my question is simple, and your work with cms do you believe cms's attitude is and will people first and worry about eligibility later, if at all? >> from where we stand currently at -- the explanation has been that they have to balance the ease of access to coverage with program integrity controls based on our undercover work, i would say that there are gaps in these controls that have yet to be addressed. we continue to look at it through our forensic work, as of now i think the balance would favor access over integrity. as we stand today. >> thank you mr. chairman. i think it is important that you were talking about taxpayer dollars here that we make sure they are spent wisely. marketplaces are required by law to verify application information, yet it appears from your investigation that subsequent interactions with cms that the buck stops with no one especially since the very contractors hired to verify the documents are not required to detect fraud. it begs to question of whether you are currently aware of any effective front or back and -- and fraud detection program used by th

the liability on the freeway corridors in san francisco from phase one and two of the cms study are from the caltrain grandparent and appropriated for cal grant this subject is the phase two and the transportation authority board approved the cms phase the report set the foundation for the took analysis in phase two by developing an evaluation frame goals moving more people and increasing the triple liability and increasing the neighborhoods adjacent to the freeway corridors this contract was waterway for a procurement process on may 8th for a request for the scope is in our packet the preproposal conference was held and 4 proposals by the dew date met the dba goal and the sfmta and caltrain interviewed the banks on june 3rd and unanimously recommended the firm the team has been experience in planning in the region in east bay and south bay and the objectives and the limits of the environment in san francisco and the development and screening of a analysis of like scenarios the a team that is here today will address the additional questions the c h s team and the solutions this is a

the liability on the freeway corridors in san francisco from phase one and two of the cms study are from the caltrain grandparent and appropriated for cal grant this subject is the phase two and the transportation authority board approved the cms phase the report set the foundation for the took analysis in phase two by developing an evaluation frame goals moving more people and increasing the triple liability and increasing the neighborhoods adjacent to the freeway corridors this contract was waterway for a procurement process on may 8th for a request for the scope is in our packet the preproposal conference was held and 4 proposals by the dew date met the dba goal and the sfmta and caltrain interviewed the banks on june 3rd and unanimously recommended the firm the team has been experience in planning in the region in east bay and south bay and the objectives and the limits of the environment in san francisco and the development and screening of a analysis of like scenarios the a team that is here today will address the additional questions the c h s team and the solutions this is a

el grosor de esta losa es mÁs obreros de unos 5 cm la que tuvo que romper, encontrÁndose en este sitiola infraestructura propia del penal. la losa de esta gruesa, allÍ esta tendrÁ mÁs o menos m de profundidad. >>las medidas de seguridad son prÁcticamente inviolables, diferentes puestos de control donde cÁmaras registran cada movimiento. al llegar a la zona de tratamientos especiales este pabellÓn que subiste en la planta baja al menos son siete u ocho las cÉlulas que se encuentran en este corredor y la nÚmero 20 donde se encontraba el chapo guzmÁn es la que se encuentra en primer instancia, es un poco mÁs grande que los demÁs y centro por izquierda. lo primero que se observa es una mesa de concreto y una pequeÑa repisa donde tienen permitido los reos proceder alguna televisiÓn pequeÑa de no mÁs de siete pulgadas. el catre que es una construcciÓn de cemento, tiene sÓlo una colchoneta, llama la atenciÓn los servicios sanitarios que tienen esta pequeÑa celda porque lamentablemente lavado se observa bastante viejo, pegado con una cinta adhesiva, la letrina del piso estÁ sucia y propiamente

the liability on the freeway corridors in san francisco from phase one and two of the cms study are from the caltrain grandparent and appropriated for cal grant this subject is the phase two and the transportation authority board approved the cms phase the report set the foundation for the took analysis in phase two by developing an evaluation frame goals moving more people and increasing the triple liability and increasing the neighborhoods adjacent to the freeway corridors this contract was waterway for a procurement process on may 8th for a request for the scope is in our packet the preproposal conference was held and 4 proposals by the dew date met the dba goal and the sfmta and caltrain interviewed the banks on june 3rd and unanimously recommended the firm the team has been experience in planning in the region in east bay and south bay and the objectives and the limits of the environment in san francisco and the development and screening of a analysis of like scenarios the a team that is here today will address the additional questions the c h s team and the solutions this is a

