cms finalized this rule in may of 2014. why did cms dramatically reverse its own policy to favor insurance companies? we look forward to getting a straight answer from cms today. we do know there say cozy relationship between insurance companies and this administration and the administration worked to incentivize insurers to stick with the exchanges. insurers have e-mailed top white house officials begging for more money to lower premiums and keep insurers selling affordable care act plans. i expect mr. slavitt will try to justify why they changed the law. he may argue it's silent about what to do if the fund doesn't collect a full amount. however, the statute clearly states in this statement here that the portion of the contribution intended for the teshry shall be deposited into the again fund of the treasury of the united states and may not be used for a reinsurance program. thank u. this means that each contribution includes a portion intended just for the treasury. cms cannot divert the funds to pay insurance companies

cms finalized this rule in may of 2014. why did cms dramatically reverse its own policy to favor insurance companies? we look forward to getting a straight answer and do know there is a causal relationship, and the administration has worked to incentivize insurers to stick with the exchanges. i have emailedhave e-mailed top white house officials begging for more money for lower premiums. i expect there will be an attempt to justify the change in interpretation and may even argue that the statute is ambiguous or silent about what to do of the fundif the fund does not collect the full amount, however the statute clearly states that the portion of the contribution intended for the treasury shall be deposited into the general fund of the treasury of the united states and may not be used for reinsurance program. thank you. this meansyou. this means that each contribution contains a portion intended just for the treasury, and those funds cannot be diverted. the nonpartisan congressional research committee agrees with us. they ana

will cms correct its rule back to the original interpretation of march 11th? >> congressman, we still believe we have the statutory authority to issue the rule that was issued. >> okay. so you are not going to change back to the original -- >> we believe what we are following is supported by the statute. >> i disagree with you but there we are. so moving to the second question, self-insurance private -- self-insured private companies basically self-funded companies that are self-funding their employee health plans are contributing to the traditional reinsurance fund, even though they continue to cover employees and they haven't dropped employees from coverage, thereby forcing them to buy coverage on the exchange. in other words, they aren't contributing to the reinsurance issues or to the potential draw on insurance, reinsurance, and some of these companies have paid out huge sums over $50 million to bring into this program that ultimately aids insurance companies. how can we justify the payouts to insurance companies from these private companies who have main

i used to work at cms actually up until quite recently. i had a question on your bundled payments portion. so you talk about the episode of care lasting until 90 days post services. i heard you have several docs both now and in my previous position in the past at cms having issues in terms of following up with patients and you know, getting information past 90 days. i wanted to see if you all account for that and you know, what you do in terms of if a patient doesn't follow up and how that computes into bundled care. >> patient followup is a huge issue for us, particularly for the congestive heart failure. i will tell you a little bit of a story. this is only tongue in cheek. one of the medical directors of the congestive heart failure program said that if he could find a way to combine the oral lasix medication which is the drug we use for fluid retention with crack, then we could get our patients to be compliant. he was only half-kidding. so when you talk about patient followup, we have care navigators that are constantly calling and vis

the gao estimates that cms could save the taxpayers hundreds of millions of dollars but cms has not taken this action. and in 2013, the gao recommended the department of defense implement a plan to guide joint basing, meaning multiple military services using a single base to achieve efficiencies. the dod has yet to complete this action even though it could save $23.3 billion over a 20-year period. why do we need to come back year off year to discuss the same actions? that's going to be in part what we discuss today. obviously, the federal government has an obligation not to waste taxpayer's dollars. we're pulling money out of somebody's pockets and give it to somebody else and use that. weaver got to be very, very cognizant of this wasteful taxpayer spending. all federal workers should consider it part of their job description to prevent waste and should embrace the role as few disharies for the american public. disagreements over policy can lead to disagreements over appropriate spending. the imperative to prevent waste is something we can all agree on on both sides of the aisle. when we

