in 2013, cms directed the medic to address drug analysis. creating new tools against problematic prescribers and pharmacies. we finalized a provision that requires providers to enroll or have an opt out affidavit on file and establishes ref indication authority for abusing prescribing patterns. state medicaid agencies have taken action to attack that epidemic. efforts include expanding medicine dade to include behavioral health service for those addicted to drugs and pharmacy management review programs. cms are encouraged by states effected strategies tore designing benefits for the population. we launched the accelerator program to provide states with technical assistance and other support to address this important issue. cms in coordination with cdc and nih, issued informational bulletin on medication assisted treatment for substance abuse disorder in the medicaid program. it outlined that medication and behavioral therapies is the most effective combination of treatment. issued a similar bulletin focused on these services in pediatric and

cms right now, and i think mr. cavanaugh answered some questions about the metropolitan statistical area restrictions that we have. that's a great antiquated assumption that if you increase telemedicine you're going to increase costs your contact you're going to take that very scarce workforce that we have in rural america and you going to be able to extend it. it will be more efficient and you will create access in our community. >> thank you very much for being here and your testimony. i appreciated. thanks, mr. chairman. >> senator cochran? >> mr. chairman, doctor henderson company mentioned in your testimony that the reimbursement parity issue was an important factor in the growth of services that are rendered through television and telehealth services. the diabetes pilot project you described are really remarkable and, obviously, highlight the potential for significant cost savings if they could be expanded into communities across the country. what did you see it as the programs that could be expanded? amitabh

cms right now, and i think mr. cavanaugh answered some questions about the metropolitan statistical area restrictions that we have. that's a very antiquated assumption that if you increase telemedicine, you're going increase costs. in fact, you're going to take that very scarce workforce that we have in rural america, and you're going to be able to extend it. it will be more efficient. and you'll create access in our communities. >> okay. very good. thank you very much for being here and your testimony. i appreciate it. thanks, mr. chairman. >> thank you. senator cochran? >> mr. chairman, dr. henderson, you mentioned in your testimony that the reimbursement parity issue was an important factor in the growth of services that are rendered through television and telehealth services. the diabetes pilot project you described are really remarkable. and obviously i like the potential for significant cost savings if they could be expanded into communities across the country. what do you see as the programs that could be ex

at cms we have taken steps to improve service. we have numerous opportunities for stakeholders to engage to make sure we understand their concerns and challenges. cms has rural health coordinators who meet monthly with central office staff and representatives from the hersa office of rural health policy to discuss emerging issues and regular rural health open door forums for programs and learn about issues. we're also trying to remove regulatory barriers for rural health providers. last year cms reformed regulations we identified as unnecessary, obsolete or excessively burdensome. which will save providers nearly 3.2 billion over 5 years. this rule included specific provisions to reduce burdens. for example, a key provision reduces the burden on critical access hospitals, rural health clinics and fqhcs. this provision recognizes improves for lower cost maintaining high quality care. we're also expanding access to rural care through technologies. medicare's benefit allow services normally requiring a patient and practitioner in the

cms offers regular rural health open-door forums to provide current information on cms programs, answer questions on guard about the emerging rural health issues. we are trying to remove regulatory barriers for rural health providers. last year seen as reform medicare medic regulation that we didn't fight as an acidic obsolete or excessively burdensome which was a providers nearly $3.3.2 billion over the next five years. this include specific provisions target of reducing burdens on rural health care providers. for example, a key provision reduces the burden on critical access hospital world health clinics by limiting requirement that this issue be held to a prescriptive scheduled for being on psychic this provision recognizes the taliban improvements to allow physicians to provide care at lower cost while maintaining high quality care. medicare's telehealth benefit allows services that would not require a patient and practitioner to be in the same location to be delivered via interactive telecommunications system to a variety of practitioners are authorized past telehealth provided tha

