea where those statistics come from, if their base and reality or not. We do everything we can to make sure any child, before we allow them to be released to a sponsor, that that sponsor has been vetted, and the vast majority of these children and up with a Family Member, an immediate Family Member as a placement. So some of those statistics that are being thrown out, there they dont seem to be based in fact. They would go contrary to what actually we have done. My time is over, but let me tell, you we have to get this thing strident out. At anytime, you had 10,500 children under your care. The money works out to about 1400 dollars a day. We to take care of these children, you cant find these children. We have to get it straightened out. Thank, you mister chair. I think my, color we will go to senator daines, i just want to put one document into the record. References made to how a notion, according to, some of making sure medicare can bargain to hold down the cost of medicine would somehow reduce innovation and damage future drug creation. The nonpartisan congressional Budget Office looked at this issue specifically, and estimated that their words, minimal impact, new medicines coming to market under medicare and drug price negotiations. This was an issue that was very important to me. Because clearly, what we wanted, was more competition without reducing innovation. That was the finding of the nonpartisan congressional Budget Office. Senator daines . Thank, you mister secretary, thank you for being here today. There are several concerning proposals in this budget, including yet again the admission of a Hyde Amendment to allow for taxpayer funded abortions. Its clear the administration has no intention of protecting the precious lives of the unborn. Since the Dobbs Decision was, leaked it may have last, year over 80 Pregnancy Resource Centers and pro life groups have been attacked and vandalized, as have hundreds of churches that supports the prolife cause. Some, even in my home state of montana. Mister secretary, given the continued assault against Pregnancy Centers and churches, would you publicly condemn this violence . If you want to do it right, here id be happy to hear it. Senator, i dont believe anyone here would condone violence against any american, whatever the sort. And certainly, i would hope we can all Work Together to prevent any american from being harmed simply because they are either trying to exercise their rights, or receive services they might need. So i would love to join you in sending a message to all americans, please respect peoples rights. And, also make sure that we are not approaching peoples rights. You publicly condemn what has happened . Would you condemn this violence . I will condone any sort of violence. Thank you. Senator, thank you. As you are, where over 30 million seniors and people with disabilities in this country and rolled in the Medicare Advantage plans. Including one quarter of montanas seniors. Due to the added choice in control it offers beneficiaries. Rural states, like, montana we, they face unique challenges when it comes to recruiting and retaining physicians. Oftentimes we are a long ways away from larger communities. We the changes to the sea image h cc model in the proposed rate notice will further jeopardize montanas access to care. My question is, this what data can you provide that might show the current rate notice will not impede access to care enroll and underserved areas . Senator, thank you for the, question it is very important. The rate notice actually provides a greater level of funding than last year. And what we do is we try to make sure that it is funding that goes for a particular service, and not to line the pocket of a middle person in the process. So what i would say, especially because the Rural Communities you represent, we need to make sure every dollar that is being put out for medicare recipients gets to service a medicare recipient. What were finding is that too often programs are gaming the system. As you heard earlier, the programs, some of the plans are claiming that Medicare Beneficiaries are sicker than what the person, maybe as a result, up quoting that person, getting more reimbursement. Even though you might not provide the care that a sick person under those circumstances would need. What i will tell you is that the end of the day, whatever we have done with this great notice, it does not cut any benefit provided by medicare, and in fact, it provides more resources to those who provide services under medicare itself. I want to shift gears and talk about medicare taxes. Mister secretary, the president s proposed budget raises medicare taxes because the president claims to care about this solvency of the Medicare Program. And that the wealthy should pay their fair share. However, there is mounting speculation, and this, is this is reported by the wall street journal, according to his own tax returns, the president improperly classified the money he made on book deals. And speaking events. Allowing him to dodge over 500,000 in medicare taxes. This is according to the wall street journal. How can the president proposed tax increases on americans, and called for the wealthy to pay their fair share, when he potentially owes half 1 Million Dollars in taxes to the Medicare Program . Senator, let me respond on the Medicare Program. The president s budget would make sure that not just for today seniors, that they would get the benefits they expected when they paid into the Medicaid Program for decades, but it also makes it clear that moving forward to the next generation, they would receive the same level of benefits. There would be no cuts, and thats the beauty of the brydons proposal. But the question is, dont you think this pledge to protect americas