>> as to meeting you are referring to, cms indicated an cms was in the best position to know, that they were confident we would be ready october 1. >> conference seems to be misplaced. i yield back. >> gentlelady from illinois, ms. duckworth, is recognized. >> thank you, mr. chairman. i strongly believe what my constituent our data with the government, the lack they should be concerned about is that the personal data is being compromised. security should be a top party for any government website. i'd like them to sort of bear with me as we go through exactly what is in place to make sure that i have a better understanding because we sort of talked about different things. ms. fryer, could you walk me through the security precautions question mentioned there were many different layers that are in place. could you explain what those three layers of protection are and what procedures and processes are used to? >> there's the operational security, the day-to-day activities. there's code software review. that's the operational marketplace security team that doesn't those activities. they also

you have a relationship with cms. you have to recognize that we can't make the case that any website is going to be secure to try to make a political argument to prove that the way we are managing health care is the right way to go. that's not the discussion. that discussion is how do we protect information. you would have to agree with that speak with i agree with that. it. i would just say i agree with that, with the idea that the process that we use, you know, to secure the data on federal information systems is a very rigorous. that's my complete argument. >> i would agree with it. when it comes to confidence i know we discussed third party people out there looking at this, and i'll be honest with you, i'm a member of congress and i have no idea whether there's a third party person out there, there obviously is, looking at this. so our charge is to get that to the american people. is the american people don't know it, and i can tell you as a political person trying to get a message across to 700,000 people, it's d

cms information security policy, insuring the cms systems comply with applicable laws and regulations and providing oversight to maintain the confidentiality, integrity and availability of all cms information and information systems. cms has a long track record of successfully securing and protecting almost 200 complex i.t. systems related not only to ffm, but also to medicare, medicaid and the children's health insurance program. in my role at cms, i lead the team that is responsible for overseeing the independent security control assessments of cms systems including the ffm. these are conducted to assess the effectiveness of the security controls that cms has implemented in the agency's information systems. independent security contractors completed a security control assessment of the ffm on december 18th with no open high findings. this security control assessment meant all industry standards was an end-to-end test and was conducted in a stable environment and allowed for testing to be completed in the allotted timement given -- time. given the positive results of the recent secur

that does work for cms. >> no. those amounts are very high. i'm talking across the government. i just don't know specifically with cms. that's why i can talk from a technical perspective on some of the -- >> is it true that your testimony you filed i think it's 1.5 million that you do have -- >> okay, that sounds good. >> if you'll take my word for it. >> yep. >> in that case, isn't it natural that we might suspect that your testimony is a result of your being paid by, directly or indirectly by cms, and here you're not going to actually testify against them if you're getting $1.5 million worth of contracts with hem. isn't that a reasonable -- >> well, chairman smith, as it relates to cms, if you look at the gao docket, i actually have a protest in with them. on the contracting side, me and cms are not merely best of friends. >> but you're still -- i know what you're, i know what you'd rather be talking about, but it still seems to me $1.5 million or more in contracts does, perhaps, influence your testimony. that's

i've got to calm down, get on cm.e been on cm for three years, so right now, i ain't seen my family in four years. when i go to sleep at 10:00, 11:00, that's when i think about my family. that's the only thing i've really got, because in the end, no friends are going to do anything for you, but your family's the ones that are going to be there. >> it will now be up to administrators to determine if roca moreno will have his visitation restored. in the meantime, officers knight and demerey will update their photos with roca moreno's tattoos and question him about his ties to the nietas. >> on the wall, on the wall. >> just going to take a few pictures. >> what do they call you, roca? >> alfredo. >> alfredo? >> we're not going to call you by your first name. >> come on now. what do the other guys call you around here? >> alfredo. >> no, no, what's your ak, your nickname? it's going to be one of them? >> one of what? >> i ask questions, you don't answer? >> no, all depends on what kind of questions you ask me. >> where a

