they work together with cms and cms approves the type of issues that racs are going to investigate. >> they make the request of a certain type of client that is there. they are not just pulling one patient, are they, from that type? in april 10, the maple 20. how many? >> i believe became -- the claims are investigate on an individual basis. >> the provider when they get notification. >> yes. they will get notification of a claim, investigation of a claim. [inaudible] >> i'm sorry, correction. that could be more than one but there is a limit on the number. >> what is that limit? does anybody else know the number on that? how many other trying to put one time for rac audit? >> take a bit of a step back because i agree there are numerous contractors that can audit a single provided at each contractors, they are set instead you are supposed to do the job they're doing. assert contractors on these differ from the rocket contractor. the cert contractors for kids to go in there and determine the improper payment rate. it's not privately look at the provider. it has to do the medical record

we do regular meetings with cms and their appeals group within cms. i think those happen on a weekly basis? weekly basis. when we identify a trend, we would bring that up at those meetings or if it was significant trends, i would bring it up with marilyn tavenner. i'm not aware of the specific instance that you are describing. >> all, it's more than one. we have a 100 processes who have gone out of business in this country waiting to be reimbursed and i've gone out of business. so it's more than one. i am sure that we can get you a lot of those examples. >> if we become aware of them i think that's part of, part of the issue. our judges are individual adjudicators and so we have to become aware that there is a trend. when we do, we have those feedback loop is in place and we are able to do that. >> how do you spot a trend quick view of a system in place to forget to find of those trends? i see mr. meadows, my colleague of -- >> i just want to reiterate what the gentlewoman from illinois was talking about. she is exactly right and this is not just uniq

it goes back to cms. handle it in three months, whatever it maybe and then they are waiting back in line again and that may be another three or four years to get to you? a remand is an incredible amount of time. >> it's my understanding that these cases are really already back with us, that they were sent back in bulk and so these are already back in cuba. -- in thank you. but as far as how long that is, that's a number of up to get back with you on. >> that's what we're trying to figure. a remand is the new number were trying to track based on what we got last night on the. i'm trying to get if it is three years to get a decision to get remand, goes back and back in the queue again so now we are up to six years minimum to get fully through all five of those steps. >> i believe, i will check on this for you and clarify it but i believe that they retain their spot in the queue windier remanded. >> so once cms makes a decision they're right back to you again quickly. >> and right back into the key e where t

the first two levels are conducted at cms. they are administered by cms, and cms' contractors. they, the third level is at the office of medicare hearings and appeals and is conducted by administrative law judges. the fourth level is at the medicare appeals council which is part of the departmental appeals board. and it's also a separate agency within health and human services. and the final level is with the federal district courts. >> gotcha. can you describe the different types of appeals heard by the aljs? >> yes. we hear both part a and part b appeals under medicare, and we also hear the part d appeals. this was part of our original charge, the prescription drug appeals. we hear irma appeals, we hear appeals on entitlements. we also hear the part c medicare advantage appeals. >> in percentages of those, what do you hear more often, most often in those appeals for aljs? >> well, it does, it varies. in recent years we have heard a significant number of appeals under part a. which are the acute care hospital, the acute hospital appeals. >> and does that happen, would you say,

>> we have regular meetings with cms and their appeals grade within cms. i think those happen on a weekly basis, a weekly basis. when we identify a trend, we would bring that up at those meetings or if it was a significant trend i would bring it up. i'm not aware of the specific instance that you are describing. >> it's more than one. we have 100 auditors in this country who have gone out of business waiting to be reimbursed and have gone out of business. i am sure we can get you a lot of those examples. >> we have been aware of them. i think that's part of the issue. our judges are adjudicators and so we have to become aware that there is a trend and when we do we have those feedback loops in place and we are able to do that. >> how do you spot a trend? do have a system in place at the alj level to find those trends and i think it's another. >> i just want to reiterate the woman from alumni, she is exactly right. this is not just unique to her particular group. we have physicians who literally go through step one and step two that have complete records an