seniors might ring a bit hollow in light of the president s own hypocrisy of dodging 500,000 in medicare taxes . My suspicion is that the president would challenge the way youve described his circumstance, but what you cant challenge is the fact that his proposal increases benefits under medicare, and moves it forward in strengthening it for the next generation. Something no other president that ive seen when i was in congress for 24 years have really done. And i have not yet seen anyone in congress produce a plan like the president s that would provide that guarantee for seniors up tomorrow that they will have the protections they expect in a medicare. Im out of time. It looks like chairman casey. Chairman casey is recognized by himself. Thank you very much, senator whitehouse is letting me go ahead of him. He has a lot of credit. Mister secretary, great to be with, you and thank you for your testimony and your enduring commitment to public service. Members of the alzheimers association, we are grateful for your presence, and the determinant advocacy you bring to our offices year after year we are grateful and continue to work with you. Mister secretary, i will talk to you about Long Term Care in the context of two settings. I will mention one, but i really want to ask about the second. The first is in the broader context of what can only be described as a caregiving crisis. When it comes to seniors, people with disabilities, and i will include children in that as well. We are in this crisis in one of the paths forward, i believe, not the only, but one of the path forward is greater investment in home and Community Based services. So age cbs for seniors, people with, disabilities and workers that do the heroic work. I have legislation to do that but i know your wear of. We have much to do on that. But im going to set that aside for a moment and talk to you about the other setting, which is institutional settings. Long term care skilled care and nursing home, by way of leading example. In particular, the special focus Facility Program that i have worked to oversee for a number of years. To make sure that we are investing in oversight that is particularly centered on those facilities that have had the greatest problems. When you look at that number, about 97 of Nursing Homes are not on that list. That is the good news. The bad news is that 3 that are have real problems in terms of care. I was pleased to see that there is a 39 increase in funding for survey and certification activities of Nursing Homes in the president s budget. Im grateful for that. But i also think more funding is needed to expand the special focus Facility Program, how additional congressional appropriations towards nursing home quality and oversight be beneficial to better protect residents in these facilities . Senator, thank you for focusing so much attention on this. Well i think most americans would say its great the majority of Nursing Homes dont fall within this program, there are some that do, and there are americans who are in these facilities you have to make sure we protect. Them so the money that the president proposes what help us do more oversight, it would help us do the surveillance to find out if these poor performing Nursing Homes are increasing services, and improving services, and it would let us help take action sooner so we can help prevent a mishap, a accident, or perhaps a death that could occur in one of these facilities. I will submit a question ill submit a question to the record regarding the plans to revise the program, the special focus Facility Program. My second and final question is about Counter Measure injury compensation. We know that 700 million covid vaccines were administered in the country, but there are instances where there are injuries related to any vaccine. I know there are rare, but they do happen. I was encouraged to see that the h h s budget requested significant increases in funding for administering two programs. The countermeasures injury compensation program, the vaccine injury compensation program. Ive written to administrative john said in her set earlier this year about the countermeasures an injury compensation program, and i want to make sure that we reiterate the message from that letter that individuals with these covid19 vaccine injury claims are waiting till long for adjudication. We want to make sure that people arent waiting for that kind of compensation. What Additional Resources do you need in order to speed up the process and respond to these climate faster . Senator, youre helping getting that money across the finish line would be indispensable. We need to move through that backlogs. One of the things we do, if we get Additional Resources, and to try to make some improvements and getting those claims through. We would set, up for example, an injury table, that lets us better target who is been harmed, what the issue is, and whether or not they qualify for some compensation. The Biggest Issue right now is just having the wherewithal, the resources, to get up to the number of cases. All these americans deserve to be compensated if theyre injured. Thank you mister secretary. Mister secretary, your friends, admirers, thanks very much for joining us today. Last year Congress Passed into law the play shun reduction act, as you know. Its not just the most significant climate legislation in the countrys history, but also, it includes landmark the lower the high cost of prescription joining a number of my colleagues altering those provisions, our work to lower drug prices is not done. We have a real opportunity to continue to tackle the cost of Prescription Drugs through reforms to the pharmacy benefit manager system. There is bipartisan interest in this, comedian outside of this committee, to do so. My