so who's right here, jason furman or cms. >> cms.slow down, first of all, it's mostly associated with the recession. there's been a worldwide slow down all over the united states and the world. i don't think the president wants to take credit for that. that was due to a very deep recession and financial crisis. every time there's been a slowdown in an economy, there's a slow down in health spending. the other factor which they never want to mention is that health savings accounts have taken off in a big way. legislation was signed by president bush in 2003. those have gone from 1 million enrollees to 15 million today. lots of employers are pushing those on to their workers. frankly, it's the advent of health savings accounts that's more likely responsible for structural change in health spending. >> because of the added competition which brings prices down, is that fair? >> added competition and frankly the fact that consumers are spending their own money on sort of the routine care. if they have to shop around for care, which health

him i've been lucky enough to work with cms and hhs on cybersecurity configuration. out of everybody here at least at this table i probably have the most hands-on knowledge, but i can't come here and just speculate about what his actual vulnerable to the system and what is not. the truth is, once on the threats i, as we've seen in the eu can probably tell that healthcare.gov is not the one getting attacked. most cybercriminals, especially those with advanced capabilities, they go where the money is, right? they will go after the target, and median market, then go after the places that contain lots of data related to intellectual property. because it just makes sense, right? if the u.s. government spends billions on our research and development, and we don't protected, and some of the country takes that, you just saved them billions of dollars. thank you. >> thank you, mr. krush. mr. gregg. >> thank you, chairman smith, and thank you, ranking member johnson, members of the committee for having me here today. minus michael gregg, i'm going to break down my speech into

and similar, cms's own e-mails from the summer of 2013 shows officials were worried the wb site would crash on takeoff. and you told us everyone would be able to go online, learn their subsidy and enroll starting october 1st. i thank you for being here and i know the number of times you have made yourself available to testify and i appreciate. but it seems hike you are faced with knowing about the problems or you did and didn't inform congress. promises made and promises broken are disheartening. we have spent over $6 million on the website and no warning was giving that a disaster was coming. after years of saying if you like your plan, you can keep it and the president apologized. and what about the decrease the president promised in the premiums? news reports are providing narrow networks as a consequence. will americans be able to keep their doctors? and now we ask if they will be able to afford their deductib deductibles. i would like us to start fresh in 2014 and our ability to do so depends on you explaining fully and honestly about what you knew. this is about more than a webs

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also a cms granted the increase to primary-care providers 2013 / 2014. that was significant in washington. on the adult sides have got a 70% increase the you can see that we have a bad blow for medicaid but we will have to evaluate what the effect of that has spent we start to do that now and then what will happen at the 2015 also located at providers to serve populations with a primary-care providers somehow they can't take it like before to look at those to break them border accessible also delivery and the prospective to be sure we are in kgb anyone -- and kgb anyone there is no easy answer it is one of the major questions over the next couple years if not longer. >> and you were to read perry innovative say this. are there programs he would like to highlight? >> there is not a lot to add to sell this but there are pretty states that are not doing everything and the tide is important to. marianne over the bridge and cramps and transformation projects through bribery care infrastructure and the development the only thing i can't take of is there is a l

that is countered by senators and also known as cm s. they say a slow economy is to blame for this. what are republicans saying over time? >> over all health care costs are rising and i love the fact that the cm s is the same folks who couldn't bring an accounting to obama care itself and had so much trouble in implementing the program and those who are excited about the change from 2010 to 2012, would do well to remember that obama care is not fully implemented until this year, maybe. we don't know the impact or cost. we know they have shuffled 50 billion in a side account to make sure it is hunky dory by this administration's terms. but the reality is medicare is going up in costs and rising at a slower rate and none theless still rising about four percent. >> and so if the math doesn't add up, premiums go higher. you have to get the money somewhere. >> the money is coming obviously from the government and the second part. seeing the higher taxes kick in for obama carry. this is the full on shot now that is taxes that are being added and we'll not have the conversation next januar