, credible, what use that word on purpose, credible data from the state of new mexico which hhs and cms have both agreed are completely missing in this design. we have the worst public health outcomes in the country, including the second highest overdose deaths related by and large to a very fragile, very complex behavioral health population in the state of new mexico. it would seem to me that as a chief medical officer one rule is we know that hospital decisions, overdose, incarcerations, acute institutional care is not the right investment for both cost savings or quality in terms of treating these patients. and i would guess you probably are also very aware that when you have a highly complex patient, say someone with schizophrenia who has developed a relationship with the provider, who is now successfully on a medication management which is very hard for many of these patients to achieve, and then that is completely taken away. and if you can get in, you see a different psychiatrist or psychologist every single time you try to get access. wouldn't you agree that this would not be th

we've had ongoing dialogue with cms. we plan to continue that and to press for full implementation of our outstanding recommendations. >> okay. thank you. and i yield back. >> i thank the gentlewoman. the chair recognizes the gentleman from michigan, mr. wahlberg, for five minutes. >> thank you, mr. chairman. and thanks to the panel for being here. and mr. dodaro, thanks for heavy lifting and sharp pencilling and pinpointing that you continue to do. one man's opinion and an overlarge federal government, but nonetheless. one area that i'm interested in is the unobligated balances that are out there. some staggering in nature. at least to my opinion. is there any value to allowing agencies to hold excess appropriations to the next fiscal year? and i guess i would add quickly to that, at what point does it become a problem? >> yeah. i think, you know, agencies need -- and it depends on the program and activity. and so it's variable. they need to have a little bit of a potential buffer depending on the nature of the programs

although cms had been running a few models on reform. the affordable care act really brought in a large multiprong effort to reform, created some permanent changes to the way hospitals are paid, for example, the hospital readmission reduction program. it created the office that medicare coordination office, looking at ways to align payments for people who are dually eligible for medicare and medicaid. and the aca also established aco's through what's called the medicare shared savings program, which will get into in a little bit, and the aca created the invasion center which, of course, cmmi because we love acronyms. cmmi was marking testing payment models and the aca gave it unprecedented authority to expand models that achieved certain specified performance on quality and spending. i'd also mention that underlined system reform in medicare was the passage of macra, the law that repealed the fjr, many former alliance briefing topics, but macra has within it financial incentives for physicians to be paid a bit more. if they are participa

we have you know, in total approximately 6,000 cms employees. trying to manage a program of huge scope and complexity. i think whether it's program integrity or quality arenas or other policies or marketplace medicaid, we have a staff and i appreciate the comments earlier. that i think is mission-driven. wants to deliver on that mission, when you look at the employee viewpoint survey, that comes across clearly. another thing that comes across, they don't feel they always have the resources, training and ability to improve the system as much as they would want. >> and just quickly, mr. doe do, any comments about what you've just heard or anything you want to add? >> no i'm very pleased that cms has taken action on a number of our recommendations in these areas. there are still some outstanding recommendations, particularly as it relates to medicaid. i'm very concerned that we've not had a good oversight over the managed care portion of medicaid at the state level. cms is in the process of instituting a process that will provide more audits of wha

i used to work at cms actually up until quite recently. i had a question on your bundled payments portion. so you talk about the episode of care lasting until 90 days post services. i heard you have several docs both now and in my previous position in the past at cms having issues in terms of following up with patients and you know, getting information past 90 days. i wanted to see if you all account for that and you know, what you do in terms of if a patient doesn't follow up and how that computes into bundled care. >> patient followup is a huge issue for us, particularly for the congestive heart failure. i will tell you a little bit of a story. this is only tongue in cheek. one of the medical directors of the congestive heart failure program said that if he could find a way to combine the oral lasix medication which is the drug we use for fluid retention with crack, then we could get our patients to be compliant. he was only half-kidding. so when you talk about patient followup, we have care navigators that are constantly calling and vis

>> no, i am very pleased cms has taken action on a number of recommendations in these areas. there are still outstanding recommendations particularly as it relates to medicaid. i am very concerned we have not had a good oversight over the manage care portion of medicaid at the state level. cms is in the process of instituting a process that will provide more audits of what is going on in the manage care portion of medicaid at that level. i am concerned we have a disagreement about the definition of budget neutrality for demonstration projects. the ones we have looked at we don't believe with budget neutral and it is costing the government tens of billions in additional money. they made the criteria more transparent but we don't agree with the implementation of criteria we have seen. there were many recommendations we made congress could do to streamline spending in the medicaid program. we have ongoing dialogue with cms and continue to keep up with that and press our outstanding recommendations. >> the chair recognizes the gentlemen from michigan, mr. walberg for five minutes

