Heard anecdotally that Child Welfare agencies reported an increase in foster care placement due to the prescription opioid abuse epidemic. How has hhs taken into account the needs of child for a population as they coordinate there is nonto this epidemic . One of the most important ways of making sure that the mother get into coverage in health care before she has the baby. This is also about the health of the baby and making sure we do everything we can and in colorado i did visit one of the Successful Programs. Making sure we have the coverage from the coverage occurred through the aca in terms of people coming into the marketplace in your own state with the expansion of medicaid we will reach more women. Step one is making sure we have the coverage. That too is making sure we are willing to come in. I hope the conversation we have publicly destigmatize because that is the other problem that the barrier. You dont have Health Insurance so you can pay for it. The question then theres different types if you come in. These are some issues we are working to do to make sure that we start at the beginning of the child life in terms of healthy birth and a method that does connect it to the child and is fun to care for in an appropriate way. I appreciate your work. The last complex we have issues that came up were legislated and now on her situation that are the worst six months of the year providers will face if they had not passed legislation. Cms says he know better than i performed these quarterly update. We had discussion, but just asking that you work with cms to ensure that the congressionally mandated payment change for complex rehab is included in the april update. We will work to implement as quickly as possible. I think they are planning on having a conversation directly with you. We will follow in that way. Thank you. Appreciate your work. I will take time out to ethnic questions because i may have to leave again. I have so many things im doing today its hard to keep up with it all. I appreciate the work you are doing and its very meaningful and very difficult. Almost an impossible agent needs to run. Great concern on the Medicare Part d there have been rumblings to issue an executive order that would allow the federal government to Prescription Drug prices in the program. Such an executive order would be in violation of the law as the statute at the slippery this wretched next. Negotiation and despite the fact, i take the possibility very seriously. I am a strong supporter of the biopharmaceutical industry as a source of innovation and intellectual property. The Part D Program gave these drugs to Medicare Beneficiaries and we need to keep the program as it was originally structured because it works. Everybody knows part d is one of the most important things that really works. They have private entities to keep costs down. Overall spending is significantly less than originally projected. Beneficially satisfaction is very high. It has a nature meant a success. Moreover allowing the government to negotiate prices is not a new idea. Always has been uttered this policy and has chosen again today. The president s Budget Proposal says it has no budgetary impact and the Congressional Budget Office doesnt mean its a big favor. Having said all that, my question is if anyone at hhs working or has hhs worked at the white house on an executive order that would allow the government to negotiate prices for any other changes related to drug races . I think you know we are focused on both sides of the issues of drugs. It is about innovation, which is by we brought everyone in for a conversation about both of those issues at the end of last year so we could hear from industry as well as can tumors in terms of the issue. The steps we have taken are focused on innovation as well as affordability. You know when senator portman raised the issue of deficit and entitlement mandatory spending and we take that very seriously and are looking for the opportunity in terms of drug prices because it is becoming an increasing percentage of our Overall Health costs. We sought increases are mostly seen in many, many years in terms of prices. That is why we are focused on the issue. The steps we have taken include the session that we did, and include closing the doughnut hole which is a part of the aca, which at this point is 20 billion, 10 million seniors and the third that is on the issue of trying to provide transparent to you. We do believe that puts downward pressure and have created damage. Me interrupt you. Im very concerned about this because they think they fouled it up with regard to the trade Promotion Authority or should i say the tpp. And frankly if you dont have the data exclusivity time of 12, which renegotiated, because we know weve got to get enough data exclusivity done for the companies to recruit their cause and in the tpp, where we can actually kick yours that takes about 15 years and 2 million so you need some time to be able to recoup the money or if you have the five years and that provision, the costs are going to be so high that it will go down the drain. That is why it might really Save Health Care costs in the long run. In the case of imus vehicles, if they get that figure, they will start to do that to pharmaceuticals which i billion dollars and teen years and recoup the regular drugs. We will lose the whole pharmaceutical and whole industry. I think senator cardin is next. Thank you, mr. Chairman. Secretary burwell comic thank you or your service. We appreciate your career service. We talked earlier, but the extension of access to emergency Psychiatric Care and i authored along with senators to me a call and is the logical extension through september that allows you to extend it through 2019. Revenue natural but we need the guidance then you are working