cm s, at the federal level had a lack of proficiency and competency with websites.ied this in the federal government and ecommerce site and the result it is utter chaos and billions of wasted taxpayer dollars. >> two states, minnesota and oregon. 450 million spent on those two state exchanges. they are not working. they are described as almost comical. who will be held responsible for the state exchange. >> the only people held accountable in all of this alisyn is the american taxpayers. no one is being fired at cm s and we had the director of the exchange in oregon resign after a three month leave of absence. and one of the president's principle advisers came in to help with healthcare.gov, and with some irony, he had to take a leave and resign for his own health, because he was apparently a basket case. >> they say he was working many, many long hours. everyone hopes he is okay. but the state exchanges, there is problems in the federal website and the state exchanges, there are some success stories, new york, california, kentucky, connecticut, what you are they do

let me ask you a quick follow-up on that, because some states are proposing things that, you know, cms may look at and say, no, you can't do that. and i know you can't get in the heads of governors or legislators in states, but how do you see requests playing out if they end up not being approved, only partially approved, some things like that? what do you see happening this some of those states -- in some of those states? >> well, it's very hard to generalize on this and i, of course, don't know what cms will or won't approve. what i'm struck by is that there is a somewhat new conversation going on that is a quirk of the statute where the expansion goes up to 133, but the premium tax credits start at 100. and so if you're in a state that didn't do the medicaid expansion, you would have people between 100-133% of poverty who would be eligible for the tax credits and in the exchange. and, of course, in the exchange there are premiums, and in the exchange there is cost sharing, although there are subsidies, of course, very significant subsidies on both of those. and i think what is a har

cms may have more specific information. has been the case and will be the case throughout the history of private health insurance, it is not between the government and an individual, it is between an individual and the insurance company. >> on the numbers, over 3 million enrolled in private insurance, 6 million and medicaid, i believe, and last night you had a republican that he of utah says will expand medicaid, which i know is something you have been trying to do around the country. some governors have done it. some haven't. with some republican governors now saying they will expand medicaid, where are we on this? do you feel you're turning the corner? what is the president's approach , because as you say the state of the union not just addresses congress but addresses the nation. where are we on this? >> it's a great question, and i think we are in the middle of the process. we are in the middle of an open enrollment that extends to march 31. thee is no question that on issue of medicaid, the more states that agree to do

some states are saying cms may look to say, you cannot do that. i know you cannot get in the heads of governors, but how do you see requests playing out if they end up not being approved, only partially approved, things like that? what do you see happening in those states cap go >> it's very hard to generalize on this and i don't know what cms will or will not approve. that thereruck by is is a somewhat new conversation of then that is a quirk statute where the expansion goes taxo 133 but the premium credits start at 100. if you are in a state that did not do the expansion, you would have people between 100 are sent-133% would be eligible for the exchange-- 100%-133% eligible. there are very significant subsidies on both of those. i think what is a hard-line coup hold in the long run is to say to a state, you did not do the between 100 sent- betweeuld have access -- access133% would have do cost-sharing. but we are seeing is a little bit of wiggle around the blend between going from traditional medicaid of two sort of the poor population covered b

hhs, cms, or where? >> it is under my program. >> okay. >> and the individual in charge of that program would be who? >> the person who works for me who is responsible for that program. her name is sharon arnold. >> is that one person that would be in charge? >> well, she -- >> she reports to me. >> okay. >> so. i'm responsible but she works for me. that's her program that he's managing. >> thank you. >> with other people. with her staff. >> threne are -- and there are multiple staff that help her to run the program. >> that's true. >> would you be able to provide us a complete list of the staffers who do perform any service connected to the risk quarter program? >> yes. >> thank you. under this program, if insurers are hit with costs greater than 103% of the premium, the government will give them money, am i correct? >> that's right. and a little more complicated than, but yes. >> i have a couple of followup questions that may allow you to answer that. how will the determination be made of what the cost

this is bowling right up your alley as a former head of cms. >> i want to remind you at being at the right side side of governor working with him and a number of states on medicaid reforms while i was at cmf there are a number of of programs available today that are relatively new that build on some things that the last administration started and the aca to make it easier for states that want to develop more integrated care for system to coso. this is a huge opportunity for improving health and saving money. these are some of the most expensive patients in the u.s. health care system. and because of the way their care traditionally has been delivered through a fragmented system that including some long-term care and other funding for medicaid and medicare, some they have to get on their own. through other programs. it's been very fragmented. the people who benefit the most from steps to help them stay out of the hospital and steps to coordinate care get the least of it. the programs that are around now are starting to change that. there are some good examples in massachusetts that i

