it cms. so we will forget about that remark. kim has had a lengthy list of credentials, she is currently serving as the principal deputy administrator for operations of the centers for medicaid and medicaid services. prior to that she was here with all of us serving as the chief oversight council on the majority staff from 2011 to 2017. prior to that work kim was a senior counsel at allston and bird so you know bob dole. after working for seven years as the cms director of the medicare program integrity group. prior to that she worked for five years at the hhs office of general counsel as director of external affairs. kim hods a bachelor's degree, a master's degree in legislative affairs from george washington university and a jd with a concentration in health law from the depaul school of law. so talk about two very qualified witnesses. without further adieu, let's get to the meat of this very important hearing. dr. giroir, would you please get us started. >> yes, sir, senator roberts. thank

the same goes with cms testing and optimization. there are always ways to optimize it and understand if there are certain deficiencies or ways that we can optimize the cms. so these two things will be something that we are constantly maintaining and moving forward with. >> any questions for the board? >> thank you for the presentation. it was great. i had a question about the ada features or design considerations. will there be for visually and hearing impaired interacting usage of these signs or static for some of those folks? >> we have been -- we are working on the push to talk functionality for the hearing impaired. based on our interactive finding way systems we use an ada compliant structure. when you touch the wheelly man all of your controls drop to the bottom of the screen so any meal chair assisted consumers can -- wheelchair assisted consumers can use it. >> thank you so much. >> thank you. >> okay. that does conclude your regular calendar for now and at this time you are scheduled to go into closed session. i believe kim

but we also know that according to cms, spending on prescription drugs is expected to grow at an average of 6.3% a year between 2017 and 2026. faster than hospital stays, doctors visits or any other health care sector. in our hearings we have learned it is difficult to track the billions of dollars americans spend each year on prescription drugs, which in 2015 was $457 billion according to the assistant secretary for planning and evaluation at the department of health and human services. we learned that one of the reasons tracking where the money goes is difficult is the use of rebates to reduce list prices. which is when a pharmacy benefit manager negotiates a discount on a drug with a manufacturer. we also learned that while the $457 billion we spent on drugs in 2015 is a big dollar amount, drug spending is only about 6.7% of what we spend overall on health care in america, according to the assistant secretary for planning and evaluation, and that number includes not only drugs purchased at the pharmacy but also drugs given in hospital settings. the administration is taking an action f

. >> cms has a list of medications that are considered high risk for members over the age of 65. it's not that they can't get them but we want the pharmacists to review those prescriptions with their doctor. >> you're saying that they, quote, high risk may have an adverse impact on certain people with certain conditions, certain age groups? >> yes. >> diseases, what have you. >> correct. that review is in place today. >> all right. >> when you transferred over this plan some of the medicare people had a big problem. i think it was around that, that they had been taking medications and all the sudden they were asked to -- >> prior authorization. >> because i don't know how it ever turned out mitchell helped out i hope but there were quite a few problems with that. >> certainly from a risk management point of view it's prudent practice to be certain that you are adverse drug effects are high level of review >> i'm wondering why there would be 1700 risk. >> those are differences. >> between what is being proposed. >> correct. >> once we were to adopt this, you would take the refinem

>> i am not aware of negotiating that cms is doing around cash pay on any product. that was -- we were having discussions, of course, with drug companies that arehink tg about decreasing their list prices to see if we can help clear barriers, do anything in the channel. as i mentioned to you privately, working to see how that can be facilitated to drive prices down. but that story was a mystery to everyone i asked about that. >> then let's make sure we understand what these conversations are all about. you don't see them as negotiating about anything? >> no, no. this is -- if companies are seeking to lower their prices and they're facing barriers from wholesalers or pharmacy benefit managers, we're attempting to seek and can we clear any barriers that we have regulatory, political or otheise around that to help facilitate that. i also -- you know, anything that we do, senar, you made a statement about my previous answer. and i think you sort of cabined it as if it didn't relate to part d. anything that we do to lower list prices will help our patients in part d beca