>> within cms. these were largely -- >> when you say did not have the authority, did you mean they had not discussed with mr. cohen or miss tavener? >> well the only person within cms has that the authority to change the can are the in a manner that increases the government's obligations is the contracting officer. >> who was? >> i'm sorry? >> and who was that? >> i don't have the name right at my fingertips. >> what i'm wondering here is, do you know if -- so the problems with the website, it took longer to develop it, the security was under question, people had problems signing up, and with inconsistent or absent oversight so i'm wondering in some cases you're saying there was actions taken without authorization, several dozen of these i believe that's documented. so people were making change orders and that was leading to some problems, but there was also absent oversight, so some people in charge were not meeting, were not paying attention, were not monitoring this contract, or they were monitor

the first two levels are conducted at cms. they are administered by cms and cms's contractors. the third level is at the office of medicare hearings and appeals and is conducted by administrative law judges. the fourth level is that the medicare appeals council, which is part of the departmental appeals board and is also a separate agency within health and human services. the final level is with the federal district court. >> can you describe the different types of appeals held by the alj? >> yes, we hear both part a and part be appeals under medicare and we also hear the part he appeals as part of our original charge. the prescription drug appeals. we hear appeals on entitlement. we also hear the part b medicare advantage appeals. >> in percentage of those, which you hear most often those appeals for aljs? >> well come in various. in recent years a pretty significant number of appeals in part a, which is the acute care hospital appeals. >> and those that have been -- would you say 30, 40, 50% of the time with the alj workload? >> i can get you that number. hold on just one min

>> within cms. these were largely. >> when you say did not have the authority, do you mean they did not discuss these with mr. cohen or ms. tavner? >> the only person within cms that has authority to change the contract in a manner that increases the government's obligation is the contracting officer. >> who was that? >> the contracting -- >> sorry? >> who was that? >> i don't have the name right at my fingertips. >> what i'm wondering here is do you know if -- what the problems of the website, it took longer to develop it. security wasn't a question. people had problems signing up. and with inconsistent or absent oversight so in some cases you're saying there were actions taken without authorization. several dozen of these? >> right. >> so people were making change orders an that was leaving problems? but there was also absent oversight so some people in charge were not meeting or pay attention or monitoring this monitoring this contract or monitoring some things and making the wrong decisions? was

for cms. but if i understood your estimating as well, you indicated that the previous employer is managing the website as a systems integrator is that correct? >> that's correct. >> said in the question as an oversight committee is how our you able to manage your former r employee are anemployer and doee a conflict of interest? >> thank you for the question. >> that there is as you know a pledge that i signed, and along with that disposed of all of my stock basically that i had in the company. >> you disposed of all of your stock? you said basically. >> all of, yes i'm not trying to qualify that. >> i didn't think you were but i want to make sure on the record -- >> got rid of my stock as appropriate. i signed that as appropriate commands it was appropriate. so now as a public servant, i have a very clear set of rules to follow. i have this ethics pledge and within that pledge, i have a limited waiver that allows me to purpose of health reform implementation only on the website to be able to i

the first two levels are conducted at cms. they are administered by cms and cms's contractors. the third level is at the office of medicare hearings and appeals and

were there any new issued contracts based on the frustration that cms had? >> the cgi contract had been extended earlier until february of 2014. >> and that was before october 1st? >> i believe that was before. >> it was already extended before october 1 as soon as. >> that's correct. >> okay, so then to that point, were there any other, again, getting back to this, were there any other contractors that were selected knowing cgi was not doing necessarily what was necessary for the repair of the website? >> the only contract that i'm aware of is the new one to accenture to continue with development of the federally facilitated marketplace. >> and can you refresh my memory on when that actually took place, when the new contract went forward? >> that was january of 2014. >> that was january, okay. okay. well, mr. speaker or excuse me, sorry, mr. chairman, i have gone over on my time and i apologize. thank you, thank you mr. woods. >> thank you. now going to recognize the gentleman from virginia, mr. griffith, for five minutes. >> thank you so much for being her

you're new to cms. you'll have primary responsibility for the website, so i hope you can tell us what you plan to do in 2015. >> we'll recommend dr. burgess for five minutes. >> thank you to the chair and thank you, mr. slavitt, for joining us again. our subcommittee throughout development and the rollout of healthcare.gov, this subcommittee had repeated assurances that the systems were and would be ready to go and that implementation was on track. we had a hearing in september lifrl literally days before the launch of healthcare.gov. we had repeated assurances from the director of consumer information oversight, mr. gary cohen. he said unambiguously that on october 1st, americans would be able to go on line, would be able to see premium net of subsidy and would be able to sign up. we all know now that those assertions were fact challenged. the center for medicare and medicaid services undertook this mammoth project without effectively planning for its development or its oversight. this has led to hundr