the heights are the same and the parcels along mission street that were cm, their fairly high. the parcels rezoned the muo and east soma is staying. the muo district is more permissive than the current slr district which allows office where slr does not. the c 3g zoning along market octavia with the sud controls will allow opportunity but also require that it be primarily residential. >> okay. thank you. is there any additional public comment? seeing none, public comment is closed. >> okay supervisor cohen can we forward item 5 and 6. supervisor malia cohen: there are amendments to item no. 5. supervisor scott weiner: yes, my apologies. supervisor kim had amendments to item 5. can we take those without objection. and recommendation to the board we'll do that without opposition. thank you. madam clerk. please call our final item. item no. 7. >> the clerk: item no. 7. competitive selection process landfill disposal. supervisor scott weiner: thank you, avalos is the lead on that. >> good evening, poll ok. it's best to turn this over the deputy of the city attorney. there are two s

i would refer you to cms for the contract.f they have more information to provide, they will. >> but cms, the center for medicare and medicaid was equally vague, issuing a statement saying we're working with our contract partners to make a mutually agreed upon transition to insure that healthcare.gov continues to operate smoothly for consumers. >> this is more political than anything else. they know they have to look like they're doing something to make the exchanges better. >> they say, oh, everything is fixed, but really it's not because we have to hire someone else, a new independent contractor to service this and get it working the way we thought it was going to. >> all this comes on the same day the house passed a bill that got 67 democratic votes to force the administration to nulli fno people of security breaches that's might have exposed that personal information. >> you launch it and put millions of americans personal information at risk. >> after months of complaints and hearings about the disa disastrous rollout, th

iss is right up your alley the former head of cms. being at the right-hand side of governor leavitt and working , there are a number of programs available today that are relatively new that build on things the last administration started to make it easier for develop moreant to integrated care systems for the dual eligible to do so. this is a huge opportunity for improving health and saving money. of the way the care has traditionally been delivered through a fragmented system that includes some long-term care and --ding through medicare it medicaid and medicare and things they have to get on their own, it has been very fragmented. the programs that are around now are starting to change that. there are good examples in massachusetts that i know andrew and robert are very much involved in. things could help along the proposals are first of all recognizing that just in a lot of the reforms in care delivery giving people more accountability and opportunities for savings when they take steps to reduce cost. we can extend the same principl

cms put out a response to cantor telling him if you're looking for smoke, keep looking.uote, today there have been no successful security attack on healthcare.gov and no person or group has maliciously accessed personally identifiable information from the site. meanwhile, there are signs the battle will soon shift to the local level including ad blitzes and legal challenges. which begs the question is the republican party signaling a retreat or just a different kind of assault when it comes to health care? the most important issue of 2014. joy reid is an msnbc contributor and john feehery is a republican strategist. you know, joy, i run through the litany of what the gop attempted to do in 2013 and i say this failed and that failed and this failed. but with regard to 2014 at the ballot box, maybe that's not a bad strategy. >> well, you know, when you show all that litany of things that republicans did last year it was sort of like a sign wave. there was escalation and then dim mission. when the republicans were on stronger ground was really before the law was actually pa

ease the transition, cms is working closely with insurers, consumers, and other key stakeholders were working together to ensure that consumers have coverage. announced thats they will help consumers by requiring insurers to accept payment through december 31, 2013 for coverage beginning january 1. ensures that stepped up of many agreeing to voluntarily extend the deadline for consumers to pay their first month premium. many pharmacies have announced plans to ensure a smooth transition by providing consumers with transitional supplies of prescriptions. i continue to believe what i said in september. the ultimate story of the affordable care act will not be what happened in the early days when the website went live. the lasting legacy will be people like nathan and emily were able to get the healthcare they need and have the security of knowing that they are able to pay for it. thank you and i welcome your questions. >> the chairman recognizes himself or fives minutes. he testified that it would be ready at october 1. wire you wrong on that? -- why were you wrong on that? andou referre

