[Senate Hearing 117-341]
[From the U.S. Government Publishing Office]
S. Hrg. 117-341
NOMINATIONS OF ANDREA JOAN PALM
AND CHIQUITA BROOKS-LaSURE
=======================================================================
HEARING
before the
COMMITTEE ON FINANCE
UNITED STATES SENATE
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
on the
NOMINATIONS OF
ANDREA JOAN PALM, TO BE DEPUTY SECRETARY, DEPARTMENT OF HEALTH AND
HUMAN SERVICES; AND CHIQUITA BROOKS-LaSURE, TO BE ADMINISTRATOR,
CENTERS FOR MEDICARE AND MEDICAID SERVICES
__________
APRIL 15, 2021
__________
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Printed for the use of the Committee on Finance
_________
U.S. GOVERNMENT PUBLISHING OFFICE
48-327 WASHINGTON : 2022
COMMITTEE ON FINANCE
RON WYDEN, Oregon, Chairman
DEBBIE STABENOW, Michigan MIKE CRAPO, Idaho
MARIA CANTWELL, Washington CHUCK GRASSLEY, Iowa
ROBERT MENENDEZ, New Jersey JOHN CORNYN, Texas
THOMAS R. CARPER, Delaware JOHN THUNE, South Dakota
BENJAMIN L. CARDIN, Maryland RICHARD BURR, North Carolina
SHERROD BROWN, Ohio ROB PORTMAN, Ohio
MICHAEL F. BENNET, Colorado PATRICK J. TOOMEY, Pennsylvania
ROBERT P. CASEY, Jr., Pennsylvania TIM SCOTT, South Carolina
MARK R. WARNER, Virginia BILL CASSIDY, Louisiana
SHELDON WHITEHOUSE, Rhode Island JAMES LANKFORD, Oklahoma
MAGGIE HASSAN, New Hampshire STEVE DAINES, Montana
CATHERINE CORTEZ MASTO, Nevada TODD YOUNG, Indiana
ELIZABETH WARREN, Massachusetts BEN SASSE, Nebraska
JOHN BARRASSO, Wyoming
Joshua Sheinkman, Staff Director
Gregg Richard, Republican Staff Director
(ii)
C O N T E N T S
----------
OPENING STATEMENTS
Page
Wyden, Hon. Ron, a U.S. Senator from Oregon, chairman, Committee
on Finance..................................................... 1
Crapo, Hon. Mike, a U.S. Senator from Idaho...................... 3
Menendez, Hon. Robert, a U.S. Senator from New Jersey............ 6
CONGRESSIONAL WITNESS
Baldwin, Hon. Tammy, a U.S. Senator from Wisconsin............... 5
ADMINISTRATION NOMINEES
Palm, Andrea Joan, nominated to be Deputy Secretary, Department
of Health and Human Services, Washington, DC................... 7
Brooks-LaSure, Chiquita, nominated to be Administrator, Centers
for Medicare and Medicaid Services, Department of Health and
Human Services, Washington, DC................................. 9
ALPHABETICAL LISTING AND APPENDIX MATERIAL
Baldwin, Hon. Tammy:
Testimony.................................................... 5
Brooks-LaSure, Chiquita:
Testimony.................................................... 9
Prepared statement........................................... 49
Biographical information..................................... 50
Responses to questions from committee members................ 59
Crapo, Hon. Mike:
Opening statement............................................ 3
Prepared statement........................................... 103
Menendez, Hon. Robert:
Opening statement............................................ 6
Palm, Andrea Joan:
Testimony.................................................... 7
Prepared statement........................................... 104
Biographical information..................................... 105
Responses to questions from committee members................ 113
Wyden, Hon. Ron:
Opening statement............................................ 1
Prepared statement with attachments.......................... 137
(iii)
NOMINATIONS OF ANDREA JOAN PALM,
TO BE DEPUTY SECRETARY, DEPARTMENT OF
HEALTH AND HUMAN SERVICES; AND
CHIQUITA BROOKS-LaSURE, TO BE
ADMINISTRATOR, CENTERS FOR MEDICARE AND MEDICAID SERVICES
----------
THURSDAY, APRIL 15, 2021
U.S. Senate,
Committee on Finance,
Washington, DC.
The hearing was convened, pursuant to notice, at 9:30 a.m.,
via Webex, in the Dirksen Senate Office Building, Hon. Ron
Wyden (chairman of the committee) presiding.
Present: Senators Stabenow, Cantwell, Menendez, Carper,
Cardin, Brown, Bennet, Casey, Warner, Whitehouse, Hassan,
Cortez Masto, Warren, Crapo, Grassley, Cornyn, Thune, Cassidy,
and Daines.
Also present: Democratic staff: Michael Evans, Deputy Staff
Director and Chief Counsel; Ian Nicholson, Investigative and
Nominations Advisor; and Joshua Sheinkman, Staff Director.
Republican staff: Kellie McConnell, Health Policy Director; and
Gregg Richard, Staff Director.
OPENING STATEMENT OF HON. RON WYDEN, A U.S. SENATOR FROM
OREGON, CHAIRMAN, COMMITTEE ON FINANCE
The Chairman. The Finance Committee will come to order.
Today, the committee meets to discuss two important health-care
nominations. Chiquita Brooks-LaSure has been nominated to serve
as Administrator for the Centers for Medicare and Medicaid
Services, and Andrea Palm is nominated to serve as Deputy
Secretary of the Department of Health and Human Services.
Ms. Brooks-LaSure has served at OMB, on the staff at Ways
and Means, at the Department of Health and Human Services, and
she has worked in the private sector. She helped craft policies
bringing down costs for older people. She helped to develop and
pass key portions of the Affordable Care Act. She helped
implement the law, and she worked hard to make sure that
middle-class families shopping for private health options would
get a fair shake thanks to strong consumer protections.
Now, the Trump administration later undermined a lot of
those protections, and that has created a host of new
challenges for the committee and for the Biden administration.
Ms. Brooks-LaSure is also very well-versed in Medicaid
policy, which is a hugely important part of this committee's
responsibility. She has worked closely with the Federal
Government, States, and private organizations to expand
coverage.
Continuing on the theme of impeccable qualifications and
experience, Ms. Palm is a proven health-care agency leader who
knows what it takes to run HHS in a smooth way. She previously
served as the Department's Chief of Staff and Senior Counselor
to the Secretary during the Obama administration. Most
recently, she served as Secretary-Designee of the Wisconsin
Department of Health Services, a $12-billion agency. She has
been the point person when it comes to COVID response in the
State of Wisconsin. There she led efforts to expand insurance
coverage, improve mental health care, and reduce hunger.
My bottom line: these are two individuals who are
extraordinarily qualified for these essential positions and
would be ready to go on Day 1 after they are confirmed by the
Senate. There is a lot of work to be done at HHS; vaccinations
are way up, but cases and deaths are still awfully high. Long,
long way to go on the pandemic.
Now, the committee is also going to keep working on other
important health challenges, which I and other members have
discussed with our nominees. For example, I have said that
every single time this committee talks about Federal health
programs, we are going to be talking about updating the
guarantee of Medicare. When I was coming up with the Gray
Panthers, Medicare was an acute-care program. If you broke your
ankle, it was Part A, or if you had a horrible case of the flu,
then you went to the doctor or hospital for the broken ankle.
Today, Medicare is cancer and diabetes and heart disease and
strokes, and so many older Americans have two or more of these
conditions.
So this committee led the bipartisan passage of the CHRONIC
Care Act in 2017. The Trump administration slow-walked the
implementation. So I am looking forward to working with both of
our nominees to turn this situation around.
Second, the American Rescue Plan made a big down payment on
mental health services. Senator Stabenow has worked tirelessly
on this issue. And I was very pleased that now in the Medicaid
program, for several years, we will have the CAHOOTS program,
which is a fresh and exciting model so that mental health
professionals and law enforcement professionals are teaming up
to deal with the tragedies we see on our streets that so often
involve mental health needs. I am very proud that Oregon has
been a pioneer, and I gather, based on reports, that the Oregon
program, their phones are ringing off the hook from around the
country, from communities that want to copy what we have done.
A special priority for us on the Finance Committee is
dealing with the issue of inequality in Federal health
programs. We saw once again, during the pandemic, the results
of health-care disparities up close. Blacks, Latinos and Native
Americans have suffered and died from COVID-19 at much higher
rates. Now, it is not just about COVID-19; it is about maternal
health, because women today are more likely to die in
childbirth than their mothers were a generation ago.
It is outrageous, I say to our nominees and colleagues,
that in affluent white suburbs there are all kinds of health-
care services of the most sophisticated nature, and in so many
communities of color, it is like a health-care desert, and this
committee is determined to change that.
Finally, we will be working closely with all of you on the
issue of lowering prescription drug costs. A lot of Americans
feel they are just getting mugged when they go to the pharmacy
counter, and we have concrete ideas for doing something about
it.
In addition to the CAHOOTS program, there will be other
mental health issues. I am very troubled about the fact that
the parity law, which is supposed to give mental health and
physical health the same treatment, seems to be honored too
often in the breach rather than in the observance. We will talk
to you about that as well.
I want to thank both of you for being willing to do another
stint in public service. We will hear from Senator Crapo, our
ranking member, also from the Pacific Northwest, and then we
have our colleagues here to introduce our nominees.
Senator Crapo?
[The prepared statement of Chairman Wyden appears in the
appendix.]
OPENING STATEMENT OF HON. MIKE CRAPO,
A U.S. SENATOR FROM IDAHO
Senator Crapo. Thank you, Mr. Chairman.
When we held our hearing for Xavier Becerra to be Secretary
of Health and Human Services, I noted the size and importance
of the department he would lead.
In normal times, HHS and its agencies provide health-care
service to nearly 150 million people, and those agencies affect
the lives of many, many more on a daily basis. The COVID-19
pandemic has raised the salience of the Department. The
Department's leadership, including the Deputy Secretary, will
continue to play a key role in bringing us out of this public
health emergency.
Similarly, Medicare and Medicaid are providing essential
health care to patients who have suffered disproportionately
from the COVID-19 pandemic. Looking to the future, the
Secretary, the Deputy Secretary, and the CMS Administrator must
carefully evaluate how best to use resources available to them
to promote the health of our citizens. They must do so
carefully, constructively, and creatively.
Two months ago, I outlined several issues in the health-
care space where I intend to focus my efforts as ranking
member, including fostering innovation to improve patient care
and make our health-care system more efficient. The COVID-19
pandemic has threatened Americans' physical and economic
health, but it has also reinforced the value of innovation and
provided an opportunity to test changes that foster it.
HHS has used this authority under the public health
emergency to waive numerous requirements to ensure Medicare and
Medicaid beneficiaries and other patients receive care during
the pandemic. Patients and providers have benefited from
expanded access to telehealth and expedited approval of COVID-
19 vaccines, diagnostics, and treatments. Going forward,
Medicare and Medicaid patients must have the same access to
those innovative items and services as those with commercial
insurance.
We must carefully evaluate our response to the pandemic and
implement appropriate reforms based on the lessons we have
learned. HHS should partner with this committee in that effort.
However, media reports about certain health-care policies
that may come before Congress, or be enacted through executive
actions, are concerning to me. Some of these policies, such as
including additional benefits under Medicare, could experience
bipartisan support if considered through a transparent,
cooperative, bipartisan process. Unfortunately, reconciliation
does not afford Congress the opportunity to work together to
evaluate these changes and make necessary reforms to protect
the long-term financial viability of the program.
Other policies, such as expanding Obamacare's premium
subsidy to everyone, regardless of income, would be incredibly
expensive for taxpayers without taking appropriate steps to
lower the cost of health insurance.
Creative, bipartisan ideas to lower the cost of insurance
in the individual market have been raised by States and my
colleagues in this committee. I welcome the opportunity to work
together on these ideas, such as allowing States to use waivers
to their full potential, diversifying benefit designs and
incentivizing competition.
Finally, I am concerned about paying for some of these
policies through changes in our drug pricing system that could
stifle innovation. We can see the end of the COVID-19 pandemic
approaching, thanks to groundbreaking vaccines developed by
pharmaceutical manufacturers. In this crisis, industry
responded to the Nation's call to arms, code-named Project Warp
Speed, developing powerful and effective vaccines in record
time.
This success was possible because of the private sector. I
strongly agree with my colleagues that this innovation is only
valuable if patients can afford it. We should establish an out-
of-pocket spending cap and reform Medicare Part D with the
market-based principles of competition and transparency in
mind.
Ms. Palm and Ms. Brooks-LaSure, if you are confirmed, I
look forward to working with you to improve our health-care
system. I ask you to commit to careful assessments of the risks
and considerations in every policy decision you make.
Political pressures possibly make unilateral actions seem
attractive, but you should also consider how the market,
individual choice, public policy, and incentives play vital
roles in development and delivery of health care.
I look forward to hearing your testimony and your responses
to questions.
These positions to which you have been nominated have
substantial influence over policy. The members of this
committee need to understand how you will implement the
administration's agenda. And we expect your answers here and in
response to the QFRs to be detailed and candid.
I look forward to the opportunity to visit with you today.
Thank you, Mr. Chairman.
[The prepared statement of Senator Crapo appears in the
appendix.]
The Chairman. Thank you, Senator Crapo.
Our nominees have the good fortune of being introduced by
two Senators with a long history of health-care advocacy, and
we will start with Senator Baldwin, who will introduce Ms.
Palm; then we will go with Senator Menendez, who will introduce
Ms. Brooks-LaSure.
Senator Baldwin?
STATEMENT OF HON. TAMMY BALDWIN,
A U.S. SENATOR FROM WISCONSIN
Senator Baldwin. Thank you, Chairman Wyden and Ranking
Member Crapo, for holding this hearing, and I am honored to be
here today to introduce Andrea Palm, President Biden's nominee
for Deputy Secretary of Health and Human Services.
More than 2 years ago, Governor Tony Evers selected Andrea
Palm to serve as Secretary of the Wisconsin Department of
Health Services. I met with her very soon after that
announcement and was immediately struck with her expert
understanding of the health policy landscape, as well as her
keen interest in building relationships with stakeholders from
across our State.
Her prior experience, as a Senior Counselor to HHS
Secretary Burwell and as a Senior Advisor on the White House
Domestic Policy Council, provided her with strong
qualifications to serve our State. With this foundation of
experience, Andrea Palm delivered leadership to Wisconsin
during the COVID-19 pandemic, and she built an effective
response to the public health crisis we faced in our State,
including her efforts to build a testing, contact tracing, and
vaccination infrastructure in the State of Wisconsin.
Andrea's nomination as Wisconsin DHS Secretary, like other
nominations from our Governor, was politicized from the
beginning by the Republican-controlled Wisconsin State
legislature. It is true they held up her nomination for months
during an unprecedented global health crisis. It is also true
that the State legislature refused to convene for more than 9
months, and instead sought to limit the power of the Governor
and other public health leaders even as Wisconsin was
experiencing one of the worst COVID-19 outbreaks in the
country.
Despite these barriers, Andrea Palm led and put the people
of Wisconsin ahead of State capital politics. In the face of
consistent and constant political bickering and obstruction,
Andrea Palm stayed the course and lived up to our State motto:
``Forward.'' She made every possible effort to collaborate with
stakeholders and trusted messengers throughout the State to
protect Wisconsinites and provide them with the information
needed to protect themselves and their families. And most
importantly, Andrea provided leadership in Wisconsin that was
always focused on science, public health, and the idea that we
are all in this together.
Because of Andrea's leadership, Wisconsin has maintained
one of the fastest vaccination rates in the country. She set us
up for success in Wisconsin as a national leader in getting
people vaccinated quickly, and I give her a tremendous amount
of credit for where we today, because she helped put the
partnerships in place that we have used to get shots in
people's arms and to protect public health.
She also worked to ensure robust data transparency since
the very beginning of the pandemic, which continues to inform
our vaccine roll-out and help us reach underserved communities.
And in rural areas of Wisconsin, residents are getting
vaccinated as quickly and as easily as residents in urban
areas, a direct result of her focus on building relationships
with stakeholders across our State.
Having Andrea back at HHS will be a tremendous benefit for
the Department and all of our States, because she understands
the urgent need to beat this pandemic and ensure the health and
safety of all Americans.
Andrea, welcome back to the Senate, and thank you for your
service to the State of Wisconsin. Your hard work has always
enabled you to meet and overcome challenges, and I look forward
to seeing you confirmed as Deputy Secretary of Health and Human
Services.
The Chairman. Senior Baldwin, thank you, and you are always
welcome in this committee.
Senator Menendez?
OPENING STATEMENT OF HON. ROBERT MENENDEZ,
A U.S. SENATOR FROM NEW JERSEY
Senator Menendez. Well, thank you, Mr. Chairman. And there
are many reasons we want to finally beat this pandemic: the
health and welfare of our families, our neighbors, and our
fellow Americans. And because, after 16 years, I had finally
worked my way down this dais close to Senator Stabenow, I am
hoping that we can get to that point--that we can get there
again.
Mr. Chairman, Ranking Member Crapo, and fellow members of
the Senate Finance Committee, today I have the pleasure of
introducing you to Ms. Chiquita Brooks-LaSure, President
Biden's nominee to lead the Center for Medicare and Medicaid
Services. And I must admit, I was thrilled to learn of Ms.
Brooks-LaSure's nomination to serve as CMS Administrator.
A native of Willingboro, NJ, Ms. Brooks-LaSure graduated
from Princeton University, earned a master's in public policy
from Georgetown, and embarked on an impressive career in
Federal health policy.
To say Ms. Brooks-LaSure understands the U.S. health-care
system would be an understatement. Over the course of more than
2 decades, she has amassed a deep working knowledge of Federal
health-care policy and the vital role that programs like
Medicare, Medicaid, and the Affordable Care Act play in the
lives of patients and consumers, especially those who are from
low-income communities and communities of color.
CMS is sure to benefit from Ms. Brooks-LaSure's extensive
experience, from her early days coordinating Medicaid policy in
the Office of Management and Budget; to her work with the House
Ways and Means Committee, passing signature legislation like
the Affordable Care Act; to her service as Director of Coverage
Policy at the Department of Health and Human Services; as well
as deputy director for policy at the Center for Consumer
Information and Insurance Oversight.
Most recently in the private sector, Ms. Brooks-LaSure
worked at the firm of Manatt, Phelps, and Phillips, helping
clients in the health-care space navigate regulatory issues
often involving Medicaid and Medicare.
Simply put, her credentials are impeccable. And her
commitment to building a more equitable and accessible health-
care system is unshakable. If confirmed, Ms. Brooks-LaSure will
be the first
African-American woman ever to serve as CMS Administrator, and
her historic nomination comes at a historic moment for our
country.
The COVID-19 pandemic has exposed and aggravated the long-
standing racial inequalities and inequities in our country,
that even in good times, leave people of color more vulnerable
to poor access, financial hardship, disease, and death. As we
emerge from this crisis, I can think of no one better
positioned or more committed to rooting out the disparities in
our health-care system than today's nominee, Ms. Brooks-LaSure.
And I know my colleague from New Jersey, Senator Booker,
asked as well to join in our enthusiasm for her historic
nomination.
Thank you, Mr. Chairman.
The Chairman. I thank our colleague, and our colleague has
been heavily involved on health-care issues here today, so we
are glad to hear his ringing support for the nominee.
I am also at this point going to introduce a letter of
support, and a statement for the record.
Without objection, I will make these a part of today's
hearing record.
[The letter and statement appear in the appendix beginning
on p. 138.]
The Chairman. We will now have opening statements for Ms.
Palm and Ms. Brooks-LaSure, and then we have some formalities
we have to deal with. I thank our colleagues for being here.
Ms. Palm?
STATEMENT OF ANDREA JOAN PALM, NOMINATED TO BE DEPUTY
SECRETARY, DEPARTMENT OF HEALTH AND HUMAN SERVICES, WASHINGTON,
DC
Ms. Palm. Thank you, Chairman Wyden, Ranking Member Crapo.
Good to see you both this morning. I'm grateful for the
opportunity to testify before you today as President Biden's
nominee for Deputy Secretary of the United States Department of
Health and Human Services.
I want to thank Senator Tammy Baldwin for the kind
introduction and for her work on behalf of the people of
Wisconsin. I'd also like to acknowledge and thank my husband
Dan, who is here with me today. And thank you to the members of
this committee for considering my nomination. I have enjoyed
the opportunity to speak with many of you individually
throughout this process.
I was born and raised in Star Lake, NY, a town of about
1,000 people. When you grow up in a small town, you understand
from a young age that together is the only way to get things
done. That sense of community was formative and is what led me
to become a social worker. I spent my twenties as a caseworker,
finding safe homes for children in crisis and working with
people in behavioral health crises.
These experiences shaped the rest of my career. It was the
children and families I worked with during this time that made
me want to change the system, and drew me to public service and
to public policy. The memories of these kids are what still
motivates me today.
I have spent my entire career focused on health and human
services policy and lifting our most vulnerable communities,
from my time in the Senate working on the HITECH Act to serving
at HHS, where I played a key role in implementing the
Affordable Care Act and negotiating bipartisan policies with
Congress like the 21st Century Cures Act.
Most recently, I had the privilege of leading Wisconsin's
Department of Health Services. I am proud of the work we were
able to accomplish in Wisconsin. There, we found ways to make
progress on a bipartisan basis, expanding access to telehealth
services, our innovative children's health insurance program to
tackle childhood lead poisoning, and improving delivery of the
programs at the Department more broadly to better serve the
people of Wisconsin.
And when the pandemic hit, we led with fact, science, and
transparency to protect our communities. As every single State
did, we faced challenges in Wisconsin. But we built a strong,
State-wide response, leveraging government assets and the
expertise of our
private-sector partners to build a stable testing and contact
tracing system, reaching our rural communities, and vaccinating
Wisconsinites. And it is working. As Senator Baldwin noted,
Wisconsin is among the top States in vaccinating our residents.
When I was previously at HHS, then-Secretary Burwell would
joke that if there was an issue that was going to require
bipartisan cooperation, the team should give it to me. She
called my portfolio the ``common ground agenda.'' And if I have
the honor of being confirmed and returning to HHS, that is what
I am bringing with me: a common ground agenda.
First, we must end the COVID pandemic. I know we can all
agree that we have lost far too many Americans to this virus.
President Biden put forward ambitious goals, and Congress has
followed through, providing the resources to get the job done.
If confirmed, I look forward to implementing the American
Rescue Plan, getting vaccines in arms, rebuilding the public
health workforce, and securing the Nation's supply chain.
Second, we must expand access to high-quality, affordable
health care. The American Rescue Plan took a major step in
bringing down the cost of health care for working families, but
we cannot stop there. We must strengthen our Medicare and
Medicaid lifelines, reduce the cost of prescription drugs,
better integrate mental health and substance use disorder
treatment into our health-care system, and ensure our global
leadership in research, development, and innovation.
And finally, we must prioritize human services. HHS has an
important role to play, from caring for children to advancing
the health and well-being of people with disabilities. We must
not lose sight of those core missions.
HHS faces big challenges. And it is our responsibility to
be tireless stewards of an agency that touches nearly every
aspect of American life. To me, that is what public service is
all about; making government work for the people it serves, and
leaving the country better than we found it.
I am ready for the task, and eager to continue serving.
Thank you again for considering my nomination.
The Chairman. Thank you very much, Ms. Palm. And we will
have some questions here in a bit.
[The prepared statement of Ms. Palm appears in the
appendix.]
The Chairman. Ms. Brooks-LaSure?
STATEMENT OF CHIQUITA BROOKS-LaSURE, NOMINATED TO BE
ADMINISTRATOR, CENTERS FOR MEDICARE AND MEDICAID SERVICES,
DEPARTMENT OF HEALTH AND HUMAN SERVICES, WASHINGTON, DC
Ms. Brooks-LaSure. Chairman Wyden, Ranking Member Crapo,
and members of the committee, thank you for considering my
nomination to be the Administrator of the Centers for Medicare
and Medicaid Services. It is humbling to be before you. And
thank you to Senator Menendez for his kind introduction.
My career in public service started at the Office of
Management and Budget, working on CMS's budget, Medicaid, and
CHIP. But after 9/11, everything changed. It did for the
victims of that terrible tragedy, their families, and for first
responders. It also changed for many of you and for all of us
in government service.
For me, my work shifted to finding coverage for dislocated
workers in the wake of the attack. I worked closely with the
Treasury Department and key members of the Bush administration
to ensure that those impacted by this senseless attack had the
health coverage they needed for such a vulnerable time in their
lives.
It was inspiring to be part of a bipartisan effort to
ensure that people who lost their jobs as a result of the
attack and the economic aftermath were able to get the health
care they needed. I took that philosophy and sense of mission
with me to the Ways and Means Committee and then to HHS and
CMS, where I led the development of policies that expanded
coverage to more than 20 million Americans.
I have approached my work in the private sector with the
same philosophy, working with States and stakeholders to expand
coverage options, especially for those living in rural parts of
the country and for traditionally marginalized communities.
Today, as we navigate this public health crisis and its
aftermath, that philosophy guides me yet again, and if
confirmed, that is the collaborative, common-sense, results-
oriented philosophy I will take to CMS to address the complex
challenges we face.
First, we must get the pandemic under control. COVID-19 has
put unbearable pressure on front-line health-care workers, put
vulnerable seniors and those with disabilities at great risk,
and unmasked inequities that persist in our health-care system.
My own home town, a predominantly black community where my
parents still live, experienced higher rates of COVID
infections and deaths compared to many of our surrounding
communities.
I am committed to working with you and leaders across the
government to ensure that CMS is supporting patients, their
families, and providers, including communities of color, who
have been hardest hit by this pandemic.
If confirmed, I will work to make CMS programs work
together better and remain the pillars of our health-care
system. This includes addressing Medicare solvency to protect
Medicare for current and future beneficiaries. There is much we
can do to strengthen these programs, to improve quality, lower
cost, and expand access, including implementing the critical
reforms in last December's appropriations bill and the American
Rescue Plan.
If confirmed, I am also committed to working with you to
expand access to innovative therapies, procedures, and models
of care. We are living in an era of incredible change, as
researchers find new ways to conquer disease and improve our
quality of life. We must bear in mind, though, that innovation
is only effective if patients can actually afford it. So I will
work with you to reign in health-care costs, including for
prescription drugs.
I realize we may not always agree on the best approaches to
solve these challenges, but I pledge to work closely with all
of you to ensure that our decisions are transparent, our team
is accessible, and that CMS is listening to your views.
Before I close, I would be remiss if I did not acknowledge
the outpouring of support I have received from women of color
across this country. I am proud that, if I have the honor of
being confirmed, I will be the first black woman to lead CMS. I
would not be here without God and my family, my husband sitting
behind me, my parents, my brother and sister, and the many
strong, smart black women and men who came before me. Too often
they were not given the opportunity to live up to their full
God-given potential, but their selfless, often silent sacrifice
paved the way for me and so many other women of color.
Today, I am proud that my daughter can see her mother
nominated by the President of the United States to lead such a
critical agency and know that she can be anything she wants to
be.
Thank you for considering my nomination, and I look forward
to answering your questions.
The Chairman. Thank you very much, Ms. Brooks-LaSure. And
let the record show that Ms. Brooks-LaSure was also an intern
to the Senate Finance Committee, and so we are very proud of
that.
[The prepared statement of Ms. Brooks-LaSure appears in the
appendix.]
The Chairman. Now, we have some obligatory questions we are
going to ask, and I am just going to ask the question and have
a response from each of you, if that would be all right.
First, is there anything that you are aware of in your
background that might present a conflict of interest with the
duties of the office to which you have been nominated?
Ms. Palm?
Ms. Palm. No.
The Chairman. Ms. Brooks-LaSure?
Ms. Brooks-LaSure. No.
The Chairman. Second, do you know of any reason, personal
or otherwise, that would in any way prevent you from fully and
honorably discharging the responsibilities of the office to
which you have been nominated?
Ms. Palm?
Ms. Palm. No.
The Chairman. Ms. Brooks-LaSure?
Ms. Brooks-LaSure. No.
The Chairman. Third, do you agree, without reservation, to
respond to any reasonable summons to appear and testify before
any duly constituted committee of the Congress, if you are
confirmed?
Ms. Palm?
Ms. Palm. Yes.
The Chairman. Ms. Brooks-LaSure?
Ms. Brooks-LaSure. Yes.
The Chairman. Finally, do you commit to provide a prompt
response in writing to any questions addressed to you by any
Senator of the committee?
Ms. Palm?
Ms. Palm. Yes.
The Chairman. Ms. Brooks-LaSure?
Ms. Brooks-LaSure. Yes.
The Chairman. Thank you both.
All right. Let us go on now to members' questions. We are
going to do this in 5-minute rounds. And let me start with
questions for you, Ms. Brooks-LaSure, and it really speaks to
this judgment that I have had--and I have had two colleagues
sitting on my sides who have shared it with me over the years--
which is that I do not believe the Federal Government has a
monopoly on good ideas. If the States can do better, they ought
to be able to do it.
That is why I wrote section 1332 of the Affordable Care
Act. It allows States to get a waiver to put in place fresh and
creative strategies as long as they meet--this is critical--the
essential consumer protection guard rails that are embedded in
the Affordable Care Act.
So now, all over the country, there are States that would
like to promote a public option, for example, to increase
competition and hold down health-care costs, and there are some
that are interested in aggregating Medicare and Medicaid
dollars because they would like to move closer to a single-
payer approach at the State level. Conversely, there are States
with conservative ideas that would like to advance what they
believe is the right course, and they believe that they can
advance those conservative ideas while meeting consumer
protection guard rails.
The reason I am asking you this question, Ms. Brooks-
LaSure, is you had years of experience working closely with the
States. And if confirmed--I believe, when you are confirmed--
you will have authority to be involved in promulgating those
kinds of guidance rules that will give a road map for the
States on how to proceed.
How are you looking at your authority with respect to the
States, and particularly ensuring that both progressive States
and conservative States will say they have been treated fairly,
showing that they have good ideas but never fudging on the
essential consumer protection guidelines? How do you see your
job in that regard?
Ms. Brooks-LaSure. Thank you, Chairman Wyden, for the
question and for your leadership in ensuring that States had an
option of applying for waivers to think about ways to improve
upon the Affordable Care Act.
As you said, the Federal Government does not have a
monopoly on good ideas and, in fact, some of the best ideas
that are eventually enacted in Washington start at the State
level, through waivers, through demonstrations. And there are
so many States that are looking for the best ways to cover
their populations; there is so much variety in our great
country.
I see the role of the Federal Government in granting
waivers as being a trusted partner with the States that have a
great deal of responsibility across the Medicaid program, and
in many States, their marketplaces and certainly their
insurance markets. And I want States to understand what the
rules are, to have consistent guidance, and to make sure they
are meeting the standards that are set forth in the law.
Certainly I agree, and I think that States want to use the
1332 guidance to expand coverage and test different options in
many ways. And if confirmed, CMS will certainly have an open
door to States, to new ideas. And I really want to treat all
the States with consistency and fairness, and then make sure
they are meeting the guard rails.
The Chairman. One last question on this. Would you make it
a priority to get the guidance out so that States with
different philosophical viewpoints would know how to proceed?
Ms. Brooks-LaSure. Absolutely. States need certainty and
are on important schedules, annual budgets, and that is
absolutely important.
The Chairman. We will have more conversations about the
guidance, and I thank you for that.
Ms. Palm, let us talk about this whole question of health-
care equity. I think you heard me in my opening statement say I
think there are two health-care systems in America, plain and
simple. The most affluent, and particularly those who live in
suburbs, have a technology treasure trove in front of them in
terms of how they can use telehealth and all kinds of services
that are beneficial. Conversely, folks of modest means are just
trying to figure out how to make their way through the maze of
rules, even dealing with COVID services.
So my question to you is, if confirmed--and I believe you
will be confirmed--how would you actually lead at the
Department to root out the significant racial, ethnic, and
geographical health disparities? Because I think that is what
this is going to be all about. We are going to need leadership
that has a real agenda to root out these systematic inequities.
Tell us what yours would be.
Ms. Palm. Thank you, Chairman Wyden.
From my perspective, as Deputy Secretary, should I be
confirmed, I think about this sort of on two levels. One is how
we are working to ensure, at the programmatic and policy
development level, equity and that an equity lens is baked into
the development and implementation of our programs.
And then I lift up and think operationally about how we as
a department are infusing, within our processes, the ways we
need to do the work better, to bake equity in at the beginning
so that we are not chasing it at the end. And so that, for me,
is both programmatic and policy development, but then also
operationally, we have the opportunity to really structurally
change the way we do our work so that everybody is responsible
for equity and making sure that the work that we do is
equitable and that we are eliminating the systemic issues that
have brought us to where we are today.
The Chairman. I think your point about individual
accountability--my time is up--is hugely important, because at
the end of the day, these issues have just gotten short shrift.
I mean, the country has known about them, people say that you
ought to do something about it, but it is really time for the
kind of accountability that you just mentioned.
Senator Crapo?
Senator Crapo. Thank you very much, Mr. Chairman. And I
want to return in my questioning to the issue that the chairman
dedicated his first question to: that of waivers.
I appreciated the chairman highlighting this issue and the
focus that he brought to it. Waivers are an essential tool for
States, allowing them to tailor insurance programs to fit the
needs of their patients. Across the country, States continue to
prioritize flexibility and the use of innovative, local
solutions to expand coverage.
Unfortunately, this desire for flexibility has met Federal
Government roadblocks, and this is especially true for Idaho.
As I mentioned with both of you privately when we talked, Idaho
has tried numerous creative approaches to expand and coordinate
coverage between certain individual market and Medicaid
populations. Medicaid 1115 waivers grant important
flexibilities for States to improve benefits and to try new
ideas in their Medicaid programs.
Obamacare's 1332 waivers allow States to implement policies
that stabilize the market, lower insurance costs, and incent
competition, provided--as Senator Wyden mentioned--that the
guard rails are protected.
Yet when States try to merge the two waivers to coordinate
and expand coverage, they are met with rejection and
disappointment from the Federal Government far too often. This
appears to be a statutory problem in many cases that prevents
novel approaches to creating more seamless, harmonized
insurance markets for patients. Without solving this issue,
States must deal with population churn, inconsistent benefits,
budget uncertainty, and the inability to advance changes that
would improve care.
I realize you cannot change the statutes, but I do believe
that as much flexibility as possible to allow States to use
these creative options should be utilized. And I just first
want to ask--and I think you have already basically said this
to Senator Wyden--but if confirmed, would you work with me and
others interested in improving the 1115 and 1332 waiver
coordination through statutes? It is just a ``yes'' or ``no''
for each of you.
Ms. Palm. Yes.
Ms. Brooks-LaSure. Yes.
Senator Crapo. And I appreciate that.