all of the contractors across the cms have data that shows that and in fact cms did a study with one of the contractors where the attendance of cms at the hearing makes a difference in the outcome of those hearings. where the medicare rules and regulations and the medical record compared to the claim is reviewed. so, i think it's an area that we can be looked at. but i think that is part of the difficulty, if you look at the last study. the 7% overturn across the board is the last data that we have. >> could those who are providers weigh in on this from your perspective at well, the cases that get to the alj level? >> thank you for the question. we have little data on the alj level 3 appeals at this time. the majority of our appeals are turned over in level 1 or level 2. i will just comment that i think the 2010 data is, i think, the rac process, and observation care has evolved enormously in the last four years that i think it's worth looking at a new set of numbers and data. we know that the rac recovery rate for back to the government has increased, we know the number of rac audit

you now work for cms. and from what i understand cms. you're very talented individuale and that's a good thing for cms. but if i understood your testimony as well, you indicatel that your previous employer is managing the website as the systems integrator, is that correct?e >> that's correct. >> okay. so then the natural question as an oversight committee is how o are you able to manage your former employer and doesn't thiy create a conflict of interest? >> sure.create a yeah. thank you for the question. so congressman there is, as you know, an ethics pledge i signed and along with that disposed of all of my stock basically that i had in the company, t i completely -- >> you disposed of all of your stock? you said basically. >> all of, yes.>> a >> okay. >> yes, i'm not trying to qualify that. i'm >> i didn't think you were. but i wanted to make sure on the record you said you got rid of all of your stock -- >> got rid of all my stock and e any other ties as appropriate. i have signed -- not as as appropriate, as is appropriate, so now as

this is in addition to the usual cms appeals process. though the program has proven to be cost effective, recent restraints have caused a decrease. first, as part of the implementation of the two-night rule implementation for 18 months. second, the program would be suspended until new projects are in place. these two changes will result in over $5 billion of improper payments not being restored to the medicare trust fund. now, let me provide you some facts about the program. this means recovery auditors are incentivized to work accurately and precisely. second, according to the most recent cms report to congress, 7% of all determinations have been overturned on appeal. third, recovery auditors are accurate. giving recovery auditors a couple la sill accuracy score of over 85%. finally, recovery auditors target improperly-paid claims of all types. yet, medicare data have noted consistent high-care dollars for in-patient stays. it is imperative for the lo longevity of the trust fund that it stays. expressed by the hospital communities surro

you're new to cms. you'll have primary responsibility for the website, so i hope you can tell us what you plan to do in 2015. >> we'll recommend dr. burgess for five minutes. >> thank you to the chair and thank you, mr. slavitt, for joining us again. our subcommittee throughout development and the rollout of healthcare.gov, this subcommittee had repeated assurances that the systems were and would be ready to go and that implementation was on track. we had a hearing in september lifrlly literally days before the launch of healthcare.gov. we had repeated assurances from the director of consumer information oversight, mr. gary cohen. he said unambiguously that on october 1st americans would be able to go on line, would be able to see premium net of subsidy and would be able to sign up. we all know now that those assertions were fact challenged. the center for medicare and medicaid services undertook this mammoth project without effectively planning for its development or its oversight. this has led to hund

cms blames the companies and organizations that submitted the data. dr.esident of the american medical association. >> we're very committed to transparency. we've supported the sunshine act, but we're also committed to accuracy. # >> reporter: the ama and more than 100 other associations want cms to delay the september 30th rollout for six months. do you not believe this database is ready for primetime? >> i don't. i really don't. i don't want my patients having the wrong impression because of inaccurate data that may be released on a database from the government. >> i think the database should go public right now. >> reporter: lina wen, an er doctor at george washington university who says she takes no payments from drug companies calls any delay in publishing the information unacceptable. >> i have a lack of faith in doctors who do not want to be transparent with their patients. doctors need to become accountable to the people we serve. >> reporter: cms declined to go on camera but said in an e-mail quote, data accuracy is critical to the success of thi