gao estimates cms could save taxpayers hundreds of millions but cms has not taken this action. and in 2013 the gao recommended the department of defense implement a plan to guide joint basing meaning multiple military services using a single base to achieve efficiency. that dod has yet to complete this action even though it could save as much as $2.3 billion over a 20 year period. why do we need to come back year after year to discuss the same actions? that's in part what we will be discussing today. the federal government has an obligation not to waste taxpayer dollars. we are pulling money out of somebody's pocket and then trying to give it to someone else and use that so got to be very, very cognizant of this wasteful taxpayer spending. all federal workers should consider it part of the job description to prevent waste and should embrace the role as fiduciaries for the american public. disagreements over policy can lead to disagreements over appropriate spending at the imperative to prevent waste is something you can all agree in both sides of the aisle. when we know it's ab

conway, can we get to this committee within the next 120 days a plan on how cms plans to address that particular recommendation? >> we will work to get back to you with that information, yes, sir. >> all right. so in 120 days we'll have >> what time frame would be reasonable, dr. conway? i see the person that is doing the work said you could make the 120 days. that is correct. all right. thank you. and my final question, then i'm going to recognize the ranking member for his closing remarks, mr. till itson, let me share a concern that i have. we have -- we want to always give our fighting men and women the resources that they need. and yet what i heard today was a less than robust implementation of some of the gao reports as it relates to your particular area. i also heard you saying, well we're making progress and all of that. what i don't want to do is see that 40% of what you implement, really have no impact -- substantial impact in terms of the bottom line getting implemented year and year and the 60% that would actually make very systemic changes continue to get rolled over. and

two improvements to mitigate the program cms helped recover nearly 65 $7 million of improper medicaid payments in fiscal year 2015 according to gao. on the flipside, they found the department of defense still has 79 major programs of a total acquisition cost of over $14 trillion. dod spends $100 billion each year on the systems but has failed to strategically manage those in investments resulting in inefficiency and waste. taxpayers and our troops deserve better than that. i i want to thank all of our witnesses today , i think you free you and your talented staff are providing critical critical service to congress and the american people with this annual report. as well as with the work that you do every day. you help ensure our tax dollars are spent wisely, hope that you will share with all of your employees how grateful we are for their pursuit of excellence and for them helping to provide us with roadmaps to make a difference. with that i yelled back. >> inc. you. i will hold the record open for five legislative dates for any members would like to summit a written statement. i'll n

the fda does a ton of inspections, cms does the same thing. of times, they will go after areas where they think there are problems. i'm sure that's what happened here. this company got a ton of attention and all of a sudden, they are being investigated by cms. lisa: thank you so much, drew armstrong of bloomberg news. david: killer clinton has lost seven straight contests to bernie sanders. -- hillary clinton has lost seven straight contests to bernie sanders. lisa: facebook shares gave up early gains today as the company holds its annual developers conference. david: a list of the so-called -- ♪ david: this is "bloomberg markets." time for the bloomberg business flash. a federal appeals court has cleared the way for argentina to settle its debt. since shane or a, argentina has reached deals to pay out over eight billion dollars to creditors. -- since january. in miami, carnival is being sued in federal court. the case involves a policy that prevents cuban nationals from arriving or departing to the island by sea. they said their rights were v

i know i definitely would never want to be in cm. >> cm is the close management unit where some of theoblematic inmates in the entire state of florida are housed. >> keep it quiet, you understand? no talking. >> among them is anthony cruzado, whose most recent problems have involved sending death threats to the president and cutting himself. now he has taken things to a new level. and we warn you, what you are about to hear is graphic and disturbing. >> we heard kicking on the door. i went ahead and i come in the wing and i went to his door. and he was standing there and he had blood on him. and i look down, and he said, "look." and i look down and he had his testicle out of his scrotum. i ordered him to submit to hand restraints. we consisted on up, we took him to medical staff. >> staff believe that he peeled off the casing of a battery and used that to cut himself. he was treated at a local hospital. after returning to prison, cruzado underwent three days of psychological evaluation. >> you can imagine officers and nursing seeing that for the first time, it's pretty bizarre. and so,