cm. there are statements about what it is. it roughly runs 16% and we talked about before and that is several million dollars. it's 30 middle annually for this population. >> >> we have a statement as was shared by lisa and peter. kaiser is committed to continue communications on this topic and appreciates the opportunity to get feedback and input that would be valuable to hss and as was stated earlier negotiations are ongoing. now with that this is the page on icm. any additional questions? okay. this is where we are on this item. >> commissioner scott. >> yes, sir? >> in regard to this and i have been party to some of the discussions, not every one of the meetings in the pre-negotiation phase of this i still come away from the process slightly disappointed recognizing there is more work to do around this topic, and i say that publicly because i will be sitting in a chair during the rate -- as chair of the rates committee and i will raise rigorous questions. the fact is some of the elements, the icm, aren't clinical in nature

it seemed an ideal whole time cms said one single meeting is not enough to iron out the differences between the two sides because the negotiations have continued over many years people in china are set to mark the lunar new year celebrations across the country are usually loud and extravagant but this year some are choosing to save money and tone down their festivities. nhk rules committee by a mom also has more from aging . the across the country. when he's older cities with new wheels to kuwait. it's a time when people shop for gifts to be given on this special day. i hummed and that i came to find her way. i went and saw that i feel pretty good for something. this led to rest on in eugene. we told the nobles and she can still hold true to its two previous years. during you is holy days most part he's used to be held here every day the manager was that by targeting cost of a school of politics. now this restaurant offers coastal issues like new. instead of expensive talking and ability. still they rock. the average customer needs to spend a hundred dollars. but now it's twenty. two and re

more houses that cost that sebastian but there was any cms sebastian the opposition's been offered places in that the government whoever they're refusing to stand out with the protests are people reacting to this well employed. if you click here to petition the inner nerd and touch it though because it didn't take it andy had been expected to negotiate with the help of the year mike and movement is the lesson that aptly put the kids bring them for feeding or keep the people he became the coach of the confusion between the weird thing is we've got them going and going. but the streak which of course a few more than before he changed it up it to them. i couldn't get any of the one who would or could it be the traditional rite of bringing that. there he was able to stay with eric in wet with a new baby to accept that the petition or not but he never came back to the thunder hit peter smith of the common good that the current hero for up to the thirtieth of each tool for no position to get people negotiate think of the applicant to the to protect conditions meaning than the epic and her actio

verses doing some bundling which would, or could reduce some or both the preconstruction or the ongoing cm costs. >> there is a couple of advantages to breaking them down. and one of them is a small business, components because a lot of these going forward are the smaller packages. and the ones that we, that are either out today or have already been let, are the very large ones. and going forward, there is a lot more smaller ones and so it gives the small business opportunity, and also, what it allows some flexibility and schedule, and knowing that as we move forward in the, and with the design and we are able to know, when the time comes on the schedule, and we are able to get that out. and the dollars for the preconstruction, component to handle that, is minimal compared to, you know, what we are doing too by breaking it down is that we are trying to get more bidders as possible up the bidder environment, and as well. and in that, and so there is multiple benefits to that, and in that, this is how and this is web cor is really who drives their packages and we are in support of their, and

>> if you will get us information, it emily is willing to talk to cms, to understand what her options are -- >> i would appreciate that -- >> we will be happy to do that. >> she is a classic victim where the government says all these plans that work for you, we are not going to let you keep them because we think we know better how emily can handle her lupus. that is what you have done to the american people and when you come in here, you give us misinformation and then when we ask you a question, you cannot be specific. mr. cohen, i agree with dr. burgess. you ought to be fired. >> the time has expired. >> thank you. mr. cohen, there are a lot of things in the affordable care act, but many of the provisions are about consumer protections to ensure that americans have a diverse choice of health care providers. as with many new laws, there are wrinkles in the implementation and disagreement about rational intent. i want to ask you about one of those with respect to the aca. i have been hearing from some providers, and my colleagues have been hearing same concerns, about the interpretati

