other states. russia has abandoning double standards. we have all countries to implement the resolutions that andfour ending terrorism establish sanctions against the taliban and al qaeda and also that prohibit the dissemination of weapons from libya. we supported the resolution that is aimed at ratcheting up sanctions and pressure on terrorism. ,fter the intervention in iraq

the problem of foreign terrorist fighters has seriously worsened. we need a comprehensive approach that encompasses social and ideological components and also that would ensure respect for the sovereignty of all states. we support the initiative of the u.s. presidency and the security council to adopt a resolution aimed at choking off any activities of foreign terrorist fighters. likee same time, we would to caution again the temptation to narrow down the problem because of the islamic state with its ideology. there is a need to consider the problems of terrorism and in all its dimensions. establish a form

involving countries of the region, the african union, league of arab states, the permanent five members of the un security council council, and other stakeholders. we should address long-standing conflicts primary being the arab-israeli conflict. this is one of the primary reasons enabling terrorist to receive moral support and recruit ever new members into their ranks. we call upon -- call for looking at the cause of the problems and avoid responding solely to their symptoms trade we will be prepared to cooperate on an equal basis as to how to -- how this problem came up and how to work our way out of this crisis. >> we think his excellency for his statement.

and now from the evils republic of china. >> china supports the convocation and the initiative of the united states of the un security council summit on terrorism as well as the resolution adopted today. this resolution which affects the commonwealth of the community should the implemented in a comprehensive and balanced manner. 13 years ago al qaeda launched the 9/11 attacks in this very city that shot the entire world and took away over 3000 innocent lives. year, theend of last have caused heavy

casualties. new terrorist incident took laced. we wish to extend our .ondolences to france at the moment we are witnessing terrorism which deserves serious international attention and vigilance. conflicts in the middle east teh deserves serious international attention and [indiscernible] they will pose a serious threat to the security and stability of many countries and the world as a whole. in this area of rising interconnectivity terrorist financing has become easier.

hashe meantime social media .ecome a battlefield -- we must stay alert for ideologies competing with us. this is a battle. rising oncesm rates again we must adhere to the practices that have been proven effective. first we must ensure sound .oordination the u.n. and the security council have to play a role in the global war on terrorism. this is the only way to maintain coordination and take concerted action.

modelst adopt a multi- approach. this is especially removing its ground. military actions must comply with the u.n. charter. we must follow a consistent standard. any active terrorism whenever and wherever it is committed or -- no double standards. should terrorism be identified with any ethnic group or religion. we must come up with new thinking and new steps and response. china wishes to propose the following. we should step up information gathering.

and step up sharing of resources and intelligence analysis. we should strengthen counterterrorism on the internet. toyou should be taken address social media. internet companies should exercise self-discipline. formulate ative to code of conduct for the industry. china will host a symposium on [indiscernible] in beijing later this year. we must lock the channel on financing of terrorism.

we must lock terrorist financing. we should promote de-radicalization while taking andon to crack down [indiscernible] positivecting more energy. the u.n. should sum up the useful experience and promote the best practices around the world are you the middle eastern countries are on the frontline of the war on terrorism. it is important for these countries to work in unity and coordination and put aside their differences. china supports these activities and capacity building and we stand ready to [indiscernible] provide military

assistance including its kurdish region. terrorism, weh have no choice to work together to address this problem. china has opposed all forms of terrorism and will continue to cooperation. terrorism has no place different -- to hide and will be thoroughly defeated. thank you. >> i think is excellency -- i thank his excellency for his statement. matters i want to mention before we go to our next speaker. 101id earlier that we had cosponsors for this resolution. we have 104. consistent with our earlier agreement and past president --

precedent, we have opened this of countriesers that are not currently on the council. we have a deep interest not only in the problem we discussed today on the issue of foreign --hters but our critical but but are critical in a solving this problem. i want to know welcome and give the floor to his excellency, the prime minister of the republic of iraq. >> mr. president, distinguished members of the security council. i think you for holding this meeting which reflects your attention to the question of terrorism and i thank you for your invitation to iraq to

attend this high-level meeting and i thank you personally for the support you provided to iraq in confronting terrorism. iraq stands in the first line of confrontation against terrorism stateainst the islamic which has attacked iraq and displaced thousands of its citizens in the north and in the occupied areas and has killed andreds of our citizens others and has targeted religious minorities. sufferedas have sectarian and religious cleansing. it changed its to graphics and its cultural and religious indices in addition to the booby-trapped corridor killing

tens of thousands. ofihch is a mixture ideologies which claim allegiance to islam, they are calling -- causing more damage to islam and have adopted ittarian rhetoric but also is clear to all the groups that this organization is not an internal iraqi organization. it is a transnational organization that derives its strength from [indiscernible] provide hatred for the other and finding leisure in shedding blood and beheading

others. presencecing network that provides liquidity to smuggling networks in the territory under control by isis. grouppport that this enjoys from recruitment, networks throughout the world that empties into iraq for my media and propaganda networks that spread news about the success of this organization and helped recruit members. this is not limited to iraq. we will not allow regional

disagreements or international disagreements to affect the priority and primacy of this these or to disburse international alliance. allegiance is to iraq and its people. gratitude to all the states. we also affirm that this is the cornerstone. we call upon the security council to the following. providing all forms of support and assistance and security assistance. to defeat terrorism and protect the energy, independents, and sovereignty of iraq and its

landscape and water and air. second, the blocking of all sources of financing and financing networks including the purchase of oil from areas under the control of ice is. of thecking the entrance extremists to iraq and stopping all forms of support including dismantling and criminalization of recruitment networks. ices from the use of technology for its ideology including the use of the throughoutd the use the media. and support from the entire world for refugees and the is byuction whether it occupying the states or the

booby-trapped cars that explode in these areas. successful inn -- withthe progress of the use of our heroic security forces and the courageous people that have responded to the call of the spiritual leaders. iraq is also succeeded in achieving a peaceful transition of power and increasing an international alliance and this is -- according to specific time statement and this is a necessity, a priority for the confrontation of terrorism. our government while we look forward to an urgent effort to and terrorism we look forward to constructing [indiscernible] in the world especially in the region of iraq, the neighborhood states, who stand together with us in this confrontation and

this relationship would be based on political and military operations and common interests. thank you, mr. president. the thank his excellency prime minister for his statement. we recognize that iraq is on the againstnes of the fight extremism and terrorism and we are heartened by the numerous countries that have latest assistance to iraq in support of this fight. i would like to give the floor the presidentncy, of the republic of turkey. turkey has obviously been deeply affected by oath of flow of foreign fighters and the displacement that has resulted in the -- from the conflict of neighboring states. we thank the president for being here today. >> thank you.