colleague, senator blunt word, another hearing, and i want to follow up on his question. What common sense pv am reforms do you think should in particular, this committee, the finance committee, consider will lower the cost of Prescription Drugs for American Families for their, and will you and your family at hhs work with us to move those reforms forward during this congress . Senator, thank you for the question. As you know, this is an area where whatever move for change we make, we probably will find ourselves facing a complete file in court. There is money involved in this, but what i will tell you is that transparency is so critical to know how these middlemen are operated. We understand where the money is going, and how the drugs are getting into people who need them from the manufacturers. I would say to that were going to try to do the work possible, to try to increase oversight and transparency and the way the pbms offer. Thank you. I will talk a little bit about the implementation of youth Mental Health provisions. We put up Public School nurse in every Public School, we opened up wellness enters an just about every high school in our state. Were extending those, as you may recall, to our middle schools, and elementary schools. They the years i was privileged to serve as governor, we focused on making sure that kids get the care that they need where theyre at. The last congress was along with senator cassidy of the youth Mental Health working group, alongside from several of our priorities were including the bipartisan Safer Communities act, as you may recall. This includes important provisions and make it easy for schools to provide Mental Health services to students, and to get reimbursed for those services under medicaid. You think maybe on the chip program as well. Understand that hhs is under the process of lump inventing those important provisions. To say, what works, and do more of that. That spirit, can you share with us the best practices that are doing a great job providing Mental Health services to students and school based setting so that other states can learn from their success . Senator, your right. Youve probably can identify a number of these programs that are really having success. What i will tell you is that were trying to partner with those that have really got into the schools to provide kids with access, early access, to preventative Behavioral Health services. One of the programs we have this project aware, with really works closely with students to ensure were reaching them when theyre manifesting certain issues regarding behave eleMental Health. The next day were going to push, and heres where we need the help of the states, governors, is to see if we can get medicaid into the schools far more deeply, and quickly. Many of these kids will qualify for Medicaid Services, why wait until apparent applies, or finds out that a child is eligible to receive Mental Health services, in the doctors office, or hospital when, as you mentioned, the beauty of having a nurse at a school, and we bayville Health Specialist at a school, where you get reimbursed funding for having those professionals there. This helps us get to those children quickly. Last question is are up, as you know, for the authorization at the end of the school year. As you noted in your testimony, the president s budget includes a pathway to double the size over five years, in greatly expand its reach. We see the Prioritize Health as cochair of the senate, the Community Health center caucus, was several beloved senators up and down my state that can provide Critical HealthCare Services to my constituents. My question, the last question to the secretary is, can you share your thoughts on the top three areas, the top three areas where congress should focus when it comes to reauthorize the federally qualified Community HealthCenter Program . Well, the Community Health centers really delivered. They saved lives. Amid tens to millions got their covid shot to Community Health centers. They are the centers that are providing dental services to americans who otherwise dont have dental insurance, to the two or three Top Priorities are expanded, their parts of role america that dont have that access to Community Health centers. Let them expand their services. Some dont provide Ob Gyn Services because its expensive, and at the same time, please, please, pass the president s budget on Community Health centers, because we expand the scope of Community Health centers under funding, so we can continue to have these great successes for so many americans. Great, thank you so much. Mr. , chairman i approve that message. Very, very, very good. Were glad youre on the committee. Thank you. Senator whitehouse. Thanks very much. Thank you secretary for being here. As usual, i want to bring up my graph. Which weve updated to show that from the original cbo federal Health Care Cost projections, this actually happened with a spy, obviously, for covid, here. That brings us up to today. And that backward looking period in the past, that is an actual 2. 2 trillion Dollar Savings and health care spending, below what cbo forecast. If you bring the forecast forward, in the next ten years, the budget period, the projected savings are 6. 