on it. Its very important for those at 64 years of age. I urge you to stay focused on that. We think it is important to access to Psychiatric Care. I ask you to look at the Oral Health Care issues we coverage under the Affordable Care at. It indicates far too Many Americans are not getting access, children not getting access to dental care. We need to figure out a strategy and make sure there is access to qualified dental services. I want to file a Honda CommunityMental Health needs. This past week i had a roundtable discussion in baltimore by taxpayers on Mental Health services. We talked about the need for greater access to Mental Health and addiction services. The number one priority that does not take into consideration if you know how to triage the person and the most effective least expensive care setting. Do you have that capability . If your qualified health center, can you deal with walkins and referrals and do you capacity to do this . It is not terribly friendly to those who understand that they must have those types of capacity in their facilities. To make it more affect event of congress have taken action in regard to a program in several state. Can you update us. Section 223 in terms of the implementation of an approach where were trying to experiment both with different payment bottles and build on the backs of the Behavioral Health centers are hurting and communities well as federally qualified health enters. That is the effort to end senators sat there now and blogged and ms. Matsui have been very engaged on this issue. We are headed to the implementation is reflected in terms of the demonstration and the budget that came up on tuesday. We would like to extend we are hopeful the Budget Proposal are both supportive of going beyond the budget. I strongly support that. We need system wide structure to do with Mental Health. It is part of your july inquiry. We should take what we have learned. Or every dollar we spend in the settings, we are going to say 6 get the Reimbursement Structure doesnt allow creative ways of using care managers. I would urge us to think broader about how we can make the system work for Mental Health. Today it is still not. We are hopeful we can get the examples in the model sues tales in terms of the changes that what youre talking about can have been through her Accountable Care organization. Having visited some of those in new york in the progress they make with integrated behaviOral Health Care, and we are finding most are Accountable Care. It is both through 223 as well as Accountable Care organizations that we are creating the models. We need to have the analytics. I know i have one of our real champions on this issue. Good morning, madam secretary. Good to see you again. I have been to be there is then enter out the budget for opioid abuse. There is one account he was carried out by the administration. Their other resources in parts of the budget and more people are dying because of an overdose that auto act cements her gun violence. God help the concerns. Biscuits to one of the topics ive heard about making sure theres not overlapping we are doing that in the proposal and the money we fastforward specifically and even last year with the esteemed by name with the those monies out. We are starting to work on two fronts in terms of helping people with the overdose portion of this and that is through funding and helping communities. We also work with the private sector to make sure you take steps to be able to access it. In a number of states we see pharmacies like cvs and walgreen working with the state to do regulations to do it over the counter so i can occur not just for rest responders, but that they sometimes Family Members need to. The other thing we are doing is fda has approved the first nasal melodic sound, making it easier or regular people to give it to their loved ones so they dont need to do what you asked. Very good good thank you. I know youve spent some time in the south and we appreciate that. You should come back more often. In 2013, each day was provided with the liaison to contact questions and issues and these were removed recently in place of the generic email account and some challenges and is impossible to the department of insurance like South Carolina for quality answers, especially answers from a family is. What ive been told if they responded many times they talk to to list their names. Via email contact and the fsm is on steam. When they identify themselves it is almost never is the individuals email or contact information. Long story short it is very difficult to have an actual conversation via email or by phone at a specific person and that leads to immediate response. Two things. I will follow up on the on his and their relationships with diy. I need to figure out which part and does that have to do with the federal market . I will follow up in terms of that. The other thing is the issue of resource is for cms. The question of funding for these things than this particular type of service we can to the fees. In our budget this year, fees coming in will fire escape but we are asking for in appropriations and we are happy about. Theyre a Certain Services that feeds can pay for. If we change something and doing it to figure out how to know who to contact . I hear clearly we need to follow up with him one. It factly. The person to get an immediate response. There is some flexibility to shuffle resources around . Do not redo, but im sure you know the funding over the past few years has certainly been a challenge for us and we are hope it where it is different place this year. Last question. I know youve answered a couple questions about the challenges around the coops of 2. 