. >> the commercial r x plan for the early retirees not a cms regulated plan in place today i believe we have a little bit under one hundred people as the plan that does not have ab so those folks will not be able to enroll in a medicare advantaged plan because cms required ab city enrolled. >> if you look at the plans first, i want to talk about the medical the medical benefits quoted under the ppo it current to the network plan on average the members as a whole pay a similar amount under the proposed arrangement some costs are more and some less i'll get the chart. >> i'm saying as i read through the proposal i participated on the call with director dodd and it seems like everything was we can do it all and whether that carries through is understanding the level of detail so when i see a sweeping statement matt haney members of a whole paying a average i get nervous i want to see a memoranda price because averages range from god awful million dollars dollars to a few cents in change it would be helpful when you're making those references to have the data to support it but talk about

cms has made progress but there's more work to be done. is taking interventions to reduce the addiction and overdoses and medicare and medicaid. previous testimonies i have never had family here or time to thank them. i want to thank my mother, diane conway is here, my son jack who is out of school as well as my wonderful wife, heather, daughters alexa and savannah. and without their love and support, i would not be able to work on issues like this. they're critically important to our nation, so thank you. chairman murphy: thank you, doctor, thank you for recognizing to take your family to testifying day. apparently everybody else didn't get the memo. i just want to start by saying if talent and dedication alone could solve this crisis, we'd be there with the testimony of today and other days. obviously we still have problems. let me start by asking a few questions. for the director, office of national control policy uses the term recovery, does it mean to include patients with opioid addiction in buprenorphine or methadone treatment progr

cms is dedicated to providing the best care to beneficiaries with opioid addiction.working with part d sponsors and state medicare programs to have safeguards to prevent the abuse and treat them effectively.: >> thank you, doctor, thank you for recognizing to take your family to testifying day. apparently everybody else didn't get the memo. i just want to start by saying if talents and dedication alone could solve this crisis, we'd be there with the testimony of today and other days. obviously we still have problems. let me start by asking a few questions. for the director, office of national drug control policy uses the term recovery, does it mean to include patients with opioid addiction in buprenorphine or methadone treatment program still using heroin or illicit drugs, or would you say that's not recovery? >> from our perspective and as a person in recovery, clearly we want to make sure that people are continuing to progress in recovery, free from substances is the ultimate goal of recovery programs. i think everyone would agree on that. we also know that substan

cms offers rural health open door forums to provide information on cms programs, answer questions, and learn about emerging rural health issues. we're trying to remove regulatory barriers for rural health providers. last year cms reform medicare regulations identified as unnecessary, obsolete, or burden p some saving providers over the next five years. they reduced burdens on rural health care providers, for example, a key provision reloses clinics and fqhcs eliminating the requirement that a physician held to a prepgs schedule for being on site. this provision recognizes improves to provide care at lower costs while maintaining high quality care. we are expanding care through the use of technology. medicare's telehealth benefit allows services normally requiring a patient and practitioner to be in the same location to be delivered via interactive communication system. there's physician, physician assistants, nurse practitioners and this requires that they pay for professional consultation, office visits, and psychiatry services. each year, cms solicits comments on additional services

. >> on this point i say you say you haven't filled the cms your formula for 2006 when will- >> that will be foiled over the summer. >> that would be important this is a business prospective you've got to get an approved by certain dates i'd put a red star besides that one i don't know how long is take for powerful they motive fast tracking track you through the process but knowing again, we're kind of doing this without kind of the full detail is from a policy standpoint raises a question. >> of we'll get more information on that, too. >> can i ask the mechanic formula is the same as the other. >> it would be the same formula last year, it is the treatment of high-risk medication. >> but an approval process with the cms. >> surely we do that every year. >> okay. all right. >> do you want to mention that their expected to be rolled out to your part d plan we're starting in 2016 with the medicare advantage plan last sliced we're talking about the advantages of the national p p pox your members are flexibility they can go to in network and out of network doctors and enjoy the same plan

and the model itself is one of the largest trials that cms has ever done of a preventive outcome.e are going to enroll 300,000 medicare beneficiaries. it is a randomized design as well, to give a high degree of data fidelity. at the end of it, it is powered to detect meaningful reductions in heart attack and stroke. ok, that is really great, i will close with this, but i think this notion, how is it that we pay for the long-term outcome that is so far away that we do not know how much it costs? we break it down into things that actually predicted this. let's pay to reduce the risk. this is how we can think about our way of designing payments. it is not a broader structure. they are very good ways to predict what you are risk of hip fracture is, for example. based on your generic profile, you can tell with a reasonably high degree of fidelity what your risk of breast cancer is. wouldn't that be better than saying that all women over the age of 40 should get a mammogram and fighting about that? or we could break it down to say, risk of suicide. those of the ways in which we can thin

