first and then see your responses. they all deal with elements of the affordable care act and which i supported, and i want to see some of these are are particularly of great interest to me and to many people in the country who would advantage themselves what these provisions in the act would do. one is in the law, we insured all qualified health plans would include behaviorial health services as part of the essential health benefits package. among the universe of those who receive those benefits of course are those who have families in the autism spectrum, new jersey has the highest autism rate in the nation, unfortunately, so i've heard these stories very vividly. access vital behaviorial health services, even in states with autism coverage mandate there

are a number of exemptions that lead people to fall through the cracks. the language in the law, affordable care act, specifically designed to address their needs insure all qualified health plans provide the benefits so many families need. i am concerned hhs recent bulletin on the benefits package refers to states using a benchmark plan. as the basis for the essential health benefits package, but because of the current patchwork of state autism coverage requirements and exemptions, i know i'm not alone. in the serious concerns that the benchmarking plan is insufficient to insure coverage would be available at all qualified health plans as the law dictates it to be. so, one is please explain what steps hhs will tall to insure

plans will provide behaviorial health services as required by the law, and how will the process move forward on finalizing the essential health benefits rule, that is my first question. the second question is with reference to provision of the law that i previously introduced call the mother's act, focuses on the devastating disease of post-partum depression and the language in the law required that hhs submit a report to congress specifically addressing the benefits associated with screening for post-partum depression and this report is supposed to be due two years after enactment, which is march 23rd, so i would like to get a sense how that report is coming along, when we can expect to see it. and if you know what the report is going to stay, what findings does it have as it relates to this issue. and lastly, new jersey currently

has 115 demonstration waiver pending before hhs, they can be comprehensive involve structural changes to a state's medicaid program, affecting hundreds of thousands of state's most vulnerable residents. new jersey's application submitted in september last year, rumor has it, it may be approved, i say rumor because the entire process i have to be honest goes behind closed doors, without public notice, certainly without public input. my understanding of the law requires a process that is more transparent, and the rules on that have not been finalized. i have to say as a member of the committee with jurisdiction over the medicaid program and a senator it's more than frustrating to be shutout of a discussion affecting not only medicaid beneficiaries in my

state, but institutional providers such as hospitals, scheduled nursing facilities and home health care providers. if the law was meant to be transparent and a member of the financial committee and a united states senator can't get information about the process, which is what we're constantly being told over, something is wrong with the process. >> senator, let me see if i can address your concerns. the essential health benefit model that we chose for the job is so-called benchmark model which would allow a state to use a popular employer coverage or states employee coverage or federal employee coverage existing as a benchmark. but always of the rules apply including the 10 category ris of mandatory coverage. none of that is waived as you look at a benchmark for a

particular state and i would say that we tried to balance affordability with comprehensive coverage in order to get a state up and running and what we found looking at the models across the country is that there was very little variation in the actual coverage, there was a lot of variation in cost sharing that seemed to be the most significant in the categories, but the anti-discrimination, the ability of a plan to wait one category disadvantage behalf i don't recall health and say we're looking at nine of the ten but very skimpy on behalf i don't recall health, those rules are imposed on top of the benchmark strategy, so we will be working very closely with states to make sure that as you know behaviorial health is one of those critical categories of care that is an underlying premise for what has to be in every essential health benefit.

but to make sure that is in place not only in new jersey but around the country. but we wanted to take advantage of plans that were in the market, were priced and could be up and running as we start the process and will reevaluate and make sure there are not benefits that are being overlooked or skipped along the way. the mother act provision is definitely underway at the national institute of mental health looking at post-partum depression, studies, they have 60 grants on the issue, two program announcements and we will be reporting back, i can't tell you right now what exactly that is going to say because i haven't seen the draft of the report, but we will make sure senator and get you the various clinical research that has been going on. risk factors, neuro-science they are taking a look at and make

sure that your concerns about this very important area are addressed when we come back with the study. >> can i get the third answer? >> we're over time here, okay. >> my questions were within time. >> i'm not going to get in that debate. go ahead, finish the answer, madam secretary. >> you're absolutely right, new rules in place will require a far more robust process with 1115 waivers, hearing at the state level an opportunity for comment. the current rules really is the governor and the state negotiates with our department, we are not by practice and