there is not a person at cms that explain how the medicaid works for a 500 billion-dollar program. some southern governors don't want do cover because conservatives don't want to spend money. democrats say you have to expand the medicaid program in every state because it is free. it is no the free. this is our country and our should make the right decision. n the medicaid program functionally the most screwed up program by a long shot. looks like va like all-stars. we should have a serious debit about medicaid. once you have a well-run medicaid program i am all for it. that is a what the president out to have in mind. anybody that h understands the program at waa would cover their eyes, you're right the problem isam a total disaster structuray >> host: gretchen, napierville, nil know. republican caller. >> caller: i was interested in finding out more about a push, i think it was dick armey and somebody else from congress they were looking into opting out of medicare and it, at some point was linked with social security if you opt out you don't get your social security. there is not

as i mentioned the contract that cms issued as well.h resources administration provided funding for the fqhc's provided about 44% of the total federal fund g funding. importantly this only represents federal funding to support the programs. we know there was a great deal of funding through private foundations and other private organizations as well as funding that was repurposed from organization's own budget to support the assister programs. i think we will discuss future funding for the assister programs. there funding foa has been announced for the navigator program at $60 million this year and that represents $7 million less than was available last year. cms hasn't made a decision on whether it will extend its contract with the federal enrollment assistance and the two entities that participated in that. states can continue to fund with 1311 this year but next year they will have to identify other sources of funding for their programs. and hersa will continue funding hqrc's at the same level next year. we could not document the role

times struggled to explain their actions and david there sce acowed that he is a convicted sex offender cm agast young girls tat he says both s.>ar of apps ask cor.an have access to people say those shedding 5% of th weight have better blood pressure and physical health factors but more likely to be depressed. experts areot sure why but may loss upteels alistic ioa o g toeceasvoluner colgentst diffel al.ection from hip-hop to heavy thhbikend aret quhr he tebbs. .softtu tnghepind weed hhiou nead la.bahu tlokamcwthed nd somikeer ze a -nde es r, r ar ,ing- sm begin with that line because they were huge fans of "the wizard tenttoefu she was. and she was buried in a white dress, and red ruby slippers. >> a woman with a sense of humor, you love that. >>> and a check of the roads right now. >> and matt pellman in the traffic center with an update. >> we wish we could click our heels this afternoon and get out of this mesuc icownhebe overturk thng se north tradowy are them come up here to 95. still a parking lot near business 1 northbound tothi point at 95. southbound, you also have a big old jam

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it took us a decade to get that approved and it's finally approved through cms. it took a $200 million study and 50,000 patits and smokers have the ct scan and show that t ct scan is a 25% more preventable death over justuitting a lobe and that proved 50,000 patients in nine months. >> you mentioned bonnie now, for folks that don't know bonnie, she's from the cancer foundation. you walked into my clinic and you fixed r. >> stage three lung cancer. >> she had 3b in a trekkie spot. she's a fighter and we're a can-do team and we built a program and she was in the thoracic oology program and she realized she could do more on herown and started foundation that i helped her start and the rest has been history and she's been trying to change the perpective on lung cancer and drive awarene and build novel clinical trials and novel approaches because, you know, it's never a good time, obviously, to have cancer but it's alst a good time because we're on the cusp of what i think areramatic changes. >> in just a moment, we do is to take a break in just a hey can you fix this

a new cm can apply to be a smithsonian affiliates and that allows them to borrow items to an exchange of staff sometimes. it's an interesting -- it is a good program that gives the smithsonian into the rest of the nation, which is the reason for the program. [inaudible] >> on occasion, yeah. yes, on occasion. there are some i can't think of right now, but we got something great recently from one of them. if you go online the first smithsonian individuals you can see all types. >> okay, thank you. >> thank you. [applause] >> okay, don't hold up the chairs because we have another event to 6:00. but if you line up to my left, tim grove will stand up here and sign copies of his book. thanks for coming. [inaudible conversations] >> author suki kim, where are you from? >> i'm from south korea. originally i was born a race they are and i came to america when i was 13. >> host: why did you come to the state? >> guest: do now, as all immigrants do, there's a lot of turbulence and i ended up in queens originally come in new york a word of english. >> what do you do for their day-to-day? >> iamb