and so going the cm/gc route would allow us to work with a contractor in constructability. >> mr. moran, i think you had an amendment to the resolution. >> well, we had talked to staff, and as i indicated before as ongoing discussion of administrative procedures we should put in place around the new ordinance. i had proposed a "further resolve," that basically says this contract would be subject to whatever administrative provisions this commission adopts at a later time. >> that is correct. we talked earlier today. we came up with some language in antpation of this question coming up. if i could read into the record, the language, further resolved that the award and administration of any agreement entered into pursuant to this authorization will be subject to any administrative provisions subsequently approved by the commission's applicable to cm/gc contracts. >> and i'm not sure what the appropriate process is. i can move that amendment. that might be the best thing to do, and i will do that. >> okay. >> i will second that. >> discussion? any public comment on the amendment? i w

le recortaron los manubrio para que no se viera los 80 cm de ancho del tÚnel. >> estÁ muy bien reforzadoraron un gorriÓn que entra por el tÚnel. >> los pÁjaros pueden ser sensibles, si se empieza por la motocicleta, a tener mucho humo. marÍa antonieta: el gorriÓn sobreviviÓ y ahora es parte de la evidencia. por otra parte, cuando muchos se preguntan quÉ pasa con el total del tÚnel, el gorriÓn podrÍa ser el Único sobreviviente que ha hecho ese camino de la casa de la cÁrcel. jorge: aunque algunos expertos califican como una obra de ingenierÍa, no habrÍa sido tan complicado. un especialista dice que la clave son los planos de la cÁrcel. otro detalle del vÍdeo es una aparente aparato electrÓnico, jessica se enfoca en eso. jessica: para trazar el tÚnel sÓlo se requirieron dos casos, el plano y un vuelo de reconocimiento. >> las personas que trazaron o que hicieron el tÚnel debieron haber contado con los planes de la cÁrcel. de otra manera es imposible saber por otro mÉtodo, como estÁn las relaciones. jessica: estÁn restringidas los vuelos pero hasta las imÁgenes de un dron funciona. >> el vu

these recent data from cms show that by the spring of 2015 so this just recently, more than 22 million people had gained coverage either through marketplace plans or medicaid. a majority of marketplace enrollees have subsidies that helped them reduce their premiums and also offset their cost sharing requirements. in the commonwealth fund's affordable care act tracking survey we looked at the effect of this new enrollment on uninsured rates and access to health care by. by march through may of 201313% of working age adults were uninsured. this is down from 20% prior to the first open enrollment period in 2013. these survey estimates in our survey are in the range of those reported by other recent surveys of the law has been particularly targeted helping low and moderate income families gain health insurance. there are significant coverage gains in the income groups since 2013 but we do see in the survey a leveling off in gains among the lowest income adults in 2015. we find that the law is helping previously uninsured people gain coverage. more than half of adults enrolled in marketplac

. >> aproximamente de 50 50 cm.onstruido. >> esta habilitado con la escalera. con dimensiones aproximadas de 1.7 metros de altura y de 70 a 80 cm de ancho. jessica: su longitud era mÁs de kilÓmetro y medio, alrededor de una milla. >> el tÚnel cuenta con tuberÍa de pvc presumiblemente para ventilaciÓn, asÍ como con alumbrado y una motocicleta adaptada sobre rieles como mecanismo de tracciÓn. jessica: las autoridades creen que con esta motocicleta fue extraÍdo la tierra. >> a lo largo del tÚnel se encontraron instrumentos de construcciÓn, tanques de oxÍgeno, recipientes con combustible, madera y tuberÍa pvc entre otros objetos. jessica: la desembocadura del tÚnel llegaba hasta una casa en construcciÓn donde pudieron haber camuflado la tierra. ademÁs hallaron objetos diversos. >> en ese lugar se hallÓ mobiliario en series y otros objetos que indican que habÍa presencia de trabajadores o de veladores. jessica: los alrededores de la prisiÓn han sido frecuentados por trabajadores y mÁquinas de construcciÓn que estÁn refor

alan: 10 cm, quÉ bÁrbaro.o rico cumple 15 aÑos, besos y bendiciones alan: con todos aquÍ vamos a bailar. y dice. ♪ ♪ ♪ ♪ ♪ ♪ alan: bueno, esta niÑa de seis aÑos y su mamÁ embarazada están siendo sensaciÓn en las redes sociales, mire nada mas, esta seÑora tiene ocho meses de embarazo, esta es su hija, pusieron ese vÍdeo en facebook ya tiene mÁs de 13 millones de personas que lo han visto, es una sensaciÓn, es una locura, de repente la niÑa dice, les presento mi mamÁ, tiene ocho meses de embarazo y a bailar se ha dicho, 13 millones de personas, imagÍnese nada mÁs lo que hace una pareja tan bonita de bailarinas casi expertas. karla: tiene futuro. tiene espalda y tiene ritmo. alan: satcha, asÍ deberías haber bailado cuando estabas con un baby bruce. satcha: asÍ baile cuando estaba en mi barriga y ahora mÁs cuando lo tengo en mis manos. muy bonito. exceso de velocidad serÍan las causas de que un autobusero seÑora desde lo alto de un puente luego de entrar a una curva en el vehÍculo gira, al menos 11 personas fallec