And while this waiver work is underway, do you commit to
incorporating State perspectives and expertise in CMS and HHS
decision-making to ensure that local solutions to address
coverage are included in your work?
Ms. Brooks-LaSure. Yes.
Ms. Palm. Yes.
Senator Crapo. Thank you.
And finally on this, I am deeply concerned by the current
administration's approach to Medicaid waivers that were granted
in the last administration. In other words, what will be the
approach to waivers that have already been granted? While we
should work to improve evaluations and processes for all
waivers and demonstrations, the changes that have occurred this
year on Medicaid waivers necessitate more immediate action.
Ms. Brooks-LaSure, do you believe revoking approved
Medicaid waivers or portions of approved Medicaid waivers
immediately following an election sends the wrong message to
the States?
Ms. Brooks-LaSure. Senator Crapo, thank you for raising the
issue, and as I have mentioned, I do a lot of work with States
and understand how much they want certainty from the Federal
Government. That is something, if confirmed, I will really work
on: to make sure that States understand decisions and, as you
said, are part of the decision-making.
Senator Crapo. All right; thank you.
And in the little bit of time I have left, I want to go
back to you, Ms. Brooks-LaSure, on the Medicare Advantage
issue.
I am a huge advocate for Medicare Advantage; I think it is
one of the best-working pieces of Medicare, and we should do
all we can to take advantage of it.
During the COVID-19 pandemic, CMS provided Medicare
Advantage plans with additional flexibilities, such as
expanding telehealth services, providing beneficiaries with
devices to use for telehealth and remote patient monitoring,
and reducing cost sharing and premiums, and we found some
things that really worked.
Ms. Brooks-LaSure. Yes.
Senator Crapo. How would you work with stakeholders and
Congress to continue these certain enhanced benefits and
flexibilities? What I am talking about is, why do we have to
stop this when the pandemic ends? Could you respond to that.
Ms. Brooks-LaSure. Absolutely. I think that this pandemic
has given us an opportunity to take the lessons across a
variety of issues, and telehealth has been something that has
been discussed for more than a decade, and now we have been
able to see what value it brings. My brother is a psychologist,
and he has been able to see more patients during a difficult
time as a result of it.
I really want to work with all of you to look at what CMS's
administrative authority is and what changes we may need
congressionally to work on bringing the lessons that we have
learned from COVID into our health-care system on a permanent
basis.
Senator Crapo. All right. Thank you very much.
My time has expired so, Ms. Palm, I will have to probably
send you some questions for the record.
Ms. Palm. Thank you.
The Chairman. Colleagues, here is where we are: Senator
Stabenow will go next in person, then we will have Senator
Grassley on the web, and then we will have Senator Cantwell in
person.
Senator Stabenow?
Senator Stabenow. Thank you very much, Mr. Chairman, and
welcome to Ms. Palm and to Ms. Brooks-LaSure. We are so lucky
to have both of you willing to commit to public service at this
very important time, and I am very impressed with your
credentials, both of you--your experience and your credentials.
I care about every part of the health-care system, as you
know. I have worked for years--it was actually health care that
got me in to my own public service, and I think it is probably
no surprise that I would like to start talking about behavioral
health.
And so I would ask both of you--and I know, Ms. Palm, that
you were at HHS when Senator Roy Blunt and I were able to pass
the Excellence in Mental Health and Addiction Services
Treatment Act, and that you were involved in the initial
implementation and in establishing the quality standards. So I
appreciate that very much, and I know you both have been
involved in these issues.
But as you know, so many people are living with mental
health issues and addiction issues right now, even more because
of COVID. In January, 41 percent of American adults reported
that they were struggling with anxiety and depression, and that
is up from 11 percent before the pandemic. So we have serious,
serious issues.
And more than one in four young people have reported
suicidal thoughts. Meanwhile, communities are seeing more
people overdose. Just yesterday the CDC reported that more than
87,000 Americans died of drug overdoses over a 12-month period
that ended in September, the most deaths in a year since the
opioid epidemic began in the 1990s. Serious alarm.
So long after the epidemic ends, these behavioral health
issues will linger. And I have talked to both of you about--I
believe strongly we need to treat health care above the neck
the same as health care below the neck as part of the health-
care system.
The good news is that, through Certified Community
Behavioral Health Clinics that we now have in 41 States--and
expanding now because of the American Rescue plan as well--we
have a structure that allows clinics to truly meet the needs of
the community. This has been a tremendous success, a model for
the future, and I have to commend our chairman on the CAHOOTS
program which this model also embraces as a partnership; so
this is so, so important.
And now we have the opportunity to expand it nationwide so
that every State has the opportunity to meet quality standards
and provide comprehensive services. And now is really the time
to do that.
So my question--I will start with Ms. Palm--is, could you
talk about your experience working on behavioral health issues
and how you will work with us to ensure high-quality
comprehensive care, including through the CCBHC program?
Ms. Palm. Yes. Thank you for the question, and thank you
for your leadership on this issue.
I think to your point, the bipartisan nature of the work
that you and Senator Blunt have done on this, the bipartisan
work that has happened around the opioid epidemic, really does
afford us a critical opportunity at this moment to do
additional work, to really, as I mentioned in my opening,
integrate behavioral health into the health-care system. Your
analogy of the neck-up and the neck-down is exactly right, and
I think it is really time that we think about mental health,
substance abuse, the behavioral health issues as chronic
conditions that need to be managed and treated the way other
health-care conditions are; and that the health and wellness of
people and putting them at the center of their health care
means that we have to do that for behavioral health.
I have worked in behavioral health from direct service all
the way to, as you mentioned, implementation of programs, and
then most recently running them at the Department of Health
Services in Wisconsin. And so I would look forward to the
opportunity to work with you and others on this committee to
really sort of turn the crank and take these next important
steps in behavioral health.
Senator Stabenow. Thank you.
Ms. Brooks-LaSure?
Ms. Brooks-LaSure. I join my colleague in thanking you for
your bipartisan work in this area, and highlighting just how
much of an issue this is and has been. And then as you have
stated, with COVID-19, it has been an incredibly difficult time
for a host of people, including children, for a number of
reasons.
I think that one of the important pieces is increasing
providers, which is what the work of your clinic does by making
more availability. We have seen telehealth help in this area.
One of the things, if confirmed, I really want to focus on is
helping CMS to coordinate better with the Department on these
critical issues. States are doing some incredible things in
their Medicaid programs and really coordinating that with the
grants from SAMHSA to make sure that we are integrating
behavioral health and substance abuse with physical health.
And finally I mention, of course, mental health parity is
an important part of CMS's role of enforcing and ensuring that
mental services are treated equally.
Senator Stabenow. Thank you.
Mr. Chairman, I know my time is up, but I have just one
other thing I want to mention--no question, though--and that is
school-based health clinics. We have authorized school-based
health clinics to the end of the year, bipartisan legislation,
but they are not yet funded. And yet we know that children and
young adults have been hit particularly hard by the pandemic,
not only anxiety and depression and other issues, but routine
vaccination rates are down, and many children have missed
primary care doctor's appointments and dental visits.
So Senator Capito and I are working together to secure
funding for these clinics that have been authorized. We invite
all of our colleagues to join us. I also want to work with each
of you on these issues to make sure that school-based health
centers are able to get the CHIP funding and Medicaid funding
that will allow them again to be a permanent part of our
health-care structure. This is very, very important for our
children.
Thank you, Mr. Chairman.
The Chairman. Thank you, Senator Stabenow.
Senator Cantwell?
Senator Cantwell. I thought Senator Grassley was next.
The Chairman. Excuse me, he is not available right now.
Senator Cantwell. Okay; thank you, Mr. Chairman. I just
wanted to make sure we were not skipping ahead.
Thank you to the witnesses, and congratulations on your
nominations. I certainly support moving you forward.
We have had a chance, at least our CMS nominee, Ms. Brooks-
LaSure, to talk about the basic health plan I mentioned to you;
how in New York approximately 800,000 people are enrolled in a
plan that costs $500--$500--$500 annually for a family of four
buying coverage. That saves $1,000 compared to the silver
exchange plans, and it saves the State billions of dollars as
well. So I want to make sure that it also saves us federally if
more States implement this.
So I want to hear if both nominees are comfortable with
States expanding this program, and if you would encourage them
to do so. I do not mean to tell them to do so; I mean if they
wanted to do so, would you be encouraging of that?
Can I get it for the record so we can hear you?
Ms. Brooks-LaSure. Yes, Senator. Absolutely.
Senator Cantwell. Thank you.
Also I want to make sure that the Department, Ms. Palm,
would assist people in the implementation of that.
Ms. Palm. Absolutely.
Senator Cantwell. Okay; great.
On Medicaid rebalancing, Senator Portman and I have been
very big supporters. I just want to add that Senator Stabenow
was also a big supporter of the basic health plan, and so I do
not want to--she is very much appreciated, her efforts in
getting that implemented; and we would like to continue to see
the implementation.
On the Money Follows the Person program, Senator Portman
and I and several others have been continuing to push that,
giving over 8,000 individuals in long-term care facilities the
ability to go back into their homes, saving Medicaid dollars.
We feel like this has been--and rebalancing in general--a big
cost savings.
So, Ms. Palm, will you work with States to implement the
Money Follows the Person program to assure seniors and people
with disabilities can avoid institutional living?
Ms. Palm. Absolutely.
Senator Cantwell. Thank you.
And, Ms. Brooks-LaSure, do you support Federal incentives
like those to help States move people from these high-cost
institutional settings?
Ms. Brooks-LaSure. Yes.
Senator Cantwell. Okay; great.
My colleague has covered mental health.
So on my colleague from Idaho's conversation about
telehealth, let's see if we can get a little more granular
here.
What do you think--how do you characterize where the
reimbursement rate should be? I have had great conversations
with the University of Washington, Paul Ramsey, the CEO of that
institution's health-care system. So in the Northwest we
definitely are going to support more broadband access; we
definitely see how this worked--you mentioned your brother. I
can tell you personally there are lots of indications in my
State of how successful this has been. I think we got a real
feel--a real feel for the medicine of the future.
So what do we do about the reimbursement rate? Is it 100
percent; is it the same? Is it slightly different for some
reason? Where do you think we are? And I will start with you,
Ms. Brooks-LaSure.
Ms. Brooks-LaSure. Thank you for the question. I think it
is an incredibly important issue, and one, as you said, that
has been really critical in a number of States, in rural areas.
And we need to think about how we continue to move this issue
forward.
Reimbursement, I would say, is something I, if confirmed,
would be happy to talk with you about and think through. There
are certainly safeguards that we need, to make sure, from a
program integrity perspective, that we know that services are
being delivered, but it is one that I think that we will have
to titrate but figure out.
Senator Cantwell. Okay. For somebody who is intellectually
smart on this subject, I consider that a little bit of a punt,
but----
I think the issue--I am good with examining the savings,
but I would say to people that this is just a new efficiency
discovered in the information age, with COVID being the thing
that prompted us here. But my guess is, we are going to see
huge savings. So I would say you are at or close to the
reimbursement rate that we are at today. It is almost something
we want to incent, just like we have had pay follow the person,
just like we have had these other things. Why? Because we are
going to discover that there are probably savings here in the
system overall.
So anyway, I do not know if you have any comments, Ms.
Palm.
Ms. Palm. I would echo what my colleague said. I would also
say we worked hard on a bipartisan bill in Wisconsin to bring
telehealth into the Medicaid program, where we treated them the
same for purposes of coverage and reimbursement, and we were
really so grateful to put that statutory framework in place
before the pandemic, and we used our flexibilities to really
make sure we were ensuring access during the pandemic.
But I would certainly welcome an opportunity to continue
working with you on this issue.
Senator Cantwell. Thank you.
Well, Mr. Chairman and Senator Crapo, I think this is an
incredibly important subject. We in the Commerce Committee with
Senator Lujan will be working on a broadband piece for the
medicine delivery system. And one thing we really like is that
we do have, even in rural communities, rural hospitals
everywhere. So they are a system of delivery, and I think it
would be foolish not to try to pair the broadband investment
with the right reimbursement rate, because otherwise we would
be making this investment and giving us access but not having
the utilization because physicians or the system would continue
to defer to see people in person.
So we have to get it right, and I so appreciate my
colleagues. Thank you.
The Chairman. Senator Cantwell, as always, you are out in
front on these issues. And Senator Crapo and I have been
talking about a bipartisan effort in this telehealth area and
as part of the critical reimbursement issue you mention,
because this committee really shoehorned the telehealth efforts
into the first CARES package.
I think it is going to be important to make sure that right
now, as a result of the pandemic, we have removed some of the
roadblocks for people to actually get to a telehealth provider.
We are going to have to make those kinds of changes permanent,
in addition to working on the critical reimbursement issue you
have mentioned.
And I want to thank Senator Crapo, because he has indicated
that telehealth could be one of the real bipartisan priorities
for the committee.
Senator Cantwell. Well, I am pretty sure that the three of
us, whether it is the panhandle of Idaho or eastern Oregon or
the Okanagan in my State, we see a very dispersed rural health-
care delivery system where people have to drive hours. So I
think this would be very helpful.
Thank you, Mr. Chairman.
The Chairman. Thank you for your leadership.
We are now on to Senator Cassidy on the web, and then
Senator Bennet. Colleagues have a hectic morning, so we are
trying in a bipartisan way to make sure that everybody gets a
chance to be heard as soon as possible.
Senator Cassidy, I think you are out in cyberspace. So we
would like to hear from you.
Senator Cassidy. Yes, sir, Mr. Chairman.
Ms. Brooks-LaSure, thanks for reaching out. I enjoyed our
conversation. As I told you, I was going to follow up on dual
eligibles, not as a ``got you'' question but rather just kind
of to explore it. We both know that we spend a lot of money in
this country on duals, and we get miserable outcomes.
Now duals are a heterogeneous population, both in terms of
who they are medically but also in terms of the method by which
they are financed. But one thing you pointed out in our
conversation is the difficulty in aligning the incentive for
the State and the Federal Governments.
The ACA attempted to address the duals, and I do not think
it worked. Can you give a little bit of a kind of ``lessons
learned'' from the ACA's attempt to address the lack of
alignment among duals?
Ms. Brooks-LaSure. Senator Cassidy, I very much appreciated
our conversation and enjoyed the opportunity to talk. As we
talked about, dual eligibles are sometimes the most vulnerable
in our society in terms of comorbidities, and often very
expensive for both the Medicare and the Medicaid programs.
I think that, as we talked about, greater alignment is
something that we are going to need to continue to work on.
Some of that can be done by CMS administratively, with getting
the programs----
Senator Cassidy. But let me ask you particularly, what were
the lessons learned from the ACA's effort? Because I think
Minnesota may have been the only State in which their
particular program worked. And so again I would like to build
upon what we have learned. What have we learned?
Ms. Brooks-LaSure. I would say--you know, when I look at
the valuation, particularly around Minnesota, what I would say
is, there still is a need to coordinate better on what we see
in long-term care, and the nursing homes, and hospitalization.
And some of that is going to take legislation and really
thinking about how do we treat people on the continuum?
So particularly in assisted living, PACE programs, I think
there is more we can do to encourage that kind of coordination.
Senator Cassidy. Ms. Palm, you have been kind of front and
center on this in your jobs in Wisconsin. What thoughts do you
have about the duals?
Ms. Palm. I appreciate the question, and your point about
the different financing, and States and the feds working
together for us, we were very focused on the continuum of long-
term care services and providing the opportunity for patients,
for seniors, people with disabilities, to choose care that best
met their needs with the greatest amount of independence. And
our ability to do that most effectively and efficiently would
benefit from, as Ms. Brooks-LaSure mentioned, a greater
alignment as you are sort of driving towards----
Senator Cassidy. Let me stop you for a second. Let me just
kind of stop you for a second. I think one of the things that
happened in California was that there was an incredible amount
of churn. People got assigned to a program, I think run by
Medicaid, but with a Medicare--I may have this wrong, and you
guys may know if I am correct. But this so-called patient
choice ended up being churn where people were changing from
program to program several times within a year, which of course
destroyed continuity of care. And it begs the question as to
whether or not the decision as to where to receive care was
informed, or whether it was perhaps influenced by those who had
other agendas.
Any thoughts upon this? Is there a way to address that? I
will start with you, Ms. Palm.
Ms. Palm. Yes, I would say, Senator, we saw much more churn
in our non-long-term care population in Wisconsin. I am not
saying that what you are raising is not an issue----
Senator Cassidy. I am saying among duals in general--duals
in general.
Ms. Palm. Yes, I think that, sort of to your fundamental
point, continuity of care, care coordination, making sure that
we are putting patients at the center of the care they are
receiving, and doing what we can to do that----
Senator Cassidy. I guess I am not making my point, Ms.
Palm. Everything you are saying is true. What I am trying to
get at is, how do we address the churn?
Ms. Palm. Well, I think, Senator, from our perspective in
Wisconsin, we wanted to make sure that the products that were
available and the choices that seniors had were transparent on
the front end, that they understood them, and that when they
made their choice, they made a good choice for them so that
there were not--there was not a need to change----
Senator Cassidy. What was your rate of churn in Wisconsin?
I am just curious; I do not know that answer.
Ms. Palm. Again, I am not sure I can remember off the top
of my head in long-term care versus in the regular population,
but I would be happy to get that information back to you,
Senator.
Senator Cassidy. Okay. I yield back. Thank you.
The Chairman. I thank my colleague.
Senator Menendez is next.
Senator Menendez. Thank you, Mr. Chairman.
In March of last year, as COVID began to spread in States
like mine, the shutdowns helped save lives. But at the same
time, there were not systems in place to help individuals who
rely on home and community-based services to continue to access
care in such a situation.
The scarcity of protective equipment meant many providers
were not able to access necessary gear. Fortunately, the
American Rescue Plan provided an enhanced FMAP for these
services.
My question to you is, will you commit to working with
States to swiftly roll out information on how States can spend
their increased FMAP for home and community-based services?
Ms. Brooks-LaSure. Yes, sir.
Senator Menendez. Okay.
COVID-19 has disproportionately impacted black and Latino
communities. I am pleased to see this administration is
committed to improving health equity. However, even as we have
seen record-breaking developments of diagnostic treatments and
vaccines for COVID-19, members of the most heavily impacted
communities do not have equal access to clinical trials for
these innovations.
And I believe we have to take active steps to remove these
barriers. So, Ms. Brooks-LaSure, what role do you see for CMS
to play in improving minority clinical trial participation?
Ms. Brooks-LaSure. Thank you, Senator, for the question.
This is such a crucial issue, and I am glad that Congress has
made it so that Medicaid will be paying for covered services,
to make sure that people can get into clinical trials. I think
CMS can do more to integrate with NIH, as well as work with
trusted partners.
One of the things that I think we have learned with the
pandemic is how important it is to have the medical community,
community organizations, really making sure that communities of
color build trust in these types of programs.
Senator Menendez. So will you commit to working with me on
improving clinical trial diversity?
Ms. Brooks-LaSure. Absolutely.
Senator Menendez. Ms. Palm, the same question to you.
Ms. Palm. Yes, sir.
Senator Menendez. Thank you.
Now throughout the pandemic, Americans have deferred health
care. An October 2020 study in JAMA found that primary care
visits declined 21 percent during the second quarter of 2020 as
compared to the same time frames in 2018 and 2019.
In particular, I am deeply concerned that delays in cancer
and other screenings will translate into an increase in
advanced disease cases, and ultimately death as a result of
millions of Americans avoiding routine preventative care over
the past year. And once again, I feel these delays in care will
disproportionately harm health-care outcomes for black and
Latino communities, who already have less likely access to
preventative care.
So, Ms. Brooks-LaSure, what steps can the Centers for
Medicare and Medicaid Services take to raise awareness and
encourage Americans to seek important and necessary
preventative screenings that have been delayed as a result of
the pandemic?
Ms. Brooks-LaSure. You are so right to raise this issue,
with so many people being concerned about going back to their
providers. Because of the Affordable Care Act, preventative
services across several of the programs are free. Because of
its importance, CMS needs to continue to educate providers,
beneficiaries, patients, and families, and again, working with
stakeholders who are trusted partners, to encourage people to
get preventative care.
Senator Menendez. Ms. Palm, what additional steps can HHS
take to help raise awareness of this looming issue?
Ms. Palm. It is a great question and really does lend
itself to an opportunity across the Department, through our
HRSA programs, to SAMHSA, to IHS, to the other avenues that we
have, to reach the people that we serve with these messages
encouraging folks to return for care, for the preventative
treatment. So we should use all of our channels as well as our
partners to reach people and encourage folks to return for care
that they need.
Senator Menendez. Finally, I worked on a bipartisan basis
with members from both urban and rural areas at the end of the
last Congress to secure 1,000 new Medicare-supported graduate
medical education slots in the Consolidated Appropriations Act,
the first increase in these positions in nearly 25 years.
Senator Boozman and Leader Schumer joined me in
reintroducing the Resident Physician Shortage Reduction Act,
which would build upon our bipartisan success by further
increasing Federal support for GME.
Now that Congress has provided the slots, it will be up to
the administration to determine their implementation, and it is
important that they are distributed in a timely and efficient
manner.
How would you plan to ensure smooth implementation of these
critical new GME slots, and how do you envision working with
Congress to address physician shortages?
Ms. Brooks-LaSure. Thank you, Senator, for your work on
this critical issue. And I very much understand that the
congressional intent is for these slots to go particularly to
underserved areas. I, as we have talked about, want to make
sure that we have an open dialogue, one with public notice and
comment where stakeholders can engage, and certainly an open
door to hear your views.
Senator Menendez. I will look forward to working with you
on that.
Thank you, Mr. Chairman.
The Chairman. Thank you, Senator Menendez.
Senator Bennet has to preside on the floor, so proceed.
Senator Bennet. Thank you, Mr. Chairman, and I thank my
colleagues for letting me jump in.
Ms. Palm and Ms. Brooks-LaSure, thank you for your
willingness to serve and for all the work you have done to pass
and implement reforms such as the Affordable Care Act, which
dramatically improved coverage and affordability for health
care in this country.
Despite the ACA's strides in coverage and affordability,
many Coloradans and many Americans still face high costs and
limited options. The American Rescue Plan expanded eligibility
to the ACA premium tax credit. This capped how much Americans
are paying for health plans on the exchange, which was, I
think, very important, but still not enough.
Separately, Senator Kaine and I have previously introduced
the Medicare-X Choice Act. It would work within the Medicare
framework to establish a public option for individuals,
families, and small businesses. It would also make the American
Rescue Plan caps permanent.
As you know, President Biden ran on a public option as the
answer to creating universal health care in this country, so I
would ask that, if you are confirmed, that you--are both of you
committed to working with me and others on the public option,
and when it passes, implementing it to ensure that every single
American has the health care that they need?
Ms. Brooks-LaSure. Senator, thank you for your leadership
on this issue, and for passing the American Rescue Plan which,
as you have said, has significantly helped with affordability
for middle-class families and given States options to expand
the Medicaid program.
Of course we will work with you, and really want to advance
the President's agenda; and as you said, he is supportive of a
public option.
Senator Bennet. Ms. Palm?
Ms. Palm. I would concur with my colleague. I look forward
to working with you.
Senator Bennet. I think this is something we should get
done now. You mentioned it, Mr. Chairman, in your questions.
The American people, coming through this pandemic,
understand how critical it is for us to have, for everybody to
have, access to primary care. And this was litigated
extensively during the campaign, in both the Democratic primary
and the general election.
And so I hope the Biden administration will take us up on
our offer to be helpful in fulfilling these commitments, and I
look forward to working with the chairman as well.
Children with complex medical needs may not be able to
receive highly specialized care that they need in their home
State. This requires families and State Medicaid officials to
go through the difficult process of finding out-of-State
providers. Senator Grassley and I worked hard to pass the ACE
Kids Act, which will be implemented in October of 2022 and
would enable better care coordination for these kids to make
sure that they get the best services, no matter where they
live.
As a follow-up, last year we introduced the Accelerating
Kids Access to Care Act. This bill would provide certainty for
State Medicaid agencies to better determine who is responsible
for paying and reduce regulatory burdens that can slow or
prohibit access to care.
If confirmed, will you commit to a timely implementation of
the ACE Kids Act and work with us on the Accelerating Kids
Access to Care Act so we can make sure we are taking care of
the Nation's most sick kids.
Ms. Brooks-LaSure?
Ms. Brooks-LaSure. Yes.
Senator Bennet. Thank you.
Ms. Palm. Yes. I would welcome the opportunity, Senator.
Senator Bennet. Thank you. I would welcome the opportunity
too.
I guess I have time for one more question, so I am going to
ask one. In December we passed the No Surprises Act, which will
end the practice of surprise billing. I think this was a major
step to protect patients who are often taken advantage of in
their most vulnerable state. I have been working on that effort
for years with Senators Cassidy and Hassan and others on the
committee, and I am grateful it was signed into law.
Ms. Brooks-LaSure, in your written statement you mentioned
you have the responsibility to implement the legislation when
it goes into effect next year.
Can you highlight your thoughts on eliminating surprise
billing and reiterate your commitment to implement the
legislation over the next year, should you be confirmed?
Ms. Brooks-LaSure. Thank you, Senator, and thank you to
this committee, which has done so much work. Surprise billing
has been an incredibly difficult issue for patients. Several
States, before you passed legislation, had legislation on the
books, but thank goodness that you all were able to reach a
bipartisan agreement and really make sure the protections are
in place.
If confirmed, I will absolutely work very hard to implement
the regulations. I know we are on a very tight timeline, so I
hope that I am so fortunate to be confirmed quickly to help
with that effort.
Senator Bennet. Great. Thank you very much for your
testimony.
Thank you, Mr. Chairman.
The Chairman. I thank my colleague.
Senator Carper is next.
Senator Carper. Good morning. Great to see you both. I
enjoyed talking with you by phone the other day. Thank you for
joining us today, and congratulations on your nominations. We
look forward to a swift confirmation, and the opportunity to
work with you for any number of years.
I have the opportunity--we have a bunch of caucuses here in
the U.S. Senate, as you may know. One of those is called the
Senate Community Health Center Caucus, and the last time I
checked, we have about 1,400 federally qualified community
health centers across the country.
I think one of the smart things this administration has
done early in its tenure is to make sure that people in
neighborhoods across America can go to the federally qualified
community health center and be vaccinated. I think that is a
great move, and I think as we especially reach out to
communities of color, folks who are frankly skeptical of taking
the vaccine at all, it is a very wise move.
Ms. Palm, can you think of any other areas where community
health centers could be better leveraged to address rural and
ethnic health disparities and our pandemic recovery?
Ms. Palm. Thank you for those questions, Senator, and for
your leadership on this issue.
I think from my experience in Wisconsin, I can tell you our
partnership with our community health centers was critical,
both before the pandemic and during the pandemic. Areas like
behavioral health and their ability to be providers in that
space, particularly in rural communities, were critical assets
they brought to the table. We have a shortage of dentists in
the State of Wisconsin, so dental care in our community health
centers is a critical access issue, again particularly in rural
communities.
But to your point, their ability to reach underserved and
ethnic minority communities is really critical for us to tackle
some of these health disparity issues and deal with those head-
on. So I think there are lots of opportunities for us to
continue to work with those critical partners, and I look
forward to doing that.
Senator Carper. Good.
Ms. LaSure--do people call you ``Ms. LaSure,'' or do they
call you ``Ms. Brooks-LaSure''?
Ms. Brooks-LaSure. They call me Chiquita. [Laughing.]
Senator Carper. I want so badly to ask you who you are
named after, but I am not going to go there.
Ms. LaSure, as you know, we are not out of the woods yet on
the pandemic. I think we are making some good progress; a lot
still to be done, but it is incredibly important we keep the
main thing the main thing--that is, to get as many people
vaccinated as quickly as we can.
When I was Governor, I was very active with the National
Governors Association and helped stand up something called the
American Legacy Foundation, which was very actively involved in
messaging on youth smoking, trying to convince young people not
to use tobacco, and those who were using it to stop. Hugely
successful initiative--hugely successful initiative.
And we are in a situation right now where we need a hugely
successful messaging process on convincing people to accept
vaccinations. And part of that is coming out of the private
sector, part of it is coming out of like NYU, part of it is
coming out of a coalition led by former Governors of, I think
of Idaho and Massachusetts.
But I think it is a shared responsibility, and just talk to
us, if you will, about that shared responsibility, the role the
Department of Health and Human Services plays in getting that
message out and convincing people to take the vaccine.
Ms. Brooks-LaSure. It is so important. Thank you for your
leadership in this area, making sure that people know and are
aware that they can get vaccines, that they do not have to pay
for them.
I, once again, want to talk about how what I really would
like to see for CMS is to continue to partner with
organizations. One of the things that I have heard over the
last couple of months is how much people want to know, have
their providers taken the vaccine? My brother-in-law, who sees
many patients--he is a nephrologist--got vaccinated in part to
make sure his patients knew he had taken the vaccine. And I
think it is critical that we, if confirmed, at CMS are making
sure that all the programs are encouraging this; that the plans
are encouraging patients to know that this is an option.
Senator Carper. One last quick question--and you can answer
this for the record, but answer it a little bit while we are
here--and that is, dealing with drugs, trying to rein in drug
prices with the help of the Senate Finance Committee in
Congress--and this would be for you, Ms. LaSure.
In your testimony, I think you mentioned that, although
research is finding new ways to conquer disease and improve our
quality of life--and this is a quote, I believe, from you--``we
must bear in mind, though, that innovation is only effective if
patients can actually afford it,'' close quote.
That being said, in the interest of reining in health-care
costs in collaboration with the committee and Congress, as CMS
Administrator, how do you plan to use your role to address
prescription drug costs? Please.
Ms. Brooks-LaSure. Thank you. This committee has done so
much bipartisan work on prescription drugs. We have to address
this issue and make sure that we are lowering costs for these
innovative medicines; and as Ranking Member Crapo said, we have
seen so much innovation, and we want to make sure that people
have it available.
I want to work with you all to make sure that we lower
prescription drug costs--and am open to really working closely
with you all on that.
Senator Carper. Oh, you will have an opportunity in
answering questions for the record to respond more fully, but I
really was looking for, how do you plan to use your rulemaking
authority to address prescription drug costs. I realize we are
in this together, and we look forward to working towards that.
Thank you.
The Chairman. Thank you, Senator Carper.
Senator Grassley?
Senator Grassley. Thank you, Mr. Chairman. I want to take
up where the Senator from Delaware just left off, because
Senator Wyden and I have been working together for well over a
year to lower prescription drug prices. Our bipartisan bill
would cap out-of-pocket costs for seniors at $3,100. It slows
the rate of growth of drug costs, saving the taxpayers $95
billion. Some believe we should let the government do more than
what our bill would do. I am not sure that CBO is very
interested in giving us much cost savings on that, if any. And
some people in CBO would say if you did more, you would have to
limit consumer choice and access to lifesaving drugs.
I believe that Congress must pass a bipartisan prescription
drug bill if it is going to get done. I suppose if Democrats
stuck together, then you could do it under reconciliation and
that argument would not hold, but I hope that is not the course
you go. And I think that a Wyden-Grassley bill could get 60
votes very easily.
The bill has meaningful provisions to lower drug prices. So
is there any interest in the administration beyond what you
told Senator Carper to working on enacting bipartisan
prescription drug legislation?
Ms. Brooks-LaSure. Senator Grassley, I so enjoyed our
conversation and so appreciate your leadership with Chairman
Wyden on this area and this issue, as I know you all care very
deeply about making sure that we lower costs for patients and
families. I have heard it from almost everyone--I think in all
of my discussions--how much you all care about prescription
drugs, and the administration certainly wants to work with
Congress to come up with solutions for patients.
Senator Grassley. And would I assume that that would be in
a bipartisan effort?
Ms. Brooks-LaSure. Absolutely, if people are interested--
which I know you are--in lowering costs. The importance is in
making sure we get this right.
Senator Grassley. On rural health care, this is a big item
for me and even for the chairman, because Oregon has a lot
rural areas as well. I led a charge to create a newly voluntary
Medicare payment program called Rural Emergency Hospitals. It
is a new voluntary Medicare designation; I suppose something
specifically for critical access hospitals. It would let
hospitals maintain essential medical services in their
communities, like 24/7 emergency care, outpatient care,
ambulance services, and obviously a lot more. It will also let
certain rural hospitals right-size their health-care
infrastructure, letting them provide services that better align
with the needs of their community.
Maybe this is something both of you should comment on; of
course, you do not have to repeat the first person. But for
both of you: can I have your commitment to implement the Rural
Emergency Hospital program as quickly as possible--and I
suppose as fairly as possible?
Ms. Brooks-LaSure. Yes.
Ms. Palm. Yes.
Ms. Brooks-LaSure. You have my commitment, Senator.
Senator Grassley. Okay. Thank you, and I appreciated that
discussion we had in my office.
This will probably have to be my last question. During the
last 2 years as chairman of this committee, I worked to ensure
that HHS's Office of National Security received access to
intelligence community information. This included information
involving threats to the Nation's health because of the virus.
That office has gained access to some intelligence community
elements, but more must be done.
On March 8th, I wrote a follow-up letter to HHS and the
Director of National Intelligence, asking what they have done
to incorporate Federal health agencies into the intelligence
community. HHS has failed to respond, so I hope you can help us
get a full response to that letter.
So let me go on to the second question. Do you agree that
China is a significant and consistent bad actor when it comes
to stealing U.S. taxpayer-funded intellectual property and
academic research? If so, what will you do to protect American
work products from the Communist Chinese Government's theft and
espionage activities?
And if you do not feel that way, why.
Ms. Palm. Senator, I will take that one first.
If I am lucky to be confirmed as Deputy Secretary, I think
this just is a place where my office--and where I--will
certainly play a role in making sure, to your point, that HHS
is read into intelligence that pertains to our health-care
system, our data privacy, and some of the cyber issues that we
hold at the Department.
To your point on intellectual property, I think it is a
critical issue as we think about how we maintain and reassert
our leadership in technology and innovation, and bringing our
products to market in a way that continues to drive the health-
care system forward. And I would look forward to the
opportunity to work with you on both of those issues, should I
be confirmed.
The Chairman. I thank my colleague.
Senator Cardin----
Senator Carper. Mr. Chairman, can I be recognized for 30
seconds out of order, please?
The Chairman. Sure.
Senator Carper. To our witnesses I will say, I have the
privilege of working along with Sheldon Whitehouse and Ben
Cardin and others on this committee, and on the Environment and
Public Works Committee. We spent a lot of time in the last
Congress trying to come to agreement on water infrastructure,
clean drinking water, that sort of thing; wastewater or
sanitation stuff.
We came close to getting it done; could not. We came back,
and we were using that as a building block. To work on it, we
are going to be on the floor next week with our water
infrastructure legislation, all bipartisan.