host: tom scully was the cms administrator for 12 years. he's talking to us from new york this morning. on the issue of medicare, the national committee to preserve social security and medicare has put together the top ten reasons americans love medicare and number seven, medicare is efficient. only 1 percent of traditional medicare spending is overhead chaired to 9 percent for private insurance. do you want to weigh in on that? guest: that's completely and totally wrong. you know, i'm trying to be objective. medicare is a wonderful program. it's incredibly efficient. basically it's a single-payer system where the government pays every hospital in toledo and every doctor the same thing. so when you fix problems, there's value. they pay every doctor $50 for a hospital business and every hospital $5,000. so what's happened over the years is the government is basically -- administrative dollars, they spend one percent of writing checks. so doctors and hospitals just compete on value. and what's happened in every other system in the world where

somehow goes up that the american people don't understand, that they all see you part of hhs or part of cms. and yet you have a

the thing with the colon cancer, there's a cms thing, and i think it's 590 is what it costs, and cms2, $502, so everybody could do that. if you know you're not going to get a colonoscopy, why not do this for $500? >> totally great. there's innovations that save the system money. i remember when we first on "mad money" said exact science has to go through. it was rejected. we had the ceo -- i mean, how can you reject this? people don't like the colonoscopy so they don't get it. now there's no choice, here's the optionsment i think it's something that saves the system instantly. you wish washington would recognize this is something that came along so fewer people have colon cancer. fantastic invention. >> before stage 1, markers for po pollyps. you can't guarantee the kbie doing the colonoscopy would find them. you could do both. >> i know. this is great. you have guys on, just, oh, yeah -- no. these are the guys who save the system money and save lives. fantastic stuff. >> you have a colonoscopy, right? >> yes. >> just one. >> would rather have this thing. >> me too. >> loutly. >> tha

been available within a correctional health setting because they have not been subject to any of the cms standards or quality review or anything else that's required. so, frankly, when you've seen one jurisdiction, you've seen one jurisdiction. >> and i do want to quickly. >> we do have -- i was thinking more of contractual and we do have measures in place that our vendor partner would look at frequently and there are incentives to make sure they're running smoothly as far as contractual. >> very good. thank you. >> yes, go right ahead. >> thank you for having us today. specifically, dr. lewis. lots of strategies, i'm curious about once you're outside of the wire, i totally agree, trying to do the best you can inside makes a lot of sense and that structure, never missing an appointment, that's real. once you're outside, unless you have a really strong community intervention and we're able to coordinate that care from inside to outside that wire. how do we encourage those strategies? what do we do other than create a link with the medical record and things like that to ensure that those f

coming up next, the irs hit with an unfavorable ruling as congress reveals proof that the cms directore-mails during the botched obamacare rollout and all that is coming up and so much more next ♪ ♪ ♪ ♪ create a better website at squarespace.com start your free trial today. ashely: coming up here in just a moment. a pending war between ukraine and russia. former georgian president mikheil saakashvili will be here to discuss the outlook for the ukraine. and the "a-team" tells us why president obama is heading back to the white house for a one-day mid-vacation. why is he doing that? he is going to sneak a cigarette in the rose garden. that is what i think. here in the u.s., more than 8000 voters recovering from tropical storm is affecting the primary. a 1600 vote lead in the race is hinging on two precincts that were unable to vote due to power outages and block roads. 6:00 p.m. local time, that's midnight here on the east coast. whoever wins is widely expected to post to victory in november. and a shocking new e-mail raising concerns that the obama administration may be trying to hide i

nowlpçó tens of thousands fleeing religious persecution by isis are trapped on a mountain in northern çmorces in northern iraq are also delivering aidi] by helicopter to the frightened refugees who areok marooned in >>> hawaii is catching a break. hurricane julioxd isÑi weakenind moving north of the islands. pa the stat4/c still cleaning up after a tropical storm iselle made landfall yesterday. thousands of2pgople living in a rural part of the big island still don't have power. >> a , p%i(lc% aa lot of rain the wind and the rain stopped and we had axd lotf wind. trees were cracking. >> we got to clear the way. my mom is on fáoxygen. she is not doing good. and i need to ope >> today hundreds waited in a line thatñr stretched hours to t drinking water and ice from volá;qimeÑ a local police station. abc 7çóxd news meteorologist frs mclaughlin is tracking the storm,pqd she joins us with an up francis?xd >> reporter: still causing showers through parts ofq qhawa. you can seejf that right oknow. and i'll put in motion so youxd can see how it has weakened and how julio has also beençó downgrad