president obama and secretary general, distinguished guests. i would like to start by for enablingriend such an important discussion at the highest level. the foreign terrorist fighters is no doubt a very important issue and it is an issue that has presented itself as a reflection and the center of a bigger problem and the collapse in our southern neighborhoods and the resulting atmosphere of chaos and instability. unfortunately the region has become a magnet for terrorist fighters. turkey especially with the emergency of instability in syria has repeatedly made all the necessary warnings to the

international community about this threat. the inertia of the international community despite the policies of violence towards the syrian population by the regime has prepared the ground for a dash for al qaeda to reemerge in syria and grow stronger under thename of isil with support of the regime. this bread of the thread toward iraq is a result of conditions on the ground and has been nurtured by the earlier sectarian policies. those circumstances, the international community has to work together. i'll problems can be overcome if the international community works together. we have to have a long-term approach of comprehensive and realistic approach in order to overcome this threat. turkey has been taking a leading role in this direction and has the flowing to prevent

of foreign fighters toward the region for quite a long time but this is not a fight to be carried out solely by turkey. the thread of foreign terrorist fighters start the moment these individuals depart from the source country. thus the combat against these individuals should start in the source countries and our initial targets therefore for us is to prevent their entry into turkey and for a long time, we have been calling upon the countries concerned to cooperate with us on this topic create unfortunately, a timely reaction has not been shown on this issue , either. upon the deterioration of the situation, we finally witnessed recently an increased share of information from the source countries. within the scope of our struggle, against the foreign terrorist fighters, around 6300 individuals have been included in the no entry list and close to 1000 foreigners have been

deported and we have established risk analysis groups at the airport. i would like to once again emphasize that we can stop this flow of foreign fighters only if our friends and partners awaiting our corporation show themselves the spirit of cooperation as well. another important issue is the -- we must will upon is the fact that the exposition of these measures and the damage to our common civilized values should not be allowed. distinguished participants, turkey has suffered for years from the malaise of terrorism that has claimed the lives of thousands of its children. we are among the best and know the pain that terror and tales. we are among the best to know -- we would be among the first to try to make sure we can prevent youngsters from all over the world to fall into the hands of terrorism.

together with the united states launched the global cap -- counterterrorism forum. -- turkey takes all national, regional, and international steps to counter this threat and is committed to taking enhanced measures in this regard. is a terrorist organization with blood on its hands and since the beginning, our government has taken all the serial legal measures in this respect. in our fight against terrorism, all measures at our -- will be taken with new regard to regional stability and humanitarian needs. there is on our turkish orders a huge pressure and since the beginning of the conflict in syria, we have received 1,300,000 syrian refugees from every ethnic and sectarian group. , more thaneek 140,000 syrian kurdish refugees

l haveve been fleeing isi found shelter in our country and we are temporarily housing refugees from iraq. despite the expectation of solidarity we have not receive the kind of support we have been looking for from the internet -- this -- come 20 in conflict create it is very sad for us. turkey's determination cannot be questioned. [inaudible] if we go deep to the roots of the conflict and ensure the desire of solidarity, we can get results. and our goal should the two create an atmosphere of peace, democracy, and stability where millions of our syrian brothers can safely return home and our other brothers can feel themselves part of iraq. to be our goal in

turkey will continue to carry out efforts in this regard. thank you. for thank his excellency his statement. i not give the lord to his highness, a mirror of the state of qatar. >> in the name of mohammed the merciful, members of the council and president, let me thank president obama for convening this important meeting and i hope that the meaning of this will strengthen our collective efforts to deal with the phenomenon of foreign terrorist specifically [inaudible] which is why we are taking part in today's meeting. the international community

agrees with respect to the diagnosis on terrorism. this is an imminent danger. hence, we need to deal with this as a priority. the peoples of the region unfortunately have hit a heavy price with respect to this phenomenon. institutions and for logical reasons. i said this morning to the general assembly that in the modern era there is no civilization that has not had to civilizations, being right, left, religious. it would be a fatal mistake to attach this violence to one culture or religion or nationality, whatever they be. it goes without saying that the international nature of terrorism and the use of met -- modern technologies contribute to spread this courage -- scourge.

this makes the response impossible essentially without international solidarity. we believe in qatar we are part of the international solidarity to deal with terrorism and we will deal with this nationally and internationally by working with international efforts. resident, there is no other choice but a security response even military, urgent response given the imminent threat posed by terrorist groups who recruit and transport terrorist combatants across borders. the current state of alert should not make us forget the origins or motivations for this phenomenon. in fact, terrorism should be a very rare and exceptional phenomenon. however, when we see terrorist groups have under them entire

populations and territories in certain countries, the only possible when the state is absent, when there is a lyrical vacuum or when they become an instrument of murder and repression, that leavesfor -- for dialogue or political reforms, gradual reforms, or civil evolutions. there are regimes of terror killing their own people and if the efforts aimed at eradicating terrorism need to bear fruit, you would have to come back to restoring the state. the framework [indiscernible] should not be within repression cannot wait until more people are killed.

we cannot overcome terrorism unless society is affected i this and we respond to the bloody repressions such as that we see in syria or the kind that we are witnessing in iraq. with respect to the rejection of other people and that -- their religion, that is different. we have heard military action is not the sole solution. this is within the framework of political solutions that open the door to a better future. violence leads to violence. therefore it is necessary to follow a political hath. for the political aspect to be credible and we should avoid double standards when civilians are aimed, the response should be the same regardless of the origins of this violence against civilians.

and one cannot stand by while thousands are killed. there is always the explanation for this but i fear that this gives a sense that there is a double standard. thirdly, we should not give cart wants to deal with terrorism. we need to ensure the rule of law and civilians should not be the victims once again. [indiscernible] we support all efforts that are based on international consensus to put an end to this scourge regardless of its motivations or the excuses given for it. >> i want to thank his imus -- his highness for his statement. unfortunately, i am being called to deliver another address and participate in another u.n. forum.

my able secretary of state, john kerry, will be taking the chair. i want to say to my friends, the leaders of kenya, bulgaria, and moldova as well as my good friend stephen harford -- stephen harper from canada. and other heads of state. we very much welcome your commitment and your participation in this forum and i want to thank the entire security council for the seriousness with which we have tackled this problem. i will note that it is very rare where the united nations achieves the kind of consensus that we see represented in this resolution. and i think if you look at all the statements that have been made today, several things stand out. number one, the brand of violent extreme terrorism that is represented by isil is something that should be rejected by all of us in the civilized world.

number two, in addition to militarily dealing with the challenges, we are also going to have to change hearts and minds and that requires a wide range of strategies, and this resolution commits each of us to find tools to counter their radicalization that can lead to the recruitment of young people who obviously are not taking a -- obviously we want taking a better path in life. i want to reaffirm that the united states will be recommitted not simply to a military approach, but we also are deeply committed to working with every single country that is prepared to cooperate in making sure that the scourge of terrorism and the use of foreign fighters for perverted ambitions is sorted and that we are going