4 billion in loans around the country. However recently including my home state of South Carolina, we have seen a result of mass coverage higher premiums and higher data to both likely about 67,000 south carolinians could lose their insurance. Sadly, coops for the operators according to last years race will. They are very few signs that this coops will be successful into the future. What is your next death . With regard to the coops, the consumers at the center of our strategy and our approach to making sure we take care of consumers. That is why a number of coops came out before enrollment and we would continue to monitor with the regulator because having said that, one of the steps weve taken is clarity in our guide and said the coops can actually seek a broader range of capital for them as they try and work through any issues we have. We support the state can continue to monitor closely is the very changes in the fax has given us. By time is a good thank you very much. Senator schumer, you are next. With a thank you, secretary burwell. Nobody has a greater grip on what is going on, understands the policies, understands the practicalities and is able to get it done. Kudos inoculated and i know for many more. What i wanted to talk to you about is two things. One is the zika virus. I dont know if thats come up so far, but i apologize if it has. Your administration has sent us 1. 8 billion american supplemental request for funding to address the zika virus. We have time because the mosquitoes that carry the tiger virus is not going to come for several dead. We have time and were pretty good if we gave mosquito borne diseases witness will be done with yellow fever here in the United States. I am glad you have asked for these monies. Again, a republican colleagues and going to plead with bad not to just talk the talk, but walk the walk. You cannot combat crazy is whether it is zika, opioids, Mental Health, security and our country without giving effect to his government. The air was not fight the zika. Fda makes no sense. What they are trying to do right now were some are trying to do is say we should not give any new monies are used to monies that aside for a bola. It seems to me like robbing peter to pay paul. It could come back. Would you please explain to me why we shouldnt do that in rather have a new allocation money and let the money is for it people are being used for in wyethayerst donated even though the crisis for the moment has subsided both here and in africa. With regard comment there are three main pots and one is a budget person are fully obligated. As many of you out now, much of the money in the middle of negotiating contracts. The biggest part of the money that is left is about 500 million that has to do with the Global Security agenda. The Congress Gave us that money and we have committed 17 countries to help in a fiveyear period so as then they wisely. Our monies go down as their monies go. We are negotiating plans with implementation and what we are working on together. The reason that is so important in terms of why we just take the money is one of the conversations begin to have this year was middle east respiratory system. Last year we have more cases outside of saudi arabia than weve ever had in history, but we didnt talk about it because korea was able to handle it. We have to get these countries ready and zika started and we dont outbid microcephaly in africa because theres no ability. Be back some of the money goes to stop ebola from spreading to other countries in dealing with existing countries. You all know it will come here if it is fair. Thats another portion of the money. Just recently a case came back. We were able to detect the cases because they were still swabbing. Dead bodies spacebar been tested and that is how it was found and so it didnt spread more. We need to get the job done in the west african countries, continue prevention is not just zika or ebola. There is some kind of preventative measure. It is the other piece of it. So we would be robbing peter to pay paul, making us less safe if we just didnt post the new dollars and use the money for that. You think that would be a Serious Health day, is that fair to say . Fair to say. Quickly because im running out of time. Puerto rico. Weve been talking about puerto rico in a dire situation. As you know i sponsored along with many of my colleagues, some of whom are here. Senator cantwell has played a leading role in this to deal with the problems of puerto rico and we need a script cf. Number one. Senator hatch has been trained to be very, very helpful on this and we appreciate it. In addition to bankruptcy and bankruptcy no money should be a substitute for allowing a territory to declare bankruptcy. We need other monies to help in those would be additional. My question is how long do you estimate puerto ricos current medicaid allotment to last and what would happen if Congress Fails to provide additional money to their Medicaid Program for us we have both proposed to grant them a state like treatment. We will continue to analyze. We worry things in terms of that a lot in could have been as soon as this year and that is why we have the proposal in the budget to treat puerto rico in terms of how other americans with regard to medicaid. Its an important financial issue and health issue. Mr. Chairman, a thank you for that and appreciate your holding this hearing and always your courtesy. Thank you, senator schumer is wait just a second. I have to leave. Let me thank senator caldwell for being here as well as all of our colleagues participated in this hearing. My hope is the issues we discuss here today can be addressed with the Nations Health care system to ensure that taxpayer dollars are used efficiently and effectively. We owe that to the citizens of this great country. I would also ask any written questions for the record he admitted that her stake on february 25th, 2016 i