. >> el tratamiento empieza por 800 $, dependiendo del Área, y se pueden perder hasta 3 cm de circunferenciatwitter, facebook e instagram. estamos compartiendo fotos, anÉcdotas, testimonios, como siempre, gracia ... .. .. .. .. boroto causo el cantante enrique iglesias a su llegada a una emisora de radio en nueva york!!! algunos seguidores lo esperaban para >> algunos seguidores lo estaban esperando para tomarse una foto. Él se detuvo para saludar a todos, les contamos que estÁ ofreciendo un concierto en central park, y tendremos una entrevista con el cantante espaÑol. y serÁ abuelo el cantante mexicano pedro fernÁndez, Él lo confirmÓ en una entrevista de radio en su paÍs, y dijo que estÁ feliz con el embarazo de su hija mayor que se casÓ en marzo. felicidades a toda esa familia, nos llena de satisfacciÓn poder dar la noticia del embarazo. y se presentarÁ juan gabriel en monterrey como parte de la gira "juntos", lo acompaÑarÁn más de 40 mÚsicos, bailarines, y coristas en el escenario, ademÁs las primeras personas que comprar el boleto van a recibir el dvd ser concierto mis 40 en bellas artes

coming up next, the irs hit with an unfavorable ruling as congress reveals proof that the cms director was purposely hiding e-mails during the botched obamacare rollout and all that is coming up and so much more next i'm m-a-r-y and i have copd. i'm j-e-f-f and i have copd. i'm l-i-s-a and i have copd, but i don't want my breathing problems to get in the way of hosting my book club. that's why i asked my doctor about b-r-e-o. once-daily breo ellipta helps increase airflow from the lungs for a full 24 hours. and breo helps reduce symptom flare-ups that last several days and require oral steroids, antibiotics, or hospital stay. breo is not for asthma. breo contains a type of medicine that increases risk of death in people with asthma. it is not known if this risk is increased in copd. breo won't replace rescue inhalers for sudden copd symptoms and should not be used more than once a day. breo may increase your risk of pneumonia, thrush, osteoporosis, and some eye problems. tell your doctor if you have a heart condition or high blood pressure before taking breo. ask your doctor about b-r-

and it is with redactions and what happened with camericas say wait -- cms they wait until congress leavesto for august work period, then they provide information that we've been asking for since october of 2013. and they are saying well e-mails were deleteed, we don't know if we can get them for you, in mid st*midst of this, hhs does prove e-mail that go too of 2013, here it is with redactions they discuss the debacle of health care.com, and then tavenner saying release this email. cheryl: this is in relateed to roll out of obamacare going become wards a little bit, then you want to know what other e-mails were deleteed, she made that come, delete this ephraeul buemade but-- e-mail but see ifd work on call script, what does that mean to you? >> they call and contact people, to get them enrolled, when you read through e-mail chain, it shows they are having trouble converting those manual enrollments into the on-line enrollment and mergeing that and having circo, one of the the companies doing the verycasion, turley making -- actually making the process work and feedback into health care.co

. >> count on nbc 10 and nbc 10.cm for new information. we will pass any new information along to you. >>> we have more breaking news. police arrested a suspect in a series of robberies. they are looking for two more people as well. we showed you this video of who police were looking for. they say keith perkins turned himself in yesterday. detectives say the suspects are accused of targeting their victims after they left banks. here is a bert look at perkins. please are looking for joseph donaldson. he is the man on the right. as well as 52-year-old ronald singleton. >>> new information from the trial of a woman accused of kidnapping and sexual asaul of a philadelphia child. courtroom was cleared as a doctor told jurors about the child's injuries. christina regusters maintains she is not guilty. the doctor testified she has rarely seen rape injuries this severe. while injujurors were shaken regusters did not react. it could be consistent with an assault by a broom handle. she is the woman seen here in muslim garb taking the girl in january