les removieron asiento, tapa del tanque de gasolina, recortaron manubrio se para que no excediera 80 cmficar la calidad del tÚnel. maria: el gorriÓn es la Única prueba de que un ser viviente a cruzados de la casa a la senda. cla regresamos con ustedes. illia: muchas gracias buenas noches, tras la espectacular fuga hace falta saber por quÉ el gobierno mexicano no habÍa desmantelado la estructura econÓmica del campo. reportera: joaquÍn el chapo guzmÁn no sÓlo logrÓ dos fugas de cÁrceles federales, Único en toda la historia criminal de mÉxico. sobreviviÓ a cinco administraciones de cinco presidentes , 11 procuradores y a su propia adicciÓn de mujeres. segÚn expertos en sistemas penitenciarios el gobierno nunca supo destruir su mejor arma y que provocÓ nuevamente su libertad. la estructura financiera. >> no seas desentraÑado la red que limpia y lavar dinero. reportera: de acuerdo con guillermo zepeda catedrÁtico de sistemas penitenciarios desde su primera fuga en 2001 en el penal de mÁxima seguridad se desestimÓ ademÁs el gran poder corrupto. de hecho fue lo primero que reconocieron las ent

and so going the cm/gc route would allow us to work with a contractor in constructability. >> mr.moran, i think you had an amendment to the resolution. >> well, we had talked to staff, and as i indicated before as ongoing discussion of administrative procedures we should put in place around the new ordinance. i had proposed a "further resolve," that basically says this contract would be subject to whatever administrative provisions this commission adopts at a later time. >> that is correct. we talked earlier today. we came up with some language in antpation of this question coming up. if i could read into the record, the language, further resolved that the award and administration of any agreement entered into pursuant to this authorization will be subject to any administrative provisions subsequently approved by the commission's applicable to cm/gc contracts. >> and i'm not sure what the appropriate process is. i can move that amendment. that might be the best thing to do, and i will do that. >> okay. >> i will second that. >> discussion? any public comment on the amendment? i wi

la anchura es de 70 cm y 1 m y medio de alto.ica que utilizÓ para la fuga de los reos. a lo largo de 16 minutos se aprecian tres terminales de electricidad. >> otro equipo como de ventilaciÓn. pedro: el tÚnel cuenta con tuberÍa plÁstica que sirve para la circulaciÓn de aire a travÉs aparatos de ventilaciÓn. hay tres en el trayecto. se acercaban al final del tÚnel e iban alcanzando detalles de la construcciÓn. >> con martillo alguien picÓ... pedro: en el exterior se aprecia la vivienda que sirviÓ como para escaparate para acabar el tÚnel. la boca de entrada fue cubierta y se estima que aquÍ sacaron 400 t de tierra sin que nadie se diera cuenta. el tÚnel tiene entre 12 a 15 m de profundidad y pasa cerca de la colonia donde estaba la salida. el capo escapÓ por ahÍ era el memo, y dos de sus guardaespaldas. hace un aÑo que se fugaron de esta presiÓn por este certificado tÚnel y desde entonces estÁn prÓfugos de la justicia. de ese sinaloa, mÉxico, pedro. jorge: se presentan las dos entradas lo conectan. en cambio las imÁgenes difundida

Éste iniciaba con un hueco de forma rectangular en el Área de la regadera, de aproximadamente 50 50 cmconducto vertical de aproximadamente 10 m de profundidad habilitado con una escalera. >> que se tÚnel con dimensiones aproximadas de mÁs de cinco pies de altura y tres pies de ancho se extiende en lÍnea recta por mÁs de 1.5 kilÓmetros, es decir casi una milla. >> el tÚnel cuenta con tuberÍa de pvc, presumiblemente para ventilaciÓn, asÍ como con alumbrado y una motocicleta adaptada sobre rieles como mecanismo de tracciÓn, mediante el cual fue extraÍda la tierra. >> los mexicanos no podÍan creer lo que escuchaba. el chapo apenas habÍa ingresado ese penal aÑo y medio atrÁs, el tÚnel que comenzÓ en este penal de alta seguridad, a casi una milla de distancia terminÓ aquÍ en esta casa a medio construir. el penal estÁ rodeado de trabajos de excavaciÓn, y grandes tubos que provee de agua que provee a mÉxico. >> impresionante la construcciÓn de este tÚnel, hay que decir que la casa por donde saliÓ no habÍa sido construida en febrero del 2014 que fue cuando llegÓ. nosotros nos hemos mantenido to