-- thwarted and we are going to make sure that we reach out to each of you individually to find out how we can be helpful and cooperative with you. i will repeat what i said at the outset of this security council meeting, though. resolutions alone will not be enough. lofty rhetoric, good intentions are not enough. we are going to have to translate words into deeds but given the seriousness with which all of us have made our presentations here today i am confident that in fact we can succeed. that we can drain the sources of the kind of extreme radicalization that we have been seeing, that as a to clients and with the help of political resolutions of conflict in the middle east, and north africa, we can arrive at a situation in which all of our young people, rather than resorting to violence and suicide bombings, can be confident about getting a

good education and seeking opportunity and raising families and living in peace. i want to say thank you to all of you for your outstanding contributions to this very important and historic effort. >> let me express my heads ofion to the state. continuescoverage thursday night at 9 p.m. and bradhe kerry ashford. at friday afternoon at two, the organ governors made between john kitzhaber and state representative republican desert -- dennis richardson. and the i/o u.s. senate be between democrat bruce fraley

and republican johnny earns. more than 100 debates before the -- for the control of congress. andech president holl 'siterated his country commitment. his remarks are 15 minutes.

>> your excellency. [applause] rex today i am speaking to for you with particular emotion because [inaudible] the cowardly assassination in algeria. by a terrorist group with links to islamic state. he was a man who was full of enthusiasm. he loved the mountains. ought he would be able to pursue his passion, moving into the area in algeria. he was abducted and he was beheaded. this is what terrorism does.

it does not do it only to france. there were americans and british people who were dealing with the same level of barbarity. , they do not strike only those who do not think like they do. they strike muslims, they strike civilian populations and the strike when artie's. they rape, they kill. reason that the fight of the international community needs to rage against terrorism which knows no borders. and it is the same fight that needs to be carried, the fight goes out for which this organization was founded.

human dignity and freedom. is one of this justice. it was joined by many african and european countries and now the united nations. france has been committed each time there has been a danger but today, this thread exists in iraq and syria. regiononly concerns this , they have decided not to conquer territories. this group is threatening the entire world. androvoking attacks

organizing -- recruiting fighters coming from all over to showd to train them them the barbarity that this group is capable of. repeat andy can reproduce this sinister terrorism movement in their own countries. therefore this threat exists not only for the region but for the world. it is for that reason that france has responded to the call of the american authorities so that we can bring military assistance by providing weapons. supportbringing aerial to avoid this group continuing to progress.

we want to weaken it, we want to reduce it. know that while there is no settlement of the syrian crisis, all of our andrts could be reduced that could mean simply that there is an action but -- an action but political solutions. we and france support [indiscernible] the only legitimate representation of the syrian people. change and we will not make any compromise. there is the threat of assad regime, they also need to be condemned because they are complicit in what has been happening for the last two years in syria emma 200,000 cert --

syria, 200,000 dead. this is a tragedy following the assassination of one of our compatriots but france will never given to blackmail, to pressure, to barbaric act. quite to the contrary. france knows what is expected. it knows that it has a role to -- a role to play. terrorismht against will be pursued and accelerated as much as is necessary with respect for law. with a respect for sovereignty of states. mistake when we act. we will always do so with respect for the principles of the united nations. i would like to talk to about some other things.

please understand that in my is nevertheless a great question which is being asked and being asked to you. when faced with this barbaric act, faced with terrorism, will remain spectators? together ine actors what should be an international order. this question if we do not respond to it or respond to thely -- too weakly, terrorists will continue with their undertaking and indoctrination. it is not weakness that will be the response, it is force. the force of law, the force of the united nations. also, thein point force of military action when it becomes necessary. also wanted to talk to you

about other regions of the world. which are also going through threats to our own security. i want to talk to you about the ebola epidemic is i know just how much it is affecting our african friends in here again, let's look the on and -- beyond. who can imagine that this epidemic can remain contained in a few countries. this is also a global threat and the response must be global and therefore france and the world must ring to those countries affected by the epidemic necessary care, the protection that is required, because there again if there is the thehtest weakness, slightest lack of solidarity, all of our countries will be affected.

gentlemen, i have also come here before you to speak to about what is next to europe to what happened in ukraine. the [inaudible] what we needurope to do is achieve for peace and the cease-fire and the truce that has been concluded there. this needs to be pursued. continent is spared from this threat. everything is fragile and vulnerable. we need to have the same awareness of the dangers. beyond the second world war. it aed not only to make memory but the task of the future. this is the world we want.

this is the last man want to talk about. there is a world that we want. [inaudible] this is threatening not only our generation but the one that will follow us. it is a threat to our own security because there are more by climatelaced change than by wars. which are so intense and deadly. throughout our world. france has also taken on its responsibilities having decided to organize the climate conference in december 2015. toht here, thanks secretary-general and cumin, there was a summit which enabled state andbilize

financial institutions, countries and societies. this conference to succeed not only because of [indiscernible] it is the world we want. experiences in history when we can decide not only for ourselves but for humanity and this time has come. therefore, in paris, we must do everything to make sure that the global agreement can be reached. an agreement that can be binding and can be differentiated according to levels of development. which can have its green fund to which france has contributed $1 billion for the coming years and the hope other countries will follow us because we need this green fund to enable countries who do not have this level of development to be able to ensure their gross and at the same time, there energy transition.

that i amsad moment experiencing today on behalf of france that the french people are going through but it is also a moment when we can move forward and take on our responsibility for the world, the planet, we need to act for peace, we need to reduce inequality. we also need to do our job for future generations to make sure -- to make sure the u.n. can always be faithful to the mandate that was given to it following a perfect more. we are still facing challenges. we are certain to be able to deal with them if we are united and together, we can achieve this victory. thank you. [applause]