9 trillion. This is against the extended earlier cbo projections. That tells me that something is going on out there. I think it has a lot to do with the improvements in the quality of care, the improvements in the move to value based care. The success of a tumble care organizations, and perhaps, also, some of the pharmaceuticals that have come our way. I do think that this is worth taking a good hard look at. If we can get those kinds of savings and Health Care System without taking away benefits, we should be all over that. I know for sure that the a ceos and rhode island, and telegraph, and coastal medical, hit it out of the park. They produce significant savings, wrote big checks, and their patients loved it. The Patient Experience got so much better. So i commend that point to you, as i always do. I hope we can make more progress there. I also want to go back to something that i have referred to before which is my effort to try to get it endoflife care model set up in rhode island using the sienna five pilot. Im not asking the rest of the world to come with us, just let us try it. Weve been working for years. This began under director bowler. When he left it, it was groundhog day. We started him with his successor. Then the administration changed, it was groundhog day. Now its live fowler. The things that weve been asking for as a pool of labour is that really relate to how people near the end of their lives can use. The threeday rule. It is preposterous to take someone who says within months or weeks of dying, and the family things they need to be in a nursing home, and you insist on two nights, three days in a hospital on the way there. Thats frightening, thats expensive, thats, you know, thats unjustifiable. Wed like to see that way for people who are in that category. Curative him piloted, of able to proceed at parallel, and Home Health Resources ought to be available. If you are towards the end of your life, but you can still walk out into the garden, that should not bore you from getting home Health Services, because going elsewhere to get services as, again, more expensive, and cruel to the was waived for covid. The curative, politic distinction you way for the medicare are in that category. Curative him piloted, of able to proceed at parallel, and Home Health Resources ought to be available. If you are towards the end of your life, but you can still walk out into the garden, that should not bore you from getting home Health Services, because going elsewhere to get services as, again, more expensive, and cruel to the family, so you really want to try to land, this and try to get cmmi to say yes. The three day will, you board agreed to under covid, it was waived for covid. The curative, politic distinction you way for the medicare choices you way for cmmi models. It is not as if im asking you to do things that you arent sensible, ineligible, and ready to go. I just want to package so that we can land this program in rhode island, where ive been working out for eight years. Would you please help me with that . Very persuasive, senator. Very, very persuasive. Absolutely, let me work with you on that, because like you, said many of these items are already placed, or have been placed, and i think some of my says, no do in our way. No, do it our way. Right . Were going to be the pilot, well put it all together, i will make it work. Very persuasive, senator. Very, very persuasive. Absolutely, let me work with you on that, because like you, said many of these items are already placed, or have been placed, and i think some of my says, no do in our way. No, do it our way. Right . Were going to be the pilot, well put it all together, i will make it work. You can measure a model, us will do whatever they want, but ive had enough groundhog days. Lets follow, up because i think seem us would like to get there as well. Again, were heading in that direction. Lets see if we can get there. Thank you. Just because i see all the terrific purple shirts in the back, my rhode island alltimers folks who are in yesterday, and they were eager to have medicare approved, like for early onset alzheimers, and if theres anything that you can do to help facilitate, that i think that would be particularly helpful, and welcome. Last question, we would like to try to make sure that medication assisted treatment for people who are happen , disorders can be accomplished through telehealth. We did that through covid, can we please find ways to extend that . It seems to have worked very, while at least according to everybody in my recovery treatment community. That last part was a question. Can we do more, that can we keep doing that . There, senator, we will work with you. That goes beyond us, it goes and other departments as well. Its a joint effort to that last part was a question. Can we do more, that can we keep doing that . There, senator, we will work with you. That goes beyond us, it goes and other departments as well. Its a joint effort to work on that we can. Follow up. Thank, you chairman. Senator brown. All the chairmans in the white house. Secretary, nice to see you. Again senator, wise thank you for your work on alltimers. We appreciate that. Secretary, as you, now the Norfolk Southern derailment in East Palestine, i was there yesterday, has left Many Community members with questions. They want to know how the toxic exposure they and i loved ones experience will affect their health and support and in the process of searching for and receiving answers about these effects and concerns are taken into account. I know some of your agencies have been there since the very beginning, you are aware of, that of course, thank you. I know that moving forward hhs will be heavily involved yesterday, one of my troops back to East Palestine i visited the mobile health clinic, set up, partially funded by herschel, people are coming and seeking help for symptoms related to exposure. Of course, they fear for the future. People are frustrated, theyre scared, they feel like times of the essence. Theyre afraid when the cameras leaves that the help believes. Can you assure me that hhs will continue to move with urgency and response to this disaster . Senator we were there from the beginning and we are not leaving. Weve been on the ground. As you said, weve provided resources, for example, to the Community Health clinic. Thank you. I know that even though the president in gun right away, or you can go right away, or people where there. That made a difference. Thank you. I want to talk to you about briefly. One of the benefits of the Inflation Reduction Act, was cap in the medicare for 35 a month. But that means for an average ohio see who needs this lifesaving drug . For the average ohio seniors above 500 here they get to keep in their pocket. 