he also served in a state oversight capacity within cms for the affordable care act and next to him, and our final panelist is peter lee who as sara noted runs one of those affordable care act marketplaces established by the state as the phrase goes. state in question being california. he too has held aca-related positions within cms as well as running a business collision on health and a noted consumer group on the west coast. gentlemen, thank you all for being here. let's start with tim jost to get the conversation going. tim? thanks for being with us. >> thank you, ed. supreme court's decision in king v. burwell is by now is old news but i would like to begin with a few observations concerning it. first as you all know the decision was not close. it was 6-3. the opinion was written by the chief justice and he was joined by justice kennedy who joined the dissent in the fnib case. there was however in the king v. burwell an outraged dissent. justice scalia as dissent was the same length, 21 page as the majority opinion. it is eloquent and well-reasoned. focuses on the phrase at issu

it is cms that runs all of our health care programs.is an issue for running medicare and other programs like that, but also the in ih and -- the nih and places like that, or the centers for disease control, that we depended on so much this year for so many things, whether ebola or our conversations around measles, or supporting a state like indiana as it is going through its difficulties with hiv. al: how optimistic are you? sylvia: i think you know i am an optimist. i came to town as an optimist. i came to town right as the sequester was beginning and people we were going to get -- thought we weren't going to get there. then there was a deal that led to all of the bills being passed. that was the first time since 1987 that all the bills passed together. i think it can be done again. we can get to a place where there can be agreement. al: you've got to do it pretty soon, though. sylvia: we will need to do it. october 1 is a very important deadline in terms of funding the government for the next year. al: bill frist, former senate republ

and so people get confused just by the data cms is releasing. for example, earlier this year was a release of physician claims data. the thought being i would get online and search my provider online and search my provider and see how many claims he was responsible for, the cost of that provider. the media picked up on this, and a lot of it was gotcha journalism. so my provider is the most costly provider because they prescribed the most costly drugs, for example. that's not necessarily helpful to a consumer. i could turn that around and say, my provider does the most hip replacements, and therefore, is an expert at doing hip replacements. so we need to put this data into context. the second thing that we know consumers really value is this cost quality equation. in other words the value equation. right now, we don't have very good measures of quality. so the information that could be presented on some of these health plan comparison websites just simply haven't available. we're just measuring the wrong things and things that consumers don't fin

that i think is actually centered less in acl and more with cms. and it's also a part of the affordable care act in terms of people knowing they can do preventive and wellness visits without copays. those numbers are increasing. we need to increase them more so that the people accessing these services are not increasing. nutrition and wellness come into that as well in terms of how it fits into the broader thing that i think changes that and the larger piece. the last piece is the ferry family care giving and encouraging that staying in community and home. you have seen our most recent rule making at cms which is an important part of reforming the delivery of our health care and paying and encouraging ways of providing that care at home. the rule making are probably our most effective tools because those are the ones that scale broadly and because payment is an important part of how people are making the decisions about staying in a commune and making a change. >> thank you so much. my time has expired. >> mr. carter you are recognized for three mi

and can be brought on -- brought on with the cm/gc as part of the team, or they can be on-boarded later. they go through a pre-qualification or an evaluation process of their qualifications before a core contractor can provide a bid, in the bid process; that bid is compared to a third-party estimate. if it's within certain percentage, usually around 3%, the project team may elect to use that core contractor's bid. if not, then it will be competitive bid, like all other trade subcontractors. >> okay. so as i understand it, then the advantage of having a core contractor come on early is that you have their knowledge and expertise, advising you about constructability. >> on certain key parts of the work, right. >> which is a huge benefit. >> huge benefit in the design process. >> and part of -- >> and construction. >> and part of -- under prior rule as i recall, if you were involved in design like that, you could then not bid on the final contract. that was deemeds a conflict of interest and we had to deal with that before. in this case, you are allowed not only to bid, but you are allowed