. >> reporter: cms wants to bar them from any human tolling testing. >> reporter: they are contestingunderstand federal law, they have ten days to give cms evidence why sanctions should not be levied. that letter was received on march 18th. in the newsroom, andria borba, kpix5. >>> remember this? when uc davis police officer pepper sprayed protestors in 2011? the school suffered negative public at the for months after -- publicity for months, and the school spent big bucks to try to patch up the image, according to some released documents, the university paid consultants at least $175,000 to scrub the internet of all the negative postings, the goal? to cut down on unfavorable search results. >>> san francisco board of supervisors may take a nearly $3.5 million settlement in the deadly airline crash. the plane clipped a sea wall on approach to sfo, and burst into flames. the proposed settlement would cover legal fees and airport repair costs. more than 70 passengers settled their lawsuits against asiana last year. >>> police in riot gear had to intervene in pittsbg to separate some don

if they do we'll work with cms to address all of their concerns.his is hypothetical right now but the sanctions on the table if cms deems their response insufficient again include revoking the certification of that newark, california laboratory. with that comes the prohibition from owning and operating in this industry for two years. that would effect the arizona laboratory which does 90% of its business. so this is what we're talking about when we're talking about regulators threatening a ban from the industry. so the next step here is to see how cms responds to what they got back from theranos. >> fascinating story that just continues to evolve. one story involves the make up of the board which on paper looked like the most impressive board you have seen. >> >> it's most of what you heard about the company. you haven't heard a lot about what it has meant for the valuation of the company and all the rest of it. obviously just fascinating and also the flip side of the whole story coming in which is somehow, this individual had created this kind of

little. >> so we are directly working with the state assuring that the state is currently following cms payment suspension tool kit guidance. >> but how does that get us a new work force and behavioral health system up? >> on the medicaid side we're working directly with the state on access of care issues, on ensuring proper networks. we both from the program integrity side have put in place guidance and are working directly with the state on these issues moving forward on the medicaid side. >> given that three years has gone by -- and i apologize for being so -- interrupting you but this as a physician i was a cabinet secretary for health, this is untenable can you provide something to this committee in writing that would talk about ways in which, god forbid, this ever occurs in any other state anywhere ever again what cms ought to be doing to ensure you didn't spend the kind of acute care dollars? in fact, mr. chairman, people lost their lives in my state and continue to do so. so i would appreciate that responsibility in writing to this committee, if i may, mr. chairman. >> i agree w

that being said cms rarely loses these appeals.f the sapgss are imposed on the lab, the lab loses its license, then that means elizabeth holmes, who the letter is addressed to and her number two, sunny balwani, will be barred from owning any laboratory for two yours, that would force theranos to shut down the second lab in arizona, and severalally put them out of the business for two years. >> they are in the process of preparing a response. what's the timeline, or is this open-ended? >> my understanding is they have already responded to this march 18th letter and cms is considering the response. the response is intended to try to convince the agency not to impose these sanctions. as is often the case in these occasions, if cms does impose sanctions, then the company has a window of time of about 60 days i think to appeal to the administrative law judge and then to the departmental appeals board. and then even if it loses in that process, which could drag on for several months, i believe it can still go to federal court and sue the

the company has responded and they say they are working with cms to work it out, but these are heavyhat could come down on the company. emily: sometimes, these tests are a matter of life and death. these are important blood tests. shira, what is your take on this theranos story? shira: what is the plan b? what if the ceo of this company can't participate in the blood testing industry for a couple years? is there a theranos without elizabeth holmes? emily: i wonder, if things got to that point, caroline, the brand has been damaged at this point. can they survive under the theranos name? caroline: they have to publish data. i think the scientific community does really respect published peer-reviewed data. if theranos can show -- emily: it has been month since they have published. caroline: i think people would at least pause and maybe say, all right, let's see more and maybe give them a chance. i think the brand has been damaged. it is going to take not just one paper, but a number of papers, to convince the industry. emily: caroline chen, sarah frier, thank you both. shira ovide, than

cm jump over cars, people's heads. earning him the title human trampoline. chasing a story. >> we are hearing a lot. perhaps nothing exemplifies the better. 129-foot vessel protecting and serving new york city. phibro came to the rescue of flight 1549, landing in the river after a bird strike cause the engine to fail. the most notable time was december 11. the world trade center tower >> why cannot? >> that is one of the new owners. now fixing up their prized possession. >> you can't on something like this. her custodians, take care of her. we are glad to see. i hope you are. >> plenty of lifejackets. bill: i am surprised it went so cheap. >> i know. a fresh coat of lipstick. >> restaurant owners. >> yes, it is. website to donate, a go fund me page. as of right now anybody can come by. that is going to be free of charge. everything on their works. >> you can't just buy something like this. going to have to pay all kinds of different costs. keep it looking nice. >> they are back. what about why new yorkers a dropping their closed for this guy. >> should they