>> on behalf of the general assembly, i wish to thank the president of the french republic for the statement just made. may i request representatives to remain seated while we greet the president. >> coming up. -- lookingthe ways at the medicare appeals process. and the un security council considers action against a militant group isis. on the next "washington journal," a look at the president's strategy for combating isis. vladeck to stephen

and charles stimson. simon on public aussie and higher education. on c-span. this weekend on the c-span networks. friday night in prime time, the value voters summit. featured speakers include texas senator ted cruz and kentucky senator rand paul and said are you tonight at 8 p.m. eastern, a national town hall on the critical and historic impact of voting and sunday evening at 8 a," sally quinn. daniel green and william mullen, two operation iraqi freedom veterans talk about their experiences. saturday night at 10 p.m. on theer words," on

distractions of technology and its impact on society. sunday at 1 p.m., the ninth annual rutland books festival. chiefsat 8 p.m., former of staff and advisors to recent presidents talk about the relationship with the commander-in-chief and how he makes important decisions. saturday night at 10 p.m. eastern, the role of the union army and abraham lincoln's 1864 reelection. sunday afternoon at 8 p.m. eastern, author annette dunlap explores the evolution of first ladies' fashion. let us know what you think about the programs you're watching. mail us, a mail us -- e- tweet. us a july i house review looked

at the medicare appeals process. medicare has a backlog waiting to be heard by administrative law judges. has delayed some hearings by 28 months. this is an hour and a half. rex good afternoon. the boats will be called for that in the next 15 to 20 minutes so what i am going to do is an opportunity to go through some of our opening statements. this is an energy policy and

entitlements hearing. the chair is authorized to declare recess. i would like to begin by stating the existing statement. we have [inaudible] americans deserve an efficient effective government that works for them. and our solemn responsibility is governments accountable. we will work in partnership to deliver the fact and bring genuine reform to the bureaucracy. this is the mission of the committee. this conversation is as i mentioned already the second part of a two-part conversation about how things are going and we have multiple different entities that have a significant backup. there waiting through the appeals process. some of them for years in the appeals process. health care writers, hospitals,

individuals that do not have a large cash flow and individuals and businesses that do. the issue today is, why does that exist, how do we resolve this, what are the fixes that are needed legislatively, and what can we take care of right now question mark i will yield additional time to mr. meadows vexes boils down to people. we have to make sure to do the best we can to go after waste, fraud, and abuse which the chair has so eloquently articulated. yet at the same time, make sure that the rule of law and fairness to everyone is upheld and right now, i think there is great question. i am not singling you out because i have had some great conversations with folks within

the alj and there seems to be a very compassionate desire to fix the problem. that is what we are looking for here today. my other concern and i think the concern of the american people is this whole process in terms of when we go after waste, fraud, and abuse. if we cast such a wide net than we are taking the decision-making away from doctors, health care providers, hospitals, many people who make their decisions who are trained, who go to years of training to do that. we are transferring that decision-making capability because of reimbursements to bureaucrat. for me i have a lot more trust in the nurse or the dr. that cares for me than i do somebody that works here in washington, d.c.. i think that polls would show that to be the fact as well. so what i am looking for

specifically and it will be difficult i know because you are part of it -- part of the agency, but there's this wall of separation that somehow goes up. the american people do not understand that they all see you part of hhs or part of cms you have a law, -- a wall. what i need to do is have as much finger-pointing as possible to say this is what will solve it. knowing that i am not asking you to throw anybody under the bus. we are looking for legislative fix for appropriations that need to be done so that we can help this to quit the a problem so we can obey the laws the way it is written. i think the chairman -- i thank the chairman and i yield back.

>> i will submit comments for the record to protect our time. chart with outcome rates that was given to us i the office of medicare hearing -- hearing and appeals. recognize theo ranking member for her statement. >> thank you for holding this hearing and want to thank the beforeudge for appearing us today on this important issue. i think we can all agree that medicare providers are entitled to have their claims administered fairly, efficiently, and without undue delay so they can focus on their core mission of providing care to our nation's seniors. if they are billing and correct the, they deserve to know sooner than later. unfortunately, that is not the situation facing providers

today. medicare providers appealing payment decisions made by contractors are waiting on average 387 days to have their claims adjudicated by the office of medicare hearings and appeals. for provider submitting new claims the way could be as long as 28 months just to have an appeal assigned to an alj. the current claims backlog is unacceptable and unsustainable. omaha must make significant changes in how it does business. i look forward to hearing from the chief judge about the initiatives omaha is venting to improve efficiency and alleviate the backlog and want to remind my colleagues that the backlog is a problem that congress created. cms to beas required increasingly vigilant in detecting or reducing the amount of waste, fraud, and abuse in the 600 and dollar may care program that covers 51 million beneficiaries.

this emphasis on program integrity is critical to the health of our nation's seniors and to the protection of our taxpayer dollars. this increase scrutiny has not and coupled with additional funds to address the influx of claims and appeals that have resulted. with the medicare prescription drug act, congress created contractors and the recovery out of chair contractors pilot program. in 2010 the program was made permanent and expanded nationwide. contractors conduct audits of medicare providers. has of these contractors increased the number of claims being audited for payment accuracy in recent years. according to a 2013 gao study, the volume of contractor post payment claims reviews increased by 55% between 2011 and 2012.

more audits means obviously more appeals. that is an inevitable result of the additional from integrity functions that we here have asked cms to government. congress has not provided omaha with more funding for more judges to adjudicate claims so when we wring our hands about the number of days that these providers have to wait, we have to wring our hands and look directly at ourselves. despite a sixfold increase in the number of appeals since 's in the number of alj omaha has received constant. 192 claimsi received get received no additional funding to handle the workload. i joined my colleagues in sending a letter to the secretary of hhs citing concerns about the program and expressing the need for reform.

it is also important to note that has led to the exposure of many questionable billing billing forch as hospital readmissions on the same day with the same diagnosis. durable medical equipment items delivered but never ordered i a position. hospital claims coated with did nota patient possess and excessive units of medication ordered especially ed dose would be harmful to the patient who received it. also ensure that we preserve the central program integrity functions who performed the critically important congressionally function of reducing improper payments in the medicare program. an important part of reducing the burden on providers is insuring that appeals from adverse determinations are

adjudicated in a timely manner. congress must do its part by ensuring that the budget request is fully funded. we have to give them the resources commensurate with the work load we have asked them to perform. with that, i yield back. theembers will have requisite seven days. you are the sole individual in this airing today. we are great all that you are here. pursuant to all committee rules, all members are sworn in. if you would stand and raise your right hand? theou solemnly affirm testimony you are about to give is the truth, the whole truth, so help you god? let the record reflect the witness answered in the affirmative.

we have not called for a vote yet so we are not at a critical moment yet. you may begin. >> members of the subcommittee are want to thank you for the -invitation. we distribute the hearing program and are responsible for conducting the third level overview of medicare appeals. in order to make sure the adjudicators have independence from the cms, it was established as a separate agency within the department of health and human services and reports directly to the secretary. accordingly, we operate under separate appropriation and we are functionally and fiscally separate. andeen fiscal years of 2011