statute able to share those negotiations, the governor's office could share. as far as i know there is no imminent, there isn't any imminent waiver decision but i understand what you're saying, we hope to get to the point where this is a much more transparent process in the very near future. >> thank you. >> well came madam secretary, the first question i have two areas, one on low income assistance program and other medicaid program. first of all, i am truly surprised and disappointed the president's proposed budget for next year advances another major reduction on fuel assistance by almost half a billion dollars in addition to the proposed cut last year, that was almost 1.2 billion. fortunately, 2.2 billion, actually, and the congress

restored a billion of that. this is historically low, you know, assistance for the needy population, certainly in cold weather states. new york times did a front page story just a couple weeks ago on the dire desperate circumstances so many people face including in this instance where the individual offered his car as assistance. maine has gone from 80 million to 32 million with this additional cut. given the significant in oil prices close to $3.80 for propane, requires an average $850 -- 850 gallons, that is devastating. i talked to one woman, she and her husband both lost their jobs, one child contracted pneumonia because they had no heat. why is the president proposing

cuts in the program in the final bill, but 1.2 of the seven billion ended up being the low income fuel assistance? >> well, senator, your concerns and certainly the states where heating oil is primary heat is particularly dire. i would say this budget is half a billion dollars above the president's request, i know that is not much solace as you look back, in better budget times the request would be far more substantial but it an increase over what was requested last year. and i do understand your concerns. >> i appreciate that. the budget is 70 billion i would hope we would find a break for people who have incurred $16,000

and have to pay $2500 in oil. i would hope the president would find something -- this program is taking a heavy hit. the second question on medicaid, i know this has been much discussed, many states including mine are wrestling with major challenges and debating the health care here, we were able to include it and some flexibility in the ma-- maine happens to have the most one of the top five most generous programs in the country for parents, i can see the red line, that's maine. the point is as you know states are grappling with deficits, that is whats memo is about to give them flex built, that is the main circumstance. you have written to the governors back in february of last year that you were

committed committed to responsiveness to address some of the problems in medicaid. in addition, the medicate director suggested your department reductions sole lil for budgetary purposes would not be experimental. there is obviously a concern exactly what you have and what you don't. the point is we want to avoid reductions in eligibility and for the -- to continue with the eligible population having coverage but also avert hospital choices like in maine, eliminating optional benefits like weighting lifts for the developmentally disabled. what can you offer to states like maine so we would avert and avoid those choices but address some of the budgetary issues they are facing that could provide short term savings now? >> senator, i had a conversation with your governor i think in the last two weeks about this

very issue. we again made it clear to him what was within the state's discretion and some of the provisions that you just outlined they had -- that is a choice they could make right away. we volunteered to send a team to look at their other choices. we did not have a lot of paper from the governor about what exactly was the proposal but committed to doing whatever we could to look at ways that not only that could make immediate changes in areas where they had administrative flex built and we would identified them category at a time but look at ways to reduce the cost in categories where we don't have a loft flex built but we're waiting to get some responsiveness and we're doing that with states across the country. >> i think it would be helpful if we could going forward to find models that work and i know the areas you identified five

areas for the national governance association they could find short term savings. but i'm wondering if we could go beyond that, figure out what can work that would end the constraints and even with the constraints of maintenance offest, continue the eligible population but are there ways and models and programs that could be used to actually work to r savings or achieve savings and help deliver the programs and services more efficiently. >> and we are eager to do that. the former head of the congressional budget office was in my office yesterday and we talked about the fact there was a new class of governors in 2010, 19 new governors, while i met with each and every one of them a number of them were facing lots of in-coming and it's very difficult what we want to do is go back around and have

those conversations in great detail, we have lots of governors participating in the effort on dual eligible, one of the most expensive populations that any state has in their medicaid budget, frankly moms and kid are fairly inexpensive to cover. disabled, elderly, poor with multiple chronic disease are often very, very challenging not only in terms of care but in terms of cost. so we're working closely and we want to get those good strategies and ideas to everybody and i would be happy to work with your office and keep you updated. >> if there is anything we can do to help in that, i think then sort of becomes a win-win, collaborative rather than adversaryial. thank you. senator grassley? >> i only have a couple questions before i do that, i want to associate myself with the remarks made by my