meanwhile, rah acres ra rahim rebashi is cms just a warning some of the are images are disturbing. >> some call the crossing of the mediterranean the journey of death, still thousands and thousands are willing to take the chance. he tells me there was people were shouting and people fell into the water. he doesn't know what happened next, he was thinking of himself. he was rescued by the libyan coast guard. often, the people fall in the sea and they float back to libya. he is an ambulance driver, he sees all kinds of wounds snrp it is horrifying. therethere is a horrible smell some were eaten by fish, others bloated and dissolved by salt. they find the corpses and bring them back. >> reporter: look at how they keep the fridge closed, it is not cold enough, the smell of rotting bodies is overwhelming. nobody knows for how long they have been floating in the sea before they are washed ashore. there is even the body of a child and by the looks of it he was between three and four years old. they have been found in january. so far they have been decomposing. somewhere, their families are w

cms has made progress to more work to be done. cms is undertaking multiple policy initiative and innovation to reduce the rate of opioid addiction in both medicare and medicaid. in previous testimony i've never had family here for time to think in the 20 thank my mother, diane, and my son jack was out of school, as was my wonderful wife heather and daughters. and without their love into the i would not be able to work on issues like this. that our crews important to our nation. thanks. >> thank you dr. kim and thank you for recognizing your family on testifying david everybody else russia apparently nobody else got the memo. ice want to start off by saying if talent and dedication alone could solve this crisis we would be there with the testimony of today and of the days, but we still a problem to let me start with asking a few questions. first or director botticelli we office of national drug control policy, uses the term recovery. does it mean to include patients with opioid addiction in a treatment program and so using heroin o

years and we've received it last novantrone extension to may to see if we could improve the numbers cms wanted us to serve 5 heed people a month we've been serving about two or three plus closer to 4 they gave us an extension actually may we knew we'll he will 0 hear in miracle or april for a third full year we look forward to this with all we've learned in our business practices to sunday morning ahead but we're not getting american people extension the contract will end with them in june we're told we couldn't appeal because the contract itself was actually ending in may we did do a letter of reconsideration we gave to our congressional delegates we've heard at the end of the lecture we'll not get a reconsideration we'll end the program ends in may but we'll be billing a little bit farther up we're working now with our community partners and the hospital partners to determine what we'll do avenue july one we know we have to do something because the program we were running was costing a substantial sum of money we're daikd draikd the good news we showed in the intervention one year we

mgms staff i'd like to introduce them and have them stand up and like to ask the subcontractors from cms c, a topnotch and garden thank you very much this xhukdz staffs presentation. >> do we have any speaker cards. >> i have several i'll call them in sets of 3. >> okay. >> (calling names). >> hi good afternoon. i'm virginia with the yerba buena loinsz this year the yerba buena alliance slbtsdz our 2, 3, 40 had 24th anniversary and here to voice the yerba buena loinsz and the management i want to acknowledge her dedicated partnering in the yerba buena and mgm management a supporter of the alliance as many other organizations i know that mary sits on a one an influential board member of spur i want to acknowledge her dictated staff that are some of the friendly it faces in downtown san francisco and just is how wonderful and hard everyone is working to make yerba buena the world-class designation it is and the yerba buena alliance celebrates that neighborhood as the art heart of the downtown san francisco and we know that mary and her designated team are making that area clean and safe an

cm louis, hotel and restaurant workers union 2. i appreciate and you are quite right to ask the tough questions about a sole-source. you are going to hear in public comment the reasons that this project is quite exceptional. i just want to put this from our perspective: what is most critical here? as you know for almost two decades, the city has required to developers on their lands to protect the fiduciary interest of the city through labor piece agreements. this project goes way above and beyond this. the developer approached our union with the intent and idea of negotiating an agreement that guaranteed good quality jobss and not just this project, but every project that they develop nationwide going forward. and from our perspective, that really drives home the level of commitment that they have to making this project exactly the kind of project that the port needs more of. the kind of project that brings not just jobs, but good-quality, living-wage jobs, to portlands, which have traditionally been the center of good quality liv

those policy decisions, the threshold amount on contracts, so so construct contracts, and cm d.c. contracts as part of the process we also involved in of the contractors, i see magil in the room today, he's representing the mte's so we feel good about the recommendations we're putting forth. and leading today a presentation will be rachel superman pr the controllers office. if i may introduce rachel. >> hello supervisors rachel from the controllers office i'm a project manager the city services auditor you have a presentation before you, is there something i need to do on the computer? >> (speaking off the mic). >> power point presentation? >> yeah there is a power point presentation. is it on here? sorry about that. so we are here to talk about the legislation sponsored by public works as mohammed mentioned and the chapter six deports, cp, airport, the port, reck park and mta, the before you will revise the administration code, i will briefly talk overthe process to get to the ordinance that is before you talk about some of the reasons for the change and introduce edgar lopez, wh