And the other thing is, we spent a lot of time in the last
Congress trying to pass service transportation reauthorization,
a 5-year bill, and which we have part of the jurisdiction for;
could not get it done. We are coming back and using what we did
last year as a building block.
I just think you--and Mr. Chairman, you and Senator
Grassley, before he leaves--you fellows did great work,
absolutely great work. And we ought to be using your work as a
building block in this Congress on drug pricing, and I would
just urge us to do that. Thank you.
The Chairman. I thank my colleague for his kind words. I
know we are going to talk about that topic this afternoon.
Our next member is Senator Cardin, who is on the web.
Senator Cardin. Thank you, Mr. Chairman, and let me thank
both of our nominees for their willingness to serve our
country.
Ms. Palm, I would like to start with a question following
up on Chairman Wyden's point in regards to minority health and
health disparities. I heard your answer, but I would like to at
least call attention to the fact that we have offices within
the Department of Health and Human Services that are devoted to
minority health and health disparities. We have the National
Institute of Minority Health and Health Disparities, and we
have been talking about a commitment to really deal with the
systemic challenges that we have in health care in America. It
came out very clearly in COVID-19.
So I would ask if you are committed to using every resource
we have, including the direct involvement by your office in the
minority health offices to develop a strategy to make
fundamental changes in our health-care system to help the
underserved communities. Your response?
Ms. Palm. Sir, I appreciate your raising this, and for your
leadership in the creation of those components at HHS. And
certainly, we need to integrate them in our work, because I
think the challenge is that we cannot allow those offices to be
seen as the only places where that work happens.
And so it is critical that they exist, but it is critical
that we integrate them in a way that helps us all be
accountable for the equity work that we need to do.
Senator Cardin. I thank you for that. I agree completely
with that. These offices are critically important, but they
need to be integrated into the overall strategy on our health-
care policies.
I also was listening to my colleagues talk about
telehealth, and I certainly concur in their view that
telehealth offers tremendous potential for access to care,
particularly in underserved communities. We have talked about
it being available for those who understand how to use
telehealth and have the access to it, but we also need to make
a priority of dealing with the underserved community, with
access to telehealth as well as structural changes within the
reimbursement structure, to allow the development of telehealth
in so many different fields.
We did that during COVID-19; we made some of those
provisions permanent. We need to expand that, and I look
forward to working with you and the other members of the
committee as we expand telehealth.
Ms. Brooks-LaSure, I want to ask you--we had a chance to
talk about the fact that the Department has started the process
of filling the position of Chief Dental Officer. I just really
want to underscore the importance of getting that position
filled as soon as possible. It was vacant during the Trump
administration, but it demonstrates a priority within CMS to
deal with the issues of oral health.
So I hope that you will pay attention to getting that
position filled when you are confirmed.
Ms. Brooks-LaSure. Absolutely, Senator Cardin. You have my
commitment on that, and I want to thank you for your leadership
in keeping the memory alive of the young boy who died because
of lack of dental coverage. It will be a priority of mine to
make sure that the Medicaid and CHIP programs have a dental
officer who is informing the work.
Senator Cardin. Thank you. Deamonte Driver was that
individual who died in my State in 2007, and it did change our
understanding of the importance of oral health care, as policy-
makers, and I am pleased that we took action both in the CHIP
program and in the Affordable Care Act program.
My last point deals with the issue of prescription drugs,
and one area which is totally unacceptable. In the wealthiest
Nation in the world, we have relatively inexpensive drugs that
are in drug shortage because drug manufacturers do not make the
same amount of profit on those drugs as they do on others. In
some cases, they are single-source manufactured drugs.
And I would ask that there be a commitment by both of our
nominees to make sure that that circumstance does not exist in
this country, that we do not have drug shortages of inexpensive
drugs that are not being made available solely because of the
lack-of-profit motive to the private sector.
And if I could have a commitment to work with us to deal
with those drug shortages--let me start first, if I might, with
Ms. Palm.
Ms. Palm. Yes. It is a critical issue, Senator. You have my
commitment.
Senator Cardin. Thank you.
Ms. Brooks-LaSure?
Ms. Brooks-LaSure. And mine as well.
Senator Cardin. Thank you.
Thank you, Mr. Chairman.
The Chairman. Thank you, Senator Cardin.
The next member--and I believe he is on the web--would be
Senator Thune. Is Senator Thune out there in cyberspace?
[No response.]
The Chairman. All right. Then Senator Brown is next, also
on the web.
Senator Brown. Thank you, Mr. Chairman. I just want to
thank Senator Cardin for always raising oral health and dental
health, and that is so, so important, both for Medicare,
obviously, and Medicaid, but especially Medicaid and the work
that he has done.
Thank you for that.
Thanks to both of the witnesses for their willingness to
serve and for their commitment to reducing health disparities,
prioritizing policies to address social determinants of health.
The history of institutional racism within our health-care
system continues to affect health outcomes for communities of
color.
I chair the Banking, Housing, and Urban Affairs Committee.
We just had a hearing yesterday on, from the Black Codes to Jim
Crow to redlining, to the Trump administration locking in
discriminatory housing practices, what that has meant to health
care and to wealth accumulation and inequality and all that. So
what you are doing in health care is so very important.
Ms. Brooks-LaSure, a question first for you. Medicaid and
Medicare are not just payers; they are powerful tools to
advance health-care quality and access to improve population
health outcomes and act as economic drivers for workers in
their communities.
Will you commit to working with my staff and others on this
committee to create and strengthen initiatives across CMS to
address social determinants of health and reduce health
disparities?
Ms. Brooks-LaSure. Absolutely, Senator. And thank you for
your leadership in this role, this critical issue. And it is
certainly a priority of mine.
Senator Brown. Thank you. We knew that; we wanted to hear
you say it again. So thank you.
One of the topics I raised with Secretary Becerra at his
confirmation hearing was the growing gulf between traditional
Medicare and Medicare Advantage. In recent years, both Congress
and HHS have expanded the scope of benefits available to those
enrolled in Medicare Advantage plans without doing so for those
individuals who choose to remain in traditional Medicare. You
have seen what has happened over 20 years of essentially
privatization efforts.
This question is for you both. If confirmed, will you work
with me to ensure all Medicare beneficiaries, whether they are
in traditional Medicare or enrolled in Medicare Advantage
plans, have access to the same benefits and out-of-pocket
protections?
Ms. Brooks-LaSure. Yes, Senator.
Ms. Palm. Yes, sir.
Senator Brown. Thank you.
One final issue for Ms. Palm. The Children's Hospitals
Graduate Medical Education (CHGME) program is of critical
importance to Ohio's six freestanding children's hospitals.
Senator Casey and I have for years worked together on a number
of children's issues where he has led, and especially with
children's hospitals. Our States have some of the best
children's hospitals in the country.
Ms. Palm, will you commit to working with Senator Casey and
me and the future head of HRSA to make sure that the Children's
Hospitals Graduate Medical Education program and training for
the next generation of pediatricians remains a priority for
this administration?
Ms. Palm. I would be happy to, Senator.
Senator Brown. Thank you. It has never been easy with any
administration, by budget time and other things, for GME, for
Children's Hospitals GME. So we are counting on you to be a
little bit different and a lot better than some of your
predecessors, Ms. Palm. Thank you so much.
Mr. Chairman, I yield back a minute and 40 seconds.
The Chairman. Thank you, Senator Brown. Always leading,
always leading.
Senator Thune, are you available now?
[No response.]
The Chairman. All right. Then we have Senator Casey and
Senator Whitehouse next.
Senator Casey?
Senator Casey. Mr. Chairman, yes, thank you very much. And
thanks for your leadership on a number of the issues we are
going to raise with our two nominees. Ms. Brooks-LaSure and Ms.
Palm, we are grateful for your willingness to continue public
service, especially at this time.
I wanted to start by talking about an issue that, frankly,
we have not spent enough time on over the last decade in terms
of what the Federal Government does, and that is home and
community-based services.
President Biden's American Jobs plan calls for a bold
investment in a great American idea, which is Medicaid-only
community-based services. The President has acknowledged what
every family in America already knows to be true: caregiving is
part of our basic American infrastructure. It is part of who we
are; it is how we function. It is part of our efforts to build
back better with the emphasis on the word ``better.'' Not the
old way, not the way it was in 2019, but better. And I would
hope much better.
Just as our society needs bridges, waterways, and roads to
function, families need services and supports to care for older
family members, to care for people with disabilities, and to
care for children. The President's proposal builds on the $12.7
billion of funding for home and community-based services that
was made possible when Congress passed the American Rescue
Plan.
We know that investing in home and community-based services
will, number one, improve the lives of both seniors and people
with disabilities. It will at the same time increase wages and
benefits for workers; and thirdly, it will create jobs, a lot
of jobs across the country.
A majority of these workers are low-income women of color
who earn an average of just $12 an hour. An investment in their
work is not only long overdue, it is consistent with American
values. If we claim to be the greatest country in the world but
our home and community-based services are not anywhere near the
best in the world, we cannot say we are the country we claim to
be. And for seniors and people with disabilities, access to
these services is the difference between simply just surviving
and indeed thriving.
So I would ask both Ms. Brooks-LaSure and Ms. Palm one
fundamental question, and I am going to ask you both the same
question. I would ask for your commitment to work with us to
secure funding for these services, the funding the President
has outlined, and thereby realize the President's vision for
home and community-based services.
Ms. Brooks-LaSure, I will start with you.
Ms. Brooks-LaSure. Yes; thank you, Senator, for your work
on this issue, and so many of the members of this committee.
Yes, I pledge to work with you on this.
Senator Casey. Thank you.
Ms. Palm. You have my commitment as well, Senator. This was
a priority in Wisconsin as we looked at the whole continuum of
the long-term care system and making sure that we were
modernizing and preparing for the needs of the future in this
system. And it would be my pleasure to work with you moving
forward.
Senator Casey. Thanks very much. I will stay with Ms. Palm
for this question. I am holding a document which I think I have
held up when we had a virtual engagement; it is called ``Five
Freedoms for America's Children.'' This is a document that our
staff worked on for a good long time; we are about to reissue
it in an even more ambitious form.
But when I proposed the ``Five Freedoms for America's
Children''--borrowing directly from Franklin Roosevelt's ``Four
Freedoms''--we were focused on, of course, this in a domestic
context for children. But what we wanted to do was put in place
a strategy for America's children. The good news is, in this
long, 33-page, 136-footnote document that I am very proud of,
some of the proposals in there were achieved in the American
Rescue Plan: the great expansion of the Child Tax Credit, for
example; the expansion of the Child and Dependent Care Credit.
So I would just ask Ms. Palm if you would make a commitment
to working with me--and obviously as one of the leaders of the
Department--working with me to get as much of this, of these
five freedoms implemented in the time that you serve.
Ms. Palm. I appreciate the question, and certainly your
leadership on this issue. I think to your point, if I am
confirmed, the Deputy Secretary has the opportunity to leverage
across the Department. We touch children in a whole variety of
ways, in various programs at ACF, at SAMHSA, at HRSA, and
across the board, and I would welcome the opportunity to work
with you moving forward on these critical issues.
Senator Casey. Thanks very much, and, Mr. Chairman, thank
you for working with me on all these issues. We are grateful.
The Chairman. Thank you.
Senator Casey. I have one question for the record on
nursing homes.
The Chairman. Very good. Thank you for your outstanding
work.
The order now is Senator Thune next, followed by Senator
Whitehouse and Senator Hassan.
So, Senator Thune.
Senator Thune. Thank you, Mr. Chairman.
Ms. Palm, I raised this issue with Secretary Becerra when
he was in front of the committee, but the topic of 340B is
enormously important to hospitals all across South Dakota and
across the region; we have three systems that serve the State
but also overlap into Minnesota and Iowa and Wyoming and
Nebraska--places like that.
And that program has been dysfunctional, I would say, for
some time now. And we have heard concerns recently from covered
entities in my State about actions taken by manufacturers, not
reimbursing contract pharmacies, all of a sudden deciding to
dispense with that--which they have questionable authority to
do--and now PBMs that are imposing conditions on hospitals in
order to get reimbursed, to get payment. And that affects their
ability to continue to provide a robust community benefit.
So it is an issue that has been hanging around for a long
time; it is a program, obviously, that Congress has expressed
support for in law, and it seems like a lot of the entities
that are designed to make it work are trying intentionally to
undermine the program.
So I am curious, if confirmed, how the Department would
respond to ensure that covered entities are not harmed by these
actions taken in that sort of supply chain, if you will, both
manufacturers and PBMs.
Ms. Palm. Thank you, Senator, for this question. And you
are right. I recall from my previous time at HHS that the 340B
program was often a topic of conversation, and a challenge. So
you are right, there are things we can and need to be doing in
this space.
I think to your point, it is a critical program for our
safety net providers and for the low-income folks who are able
to access drugs through the program. And I, if confirmed, would
look forward to the opportunity to make sure that the program
is working as it is supposed to be working, and that the
oversight and implementation are appropriate so that we really
are implementing legislative intent and getting to our safety
net providers in low-income communities the access that they
need.
Senator Thune. Thank you. And I am going to hold you to
that and follow up with you. But thank you for that answer. You
are absolutely right, it needs to be fixed, and I hope that,
once confirmed, you will help us get on top of this issue as
quickly as possible.
Let me just ask you too, if confirmed: the Indian Health
Service is one of the many operating divisions that would fall
under your purview. As you may know, for several years IHS
facilities in the Great Plains region have struggled with
staffing and quality-of-care issues.
Could you discuss your approach for how you would manage
IHS, drive quality improvements, and ensure accountability to
Congress? And maybe the follow-up to that, would you support
legislation that would enable IHS to terminate poor-performing
employees, and also to streamline the hiring process to enable
the recruitment of talented health-care professionals?
Ms. Palm. I really appreciate the question, Senator. I
think that IHS is such a unique part of the Department of
Health and Human Services, and when I served previously, I had
the opportunity to visit an IHS facility in your State, and so
I certainly understand firsthand the need for the work that is
before us to make sure that our tribal communities are
receiving the high-quality care that they need.
So I would look forward--I really appreciate you
prioritizing this, because there is important work that needs
to be done here to meet our mission at HHS as it relates to
IHS, and I would look forward to working with you, both through
the work we can do at IHS, but then you mentioned legislation.
I would be happy to work with you legislatively if there are
things we need to do in that space as well.
Senator Thune. Thank you.
And very quickly, Ms. Brooks-LaSure, CMS plays a
significant role with IHS as a payer and because of its
involvement in accrediting facilities and assessing compliance
with quality and safety measures.
Over the years, multiple facilities in my State have lost
or were in jeopardy of losing CMS accreditation because of
quality issues. What can we do to improve coordination between
IHS and CMS in holding facilities accountable for delivering
the highest quality of care?
Ms. Brooks-LaSure. This is a critical issue, and we have to
maintain our commitment, as the government, to work with Indian
populations to make sure they are getting the care that they
need. I pledge to work with my colleague to make sure that IHS
and CMS are coordinating well, and, whether it means that CMS
needs to provide technical assistance or take other steps, we
will work with you on this.
Senator Thune. Thank you.
And thank you, Mr. Chairman. I would just point out one
thing I forgot to mention. North Dakota is also a State that is
impacted by all these 340B issues; the regional systems that
serve South Dakota also serve North Dakota.
The Chairman. Thank you, Senator Thune.
Senator Whitehouse?
Senator Whitehouse. Thank you, Mr. Chairman. Welcome to
both of you. I have 5 minutes to ask you four questions, so I
will try to go quickly, macro to micro.
We have trillions of dollars in debt. Now, 2024 is the
first insolvency date for Medicare, and as my perennial graph
that I have shown you before shows, something happened in here
[pointing to graph] that has saved $6 trillion in Federal
health-care spending predicted within the next decade. I think
that what happened in here was delivery system reform.
And I am asking that both of you agree that this needs to
be a top priority for CMS and HHS, to figure out why that has
happened and to do more of it. Do you agree?
Ms. Brooks-LaSure. Yes, Senator. I think that delivery
system reform is critical for addressing costs, making sure
that we are delivering the care that people need, and CMS will
continue to look at its authority, through the Innovation
Center and through the Medicaid program, to continue to work on
these issues.
Ms. Palm. I would echo my colleague and would just suggest
that it is also the opportunity to put patients at the center
of care, as we are thinking about this.
Senator Whitehouse. Second point: ACOs. We have a lot of
really wonderful ACOs where I live. I have two of the best-
performing ACOs in the country, and it has been a constant
battle to defend the ACOs from you guys trying to pick their
pockets before they really get the reward of the investment
that they have made. We are seeing ACO participation shrinking
rather than growing. And you need to make sure that the ACO
lead dogs who are crafting a new model of care actually get
supported and encouraged so that that model of care can
propagate.
Ms. Palm. Senator, you have raised such an important issue,
which is that we want to make sure that our private-sector
stakeholders want to continue to innovate. And, if confirmed, I
will work with you to make sure that our incentives continue to
keep innovators wanting to innovate.
Senator Whitehouse. Thank you. We have another project on
end-of-life care where we will ask for waivers of some Medicare
payment regulations that are frankly stupid when they are
applied to this population. And I have been working on this now
for 8 years, and every time we get close, there is an
administration change or a personnel change or something, and
it is imperative to get a CMMI waiver to make this happen.
Will you promise that you will work with me to help me get
this CMMI pilot and those requisite waivers?
Ms. Brooks-LaSure. If confirmed, Senator, I am happy to
understand this demo better and work with you on what we can do
here.
Senator Whitehouse. Yes; I come into this boiling with
frustration because of 8 years of work--and it always falls off
the ledge because of a change in the executive branch. And I am
going to get this done.
Then the last thing is, we are working with medication-
assisted treatment. We have seen telehealth be very helpful in
this space. There is an ongoing conversation about the extent
to which that telehealth engagement needs to be video
conference and when it can be the audio conference. With people
who do not have a home to go to, people who are in perilous
circumstances of various kinds, the audio can be actually
necessary, and often can be mediated by responsible groups that
are serving that population.
Can you help me understand the best practices for the video
versus audio and also have somebody from HHS and CMS assigned
to give me advice on where we should be fighting to draw that
line: when is audio okay; when do you actually need it to be
video for medication-assisted treatment in telehealth?
Ms. Palm. Yes, Senator, this is a critical issue. So many
underserved areas struggle with this distinction; and as much
as we have seen telehealth improve care for some, we need to
make sure that it really is available for all. I am happy to
talk to you and learn more about this.
Senator Whitehouse. I will wrap up with the observation
that a lot of people, including our people in our national
security establishment, have said that the biggest issues to
America actually are the debt and deficits, and they go on to
say that it appears that the biggest part in our debt and
deficit area is this explosion of health-care expense. So that
begs this question of how you draw down without taking benefits
from people and making this really turgid system clear, fast,
and efficient and provide people care early so they do not have
the expensive care. That to me is just such an important
priority. I hope you will see it that way. You may end up being
the most important people in government, as I see it, in
solving that problem. Thank you.
The Chairman. Thank you, Senator Whitehouse.
Senator Hassan?
Senator Hassan. Well, thank you, Mr. Chair; and I want to
thank you and our ranking member for this hearing. And to our
nominees, thank you both for being here, for your willingness
to serve, for the service you have already provided to your
country and your State, and to your families too.
And I want to associate myself with everything that Senator
Whitehouse just asked you about; and I will just say that I
know Senator Bennet asked about the elimination of surprise
medical bills. I think that, the passage of that legislation to
end that practice, was an example of really patient-focused
policy-making. So I would look forward to working with you both
as we implement that provision and find further ways to really
look at our health-care system from the patient's perspective.
And I appreciate very much your willingness to do that.
Ms. Palm, I wanted to start with a question to you. As you
know, the COVID-19 pandemic has exacerbated the ongoing
substance use disorder crisis in the country. It is critical
that Congress and HHS work together to ensure that States
receive the funding that they need to support continued access
to substance use disorder treatment and services.
Over the past several years, State opioid response grant
funding has allowed New Hampshire to dramatically expand access
to opioid use disorder treatment and services for Granite
Staters. But under the current funding formula, a significant
portion of New Hampshire State opioid response grant funding is
now at risk.
I am working to ensure that States like New Hampshire do
not face dramatic funding cuts that would devastate opioid use
disorder treatment programs. Will you commit, Ms. Palm, to
working with Congress to ensure that States do not face
dramatic cuts in State opioid response grant funding?
Ms. Palm. Senator, I am so grateful for your leadership on
this issue, and considering what we have seen with the
pandemic--we were making such good progress--we have to double
down. And it is critical that States have the funding that they
need to continue to provide treatment for opioid use disorders.
Senator Hassan. Thank you very much.
Ms. Brooks-LaSure, I want to turn to you, and I just want
to say that I have two of the most eloquent colleagues in the
world, Senators Menendez and Casey, when it comes to talking
about home and community-based services.
So I will associate myself with their comments about the
importance of it. We know how important it is to individuals
and families to have the choice to get their long-term care at
home among familiar faces, in their community, and a chance to
really interact with their loved ones and control their care
that way.
But I want to drill down on a couple of things.
Unfortunately, many individuals who receive care in home and
community-based settings have really faced unique challenges
accessing, for instance, COVID-19 vaccines. And we know that
home health workers have struggled to access the personal
protective equipment and COVID-19 testing that they need to do
their jobs safely. Just as we saw other disparities really
highlighted by the pandemic, the disparity in terms of being
either a home health-care patient or a home health-care worker
has really been exacerbated too.
So, following up on the commitment you made to Senators
Menendez and Casey, as CMS Administrator, how would you work
with States to better support home health-care workers and
individuals who receive home and community-based care during
the COVID-19 pandemic?
Ms. Brooks-LaSure. Thank you, Senator. This issue you
raised, and the other Senators have raised, is such a critical
issue. We want to make sure that people are in the setting that
makes the most sense for them. And if confirmed, you certainly
have my commitment to make sure that CMS is doing everything it
can do, whether it is approving waivers or working with States
to address issues; and I would love to follow up with you on
this particular point.
Senator Hassan. Well, I would look forward to that as well,
because it continues to be a really serious issue.
I have one more question, and it is to Ms. Palm. As the
Secretary of the Wisconsin Department of Health Services, you
emphasized the importance of health data infrastructure in
expanding access to COVID-19 testing.
With the continued emergence of COVID-19 variants, ongoing
surveillance and health data exchange will be essential for
tracking emergent variants and mitigating community spread.
If confirmed, how will you leverage the tools at CMS or
throughout the Department to incentivize health data
modernization and improve data exchange?
Ms. Palm. It is such an important question. I think, more
broadly, our data infrastructure, our technology, our
modernization of the way we think about surveillance and data
is critical, and it is a place where HHS can and should help be
a leader, so that we are learning the lessons of what our data
infrastructure could do and could not do; what we need it to
do; where we could partner with the private sector to really
maximize our ability to understand community spread in the
example you gave; and how that helps us get in front of the
next surge or the next community that is facing an outbreak.
And so there is a lot of opportunity there, and I think we
really have to be focused, learn the lessons, and drive that
into the next iteration of how we work on data and the
transparency of that data moving forward.
Senator Hassan. Thank you very much. I look forward to
working with you on that.
Thank you, Mr. Chair.
The Chairman. I thank my colleague.
Next is Senator Daines.
Senator Daines. Thank you, Mr. Chairman.
Due to the open-border policies of this administration, we
are experiencing a public health and, sadly, humanitarian
crisis at our southern border. I saw it firsthand myself; other
Senators on this committee in fact were there as well,
including Senator Cornyn just a few weeks ago.
We had a chance to talk face-to-face with the border patrol
agents, who are overwhelmed by the influx of migrants at the
border. The Donna, TX facility has a capacity of 1,000. With
COVID, they reduced that number to 250. There were 4,200
migrants in that facility the day we visited, about 2\1/2\
weeks ago.
If confirmed, you will help oversee the agency that handles
care for unaccompanied children.
Ms. Palm, do you think the current situation at the
southern border is a crisis?
Ms. Palm. Senator, I am so grateful that you raised this.
This is one of the most pressing issues that HHS is working on
right now; and should I be fortunate enough to be confirmed, I
look forward to being part of helping get these children
through the system and placed in safe places with sponsors as
quickly as possible.
Senator Daines. Do you think it is a crisis?
Ms. Palm. I think it is a very urgent need, and----
Senator Daines. Have you seen it?
Ms. Palm. I have not been to the border.
Senator Daines. Have you seen the photos of the children in
these overcrowded facilities with no COVID protocols in place?
You know, I come from a northern border State. The northern
border is still virtually shut down. The southern border had
4,200, many of whom were children, in this facility with a 250-
person capacity. A high percentage of COVID transmission is
going on, high positive COVID test rates.
Have you seen those photos with really no COVID protocols
in place?
Ms. Palm. I have, Senator, and I can tell you as a social
worker, the care and safety of those kids has to be our top
priority at HHS, and if I am confirmed, I certainly will----
Senator Daines. And you are aware of what is going on
across the Mexican desert with the cartels and the coyotes, the
human trafficking, the abuse of these children that is going on
as a result of creating an incentive by the Biden
administration for them to make that dangerous journey, give
their life savings away to the cartels to come across
illegally?
Ms. Palm. I think one of the most important parts of the
process for us in placing these children with sponsors is that
screening, to make sure that those children are going to safe
homes, trusted homes, so that we are--so that human trafficking
and those abuse issues are screened out.
Senator Daines. Yes, but once you get across the border,
the trafficking issues and the abuse issues have already
occurred. This becomes a question of, how do we prevent that
and frankly stop it?
Ms. Palm. Senator, I know that there are--my colleagues
across the administration are looking at the broader issues at
play here, at the root causes and other issues. What I can tell
you is, should I be confirmed, our focus at HHS will be on the
safety of those children's placement in safe homes and finding
efficiencies in the system so that we are moving them quickly.
Senator Daines. Thank you. Do you think that the Vice
President, who the President has put in charge of resolving the
issue at the southern border, do you think she should be
visiting to see firsthand what is happening on the southern
border and witness conditions that we all saw here 2\1/2\ weeks
ago?
Ms. Palm. I think the Vice President has been tasked with a
great challenge, and I am sure she is doing everything she
needs to do----
Senator Daines. Why--we are just curious, why wouldn't she
go down and see this firsthand? The President has given her
explicit responsibilities. And that was 20 days ago. And she
has yet to show any interest in actually visiting the southern
border; has not shown up.
Ms. Palm. Senator, what I can tell you is, should I be
confirmed, I really want to emphasize the priority that we have
on placing those children as safely and quickly as possible.
Senator Daines. Throughout the pandemic, assisted living
providers in my home State have cared for over 6,000 vulnerable
Montanans, many of who are living with Alzheimer's or some form
of dementia.
Due to PPE needs, workforce needs, occupancy deadlines,
many of these providers have suffered millions in losses
throughout the pandemic and will struggle to sustain their
operations without financial relief. There is about $23 billion
remaining in the Provider Relief Fund to help support our
health-care heroes, who are on the front line of the COVID
response. I have urged Secretary Becerra to distribute more of
the remaining PRF to assisted living facilities and other
senior care centers.
Ms. Palm, would you support that kind of request?
Ms. Palm. Yes; to your point, our front-line health-care
workers have borne the brunt of this pandemic. When I was in
Wisconsin, we added additional dollars to what the feds were
providing to help ease the workload and the burden that they
were facing.
Senator Daines. Thank you.
One final question for Ms. Brooks-LaSure.
I founded this pro-life caucus in the United States Senate.
I am deeply committed to protecting the most vulnerable, and
that is the unborn. That is why I was troubled to see the
Democrats' $1.9-
trillion, quote ``rescue package'' include a taxpayer funding
of abortion and numerous provisions, including through
Obamacare.
If confirmed, how will you ensure compliance with separate
billing requirements for abortion under section 1303 of
Obamacare?
Ms. Brooks-LaSure. Senator, I will, if confirmed as CMS
Administrator, absolutely follow the law. And Congress sets
that, and whatever the requirements are, I will meet those.
Senator Daines. And more specifically, will you require
recipients of abortion-covering plans with zero-cost premiums
due to the expanded tax credits to pay the required abortion
coverage surcharge of at least a dollar a month?
Ms. Brooks-LaSure. Senator, I will follow the law. So if
that is the law, I will move forward with whatever you, as
Congress, have passed for me to do. Those are my
responsibilities.
Senator Daines. Thank you.
The Chairman. Thank you, Senator Daines.
Next is Senator Cornyn.
Senator Cornyn. Ms. Palm, as I think the chairman will back
me up on this, China has risen to the top of everybody's
agenda, out of concerns about cybersecurity, cyber-attacks,
stealing intellectual property, espionage, obviously with vast
national security implications.
So I will ask you some specific questions in writing later
on, but I want to follow up on some of the things that Senator
Daines raised, because it has such a dramatic impact on my
State and the country.
So, if confirmed, you would oversee the Office of Refugee
Resettlement, correct?
Ms. Palm. Yes, as part of the Administration for Children
and Families; yes.
Senator Cornyn. And you mentioned that the goal, your goal,
would be to place these children, unaccompanied children, with
sponsors as soon as you could.
Ms. Palm. Yes. Our mission is to find the sponsors, the
families, the relatives to care for these kids while their
immigration processes are proceeding.
Senator Cornyn. And after you have placed them with
sponsors, is the responsibility of the Office of Refugee
Resettlement finished?
Ms. Palm. As I understand it, Senator, yes.
Senator Cornyn. Which government agency monitors the
welfare of these children once they are placed with sponsors?
Is there any government agency you are aware of that has that
responsibility?
Ms. Palm. It is my understanding--and I'm happy to follow
up--that if there are concerns once they are placed, State
child welfare agencies can become involved in those situations.
Senator Cornyn. Are you aware of the fact that roughly 18
percent of the wellness checks, telephone calls made to the
sponsors' telephone number, go unanswered?
Ms. Palm. I did not know that, sir.
Senator Cornyn. Are you aware of the investigation--the
Permanent Subcommittee on Investigations of the Homeland
Security and Governmental Affairs Committee revealed that some
unaccompanied children, once placed with sponsors, I believe in
Ohio, were put into a forced labor condition. Have you heard of
that?
Ms. Palm. I have heard of that, sir, yes.
Senator Cornyn. So do you share my concern for the welfare
of these children once they are placed with these sponsors who
may not even be American citizens, who may not even be related
to the child?
Ms. Palm. Senator, our mission at HHS is the safety and
welfare of those children while they are in our custody; and it
is our job to screen those sponsors before placement; and
should I be confirmed, I certainly am committed to doing that
work.
Senator Cornyn. Well, after they have been placed with the
sponsors, who is supposed to protect these children?
Ms. Palm. Senator, as I mentioned, it is my understanding
that, if there are concerns beyond the placement, our placement
and the transfer of custody to those sponsors, child welfare
agencies may get involved.
Senator Cornyn. So there may or may not be a report to the
child welfare agencies if these children are put into a forced
labor situation or if they are being trafficked for sex or they
are being recruited into gangs? We are supposed to wait on a
report from somebody that alerts the child welfare system. Is
that correct?
Ms. Palm. Senator, it is my understanding that, if there
are concerns post-placement by HHS, child welfare agencies may
become involved.
Senator Cornyn. Well, let us talk about while these
children are still in the custody of HHS and the Office of
Refugee Resettlement. Last week my Governor, Governor Abbot,
sent a letter to Vice President Harris with regard to
complaints of sexual assault while the young children, I think
they are all males, were located at the Joe Freeman Coliseum in
San Antonio in an HHS facility.
The complaints outlined multiple allegations involving
sexual assault, shortage of staff to supervise the children,
and reports that the children were not receiving enough food.
There were also complaints that the children who have been
exposed to COVID were not properly isolated from other children
who were not, had not been exposed.
Obviously these allegations, if true, are extremely
disturbing. What steps would you take, if confirmed, to address
these sort of allegations?
Ms. Palm. Senator, these are serious allegations and
certainly ones that I take seriously. Should I be confirmed--I
think there are a couple of things here. From my experience
previously but also my priorities moving forward, there is a
zero-tolerance policy for abuse in HHS facilities. There is an
internal investigation and, because they are mandatory
reporters, there also is an external investigation that comes
forward. Staff are removed from the facility pending that
investigation, and that speaks to the seriousness with which
HHS takes allegations around abuse of children in our care.
As it relates to COVID protocols, obviously that is a
critical part of reducing the spread of COVID, and it is my
understanding that CDC is both providing assistance in the
development of those protocols but also that there are CDC
folks on the ground at our facilities to help with
implementation and to help make sure that what is necessary is
being done. But if there are concerns that that is not
happening, I would look forward to hearing about them and
working with you to make sure that those COVID protocols are in
place and implemented.
The Chairman. The time of my colleague has expired, and we
still have other Senators waiting.
Senator Warner?
Senator Warner. Thank you, Mr. Chairman.
And again, Ms. Brooks-LaSure and Ms. Palm, thank you for
your willingness to serve. I have a series of questions.
Over the past decade, a hundred rural hospitals have
closed; we have seen three of those in my State of Virginia.
Obviously, the pandemic has particularly hit the rural
communities extra hard, and rural hospitals extra hard. And it
is no coincidence that the vast majority of these hospital
closures occurred in areas with the lowest Medicare area wage
index rates.
In Virginia, for example, I have been working for 3 or 4
years in one of our most rural far southwest counties, Lee
County, to get a hospital facility reopened. And they have told
me point-blank on the path to getting it reopened that fixing
the Medicare area wage index would be a huge step in the right
direction.
To help solve this problem, we have bipartisan
legislation--the Save Rural Hospitals Act of 2021, with
Senators Blackburn, Cornyn, and Warnock--which would establish
a reasonable match, no-
minimum Medicare wage index of .85, which would increase
Medicare payments for rural hospitals in 22 States.
Ms. Brooks-LaSure and Ms. Palm, obviously both HHS and CMS
would play an incredibly important role. I would like you to
both pledge to work with Congress, if you are confirmed, to
support rural hospitals by addressing the problem in the
Medicare area wage system, and any other comments you might
have specifically on how we can guarantee the viability, long-
term, of our rural health system.
Ms. Brooks-LaSure. Thank you, Senator Warner, for your
leadership, and for other members of this committee, who I know
very much care about your rural hospitals, which are in so many
areas, backbones of their communities; and their issues can be
different across the different States.
We will absolutely work with you to make sure that we are
supporting rural hospitals in the way that is appropriate, and
I want to work with you on this topic.
Senator Warner. And specifically on the--you know, the
rubber hits the road on the Medicare area wage system. You will
work with us on that issue specifically as well?
Ms. Brooks-LaSure. Certainly.
Senator Warner. Ms. Palm?
Ms. Palm. I look forward to working with you, Senator, on
this issue.
Senator Warner. And both are very, very important. And I
again think you are going to find broad-based bipartisan
support for changing the ratio to the .85 we have suggested;
and again, I look forward to working with you both on that.