500. Just like that. Before, they were paid 100 that insulin a month. Some pain up to hundred and 50, 200 a month. On average, its somebody save much more, some will save a little, last but on average, every senior in ohio who needs insulin, 500 extra in your pocket this year. By the, way weve done this last, year they wouldve been 500 last year you wouldve gotten that. The year before. Theres no reason why a drug that we know to cost no more than to manufacture should be costing seniors 100 to 200. Thank, you that was said while. Switching gears, i know that were talking about Medicare Advantage, a Great Program that serves many of beneficiaries. Im concerned that some seniors are overpaid, and are receiving the benefits they deserve, some Medicare Advantage plans misrepresent how secular patients are to see a massive need to take more money from taxpayers. Mad packs say without fixing, those tech squares and seniors will be paying billions of dollars more than they should be. Mid pack estimates that it cost somewhere between 20 billion dollars, 20 billion dollars in 2023 alone. Seniors are literally paying for this in the form of higher premiums, facing this feels like a great way to save money, but i keep hearing that saving this money that is, bad is going to hurt our seniors, put them in danger if having their benefits cut. Explain to me why this is just not true. Senator, its not true because there is nothing that were doing in this advance notice that would require any unsure to cut medicare benefits. In fact they remained over the same benefits, those benefits must be provided by law. What we do, we take out that extra charge, were going to try to get back some of the money that we were overcharged as a Medicare Program that should have been used to provide more services to medicare recipients. We think its the right thing to do to ensure that every dollar that somebody paid him when they were working in, and Southern Production from the paycheck, is to provide medicare once they are retired. Not to help line the pockets of those who are overbilling. Well go after any one who is over bill in where we can. I know you, well in your record is that. Thank you. I think my colleague. Before he leaves, oldest thank you to senator brown. Then well go to senator young, because he remembers in 2019 when we were in this room. We werent going to be able to get everything we wanted and that bell. We came up with an anti price gouging strategy to protect consumers, to just this week, we saw the fruits of it. The administration announced lower cohen surest payments for 27 drugs. And medicare, part b, as a result of the penalties for prescott would jean. And you see a particularly with drugs like you marrow, just sort of a poster child for what you want to have more bargaining power. And this room, senator brown is incredibly helpful with, that i want to thank. Im senator young. Thank, you chairman. Good to be with you, mister secretary. Welcome to the committee. The world is facing an Antimicrobial Resistance crisis. I know you know that. Superbugs make us all more vulnerable. They undermine treatment of everything from kaufman ear infections to cancer treatments, and routine surgeries. Were seeing more resistance to infection right now than we ever have before. Blessedly, there is not a lot of public attention that has been paid to. That the antimicrobial market is failing. Theyre hard to develop, theyre almost impossible to sell for at least five years because they need to hold new antimicrobial zone reserve to prevent resistance to those anti microbials from developing. The administration has stated that Drug Resistance is a crisis, and the budget highlights appropriate. They provided incentive for novel antimicrobials. So in the pastore act, which is Bipartisan Legislation that ive introduced from senator bennett. Just days later, after the budget was submitted cms rolled out illicit 27 menaces that the Inflation Reduction Act is going to penalize for price increases. Five of them are antimicrobials, with prices that are overall well below the total expenditures of other classes of drugs. Theyre generally used for short durations, for acute infections. These are infuse medicines, the kind that you get when there is nothing else available. So, mister secretary, ill give you an opportunity, how will penalties on these antimicrobials medicines help our crisis . Senator, you are the only one that has asked a question about Antimicrobial Resistance, and i thank you for that. We dont think about. It but were losing the effectiveness of some of these drugs, like penicillin. We count on it. Because its been over, used or misused, were losing the effectiveness of those drugs, so thank you proposing the question. Secondly, remember that the only drugs that will fall on this list, to rebate back some of the money, is drugs that were raised beyond the rate of inflation. They cant be new drugs, and so these are drugs that have been on the market. That many will have to explain, why they had to a race that drug beyond the inflation, and some cases, beyond this dramatically. Were trying to be careful here. Were going after only those drugs where we see the price hike dramatically. The price increases on these antimicrobials are based on relatively low overall cost, compared to many other disease treatments. I dont think