representing the cms in our role here. so being that it's a number deviseable by five, i thought it was important to take a step back and reflect that important milestone and take a look to see how how the financial status of the program has changed. back and reflect that important it's a short period of time, but there are significant changes that go through, that are reflected each and every year and so just take a little bit of a step back and see how those, see how the programs have changed and the fairly recent past. i'd like to start with this slide because one of the important responsible of the tree's reports is to reflect the financial condition of the programs. that projection looks out 75 years. this slide to me highlights how challenging that prospect is. we do our best. the best economic assumptions to doing so. but if you were to stand in 1977 and try to look just 40 years into the future, the likelihood that you would be able to project that pie certainly how that pie is distributed, maybe you can get close

what that has done is basically since i mentioned earlier, cms conditions of participation. the condition was changed a number of years ago to allow meeting the necessity for an on call physician through the use of telehealth because you can have add an vanced practice physician in the er that can quickly access a board certified physician, but more important even than that is the finding that the use of that kind of tel ler health helps in recruitment of prov this help to aader point f the more we can do to support those professionals in a local environment, the greater likelihood is they'll come through tl because that's how they want to practice withhe support of board certifiy eied physicians and the greater likelihood they'll stay. the other quick example is in the case of the pharmaceutical services. inside the hospital in particular, which is how the e health sweuite from a variable reaches out. you can meet the requirement frs a review of medication as it's being prescribed much more efficiently and effectively through the use of telehealth. >> we've put forward poli

amen. >> anthony: amen. >> cm dufrene: thank you. >> anthony: all right. i got right with god.e on the wall as you walk in, so you know what you're getting. hi. >> lady: how're you doing? >> anthony: oh, real good now. how are you guys doing today? i think oyster po-boy. do you have crawfish etouffee as well? yes? yeah, i got to do that. and do you do pecan pie by the slice, as well? >> lady: yes, sir. >> anthony: okay, i'll be having some of that later. how come my grocery store doesn't have this? { bell ringing ] oh man, eat your heart out. got everything i need here. feeling pretty good about the world, considering. minimal hangover, minimal mardi gras-related damage. few bruises. my age, i should be happy i didn't break my hip. ah, thank you. >> lady: and your pecan pie. >> anthony: thank you. >> lady: how do you like it? >> anthony: so good. really, really good. thank you. >> lady: thank you. >> anthony: i love this place. on balance, my cajun mardi gras experience was certainly memorable if nothing else. and through the parting clouds of cruel winter, there is light, and

contrast and temperatures in new castle may not even reached 20 degrees where i west you can see 28 cmest temperatures in the west because of the breeze coming off the north sea. the wind is going around the high—pressure and across the north sea and it is moving inland and basically once it moves inland, it warms up and by the time he gets to western britain that is where we get the highest temperatures. anywhere from aberdeen from newcastle into nor it, that is where we are seeing these lately lower temperatures, eating there and newcastle temperatures, eating there and n ewcastle o n temperatures, eating there and newcastle on saturday were the high 20s are expected in the west in london always warms up with the heat tide effect. sunday we are saying low— pressure tide effect. sunday we are saying low—pressure approaching our neighbourhood and that is going to produce some showers, very hit and miss. 0nly produce some showers, very hit and miss. only a small risk but probably would think reaching southwestern parts of the uk and wales, and wa nted parts of the uk and wales, and want

we have done the cms dashboard. this inve talked about this hearing so far, that the medicare dashboard, the prices being revealed and direct to consumer advertisements. but do nothing to require companies to show or explain why they are increasing their prices. i want to ask an additional question. before i do i want to associate myself with the many senators who have raised the issue of the trump position on litigation regarding coverage for people with pre-existing conditions. more think of nothing toiety provoking and harmful the people i represent. i want to associate myself with senators who requested additional information of why there is no focus on naloxone authority to negotiate over that. this is costing taxpayers in my state through the roof because we want to make sure every first responder has an opioid overdose reversal drug. the question i want to ask in my time relates to the transparency issue and a topic we have not talked about yet. over the last decade the number of pharmaceutical executives amo