I want to raise another issue, which is the question around
diabetes and diabetes education. I think we all know--you know,
one in three Americans has diabetes. My home, in Virginia--we
have 631,000 Virginians who have diabetes. To try to educate
those individuals--life-style changes have been a bit of a
challenge. That national diabetes prevention program, which
again CMS has worked with, has shown, I think, great results.
The problem has been that, for example in Virginia, we only
have one in-person educator for the whole State.
So with COVID coming, we have been able to show, through
telehealth, that this is a much more efficient delivery model,
oftentimes again to the rural communities we were just talking
about. So I have legislation, bipartisan with Senator Scott of
South Carolina, that would allow a virtual platform to be used.
I do not know if this has come to your attention, Ms. LaSure,
but again, it is for both nominees.
I would hope you would be willing to take some of the
lessons learned from COVID in delivery of telehealth,
particularly on the education side with diabetes. I think this
may be one of the areas where we have a better solution set
now, and my hope would be that we could make that permanent.
Ms. Brooks-LaSure. Thank you, Senator Warner. I certainly
have heard, across this discussion, how important telehealth
is, and what a great example of a clear area where it has been
helpful. I really want to work with you and all the members of
this committee to see what we can do certainly, if confirmed,
administratively, as well as where we might need congressional
help.
Senator Warner. Ms. Palm?
Ms. Palm. I would welcome the opportunity. I think we
learned in Wisconsin that these flexibilities and the
opportunities to be creative in this space provided us
learnings and places where we ought to maintain those
flexibilities; and I would look forward to working with you.
Senator Warner. Mr. Chairman, this is an area I hope I
could work with you on as well. I think getting diabetes
education on a virtual platform really makes good sense.
The Chairman. Absolutely, Senator Warner. I think it is
hugely important. Thank you.
Our next speaker is Senator Cortez Masto.
Senator Cortez Masto. Thank you. Congratulations to both of
you.
Let me just say, in nearly every conversation I have with
Nevadans about the pandemic, they mention the toll COVID-19 has
taken on mental health and wellness, from students experiencing
trauma to isolated seniors, to communities of color who have
been hardest hit, and families experiencing severe economic
hardship. No one has been spared in Nevada, and similarly
across the country.
In my view, addressing these impacts should be at the top
of both of your lists. So let me start with--there has been a
lot of discussion about telehealth and telemedicine. Count me
in; that is something that I have seen in my State that should
be permanent. It has brought essential services into our
underserved communities.
But one thing I do want to add, Ms. LaSure, is that
utilization of telehealth services via telephone without any
video is just as important. So I hope, as we look at maybe
making this a permanent infrastructure, we recognize the
benefits of both, whether it is video or just a telephone,
working with a patient. Because that has brought essential
services into my communities as well. And I just want to put
that on your radar.
Another area I want to focus on is that, unfortunately, we
have seen high suicide rates in southern Nevada from some of
our students. And recently, I wrote a letter to Secretary
Becerra and Secretary Cardona about my concerns over students'
mental health and behavioral health. And I asked the
Secretaries to work together to ensure that schools are
welcoming kids back to classrooms, and they have guidance and
best practices at their fingertips that incorporate the wealth
of knowledge at HHS on dealing with youth mental health.
So let me ask, Ms. Palm, as the COO of HHS, how will you
work to ensure that we are leveraging all of the expertise at
the Department, from ACF's work with kids in the child welfare
system to SAMHSA's experience in providing trauma-informed
care, to make sure that we are spending the American Rescue
Plan resources as effectively as possible?
Ms. Palm. I really appreciate the question, Senator, and
appreciate your leadership in this space. I think, as we talked
about when we met and here today, it is--if I am fortunate
enough to be confirmed, I think one of the places where the
Deputy Secretary's office has a real opportunity is in making
sure that the whole is greater than the sum of its parts; that
we really are leveraging the assets and the expertise of the
various programs in the Department to really put the people
that we serve, the American people, at the center of what we do
and the programs that we implement.
And so, whether it is kids' mental health or other issues,
we have a real opportunity, and I certainly would look forward
to working with you on this issue and others where our
coordination and our ability to work together really does
better serve the people of this country.
Senator Cortez Masto. Thank you.
And staying on the same theme of behavioral health--crisis
services. So last year, SAMHSA released national guidelines for
behavioral health crisis care. This playbook is the product of
years of work by the agency and draws from innovative projects
in communities across the country that are going above and
beyond to meet the needs of individuals experiencing behavioral
health services.
This tool is so important because it paints a picture of
how we can build a sustainable continuum of crisis services
that we do not have in Nevada. And similarly, I am hearing from
some colleagues across the country.
I started working with Senator Cornyn on legislation that
would help States stand up crisis services and make them
sustainable by integrating them into both public and commercial
insurance plans.
So Ms. Brooks-LaSure, these guidelines are a product of
SAMHSA, but CMS will play an integral role in expanding crisis
services to patients across the country. Can you speak to what
you see as the need for behavioral health crisis services and
how you would work with SAMHSA to make sure that those needs
are met?
Ms. Brooks-LaSure. Thank you for raising this issue and for
your leadership in this area, as we have been talking about
today. What we have seen across our country in terms of mental
health is, we had an issue before COVID, and COVID has
absolutely had such an effect on so many individuals, and
particularly students, as you raise and point out.
One of the things that, if confirmed, I want to make sure
of, is that CMS is really integrating very closely with the
other parts of HHS and with my colleagues. States in the
Medicaid program have a very important role in behavioral
health, and many of them are engaging and working in this area.
I think certainly in the Medicaid program and others, we want
CMS to integrate with SAMHSA to make sure we are tackling this
issue holistically as opposed to one part of the agency.
Senator Cortez Masto. Thank you. And I know my time is up.
I just want to say, you have heard from the discussion, this is
such an important topic for all of my colleagues; we have
talked about this in a bipartisan way, as you can imagine. We
look forward to working with you to really bring additional
resources that are necessary to address behavioral health needs
across this country.
Thank you again, and congratulations on your nominations.
Ms. Brooks-LaSure. Thank you.
The Chairman. I thank my colleague.
Senator Warren is next.
Senator Warren. Thank you, Mr. Chairman, and
congratulations to our nominees.
It is no secret that our health insurance system, even in
the best of times, leaves millions of people without the
coverage that they need. But because most Americans still
depend on their jobs to provide health coverage, our system
performs even worse in a crisis like the one we are now living
through.
Heading into 2020, nearly 30 million people were uninsured.
Then when the coronavirus hit, unemployment spiked, and up to 3
million more people lost their employer-based insurance.
Now President Biden has promised to expand health coverage,
and public programs like Medicare that provide high-quality
care at low cost will be the backbone of that expansion, not
for-profit insurers that will find any opportunity to shift
costs to patients while they line their own pockets.
So, Ms. Brooks-LaSure, you have testified previously about
the popularity of the Medicare program. Americans aged 65 and
up, and some people with disabilities, are eligible for
Medicare right now, but there are a lot of people, many just
below the eligibility age, who struggle to get high-quality,
affordable care through private insurance.
Can you just say a word about what are the challenges
facing older Americans who may want Medicare but have not hit
their 65th birthday yet?
Ms. Brooks-LaSure. Thank you, Senator Warren, for your
leadership in making sure that policy-makers continue to focus
on making sure coverage is affordable in this country. The
Affordable Care Act was such an incredible, important first
step in making sure that people had affordable care options.
The Congress has just passed the American Rescue Plan--thank
you for that--which is making such a difference to people on
the ground right now who, as a result of the COVID pandemic,
may be struggling to pay for their health insurance.
Being right below the Medicare-eligible age can be an
incredible challenge for people if they do not have affordable
employer-
sponsored insurance. In many States, coverage through the
marketplaces is available to them, and we need to continue to
work to make sure that we have affordable options available for
that population in particular, as they may want to make
decisions about retirement, make decisions about job changes at
that point in their lives.
Senator Warren. Right. So we have this group of Americans
who are not quite old enough yet for Medicare, but who are
sometimes struggling to access health care right now, during
the time in their lives when they start to need health-care
coverage the most.
As a candidate, President Biden promised to help this group
of Americans by lowering the age of Medicare eligibility to 60
years old. And doing so would expand Medicare coverage to
roughly 23 million people.
Ms. Brooks-LaSure, analysts have shown that lowering the
Medicare eligibility age to 60 could ensure nearly 2 million
previously uninsured people would get coverage, and it would
help reduce premiums for the current Medicare population
because it would add a younger, healthier population to the
Medicare risk pool, benefiting the health system overall.
Is that correct?
Ms. Brooks-LaSure. I am not familiar with that particular
study. I do know that the population you are talking about is
absolutely one that--I have worked with States where
eligibility for various programs could be higher, and we need
to make sure that that population has coverage.
Senator Warren. Well, let me just ask it slightly
differently. I understand if you do not know this particular
study, but the general principle makes sense.
When we have fewer uninsured people, and when healthier,
younger people join risk pools, that is a good thing, right?
Ms. Brooks-LaSure. Yes, it is a good thing when healthier,
younger people join this pool.
Senator Warren. And more people get coverage.
So, Ms. Brooks-LaSure, do you agree with President Biden
that lowering the Medicare eligibility age could strengthen
health-care coverage in America?
Ms. Brooks-LaSure. I think that the President has outlined
several important policies, including as you said, the lowering
of the Medicare age; and if confirmed, I will work to implement
the policies of the administration.
Senator Warren. All right. And I appreciate your answer. I
have to tell you, lowering the Medicare eligibility age to
expand coverage and lower costs is a no-brainer. I know
President Biden has talked about dropping the Medicare age from
65 to 60, but frankly I think we should go even further. People
need low-cost health-care options, particularly as they get
older and need more health care.
Dropping the age to 60 could expand Medicare for 23 million
people, but dropping the age to 55 could expand it for an
additional 14 million people. And doing so has the potential to
lower premiums in the Medicare program, and depending on how we
structure it, lower premiums for private health insurance too.
So we have this opportunity to expand Medicare coverage to
tens of millions of Americans, and we cannot waste it. We need
to get this done.
Thank you, Mr. Chairman.
The Chairman. Thank you, Senator Warren. And Senator Warren
is raising an important point. I was director of the Gray
Panthers for about 7 years before I was elected to Congress,
and one of the things we always talked about is that Medicare,
when it began in 1965, was just half a loaf. It did not cover
so many crucial needs; dental care, for example, which we have
seen during the pandemic being a particularly urgent priority.
So I think these are critical issues that we are going to
be digging into.
I have a couple more questions, and then we will wrap up.
On the chronic care question--apropos again to how Medicare has
changed. Back in those Gray Panthers days, I taught gerontology
as well. The first question on every exam I gave was, what was
the difference between Medicare Part A and Medicare Part B?
Because that was it. You had hospitals, you had doctors, and
you were basically dealing with acute care.
That is not it anymore. Now the program is overwhelmingly
about chronic illness, and it is increasingly headed that way.
So I have a very specific question. Our bill in 2017
finally put a stake in the ground that we were going to update
the Medicare guarantee. We did fairly well, in some key pieces.
Telehealth would be one--the Trump administration, your
predecessor, Ms. Brooks-LaSure, did not do much, but at least
we got that position--Medicare Advantage.
But my question to you is, what are the next steps in your
view, because it seems to me that one of the next crucial
priorities for chronic care is doing more to bring traditional
Medicare, which still covers millions and millions of people,
into this circle of better care for what is overwhelmingly
going to be the future of the program.
What are your thoughts on that?
Ms. Brooks-LaSure. Thank you, Chairman Wyden, for your
leadership in passing the CHRONIC Care Act, and I know that
there has been so much analysis on how effective and helpful
that is, including an article by the late Robert Pear. And
Medicare Advantage has been able to take advantage of the
legislation and the work that you have passed.
I think, as Senator Brown mentioned, it is critically
important that we bring some of the innovations and advantages
to traditional fee-for-service and traditional Medicare. And
whether that is something that we can, if confirmed, look at
administratively or whether that is something we need to come
back to Congress for, I am happy to work with you on this
topic.
The Chairman. Again, I put this in the context, not just if
you are confirmed, but when you are confirmed, because we are
deeply committed to that. I would very much like you all to
assign some staff from the Department to work with us. We will
work on a bipartisan basis. Then-chairman Hatch and I did that
when we wrote the original bill.
But I just think we have to do more to bring traditional
Medicare into the update of what is, I think to the American
people, a guarantee of Medicare.
Now, a quick point about prescription drugs, because you
have heard this back and forth and the like. I think we know
why this is such an acutely important issue to millions of
people; they just feel like they are getting mugged at the
pharmacy counter.
I mean, insulin prices went up 12-fold in a period of time
that was not very long; the drug is not 12 times better. I
mean, it is just plain old price gouging.
So I want you to know that what I am in favor of is a
policy that has Medicare negotiate on behalf of the more than
60 million Medicare beneficiaries in order to get them a better
deal. That is piece number one.
And the second piece, which we focused on here in the
Finance Committee, is when big pharma is price-gouging, they
are going to lose subsidies. You know, they get subsidies from
the Federal Government; if they price gouge on insulin, they
are going to lose some of those subsidies.
And so as you all in the administration, when confirmed,
debate those issues, I want you to hear from me, we ought to be
pursuing both policies: letting Medicare negotiate, because
everybody tries to negotiate, it is just common sense; and we
cut subsidies when there is price-gouging. That will produce
more savings for the seniors and more savings for taxpayers.
Last point, just to send you both off formally, I consider
you both to be eminently qualified, and I think people who
review this hearing and look at the record will see
considerable bipartisanship. And, Ms. Palm, I noted that, if
confirmed, you would advance the common-ground agenda. That is
pretty conciliatory language. And, Ms. Brooks-LaSure, you
indicated that you would work with Finance members on several
bipartisan issues like the telehealth question and the 1332
waivers which I talked about at some length; we do not need to
do that again. But I appreciated your saying that that would be
a priority for you when confirmed, in terms of getting the
guidance out.
So, we have had a long hearing today. I just want members
to know I am going to support these two nominees strongly. The
deadline for Senators to submit their questions for the record
is 5 p.m., Friday, April 16th.
And with that, the Finance Committee is adjourned.
[Whereupon, at 1 p.m., the hearing was concluded.]
A P P E N D I X
Additional Material Submitted for the Record
----------
Prepared Statement of Chiquita Brooks-LaSure, Nominated to be
Administrator, Centers for Medicare and Medicaid Services, Department
of Health and Human Services
Chairman Wyden, Ranking Member Crapo, and members of the committee,
thank you for considering my nomination to be the Administrator of the
Centers for Medicare and Medicaid Services. And thank you to Senators
Booker and Menendez for their kind words.
As a graduate student, one of my first internships was with the
Senate Finance Committee. I remember being so awestruck the first time
I saw the committee room and the important business being done on
behalf of the American people. So, it's incredibly humbling to sit in
front of this committee, this time to testify before you as President
Biden's nominee to lead CMS.
My career in public service started at the Office of Management and
Budget. My portfolio included CMS's budget, the Children's Health
Insurance Program, and coverage options for the uninsured.
But after 9/11, everything changed. It did for the victims of that
terrible tragedy, their families, and for first responders. It also
changed for many of you, and for everyone in government service. For
me, my work shifted toward finding coverage for dislocated workers in
the wake of the attack. I worked closely with the Treasury Department
and key members of the Bush administration to ensure that those
impacted by this senseless attack had health coverage during such a
vulnerable time in their lives.
It was inspiring to be part of a bipartisan effort to ensure that
people who lost jobs as a result of the attack and its impact on the
economy were able to get the health care they needed. I took that
philosophy of bipartisanship and sense of mission to improve health
care for patients and families with me to the House Ways and Means
Committee--where I was privileged to work for the members of that
committee on five bills that eventually became law. It's the philosophy
I took to HHS and CMS--where I led the development of policies needed
to implement the Affordable Care Act and expand coverage to more than
20 million Americans.
I've approached my work in the private sector with the same
philosophy--working with States and other stakeholders to expand
coverage options, especially for those living in rural parts of the
country and for traditionally marginalized communities. Today, as we
navigate this public health crisis and its aftermath, that philosophy
guides me yet again. If confirmed, that is the collaborative, common-
sense, results-oriented philosophy I'll take to CMS to address the
complex challenges we face.
I am excited by the many opportunities we have to work together to
improve health-care quality, lower costs, and promote better access. I
am committed to leading the agency in a way that ensures it acts with
the utmost integrity and upholds its fiduciary responsibilities. This
includes addressing Medicare solvency to protect Medicare for current
and future beneficiaries.
We must get the pandemic under control. COVID-19 has put unbearable
pressure on front-line health-care workers, put vulnerable seniors and
those with disabilities at great risk, and unmasked inequities that
persist in our health-care system. I am committed to working with you
and with leaders across government to ensure that CMS is supporting
patients and providers, including communities of color who have been
hardest hit by this pandemic.
But we cannot wait to deliver better care to patients and families.
If confirmed, I will work to make the programs overseen by CMS work
better together to help the people they serve. Medicare, Medicaid, and
coverage on the marketplaces remain the pillars of our health-care
system, and there is much we can do to strengthen those programs to
improve quality, lower costs, and expand access.
That includes implementing the critical reforms in last December's
appropriations bill and in the American Rescue Plan, particularly the
prohibition on surprise medical bills, the new emergency rural hospital
designation, and the expansion of financial help for working families
to buy comprehensive coverage on the marketplaces.
If confirmed, I am also committed to working with you to expand
access to innovative therapies, procedures, and models of care. We are
living in an era of incredible change as researchers find new ways to
conquer disease and improve our quality of life. We must bear in mind
though, that innovation is only effective if patients can actually
afford it. I will also work with the committee and all of Congress to
rein in health-care costs, including for prescription drugs.
Finally, we must think broadly about health equity. During my
career, I've seen how communities of color too often experience worse
health outcomes, which we've seen so acutely during this pandemic. Last
year in April, my own hometown, a predominately black community where
my parents still live, experienced higher rates of COVID-19 infections
and deaths compared to much of the surrounding communities. If
confirmed, I look forward to working with each of you to expand access
to quality care for all communities.
I realize that members of this committee may not always agree on
the best approaches to solve these challenges. While there may be
disagreements on policy, I pledge to work closely with all members of
this committee to ensure that our decisions are transparent, our team
is accessible, and that CMS closely listens to and respects your views
and ideas for how we can ensure that CMS's programs fulfill their
mission to best serve patients, providers, and their communities.
Before I close, I'd also be remiss if I did not acknowledge the
outpouring of support I've received from women of color from across the
country. I am proud that, if I have the honor of being confirmed, I
will be the first black woman to lead CMS.
And I wouldn't be here without my family--my husband sitting behind
me, my parents and siblings, and the many strong, smart black women and
men who came before me. Too often, they weren't given the opportunity
to live up to their full God-given potential. But their selfless, often
silent sacrifice paved the way for me and so many other women of color.
Today, I'm proud that my daughter can see her mother nominated by the
President of the United States to lead such a critical agency--and know
that she can be anything she wants to be.
Thank you for considering my nomination, and I look forward to
answering your questions.
______
SENATE FINANCE COMMITTEE
STATEMENT OF INFORMATION REQUESTED
OF NOMINEE
A. BIOGRAPHICAL INFORMATION
1. Name (include any former names used): Current: Chiquita White
Brooks-LaSure; Former: Chiquita Lynn White.
2. Position to which nominated: Centers for Medicare and Medicaid
Services Administrator.
3. Date of nomination: February 19, 2021.
4. Address (list current residence, office, and mailing addresses):
5. Date and place of birth: March 17, 1975; Philadelphia, PA.
6. Marital status (include maiden name of wife or husband's name):
7. Names and ages of children:
8. Education (list all secondary and higher education institutions,
dates attended, degree received, and date degree granted):
Georgetown University.
Dates Attended: August 1997-June 1999.
Degree Received: Master of Public Policy (MPP).
Date Degree Granted: June 1999.
Princeton University.
Dates Attended: September 1992-June 1996.
Degree Received: Bachelor of Arts Degree (AB).
Date Degree Granted: June 1996.
Willingboro High School.
Dates Attended: 8th-12th grade--September 1987-June 1992.
Degree Received: High School Diploma.
Date Degree Granted: June 1992.
9. Employment record (list all jobs held since college, including the
title or description of job, name of employer, location of work, and
dates of employment for each job):
Manatt Health Strategies, Manatt, Phelps, and Phillips, LLP.
Managing Director.
January 2016-present.
Washington, DC.
CapView Associates (Consulting).
Senior Advisor.
July-December 2015.
Headquarters: Washington, DC; worked from Melbourne, Australia
and Falls Church, VA.
Commonwealth Fund.
Author.
June-November 2015.
Headquarters: New York, NY; worked from Melbourne, Australia
and Falls Church, VA.
Deakin University.
Visiting Scholar.
May-August 2015.
Melbourne, Australia.
Breakaway Policy (Consulting).
Senior Advisor.
June 2014-January 2015.
Headquarters: Washington, DC; worked from Melbourne, Australia.
U.S. Department of Health and Human Services.
Director of Coverage Policy, Office of Health Reform.
April 2010-December 2012.
Washington, DC.
Centers for Consumer Information and Insurance Oversight
(CCIIO), Centers for Medicare and Medicaid Services (CMS).
Deputy Center Director and Deputy Director for Policy and
Regulation.
December 2012-May 2014.
Washington, DC and Bethesda, MD.
U.S. House of Representatives.
Majority Professional Staff, Ways and Means Committee.
November 2007-April 2010.
Washington, DC.
Avalere Health.
Senior Manager/Manager (September 2003-September 2006).
Director (October 2006-October 2007).
Washington, DC.
Office of Management and Budget.
Program Examiner.
July 1999-September 2003.
Washington, DC.
U.S. Senate.
(Unpaid) Intern, Senate Finance Committee.
January-June 1998 (Estimated).
McCarter and English.
Paralegal.
July 1996-July 1997.
Newark, NJ.
10. Government experience (list any current and former advisory,
consultative, honorary, or other part-time service or positions with
Federal, State, or local governments held since college, including
dates, other than those listed above):
Advisory: Committee Member, Virginia Health Benefit Exchange
(September 2020-present). Upon confirmation, as outlined in my
Ethics Agreement, I will resign from this position. My role is
advisory; the committee provides advice to the Exchange
Executive Director and VA State officials as they develop their
State-based exchange in place of the federally facilitated
exchange.
Volunteered as one of the two leads for the Biden-Harris
Transition Agency Review Team for HHS, October 2020-January
2021.
Consultative: Authored reports for the States of Nevada
(January 2021), New Mexico (December 2018 and January 2019),
and Oregon (December 2020). Further detail included in response
to Question 15.
11. Business relationships (list all current and former positions held
as an officer, director, trustee, partner (e.g., limited partner, non-
voting, etc.), proprietor, agent, representative, or consultant of any
corporation, company, firm, partnership, other business enterprise, or
educational or other institution):
The following are current positions. Upon confirmation, as
outlined in my Ethics Agreement, I will resign from these
positions:
Board of directors, FAIR Health. I have served on the board of
directors since Spring 2018. The board of directors provides
input on the organization's strategic goals and activities and
approves the organization's budget and executive director's
salary. We receive regular updates on how the organization is
performing against its goals and budget and are updated on
personnel matters.
Board of directors, Children's Law Center. I have served on the
board of directors since May 2019. The role of the board of
directors includes the activities and responsibilities listed
above for FAIR Health, with the additional responsibility of
fundraising. I am also on the Development Subcommittee which
assists with the organization's fundraising efforts, including
planning for the annual benefit.
Managing Director, Manatt, Phelps, and Phillips, LLP (income,
but not equity, partner).
12. Memberships (list all current and former memberships, as well as
any current and former offices held in professional, fraternal,
scholarly, civic, business, charitable, and other organizations dating
back to college, including dates for these memberships and offices):
Alfred Street Baptist Church.
Member.
2012-present.
Thursday Network, Auxiliary of the National Urban League.
Member.
2001-2005 (Estimated).
Princeton Evangelical Fellowship (now Princeton Christian
Fellowship).
Social Chair: 1995-1996.
Member: 1992-1996.
13. Political affiliations and activities:
a. List all public offices for which you have been a candidate
dating back to the age of 18.
None.
b. List all memberships and offices held in and services
rendered to all political parties or election committees,
currently and during the last 10 years prior to the date of
your nomination.
Co-led the Coverage Subcommittee within the volunteer Health
Policy Committee for the Biden Presidential Campaign, Summer 2020.
c. Itemize all political contributions to any individual,
campaign organization, political party, political action
committee, or similar entity of $50 or more for the past 10
years prior to the date of your nomination.
See Table.
------------------------------------------------------------------------
Contribution Description Date Amount
------------------------------------------------------------------------
OBAMA FOR AMERICA 2012-08-31 $56.00
------------------------------------------------------------------------
OBAMA FOR AMERICA 2012-10-03 $56.00
------------------------------------------------------------------------
CALONE FOR CONGRESS 2016-04-27 $250.00
------------------------------------------------------------------------
PEOPLE FOR DEREK KILMER 2016-04-27 $250.00
------------------------------------------------------------------------
HILLARY FOR AMERICA 2016-07-06 $500.00
------------------------------------------------------------------------
HILLARY FOR AMERICA 2016-11-07 $120.00
------------------------------------------------------------------------
HILLARY FOR AMERICA 2016-11-07 $250.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2017-09-30 $100.00
------------------------------------------------------------------------
ROSEN FOR NEVADA 2018-04-30 $100.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2018-05-29 $1,000.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2018-09-03 $100.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2018-09-03 $100.00
------------------------------------------------------------------------
ROSEN FOR NEVADA 2018-09-30 $100.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2018-09-30 $100.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2019-06-10 $500.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2020-02-05 $100.00
------------------------------------------------------------------------
DSCC 2020-04-25 $125.00
------------------------------------------------------------------------
BIDEN FOR PRESIDENT 2020-04-25 $125.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2020-04-25 $250.00
------------------------------------------------------------------------
BIDEN FOR PRESIDENT 2020-04-29 $250.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2020-07-29 $100.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2020-07-29 $100.00
------------------------------------------------------------------------
DNC SERVICES CORP/ DEMOCRATIC 2020-10-11 $1,000.00
NATIONAL COMMITTEE
------------------------------------------------------------------------
WARNOCK FOR GEORGIA 2020-12-08 $250.00
------------------------------------------------------------------------
14. Honors and awards (list all scholarships, fellowships, honorary
degrees, honorary society memberships, military medals, and any other
special recognitions for outstanding service or achievement received
since the age of 18.):
Recognition Award for Ten Years of Federal Service: 2013.
OMB Performance Award: 2002 (Estimated).
Campbell Award for Alumni (Georgetown University): May 2001.
Merit Scholarship (Georgetown University): 1997-1999.
15. Published writings (list the titles, publishers, dates and
hyperlinks (as applicable) of all books, articles, reports, blog posts,
or other published materials you have written):
Publications
Co-author, Senate Concurrent Resolution No. 10 Study:
Evaluating Public Health Insurance Options for Nevada
Residents, Nevada Legislative Commission, January 2021.
Co-author, ``Oregon Public Option Report: An Evaluation and
Comparison of Proposed Delivery Models,'' Oregon Health
Authority, December 17, 2020.
Co-author, ``State Strategies for Overcoming Barriers to
Advance Health Equity,'' Robert Wood Johnson Foundation's State
Health and Value Strategies program, November 25, 2020.
Co-author, ``The Federal Government's Response to the
Coronavirus (COVID-19) Pandemic: Questions and Answers,''
Robert Wood Johnson Foundation's State Health and Value
Strategies program, April 22, 2020.
Co-author, ``Building on the Gains of the ACA: Federal
Proposals to Improve Coverage and Affordability,'' Health
Affairs, March 2, 2020.
Author, ``State Medicaid Buy-Ins: Key Questions to Consider,''
Robert Wood Johnson Foundation's State Health and Value
Strategies program, April 25, 2019.
Co-author, ``The Landscape of Federal and State Healthcare Buy-
In Models: Considerations for Policymakers,'' Arnold Ventures,
February 2019.
Co-author, ``Quantitative Evaluation of a Targeted Medicaid
Buy-In for New Mexico,'' Health Action New Mexico and the New
Mexico Center on Law and Poverty, January 31, 2019.
Co-author, ``A Promising Strategy for an Affordable Medicaid
Buy-In Option in Colorado,'' Colorado Center on Law and Policy,
the Colorado Consumer Health Initiative, and the Bell Policy
Center, December 2018.
Co-author, ``Evaluating Medicaid Buy-in Options for New
Mexico,'' Health Action New Mexico and the New Mexico Center on
Law and Poverty, December 7, 2018.
Co-author, ``Medicaid Buy-in: State Options, Design
Considerations and 1332 Implications,'' Robert Wood Johnson
Foundation's State Health and Value Strategies program, May 16,
2018.
Co-author, ``Manatt on Medicaid: 10 Trends to Watch in 2018,''
February 7, 2018.
Co-author, ``Understanding the Rules: Federal Legal
Considerations for State-Based Approaches to Expand Coverage in
California,'' California Health Care Foundation, February 2,
2018.
Co-author, ``State Marketplace Stabilization Strategies,''
American Hospital Association, January 22, 2018.
Co-author, ``Liberating Data to Enable Healthcare Market
Transparency: A Guide for Regulators and Policymaker,'' Novo
Nordisk, March 22, 2016.
Author, ``Increased Transparency and Consumer Protections for
2016 Marketplace Plans,'' The Commonwealth Fund, December 22,
2015.
Co-author, ``The Insurance Commissioners,'' Morning Consult
Blog, September 2014.
Co-author, ``Chapter Three: Quality of Care,'' The Healthcare
Delivery System: A Blueprint for Reform, Center for American
Progress, October 2008.
Co-author, ``The Medicare Drug Benefit in California: Facts and
Figures,'' California HealthCare Foundation, September 2006.
Co-author, ``The Medicare Drug Benefit: How Good Are the
Options?'' California HealthCare Foundation, March 2006.
Co-author, ``The Impact of Enrollment in the Medicare
Prescription Drug Benefit on Premiums,'' Kaiser Family
Foundation, October 2005.
Co-author, ``The Medicare Drug Benefit: Implications for
Chronic Disease Care,'' California HealthCare Foundation,
October 2005.
Co-author, ``The Medicare Drug Benefit: Implications for
California,'' California HealthCare Foundation, April 26, 2005.
Co-author, ``State Disease Medicaid Management: Lessons From
Florida,'' Avalere Health and Duke University, March 2005.
Newsletters
Co-author, ``What a Supreme Court Vacancy Could Mean for the
ACA,'' Manatt on Health, October 21, 2020.
Co-author, ``House Passes the Heroes Act,'' COVID-19 Update,
May 19, 2020.
Co-author, ``ACA 10th Anniversary Infographic,'' Manatt on
Health, March 23, 2020.
Co-author, ``Georgia Releases Section 1332 and 1115 Waivers,''
Manatt on Health, November 20, 2019.
Co-author, ``California Supreme Court: Unpaid Wages Are Not
Recoverable Under PAGA,'' Retail and Consumer Products Law
Roundup, October 11, 2019.
Co-author, ``With 2020 in View, Democrats Outline Healthcare
Reform Positions,'' Manatt on Health, June 19, 2019.
Co-author, ``Marketplace Roundup: Recent Federal Marketplace
Activity Promotes State-Level Policymaking,'' Manatt on Health,
May 2, 2019.
Co-author, ``Medicaid Buy-In and Public Option: The State of
Play,'' Manatt on Health, February 26, 2019.
Co-author, ``What's Ahead for Health Policy in 2019,'' Manatt
on Health, January 17, 2019.
Co-author, ``Now on Demand: The Midterm Elections' Impact on
Healthcare--and Your Organization,'' Health Update, December
19, 2018.
Co-author, ``CMS Promotes New 1332 Waiver Models, States Weigh
Options,'' Manatt on Health, December 19, 2018.
Co-author, ``The Midterm Elections' Potential Impact on
Healthcare,'' Manatt on Health, October 24, 2018.
Co-author, ``New Webinar Series: The Midterm Elections' Impact
on Healthcare,'' Health Update, October 23, 2018.
Co-author, ``New Webinar: Are Medicaid Buy-In Proposals Gaining
Traction?'', Health Update, September 25, 2018.
Co-author, ``State Action on Market Stabilization,'' Manatt on
Health, May 17, 2018.
Co-author, ``States Choosing Divergent Paths for Individual
Market Coverage,'' Manatt on Health, April 11, 2018.
Co-author, ``New Webinar: America's Multidimensional Opioid
Crisis,'' Manatt on Health: Medicaid Edition, March 28, 2018.
Co-author, ``The President's Budget and Shifting Policy on
Prescription Drugs,'' Manatt on Health, February 26, 2018.
Co-author, ``What's Ahead in 2018,'' Manatt on Health, January
10, 2018.
Co-author, ``Next Steps on Healthcare Reform,'' Manatt on
Health, August 8, 2017.
Co-author, ``Key BCRA Policy Concerns,'' Manatt on Health, July
25, 2017.
Co-author, ``Special Edition: Key BCRA Policy Concerns,''
Manatt on Health, July 21, 2017.
Co-author, ``BCRA Implications: Affordability of Coverage,''
Manatt on Health, July 11, 2017.
Co-author, ``The Better Care Reconciliation Act of 2017,''
Health Update, June 28, 2017.
Co-author, ``Iowa Submits Sweeping 1332 Waiver Seeking
Emergency Relief,'' Manatt on 1332, June 21, 2017.
Co-author, ``House Repeal and Replace Bill: The American Health
Care Act,'' Health Update, May 5, 2017.
Co-author, ``New Manatt Webinar, Election 2016: Strategic
Implications for Healthcare,'' Health Update, January 23, 2017.
Co-author, ``Special Edition: Comparison of Key Repeal and
Replace Proposals,'' Health Update, December 6, 2016.
Co-author, ``The Election's Impact on Healthcare: Preparing for
Potential Scenarios,'' Health Update, September 22, 2016.
Co-author, ``Transparency and Decision Support for Medicaid
Managed Care Consumers,'' Manatt on Health: Medicaid Edition,
June 30, 2016.
Co-author, ``Despite Differences in Coverage Markets,
Regulatory Alignment Is Increasing,'' Health Update, June 23,
2016.
Co-author, ``Now You Have a Second Chance to Benefit From What
Does the Medicare Part B Drug Payment Model Mean for Hospitals,
Physicians and Biopharmaceutical Companies?'', Health Update,
April 26, 2016.
Co-author, ``Liberating Data to Enable Healthcare Market
Transparency: A Guide for Regulators and Policymakers,'' Health
Update, March 23, 2016.