in november, a federal inspection by cms, the centers for medicare and medicaid services found critical violations at one of her two labs. including failure to properly hire and train qualified staff to run the blood testing machine and allowing unlicensed workers to review patient test results. according to regulators, the lab posed immediate jeopardy to patient safety. >> i feel devastated that we did not catch and fix these issues faster. >> reporter: you hold yourself responsible for hiring the wrong people, not doing the proper oversight, not giving the proper controls in what do you hold yourself responsible for? >> i'm the founder and ceo of this company. anything that happened in this company is my responsibility at the end of the day. we stopped testing and have taken the approach of saying let's rebuild this entire laboratory from scratch so that we can ensure it never happens again. >> reporter: but in a scathing letter in march, cms called her fixes insufficient and threatened to not only shut down her california lab but ban holmes from the industry altogether for at least t

the first time they went back cms came back and said, no, not good enough. gone back again and she's hoping -- hoping that this time it will be good enough. but she knows that this is an ongoing process. i asked her that question, i said, you know, this is not a transportation startup, this is not a makeup startup, this is a startup dealing with people's lives. doctors are writing prescriptions based on these results. >> exactly. >> this is a dangerous business and she goes, i know. you know, i'm going to work harder. i'm going to do better. and we grew really, really fast. i think that's also part of the things that she said is they grew faster than she expected. >> did she speak at all about the possibility of being banned and what that would mean, whether she would continue to run the company that way? >> yeah. i asked her about that. she said, look it, whatever, that will be a decision for the board. whatever they think i can -- how i can best serve, that's an open discussion. i think she feels that this is her baby and she's now at the place where she s

. >> in fact, in a follow-up letter, cms called the fixes, "insufficien "insufficient" and threatened to shut down her lab and ban her from the industry for two years. >> i'm the founder and ceo of this company. anything that happens in this company is my responsibility. >> nbc news reached out to both walgreens and cms. each declined to comment today. we will continue to follow this story. jessica, back to you. >> fascinating interview. thank you, scott. >>> 75 feet in the air. the daring rescue of some hikers who got stranded on a cliff in marin county. >>> i'm michelle roberts in richmond where police are trying to make contact with a woman seen in a facebook video apparently leaving a child unattended in a car. coming up, see that video and the latest on the investigation. >>> the former head of the police officers' association ramps up hostilities between some members of the police department and the d.a.'s office. we'll show you what gary delaine us had to say and reaction from gas cone's office. when consultant josh atkins books at laquinta.com. he gets a ready for you alert th

. --- un da despus del cm, "estrada" fue arrestado en oakland, luego que fue atendido por una rida deala bump lorena ---hacemos nuestra primera pausa en noticiero telemundo 48 a las diez. take vo --se duplica el nmero de muertos por la poderosa explosin en una planta de pemex en mxico. wait for sot 10 sec "todo aquel que le diga le vamos proceswo de los programas daca fraude" cont.vo / lorena --mientras la corte suprema debate los alios gratorioshay una alerta para los inmigrantes a que no caigan vctimas de un fraude. take vo / lorena --sorprendente imageen un ultran las redes sociales... la mujer embarazada dice que es una bendicin... lorena facebook 2 shot/lorena --con toda la atencin que estn recibiendo las polticas migratorias de daca y dapa en estos das..no falta quien se quiera aprovechar de las esperanzas de la gente .. --al parecer..han comenzado a aparecer personas sin escruplos que prometen arreglar documentos...cua ndo en realidad no pueden.. --jesmine thomas nos explica... take pkg :01 :09 no se deje engaÑar por person o negocios que le ofrezcan tramitarle su solicitud de dac

this car was also hit by gunfire cm color="#00ff00"> police focused on yet another car parked down the block. a block which has garnered note right over some time. >> it's not the first time. this is a dozen times that this happens. >> reporter: it happened in sight of the seventh district police station. >> this is something like a norm. and this has to stop. >> reporter: residents have complained, trouble spots have been shuttered. yet the problem continues. and now a little girl, just 7 years old, has been shot.