is that an arc issue, is that a cdc issue a cms issue? >> so we could create measures. i'm not sure who it would be, but just as an example, i was at partners health care. we created a measure. we said these ten things need to be in a discharge summary. and, you know what? if you have nine out of ten, you get a zero. >> uh-huh. >> and we could measure it and improve it because we could measure it. so i think your point of there needs to be a measure and that could be tracked, i think medicare could certainly be part of this. we could figure out how to do it. and so i think that some body like medicare would make sense. >> one important problem here is if you look at the high-tech act, which you know well, senator, and we are providing incentives for doctors and hospitals to put in electronic health records, and by all means, it's going pretty well. >> don't get me started on this one. i'm with you all the way. >> i know this is a topic near and dear to your heart. >> nursing homes and behavioral health providers when you did that, so you're not part of the -- >> i told

>> i am a retired cm in drug policy, about 43 years ago.i don't think i have ever heard a better presentation. i will mention the name of mark ucla, would believe is one of the original proponents of hope. any comments about his contributions? >> he is a friend to all of us. absolutely. he is here with us today. we would not be here without him. he is the one who got everyone's attention. he got college are still in this field. so, three cheers for mark and his role. >> i had never heard of mark fineman when all this started. we all started looking around the country to see other people talking about this. someone said you have to rebut this guy is writing. he had a paper. it sounded kind of similar to what we were doing. i called him up and i said, that is interesting. we might have this conversation differently today. i called them up in december and said we are up to 93 people. we have 80%. he was thrilled. he had been talking about this for 20 years, but could not get anybody to pay attention. so, he talked to the national institute of

and now we have implementation programs working with cms and and a top priority right now is to make sure that every hospital in the country has an antimicrobial stewardship program to make sure antibiotics are being used correctly or excessively. so we want to get it right so patients have the right treatment. the global capacity is also very important. let's take a few more questions. >> can you hear me act oh the evening. -- can you hear me? good evening. people are coming into america and coming in from south america and places unknown. what is being done by the centers of disease to protect americans because those children are being sent to relatives throughout america. what is being done to protect the rest of these people? we can take the microphone and bring it here. it is very moving. there is a federal response run with a veryis doing complex legal and humanitarian project. they walk for 15 hours, coming in quite ill. actually, vaccination rates are very high. there is one disease, chickenpox, that is not routinely vaccinated for. when they being done come in? there are cer

and now we have implementation programs working with cms and and a top priority right now is to make sure that every hospital in the country has an antimicrobial stewardship program to make sure antibiotics are being used correctly or excessively. so we want to get it right so patients have the right treatment. the global capacity is also very important. let's take a few more questions. >> can you hear me act oh the evening. -- can you hear me? good evening. people are coming into america and coming in from south america and places unknown. what is being done by the centers of disease to protect americans because those children are being sent to relatives throughout america. what is being done to protect the rest of these people? we can take the microphone and bring it here. it is very moving. there is a federal response run with a veryis doing complex legal and humanitarian project. they walk for 15 hours, coming in quite ill. actually, vaccination rates are very high. there is one disease, chickenpox, that is not routinely vaccinated for. when they being done come in? there are cer

according to the congressional budget office cms has paid 34 programs in six major demonstrations to provide disease management or care coordination services in traditional medicare. on average the 34 programs had little to no effect on hospital admissions or medicare spending. in 2010 obamacare created accountable care organizations that allows certain providers to coordinate and integrate medicare services. these provider groups must meet specific quality standards in order to share any savings or share in any savings they achieve for the medicare program. the initiative is relatively new. there is no definitive data to prove they improve quality. if they show any promise to save medicare money or if they are simply failing. the jury is out whether they produce results, obamacare a health and human services broad authority to create and implement new medicare pilot programs. through the center for medicare and medicaid innovation, the obama administration is conducting care coordination programs in various medicare settings. my hope is my research will yield results. as we all know

so far cms has chosen there is legislative authority to make a decision for cms to decide whether or not to extend that. in the case of the aca the decision in the law was to have it last the three years. they really are ways in both programs to protect the tex payer in setting premiums. >> i would like to highlight the report on the medicare trustee board they projected the hospital trust fund would be unable to pay its bills in 2017. the new report puts it at 2030. the report goes on to explain this improvement is thanks to the part of the reforms in the affordable care act. today's report is on medicare but this shows areas are slower growth cost. over the 50 months since the health care act, health care rates for increased. there are positive stories on for the underinsured and better health care cost. would you comment on the aca and that impact on medicare? >> you hit the point accurately. and one thing we can take from that lesson that came out in the report on that lower growth rate is if that turns out to be true for the broader health care system as well. that is one of the