16. Speeches (list all formal speeches and presentations (e.g.,
PowerPoint) you have delivered during the past 5 years which are on
topics relevant to the position for which you have been nominated,
including dates):
I delivered the following presentations but did not have formal
prepared remarks or slides for any of these presentations:
Panelist, ``Solutions Over Politics: Improving Healthcare for
Every American Breakout Session,'' NEXT: Powered by the NewDem
Action Fund, October 14, 2020.
Speaker, ``The Midterm Elections: How They May Impact Your
Business in 2018 and Beyond,'' Bloomberg Next Webinar, November
8, 2018.
Panelist, ``Healthcare Exchanges,'' Democratic Attorneys
General Association Fall Policy Conference, Nashville
Tennessee, September 14, 2017.
Speaker, ``The Future of Obamacare Individual Exchange
Marketplaces,'' Leerink Partners' 2017 Global Healthcare
Conference, New York, NY, February 16, 2017.
Co-presenter, ``The Election's Impact on Healthcare: Preparing
for Potential Scenarios,'' PharmaVOICE podcast, September 15,
2016.
17. Qualifications (state what, in your opinion, qualifies you to
serve in the position to which you have been nominated):
My professional background and health policy experience have
positioned me to serve as Centers for Medicare and Medicaid
Services (CMS) Administrator. I have extensive knowledge of
CMS, having worked at the agency as Deputy Director for Policy
in the Center for Consumer Information and Insurance Oversight
(CCIIO). In addition, I have a considerable amount of Federal
Government experience--including my time in Congress, at the
Office of Management and Budget (OMB), and the Department of
Health and Human Services (HHS)--and I am thoroughly familiar
with how these institutions work together to best serve the
American people.
I have deep expertise across all of CMS's areas of
responsibility, including Medicare, Medicaid, and Affordable
Care Act (ACA) coverage. Since the beginning of my career at
OMB, I have worked extensively on Medicaid, the Children's
Health Insurance Program, and coverage for the uninsured. I
also have Medicare experience, most notably from my time at the
House Ways and Means Committee, working on Medicare Advantage
and Medicare Part D. I was fortunate to play a key role in the
passage and implementation of the ACA--first on the Ways and
Means Committee, and then in the Obama administration at HHS.
In this capacity, I focused primarily on expanding access for
the uninsured through the creation of marketplaces, consumer
protections for health coverage, and tax credits.
In the private sector, I worked with States, consumer groups,
and other stakeholders on options to cover more of the
uninsured and underinsured--focusing on policies to expand
access to health insurance coverage and working on strategies
to address health equity. This work included exploring the role
that Medicaid programs can play in addressing maternal
mortality--a critical issue disproportionately affecting black
and brown women in America. This work has never been more
urgent as we have seen longstanding health disparities
illuminated during the COVID-19 pandemic.
My role serving as one of the leads for the Biden-Harris
Transition Agency Review Team for HHS provided me a clear
picture of the work needed to rebuild HHS and CMS. Moreover,
this experience made clear the ways that CMS can work better
within HHS and across government to address inefficiencies in
our system, and also tackle public health crises such as COVID-
19 and health inequities.
If I have the honor of being confirmed, my priorities for CMS
are integrating--within CMS and between CMS and other parts of
HHS--to make coverage more affordable for people and make
programs work together for the people they serve. If our
health-care system is better integrated, we will not only be
better prepared for the next public health crisis, but also
better equipped to advance health equity and improve health-
care access and coverage. If confirmed, I would seek to advance
payment reforms while promoting equity and health-care
coverage--and also working with Congress to reduce prescription
drug costs for seniors, people with disabilities, and other
consumers.
It would be an honor and a privilege to be confirmed by the
Senate to lead CMS. And the significance of my nomination and
possibility that I would be the first black woman confirmed to
this role are not lost on me. After several decades working on
health policy on Capitol Hill, in the Obama administration, and
in the private sector, I believe I have the experience and
judgment needed to lead CMS during this critical time--not only
to recover from the pandemic, but to ensure that all Americans
have access to quality, affordable health care no matter their
zip code.
B. FUTURE EMPLOYMENT RELATIONSHIPS
1. Will you sever all connections (including participation in future
benefit arrangements) with your present employers, business firms,
associations, or organizations if you are confirmed by the Senate? If
not, provide details.
Upon consultation with and approval by my agency ethics
officials, I will receive a performance-based bonus for
calendar year 2020 in three installments and an additional
contribution to my Manatt, Phelps, and Phillips, LLP defined
contribution plan.
2. Do you have any plans, commitments, or agreements to pursue
outside employment, with or without compensation, during your service
with the government? If so, provide details.
No.
3. Has any person or entity made a commitment or agreement to employ
your services in any capacity after you leave government service? If
so, provide details.
No.
4. If you are confirmed by the Senate, do you expect to serve out
your full term or until the next presidential election, whichever is
applicable? If not, explain.
Yes.
C. POTENTIAL CONFLICTS OF INTEREST
1. Indicate any current and former investments, obligations,
liabilities, or other personal relationships, including spousal or
family employment, which could involve potential conflicts of interest
in the position to which you have been nominated.
Any potential conflict of interest will be resolved in
accordance with the terms of my ethics agreement, which was
developed in consultation with ethics officials at the
Department of Health and Human Services and the Office of
Government Ethics. I understand that my ethics agreement has
been provided to the committee. I am not aware of any potential
conflict other than those addressed by my ethics agreement.
2. Describe any business relationship, dealing, or financial
transaction which you have had during the last 10 years (prior to the
date of your nomination), whether for yourself, on behalf of a client,
or acting as an agent, that could in any way constitute or result in a
possible conflict of interest in the position to which you have been
nominated.
Any potential conflict of interest will be resolved in
accordance with the terms of my ethics agreement, which was
developed in consultation with ethics officials at the
Department of Health and Human Services and the Office of
Government Ethics. I understand that my ethics agreement has
been provided to the committee. I am not aware of any potential
conflict other than those addressed by my ethics agreement.
3. Describe any activity during the past 10 years (prior to the date
of your nomination) in which you have engaged for the purpose of
directly or indirectly influencing the passage, defeat, or modification
of any legislation or affecting the administration and execution of law
or public policy. Activities performed as an employee of the Federal
government need not be listed.
In the last 5 years as a managing director at Manatt, I have
been involved in legislative and public policy issues at the
local and State level (as summarized in my list of publications
and discussed in my ethics agreement). I have testified one
time before Congress:
On June 12, 2019, I testified before the U.S. House of
Representatives Ways and Means Committee regarding universal
health coverage. The hearing was titled, ``Pathways to
Universal Health Coverage.''
4. Explain how you will resolve any potential conflict of interest,
including any that are disclosed by your responses to the above items.
Any potential conflict of interest will be resolved in
accordance with the terms of my ethics agreement, which was
developed in consultation with ethics officials at the
Department of Health and Human Services and the Office of
Government Ethics. I understand that my ethics agreement has
been provided to the committee. I am not aware of any potential
conflict other than those addressed by my ethics agreement.
5. Two copies of written opinions should be provided directly to the
committee by the designated agency ethics officer of the agency to
which you have been nominated and by the Office of Government Ethics
concerning potential conflicts of interest or any legal impediments to
your serving in this position.
I understand that my ethics agreement has been provided to the
committee.
D. LEGAL AND OTHER MATTERS
1. Have you ever been the subject of a complaint or been
investigated, disciplined, or otherwise cited for a breach of ethics
for unprofessional conduct before any court, administrative agency
(e.g., an Inspector General's office), professional association,
disciplinary committee, or other ethics enforcement entity at any time?
Have you ever been interviewed regarding your own conduct as part of
any such inquiry or investigation? If so, provide details, regardless
of the outcome.
No.
2. Have you ever been investigated, arrested, charged, or held by any
Federal, State, or other law enforcement authority for a violation of
any Federal, State, county, or municipal law, regulation, or ordinance,
other than a minor traffic offense? Have you ever been interviewed
regarding your own conduct as part of any such inquiry or
investigation? If so, provide details.
No.
3. Have you ever been involved as a party in interest in any
administrative agency proceeding or civil litigation? If so, provide
details.
No.
4. Have you ever been convicted (including pleas of guilty or nolo
contendere) of any criminal violation other than a minor traffic
offense? If so, provide details.
No.
5. Please advise the committee of any additional information,
favorable or unfavorable, which you feel should be considered in
connection with your nomination.
N/A.
E. TESTIFYING BEFORE CONGRESS
1. If you are confirmed by the Senate, are you willing to appear and
testify before any duly constituted committee of the Congress on such
occasions as you may be reasonably requested to do so?
Yes.
2. If you are confirmed by the Senate, are you willing to provide
such information as is requested by such committees?
Yes.
______
Questions Submitted for the Record to Chiquita Brooks-LaSure
Questions Submitted by Hon. Ron Wyden
nursing home quality
Question. The crisis of COVID-19 in nursing homes has been a
collision of mismanagement at every level of the industry from
government regulators to individual facilities. More than 175,000
people living and working in the Nation's long-term care facilities
have died of COVID-19, including more than 130,000 in nursing homes
participating in Medicare and Medicaid. The Senate Finance Committee
heard from witnesses during a hearing on March 17, 2021 about ongoing
issues in nursing homes that negatively affect patient care like
understaffing, poor infection control and inadequate emergency
preparedness. These issues have persisted for decades and left
facilities particularly ill-prepared for a public health crisis like
the COVID-19 pandemic. If confirmed, what would you do to improve the
care provided in our Nation's nursing homes?
Answer. It has been heartbreaking to see how hard the COVID-19
pandemic has hit the Nation's nursing homes, and as you noted, nursing
home safety is not an issue newly created by the pandemic. Nursing
homes' first obligation should be to their residents, and every nursing
home that participates in Medicare and Medicaid must meet Federal
health and safety standards. If confirmed, it will be a top priority
for me to hold nursing homes accountable for providing high quality
care to their residents. Thank you for your leadership on this critical
issue.
Question. Thorough and publicly available information on the health
and safety of nursing homes is essential. I've worked closely with
Senator Casey over the last year to push and prod CMS to collect and
make public information about COVID-19's impact on nursing homes that
participate in Medicare and Medicaid. More recently, Senator Casey and
I were joined by Ranking Member Crapo and Senator Scott (South
Carolina) to request that CMS begin collecting and disseminating
information regarding facility-level vaccination data. I was pleased to
see CMS recently take some important steps toward improving
transparency--such as requiring reporting of staff vaccination rates--
but there is more work to do. For example, the Finance Committee has
repeatedly received testimony about the shortcomings of the Five Star
System, which was created to provide clear and meaningful information
on the quality of nursing homes. Unfortunately, in many cases a ``five
star'' facility may not provide any better care or protection for
residents than a one-star home. This system needs to be fundamentally
rethought.
Broadly speaking, if confirmed as CMS Administrator, will you
support efforts to improve transparency relating to COVID-19 in nursing
homes and address the disproportionate impacts of COVID-19 on nursing
home residents of color?
And specifically in regard to vaccinations, will you support
efforts to provide consumers and Congress facility-level data about the
rate of COVID-19 vaccinations in nursing homes?
Answer. If I am fortunate enough to be confirmed, it will be a top
priority for CMS to work to address the disproportionate impact of the
COVID-19 pandemic on nursing home residents, especially those of color.
I will also work to improve transparency, evaluation and
accountability, including increasing the available data regarding
vaccinations in nursing homes.
Question. For years, press reports and academic research have
repeatedly shown the negative impact that private-equity ownership of
nursing homes takes on patient care--an issue that has long been of
interest to the Finance Committee. Most recently, a study published by
the National Bureau of Economic Research found that private-equity
ownership of nursing homes was associated with 10-percent higher short-
term mortality of Medicare patients, was ``accompanied by declines in
other measures of patient well-being,'' and led to 11-percent higher
taxpayer spending on a per-patient basis. Despite these issues,
patients, families, and regulators are often hard-pressed to untangle
when a nursing home is owned--or controlled through various
subsidiaries--by a private equity firm. Section 6101 of the Affordable
Care Act sought to address the black box of nursing home ownership by
setting out statutory requirements to increase the amount of
information made available to the public. CMS issued a proposed rule to
implement the statute in 2011, but withdrew it in 2012 after receiving
comments. At the time, the agency signaled its intention to reissue
regulations that addressed the comments, but never did so.
Does private equity's growing role in the nursing home industry,
and its impact on care quality, concern you?
Do you plan to increase the transparency of nursing home ownership
information, either through implementation of section 6101, or other
regulatory requirements and guidance?
Answer. Nursing homes' first obligation should be to their
residents, no matter what kind of ownership arrangements they have, and
nursing homes participating in Medicare and Medicaid programs must meet
required Federal health and safety standards. If confirmed, I am
committed to working with you and your colleagues to ensure nursing
homes provide high-quality care to their residents.
______
Questions Submitted by Hon. Benjamin L. Cardin
dxa reimbursements
Question. Hip fracture is the most devastating fracture that
someone with osteoporosis can experience. In Maryland, there has been
an 18.5-percent decline in DXA testing of Medicare women since 2008,
resulting in too many unnecessary and avoidable hip fracture related
deaths each year.
Will you commit to working with me and Senator Collins to improve
access to osteoporosis testing by restoring adequate reimbursement for
screenings in the physician office?
Answer. Thank you for bringing this issue to my attention. If
confirmed, I am happy to work with you and Senator Collins to explore
options to encourage osteoporosis screenings.
hospice payments
Question. Hospices in Montgomery County, Maryland are at a long-
term competitive disadvantage due to a Medicare hospice Federal payment
inequity imposed in 2006 by CMS involving the use of core-based
statistical areas (CBSAs) when Metropolitan Divisions are present.
Since CMS began using CBSAs to determine payment, hospices in
Montgomery County have received lower payments than hospices in
adjacent counties, or even those in more rural, low-cost parts of the
tri-State area.
Using CBSAs in this manner is flawed for the following reasons.
Montgomery County has a similar cost of living compared to Washington,
DC and shares the same labor market when competing for labor. As a
result, hospices in Montgomery County are having difficulty providing
the same level of services as hospices in DC, the three nearby Maryland
counties, and the neighboring counties of Northern Virginia, all of
which are paid a higher reimbursement.
I sought an administration solution to this issue in two delegation
letters to CMS in 2017 and 2018 and hospices in Montgomery County have
commented on this problem to CMS annually since 2005.
In your role as CMS Administrator, will you commit to work to
resolve this problem?
Answer. Thank you for raising this concern. I know you have been a
leader in making sure Montgomery County, Maryland is treated fairly. I
too want to make sure the Medicare program operates in an equitable and
transparent way. If confirmed, I would be happy to work with you and
others in the Maryland delegation on this issue to make sure your
constituents have access to high quality hospice services.
______
Questions Submitted by Hon. Sherrod Brown
mental health services in child welfare
Question. One of the ongoing challenges in child welfare is the
greater need for mental health services including a greater supply of
health professionals with knowledge and experience in child psychology.
This is true in the need for post-adoption services as well as families
we are trying to keep together.
If confirmed, will you commit to working with States to improve
coordination between State child welfare agencies and State Medicaid
departments to streamline services and supports for children and young
people? How would you work to increase the supply of health
professionals to better meet children and young people's mental health
needs?
Answer. I share your commitment to making quality mental health
services available to children and families involved in the child
welfare system, including families who adopt children from the child
welfare system. If confirmed, I will make it a priority for CMS to
encourage better coordination between State Medicaid and child welfare
agencies. The pandemic has created challenges for Americans' mental
health, especially for children, and increasing the number of providers
is an important step to address these challenges. If I have the
privilege of being confirmed, I also want to focus on improved
coordination with other Agencies in HHS, including SAMHSA, to make sure
we are better integrating mental and behavioral health into the health-
care system.
hcbs workforce
Question. In order to strengthen Medicaid's home and community-
based services (HCBS), it is essential that we prioritize policies to
develop, support, and build our Nation's long-term care/HCBS workforce.
We need to find ways to ensure higher wages for our home care workers
and direct support professionals, and support their professional
development.
If confirmed, will you work with me and other members of Congress,
the labor community, and other stakeholders on ways to provide more
support for this essential workforce?
Answer. I appreciate your leadership in this area, and I understand
we still have a ways to go to make HCBS a reality for seniors and
individuals with disabilities in need of long-term care. Developing,
supporting and building the workforce is key to ensuring access to
these important services. If confirmed, I look forward to working with
you and our State partners to champion further progress to rebalance
Medicaid's long-term care services and supports, including looking at
what we can do together to help bolster the workforce.
continuous eligibility
Question. Each year, millions of Medicaid and CHIP beneficiaries
who enroll in coverage are at risk of losing that coverage as a result
of taking on an extra shift or working overtime, simply because their
income fluctuates slightly. As a result, these short-term changes set
in motion bureaucratic snafus that cause taxpayers to be disenrolled
from their insurance. This breakdown in coverage often disrupts
treatment plans and undermines the progress of their care, but can also
cause significant administrative challenges that result in higher costs
for States, providers, and health plans. This can be particularly
disruptive for Medicaid beneficiaries using care coordination and care
management services, which are interrupted every time a beneficiary is
disenrolled.
The Stabilize Medicaid and CHIP Coverage Act--legislation I've
introduced with two other members of this committee, Senators
Whitehouse and Warren--would ease the burden caused by churn by
ensuring beneficiaries can depend on their coverage for a continuous
12-month period regardless of their age.
Do you agree that we should work to minimize churn in health
insurance coverage and eliminate disruptions in care that result when a
beneficiary churns in and out of coverage?
If confirmed, will you work with me and my colleagues to strengthen
the Medicaid and CHIP programs to minimize churn and ensure continued
access to care for beneficiaries?
Answer. I agree that reducing churn in health-care coverage is
critical to ensuring continuity of care and positive health outcomes. I
look forward to working with you on solutions to ensure that
beneficiaries have continued access to health-care coverage they can
rely on.
medicare advantage/prior authorization
Question. Thank you for your commitment to working with me to equal
the playing field between traditional Medicare and the Medicare
Advantage program. I look forward to collaborating on this effort.
One area where we can create some parity lies in the prior
authorization process. Last Congress, I introduced legislation with
Senator Thune to establish an electronic prior authorization program in
Medicare Advantage (MA) to better facilitate the prior authorization
process in MA and improve the timeliness and efficacy of care delivery
for beneficiaries and their providers. CMS has issued a notice of
proposed rulemaking to establish similar programs in Medicaid, the
Children's Health Insurance Program (CHIP), and insurers operating
qualified health plans on the federally facilitated exchange under the
Affordable Care Act (ACA). Beneficiaries and their providers should not
have to jump through hoops in order to access medically necessary
services.
If confirmed, will you work with Senator Thune and me to provide
additional technical assistance on our legislation so that we can
advance improved prior authorization processes that put the patient
back at the center of care and reduce barrier to timely access to
essential services?
CMS has the legal authority to implement some of the provisions
included in the Improving Seniors' Timely Access to Care Act. As
Administrator, will you consider regulatory action to move forward with
the provisions of this legislation that are within your current
authority to implement?
Answer. I believe that ensuring Americans have timely access to
health care is critical, and I agree with you that both providers and
beneficiaries should not have to jump through unnecessary hoops for
access to medically appropriate care. If confirmed, I look forward to
working with you, Senator Thune, and other members of Congress on these
important issues.
nursing schools
Question. 42 U.S.C. 1395ww(l) provides an important source of
support for
hospital-based nursing schools across the country. Unfortunately,
nearly a decade ago mistakes in the implementation of 42 U.S.C.
1395ww(l) resulted in several hundred million dollars of CMS
overpayments. After becoming aware of these prior overpayments, CMS
issued Transmittal 10315, requiring the recoupment of funds from
hospitals to correct for past program overpayments.
Unfortunately, this has resulted in a situation where hospital-
based nursing schools in Ohio and across the country, due to no fault
of their own, are required to pay back millions in funds that CMS
mistakenly sent out in past years. While this claw-back of funding
would be hard for hospital-based nursing schools to endure during
normal times, this recoupment effort during the middle of a global
pandemic that has decimated hospital revenues and highlighted the
importance of our nursing workforce is both impossible and ironic.
I have shared draft legislation with CMS that could help provide
relief to these hospital-based nursing schools for the agency's
technical assistance. If confirmed, will you help expedite the process
for agency feedback on this proposed fix and work with me and my
colleagues on a solution that will support our hospital-based nursing
schools and their students?
Answer. I am committed to supporting hospital-based nursing schools
training the Nation's next generation of practitioners. If I am
fortunate enough to be confirmed, I will look into this important issue
and look forward to working with you.
direct and indirect remuneration fees
Question. Community pharmacists are a critical player in our
Nation's health-care workforce, extending essential services to
underserved and disproportionately at-risk communities. Especially
during the COVID-19 pandemic, pharmacists have been critical in our
efforts to expand access to testing and vaccination services, including
long-term care residents and other seniors and Part D beneficiaries.
Unfortunately, the rapid growth of pharmacy direct and indirect
remuneration (DIR) fees continues to create uncertainty for the
community pharmacies Ohioans rely on for essential services. The use of
DIR fees in Medicare Part D has exploded over the past several years,
threatening the financial viability of pharmacies across Ohio and the
health of the patients they serve. The Centers for Medicare and
Medicaid Services (CMS) has estimated that pharmacy DIR fee reform
could result in saving Medicare beneficiaries between $7.1 and $9.2
billion in cost sharing burden over the next decade.
If confirmed, will you commit to working with Congress on solutions
to address the explosion of DIR fees and support stability for
community pharmacies, while ensuring quality and low costs for Medicare
beneficiaries?
Answer. Small and rural pharmacies are critical to our Nation's
health-care system and have been especially important during the
pandemic. It can be hard for these pharmacies to predict retroactive
DIR fees. We must do all we can to ensure that Americans can access
important health-care services, including from local pharmacies in
their communities. If confirmed, I look forward to working with
Congress to ensure that community pharmacists have predictability and
to lower drug prices for patients and families.
social determinants of health
Question. As was discussed during Thursday's hearing, entities
across the health-care and political spectrum are increasingly focused
on ways to address the social determinants of health. The Centers for
Medicare and Medicaid Services (CMS)--as both a payer and a policy
driver--has many tools at its disposal to improve health and drive
value by addressing social determinants.
If confirmed, how will you use Federal payment policy--across
Medicare and Medicaid and through the Center for Medicare and Medicaid
Innovation (CMMI)--to address the social determinants of health, ensure
our Federal programs and models address health-related social needs of
patients, and support upstream investments in the social determinants
of health?
Answer. The COVID-19 pandemic has further exposed the disparities
that exist in our society. I understand the CMS Innovation Center is
currently testing the Accountable Health Communities Model, which
evaluates whether systematically identifying and addressing the health-
related social needs of Medicare and Medicaid beneficiaries through
screening, referral, and community navigation services will impact
health-care costs and reduce health-care utilization. In addition, if
confirmed, I intend to take a department-wide approach to the
advancement of equity, consistent with President Biden's charge to
Federal departments and agencies, and this would include examination of
ways to address the social determinants of health.
reimbursements for new technologies
Question. In January 2021, HHS released its Artificial Intelligence
(AI) strategy, which reads, in part: together with its partners in
academia, industry, and government, HHS will leverage AI to solve
previously unsolvable problems by continuing to lead advances in the
health and well-being of the American people, responding to the use of
AI across the health and human services ecosystem, and scaling
trustworthy AI adoption across the Department.
While the growth of technology in health care has the potential to
facilitate access to care and improve quality for beneficiaries, it is
critical that any strategy to incorporate AI in HHS policy center
consumers. As the Department works to leverage AI and incorporate AI
applications and other advanced technologies across health care, HHS
should use all existing tools, including payment systems, to support
the adoption of technology that increases access to and quality of
care.
CMS payment policy has lagged behind when it comes to coverage of
newer technologies that offer more personalized approaches to diagnosis
and treatment, including those that utilize a form of AI. If confirmed,
will you commit to reviewing CMS payment policies for disparities in
coverage of AI and other new technologies and acting to update payment
systems, where appropriate, to ensure access to those technologies that
improve access to and quality of care?
Answer. Thank you for raising this important issue. It is
incredible what scientific progress has been made with innovative drugs
and treatments, and we need to continue to modernize the Medicare and
Medicaid programs to make sure beneficiaries have access to proven new
treatments. I understand that in 2019, CMS launched the AI Health
Outcomes Challenge, to engage with innovators with harness AI solutions
to predict health outcomes for potential use in CMS Innovation Center
innovative payment and service delivery models. If confirmed, I commit
to continuing to review how CMS can harness new technologies that
utilize AI to improve health outcomes for beneficiaries.
______
Question Submitted by Hon. Robert P. Casey, Jr.
Question. The COVID-19 pandemic has underscored the urgent need to
enhance quality in our Nation's nursing homes. The profound loss of
life we have experienced over the last year is a tragedy within the
broader tragedy of this pandemic. More than 182,000 residents and
workers have died of COVID-19 in nursing homes and other long-term care
facilities. Well before the pandemic, I worked alongside Senator Toomey
to shed light on cases of abuse and neglect in underperforming nursing
homes. These nursing homes are part of what's known as the Special
Focus Facility program.
My 2019 investigation with Senator Toomey found that this subset of
nursing homes consistently fails to provide quality care, and yet not
every nursing home that needs it is receiving intervention. We have an
obligation to use every tool available to ensure that the residents who
live in these homes receive the highest standard of care.
That is why, last month, Senator Toomey and I reintroduced our
bill, the Nursing Home Reform Modernization Act (S. 782). Together, we
have laid out a bipartisan path forward to strengthen, target and
expand oversight and give help and assistance to nursing homes that
need it.
Ms. Brooks-LaSure, can I count on you to prioritize making
improvements to nursing home quality and to work with me and Senator
Toomey to identify how to enhance oversight for the poorest performing
facilities?
Answer. It has been heartbreaking to see how hard the COVID-19
pandemic has hit the Nation's nursing homes, and this is not an issue
newly created by the pandemic, as you noted. I agree that nursing homes
must provide high-quality care to their residents. Nursing homes' first
obligation should be to their residents, and every nursing home that
participates in Medicare and Medicaid must meet Federal health and
safety standards. If confirmed, it will be a top priority for me to
hold nursing homes accountable for providing high quality of care to
their residents.
Thank you for your leadership on this critical issue. I know this
has been a priority of yours, and I would be happy to work with you and
Senator Toomey on this issue if I am fortunate enough to be confirmed.
Questions Submitted by Hon. Mark R. Warner
Question. The PACE (Program of All-Inclusive Care for the Elderly)
was established by Federal statute to provide the full range of
Medicare and Medicaid benefits to seniors who want to remain safely in
their homes, rather than enter a nursing home setting. The COVID-19
pandemic bolstered the attractiveness of the PACE program as these
programs were able to pivot from providing services in PACE centers
toward doing more telehealth and in-home visits, showing that PACE can
help maintain seniors' well-being when it is dangerous for them to be
in group settings.
We have a number of large and successful PACE programs across
Virginia. I have always been a fan of PACE, and Virginia is one of the
more active and supportive States for PACE. PACE does have a big runway
for growth, considering that more than two million people in the United
States qualify for PACE, but only about 55,000 individuals are
currently enrolled.
How do you feel about PACE? Do you have a plan for promoting more
PACE centers in the States?
Answer. PACE is an important option that helps individuals in need
of nursing home-level care to get health care at home or in community-
based settings. PACE provides Medicare and Medicaid services under a
model of care that includes comprehensive care management. More can be
done to encourage the kind of care coordination and alternative to
institutional care seen in PACE. If I am fortunate enough to be
confirmed, I will look forward to working with you on this important
issue.
Question. The American Federation of Government Employees (AFGE)
Local 1923, the union that represents employees at the Centers for
Medicare and Medicaid Services (CMS), has expressed concerns to my
office about unfair labor practices enacted by the previous
administration. Specifically, these dedicated public servants have
expressed concern they were forced to accept an unfair collective
bargaining agreement (CBA) due to the Trump administration's executive
orders (EOs) of 2018 and the Federal Services Impasses Panel (FSIP).
If confirmed, will you commit to reexamining this collective
bargaining agreement (CBA) to ensure it is fair to the dedicated public
servants you will oversee?
Will you also ensure that CMS engages in good faith negotiations
with AFGE and that the agency and its managers appropriately implement
EO 14003?
Answer. Thank you for raising this important issue. Our workforce
is critical to the continued success of CMS's programs. If I am so
fortunate to be confirmed, I would like to learn more about the issues
that have been raised to your office, and I will look into this issue
to make sure CMS employees have the protections they deserve.
______
Questions Submitted by Hon. Sheldon Whitehouse
eleanor slater hospital
Question. The Rhode Island Department of Behavioral Health,
Developmental Disabilities and Hospitals stopped billing CMS for
Medicaid claims in 2019 following a State audit that flagged the need
for some technical fixes to the Rhode Island Medicaid State Plan. CMS
recently approved an amendment to the State Plan, but the suspension of
billing may amount to approximately $60 million of lost Medicaid
dollars for my State. I have contacted CMS with number of questions
regarding the suspension and the possibility of the State recouping
some of the $60 million. Will you commit to providing me with detailed
information regarding the billing suspension at Eleanor Slater Memorial
Hospital and to working with me to recoup some of the funding that was
lost?
Answer. If confirmed, I would be happy to work with you on this
issue. Responsiveness and communication with Congress will be a key
priority for me, as I understand your important role in helping your
constituents.
imputed rural floor implementation
Question. As part of the American Rescue Plan, I championed a
legislative fix to restore the imputed rural floor for Medicare
hospital reimbursement rates. CMS is responsible for implementing the
legislative fix and should include the imputed rural floor in the FY22
Inpatient Prospective Payment System rule. Do you commit to restoring
the imputed rural floor in the forthcoming IPPS rule?
Answer. Thank you for your leadership on this issue. I want to make
sure we operate the Medicare program in an equitable and transparent
way. I know you worked very hard to make sure this was addressed in the
American Rescue Plan Act, and I have every reason to anticipate that
CMS is working hard to ensure that the provision will be implemented as
quickly as possible. I would be very happy to stay in touch with you,
if confirmed, on CMS's implementation of this provision.
medicaid
Question. Rhode Island's Medicaid 1115 waiver will expire on
December 31, 2023. The current 1115 waiver focuses on social
determinants of health, long-term services and support rebalancing and
alternative payment methodologies. How will CMS work with the State
when it is time to renew the 1115 waiver?
Answer. Medicaid is an important lifeline for many American
families. Section 1115 demonstration projects, or waivers, are one
available tool to States to help test new and innovative policies in
Medicaid. I have worked closely with States throughout my career, so I
know they face different challenges and need consistency and
predictability. If confirmed, I will keep in mind what I have learned
working on behalf of States to make sure waiver requests are
appropriately evaluated while giving them consistent guidance. I will
support State innovation and the ability of States to test out
different models that meet the objectives of the Medicaid program. I
look forward to seeing the ideas States bring to the table and will
consider each one on its merits.
Question. Rhode Island is committed to alternative payment
methodologies, including Medicaid accountable care organizations but
the Federal funding for this program is time-limited. What additional
funding, policy support or technical assistance will CMS provide to
advance alternative payment methodologies?
Answer. Alternative payment methodologies and delivery reform,
generally, are so important to moving our health-care system towards
one that rewards value over volume. States, like Rhode Island, are
often the leading innovators in this effort, and we should be learning
from their successes. More integrated and coordinated care can help to
improve care and lower costs. If confirmed, I want to work with you to
make sure we are pursuing demonstration projects that achieve these
goals, and I would be happy to work with you to support States' efforts
to innovate in their Medicaid programs.
health it
Question. CMS played a leading role in supporting significant HIT
infrastructure under the HITECH Act. What resources does CMS need in
order to fund new investments in HIT infrastructure that are compliant
with interoperability standards?
Answer. Interoperability of patient records is so critical to
ensure appropriate coordination of care. We need to improve health
information technology across our health-care system, particularly for
behavioral health providers--an important issue I know you have worked
to address. I look forward to working with you on this issue, including
determining what additional resources might be needed, if confirmed.
affordable care act
Question. How will CMS work with States like Rhode Island that
fully embraced the ACA to reduce the remaining barriers to universal
coverage?
Answer. If I am fortunate enough to be confirmed, it will be a
priority of mine to build on the successes of the Affordable Care Act
(ACA). The ACA has extended coverage for millions of American families.
It is so important that American patients and families be able to
afford health insurance, and I appreciate Congress's leadership in
taking action through the American Rescue Plan Act to bring down
premiums during the pandemic. We need to continue to work on this issue
to make health care more affordable. This includes working with States,
like Rhode Island, that have been leaders in ACA implementation to
learn from their successes and continue to move the ball forward.
______
Questions Submitted by Hon. Catherine Cortez Masto
Question. A noteworthy pattern over the course of the pandemic has
been the high utilization of telehealth services via telephone, without
any video. This flexibility has allowed physicians to keep their doors
open and continue treating patients, and vulnerable individuals who
don't have access to a smart phone or might struggle with technology
are able to seek services.
In your view, is it important that we maintain access to these
services for both Medicare and Medicaid beneficiaries who are still
unable to utilize in-person care?
Answer. Telehealth has been invaluable during this pandemic to keep
patients, their providers and their families safe. My brother is a
psychologist, and telehealth has really helped his patients get the
care they need. If I am fortunate enough to be confirmed, I will be
taking a careful look at the telehealth flexibilities under Medicaid
and Medicare before the Public Health Emergency ends. During that
review, I will pay special attention to the issues of equity and
access. I will look at what we can and should extend administratively
and where we will need Congress's help to ensure that we bring the
lessons learned about telehealth during the pandemic forward to
modernize our health-care system.
Question. Medicare Advantage plans serve more than 26 million
vulnerable beneficiaries who have similarly benefited from this
expansion in telehealth services. I'm concerned that current CMS risk
adjustment policies that exclude audio-only diagnoses could hamper MA's
ability to serve beneficiaries during this crucial period and
negatively impact the program, its provider partners, and MA enrollees
in the future.
Will you further commit to reviewing this policy promptly to ensure
that the policy does not negatively impact premiums, benefits, out-of-
pocket costs, or the availability of plans in 2022?
Answer. Medicare Advantage serves millions of Americans and is an
important option for Medicare beneficiaries. During the pandemic, we
have been able to see the value telehealth brings for patients,
including those enrolled in Medicare Advantage. If confirmed, I look
forward to working with you to ensure that beneficiaries enrolled in
Medicare Advantage plans can continue to benefit from these services.
______
Questions Submitted by Hon. Elizabeth Warren
unique device identifiers
Question. Although medical device failures are rare, when they do
occur, they can create serious health problems and significant
financial costs. A 2017 investigation by the Office of Inspector
General at the Department of Health and Human Services found that
recalls or premature failures of just seven faulty cardiac devices
resulted in $1.5 billion in Medicare payments and $140 million in out-
of-pocket costs to beneficiaries. Furthermore, the Inspector General
was not able to examine the total cost of all device failures because
of the lack of information about specific devices in claims data.