2013, what had been a gradual upward trend took an unacceptably -- unexpectedly sharp turn and omha had a 45 % increase in appeals. there were the number of been a using theciaries process in there was the new audit workflow process including the nationwide implementation of the recovery audit program. increases also been in medicaid state agency appeals. we are pleased the 2014 enacted funding level has allowed the hiring of seven additional teams bringing the adjudication capacity to 72,000 per year. this capacity pales in comparison to the adjudication workload. in fiscal year 2013, received 24,001 hundred 51 appeals and in

levels are approximately 509,100 appeals. productivity has more than doubled from fiscal year 2009 through 2013, we have been receiving approximately one years of appeals every four to six weeks driving the adjudication time frames to the current high of 387 days. recognizes the need to adjudicate appeals with greater efficiency. by the end of the fiscal year, we will release a manual utilizing best practices to standardize our business process and we are using information technology to convert our process from paper to electronic, and effort that will culminate in its first release in summer 25th team. we have also developed a

template system which simplifies the work of our staff by providing standardized billable formats for routine word processing. omha also proposed and former secretary stabile yes established a departmental interagency work route that conducted a thorough review of the appeals process and developed additional initiatives that both are currently implementing. posted two newa options for appellants the first allowing to have their claims adjudicated using statistical sampling and extrapolation methods. option uses alternative dispute resolution techniques during a facilitated settlement conference. has directed the efforts of attorneys to assist in the prioritization of beneficiary appeals. any who believe their case is not receiving priority consideration at omha may contact us directly at

medicare.appeals@hhs.gov or using our toll-free number. i cangh omha is separate, provide a general outline of initiatives being undertaken at cms which include beginning global settlement discussions similarly situated appellants, requiring the new recovery auditors to provide a 30 day discussion, allowing for recovery audit payment only after a qualified independent contractor has determined that an overpayment exists. proposed rule requiring prior authorization for durable medical equipment and requiring prior authorization for two part d services under the demonstration authority. although the department is working to address the backlog in the number of respective

appeals with authority, the initiatives discussed today will be insufficient to close the gap between workload and resources at omha. of theficant portion increase is a consequence of the department's effort to implement legislation designed to combat medicare fraud and reduce improper payments. the department is committed to crafting solutions that will bring these efforts and the resulting repeal workload and the balance. we look forward to working with this committee and stakeholders to develop and implement these solutions. inc. you for your time and concern. your time.u for can you walk us through the five levels of medicare appeals process? >> the first two levels are conducted at cms administered by cms and contractors.

the third level is at the office of medicare hearings and appeals and it is conduct that by administrative law judges. the fourth level is medicare appeals council part of the is also aard and separate agency within health and human services. the final level is with the federal district courts. describe the different level of appeals heard? >> we hear both part a and d appeals under medicare and we also hear part b. originalpart of the charge, the prescription drug appeals. we hear appeals on entitlement. we also hear part c medicare advantage appeals. >> percentages of those, what do you hear most often?

it varies. in recent years, we have heard a significant number of appeals under part a, the acute-care hospital appeals. does that happen 30%, 40%, 50% of the time? >> i can get you that number. hold on just one minute. >> trends help you out. i'm trying to figure out being the health care provider always looking at trends about what's happening giving you a workload basis with which to delegate resources to. >> most of the recovery audit appeals have been part a. you can kind of use that as a gauge. 41.2% -- i'm sorry. i have the wrong list. date were recovery

audit appeals. those are predominantly the part a appeals. according to hhs office of inspector general, 56% were decided as fully favorable to the appellate or reversed previous lower decisions. what is the current rate? >> are you asking about the appeals or just overall otr's? >> overall. >> in 2014, the fully favorable otr rates is 19.3%.

conducted an analysis on what factors are really driving this backlog? i would like to be a little more specific. >> we track what we call the traditional workload, the part a/b. we have also been tracking the dual eligible for medicaid and medicare beneficiary workload. all three of those have been going up. the traditional workload has partially byargely demographics. there are just more beneficiary on the rolls who are utilizing more services. it has also been driven by ,ncreases in cms audit efforts zone program integrity, identification of improper payments, anything that results

in more denials at lower levels will result in more appeals at the alj level. the recovery audit program is the one that gets a lot of attention. it was a new program in 2010. it was a start up. the increase in receipts was dramatic. that occurred primarily at the level between 2011 and 2013 when we saw the largest spikes in that workload. thee also seen increases in dual eligible workload, beneficiaries that are eligible for both medicare and medicaid. those workloads have gone up as well. >> thank you, i yield back. >> we are going to defer until after the vote.

ares not true that you handling more cases per adjudicator on an annual basis? >> that is true. so you are actually more 20% if you really look at the real numbers that your adjudicators are actually being a lot more efficient than they have ever been before. since 2000 nine, the adjudicators have doubled productivity. >> if we look at that, this is administrativef law judges just sitting back eating bonbons no. >> i think we can both agree on that. at this particular point, you done your homework and you've looked at the previous hearings. would you say and estimate under the current rates right now based on the estimates of potential backlogs of the cases was in the budget assessment

that we got, that it is an eight year backlog to adjudicate based on current staffing and current workload efficiency? >> if you do the simple math -- >> i'm a simple guy. >> that is the number that you come up with. it however does not take into account the efficiencies that we are putting in place, the initiatives both at cms and within our pilot program. he's part of your efficiency thing there. i see that. i'm encouraged by that. you are familiar with the fact that the law says you are 90 dayd to have a turnaround. that is the law. >> they envisioned the 90-day

processing. >> and you are familiar with the fact that the intent of the congress was to have the 90 day turnaround. ifthat's part of why omha you look at the legislative created iny we were the first place to deal with cases that existed was social security. >> you're familiar with the fact lot out therea that authorizes you to take moneys from other trust funds to do three things -- higher additional administrative law judges, provide additional training, increase the staff of the department of appeals board. you are familiar with that. you're talking about the reprogramming authority. subtitle d.

that, even the budget that yount, request guys have made i guess requires for an additional seven units. is that correct? fiscal year 2014 enacted level allows for seven additional -- >> what are we doing on 2015? would president's budget give us an additional 17. >> i've done the simple math based on the president's budget and based on where we are. does that get you to 90 days? >> no. >> does it get you to less than three years? the answer is no. i want to qualify that.

if we are talking about giving current authorities and current funding, then the answer is no. request,he president's so your request at this many yearspoint, how would somebody have to wait for justice? 5.3 years. >> i think it is impossible at this point to really pin down how long they will have to wait. think an math as i outside limit. with this.lose how many businesses have to go out of business before we start abiding by the law? the 90-day timeframe envisioned by congress -- >> its law. i can give you a copy. >> i have to point out that it

is in the statute and we recognize that. there is a safety valve and that as well that i need to point out, the right to escalate claims. we just move the 10-year backlog up to four? that won't work either. i've looked at that budget. what the statute envisions. the interesting thing is that people have chosen not to escalate. this year we had 152 requests to date which i believe indicates providers and suppliers are still finding value in the alf hearing process and choose to remain in the queue. think they should escalate their claims if they are in the 10-year backlog? >> it is an option for them. >> i yield back. >> we will take a recess because the boys have been called -- the

boats have been called. i would estimate it will take around somewhere around 30 minutes. maybe a little bit longer. we will reconvene at that time. >> 9:00 is the next vote series. here at thatll