>> miden 15 cm, seis pulgadas de alto y unos 5 cm dos pulgadas de alto. >> me gustarÍa que se pudieraataques aÉreos de militantes islÁmicos en donde los asesores militares estadounidenses encuentran estacionados el mandatario habÍa advertido este jueves que atacarÍa a los milicianos sobre todo si ponÍan entre intereses americanos por solicitud del gobierno iraquÍ hemos iniciado operaciones para salvar a civiles. mientras estÁn avanzando están librando una batalla terrible contra los civiles especialmente tienen en la mira a minorÍas religiosas como a los grupos cristianos. muchos iraquÍes han sido desplazados. >> funcionarios gubernamentales consideran que los ataques son consistentes con la ley internacional en parte porque el gobierno. la situaciÓn en irak parece haber motivado a un pequeÑo a invadir la seguridad ni nada mÁs y nada menos que de la casa blanca el menor psicÓlogo a travÉs de una de las rejas mientras el presidente pronunciaba un discurso sobre el convulsionado paÍs de medio oriente lo que obligÓ al servicio secreto aislar al mandatario. el niÑo no fue cuestionado por

let's go to cm e-trader andrew keane there with what is going on.ndrew, what is the main focus right now? >> this market has been unbelievable. i find this is very, very challenging market to trade, seems like for the most part, every time we rallied over the course of the last week we pot sold. last thursday on the 31st, got ugly. dollar was down 100 points of the looks like headed to 18 eight at this on s&p 500 futures 1880. possibly short-term bottom could be in. we haven't had big correction over 10% in two years. i don't think this is the thing to do it. i've been very cautious. i've been net long over the last couple weeks. hurt me a little bit, not that badly. melissa: what are you expecting monday? what are you looking for? >> s&p 500 futures open sunday night at 5:00 p.m. i will be glued in to see reaction. if we close in on the highs, looks likes we'll, we'll get follow through from airlines and banks with nice reversals today. melissa: andrew, thank you so much. appreciate your time. just stumbling along, according to the new survey. one

if the administration has a system in place capable of handling consistencies, web security, or the cms will ever put in place a functioning payment system. >> i don't understand why my colleagues across the aisle continue to defend this thing. >> how much should healthcare.gov have cost? >> that's a really good question. i'm not sure i know the answer to it. >> taxpayer dollars are paying for this and the people don't like it. >> there are absolutely inefficiencies and waste. >> joining us or political panel washington examiner susan ferrechio, a.b. stoddard and john mccormick. $840 million. 150 of it was overruns just for the healthcare.gov web site. wow, we are in the wrong business. >> it's incredibly embarrassing they spent that much money and had how many years to build this thing and didn't work. clearly embarrassing. bigger problems coming out are beyond this web site. it's a political problem. if you look at the polls right now by a two to one margin people say they are hurt rather than helped by the law. i think this thing is going to continue to drag them down even though you

has described dovetails very well a large demonstration project that is beginning shortly ran through cms called medicare care choices in the first time this would allow those to have an option between curative care and hospice care, which in the past has not been permitted in all the applications are in making decisions so this is about to be rolled out shortly and dovetails well with the important work senator warner is talking about. senator casey. >> mr. chairman, thank you for the hearing i want to thank you as well for sharing your own personal story about your mom. unless you're a couple moments ago and had a meeting but a whole set of topics of foreign policy and the person the meeting when i told him were escorted back to setting up a 944 euros mother choose the equivalent of a concert pianist. she is 94 and has alzheimer's, but she can still play very well in yet other parts of her life are more complicated. so it affects so many families, senator warner and others have spoken to this over many years. i will direct my questions not to ms. dempsey and mistry and eight and i don't