that patients are going to see much benefits from the penalties that are imposed from the Inflation Reduction Act, if any at all. It seems like a pretty arbitrary penalty to me, that could Impact Development of new antimicrobial, which is indicated we really need to develop i would love to follow up with you anyway you like on, that because youve touched on something thats really important. We have to figure out a way to have a consistent flow of new drugs, that combat bacteria. As you mentioned, is a tough business. Theres not enough money in it as you might think. And definitely interested in buying up with you. Im interested in working together on this. I know the administration, through their budget, proposal, has indicated some day in, theyve supported something seemingly similar to this act. Maybe you can share with the committee how that proposal, you imagine, might strengthen the anti microbial pipeline. Part of what we think may be and the solution is rather than have a manufacture produce a good, drug right now try to market, depend on the market actually receiving the drug, combine, it is maybe to have more of a subscription model, where what you do, you say to the industry, come up with a drug, unlike the Subscription Services on netflix and all their, asked if one pays a little back. This, why theres always money in the pot. Then these manufacturers have an incentive to go forward with their production, and creation of the drugs. They know that there will be money in the pot. Most of these manufacturers are afraid that there wont be a market further drunk. Sounds very similar to the pastore act, and all the more reason we should Work Together on this moving forward. Mister chairman, if i cannot a quick question about organ procurement. This is something youve been a leader on. I was just going to commend you, because yesterday we got some good news, but the administration is going to be receptive to recommendations that you and others work with all of us on, unhappy in a more competitive system, not just give out the contracts. It is getting ready to praise you. Thank you for that. I will just pointedly asked the secretary on this topic here. Getting opo process data has been a real challenge. The chairman and i have both requested this data, we think that is consistent with their oversight responsibilities and ensuring that more organs are available to save more lives, will you commit to release opo process data in line with the bipartisan calls from this committee . Senator, we are working to change the way we handle a war procurement in transportation. Were definitely interested in working with you on the subject. I dont know if you heard, but we Just Announced that were doing three specific things that are changing the dynamic in this space. We are going to get a call for more data transparency, from the contractors, we are actually going to open up competition for the contract, so that this is a contractor thats had this for years and years doesnt just expect they will get the contract. Then were also trying to, the president s budget calls more resources to actually modernize already, because were not keeping up with technology, we are losing time, which could be led an organ go to waste. The scene with the right priorities, i would say that i hope this process data is forthcoming, and consistent with the data transparency focus. Make you so much. Senator barrasso . Welcome back to the committee. Thank you for taking the time to be here. As you know, as a physician, i know that the importance of procuring medicare for future generations, stopping waste, and this is critical for all of us. This is a bipartisan priority. The late last, year i was joined by my colleagues on the comprehensive care caucus and sending a letter to see a mass. The purpose was to point out the proliferation of a new for profit hospice providers. I think the hospices and central wyoming harbor involved with casper. We have some around the state of wyoming, community involvement, people volunteer, go to events, raise money, help. These are amazing centers that provide care, calm, for compassion. Most troubling is that your own data shows many hospices now who are a proliferation of these new for profit hospitals. Theyre sharing the exact same addresses in, trying to figure out what exactly is going on here. Why this is happening. Do you share my concern regarding this pattern of sudden growth as these medicare are certified hospices and certain parts of the country . Absolutely. Weve conducted some unannounced site visits to some of these hospices that were identified in that article. What are you finding out in terms of, where theyre bad actors out there . Are the things we can do to curb them so we can prevent some of this . We will absolutely share some of that information, but no, doubt what were looking for is to find out if theyre taking advantage of people, if theyre defrauding the american taxpayer, and if theyre abusing the privileges that they had by being able to provide the services. I point out that theres a Bipartisan Group on this committee, in this body, that did what has this shoe with that, help, you share that information that you come up, what so we can put it ends with the sort of thing. As someone who cared for his dad, get pain free hospice care, i cared for that with us we, could we are absolutely with you on that. Thank you. The next is that will help remains a top priority. Today, with the wyoming alltimers association, theres a number of people the audience today who are listening to you testify, where the sashes representing Family Members and others with alzheimers. I am encouraged that there is a new class of alzheimers treatments. Hes giving family some hope that they may have more quality time with their