colleagues about the so-called contraceptive rule. i think you got it very wrong the first try and you have a lot more work to do. my question deals with whistle blowers. first question does. and of course, i made the point that i wouldn't be able to perform my constitutional oversight of the executive branch without federal whies he'll blowers, they shed light on matters that affect public safety and the public and risk losing their jobs, they expose incompetence and promote reform take leads better government, has done a lot of good. the fda faces accusations that it monitored nine fda scientists personal e-mail accounts. however, the health and human services office of inspector general concluded the employees did not leak genuinely classified information. instead it looks like fda

monitored the accounts because the whistle blowers were talking to the office of the special counsel and in the case of congress, some of the e-mails of people on my staff came up, showed up. i'm very concerned about this. fda's retaliation is shocking, may be unlawful, should not be tolerated and i'm committed to getting to the bottom of it. today, chairman isa and i are signeding a letter to the u.s. office of special counsel to launch an investigation in the facts and circumstances surrounding the e-mail monitoring and i would ask permission to put that letter in the record, mr. chairman. >> without objection. >> so here's my question. do you agree that searching through employees personal e-mails should is okay just because they contacted the special counsel or congress and

would you agree that would be unacceptable? >> senator, i certainly share your concerns about the potential retaliation against any whistle blower and feel that government employees need to have a whistle blower protection. on the other hand i think the fda needs to have protections around pro pry tear information. as you know this case is in litigation. >> we're talking about personal e-mails, though, here. is it okay -- >> senator, it's my understanding and i can't really discuss a lot with the litigation, but my understanding is there was some monitoring of office e-mails and screen shots may have appeared that accessed a personal e-mail. there was no monitoring of personal e-mails that had anything to do with anything

outside of the office space and that is something that federal employees throughout government are put on notice that their e-mails can be monitored. >> let me lead it to this question, then. now the fda may have the right to monitor e-mails sent from government computers, but the evidence showed they captured e-mails not sent from a government computer, then do you agree that that would be inappropriate? >> again, senator, this is in litigation, i don't want to speculate. i do know employees are put on notice their government e-mails will be monitored. >> could i get this commitment from you. would you commit to insuring that the fda fully cooperate with the special counsel's investigation? >> to the extent that they can while litigation is underway, i assume they will listen to the justice department about what they can and cannot do. but yes, sir, i think everyone shares your concern about

inappropriate and retaliation whistle blowers. also think you would share our concern the >> i want to emphasize two years ago. i'm disappointed that cms is taking so long to issue the sunshine regulations. the proposed regulations was two months late. last week the office omb said law would not be fully implemented until, can you believe it, december 2014. in the absence of final guidance companies cannot prepare to comply with the law, cms does not seem to be taking this seriously or working to implement the law with any sense of urgency. your agency has implemented many other provisions of the health care reform law already.

just think of all the ones you've already put out. the longer you delay the provision, the longer consumers will have to wait to learn about financial relationships between their doctors, drug and medical device companies. how can you wait until december 2014 to issue a final regulation when the law requires companies to begin reporting information march 2013. >> i want to clarify. the final rule -- the rule has been finalized and is out and available. we are talking about a timetable for reporting. this is a balancing act. i share concerns about relationships that may influence their health care provider's decision. health care providers are concerned that additional reporting requirements may

impede their ability to practice medicine. we're trying to have a balance between the public right to know and the provider sensitivities. >> let me correct you. the final rule can't be out because the comment period ends friday this week. >> i apologize senator. i'm thinking of the rule that may apply to nih scientists and reporters dealing with sunshine. i will get you an updated timetable. i apologize. >> we need to have the companies know what this is a long time before march of 2013. thank you, mr. chairman. >> senator car den. >> thank you, mr. chairman. it's a pleasure to have you before our committee. i appreciate the way you're moving forward to implement the affordable care act. you sometimes get inconsistent messages from my colleagues in congress. but i can tell you -- >> never. >> as i travel through maryland i run into people affected every