de encontrar del otro lado, donde estamos haciendo movimiento, que la temperatura abajo de unos 20 cmntinÚan buscando a su familia, lograron regresar y rescatÁronlo poquito que les quedo. ¿quÉ encontraste? >> sÓlo mi ropa, que llevo aquÍ ahorita.loÚcoue pud vilma: el volcÁn continÚa activo y hoy se vio el descenso de piedras y humo. >> u otra actividad volcÁnica, entonces segÚn el protocolo, tenemos que evacuar ahorita. ilia: en medio de todo este panorama tan desolador,l volcÁn registrÓ y explosiones intermitentes, obligando a las acciones en las zonas aledaÑas. esto obligÓ a suspender las labores de desapos y reatde cueoÉlica nzÁlez nos muestra las >> mÁs personas fallecidas en esta Área, aldea del rodeo. angÉlica: los bomberos salen uno detrÁs del otro de una de las comunidades destruidas en guatemala, todavÍa aturdidos por lo que estÁn viviendo. >> son criaturas. s es aÑos,en s totalidad calcinados. angÉlica: tres casi borradas delmapa de guatemala es la consecuencia del volcÁn del fuego, una furia que no parece detenerse. >> todas las sirenas de los bomberos estÁn sonando. angÉli

the water on the potomacno is cm right but maryland natural resources police say in minutes an accidentld put boats in danger, thi t weekend,wo brothers from silver springs, franklin and eriberto f irufino bothn their 40's, died after it appears their small fishing boat hit something near cobb island inharles coundy. they were eject policeou differ f their bodies sunday morning >> the boat w found going around ine a circl off cobb island >> spokes wom for natural resources police said the summer to come is already looking like it will be a deadly one for boaters in maryland. in las 18 months, 16 people have died on maryland waters. notf one oem was wearing a li vt >> life jackets are your personal line of defense. all of our victims this year re certainly within sight of shore. in many cases help was on the way. that life jacket givesn you opportunity to stay afloat until we can get there. >> reporter: officialsn makin effort to reach out to the hispanic community. since of the nine deaths, so far this year, six of those victims were hispan thomas saide ineange of tak both while toxic.

la barba mÁs larga de 20 cm, tipo garibaldi, tipo verdi, y hombres con bigotes estilo libre. indocumentado fue separado de su hijo. conmociÓn en la florida por el descubrimiento del

i understand that cms is taking steps to reform the system. recently you and the department and cms have renamed meaningful use, quote/unquote, as advancing care information and now the merit-based incentive payment system also known as mips is promoting interoperability of different systems. i hope these changes are more than just cosmetic, sretary azar, and i hope that they are a sign of meaningful changes to come. so what i wanted to ask you was simply this, which is: what's going to be the practical impact of these changes and how are you going to measure whether they are going to be effective and, you know, basically improving patient outcomes and allowing physicians to spend more time with patients? >> great question, congressman. thank you. the measure for us of interoperability and success with electronic health records is when the patient shows up does their data arrive with them? we have to get out of the business of micromanaging the how of health records and instead when the patient shows up is the information there? do they own it

la barba mÁs larga de 20 cm, tipo garibaldi, tipo verdi, y hombres con bigotes estilo libre.hÍ los tiene. yo me quedo con mis bigotes normales y tranquilos. llegamos al final. gracias y nos vemos maÑana a las seis y a las 11. sÁbado 9 de junioas noches. y estas son las principales noticias. caÓtico final de la cumbre del g7. responsabilidad al primer ministro de canadÁ. se suicida en detenciÓn un hondureÑo que al cruzar la frontera como indocumentado fue separado de su hijo. conmociÓn en la florida por el descubrimiento del cadÁver de una mujerque habrÍa sido atacada por un gigantesco cocodrilo. vamos ahora con toda la informaciÓn. locutor: este es su noticiero univisiÓn fin de semana, con fÉlix y arantxa. arantxa: buenas noches y bienvenidos al noticiero univisiÓn.la cumbre del g7 que reÚne a los principales socios de estados unidos se volviÓ mÁs caÓtica cuando al abandonar a trump insultÓ al primer ministro canadiense dijo que retiraba el -- carlo tiene los detalles. >> casi logran un acuerdo comÚn pero lo cierto es que el momento mÁs tenso entre los paÍses miembro del grup