>> is there a particular example in the cms proposed rule? >> i'm particularly concerned with oncologist services. but certainly any of the outpatient services that can be provided in a hospital or outside of in an outpatient setting care. >> yeah. so you correctly stated we shouldn't pay higher rates for hospitals if the same service can be safely provided and lower cost settings. we are in the process of making recommendations to the congress to move medicare policy in that direction. we made a recommendation about evaluation and management services a couple of years ago. at this upcoming meeting next week, we're looking at an additional batch of services. many cardiologist services, for example. cms doesn't always agree with our perspective on issues inspect is an example where i think there are some differences of p.r.n. >> okay. i cited oncologist services and some of the outpatient. i'm also concerned about reimburstment for some of the medicare therapy services. now earlier i crossed it aoff my list. what we've recommended on outpatien

exchanges between the officials at cms and the contractor, cgi, show the adminisation as i just said,business exchange, they knew it wasn't going to be ready, but as you suggest, refused to let anybody knowas until effectively the last minute >> well the good news at least is the small business exchange can be delayed without, they delayed, delayed it and it won't disrupts much insurance market for people who wrk for small business. the problem is, they should have done the same thing for the individual market exchange becaus thatg exchange hasn't been ready either. delayed that exchange for a year, we wouldn't see massive disruptions in that market we're seeing today.% lou: the idea thaa this administrationhi is watchg the number of sign-ups and i won't call them enrollments. insurance sign-ups but let's call them sign-ups for medicaid, outpacing thosel for obamacaret a ridiculous rate. they have inverted the ratioed they soughtnd then some. we're looking at prospects according to some authorities, $17 trillion in unfunded liabilities because of unintended, massive expansion of medic

>> if you will get us information, it emily is willing to talk to cms, to understand what her options are -- >> i would appreciate that -- >> we will be happy to do that. >> she is a classic victim where the government says all these plans that work for you, we are not going to let you keep them because we think we know better how emily can handle her lupus. that is what you have done to the american people and when you come in here, you give us misinformation and then when we ask you a question, you cannot be specific. mr. cohen, i agree with dr. burgess. you ought to be fired. >> the time has expired. >> thank you. mr. cohen, there are a lot of things in the affordable care act, but many of the provisions are about consumer protections to ensure that americans have a diverse choice of health care providers. as with many new laws, there are wrinkles in the implementation and disagreement about rational intent. i want to ask you about one of those with respect to the aca. i have been hearing from some providers, and my colleagues have been hearing same concerns, about the interpretati

>> what you should know is the top two security people, both at health and human service, cms, have bothfied under oath that they were not given the kind of information that would lead them to be comfortable with the security beforehand, or, that in fact the known flaws in security had been mitigated prior to the launch. it is really a question of locking out the people who said they weren't comfortable, didn't want to sign for this thing to go live, it wasn't secure in their opinion or at least they couldn't be comfortable that it was secure and that continues to be the area in which going live was certainly a mistake, even if they got lucky and didn't have a major loss of your personal information. bill: first of those three hearings begins in a couple minutes. we'll be watching it from new york. sir, thank you. darrell issa on the hill. >> thank you, bill. bill: martha. martha: so irs official who is targeted conservatives appear now to be off the hook as the investigation into the agency seems to be going nowhere at this point. there is a growing chorus of lawmakers say it is time to

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i mean, there's no subpoena issuing tonight from any -- any oversight committee demanding that cms show up tomorrow with that demographic information. zero, none. >> there's something to what nancy pelosi said, we'll find out what's in it after we read it. >> why aren't the republicans more aggressive in at least trying to figure out what's going on? >> the press is doing their work for them. look, they've got television -- >> that's not exactly leadership dish. >> no, it's not, but they've got television -- your audience is bigger than any ecommerce has got today. you're talking about what's happened, what he said, what's wrong with what carney said. i think they figure why put together a great big committee and go into all this when the press is covering this. and the truth is, even the mainstream media finally got on the case, and it's doing the job when w obamacarrot front pages as well as the editorial pages and on the network news as well as -- as well as fox and maybe even msnbc. >> that's the republicans getting into the food fight, too. when i'm searching for is a sense of wher