time, that would not be a good sign. . do apologize for the delay we will go back and forth here. if you're ok with the number that's here, i'm ok if we just aren't opening up questions and getting through this. is that ok with you? we will turn clocks off and i have no particular order. if you want to be able to interrupt, you will be able to do that and follow. that changes our format but it will not change yours. we typically do a very structured five-minute timed around. it is a more open process where they can ask questions at any time. if you make a statement, they are not limited to the one that does the follow-up if that is fair. we just open it up to more conversation. they will not change with happening on your side. it just changes our process. i do have a question on the

numbers that you submitted to us on the recovery audit appeals work, percent increase in the non-recovery. i want to go through couple of these with you. on the outcome rates fully favorable, partially remanded, dismissed, and other. can you give us a quick to finish in and what that means to the provider for each of those and the process that happens? fully favorable, they have overturned, partially favorable a change in the definition, unfavorable and they lost entirely and they will appeal to the fourth level at that point. what partially favorable, remanded, dismissed, and other. >> it is the number of claims that will be submitted with each appeal. a partially favorable decision would say that some of these claims are payable and some of them are not.

that would be what that is. >> fully favorable if they have 10 cases in front of you and they win all 10, another provider could come in and bring 10 cases and win seven or two of them. so we do not know if they win seven or 10? >> exactly. >> unfavorable they lost all of them. we do have some authority to send cases back to the lower level if there is information that we need from them and that information is only available from cms and its contractors. we can do some limited reman thing. >> with part eight, that seems to be a very high percentage. do we know what happens then once they go back down to the second level? with most of those, they come back to us. this large number was related to policy issue that

was resolved through cms and rulemaking so those are coming back to us. >> help us understand the order. you said it comes back up and it goes to the fourth level and comes back to you? a very high number here. you are talking about many remanded as were found only favorable, partially favorable combined. >> in these cases, many of the judges decided to remand them. they're basically questions about whether or not claims would be paid as inpatient, part b. or outpatient under part that was the basic issue. in order to get, many judges felt they needed additional information in order to make a decision. they sent these claims back to

the lower level to get that information. result ofappened as a in these cases are actually going to be coming back to us. i think they have come back to us. they remanded and it's now coming back to you. how does that show up in the statistics here? we're trying to evaluate when a very high are remanded and dismissed. it's hard to be able to tell what's going on. >> we do not double count them. they do not recount into the receipt levels when they do come back to us. we adjudicate them within the process and then we send them on. or theyher get paid

don't. many of them will get appealed. >> i'm still trying to track this. they've gone to the first two levels of cns. they come to you. there is not the information that you need and you remand it back to cms. they get additional information and that it comes back to you again? 4, 5 different events within the first three levels. >> five handoffs. >> they come back to you again be thes would basically same percentage between the fully favorable, partially, and unfavorable again? you say it's not double counted. >> it's not a double count. >> when it comes back to you again i should expect it to be similar to this percentage? i'm trying to find out what happens when it's remanded. are they more likely to be found

favorable or unfavorable? the remanded does not predispose it to any sort of disposition when it comes back. when it comes back to us, we adjudicated as all other claims and we will have a hearing on it and make a decision. >> this is somewhere around 60%, part a, being found fully favorable. you.they are coming to i should expect if they are remanded it is about the same percentage coming back again. once they are remanded, basically if they are very, very persistent in part a at least, a pretty good chance they will be found fully favorable? percentages hold true, you can use them to say what what will happen with the remand when it comes back. >> that is approximately how long? to you the first time, that consume to three years in the process then it gets remanded and goes back to cms.

they handle it in three months and they are waiting back in line again maybe another three or four years to get back to you. is an incredible amount of time. >> it's my understanding that these cases are really already back with us. they were sent back in bulk. these are already back in the hearing queue. long that took, that would be a number i would need to get back to you on. number we're trying to track based on what we have last night on this. if it's three years to get to you to get a decision, they are back in the queue again. the may have to get fully through all five of those steps. get back to this but i believe they retained the spot in the hearing queue when they are remanded. >> then they are right back to

you? >> right back into the queue where they left us because they have not given up jurisdiction of the client. we have some more information but it is still with us. generally it would come back to the same judge when it was remanded. an aberration. it was a very high number. we are not seeing that in subsequent years. we did not see that in previous years. ofyou feel that is because what is inpatient and outpatient? this deal with the two midnight rule and all of that? what a fun role. the hospitals love it. to see whatiting impact it will have at our level. we have not seen the impact yet. >> i've yet to find a fan of

that rule anywhere and it seems a rule they raise consistently saying it affects their decision-making. it was in your decision and i would expect there to be quite a bit numbing at you because there's a tremendous amount of frustration around that particular rule. something we are watching and need to watch. we need to continue to see what the appeal rates are in this inpatient-outpatient arena. able to sharee this time as well. dismissed and other. for one are cases where reason or another, usually it is has notthe appellant properly filed the request for hearing or perhaps they have abandoned the request for hearing in the process by not showing up or that sort of day and so the cases are dismissed at our level. that's the final disposition of those unless they appealed the

dismissal to the medicare appeals council. >> it's unfavorable based on they did not show up, file, or complete the process? the previous decision would still stand that is unfavorable. >> the quick decision becomes the final decision. >> what is the other? -- ok.ll actually escalations to the medicare appeals council. we have about 152 of those. occasionally, we have expedited access to judicial review but those are rare. >> thank you. i am still flummoxed by this remanded number. i just added up fully favorable, partially favorable, unfavorable and i came up with the number

21,846 which is nine from 21,855. number, are they fyting back in the light in 13 or fy 14? >> i believe they came back in fy 13 or early fiscal year 14 right about the time cms administrator issued her ruling is on this. close,e the number is so maybe that is just part of the aberration. it would mean virtually every one of these cases was remanded because there was inadequate information. not a cumulative number. i understand that they are close to the same amount, but the remand is exclusive of the fully

favorable, partially favorable. it's a separate category. >> it's a separate category which would mean we are not -- we are talking about close to 50,000 just in part a a few take all of these numbers and add them together, give or take. >> yes. >> ok. let me ask you this. alj does not have medical training, correct? they dogeneral rule, not. i don't know whether there are any who have dual certification, medical and legal, but they are attorneys who have been selected off of the register. >> because they do not have medical training, they're trying to determine whether or not a procedure was appropriate or not, correct? >> medically reasonable and necessary, yes. >> is the system flawed at the outset? >> we have some extensive

training for them that is conducted. when they come on board, we do a training session for them that but over much of this, lawyers are involved in medical-legal issues in many areas. >> they are typically advocating for one side or another and not judging. whether something is appropriate medical procedure or not. it is more a philosophical question. for ae engaged in this long time and i just find it somewhat odd that in the end there are attorneys like you and me who have been trained a certain way but do not know whether this was an appropriate urology procedure or not. essence, what they are doing is making a judicial decision based on the evidence