as joe mentioned this is my fifth year as chief actuary representing the cms in our role here. so cma is a number dwizible by five. i d divisible by five. to take a look at how the financial status of the programs have changed over that five-year program. relatively short period of time in terms of the context of the evaluation of the programs. but there are significant changes that are reflected each and every year so just take a little bit of a step back and see how those see how the programs are changing in the fairly recent past. >> i like to start with this slide. because one of the important responsibilities of the trustees' reports is to project the financial condition of the programs. that projection looks out 75 years. and this slide to me highlights how challenging that prospect is. we do our best. we apply what we think are the best actuarial and economic assumptions to doing so. but if you were to stand in 1977 and try to look, just 40 years into the future, the likelihood that you would be able to project that pie certainly how that, that pie is distributed, it may

my recollection is that it used to be 46% of hospital revenues came from cms. it could go to 60 or more. i suspect that will have an effect on them. so for doom and gloom, the average age of the medicare population, when we get to 2026, is still less than aed, but the increase in deaths will accelerate after 126 -- less than 80. i think it will strip things whether the trust fund is invalid or not. >> certainly true. i think i detected some investment advice. >> by funeral homes? >> yeah. but more broadly, what you're saying is that the whole nature of the health care system is going to have to change. it's not just because there won't be enough bodies to fill the beds, it's because that isn't going to be essence the way to deliver health care and then. it probably isn't really sensibly to deliver health care now. >> this morning we talked about the fact they may not be dying in hospitals. they may be dying in nursing homes that medicare doesn't get involved with. >> peter, i think we all have to worry about the explosion of hospital costs. as we all know healt

ago 26 cm of rain fell in just one day, a lot of warnings out on the short term across much of india india, bangladesh into the himalayas and across towards myanmar and thailand where we have concerns about the intensity of that rainfall. on a slightly smaller scale the total $0011 slightly smaller scale the total soon mount up with this from being so soon mount up with this from being so slow moving all the —— always an essential part japan to the tip of the korean peninsula into the heart of china through shanghai and back toward the southwestern quarter, an awful lot of rain at the start of the week, still pretty wet there and tha nkfully the week, still pretty wet there and thankfully things have dried out in the northern parts of vietnam where there were fatalities from flooding. for australia, not overly warm at the moment. if you always think of heat and sunshine, think again. there is sunshine to be had but 14, 15, 16 degrees there is sunshine to be had but 14, 15,16 degrees or so, 17 in sydney after a wet spell of whether their things drying out. the islands of new zealand,

before i start my questions, i want to urge your staff at cms to carefully consider the requests of the entire bipartisan new jersey delegation to extend the imputed rule. this is critical to new jersey hospitals. i hope that you will have your staff pay some critical attention to it. cms predicts prescription drug price growth in 2018 will be double what it was in 2017, contrary to the president's pronouncement that there would be a, quote, voluntarily massive drop in prices in early june. one of the reasons that we are not seeing reduced prescription drug prices is because some bad actors continue to game the system to prevent cheaper drugs from coming to market. in fact, the fda recently named and shamed some of the worst actors. congress is working to pass the creates act, which is a bipartisan bill that would go after the abuse of some companies that are preventing cheaper drugs from coming from market. does the administration support the act? >> we don't have a formal administration support on it, but what's in the act resonates completely with what we have been staying and what t

i understand that cms is taking steps to reform the system. recently, you and the department and cms have renamed meaningful use, quote-unquote as advancing care information. and now the merit-based incentive payment system, also known as mips is promoting intraoperatability of different systems. i hope the changes are more than just cosmetic, secretary azahra and i hope they are a sign of meaningful changes to come. what i want to ask you is this, what's going to be the practical impact of these changes and how are you going to measure whether they are going to be effective and basically improving patient outcomes and allowing physicians to spend more time with patients. >> the measure for us of intraorpability and success with electronic health records, when the patient shows up, does the data arrive with them. we've got 0 get out of the business of micromanaging the how of medical health records. instead when the patient shows up, do they own it, do they have access to it and get the doctor's eyes off the screen and on the patient. and love