Instead, OIG examiners were forced to engage in a ``complex and labor-
intensive audit'' to assess the impact of the seven faulty devices. As
a result, the OIG recommended that CMS add unique device identifiers
(UDIs) to Medicare claims. Including device identifiers on claims
transactions would greatly improve the health system's ability to
identify risks and reach patients who may be affected by device
failures.
The process of adding UDIs to Medicare claims is a complex one, but
ultimately will require CMS to agree to act on the recommendations of
X12, an entity that establishes accredited standards for claims
transactions. X12 recently recommended that the device identifier
portion of a medical device's UDI be included on the electronic claims
transaction. As the Administrator of CMS, will you commit to
implementing X12's recommendation and adding UDIs to Medicare claims?
Answer. Thank you for your bipartisan leadership on this issue. I
understand that a revised claims form that includes the device
identifier has made it through the first step in the consensus- based
process and that the next step is for the National Committee on Vital
and Health Statistics to make recommendations. If I am fortunate enough
to be confirmed, I would be happy to look into this issue further and
to stay in touch about it with you.
electronic visit verification
Question. The 21st Century Cures Act of 2016 included a requirement
that States implement electronic visit verification (EVV) systems for
certain Medicaid services. EVV systems are designed to certify that
personal care services and home health services in Medicaid are
actually provided. They must verify the type of service provided, the
date of service, the location of the service, the time the service
begins and ends, and the identities of the patient and provider. States
that fail to implement EVV programs are subject to a 1 percent,
incremental FMAP reduction unless they can demonstrate that a ``good
faith effort'' has been made to comply. States were required to begin
implementing EVV for personal care services in January 2020, and they
must begin doing so for home health services in January 2023.
Since the 21st Century Cures Act was passed, advocates for workers,
people with disabilities, older adults, and Medicaid patients have
expressed concern about the lack of worker and patient privacy
protections in EVV programs. Meanwhile, they have expressed concern
about the possibility of States losing Medicaid funding in the midst of
the COVID-19 pandemic. As the Administrator of CMS, will you commit to
reviewing existing Federal EVV guidance to determine (1) whether worker
and service recipient civil rights are adequately protected,
particularly with regard to the use of biometric and GPS data and (2)
whether existing EVV guidance contributes to workforce shortages, and
what improvements could made to the guidance to mitigate those
shortages? Will you commit to ensuring that States do not lose funding
for critical services via an FMAP decrease during the COVID-19
pandemic? Will you commit to improving existing Federal EVV guidance
and considering the possibility of using the rulemaking process to
ensure that worker and service recipient privacy and other rights are
protected in EVV programs?
Answer. Protecting the privacy of patients and our health-care
workforce is critically important. If confirmed, I will fully examine
these issues to determine the administrative or legislative actions
that would be needed to make sure that these requirements are
protecting privacy and not placing an undue burden on States and
health-care workers.
______
Questions Submitted by Hon. Mike Crapo
medicare/medicare advantage
Question. During the COVID-19 pandemic, CMS provided Medicare
Advantage (MA) plans with additional flexibilities, such as expanding
telehealth services, providing beneficiaries with devices to use
telehealth and remote patient monitoring, and reducing cost sharing and
premiums. How would you work with stakeholders and Congress to continue
certain enhanced benefits and flexibilities, which could continue to
further the MA program?
Answer. Medicare Advantage serves millions of Americans and its
enhanced benefits and plan flexibilities provide important options for
beneficiaries who choose to enroll in it. I believe we have to take
every approach we can in order to get people the health care they need
at an affordable price, including through the appropriate use of
telehealth services. Telehealth has been invaluable during this
pandemic in helping to keep patients, their providers and their
families safe. I want to be sure we take in the lessons from this
pandemic, including the value of telehealth, and look at what
flexibilities we can and should extend administratively, and where we
may need to work with Congress. If confirmed as CMS Administrator, I
look forward to working with you to achieve this important goal.
medicare solvency
Question. Medicare is on a near-term path toward bankruptcy. The HI
trust fund could be insolvent in anywhere from 4 to 5 years. Other than
during the first few years of the Medicare program's existence,
Congress has never allowed the HI trust fund to project less than 4
years of solvency without acting in order to minimize the impact on
health-care providers, taxpayers, and beneficiaries. Given the looming
fiscal crisis, how soon can we expect a comprehensive legislative
proposal from HHS that extends the life of the HI trust fund?
Answer. Medicare solvency is an incredibly important, longstanding
issue. I look forward to working with Congress on a bipartisan basis to
address this. We will need both short-term and long-term strategies to
make sure Medicare remains a bedrock of our health-care system. It is
essential that we protect this program for Americans who have spent
their lives paying into it.
drug prices
Question. There is broad concern that establishing Medicare (or
other) prescription drug payment amounts using foreign reference prices
will harm patient access and stifle innovation. Do you support the use
of foreign reference prices in Medicare? Do you view the use of a
foreign reference price to set payment amounts as price setting or a
form of negotiation?
Answer. We all agree that too many Americans cannot afford their
prescription drugs. Lowering prescription drug costs for American
patients and families is a priority on both sides of the aisle, as is
ensuring that the United States continues to allow for innovation in
drug development. I want to work with you and other members of Congress
to find ways to ensure patients have access to innovative drugs and
bring down prescription drug prices.
cmmi
Question. The Affordable Care Act established the Center for
Medicare and Medicaid Innovation (CMMI). There is significant
bipartisan support for testing different ways to pay for services to
figure out how patients can get better care at a lower cost. However,
there is concern that Congress ceded too much authority to the
executive branch by allowing CMMI to override statute, especially in
Medicare, in the name of a payment change ``test.''
What are your views on the appropriate use of CMMI authority?
If confirmed, will you commit to ensuring that CMS would not use
CMMI to avoid working with Congress?
Considering that many CMMI tests have run for an extended period of
time without meeting the criteria for expansion, is there a length of
time sufficient to determine if a model works?
With CMMI having a large budget of $10 billion for each decade and
little accountability to Congress, what metrics would you use to
determine whether CMMI is successful?
Answer. The Innovation Center has been an important tool to test
new models to move our system from one that rewards volume to one that
rewards value. It will continue to be important, as we move forward, to
test models that improve patient care, advance health equity, and lower
patient costs. We have now had 10 years of experience to learn from at
the Innovation Center. We need to look at what has worked and what
hasn't, and I look forward to hearing from you about what you think is
working well and what experiences you've seen in Idaho.
payments
Question. There are concerns that the inclusion of calcimimetic
medications in the Medicare End Stage Renal Disease (ESRD) bundled
payment rate may harm beneficiaries' access to these treatments. There
are anecdotal reports that some patients have had to change or
otherwise stop using a medicine that has worked for them in response to
this payment policy change. How would you ensure that ESRD patients
have access to calcimimetic treatments and monitor patient outcomes in
this area?
Answer. I agree that is it important for Medicare beneficiaries,
particularly patients with complex medical conditions such as ESRD, to
have access to medically necessary treatments such as calcimimetics. If
confirmed, I will work to preserve access to critical treatments and
improve patient outcomes.
Question. In the ``Medicare Hospital Outpatient Prospective Payment
and Ambulatory Surgical Center Payment Systems'' proposed rule for
2021, CMS solicited comments on the use of its ``equitable adjustment''
authority for pass-through products adversely impacted by the reduction
in surgical procedures during the COVID-19 pandemic. Will CMS use this
authority to ensure that products impacted by the pandemic receive
pass-through payments for a length of time that enables adequate cost
data collection that ensures reasonable payment once these products are
bundled into an ambulatory payment classification (APC) group?
Answer. The COVID pandemic is taking a toll on Americans in so many
ways, including reducing and delaying surgeries. If confirmed, I will
work with you and other members of Congress as we look for ways to help
providers, suppliers, and other stakeholders recover from the financial
impacts of the pandemic and maintain access for beneficiaries.
new treatments
Question. The 21st Century Cures Act that was enacted in 2016
created a home infusion therapy benefit to provide for the nursing
services necessary to support drug administration in the home setting
when patients are unable to self-
administer. To date, no new drugs requiring health-care professional
administration have been able to get covered for home infusion. CMS
issued a ``Durable Medical Equipment, Prosthetics, Orthotics, and
Supplies (DMEPOS) Policy Issues and Level II of the Healthcare Common
Procedure Coding System (HCPCS)'' proposed rule in 2020 that would
create a pathway for drugs requiring healthcare professional
administration to be covered for home infusion. This rule has not yet
been finalized, even though many seniors would continue to benefit from
being able to receive treatment at home during the COVID-19 pandemic.
Will CMS prioritize the finalization of this DMEPOS proposed rule to
expand seniors' access to the home infusion benefits?
Answer. Thank you for raising this important issue. We share the
goal of making sure people can receive care in their homes, when
appropriate, especially during the pandemic. If confirmed, I am happy
to make the review of this proposed rule a priority.
Question. Cell and gene therapies present a paradigm shift in the
treatment of disease, no longer just treating symptoms, but using
cutting-edge technology to address the root cause of the disease
itself. The FDA has previously predicted that it will be approving 10
to 20 cell and gene therapies a year by 2025. Many of the initial
diseases that these groundbreaking therapies aim to treat are
disproportionately insured by Medicare and Medicaid. The cost of these
potentially life-saving therapies has led to a national conversation on
the use of value-based arrangements to ensure broader access for
beneficiaries, especially for rare disease and cancer patients where
the population that is eligible for the therapy could be in the
hundreds or thousands.
Would you agree that CMS should do all they can to ensure access to
FDA-
approved cell and gene therapies when a doctor and a patient agree it
is the best treatment option?
As Administrator, would you commit to utilizing existing program
flexibility and considering innovative demonstration programs to enable
Medicare and Medicaid beneficiaries' timely access to innovative cell
and gene therapies? Will you commit to working with Congress on a
statutory solution that maximizes access without threatening future
development of these innovative products?
Answer. Thank you for raising this important issue. It is
incredible what scientific progress has been made with innovative drugs
and treatments, and we need to continue to modernize the Medicare and
Medicaid programs to make sure beneficiaries have access to proven new
treatments. I would be happy to work with you and other members of
Congress on ways to spur innovation and facilitate beneficiary access
to proven new advances in medicine.
______
Questions Submitted by Hon. Chuck Grassley
Question. American taxpayers expect us to be good stewards of
Federal money. Under section 1903(u) of the Social Security Act, the
Federal Government is required to recoup any improper Medicaid
eligibility-related payments in excess of three percent made by States.
The Centers for Medicare and Medicaid Services (CMS) has made little
improvement since 1992 to recover any of these payments. In 2019,
Congress passed the Payment Integrity Information Act requiring CMS to
periodically review programs it administers, identify programs that may
be susceptible to significant improper payments, estimate the amount of
improper payments, and report on the improper payment estimates. The
most recent annual reported improper payments figure across all
Medicare and Medicaid/CHIP programs was $134.21 billion (2020 CMS
estimated data) and $106 billion (2019 CMS data). The Medicaid improper
payment rate for 2020 was 21.36 percent (or $84.49 billion) and the
Medicare fee-for-service improper payment rate for 2020 was 6.27
percent (or $25.74). This has been ongoing for decades. If confirmed,
how will you as CMS administrator address the improper payment rate and
the waste of taxpayer dollars?
Answer. Medicaid is a critical lifeline for beneficiaries across
the country and typically the largest expenditure for States. Reducing
Medicaid improper payments is a priority because it helps ensure the
fiscal health of the program. If confirmed, I will work with States and
leaders in Congress to be responsible stewards of taxpayer dollars
across both Medicaid and Medicare.
Question. Ensuring access and protections for individuals with
serious disabilities who rely on complex rehabilitative manual
wheelchairs is important. In 2019, Congress provided 18-month relief
for complex rehab technology (CRT) by including protections for complex
rehab manual wheelchairs. On June 30, 2021, a temporary policy allowing
users of complex rehabilitative manual wheelchairs the same benefits as
complex rehabilitative power wheelchair users will expire. This policy
has given equal access for the people with disabilities who depend on
this new technology. If confirmed, would you support a permanent policy
maintaining the equal access between manual and power wheelchairs?
Answer. I agree that is important to make sure Medicare
beneficiaries have access to the durable medical equipment they need.
If confirmed, I will work with you on this issue.
Question. In 2020, I cosponsored the Temporary Reauthorization and
Study of the Emergency Scheduling of Fentanyl Analogues Act and it was
signed into law. The law extended the Drug Enforcement Administration's
temporary scheduling order to proactively control deadly fentanyl
analogues. Fentanyl-related overdose deaths continue to rise and
sophisticated drug trafficking organizations manipulate dangerous
substances to skirt the law, so this critical law placed fentanyl
substances in Schedule I so that they can be better detected and
criminals can be held accountable for their actions. The law sunsets in
May of 2021. In December 2019, 56 other State and territory attorneys
general asked Congress to permanently codify a temporary emergency
scheduling order keeping fentanyl-related substances classified as
Schedule I drugs. If confirmed, do you support permanently codifying a
temporary emergency scheduling order keeping fentanyl-related
substances classified as Schedule I drugs?
Answer. I recognize that fentanyl and fentanyl analogues pose a
significant danger and are responsible for far too many deaths every
year. While CMS does not have a role in the scheduling process, I
understand that HHS plays a key role that effort.
Question. Science tells us that an unborn child has many of the
neural connections needed to feel pain, perhaps as early as eight weeks
and most certainly by 20 weeks fetal age. Providing health care to
unborn children and their mothers can help reduce infant mortality
rates in low-income communities, research also suggests. Some States
already offer prenatal care and other health services to unborn
children through the Medicaid program. What is your view on whether
unborn children should be entitled to Medicaid coverage, and do you
believe that the Federal Government has a role to play in encouraging
such coverage?
Answer. Medicaid is an important source of pre- and post-natal
care, and if I am confirmed, I will work to ensure that pregnant people
have access to quality health care that improves their own health and
the health of their babies. I was happy to see that Congress included
incentives for States to expand Medicaid postpartum coverage in the
American Rescue Plan and that CMS has approved section 1115
demonstration projects to this effect. I look forward to working with
members of this committee and Congress to expand access to affordable,
quality care, including through the Medicaid program.
Question. Congress's ability to acquire information from Federal
agencies is critical to its constitutional responsibility of conducting
oversight of the executive branch. If you are confirmed, will you
commit to providing thorough, complete, and timely responses to
requests for information from members of this committee, including
requests from members of the minority?
Answer. If confirmed, I will provide responses to requests from any
members of this committee.
Question. In 2019, Congress passed bipartisan the Advancing Care
for Exceptional (ACE) Kids Act to improve health outcomes and care
coordination for children with complex medical conditions in Medicaid.
In 2020, I introduced the bipartisan Accelerating Kids' Access to Care
Act to further help families gain access to life-saving care for
children with complex medical conditions. The legislation aims to
facilitate access to care while retaining program safeguards and
reducing regulatory burdens on providers. If confirmed, what steps
would you take to improve the system of care for children with complex
medical conditions?
Answer. Thank you for your leadership on the ACE Kids Act and your
focus on access to care for children with complex medical needs. I
agree that we should do all we can to remove barriers to care for these
children. If I am fortunate enough to be confirmed, I will look forward
to working with you on solutions to ensure children with complex
medical needs get the best care possible.
Question. In Iowa, transitional health plans (including
grandmothered health plans) have enabled many middle class Iowans to
keep the health plans and doctors they like at a reasonable price since
the Affordable Care Act was implemented. For example, over 56,000
Iowans are covered by grandmothered health plans. To put this in
context, about 60,000 Iowans signed up for the Federal health insurance
exchange in 2021. Iowans have chosen these grandmothered health plans
that meet their individual needs. Currently, grandmothered health
plans' existence is determined by the Department of Health and Human
Services (HHS) through the Centers for Medicare and Medicaid Services
(CMS) annually through non-enforcement extensions. If confirmed, are
you committed to maintaining these affordable,
consumer-chosen health plan options for Iowans by extending the non-
enforcement authority?
Answer. Making sure that all Americans have access to quality,
affordable health care is one of the Biden administration's top
priorities. If confirmed, I will examine rules and other policies to
ensure all Americans can access the care that they need, and I look
forward to learning more from you about what is working in Iowa.
Question. Since this COVID-19 pandemic began, the Department of
Health and Human Services (HHS) including within the Centers for
Medicare and Medicaid Services (CMS) has provided health-care providers
and patients many flexibilities under the public health emergency
authority including over 80 services now furnished through telehealth
for Medicare patients. A Centers for Disease Control and Prevention
(CDC) Morbidity and Mortality Weekly Report found the use of telehealth
increased 154 percent during the last week of March 2020 during the
emergency of COVID-19 compared to the same period in 2019. We know the
use of telehealth has continued throughout the COVID-19 pandemic. The
data and response from patients and providers prove permitting
telehealth services is a positive action to improve access and care.
This last Congress, we provided permanent coverage for mental health
telehealth visits under Medicare, which is helpful during the pandemic
and will remain critical for many Americans afterwards. If confirmed,
are you committed to working with Congress and in the executive branch
to extend telehealth flexibilities in Medicare beyond the pandemic?
Additionally, some providers, including community health centers, face
regulatory barriers based on provider type or site of service. If
confirmed, do you support removing those telehealth barriers for
certain providers?
Answer. Telehealth has been invaluable during this pandemic to keep
patients, their providers and their families safe. My brother is a
psychologist, and telehealth has really helped his patients get the
care they need. If I am fortunate enough to be confirmed, I will take a
careful look at the telehealth flexibilities under Medicaid and
Medicare before the Public Health Emergency ends. During that review, I
will pay special attention to the issues of equity and access. I will
look at what we can and should extend administratively and where we
will need Congress's help to ensure that we bring the lessons learned
about telehealth during the pandemic forward to modernize our health-
care system.
Question. As a direct result of the Affordable Care Act's one-size-
fits-all approach, many Iowans have been priced out of health
insurance. To rectify this, the Trump administration and Iowa Insurance
Division enabled Iowans more choice and competition in the health-care
marketplace by enabling and expanding short-term
limited-duration insurance (STLDI). This gives Iowans access to health
insurance with consumer protections. If confirmed, will you work to
maintain, modify, or rescind the current regulations enabling Americans
to purchase STLDIs?
Answer. Making sure that all Americans have access to quality,
affordable health care is one of the Biden administration's top
priorities. If confirmed, I will examine rules and other policies to
ensure that plans provide Americans access to the care that they need.
Question. It is important to give people affordable options for
health insurance. Small business owners, like Iowa farmers, want to be
able to provide insurance for their employees. Association Health Plans
are a way for these small businesses to band together to expand access
to health insurance and drive down costs. I have introduced legislation
and support efforts to expand the pathway to affordable and accessible
health care remaining open to employees across America. Association
Health Plans allow small businesses to join together to obtain
affordable health insurance as though they were a single large
employer. The coverage offered to association members is subject to the
consumer protection requirements that apply to the nearly 160 million
Americans who receive coverage from large employers. If confirmed, will
you work to maintain, modify, or rescind current regulations enabling
employers and employees access to Association Health Plans?
Answer. Making sure that all Americans have access to quality,
affordable health care is one of the Biden administration's top
priorities. If confirmed, I will examine all rules and policies to
ensure all Americans can access the care that they need.
Question. I support access to affordable health-care coverage for
all Iowans, regardless of their health status or pre-existing
conditions. Americans want to be in control of their own health care.
National, single-payer health systems do not allow that. The Affordable
Care Act took options away from people and adopting a single-payer
system will make that worse. A national, single-payer health system
would eliminate private health insurance for nearly 200 million
Americans and require middle-class Americans to pay much more in taxes.
Single-payer health care would also dramatically increase government
spending substantially, fail to meet patient needs quickly, reduce
provider payments rates and reduce quality of care, and the government
would have more control over health care. It also threatens the
benefits that current seniors on Medicare have paid into the system
their entire working lives. If confirmed, do you intend to take
administrative actions to implement the vision of a one- size-fits-all
government-run health-care scheme like single-payer? If so, please
describe what authority you believe you have to take such actions?
Answer. President Biden has made it very clear that his goals for
improving the American health-care system begin with building on the
successes of the Affordable Care Act, and I am committed to working
toward that goal.
Question. If confirmed, will you take actions that stifles
innovation and competition in health care?
Answer. I believe it is important to foster innovation and
competition in our health-care system. CMS has a critical role in
promoting these goals and ensuring access to care. Americans should
have access to health-care services and products at an affordable
price.
Question. In 2019, the Trump administration issued two rules
requiring price transparency for hospitals and health plans. The rules
took effect in January 2021. This effort shines a light on the health-
care industry that is all too often shrouded in secrecy. While Congress
can build upon the rules, consumers can finally see sunshine in health-
care pricing. I have cosponsored legislation to codify the two health-
care price transparency rules. This transparency will bring more
accountability and competition to the health-care industry. Consumers
should have the ability to compare health-care prices online so they
can make an informed choice about what's best for them and their
families. If confirmed will you modify, rescind, or maintain the Trump
administration's health-care price transparency regulations?
Answer. I agree that the variation in pricing across hospitals is
not always justified and ultimately can be bad for consumers. For
transparency measures to work properly, patients and their families
must be able to understand them in a meaningful way. If I am fortunate
enough to be confirmed, I look forward to continuing to work on this
issue.
Question. Some States have lacked transparency in reporting their
nursing home COVID-19 deaths data. For example, the State of New York
undercounted nursing home deaths by as much as 50 percent and State
officials intentionally withheld data for months. The New York Attorney
General Letitia James released a report in January 2021 suggesting that
many nursing home residents died from COVID-19 in hospitals after being
transferred from their nursing homes. These figures were not reflected
in the New York Department of Health's nursing home death figures for
many months suggesting the State was undercounting by as much as 50
percent. There are also reports finding New York State officials
including members of New York Governor Andrew Cuomo's staff
intentionally withheld data on COVID-19-
related deaths in the State's nursing homes. Following the release of
the New York Attorney General report, the New York Department of Health
reported 12,743 nursing home residents occurred. This included an
additional 3,829 confirmed COVID-19 fatalities of those residents who
had been transported to hospitals. I have warned President Biden that
an across-the-board termination of 56 U.S. attorneys could imperil
ongoing sensitive investigations. This concern has been expressed by
Senate Democrats. Currently, Toni Bacon is serving as the U.S. attorney
for the Northern District of New York. Ms. Bacon previously served as
Justice Department's national elder justice coordinator and who
currently has jurisdiction over Federal public corruption crimes in the
State. Bacon is the obvious choice to continue a fair and unbiased
investigation into possible violations of civil liberties of the
elderly and the public corruption. Do you believe Department of Justice
must have a fair, unbiased, and experienced U.S. Attorney in the
Northern District of New York, such as Ms. Bacon?
Answer. I defer to the Department of Justice on the selection of
U.S. Attorneys.
Question. I led an effort in the Senate making additional resources
available to support elder justice initiatives that assist older
Americans especially throughout the COVID-19 pandemic. During the 116th
Congress as Senate Finance Committee chairman I convened two hearings
on elder justice initiatives and gaps in nursing home oversight. In
December 2020, I urged Senate leadership to make resources available
for regional or statewide strike teams to support nursing homes in
crisis during this pandemic. Through this work, the end-of-year COVID-
19 relief package included $100 million to support elder justice
initiatives, including $50 million for State adult protective service
agencies as they cope with unique challenges of serving vulnerable
populations during the pandemic. This work includes nursing home strike
teams who have provided needed support when an outbreak occurs at a
nursing home or when additional resources are needed to meet the
infection control or diagnostic testing requirements. Have State or
Federal nursing home strike teams been effective at controlling
outbreaks and protecting vulnerable Americans? If so, can you describe
how their work slowed the spread and protected lives?
Answer. It has been heartbreaking to see how hard the COVID-19
pandemic has hit the Nation's nursing homes. Nursing homes and long
term care facilities are the homes for some of our most vulnerable, and
we must do everything we can to work to protect them. If confirmed, I
look forward to reviewing the work of the Federal nursing home strike
teams.
Question. The global pandemic has exposed grave concerns our
society must confront to protect the Nation's most vulnerable citizens.
Approximately 1.4 million Americans live in about 15,000 nursing homes
across the country. Many Iowans have a loved one who lives in a long-
term care facility. In 2019, as chairman of the Senate Finance
Committee, I conducted a series of hearings to examine gaps in
enforcement of nursing home abuse. A Government Accountability Office
(GAO) investigation found a 103-percent increase in abuse deficiencies
between 2013 and 2017. The GAO noted abuse in nursing homes is often
underreported. The report documented physical, mental, verbal and
sexual abuse perpetrated against residents. The number of nursing home
deaths attributed to COVID-19 delivers a wake-up call we can't afford
to ignore. The Federal Government needs to do a better job enforcing
compliance with standards of care. When a loved one requires a long-
term care facility to deliver around-the-clock services, every family
deserves peace of mind that every nursing home resident will receive
high-quality, compassionate care and be treated with dignity and
respect. If confirmed, how will you as administrator ensure nursing
homes uphold the standard or care that is necessary while not placing
onerous requirements and excessive administrative burdens on nursing
home staff?
Answer. Thank you for your longstanding leadership on this
important issue of preventing elder abuse. This will be a focus of mine
if confirmed. Nursing homes and long-term care facilities are the homes
for some of our most vulnerable, and we must do everything we can to
work to protect them.
______
Questions Submitted by Hon. John Cornyn
end stage renal disease
Question. Four hundred thousand Medicare beneficiaries are on
dialysis, and those patients have not benefited from any meaningful
innovation in their standard of care in decades. Over the last several
years I have joined colleagues on both sides of the aisle and worked
with CMS, the patient community and innovators to encourage adoption of
a new policy to spur innovation in medical technology for Medicare
patients under the ESRD bundled payment system. CMS has made
significant progress, having created the TPNIES add-on payment for
innovation in medical technology used in the provision of dialysis
services. However, our work is not done. CMS should better align its
metrics for innovation and clinical improvements over existing
technologies with the lens FDA uses to evaluate such improvements and
innovations. And CMS should also extend by another year the period of
time during which the add-on payment can be made, having established an
application and qualification process via rulemaking that essentially
negates the first year of the add on payment window. I will again work
with my colleagues on legislation to make these additional improvements
to the work CMS has already done, and hope that you will commit to
working with me to achieve full success on this policy for Medicare
patients in whatever is the most expeditious and achievable path.
Will you commit to working with Congress to implement these
policies and bring long overdue innovation to this vulnerable group of
patients?
Answer. I agree that it is important to spur innovation in medical
technology that improves health outcomes, particularly for patients
with complex illnesses such as ESRD. I will always look for ways to
improve access to innovative and effective treatments for ESRD
patients, and I believe there is plenty of room for bipartisan work in
this area. If confirmed, I will work with you and other members of
Congress on ways to improve access to these innovative treatments.
medicare program integrity
Question. I'm very concerned about the billions of Medicare funds
lost to errors, waste, fraud, and abuse. Previously, CMS expressed the
need to ``elevate program integrity, unleash the power of modern
private sector innovation, prevent rather than chase fraud, waste, and
abuse through smart, proactive measures, and unburden our provider
partners so they can do what they do best--put patients first.'' Also,
Congress included language in the Fiscal Year 2021 appropriations
encouraging CMS ``to consider pilot programs using AI-enabled
documentation and coding technology to address CMS's top program
integrity priorities and reduce administrative burden.'' I think we can
do more to harness the expertise used in the private sector to benefit
our Medicare beneficiaries and safeguard the Medicare Trust Fund. I
hope this is an area of policy that we can work on together.
Will you commit to working with this committee to prioritize the
use of artificial intelligence and other emerging technologies to
bolster Medicare program integrity and protect the Medicare Trust Fund?
Answer. Fighting fraud and abuse is important for maintaining a
strong Medicare program. It is my understanding that CMS has taken
steps to explore the possibilities of artificial intelligence for
program integrity purposes in addition to a host of other tools it uses
to detect waste, fraud and abuse. If confirmed, I will work with you to
make sure that we are good stewards of the Medicare program and
taxpayer dollars.
bundled payments
Question. CMMI has recently expressed their commitment to value-
based payment programs but is no longer allowing new participants in
the BPCI model and last week announced they won't take new applicants
to the new direct contracting model. This is creating uncertainty about
the agency's commitment. My constituents have made substantial
investments in participating and/or preparing for these programs and
strongly believe in their importance in driving value for Medicare
beneficiaries and the trust fund.
Can you assure me as CMS Administrator that you are indeed
committed to these innovative models and that you will be open to
stakeholder input to improve upon CMMI models before canceling them?"
Answer. The Innovation Center has been an important tool to test
new models to move our system from one that rewards volume to one that
rewards value. It will continue to be important, as we move forward, to
test models that improve patient care, advance health equity, and lower
patient costs. We have now had 10 years of experience to learn from at
the Innovation Center. We need to look at what has worked and what
hasn't and chart a path forward from there. This absolutely includes
getting stakeholder and congressional input. If confirmed, I will work
with you to make sure we are pursuing models that recognize the strides
providers have already made and improve our health-care system.
laboratory date of service policy
Question. In 2017, CMS established regulations at 42 CFR
Sec. 414.510(b)(5) to revise its date of service policy for clinical
laboratory tests to allow a laboratory to bill Medicare directly for
molecular pathology tests and certain Advanced Diagnostic Laboratory
Tests (ADLTs) (as defined under section 1834A(d)(5)(A) of the Social
Security Act) performed on specimens collected from hospital
outpatients. These regulations eliminated access delays for Medicare
beneficiaries that resulted from the previous requirement that the
hospital at which the specimen was collected bill Medicare for these
relatively uncommon tests. Under the current policy, hospitals and SNFs
are similarly incentivized to delay submitting samples which can have
an impact on patient care and time to treatment.
Can you commit to working in future rulemaking to address this
payment policy for skilled nursing facilities and inpatient hospitals
as the agency has already done in the outpatient setting?
Answer. I share your desire to protect Medicare beneficiaries'
access to laboratory testing services. My understanding is that payment
to a hospital or skilled nursing facility for laboratory tests
furnished to an inpatient whose stay is covered under Part A is
generally included in the prospective payment system rate for the
facility. If I am fortunate enough to be confirmed, I would be happy to
hear more from you on this important issue and work with you to improve
beneficiary access to laboratory testing.
surprise billing
Question. Complex molecular diagnostic tests for advanced cancer
have tremendous benefit for patients and oncologists hoping to identify
the best treatments. Many of these tests are viewed as out-of-network
and have limited comparable tests for setting benchmarks.
Can you commit to working with my office to make sure that access
to these important tests is not delayed due to surprise billing
regulations promulgated under the No Surprises Act?
Answer. Making sure that all Americans have access to quality,
affordable health care is one of the Biden administration's top
priorities. I know that there will be a lot of work to do to implement
the No Surprises Act. If confirmed, I look forward to working with you
and other members of Congress to make sure that consumers are protected
from surprise bills while ensuring they have access to the care that
they need.
disproportionate share hospitals payments
Question. Disproportionate Share Hospitals (DSH) are owed more than
$10 billion in reimbursements going back to 2005. CMS has challenged
these payments based on a formula that defied congressional intent. The
court have consistently ruled that CMS's interpretation is wrong and
therefore its rule making is invalid. The agency continues to fight and
is planning to issue yet one more rule despite a loss on this issue at
the Supreme Court.
Will you commit to working to ensure DSH hospitals receive the DSH
payments they are owed.
Answer. Disproportionate Share Hospitals are critical to our
Nation's health-care system, providing care to low-income patients and
the uninsured, and I know that this pandemic has placed significant
pressure on these health-care providers. If confirmed, I look forward
to working with you and other members of Congress to ensure CMS is
using taxpayer dollars appropriately while supporting these providers
and the work they do on behalf of their patients. I will also ensure
that States and providers have the guidance they need to administer and
participate in the Medicaid program.
dialysis-related amyloidosis
Question. We have watched for years as the Medicare program has
delayed coverage for important medical breakthroughs offered by both
prescription drugs and medical devices. Although we are aware of
certain improvements over the past 2 years in the coding process for
new drugs and devices, the coverage process lags far behind. The result
is that patients are not receiving the care they need.
One recent example involves Dialysis-Related Amyloidosis (DRA), a
disease that affects an estimated 3,000-5,000 patients who have been
receiving dialysis treatment for 5 or more years. DRA results from the
failure of the kidneys to filter and remove a protein called ``beta-2
microglobulin,'' cause cysts across the body, from joints to internal
organs. These cysts can be extremely painful, and sometimes fatal, for
those with DRA. Although for years there was no treatment available in
the United States, a treatment was approved in 2015. Unfortunately, the
Medicare program does not cover the treatment, which is of great
concern to me and my constituents.
In March of 2015 the FDA approved a new treatment for DRA using a
special apheresis ``column'' in which blood is taken from the patient,
processed to remove an accumulation of the bad protein (beta-2
microglobulin) and returned to the patient. Because the patient
population is so small and the treatment was sufficiently safe, the FDA
approved the treatment as a Humanitarian Use Device. Yet, despite being
approved 6 years ago, I am told the Medicare program is still
evaluating the appropriate coverage pathway for the treatment. Until
Medicare reaches a decision, Medicare beneficiaries continue to be
denied access to the only FDA approved treatment for DRA.
Can you commit to work expeditiously to apply an appropriate
Medicare benefit category and finally decide coverage for this DRA
treatment, and any other Humanitarian Use Devices approved by FDA but
not yet covered by the Medicare program?
Answer. I agree that is it important for Medicare beneficiaries,
particularly patients with complex medical conditions such as ESRD, to
have access to medically necessary treatments. If confirmed, I am happy
to look into this further and work with you on this issue.
hospice
Question. The COVID-19 pandemic has brought telehealth to the
forefront of care, dramatically increasing accessibility and making
strides toward health equity. The hospice community has rapidly
expanded its telehealth services for the entire Interdisciplinary Team,
from nursing to chaplains. However, CMS does not appropriately capture
telehealth claims and therefore lacks visibility into a critical aspect
of hospice care delivery. The 2021 shift by CMS to only claims based
hospice quality measurement, exacerbates this gap in essential care
delivered. Creating telehealth codes for the entire hospice
Interdisciplinary Team including the required chaplains' visits, would
give CMS proper visibility into the hospice landscape.
Will CMS commit to implementing appropriate codes for hospice's
telehealth services for every IDT discipline, including chaplain
visits?