. >> >>> now, some saw it as a haven for cms, others a -- criminals other a social experiment. a skyscraper in caracas is empty. we were given rare access and sent this report >>> rising 45 stories hay into the caracas skyline, the tower of david as meant to be a shining prosperity. construction stopped mid way. the fate of the abandoned skyscraper took on a stranger twist when squatters took over. for the engineer behind the construction of the tower, what he considered his greatest truimph is hard to grasp. >> it was meant to stand as a symbol of economic success. it became an emblem of what the state failed to give the citizens, and they took for themselves. it's been a year since the residents walked up and down the steps, and the government cleared half of them out of what many called a vertical tomb >> translation: the story of 925 families and people changed after we gave them dignified housing. we relocated in eight months. >> for a local film-maker and the tour de france's former officer, a lot was lost with the move. >> people had organised in the tower better than th

s investigation exposes not only huge gaps, but also flaws in how the exchange and cms contractors treatmericans who are trying to correctly file legitimate applications. the g.a.o. team sent questions only to have it ignored or have the exchange respond. the fact that g.a.o. encountered mind-boggling levels of incompetence and inefficiency at every turn does not bode well for the experience of your average honest enrollee. i look forward to today's hearing and what i hope will be a good discussion of program integrity. before i conclude, i want to note even though this investigation was requested by this committee, c.m.s. was less than cooperative. indeed throughout the entire endeavor, officials appear to be dragging their feet, blowing past deadlines and good faith attempts to to put forward this work. no federal agency could stand in the way of that work. by delaying the g.a.o. and hampering their efforts, c.m.s. has delayed this committee's work and hampered our efforts. this is unacceptable and despite promises of increased transparency and cooperation from agencies throughout this

my home state of colorado is an example of working with cms on health care innovation on a variety of levels. for those of you who may not be aware, cms has approved the largest combined data warehouse and analytic system for helping human services in the country in colorado. this system hits all components of the cms triple aim of working to provide better care for individuals at higher quality better health for our population as a whole, and reduce costs as a result of those improvements in health care quality for all of our citizens. without further a do, let me introduce sylvia burwell. [applause] ms. burwell: it is great to people to join you all today. i am especially happy to welcome you to the mountains take along with governor tomblin. less than an hour away is my hometown. i want to invite all of you to visit kirks home of the hungry smile. it is both where my sister and i started as waitresses many years ago. i hope you will go by. if you don't want to go there the dairy queen is only a half-mile further. it is the most beautiful dairy queen in the nation. [laughter] i am n

en el piso, el orificio de poco mÁs de 50 50 cm por el que se iniciÓ la fuga mÁs comentado a nivel mundial cuando estaba en la cama. luego, llegaron tambiÉn las imÁgenes del famoso tÚnel de mÁs de 1 km y medio de longitud. del otro lado, estÁ la casa ubicada en la colonia santa juanita, por la que el chapo guzmÁn recobrÓ la libertad, y terminÓ de escribir esta afrenta al estado mexicano. ayer en conferencia de prensa el secretario de gobernaciÓn miguel angel osorio reconociÓ que existen puntos ciegos en las grabaciones de vigilancia por respeto a los derechos humanos de los reos. miguel: por razones de derechos humanos de respeto a la intimidad, la vÍdeo vigilancia tenÍa dos puntos ciegos. raÚl: pero para la periodista hernÁndez autora del libro "los seÑores del arco" la declaraciÓn o tiene sentido. los procedimientos de revisiÓn y el trato es muy diferentes. en base a los testimonios la periodista afirma que en un penal de mÁxima seguridad, y en particular en la del altiplano: ciegos no existen, no pueden existir. _los puntos >> nos quiere decir que hacen eso todos los dÍas con los reos p

my home state of colorado is certainly an example of working with cms on health care innovation on aty of levels. for those of you who may not be aware, cms has approved the largest combined data warehouse and analytic system for health and human services in the country in colorado. this system gets all components of the cms crippling up working to provide better care for individuals at higher quality or health for our population as a whole and reduce costs as a result of those improvements in health care quality for all of our citizens. without further ado let me introduce the secretary of health and human services sylvia burwell. [applause] >> thank you. governor hickenlooper. it's great to be able to join you all today. i am especially happy as was mentioned to welcome you to the mountain state along with governor tomblin. and less than an hour a way as my hometown of hinton right across them advantages want to invite all of you will do visit perks home of hungry small. all of my sister and i both start as which is a musical. i hope you provided if you don't want to go there becau

the liability on the freeway corridors in san francisco from phase one and two of the cms study arerom the caltrain grandparent and appropriated for cal grant this subject is the phase two and the transportation authority board approved the cms phase the report set the foundation for the took analysis in phase two by developing an evaluation frame goals moving more people and increasing the triple liability and increasing the neighborhoods adjacent to the freeway corridors this contract was waterway for a procurement process on may 8th for a request for the scope is in our packet the preproposal conference was held and 4 proposals by the dew date met the dba goal and the sfmta and caltrain interviewed the banks on june 3rd and unanimously recommended the firm the team has been experience in planning in the region in east bay and south bay and the objectives and the limits of the environment in san francisco and the development and screening of a analysis of like scenarios the a team that is here today will address the additional questions the c h s team and the solutions this is an