many different, whether it is cms, whether it is the fda, whether it is other regulatory agencies, of and for a company like johnson & johnson, given we are the largest health-care company, representing so many different interests, we think it is vital that we state engaged, again, in an appropriate way. david: and does the white house at least listen to advice? let's talk about trade for a second, very much in the news these days. are trade wars good for johnson & johnson? alex: no. we want a trade environment that is collaborative. we operate on a global stage. and making sure that we have reasonable trade guidelines in place -- and it does not mean we should not be revising and updating, particularly given the amount of time, for example, with nafta and other things, but let's make sure we don't throw the baby out with the bathwater. that we build on some of the constructs, recognizing that these are important partners for us as part of an overall global economy. ♪ david: you have got a very big company here. do ever think about whether it should be broken up? ♪ ♪ david: we talked

reports are being denied for cm chrysler. see is declined comment on the matter.to marchionne said automaker -- business flash. europeans happening to markets, were down for the second consecutive week. were down for the month. we had interesting month or two. you can't see it but all 90 industry groups are rising today. the closes next. this is bloomberg. ♪ what's a gig of data? well, it's a whole day's worth of love songs. 300 minutes of baby videos. or, it's a million chat messages. a gig goes a long way. that's why xfinity mobile lets you pay for data one gig at a time. and with millions of wifi hotspots included, you'll pay less for data. it's a new kind of network designed to save you money. click, call or visit a store today. bigelow cap european markets as we have for the close. the migration compromise that took place in brussels in the early hours of today lifting sentiment today. the euro gaining along with european equity market. sinceggest monthly drop may for the quarter, the stoxx 600 is high. europeanhe gauge the benchmark by 5%. closing at the two

but we also know that according to cms, spending on prescription ugs is expected to grow at an average of 6.3% a year between 2017 and 2026, faster than hospital stay sta for doctor a r visit or any other health-care sector. the hearings we also learned it is difficult to track the billions of dollars americans spend each year onscriion drugs, which in 2014 was $457 billion according to the assistant secretary for planning and evaluation at the department of health and human services. we learned one of the reasons tracking where the money goes is dit ifficulthe u rebates to reduce the list prices which is when a pharmacy benefit manager negotiated discount on the drug was manufactured or. we also learned when over 457 billion that we spend on nt,ou drugpending is onlyllar about 6.7% of what we spend overall on healthcare in america according to the assistant secretary for planning and evaluation. that number includes not only drugs purchased at the pharmacy but alsorugs given in hospital settings. the information has taken action to the same reason we held our hearings. we all know man

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ll call ] >> you have a cm. >> the ringing and use of cell ic des are prohibitundng p the. any person responsible for one going off may be asked to leave the room. we request they be turned. for approval of minutes of the may 1 regular meeting. >> do i have any public comment on the minutes? no. seeing none, do i have a first or sec al favor? any opposed. minutes are approved. >> item five, communications. i know of none. introduction of new business by board members. i would like to welcome director borden myself back on the board. i'm sure we were missed. director heinicke had a fantastic job. i was on a student rush hour bust yesterday and it was fascinating. it's not a line i usually ride during the week. it's usually a weekend line for me. the number of students using that bus going to san francisco state and various public and private high schools along the way was truly impressive. there were kids doing their homework on the bus. i know not a recommended study habit practice, but parents getting kid to day care, students getting themselves to school. it was a good re

with respect to odors and i think, the other thing is, one of the reasons we need the cm augmentation, because we plan to have a lot of inspectors on board, not just to inspect the job, but to meet our requirements we laid out as part of the eir, to make sure for example, there is no idling cars, or that traffic is minimized or efficient. so all those tools are already being built in to hopefully negate issues that -- i mean, construction elements we know exist, but sort of soften the impact all around. >> supervisor kim: will there be a site that the puc will maintain so neighbors are aware of the construction schedule? >> turned out we've implemented -- it's basically a construction website where we e-mail to inform biweekly. and obviously that can ramp up depending on the effort, but there is also a call-in number, that people can call in and say, what is going on? >> is it a voice mail service? >> depending on at the peak construction, i see it a live voice during the work hours. and our lead of the projects will be in the front line of answering a lot of those calls. >> superviso