presented to them. in our setting, that includes the written record, the documentary evidence, and generally during the course of the hearing, also some explanations of medical either a provider or supplier of the services. that is kind of the way the system is set up for us to be able to rely on the opinions. essentially it is the same thing i've been saying. we look at the record to determine whether it has been met. i think we are all troubled by the fact that 54% for the record that we have heard of the appeals in part a are sustained. you said earlier that the figure

for the first hard of this year is less than half that, fully favorable, but fully and partially to me need to be logged together. what is the figure for 2014 for fully and partially favorable? >> i don't have a percentage. >> could you get that? >> i certainly can. >> here's the dilemma i see. 54% of appeals are sustained. in the medical profession, if you have a better than 50-50 chance of being sustained, you will appeal. your volume is going to continue to increase as more and more providers recognize that this is a pretty good odds. when you have alj looking at a set of circumstances who is not a physician who is trained, from as someone who is

not in the profession, it could be a close call. the procedure has been performed. it's not like there has not been a service that has been actually provided in most of the circumstances so you will err in favor of single sustained the appeal. point, i wonder whether we have diminishing returns here. of a provocative, rhetorical question at this point. but i do think the construct should probably urge us to think about whether it is the way we should be doing these appeals. i would like to clarify one thing here. the percentages you are looking at are on the recovery audit appeals. thoseversal rates on

appeals have been higher than the general reversal rates for the agency. if that includes all appeals. again, the numbers i have are fully favorable decisions, it was just 19.3%. numbers -- i'm sorry, that was fully favorable otr. i keep getting to that number. i will get you a number on the reversal. when cms is actually present at these hearings, these decisions are not sustained. the cms representative is oftentimes not present. to me, again, we have a system that is not operating properly because we want fairness across the entire spectrum. one provider shows up, has their , a cms person shows up

and it is not sustained but another provider shows up, same circumstances, but the cms person is not there and it is sustained, we are not providing equal protection under the law. what we has found, and there is very limited data on this, it does come from cms, but when there is cms participation at the hearing, the reversal rate does go down. >> by how much? it was 6% almost over a few months of data that we had. i will get you the exact numbers but from about 46% down to about the percent. -- about 40%. ,s far as the reversal rates go i have that number now, which is on the dispositions. is overall favorable rate

35.2%. we had been doing a number of things which had been designed to bring our policy interpretations in line across all levels and develop some consistency and adjudication. part of that is training. had approximately 20 training sessions delivered by cms, their doctors, their policy experts. to the administrative law judges since 2010. what you will see if you look at the historical data is the reversal rates have actually been going down. were at a high in 2010, 50 5.5% fully favorable and that is now down to 35.2%. to 35.2%.

>> do you think there is a better quality of decision? the case is coming up to you. they either make better decisions at a lower level where there is something that has happened at the alj with better training and you're making better decisions earlier in finding people fully favorable more often than what would be consistent with policy. >> or joint training leading to better consistency among different adjudication levels. say in herns if you training has fixed that, it was an issue at some point that we were doing too many fully favorable and partially favorable. >> i don't think i would go so far as to say it has fixed it, but i do believe it has improved it. out,e congresswoman points the goal is to have the case

legalf it is a validly claim to have it paid as early in this process as possible to keep them from leaving that level. just want to touch on this. is the training coming from you back down to cms? expo -- expecting that as a direct audit? i'm going to use an example in the orthotics industry were after an artificial limb is made and delivered to the patient, the claim is being denied by audits because the actual words, patient is an amputee does not appear the physician notes but patient requires artificial limb or prosthesis appears in the medicare history includes payment for the surgeon to conduct a limb amputation. and so, many of you denials could be eliminated in these are

getting reversed at alj. is there feedback going back down to the cms saying just because the exact word does not appear in the surgeon's notes that the patient is an amputee does not mean that you deny these because if you look, it says the physician is saying they need a prosthetic and we paid them to amputate a lamb. are you, cms, looking at different records? >> no. general rule, we review the same records. there are some exceptions to that. there is a cause exception allows additional evidence to be given at the alj level but we are supposed to be deciding at the same record. what changes is that we do have a hearing. at our level, we are able to question their providers,

receive some explanation and then make a decision that becomes part of the evidence in front of us. my understanding is the auditors are not allowed to consider the notes but those notes are considered part of the physicians record and they show up on the physicians record. the person who makes the notes, theyeg, his are not allowed to look at his notes, only the physician notes. but when you look at the physician notes you look at the thosety which includes notes. is there feedback coming from you to cms to allow the auditors and the lower level to say you at the prosthesis notes because you are pushing these people into the system and its ridiculous when it's something as simple as "patient is amputee" is missing from a record. we do have regular meetings

with cms and with their appeals group within cms. i think does happen on a weekly basis? , we we identify a trend would bring that up at those meetings or if it was a significant trend, i bring it up with marilyn. specificsware of the that you are describing. these who havein gone out of business waiting to be reimbursed and have gotten out of business. it's more than one. i'm sure we could get you a lot of those examples. >> as we become aware of them, that's part of the issue. our judges are individual adjudicators. we have to become aware that there is a trend. when we do, we have those

feedback loops in place. we are able to do that. you spot a trend? do you have a system in place to analyze them? reiterate whatto the gentlewoman from illinois was talking about. she's exactly right. this is not just unique to her group that has told her. we've got physicians who literally go through step one and step two who have complete records and it has to go to you before you look and say it's a complete record and they've waited how many months or years to find it? it is crazy stuff. got examples and after this last hearing, we started hearing from all over the country claims that were denied because the date instead of being at the top was at the bottom.

signed hisician had name in this spot. i know we cannot fix stupid, but it seems like that's what we've got to do here. would doble person this. you talk about trends. i don't know how you define trends because you have adjudicators adjudicating across the omaha system. what one adjudicator is seeing as a trend in his or her jurisdiction does not work. i appreciate the gentlewoman yielding and i yield back. i just have one final thing. go to meet with the newly confirmed secretary burwell, i was hoping that you would consider having a conversation with her about granting the same

kind of relief from audits that were being granted the hospitals under part a to part b providers like those. if we're going to granted to those under part a, i think we need to consider granting it under part b especially since there is a halt to the hearings at this point. thank you, mr. chairman. >> i will certainly convey that. >> did you want to jump in? >> at the risk of quite frankly piling on in the last couple of comments and statements, i have the same concern. you have introduced new initiative see your productivity is better but now we are minimizing, my information says, the average hearing is now at two hours. we have not talked about the complexities. we've talked about the easy stuff. i'm not sure this gets addressed.