loved ones before the disease takes hold, and its not a cure, but theres hope there. We just need to make sure that whats available in certain locations could be made available to our tribal communities, doorbell beneficiaries. The center for medicare and Medicaid Services, have a policy for coverage that is evidence development. There are additional clinical trials, registries, that could create logistical challenges for people in role areas, as well as providers who are taking care of them. Theyre not all eligible based on where you are. So how osunas plan to ensure that those with alzheimers and rural settings, and tribal communities, gain access to therapies which are currently fda proved . Senator, i think this is where we would all agree we alzheimers and rural settings, and tribal communities, gain access to therapies which are currently fda proved . Senator, i think this is where we would all agree we need to do more Work Together. Covid taught us that telehealth flexibilities lettuce reach people more directly, more efficiently. We would love to keep those telehealth flexibilities in place. We would like to make sure that its a, not actual skilled, specialized provider is available in these Rural Communities. Were trying to expand the number of people who actually go into the profession. This is where we can all team up together to find out how we better serve our community, especially in Rural America. Specifically, with fda approved drugs, unless you are part of this kind of next generation followthrough, harder to get those, who can actually get them in the Rural Communities, tribal communities, based on your location, even though it is fda approved. Yeah, we look forward to working with you on that. That i wanted to get to rural Health Clinics, 5200 centers for medicare, mediCare Services, certified world healths clinics. They provide a clinics holy cross the country. The Census Bureau no longer defense urbanized areas as previously defined is urban areas of 50,000 or more. They plan to change that, but the rural Health Clinics statute requires that the world Health Clinics must be located in areas that are not organized areas, as defined by the Census Bureau, so they do not to find it anymore. So this kind of a lack of policy, so what were seeing is Rural Health Clinic applications are currently being an appropriately rejected based on assumptions, about the new policy, is a block by states waiting for some clarification from cms. I know you are aware of that is. Can you hold forth on that . Thanks for pointing that out. Cms is in the process of trying to provide guidance on. Not centered, also. That there is a particular facility, or clinic, that believes it was denied access to funding as a result of the census brought, and please help them contact us. Well do that. Thank you mister secretary, thank you mister chairman. Before we leave, i want to thank my neighbor with respect to rural care. I am not aware of these for profit osp assistants when my colleagues talked about. I would like to know more about those as well. Thank you so much mister chairman. Okay, lets see. I believe weve got a couple of other senators along the way. Senator campbell . Okay. Mister secretary, youve been very patient, we really appreciate that. What we wanted to do when we set out three hours ago, before your infinite patience, is to show that working families in the middle class can get ahead in this hugely important area. Ive always felt since my days, if you and your loved ones dont have your health, Everything Else goes by the board. Its the most important issue. The most important issue. And what weve set out to do here is to show that we can help working families and seniors in the middle class get ahead. And make sure that we reduce the deficit. Those two things are not mutually exclusive. We can do both. We certainly show that with respect to Prescription Drugs. I have one other question for you. It is as much as statement as anything else. Weve seen the great bipartisan interests over the last three hours in this committee. For advocacy. For alltimers. And it is just so urgent, and i want you to pass on to the department that the seamless administrator, chiquita books, that if you will just convey that i will be calling her very shortly to talk about how, given what we have heard today about alltimers, how she can lead this effort to speed up access for alzheimers treatments, and services. I think that that as a general, were not supposed to advocate clapping. I probably have a conflict of interest here, so go figure. I think that mister secretary, seriously, weve seen how strongly the committee feels. Weve seen how strongly the country feels. This is urgent, urgent business. Please. The administrator he was juggling a lot of stuff, juggling it very well, we can all be calling her about speeding up access. Well be working with you often in the professionalism. With that, the committee on finances adjourned [background noises] silence since 1979, and partnership with face cspan is provided complete coverage of the halls of congress. From the house and senate floor, these two congressional hearings, party weekends, and. Cspan is your unfiltered view of government unfiltered view of government. Cpac of dot org a cspans comcast is partnering th 1000 Community Centers to cree wifi enabled so students from low income families can get the tools that they need to be ready for anything. Comcast supports cspan as a public service, along with these other Television Providers giving you a front row seat to democracy. Next several pentagon officials including the undersecretary for about programs for Defense Department staff as part of the recent military budget talk about Mental Health, and personal retention, this is about two hours 15 minutes