day by what we did in a positive way. seniors now see a light at the end of the tunnel on the coverage gap for their prescription drugs. there just was a family last night that dealt with keeping their children on their policies to age 26. i can tell you that we've opened and e panneded clinics in maryland now covering prenatal care and dental care where they didn't have that coverage before the initiatives with the affordable care act. i want to start off by saying thank you. i understand the frustration that regulations and implementations are not moving as rapidly as some members would like to see, it would be nice to see if we gave you the budget support you need, particularly at cms, in order to be able to implement those programs. i'm going to work with you to achieve that. i want to at least concur in the comments of senator wyden on the shortage of drugs. that's unacceptable from america that these drugs are not

available. i certainly understand your need for notification. there are manufacturers not being totally forthcoming on these issues. we have to make sure that the supplies are available. i think we have a responsibility to act. i hope that we will find a way consistent with the philosophy of our country to make sure that those types of shortages do not exist in the united states. i want to talk about the fda budget. of course, you mentioned the fda, their budget only gets a modest increase under the president's numbers. more disturbing to me is the nih budget, national institutes of health are frozen in the budget you have submitted. we rely on nih to give us the answers to a lot of the medical mysteries that are out there and to provide the foundation for research that is important for innovation and job growth in america. and i've been to nih many times and have talked to the

scientists that are working there and know the number of opportunities that are there that are not being moved forward because of the limits resources. so i would have hoped that we would have seen from the administration a greater priority for the nih budget. i wanted to give you an opportunity to respond as to the priority that nih is receiving under this administration. >> well, thank you, senator. i do share your feeling that one of the most significant areas for not only the prosperity of our nation but really the world is the on going biomedical research going on at the nih. i'm struck by not only how important it is in this country but around the world. what i can tell you is nih is

one of our largest budgets and is always difficult to look at. while a number of our agencies have cuts in this year's budget, the nih budget is, as you say, kind of held harmless. having said that, dr. collins i think has done an extraordinary job adjusting resources so that we will continue the progress. this budget supports a 7.7% increase in new grants so they'll be 672 new research grants as part of this budget. the curers acceleration network and center for translational science which are two high priorities of dr. collins which helps, again, accelerate the not only strategies within government, but leverage our private partners toward cures and toward disease outcomes that are positive is -- have fairly significant increases in this

budget. so while it is a level funding, it is focusing resources on areas with the most promise. >> i appreciate that. i look forward to working with you. that's a good point that we need to set priorities within the nih. i agree with you. i want to make sure senator carver has an opportunity. let me just raise the issue post acute care. you have a large cut of medicare in your budgets, i think 50-some bill eun dollars. posted acute care has already sustained substantial reductions in recent efforts. i know there's concern that we target against fraud and abuse in ways. i would just urge to be more surgical rather than using across the board issues that could jeopardize access to post acute care. >> we'd love to work with you on that issue. thank you, senator. >> thank you, mr. chairman. >> senator carper. >> mr. chairman, hey? mr. hatch. >> just a humble servant here.

>> secretary, welcome. i just want to -- i want to thank you for a couple things. one, accountable care organizations. we all know we have to move away from fee for service toward a more coordinated care approach. they'll put out accountable regs. we heard from a lot of people you did as well. i want to commend you and your team for responding to those comments and helping create an environment where we're going to see a lot of these accountable care organizations established including, i hope in delaware we had jonathan plumb was up, met with a bunch of our hospital and provider folks and did a very nice job. we're encouraged and excited about that. i as you know, one of the things we focus on as you do is how to get better results for less money or for the same amount of money. to the extent we can find ineffective spending whether improper payments or fraud, we want to go after that.

i i'm told that you may have announced, i think even yesterday, may have announced a record level of health care recoveries totaling over $4 billion. that's up from almost nothing a few years ago. thank you so much to everybody working hard to make that happen. i have worked along with some of my colleagues, senator harkin and senator murkowski on menu labeling to make sure when people go into a chain restaurant across this country, they'll know not just the item being served and the price but actually know calories and a lot of other information about the items being served. i understand that you're pretty well along the way in terms of us being able to have that information going into restaurants. we thank you for that, too. i do have a question in all this. just a couple minutes left in this hearing. remember you can see this and all the budget-related hear