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cms has some work to do.e has to do with their statutory challenges and some of that i think they can push their authorities at built more, and i know that nih is doing a number of research projects. i wonder if you wouldn't mind taking a number or two and let us know what you're up to and what you found. >> many institutes have investments in this space and i got to tell you that more recently what is really emerged as an even more hot area and a very prompt missing one is the -- promising one is the idea of m health, using cell phone technology to make this transportable where people are walking around with their own telehealth gadget in their pocket and that's what we want to test in the pree precision medicine. the iinstitute is trying to state with babies and newborn which of those are developing a retinopathy by basically taking photographs and then sending that to an expert across the country to say that's bone needs treatment, that one doesn't. dr. gibbons has a telemedicine application for asthma. do

were were people in jets and tons of other equipment but there was nothing bigger than it except the cm the sky was always serves to emphasize the lack of everything else. so intangible ethical terms the carrier was the world and as such was all that was the case. i was not the first rider ever to set foot on an aircraft carrier. one of my predecessors have been holed up by an editor for fiddling his expenses. -somethings are not unheard of in the world of journalism but this time the editor had to write claiming taxi fares during the period being on board the carrier. i know said the journalist but have you seen the size of these things? [laughter] i heard another story about two brothers working in different sections of the same character who didn't set eyes on each other during the seven months of their deployment. didn't matter whether stories like these were factually correct the truth to which they attest its carriers are big enough to generate stories about how big they are. the flight deck is not only big, it's also overwhelmingly horizontal. that is what the carrier has come ap

cms has some work to do. some of do.some of that has to do with their statutory challenges and some of that. they could push authority more's. nih is doing a number of research projects. projects. i wonder if you would not mind taking a minute or two and letting us no what you are up to and what you have found. >> i appreciate the question. many institutes have investment in this space. more recently what has emerged as a hot area and promising one is the idea of using cell phone technology to make this even more transportable where people are walking around with their own potential telehealth gadgets in the product -- pockets. i will be a significant part of what we want to test. i can think of a telehealth method the eye institute is using. developing a retinopathy by taking photographs and sending it to an expert across the country. doctor gibbons has a telemedicine application. >> certainly one of the areas of concern with asthma chronic condition affecting children relates to transcending geographic barriers between

cms they know things are not fine. they do not don't want to admit it to massachusetts.onspiracy of silence a good product never appears. a lot of money paid to contractor. in the end both exchanges don't work. gerri: the exchange never worked, right? this is i.t. equivalent of the big dig, which was such a mess in boston. is this about the same kind of thing with boston related or are the problems really broader? >> i think there are some pieces probably very matches mass. the big dig was a fiasco. in this case they ended up dumping people into a medicaid program that was quote, free. lord knows what kind of services you get with a free medicaid program. there are broader problems. as you know, this was supposed to be technocrats dream solution to our health care problems. we'll write down magic formulas and send out the exchange. people will get all the wonderful products that we've designed and one size fits all. those technocratic solutions never work. there is nothing about -- gerri: they never work. worse they waste a lot of money. >> a lot of money. gerri: billion

is told that there is these wonderful community programs and you will have much better outcomes -- cms is holding me accountable for reducing calls among the elderly. how do i find those programs and feel confident in referring my patient? in massachusetts, the health department has developed a database that is integrated with electronic health records and makes those referrals to community-based organizations and the community-based organizations report back to the primary care provider. there is information going in both directions. just as importantly, the clinician can feel confident because there's the third-party validator of the programs. >> but it is as appointed to mention that there is almost as much mistrust from the public health site as there is from the clinical side. lisel: if you could identify yourself and ask your question -- could you pass the microphone? thank you. >> is that on? i am any violation scientist -- an evaluation scientist and register owners of some 25 years. worked a great deal of my time in home care but also worked inside hospitals. recently i attend