Answer. Improving the safety and quality of end-of-life care is
important, and telehealth has been and continues to be an important
tool during the pandemic. While often at end of life, hands-on care is
needed to manage symptoms, sometimes telehealth may be an appropriate
and safe way to receive hospice care. If I am fortunate enough to be
confirmed, I look forward to learning more from you about this issue
and working to ensure that hospice patients have access to the highest
quality care.
ma plan treatment of new technology in esrd
Question. As you know, Medicare Advantage plans are required to
ensure coverage equal to that offered under fee-for-service. However,
patient groups and other stakeholders have noted that Medicare
Advantage plans may not have, or may not plan to, appropriately
reimburse for End Stage Renal Disease (ESRD) drugs that are under the
transitional drug add-on payment adjustment (TDAPA) through their
negotiated monthly rates. Under certain circumstances this may just be
a failing of timing, but what happens when new technologies appear
after plans have already negotiated their rates? Failing to
appropriately account for TDAPA payments puts a strain on dialysis
organizations and hurts patient access to top of the line therapies.
Additionally, many stakeholders continue to be concerned about the
TDAPA ``cliff.'' After 2 years of additional payment for these
innovative therapies, drugs which fall into minimally funded categories
represent undue financial pressure for providers when the transitional
payment goes away. This cliff can result in providers having to make
difficult choices about how to continue to provide innovative products
to their patients.
While CMS does not interfere in direct negotiations between
Medicare Advantage plans and their contracted providers, it does bear
responsibility for upholding parity of coverage. How will CMS rectify
this patient access issue?
Can you commit to patients that this and other over-arching issues
with TDAPA will be something that you have CMS look at so that we can
feel comfortable knowing that the sickest patients will have access to
all of these innovative therapies in the pipeline?
Answer. It is important for Medicare beneficiaries with ESRD to
have access to the ESRD therapies they need. Given that people with
ESRD had the new option to enroll in Medicare Advantage plans for
coverage beginning this year, Medicare Advantage now has a crucial role
in providing access to ESRD therapies for Medicare beneficiaries. If
confirmed, I will work to ensure that beneficiaries have access to ESRD
therapies under Medicare Advantage plans. I will also work to ensure
that Medicare beneficiaries continue to have access to innovative
therapies and to improve patient outcomes.
global and professional direct contracting model
Question. Recently CMS announced that it would not be allowing a
second round of applications for the Global and Professional Direct
Contracting Model. However based on multiple polls, letters to the
agency, and media reports, there is a significant coalition of
providers, including Baylor Scott and White in Texas, that were
interested in participating in the second application cohort. Many
providers apparently delayed participating in the program because of
the pandemic.
What will you be doing to ensure that those providers are given an
opportunity participate if they want to take on risk in the Global and
Professional Direct Contracting Model and what are the administration's
plans for this model and other models like it?
Answer. The Innovation Center has been an important tool to test
new models to move our system from one that rewards volume to one that
rewards value. It will continue to be important, as we move forward, to
test models that improve patient care, advance health equity, and lower
patient costs. We have now had 10 years of experience to learn from at
the Innovation Center. We need to look at what has worked and what
hasn't and chart a path forward from there. This absolutely includes
getting stakeholder and congressional input. If confirmed, I will work
with you to make sure we are pursuing models that recognize the strides
providers have already made and improve our health-care system.
allina ruling
Question. As CMS Administrator, would you respect the ruling of the
Supreme Court in the Allina case with regard to calculating DSH
payments by including Medicare Advantage enrollees inpatient days who
are also eligible for Medicaid?
Answer. If confirmed, I will absolutely respect the Supreme Court
rulings and follow the law.
children's health
Question. As CMS Administrator, you will oversee a number of
programs and agencies important to children from health coverage
programs vital to children's health such as Medicaid and the Children's
Health Insurance Program (CHIP) to programs responsible for training
the pediatric health-care workforce like the Children's Hospital
Graduate Medical Education Program (CHGME) to pediatric research
initiatives at the National Institutes of Health.
What are your priorities for child health, if confirmed?
Answer. Programs such as Medicaid and the Children's Health
Insurance Program (CHIP) are critical programs that help ensure that
children have adequate access to quality health care. If confirmed, I
would work to ensure children are receiving necessary health care
through both programs. I would also look to better ensure access to
oral health and vision care for children, as both are necessary for
children to thrive in school. And we cannot forget that improving child
health begins with ensuring maternal health. I will work tirelessly to
reduce maternal and infant mortality and morbidity, using the expertise
and resources across CMS and working collaboratively with colleagues
across HHS. I look forward to working with Congress, and with State and
local partners to make sure that we are doing all we can to improve
child health in this country.
Medicaid and CHIP are critical programs for children, providing
coverage for over 40 million children. Medicaid is also the backbone of
the pediatric health-care system providing care across the continuum
from screenings and preventive to highly specialized diagnoses and
treatments.
Question. What are your plans to strengthen this safety net for
children and the providers who care for them?
Answer. If confirmed, I would work to support and strengthen
Medicaid and CHIP to ensure that children have adequate access to
quality health care. In particular, I would look to better ensure
access to oral health and vision care for children, while working to
reduce maternal and infant mortality and morbidity. If confirmed, I
look forward to working with you to make sure our children have access
to quality care.
The pandemic is having a profound impact on children's health and
the providers who care for them.
Question. What are your immediate plans to address the current
crisis in the increasing number of children facing severe mental,
emotional and behavioral health challenges due to social isolation and
the serious impact of the pandemic on the health of their families and
caregivers?
Answer. I am deeply concerned about the impact of the COVID-19
pandemic on the mental, emotional, and other behavioral health outcomes
of our children, their families and caregivers. I agree this must be an
urgent national priority. If confirmed, I commit to working on this
issue. In particular, we must ensure that we are fully leveraging
Medicaid and CHIP to connect children to the behavioral health care
they need to navigate this unprecedented time, and to work toward
better integration of physical and behavioral health care. If
confirmed, I would seek to collaborate with other HHS agencies,
including SAMHSA, to do a better job of tackling this important issue.
Question. The pediatric health-care safety net has been affected by
the pandemic in different ways then the adult health-care system, with
less direct Federal financial support because they are not eligible for
Medicare funding streams. What are your plans to sustain a stable
pediatric health-care system now and beyond the pandemic?
Answer. Medicaid and CHIP are lifelines to children and help form
the fabric of the pediatric health-care safety net. Over 77 million
individuals are enrolled in those programs, and about half are
children. It is critical that we work to support our pediatric health-
care safety net and pediatric health-care providers during the COVID-19
pandemic and beyond. If confirmed, I would make it a priority to work
within CMS and with my HHS partners and State Medicaid agencies, to
provide necessary support to pediatric providers.
Question. The Children's Hospital Graduate Medical Education
Program (CHGME) provides significant support for the training of
pediatricians and pediatric specialists. But unfortunately, the funding
for this program still lags far behind the Medicare GME program--
funding only half of what Medicare GME provides per resident.
What are your plans to address this gap in training support for our
Nation's pediatric workforce?
Answer. If confirmed, I will work with the resources within CMS and
partner with State Medicaid agencies to support the health-care
workforce, including those who work with pediatric populations. I would
look forward to working with HHS partners as well, including HRSA, on
ensuring access to needed health care for our Nation's children.
Question. During the pandemic telehealth has played a major role in
providing access to care for Medicaid beneficiaries, including
children.
How will HHS support the continued use and enhancements needed
under Medicaid to ensure telehealth continues to enable access to care
for children?
Answer. Telehealth is an important tool to improve health equity
and improve access to health care. Health care should be accessible, no
matter where you live. Under current law, States have a great deal of
flexibility with respect to delivering Medicaid services via
telehealth. Medicaid has made great strides in expanding services
available through telehealth, including pediatric services, during the
public health emergency. If confirmed, I will look at the telehealth
flexibilities under Medicaid and determine how we can build on this
work to improve health equity and improve access to health care for
children.
Question. As you know, pediatric health care is organized
differently than adult health care. Pediatric care is more regionalized
and often results in children, especially those with complex health
needs, having to travel across State lines for care. Under Medicaid,
this can be challenging for them and their providers with different
policies State to State. The ACE Kids Act passed in 2019 and is
effective next year, is one step in addressing these inconsistencies
and getting much needed national data to inform care improvements.
If confirmed, how would you approach these cross-State challenges
that children with complex needs face when traveling for needed care?
Answer. Medicaid and CHIP are crucial to ensuring children have
adequate access to quality health care, especially those with complex
needs. If confirmed, I will work to ensure children are receiving
necessary health care under both Medicaid and CHIP. I look forward to
working across the administration and with Congress to make informed
decisions that address the specific needs of children with complex
medical conditions.
Question. Oftentimes, changes in the larger health-care landscape
take place, for example in the Medicare program, without a full
examination of how these changes could potentially impact children,
even inadvertently. At times, Medicare policies designed with the
elderly population in mind have been applied to Medicaid or adopted by
State Medicaid programs and private payers.
As you look at health-care changes at the national level as HHS
Secretary, how will you ensure that children's unique health-care needs
are taken into account?
Answer. If confirmed, I will work with Congress and States to spur
and encourage innovation in these important programs. Innovative
delivery system and payment models are vital to ensuring that Medicaid
and CHIP are equipped to address emerging pediatric health issues and
can continue to provide children with access to quality health care.
Question. A major focus in health care among policy-makers has been
on pursuing delivery system reforms that improve quality and reduce
costs. The Federal Government has traditionally focused more on adult
populations rather than the needs of children in these reforms. As a
result, Medicaid for children still lags behind Medicare in supporting
improvements in care and innovative payment models.
What steps will you take to promote increased emphasis on these
types of innovations in Medicaid targeting the unique needs of
children?
Answer. If confirmed, I will work with Congress and States to spur
and encourage innovation in these important programs. Innovative
delivery system and payment models are vital to ensuring that Medicaid
and CHIP are equipped to address emerging pediatric health issues and
can continue to provide children with access to quality health care.
follow-up questions for the record
Question. Recently, CMS announced it was withdrawing the 10-year
renewal of Texas's 1115 Medicaid waiver. The State negotiated
intensively and in good faith with CMS to achieve approval of the
renewal.
If confirmed, how will you advise CMS to view the previous
agreement reached on the budget neutrality calculation which impacts
the amount of Federal Medicaid funding the State can expect to receive?
Answer. Based on my experience working with many State officials
throughout my career, I appreciate what is required for States to
develop and submit waiver applications to CMS for consideration and
approval. Additionally, I understand the challenges many States face in
formulating waiver requests given their distinct budgetary processes
and legislative calendars. With this in mind, if I am fortunate enough
to be confirmed, I will make sure that CMS provides clear guidance and
works closely with each State, including Texas, on its ideas to
innovate in the Medicaid program.
Question. The waiver recession would prevent billions of dollars
from flowing to Texans in need and would threaten numerous aspects of
Texas's health-care system, given Texas's reliance for months on the
extension approval. This could begin having dramatic impacts on Texas
as soon as September.
If confirmed, will you work with Texas to ensure that the State can
continue to provide safety-net programs notwithstanding the unique
challenges that the State faces?
Answer. If I am fortunate enough to be confirmed, I will be happy
to work with you and State officials in Texas on this issue.
Question. The decision to rescind the extension comes at a time
when the Biden-Harris administration continues to urge that COVID-19 is
a public health emergency.
How do you reconcile an action undermining the health care of many
needy Texans with the urgency of COVID-19, and if confirmed, what steps
would you take to provide Texans facing potential funding losses with
the care needed in light of COVID-19?
Answer. While I am not an official at CMS, it is my understanding
that this extension was rescinded because the agency determined that
the appropriate notice and public comment requirements were not met. I
appreciate Congress's leadership in making sure that patients suffering
from COVID-19 have been able to get the care they need during the
public health emergency, and if I am fortunate enough to be confirmed,
I would look forward to working with you on this issue.
Question. The letter purporting to rescind the extension would
effectively overturn a discretionary decision by the former Secretary,
on which Texas relied for months in planning and implementing health-
care programs. This causes serious concern for Texas and other States
considering whether they can rely on these types of discretionary
decisions.
If confirmed, what steps will you take to restore trust with States
that are relying on such decisions in structuring their health-care
systems?
Answer. I have worked closely with States throughout my career, and
I understand the relationship with CMS as States' Federal partner is
crucial. If confirmed, I will keep in mind what I have learned working
on behalf of States to make sure waiver requests are appropriately
evaluated while giving the States clear guidance.
Question. It has been reported that waivers like Texas's that
support uncompensated care pools are viewed as a roadblock to Medicaid
expansion, and that they run counter to the Biden administration push
for States to expand.
Do you believe Medicaid expansion is the only way for States to
provide care for uninsured individuals?
If not, what other options are being considered by the
administration?
Answer. I support State innovation and the ability of States to
test different models that meet the objectives of the Medicaid program.
No two Medicaid programs are exactly alike, just like no two States are
alike. If I am so fortunate as to be confirmed, I look forward to
engaging with any State that seeks to meet their population's unique
needs, including those of the most vulnerable.
Question. It has also been reported that the decision to rescind
the waiver was done to push State officials to accept Medicaid
expansion.\1\
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\1\ ``The decision was characterized as an effort to push State
officials toward accepting the Affordable Care Act's Medicaid
expansion, which would cover more low-income residents, said two
Federal health officials, who spoke on the condition of anonymity to
discuss private conversations.'' https://www.washingtonpost.com/health/
2021/04/16/biden-rejects-texas-medicaid-plan/.
Do you believe the 1115 waiver extension was rescinded in order to
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force Texas to expand their Medicaid program?
Answer. It is my understanding that this extension was rescinded
because CMS determined that the appropriate notice and public comment
requirements were not met. If I am fortunate enough to be confirmed, I
look forward to working with you and State officials in Texas if the
State decides to resubmit a section 1115 demonstration extension
application.
______
Questions Submitted by Hon. Richard Burr
cms-fda coordination
Question. I often hear from constituents about the reluctance of
the Medicare program to cover new and innovative therapies. Even as the
commercial market recognizes the benefits of breakthrough technologies
and medicines, the Medicare program lags behind in covering novel
products that can save and improve lives.
A recent CBO report on pharmaceutical R&D provided a stark reminder
of just how difficult it is to develop these new medicines. The costs
of bringing a new drug to market have been estimated to top $2
billion.\2\ Given this immense cost, the Federal Government should
ensure a clear pathway to coverage for companies that work to meet the
FDA's gold standard of safety and efficacy and bring new treatments to
patients.
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\2\ https://www.cbo.gov/system/files/2021-04/57025-Rx-RnD.pdf.
If confirmed, you will lead the agency at a time when innovative
therapies and technologies are changing the way care is delivered. To
meet this moment, Medicare must also adapt. I have long been a
proponent of increasing the coordination between CMS and FDA to ensure
that our Federal health programs--and the Americans that rely on them--
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are prepared for the upcoming pipeline of novel technologies.
Will you commit to working with my office to further the goal of
enhanced coordination between CMS and FDA to bring innovative medical
products to Americans in as timely a manner as possible?
If so, what are some of the ways in which CMS could work with FDA
in order to reduce the time patients wait for new treatments and
therapies?
Currently, there is a therapy under review at FDA that, if
approved, would be indicated for the treatment of Alzheimer's disease--
a uniquely devastating illness in terms of its breadth and lethality.
The action date for this therapy under the Prescription Drug User Fee
Act is June 7, 2021. To date, FDA has only approved one method of
diagnosis for Alzheimer's disease--a PET scan. CMS has denied Medicare
coverage of PET scans for Alzheimer's pathologies, however. If this
therapy is approved, Medicare's decision to forego coverage of this
diagnostic could present a barrier to access for patients with no other
effective therapeutic options. This specific situation is just one that
demonstrates the broader need for FDA and CMS coordination. Will you
commit to working with me on ensuring appropriate Medicare coverage of
PET scans and other diagnostics that may benefit patients with
Alzheimer's disease?
Answer. Thank you for your leadership on the issue of expanding
access to the benefits of innovative medical technologies to American
patients and families. It is incredible what science has been able to
do with innovative drugs and treatments in recent years. We need to
make sure we're looking at modernizing the Medicare program to make
sure beneficiaries have access to proven new treatments. I also think
it is important for CMS to be collaborating with other agencies,
including the FDA, to make sure we work better together. If I have the
honor of being confirmed, I would be happy to work with you on this
important issue.
Question. In 2019, now-Acting FDA Commissioner Janet Woodcock
testified before the House Energy and Commerce Committee that advanced
manufacturing technologies could enable domestic drug producers to
compete with China's lower labor, supply, and operating costs.\3\
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\3\ https://www.fda.gov/news-events/congressional-testimony/
safeguarding-pharmaceutical-supply-chains-global-economy-10302019.
How can the programs administered by CMS play a role in
strengthening the security of supply chains, both broadly and for
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specific fields, like synthetic biology?
Do you agree that if CMS is to play a role in addressing supply
chain issues that it needs to coordinate with FDA to better understand
the nuance and complexities of global supply chains?
Answer. America continues to be a leader in medical innovation.
This has been crucial during the pandemic. I agree that the Nation's
supply chain must be secure. If confirmed, I will make sure CMS is a
helpful partner to FDA in this effort.
hi trust fund
Question. Medicare Part A has a longstanding insolvency problem.
The Hospital Insurance (HI) Trust Fund that finances Part A is funded
by payroll taxes and as program spending has outpaced payroll tax
revenues, the balance of the trust fund has steadily declined. In
February, the Congressional Budget Office (CBO) projected that the HI
Trust Fund will run out of money by 2026. CBO also estimates that
expenditures will continue to outpace payroll tax revenue after the
trust fund has been depleted.
Addressing Medicare's finances sooner rather than later would allow
for subtle, gradual changes that protect seniors' access to high-
quality care while ensuring sustainability for future generations. The
alternative would threaten sudden and steep benefit cuts for tens of
millions of senior citizens.
As Administrator of CMS, if confirmed, you will be looked to by the
President and Congress for leadership and assistance on reform
proposals small and large. What specific experience do you have in
crafting or evaluating proposals to reform the Medicare program?
Answer. Medicare solvency is an incredibly important, longstanding
issue. We will need both short-term and long-term strategies to make
sure Medicare remains a bedrock of our health-care system, and I look
forward to working with Congress on a bipartisan basis to address this.
I look forward to working with you on ways to improve the solvency of
the Medicare program.
price transparency
Question. Empowering consumers with health-care price information
so they can make informed health-care decisions has long been a
bipartisan priority. If confirmed as Administrator, are you committed
to ensuring full implementation of the Transparency in Coverage final
rule?
Answer. I agree that empowering consumers with health-care price
information is important. For transparency measures to work properly,
patients and their families must be able to understand them in a
meaningful way. If I am fortunate enough to be confirmed, I look
forward to continuing to work on this issue.
foster care
Question. The Family First Prevention Services Act created a new
Federal category for settings that deliver trauma-informed treatment
for foster children with serious emotional or behavioral issues in a
residential setting, known as Qualified Residential Treatment Programs
(QRTPs). QRTPs are one of the few residential settings that are
eligible for title IV-E reimbursement. Recently, however, the Centers
for Medicare and Medicaid Services (CMS) indicated QRTPs with more than
16 beds may meet the definition of an Institutions for Mental Diseases
(IMDs), preventing Medicaid reimbursement for care in these
circumstances. This interpretation is not consistent with congressional
intent.
Do you believe that QRTPs should be exempted from the IMD payment
exclusion, allowing children in foster care to have Medicaid coverage
in these placements?
Answer. This is an important and complex question that I am
committed to addressing if I am confirmed as CMS Administrator. I share
your conviction that children in foster care should receive necessary
medical care without disruption. If I am fortunate enough to be
confirmed, I will be happy to work with you on this critical issue.
macpac proposal
Question. As you know, the statutory Medicaid Drug Rebate Program
(MDRP) requires drug manufacturers to provide rebates on drugs to State
Medicaid programs rebates to ensure Medicaid receives the lowest price
relative to private payers. There is an additional mandatory rebate on
drugs calculated according to increases in price that exceed inflation.
Earlier this month, the Congressional Budget Office cited research
showing that the MDRP contributes to higher prices paid by private
payers, as offering additional discounts in the private markets would
result in lower Medicaid revenues.\4\
---------------------------------------------------------------------------
\4\ https://www.cbo.gov/system/files/2021-04/57020-Public-
Option.pdf.
The Medicaid and Chip Payment and Access Commission (MACPAC)
recently voted on recommendations to increase the amount of rebates
manufacturers must pay for drugs brought to market under the
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accelerated approval pathway at FDA.
Do you think this recommendation is appropriate?
If so, what are your reasons for supporting this unprecedented
approach to tying rebates to FDA approval pathways?
MACPAC has acknowledged that this policy could create access issues
for the Medicaid population. How would you ensure equitable access to
these treatments and therapies if this policy were to be adopted?
Answer. We can all agree that prescription drug costs are too high
for American patients and families. From my many meetings with Senators
in the last few weeks, I have seen that addressing this is a priority
on both sides of the aisle. I think there is an opportunity for real
impact here to lower costs for American patients and families, while
making sure to continue to support innovation.
Prescription drug costs, including in the Medicaid program, are
very complex. Ultimately, we need solutions that produce real results
to bring down overall costs for American patients and families while
avoiding barriers to access. I would be happy to examine this
particular MACPAC proposal in more detail. If confirmed, I look forward
to working with you and your colleagues to find solutions to the high
cost of prescription drugs without reducing access to necessary
treatments.
clinical trials
Question. Late last year, the Clinical Treatment Act, was signed
into law. Senator Cardin and I crafted this legislation to ensure
Medicaid beneficiaries have access to clinical trials by requiring
State Medicaid programs to provide coverage of routine medical care
associated with the trial--a benefit already provided by Medicare. This
law will improve access to potentially life-saving therapies for sick
Americans as well as broaden the base of clinical trial participants,
which will improve the ability of manufacturers to conduct these
trials.
How will you ensure that this important benefit is available to
Medicaid beneficiaries as expeditiously as possible?
Answer. If I am fortunate enough to be confirmed, I will work with
the National Institutes of Health and with trusted partners in the
community to help to encourage participation in clinical trials,
which--as you noted--can offer potentially life-saving treatment
opportunities to patients. One barrier to participation in these trials
can be payment for routine medical care associated with the trial, so I
think it is so important that Medicaid will pay for covered items and
services provided as part of qualifying clinical trials starting
January 1, 2022. If confirmed, I would look forward to working with
you, Senator Cardin and other members of Congress on this issue as we
work to implement this important benefit in a timely manner.
cmmi
Question. The Patient Protection and Affordable Care Act (PPACA)
created the Centers for Medicare and Medicaid Innovation (CMMI) and
afforded it broad authority to test new payment models. The law
requires the termination or modification of any model that does not
improve quality of care without increasing spending; reduce spending
without reducing quality of care; or improve quality of care while also
reducing spending. Shockingly, the PPACA also included a clause
attempting to block any administrative or judicial review of CMMI
demonstration models, leaving the Administrator as a key, potentially
unaccountable, arbiter of whether or not the law's requirements are
being followed.
How specifically will you ensure that statutory requirements for
CMMI models are stringently adhered to? Will you commit to working with
members of this committee to establishing a permanent mechanism for
congressional input and oversight?
Answer. The Innovation Center has been an important tool to test
new models to move our health-care system from one that rewards volume
to one that rewards value. It will continue to be important, as we move
forward, to test models that improve patient care, advance health
equity, and lower patient costs. We have now had 10 years of experience
to learn from at the Innovation Center. We need to look at what has
worked and what hasn't and chart a path forward from there. If I am
fortunate enough to be confirmed, I want to have open lines of
communication with Congress, and I look forward to hearing from you
about CMMI models.
clinical laboratory fee schedule
Question. The Medicare Clinical Lab Fee Schedule (CLFS) payment
rates for antigen testing that use visual interpretation for results
have traditionally been the same as the tests that utilize instruments
to interpret results. However, CMS has recently changed this practice
for COVID-19 testing, bifurcating the rates for these types of tests.
This bifurcation occurred in June 2020.
Why does CMS believe that a bifurcation in reimbursement rates was
warranted in the case of SARS-CoV-2 antigen testing?
Under your leadership, how would CMS incentivize the development of
digital health technologies that make diagnostic test results accurate
and reliable?
Answer. Access to safe and reliable testing is key to combating the
COVID-19 pandemic. If I am fortunate enough to be confirmed, I look
forward to hearing from you about Medicare's clinical laboratory fee
schedule rates and protecting beneficiary access to laboratory testing
services, including digital technologies where appropriate.
______
Questions Submitted by Hon. Patrick J. Toomey
Question. As part of the American Rescue Plan Act (ARPA; Pub. L.
117-2), approximately $35 billion is estimated to be spent to
temporarily expand Obamacare subsidies to current marketplace enrollees
and individuals making over 400 percent of the Federal poverty level,
including high-income earners or those making over six-figure salaries.
The majority of these subsidies will go to individuals who already have
health insurance. Furthermore, taxpayers are expected to spend an
additional $6 billion to temporarily pause premium tax credit
reconciliation for plan year 2020--meaning individuals who received
more than they should will not be asked by the Federal Government to
repay taxpayers for those improper subsidies. In the past, multiple
government watchdogs have concluded that these taxpayer subsidies are
susceptible to significant improper payments. As the Federal deficit
hits records highs, more must be done to ensure our taxpayer dollars
are spent wisely.
You have extensive programmatic experience with the Federal
marketplace and Virginia's State marketplace. If confirmed, how will
you work with the Internal Revenue Service to reduce the advance
premium tax credit program's susceptibility to improper payments?
Please be specific.
Answer. Advance payments of premium tax credits have helped make
health insurance more affordable for millions of Americans and improved
their access to care. This has been especially important during the
pandemic when access to affordable health care has been more critical
than ever. If confirmed, I will take seriously these responsibilities,
including working with the Internal Revenue Service to make sure that
we are good stewards of Federal dollars.
Question. Over the years, the Medicare improper payment rate has
dropped well below 10 percent. In fact, the improper payment rate for
FY2020 dropped to 6.27 percent from 7.25 percent in FY 2019--its lowest
rate in more than a decade. Further, over the past decade, the Medicare
Advantage and Part D improper payment rates at their highest reached 11
percent and 3.7 percent respectively. In FY2020, the Medicare Advantage
and Part D improper payment rates dropped to 6.78 percent and 1.15
percent respectively. Unlike the Medicare program, however, the
Medicaid improper payment rate has ballooned. Most recently, the
national improper payment rate in Medicaid was 21.36 percent, or $86.49
billion. Not only has the Medicaid improper payment rate doubled since
2010, but it is now more than triple the improper payment rate of the
Medicare program.
If confirmed, what actions will you take to bring the improper
payment rate in the Medicaid program under 10 percent? Please be
specific.
Answer. Medicaid is a critical lifeline for beneficiaries across
the country. Reducing Medicaid improper payments is a priority because
it helps ensure the fiscal health of the program. If confirmed, I will
work with States and leaders in Congress to be responsible stewards of
taxpayer dollars.
Question. Last fall, Senator Stabenow and I sent the Department of
Health and Human Services a detailed letter recommending specific
regulatory actions to improve our Federal health-care programs for
beneficiaries with Alzheimer's disease. These recommendations were
formed with input from more than 30 organizations that responded to a
request for information as well as hearings and briefings led by
Senator Stabenow and myself. Recently, the Biden administration took
action on one of our recommendations and finalized a centralized
website for patients and their caregivers to access information
regarding their care options and clinical trial enrollment. However,
other recommendations remain unimplemented.
If confirmed, how will you help increase access to innovative
diagnostic tools and/or make improvements to existing methods of
assessing cognitive impairment, such as direct observation, in the
Medicare program to improve early detection of Alzheimer's disease?
Additionally, with the potential for the first disease modifying drug
to be approved by the U.S. Food and Drug Administration, existing tools
like the amyloid PET scan are the only option for confirmatory
diagnosis until a noninvasive, affordable, and rapid diagnostic tool,
such as a blood test, is made available to the public. Coverage
determinations play a large role in diagnosing, treating, connecting to
wrap-around services, and clinical trial enrollment. If confirmed, will
you examine existing CMS coverage policies to ensure the Medicare
program provides seamless access to the best diagnostic tool(s)
available to this patient population and other similarly situated
disease groups?
How can the Medicare Advantage program play a role in strengthening
care coordination among this population?
What other policies will you prioritize to improve the lives of
Medicare and Medicaid beneficiaries living with Alzheimer's disease?
Answer. Alzheimer's disease is a devastating condition for patients
and families. Early detection is critical to improve care, and I agree
that CMS should work to improve coverage of proven diagnostics. I also
agree that better coordinating health-care benefits patients, and we
should strive to improve care coordination across programs. Medicaid
and Medicare, including Medicare Advantage, have an important role to
play in providing this type of quality care, including to those living
with complex conditions like Alzheimer's disease. I would be happy to
work with you on this important issue should I be confirmed.
Question. Through section 1115 waiver authority, State Medicaid
programs can waive certain programmatic requirements to implement
greater flexibilities with their eligibility, benefit, and delivery
systems. CMS plays an instrumental role in the implementation of
section 1115 waivers through the negotiation process and oversight of
their financial performance.
If confirmed, how would you work to uphold and enforce the
longstanding policy of budget-neutrality for section 1115 waivers and
ensure the integrity of their financial performance?
Answer. Each State is unique, and innovation is critical to
improving the health-care system. Section 1115 demonstration projects,
or waivers, are one available tool to States to help test new and
innovative policies in Medicaid. I agree that it is important that we
are good stewards of taxpayer dollars while pursuing innovation. If
confirmed, I will support State innovation and the ability of States to
test out different models that meet the objectives of the Medicaid
program.
______
Questions Submitted by Hon. Tim Scott
on leveraging virtual health technology and telehealth
to expand access to care
On Enhancing Telehealth Access
Question. Earlier this Congress, joined by Senator Schatz and a
bipartisan group of my Senate colleagues, I introduced the Telehealth
Modernization Act, legislation aimed at increasing access to high-
quality health-care services, particularly for our Nation's seniors, by
codifying crucial flexibilities for telehealth coverage.
Long before the pandemic began, South Carolina had emerged as a
leader in telehealth innovation, hosting one of just two federally
recognized Telehealth Centers of Excellence in the Nation. High-quality
telehealth services and networks spearheaded by cutting-edge providers
like the Medical University of South Carolina have transformed the
Palmetto State's health-care landscape. Unfortunately, however, for the
majority of the State's roughly 1 million Medicare beneficiaries,
outdated coverage restrictions have long inhibited access to telehealth
services.
For years, rigid rules around patient location (geographic and site
of service), eligible services and provider sites, and other components
of care have created substantial barriers to telehealth utilization. In
February 2020, for instance, just prior to the COVID-19 public health
emergency (PHE), only 0.1 percent of Medicare fee-for-service (FFS)
primary care visits were delivered via telehealth. In any given week
before the PHE, an average of just 14,000 Medicare beneficiaries
received a telehealth service.
Congress took decisive steps towards expanding telehealth access
through the CHRONIC Care Act, particularly for the roughly 36 percent
of Medicare beneficiaries nationwide who have chosen to enroll in
Medicare Advantage (MA) plans, more than three-quarters of which
provided extra telehealth benefits, even before the pandemic struck.
For South Carolina, however, MA penetration remained below 30 percent
last year. For the 72 percent of SC's Medicare beneficiaries enrolled
in FFS coverage, substantial restrictions have remained.
While these Medicare access gaps predated the pandemic, the spread
of COVID-19 highlighted the urgency of updating telehealth coverage
rules, prompting Congress to provide authority for pivotal emergency
waivers designed to ensure safe access to care for seniors and other
vulnerable populations. As the pandemic raged, Medicare beneficiaries
turned to telehealth services to minimize viral exposure risk and
receive medically necessary care in safe and accessible settings. In
April 2020, more than two-fifths (43.5 percent) of Medicare FFS primary
care visits were provided through telehealth, and from mid-March
through early July of that year, more than 10.1 million beneficiaries
accessed telehealth services.
Without congressional action, however, these emergency
flexibilities will expire at the end of the PHE, creating an access
cliff for tens of millions of Medicare beneficiaries, including many
who have come to rely on telehealth for critically needed care.
If confirmed, can you commit to making the expansion of telehealth
access, particularly for seniors and vulnerable populations, a priority
for the Centers for Medicare and Medicaid Services (CMS)?
The Telehealth Modernization Act would eliminate a number of
outdated restrictions on Medicare coverage for telehealth services,
including by removing geographic and originating site restrictions and
ensuring that federally qualified health centers and rural health
clinics can continue to serve as distant sites, even after the pandemic
subsides. Would you support these types of policy proposals as a means
of expanding access to care?
Can you commit, if confirmed, to working with my office, Sen.
Schatz's office, and the offices of other telehealth access supporters
to ensure that the tens of millions of Medicare beneficiaries enrolled
in FFS do not face a coverage cliff when the public health emergency
expires?
In the absence of the emergency waivers, what would you cite as
some of the most significant barriers to telehealth access,
particularly for seniors and those with serious health conditions, and
what steps would you take as CMS Administrator, if confirmed, to
address some of these barriers?
What role or roles do you see telehealth and other virtual health
technologies in playing within the administration's broader goal of
combating health disparities?
I see our digital infrastructure as a powerful tool in addressing
health disparities. If confirmed, how would you work with other Federal
agencies and officials to bolster broadband access and bridge the
digital divide?
Answer. Telehealth has been invaluable during this pandemic to keep
patients, their providers, and their families safe. My brother is a
psychologist, and telehealth has helped his patients get the care they
need. Additionally, I agree that telehealth services have improved
health equity as beneficiaries have used telehealth to access care
during the COVID-19 pandemic. Broadband access is a challenge for many
patients, however, and I agree that digital infrastructure is an
important issue to consider in the context of addressing health
disparities. If confirmed, I want to be sure we learn lessons from this
pandemic on telehealth about what we can and should extend
administratively and what will need congressional action.
On Improving the Medicare Diabetes Prevention Program (MDPP) Expanded
Model
Question. The Medicare Diabetes Prevention Program (MDPP) Expanded
Model (EM) leverages proven interventions to prevent the onset of type
2 diabetes in Medicare beneficiaries with prediabetes. In 2016, the
Chief Actuary of CMS certified that ``beneficiaries participating in
diabetes prevention programs have achieved success with losing weight
and reducing the incidence of diabetes'' and that the expansion was
``expected to reduce Medicare expenditures.'' According to CMS, the
program at the core of the expanded model ``has been shown to reduce
the incidence of diabetes by 71 percent in persons age 60 years or
older.''
Unfortunately, the exclusion of innovative virtual suppliers from
the MDPP EM has impeded the program's reach and created substantial
access gaps, particularly for older Americans living in rural and
underserved urban communities. Politico reported that only 202
beneficiaries had used the program in 2018, and an American Journal of
Managed Care study published in June 2020 concluded that ``inadequate
MDPP access'' stemmed in part from ``severe shortages'' of suppliers,
particularly in States with large populations of Medicare beneficiaries
of color. The COVID-19 pandemic has highlighted and exacerbated these
access barriers, but regulatory flexibilities remain limited.