ll call ] >> you have a cm. >> the ringing and use of cell ic des are prohibitundng p the. any person responsible for one going off may be asked to leave the room. we request they be turned. for approval of minutes of the may 1 regular meeting. >> do i have any public comment on the

there are various cm songs and everhing from the iphone six to the iphone x.of them appeared to be -- they say it gravitates towards older devices. things that are running on older software. it does appear the sanctions have gotten tougher before yesterday's meeting. that might have parred back some exports. if yesterday went well, maybe he will be able to get one in the future. emily: is there a concern that some of these products, particularly american products, can be used in cyber espionage? julie: right, absolutely, that is a big concern. a lot of these might be used -- espionage might be happening outside of mainland north korea. it is a concern thing they could be using software devices from in american company to do things like cyber espionage and work on threats to the united states using american products. that is something the reports call out as a reason of concern of them using it. although, again, if they do, in fact, go away from nuclear plans, denuclearize the nation, it would not be much of a problem going forward. emily: that was "bloomberg t

. >> are you expanding the current cm contract? >> yeah. we need our contract to continue for phase 2. we need to have a seamless transition. >> thank you. >> call your next item, item 6 is the construction update. >> good morning directors. jeff peterson. right now we will present the june construction update. a lot of activity to present. a lot of pictures to show. ron will cover the schedule and budget and rifts as we get to the finish line and then jess will talk to the tco for substantial completion update. the picture here that we've been carrying for a long time continues to get groeener and greener. it's greener from this picture because they adde a lot of sod from a couple of days ago. all that sod is in place at the western end. so making some great progress. with our graphic here, that we'll probably pretty soon be retiring is. coming -- is coming along nicely. the main part left is building out the amphitheater area. once they finish out the sod they are also doing the paving of the pathway which has been a major operation. half

we have seen some 26 cm of rain falling just in the north of mumbai within the past 2a hours or so. ofuse the way toward the northeast of india where roundabouts the area of india where roundabouts the area of the highest level of warning from indian authorities is in force as we speak and indeed right through to the weekend. such as the deluge from that monsoon. none too subtle but the moment across the islands of japan and some of that rain linking back to the far south of the korean peninsula. we have also seen real issues with letting and fatalities from those floods across the southwestern quarter of china and also into the north of vietnam. by contrast things are good deal quieter as we come to australia. high pressure trying to dominate but you will see it is not doing quite enough to keep the fronts addae from those australian bank shores in the far south wet and windy here and if you are talking to the new zealanders over the next couple of days don't harp on about the heat because their top temperature on the day is 12—1a and night—time frost abound. we have heat in the briti

you to the critical foundation for their financial support -- support but also practical support from cm swanson and. theresa: and thank you to -- who is running around somewhere helping us get prepared and to tyler john and andy who have been helping out throughout the night after the q&a we are going to have come after the discussion will have q&a so if you have any discussions during this time feel free to keep them in your head and someone will be running after the interview is over so you can ask your questions. were going to have a reception until 8:00 p.m. so when this ends please go out into the hall and ted will be there if you do have a book to sign the book for you all although we won't be selling books unfortunately tonight. before we start the interview i just want to say that spring is in the air y'all. let's give a big round of applause for spring. it's beautiful, finally right? this has been a particularly long one and it's nice to see how many are venturing outside and maybe putting their screens down for a second and really enjoying the sights and the smells of the awak

end of the be and how you see the pre- behaving in congress with this greatly reduced position in the cmsrtion from the parties as well adapted? >> good that you mentioned the undecided and there is a lot of debate in mexico about what it means not to answer the question about electoral preference and let's say that the proper term is people who do not declare an electoral preference and the media sometimes confuse these is undecided but the precise term is i cannot respond to these people and they do not answer the question and it becomes a black box that does not include people who say i have not made up my mind but we also have their people that say none of these candidates will not vote and i will vote in secret so when you look at the 20% who do not give us an answer to the electoral reference question i would say that about 8% of the electorate are undecided but the thing is many of them are undecided on many other issues and they don't give us an opinion about the party or the candidate and i would say this is people that unite us from the political systems and i would not expect t