given that we now have an incredible backlog and we are struggling with this, it is time to do more than just figure out the steps and how we are cross communicating, with the training looks like. we have to maybe do something upfront. nobody on this committee and i daresay no one in congress is willing to tolerate waste, fraud, and abuse. we want everyone on the system to do everything you can not just to minimize it but eradicated. these are clearly administrative issues. i expect providers to be as administratively competent as they can, i cannot with consistency -- and i'm a lawyer medicare form.e the form was updated this year and i have 200,000 forms from last year and instead of

throwing those away, no one pays attention to that. the fact that we are doing this under waste, fraud, and abuse context, and i think that's important, we are closing these businesses who are not going to be paid and there are a lot of small providers. i know you have heard all of this and i agree with my fairness., i want just because you are a big provider, i don't think a big hospital system should have to wait and be penalized in this fashion. what critical in a ruling state like mine, that means an entire community and a place wherein one of my district, in torrance county, there are no providers, no durable medical equipment providers, no small oncology providers. there is zero access. we don't even have the right tools or strategies to re-create these practices.

i'm really interested as a result of understanding now the situations between how they are adjudicated, what your initiatives are, how you are trying to manage these cases. weeklyciate the meetings, but i would encourage you to go back to the secretary and be a really clear with at least some of these comments. it seems to be there all the same. we've got a problem on the front end. we want updates about what you are doing on the back and -- back end. because people feel like it is cumbersome, they feel like they can win on an appeal even though there might be a material problem. have half a million cases coming to you on appeal, they are administrative issues that do not come anywhere close to fraud, waste, and abuse.

we need to deal with that issue sooner rather than later. i expect my expectation is you will take this urgency back. with all of the work we've done to maximize access, this effort is minimizing it to the highest degree. it has a chilling effect on our patient population. >> i will certainly take that back. that is is a positive coming out of this situation, i think it is that the department is viewing this workload more holistic lay. although there are three separate agencies, cms, omaha, and the appeals council that work with these workloads, the department is taking an active role in trying to resolve things . i will take your concerns back. i certainly share them.

i would also say that i'm very pleased when i came here to omha be part of an agency that had, for the most hard, met the 90-day time frames. as an administrator myself, i find the delays very troubling and unacceptable. here abasically have workload and capacity problem. >> can may get to that for a moment? we can sit here and complain for hours and nothing is going to change. of 17 new alj's, talk about the simple mouth that my good friend mr. meadows had referenced -- the simple math. be,000 appeals that will backlogged by the end of this year dividing that by 1220 working at optimal levels --and i don't know if you could do

anymore than that and i don't know if we would want to so getting less than two hours to every case is probably unfair and sub-shot. that would mean we would need 410 new alj's to get rid of the backlog in one year. you have asekd 17 or have been given 17. we basically saying to all of the providers that there to suck my language. that's basically what we are saying to them. to deal withlling in the reality that we are putting blinders on, add a few more, cross our fingers, and hope that with a few newer forms you put in place that it will work but it will not reduce it to the extent to which will not be back here next year with the same discussion. how would you comment that?

>> there are several things. i'm sorry to interrupt. can you clear microphone a little closer to you? >> there are several funding issues here. in my mind, one of the primary wants us to do with the recovery audit program and legislation. i think when congress passed the legislation of the program it was envisioned that it would be self funding out of recoveries that the legislation actually that the administrative cost of cms will be covered. the does not include administrative cost of omha or the appeals board. what we have basically had in that regard is a workload that came in on us that was basically unfunded.

i think that's part of the problem. it's part of the problem that i think does have a solution. day, thatqueen for a would be one of the simple fixes that i think would be possible. meaning what? >> to be able to properly fund sisternd a plug for my agency, the department of appeals board so those that come to the last two levels are asded out of the program they are at the lower two levels. that isere enough money to pay for all of the levels of appeals? >> yes, i think that there is.

this is based on cms reports coming back from that program. think, ofe part, i the solution. there are some other things as well. we are doing these id. pilots one involving alternative .djudication models if that pilot is successful, i think we need to look at some things like that as well. >> is that being piloted in a geographic location? >> at the office of medicare hearings and appeals. there is no geographic location. it's being done with part d claims right now. where we certain time are offering these facilitated settlement conferences. >> give us an example of what that means in real life terms.

websites put on our june 30. it's a very new program and we are waiting to see how appellants respond to it. the theory is that an appellant will be able to come in and ask for a settlement conference with .n attorney who is at omha cms would provide some on the settlement authority able to discuss merits of the claimant possibly resolve them short of having to stay in the queue to go to hearings. while that is going on, they do not lose their place in the hearing queue. allowhopeful this would us to resolve some of the pending claims. this is a two-part problem. there are also the receipts coming in. this piece of the solution is designed to deal with the pending cases that are already with us. >> is it your assumption that

this will come to the signature in the wrong spot walking in and say it's not at the top but the bottom. is your assumption it will be the kind of stuff coming out you? are the settlements for a lesser paidt fully paid or fully so a faster process to full payment? depends.k it like most settlement conferences, it's probably going to be a little bit of give and take. that would be my anticipation, but if it is something in the course of what is really a prehearing conference with an attorney, point out a simple technical error or something like that in the claims, it is potentially possible that they could be fully paid. we have to wait and see how that would work. >> the alternative resolution

would be valuable to providers in particular if it was a decision that was going to be made swiftly. that becomes the appeal. no pun intended. >> we're trying to find ways of solving the claims within our pending workload more quickly .han we can get them to an alj we're trying to do that given our current authority. right now the statutory scheme is structured, and appeal cannot get out of step three. cannot believe omha -- it cannot without action by ana alj. the agreement then becomes the resolution of the claim. chartthat listed in the that you gave us as dismissal? fully favorable, favorable? be a would probably

dismissal but right now we are tracking them separately as a settlement resolution. the other alternative is this global settlement discussion concept which claimants with very similar kinds of cases would all be invited to come in and participate in a global settlement but they could choose not to. is that correct? >> it's an initiative that is one of cms's. my knowledge on this is limited. that it understanding would be a global settlement. >> that would happen before it would even get to you. >> it also contemplates >> we haven't seen it operational you? >> no, we have not.

it's an initiative. >> i know you're committed getting back and forth with cms and cms is part of the issue. i get that. that's not you. but you have these regular conversations. what we are getting to an attorney, help them try to do a type of pre-settlement, that's something that they would have rather had with cms, face-to-face with someone there, resolve this or to get on the phone and everybody looks at the same document and tries to resolve this. it's a simple, straightforward cases. they just want this resolved. if they are a physical therapist that is shy to take care of its practice as will trying to do all the paperwork, he does not need one more thing to do. to try to chase all this stuff down. to be able to leave and to do hearing and be in the process to hire outside counsel as well beyond what they want to build to do. they just want resolution of simple things. how could a process work in a cms so it never gets to you?