In order to address these access gaps, last Congress, I partnered
with Senator Warner in leading a number of letters to HHS and CMS
leaders, urging them to take administrative action to enable the
participation of CDC-recognized virtual suppliers in the MDPP EM. We
also introduced the bipartisan, bicameral PREVENT DIABETES Act, which
would accomplish the same goal legislatively. Unfortunately, virtual
suppliers remain excluded from the program, and even the flexibilities
provided for the pandemic emergency period have proven unable to
improve access for beneficiaries in need.
The Biden administration has cited combating health disparities as
a key policy priority. According to the CDC, 13 percent of American
adults have diabetes, including 26.8 percent of those aged 65 or older.
Diabetes prevalence varies substantially by race/ethnicity, affecting
16.4 percent of black adults, 14.9 percent of Asian adults, and 14.7
percent of Hispanic adults, versus 11.9 percent of white adults. A 2018
study that focused specifically on the provision of DPP services
through virtual providers found statistically significant evidence of
reduced costs and utilization pattern changes for a Medicare
population, suggesting that the inclusion of virtual suppliers in MDPP,
among other actions to strengthen the program, could help to address
disparities, reduce costs, and improve outcomes for older Americans
across the board.
If confirmed, can you commit to working, in consultation with my
office, Senator Warner's office, and other policy-makers, to enhance
access to the Medicare Diabetes Prevention Program?
Can you commit to reviewing the robust evidence base and giving due
consideration to the bipartisan and bicameral requests that I have led,
in partnership with Senator Warner and others, to secure the inclusion
of CDC-recognized virtual suppliers in the MDPP EM?
Beyond the MDPP EM, how do you envision CMMI's role in terms of
facilitating the demonstration and evaluation of virtual care solutions
and digital health tools?
More broadly, can you speak to the administration's efforts to
enable Medicare beneficiaries to leverage digital health tools for the
prevention and treatment of disease? Are their limitations in your
ability to expand access to these valuable resources for those that
want to use them within Medicare?
Answer. The Medicare Diabetes Prevention Program is an important
model, and I appreciate your leadership in supporting patients with
diabetes. I absolutely want to look at all options to help prevent
diabetes, and I look forward to hearing more from you, Senator Warner,
and other members of Congress on ways we can improve the program for
Medicare beneficiaries.
The Innovation Center has been an important tool to test new models
to move our system from one that rewards volume to one that rewards
value. It will continue to be important, as we move forward, to test
models that improve patient care, advance health equity, and lower
patient costs. We have now had 10 years of experience to learn from at
the Innovation Center. We need to look at what has worked and chart a
path forward from there. I look forward to hearing more of your
thoughts on the direction of CMMI.
on enhancing access to innovation
Question. As co-chair of the bipartisan, bicameral Personalized
Medicine Caucus, I have long championed the potential for cutting-edge
innovations like gene and cell therapies to transform the treatment
landscape. In recent years, the pace of development on these fronts has
accelerated, with a report from last Spring suggesting that more than
360 gene and cell therapies were in the United States' clinical
pipeline, versus fewer than 300 just 2 years earlier. More than one-
third of these therapies aim to treat rare diseases, providing cause
for optimism to patients across the country, as 95 percent of the 7,000
known rare diseases currently lack an FDA-
approved treatment option. Individuals with sickle cell disease, for
instance, which affects an estimated 100,000 Americans, could feasibly
see a cure on the horizon.
According to a 2019 statement by key FDA leaders, the agency
anticipated, at that point, approving 10 to 20 new gene and cell
therapies every year by 2025, in addition to receiving a projected 200
investigational new drug applications for gene and cell therapy
candidates annually, beginning in 2020.
I appreciate the emphasis that you placed, in your testimony, on
advancing innovation.
That said, even in the face of these potentially lifesaving
developments, hurdles remain, even for gene and cell therapies that
successfully gain FDA approval. A number of laws and regulations around
Medicaid ``best price,'' the Anti-Kickback Statute (AKS), and the Stark
Law, among other relevant statutes, understandably failed to
contemplate this new generation of gene and cell therapies, which have
only recently begun to come to market.
A disproportionate share of the patients affected by the diseases
most likely to be treated by the early waves of gene and cell therapies
receive health-care coverage through Medicare or Medicaid. With that in
mind, would you agree that HHS should do all that it can to ensure
access to FDA-approved cell and gene therapies when a doctor and a
patient agree that it is the most appropriate treatment option?
The current Medicaid reimbursement structure was not designed with
curative therapy payments in mind. For the roughly 100,000 Americans
affected by SCD and other painful and debilitating conditions, these
outdated rules risk delaying patient access and hinder Medicaid's
ability to pay for innovative therapies based on their value. How will
HHS overcome barriers in the current Medicaid reimbursement structure
for cell and gene therapies, giving patients access to cures and not
just treatments?
In December, HHS finalized the ``Establishing Minimum Standards in
Medicaid State Drug Utilization Review (DUR) and Supporting Value-Based
Purchasing (VBP) for Drugs Covered in Medicaid, Revising Medicaid Drug
Rebate and Third Party Liability (TPL) Requirements (CMS 2482-F)''
rule, which took important steps towards ensuring that State Medicaid
programs have the flexibility they need to hold manufacturers
accountable for the performance of their therapies. Will CMS commit to
implementing the VBP components of this rule and ensuring that patients
have timely access to lifesaving cell and gene therapies?
If and when CMS implements this rule, barriers to value-based
arrangements will remain, both within the Federal health-care programs
and in the private sector. Can you commit, if confirmed, to working
with my office to develop the additional legislative and regulatory
solutions needed to facilitate meaningful value-based arrangements for
drugs, biologics, devices, and other innovative medical products?
The prior administration issued new AKS safe harbors to protect
value-based arrangements among health-care providers and other industry
stakeholders, but value-based arrangements for drugs and biologics
received no such protections, inhibiting the development of these types
of agreements and jeopardizing patient access to innovation. Will you
commit to developing a safe harbor that would help promote greater
innovation in the pricing of drugs and biologics?
Generally speaking, what changes do you envision to CMS's policies
that would promote the development of curative medicines to ensure that
they are available to Americans as soon as possible?
With respect to sickle cell disease (SCD) in particular, can you
commit to making efforts to combat SCD, both through novel gene
therapies and through other innovative treatments and care models, a
priority for CMS?
While surveillance data on the SCD patient population remains
limited in many ways, research suggests that the majority of
individuals affected by SCD may receive health-care coverage through
Medicaid, giving CMS an especially significant role in ensuring access
to care for these Americans. Would you be willing to consider pilot
programs, demonstration projects, or other innovative models to drive
care improvement for those affected by SCD?
Answer. It is incredible what scientific progress has been made
with innovative drugs and treatments in recent years. We need to make
sure we are looking at modernizing the Medicare and Medicaid programs
to foster innovation and to make sure beneficiaries have access to
proven new treatments. Thank you for your leadership on Sickle Cell
Disease.
If confirmed, I look forward to working with you and other members
to find solutions to improve treatments, care models, and access to new
therapies, including for Sickle Cell Disease.
Question. FDA has testified ``that advanced manufacturing
technologies could enable U.S.-based pharmaceutical manufacturing to
regain its competitiveness with China.''
How can CMS leverage and advance the U.S. advantage in synthetic
biology to solidify our domestic drug supply chain security?
Answer. America continues to be a leader in medical innovation.
This has been crucial during the pandemic. I agree that the Nation's
supply chain must be secure. If confirmed, I will make sure CMS is a
helpful partner to the FDA in this effort.
On Coverage and Payment for Products Approved via Accelerated Approval
Question. As described by FDA, the Accelerated Approval Program
``allow[s] for earlier approval of drugs that treat serious conditions,
and that fill an unmet medical need based on a surrogate endpoint,''
meaning ``a marker, such as a laboratory measurement, radiographic
image, physical sign or other measure that is thought to predict
clinical benefit, but is not itself a measure of clinical benefit.''
Furthermore, as explained by the agency, ``[t]he FDA bases its decision
on whether to accept the proposed surrogate or intermediate clinical
endpoint on the scientific support for that endpoint'' (emphasis mine).
In explaining the rationale for the creation of Accelerated
Approval, FDA has noted that the use of intermediate or surrogate
endpoints ``can save valuable time in the drug approval process.'' In
the example of cancer survival, for instance, the agency points out
that measuring the extension of survival for cancer patients could take
many years, whereas trials can assess tumor shrinkage, which is
reasonably likely to predict the desired endpoint, much more
efficiently. In this broad example, the use of accelerated approval
could result in patient access to a life-saving product literally years
earlier than might have been possible otherwise. For countless
Americans, from children suffering from debilitating cancers to adults
afflicted by rare blood disorders, access to drugs and biologics
cleared through the Accelerated Approval pathway have been the
difference between life and death.
As we look towards the months and years ahead, scores of patients
can look to Accelerated Approval and other innovative, evidence-based
pathways as a source of hope, recognizing that a new generation of
game-changing therapeutics could feasibly cure conditions like sickle
cell disease.
In 2018, CMS wrote to States affirming that drugs approved via the
Accelerated Approval pathway ``must be covered by State Medicaid
programs, if the drug meets the definition of `covered outpatient
drug,' noting that said products ``must meet the same statutory
evidentiary standards for safety and effectiveness as those granted
traditional approvals.'' Can you commit to ensuring, if confirmed, that
every State Medicaid program covers all covered outpatient drugs
approved via the Accelerated Approval Program, with no difference in
treatment between these products and products approved via the
traditional approval pathway?
Despite substantial pushback from patient advocates and
policymakers, the Medicaid and CHIP Payment and Access Commission
(MACPAC) has moved to advance a proposal that would create a
differential rebate structure for products approved via the Accelerated
Approval Program, essentially penalizing drugs and biologics for moving
to market and serving patients more quickly. In addition to
disincentivizing the use of the Accelerated Approval pathway and thus
denying scores of Americans, including many childhood cancer patients,
with timely access to potentially lifesaving medications, this policy
risks deterring, chilling, or otherwise redirecting investment in
products that do not lend themselves to efficient trials with easily
and expeditiously measured primary endpoints. Moreover, the framing of
the proposal itself suggests a misunderstanding of the scientific
integrity and underlying purpose of the Accelerated Approval Program.
Before advocating for or otherwise seeking to advance any policy
proposals that might weaken, penalize, or otherwise chill the use of
the Accelerated Approval Program, can you commit to engaging with FDA
officials and experts, patient advocates, manufacturers, policymakers
on the Hill, and other relevant stakeholders to assess the potential
consequences of such policies?
Regardless of the administration in question, critics have often
argued that FDA and CMS could and should work more collaboratively to
ensure that safe and effective products can come to market as
efficiently as possible. Can you commit to working with your
counterparts at FDA to bolster collaboration and communication between
the two agencies?
Answer. Thank you for your leadership on the issue of expanding
access to the benefits of innovative medical technologies to American
patients and families. It is incredible what scientific progress has
been made with innovative drugs and treatments in recent years. We need
to make sure we're looking at modernizing the Medicare and Medicaid
programs to make sure beneficiaries have access to proven new
treatments. I also think it is important for CMS to be collaborating
with other agencies, including the FDA, to make sure we are working
together to serve patients. I would be happy to examine this particular
MACPAC proposal in more detail. If confirmed, I look forward to working
with you and your colleagues to find solutions to the high cost of
prescription drugs without reducing access to necessary treatments.
On Payment for FFR/iFR Technologies
Question. CMS has recently committed to reexamining the Medicare
payment policy for specific procedures performed in an Ambulatory
Surgical Center (ASC) to ensure that physicians can ``exercise their
clinical judgement in making site-of service determinations.'' One such
policy that warrants reexamination is the ASC payment for fractional
flow reserve and instantaneous wave-free ratio (FFR/iFR), technologies
that accurately measure blood pressure and flow through a specific part
of the coronary artery which can be critical for physicians in making
treatment decisions for their patients.
Many doctors rely on these technologies to assess whether to
perform percutaneous coronary intervention (PCI), driving improvements
in quality of care and cost savings. However, the current Medicare ASC
payment policy to package payment for FFR/iFR results in a payment rate
that is three times lower than the outpatient hospital setting, where a
complexity adjustment accounts for the cost of this important
technology. The current ASC payment policy for FFR/iFR has made these
procedures out-of-reach for physicians and Medicare beneficiaries in an
ASC. Many stakeholders, including the Society for Cardiovascular
Angiography and Interventions (SCAI) and the American College of
Cardiology (ACC), have expressed concerns over this policy and have
called for a change, whether by separately paying for FFR/iFR or
providing a payment adjustment similar to the adjustment provided under
the outpatient setting.
If confirmed as Administrator, will you commit to reexamining this
ASC policy in the upcoming rulemaking cycle and considering changes to
the policy to make FFR/iFR a viable option for providers and patients
in an ASC?
Answer. As more and more services can be provided on an outpatient
basis in various settings, we need to be thoughtful about the
incentives Medicare payment policies have on utilization in these sites
of care. If confirmed, I will make sure that CMS continues to examine
how payment policies that vary by site of care impact quality of care
and cost savings, especially for technologies that are critical for
making treatment decisions.
on vaccines
On Seniors' Access to Preventive Care
Question. While Medicare Part B covers a number of vaccines,
including for influenza, pneumococcal, and hepatitis B, with no
beneficiary cost-sharing, the majority of vaccines recommended for
adults, including for older adults, are covered under Part D, where
seniors can face substantial copays. While cost-sharing can serve as a
useful and appropriate tool in other contexts, those rationales do not
apply in the case of ACIP-recommended vaccinations, and studies have
shown a direct correlation between cost-sharing and increased
abandonment rates for vaccines.
As a number of my colleagues and I noted in a letter we sent to CMS
on this subject last summer, ``A 2017 report by Avalere Health found
between 47 and 72 percent of the 24 million Medicare beneficiaries with
Part D coverage had some level of cost sharing for vaccines, ranging
from $35 to $70 in 2015. Another study found that only 4 percent or
less of Medicare Part D enrollees had access to vaccines with no cost
sharing.''
How can the Biden administration address the issue of ensuring
medically necessary preventive care for all populations?
Answer. Making sure that all Americans have access to quality,
affordable health care is one of the Biden administration's top
priorities. I look forward to working with Congress to find ways to
ensure preventive care, including recommended vaccinations, is
accessible for all populations served by CMS programs. If confirmed, I
will work with stakeholders and trusted partners to educate providers,
beneficiaries, and families, and encourage individuals to seek
preventive care.
on medicare advantage
Question. A growing share of Medicare beneficiaries, rising from
just one-quarter in 2010 to 39 percent in 2020, have chosen to enroll
in Medicare Advantage (MA) plan, which enjoy a 94-percent satisfaction
rate. MA has enjoyed increasingly strong bipartisan backing, with 64
senators and 339 members of the House signing on to a letter of support
for the program last year.
MA plans cover an increasingly broad array of extra benefits,
relative to the fee-for-service model. Of all MA plans, 88 percent
cover hearing aids and 91 percent cover glasses and eye exams, while 92
percent include dental benefits and 96 percent have a fitness benefit.
Given the overwhelming bipartisan support and the additional
benefits, as well as the growing competition in the MA market, what
steps would you look to take, if confirmed, to continue increasing
access to and education on MA options for seniors?
Answer. Medicare Advantage serves millions of Americans and is an
important option for all beneficiaries, including older Americans and
people with disabilities. I believe that we have to take every approach
we can to provide people access to quality health care. If confirmed as
CMS Administrator, I look forward to working with Congress on this
important issue.
On Integrating Certain Diagnoses Obtained via Audio-Only Telehealth
Visits for Risk Adjustment Purposes
Question. South Carolina has seen substantial growth in MA market
penetration in recent years. As a share of all Medicare beneficiaries
across the State, MA enrollment has nearly doubled in the past decade,
from 16 percent of total Medicare enrollment in 2010 to 31 percent in
2020. We have also seen increased interest in Programs of All-Inclusive
Care for the Elderly (PACE), another innovative model intended to drive
value-based care, particularly for those dually eligible for Medicare
and Medicaid. While PACE has a much smaller population of participants,
more than 400 reside in SC, receiving care across three different
programs, which enjoy a high satisfaction rate.
Last spring, I was pleased to see the Centers for Medicare and
Medicaid Services (CMS) relax previous telehealth restrictions in
Medicare to allow high-risk individuals more options for care,
including allowing diagnoses obtained via telehealth to be used for
risk adjustment in MA and PACE. However, CMS's guidance requires a
video component to validate any diagnosis for risk adjustment purposes,
even though many beneficiaries and participants have received care via
audio-only visits during the pandemic, due in part to broadband and
technological access gaps. According to some surveys, the majority of
seniors who have access to a cell phone lack smartphone capabilities,
and for many older Americans living in rural areas, including more than
27 percent of South Carolinians, broadband hurdles persist, making
audio-visual visits challenging for many beneficiaries.
I have heard from plans, providers, and researchers from across
South Carolina that audio-only services have accounted for a
substantial portion of telehealth services during the pandemic
emergency, and lower-income patients disproportionately utilize audio-
only telehealth over both in-person and video telehealth services.
According to CMS's data, only 65 percent of beneficiaries making less
than $25,000 have access to any Internet service in their homes.
Disqualifying diagnoses obtained via audio-only telehealth
services, especially for chronic conditions that have been previously
documented, will result in inaccurate and incomplete documentation for
MA and PACE risk adjustment purposes, arbitrarily reducing risk scores.
This could lead to unequal access, fewer choices, higher premiums, or
reduced benefits for seniors and individuals with disabilities.
Notably, CMS has taken the opposite approach for insurers
participating in the Department of Health and Human Services (HHS)-
operated risk adjustment program in the commercial market. On April
27th and August 3, 2020, the Center for Consumer Information and
Insurance Oversight (CCIIO) published sets of frequently asked
questions (FAQs) clarifying that HHS will allow diagnosis codes from
audio-only telehealth services for risk adjustment purposes in 2020. On
March 24, 2021, CCIIO issued updated FAQs stating that the policy would
continue for 2021. The same logic underlying the exchange policy should
justify the application of these flexibilities to MA and PACE risk
adjustment as well.
If confirmed, can you commit to thoroughly reviewing this policy
within the agency to ensure consistency, parity, and alignment between
departments and programs regarding audio-only telehealth and risk
adjustment in the future?
The deadline for plan bid submission for 2022 is less than 2 months
away. Will you commit to working with my office and other interested
offices on this issue to prevent adverse impacts for MA beneficiaries
and PACE participants through reduced benefits, higher costs, or fewer
choices next year?
I understand and share potential concerns about beneficiary,
participant, and taxpayer protections around fraud, waste, and abuse.
For that reason, I have partnered with Senator Cortez Masto to
introduce bipartisan legislation including numerous guardrails to
prevent potential misuse. Will you commit to working with us on The
Ensuring Parity in Medicare Advantage for Audio-Only Telehealth Act of
2021 by providing technical assistance for congressional action or
looking to it as a potential guide for implementing policy changes
within the agency?
Answer. Medicare Advantage serves millions of Americans and is an
important option for Medicare beneficiaries. During the pandemic, we
have been able to see the value telehealth brings for patients,
including those enrolled in Medicare Advantage. If confirmed, I look
forward to working with you to ensure that beneficiaries enrolled in
Medicare Advantage plans can continue to benefit from these services.
on pending dme rule
Question. Last year, CMS issued a Durable Medical Equipment (DME)
proposed rule that would make the 50/50 blended rate for rural areas
permanent. Rural access to services and care has been a longtime
priority for me, given that more than one-fourth of South Carolinians
live in rural areas. The proposed rule would also create a pathway for
drugs requiring health-care professional administration to be covered
for home infusion, helping to address an urgent challenge that the
pandemic has exacerbated.
I appreciate all of the work that CMS has undertaken thus far
regarding the Medicare Durable Medical Equipment benefit, and we
appreciate the agency's engagement with stakeholders regarding
refinements to this and other rules.
Can you commit, if confirmed, to working to finalize the DME rule
as efficiently as practicable?
Answer. I recognize that rural areas have unique needs and
challenges, including access to durable medical equipment. If I am
fortunate enough to be confirmed, I am happy to look into the status of
this regulation and work with you and your office on this important
issue.
on medicaid work requirements
Question. A report on health equity that you co-authored last year
criticized work requirements and the Trump administration's public
charge rule, writing that both policies ``disproportionately impact
people of color'' and ``perpetuate historic structural inequities and
widen the health equity gap.'' The report described both as
``discriminatory policies.''
In 1996, bipartisan majorities in both chambers of Congress voted
to pass the Personal Responsibility and Work Opportunity Reconciliation
Act (PRWORA), which President Clinton signed into law, authorizing work
requirements for a number of safety-net programs. As Democrats and
Republicans who supported the legislation at the time explained, these
requirements aimed to encourage self-sufficiency and promote
opportunity. What did you mean, last year, when you described work
requirements as ``discriminatory,'' and do you stand by that
assessment?
Do you believe in the core principle of welfare-to-work--namely,
that workforce entry or reentry provides the ideal avenue out of
poverty and dependency?
Answer. Medicaid is an important lifeline for many American
families. Section 1115 demonstration projects, or waivers, are one
available tool to States to help test new and innovative policies in
Medicaid. I have worked closely with States throughout my career, so I
know they face different challenges and need consistency and
predictability. If confirmed, I will keep in mind what I have learned
working on behalf of States to make sure waiver requests are
appropriately evaluated while giving them consistent guidance. I will
support State innovation and the ability of States to test out
different models that meet the objectives of the Medicaid program. I
look forward to seeing the ideas States bring to the table and will
consider each one on its merits.
on support for nursing home i-snps
Question. As you know, Institutional Special Needs Plans (I-SNPs)
are a type of Medicare Advantage plan where the only beneficiaries
enrolled are seniors living in nursing homes. When nursing homes offer
these plans, they are 100-percent at risk for all the care their
residents need, either at their facilities or elsewhere. In the push
towards value-based care, nursing homes taking on risk via I-SNPs are
doing exactly what we want to see, but in 2020, being 100 percent at
risk for a population exclusively made up of the individuals most
vulnerable to COVID-19, and most likely to need high-cost
hospitalization, created serious financial challenges for nursing homes
with I-SNPs, including numerous communities in South Carolina. While
nursing homes in general have received funds from the Provider Relief
Fund (PRF), neither HHS nor CMS has provided relief to address the
specific challenges nursing home I-SNPs have faced in order to ensure
this model's continued viability.
Will you commit to using administrative authority to support I-SNPs
and to recognize the significant increased and unexpected costs that
these plans have faced during the COVID-19 emergency?
Answer. It has been heartbreaking to see how hard the COVID-19
pandemic has affected the Nation's nursing home residents. Nursing home
care will absolutely be a focus of mine if confirmed. Medicare
Advantage serves millions of Americans, and Institutional Special Needs
Plans provide important options for people in need of the level of care
provided in nursing homes and long-term care facilities. This pandemic
has given us the opportunity to take in lessons across a variety of
issues. Moving forward, it is critical we examine every approach we can
to improve affordability, quality, and access in long-term care. If
confirmed as CMS Administrator, I look forward to working with you and
other members of Congress to find ways to achieve this important goal.
______
Questions Submitted by Hon. James Lankford
Question. Biosimilar medicines are projected to save more than $100
billion in the next 4 years and increase patient access to lifesaving
medicines. Recent analysis found roughly 40 percent of first generics
are not covered under Part D 3 years after launch. Over the last 10
years, generic medicines have been increasingly placed on higher cost-
sharing tiers in Medicare Part D. I have been an advocate for the
creation of a specialty tier to provide lower cost-sharing for
biosimilars and specialty generics.
What steps could CMS take to encourage the use of lower-cost
biosimilars and generics?
Will you work with Congress to ensure generics are covered soon
after launch and seniors are provided rapid access to these lower-cost
medicines?
Will you work to reverse the trends of generics being placed on the
inappropriate Part D tier in order to ensure patient access to low-cost
generics with low cost sharing?
Answer. Prescription drug costs are too high for American patients
and families. From the meetings I have had with Senators in recent
weeks, I have seen that lowering drug prices is a priority on both
sides of the aisle. I agree that patient access to lower-cost generics
and biosimilars is important. Competition in the market has helped
control the growth in spending on prescription drugs, and generics
biosimilars certainly have a role to play in creating competition for
reference products. If I am fortunate enough to be confirmed, I look
forward to working with you and other members of Congress to lower the
cost of prescription drugs.
Question. I recently sent a letter to GAO alongside many of my
colleagues asking for an investigation into some recent reports on
fraud in the Medicaid program.
What holes in the system did you see when you worked as a program
analyst for Medicaid, and what possible solutions do you look toward to
help solve the problem?
Answer. Fighting fraud and abuse is so important for maintaining a
strong Medicaid program. Medicaid is a critical lifeline for
beneficiaries across the country. If I am fortunate enough to be
confirmed, I will be prepared to work with you, other members of
Congress, and States to make sure that payments are made properly and
we are good stewards of the Medicaid program and taxpayer dollars.
Question. The pandemic has underscored the importance of managing
and preventing chronic disease and removing health disparities. We also
recognize that higher out-of-pocket costs correlate with less
prescription drug access. To this end, we need to be proactive and
address system challenges that inadvertently drive out-of-pocket costs
up for seniors. For example, certain system fees, called DIR fees, lead
to increased costs for seniors at the pharmacy counter, while also
threatening the viability of pharmacies across the Nation, leading to
gaps in care. As you are aware, the Centers for Medicare and Medicaid
Services (CMS) has estimated that pharmacy DIR fee reform could result
in saving Medicare beneficiaries between $7.1 and $9.2 billion in cost
sharing burden over the next decade.
To reduce out-of-pocket costs for seniors and safeguard access to
care provided at local pharmacies, how will you commit to DIR fee claw-
back reform and the establishment of standardized performance measures
for pharmacies in Part D to help drive quality for seniors and control
rising costs?
Answer. Small and rural pharmacies are critical to our Nation's
health-care system and have been especially important during the
pandemic. It can be hard for these pharmacies to predict retroactive
DIR fees. We must do all we can to ensure that Americans can access
important health-care services, including from local pharmacies in
their communities. If confirmed, I look forward to working with
Congress to ensure that pharmacies have predictability.
Question. As you know, the Medicare Advantage institutional special
needs program is an important source of personalized support for long-
term care residents. It has proven to deliver quality care with
supplemental benefits at a lower cost. As a result, Congress has seen
the value and made the I-SNP program permanent. Since I-SNPs only serve
long-term care populations, they cannot shift the risks they may
assume. One of these plans is currently servicing several of the long-
term care facilities in Oklahoma and, unsurprisingly, the COVID
pandemic has had a particularly devastating effect on them, as nursing
home residents continue to be on the front lines of those most
negatively impacted. Special needs plans have fallen through the cracks
of COVID support and have been subject to unintended consequences,
leading to enrollment disincentives and further increasing the pressure
on I-SNPs.
Do you acknowledge that the I-SNPs are facing a significant
problem?
If so, will you commit to working with the struggling plans to
address the disparities they currently face, ensuring there are
equitable private options available for nursing home residents, and
finding a solution?
If not, please explain why.
Answer. It has been heartbreaking to see how hard the COVID-19
pandemic has affected the Nation's nursing home residents. Nursing home
care will absolutely be a focus of mine, if confirmed. Medicare
Advantage serves millions of Americans, and Institutional Special Needs
Plans provide important options for people in need of the level of care
provided in nursing homes and long-term care facilities. I agree that
it is critical we examine every approach we can to improve
affordability, quality, and access in long-term care. If confirmed as
CMS Administrator,
I look forward to working with you and other members of Congress to
find ways to achieve this important goal.
Question. Your career has focused on expanding health coverage for
Americans.
If confirmed, do you plan to increase the role of the Federal
Government in health care by promoting a public option? Please detail
your plans for expanded health coverage.
Answer. President Biden has been clear that his goals for improving
the American health-care system begin with building on the successes of
the Affordable Care Act, and I am committed to working toward that
goal. Ensuring that all Americans have access to affordable, quality
health care will be a priority of mine. I want to work with States to
expand coverage through Medicaid and the Marketplaces. I look forward
to working with you to expand access to affordable, quality health
care.
______
Questions Submitted by Hon. Steve Daines
Question. One of the silver linings of this pandemic has been the
wide-spread adoption of technology to bring people together, whether it
be families scattered across the Nation or patients and their
providers. Telehealth has truly taken root, and we have seen
exponential growth in telehealth adoption across Americans of all ages,
locations and conditions. Much of the growth in usage among Medicare
beneficiaries has been made possible by temporary flexibilities in
place for the duration of the public health emergency. These include
allowing Medicare beneficiaries to have telehealth visits from their
home, regardless of where they live across the country. This has also
allowed new types of providers, such as physical therapists and speech
pathologists to practice via telehealth.
Do you agree that the expanded access to telehealth services has
been an important component in protecting patients and providers during
the Nation's response to COVID-19?
As Congress considers permanent telehealth reform, I hope you will
be willing to work with us to ensure that telehealth is available to
all of those that wish to use it. Do you believe that there are some
telehealth regulatory restrictions that Congress and CMS can work
together to address in the near term?
Answer. Telehealth has been invaluable during this pandemic to keep
patients, their providers and their families safe. My brother is a
psychologist, and telehealth has really helped his patients get the
care they need. If I am fortunate enough to be confirmed, I will be
taking a careful look at the telehealth flexibilities under Medicaid
and Medicare before the Public Health Emergency ends.
I want to look at what we can and should extend administratively
and what will need congressional action to ensure that we bring the
lessons learned about telehealth during the pandemic into our health-
care system going forward. I look forward to hearing more from you
about what existing flexibilities you view as especially important.
Question. Emerging science indicates that addressing risk factors--
including cardiovascular disease, diabetes, obesity, and hypertension--
can delay the onset of dementia and Alzheimer's. However, we continue
to see our health-care system, particularly Medicare, fail to pursue
low-cost, effective policies to reduce the risk for chronic conditions,
including Alzheimer's. Instead, our system waits until people are sick
and treatment costs are significantly higher.
If confirmed, how will CMS pursue wellness and early intervention
policies that reduce the risk of chronic diseases like Alzheimer's?
Answer. Alzheimer's disease is a devastating condition for patients
and families. It is only going to be a growing challenge for the
Medicare program and our aging population in coming years. Preventive
care is crucial to improving health outcomes, and it is so important to
catch the signs of cognitive impairment early. I'd be happy to work
with you on this should I be confirmed.
Question. Late last year, CMS issued a Durable Medical Equipment
proposed rule, which would make the 50/50 blended rate for rural areas
permanent. This rule has not been made final as of yet. I appreciate
all the work HHS and CMS have done regarding the Medicare Durable
Medical Equipment benefit.
When will HHS and CMS issue the final DME rule?
Answer. I recognize that rural areas have unique needs and
challenges, including access to durable medical equipment. If I am
fortunate enough to be confirmed, I am happy to look into the status of
this regulation and work with you and your office on this important
issue.
Question. The coronavirus pandemic has underscored the value of
vaccines for infectious diseases, including those that originate
abroad. We all recognize that COVID-19 will not be the last time we
have to respond to an outbreak for which vaccinations are necessary in
order to stem an emerging public health threat.
Public policy should make vaccines as accessible as possible for
our citizens. That is why current law requires that insurers provide
coverage without cost sharing for all recommended vaccines, without
limitation.
Yet, inexplicably, current HHS regulations implementing the law
limit mandatory coverage to so-called ``routine'' vaccines on the
Immunization Schedules. As a result, many vaccines for infectious
diseases are not covered without cost-sharing, including those for
current vaccines such as rabies, anthrax, Japanese Encephalitis, yellow
fever and cholera, and those vaccines in the pipeline for malaria,
chikungunya, dengue, and Zika.
Last year, my colleagues and I worked on bipartisan legislation
included in the CARES Act that ensures immediate coverage of COVID-19
vaccines with no cost-sharing. As I said then, Montanans and Americans
across the country need access to vaccines, and financial barriers
should not stand in the way during a national emergency or otherwise.
Congress should not have had to be reactive. A forward-looking,
uniform approach is needed to ensure that we are prepared to move
quickly on vaccinations when the next pandemic occurs.
If confirmed, will you commit to quickly bringing agency
regulations in line with the statute requiring no cost-sharing for all
CDC recommended vaccines to maximize access to the best preventative
measures against infectious diseases?
Answer. I agree that the COVID-19 pandemic has underscored the
importance of vaccines to preventing the spread of disease, and I agree
that we should remove barriers for patients to get proven vaccines. We
need to be prepared for any potential future outbreak, and I agree we
cannot afford to be reactive on such an important issue. I am happy to
work with you to ensure we are ready for the next public health
emergency.
______
Questions Submitted by Hon. Todd Young
center for medicare and medicaid innovation (cmmi)
Question. The Center for Medicare and Medicaid Innovation (CMMI) is
charged with testing and evaluating voluntary healthcare payment and
service delivery models with the intent of increasing quality and
efficiency while reducing program expenditures under Medicare,
Medicaid, and the Children's Health Insurance Program (CHIP).
As we discussed during our meeting, I feel there is absolute value
in innovating with health-care payment and service delivery systems. We
won't know if we're truly making a difference unless we test and
evaluate--it's how we find out what works and what's most effective for
patients and doctors alike.
However, the actual experience of CMMI can too often be marked by a
lack of transparency and little stakeholder engagement in the
development and implementation of models.
At times, models also seem to initiate wholesale policy changes
rather than serve as true tests, circumventing Congress's role in
establishing Medicare policy. I also want to ensure that proposed
models sufficiently take into consideration the potential health-care
access disparities for vulnerable populations.
Will you work with the members of this committee on establishing
protections to guarantee better transparency, stakeholder input, data
sharing, and equity in the development of proposed models by CMMI?
Will you commit to come back to this committee to share updates and
release progress reports on CMMI actions and models?
Answer. The Innovation Center has been an important tool to test
new models to move our health-care system from one that rewards volume
to one that rewards value. It will continue to be important, as we move
forward, to test models that improve patient care, advance health
equity, and lower patient costs. We have now had 10 years of experience
to learn from at the Innovation Center. We need to look at what has
worked and what hasn't and chart a path forward from there. This
includes getting stakeholder input, and if I am fortunate enough to be
confirmed, it will be a priority for me to have open lines of
communication with Congress. I look forward to hearing from you about
CMMI models.
telehealth
Question. Even prior to the pandemic, I heard from my constituents
in Indiana--particularly those in rural areas--about the ways in which
telehealth can both increase access to underserved Americans and reduce
health-care costs. Since the start of the public health emergency,
telehealth flexibilities provided by Congress and HHS have been a
lifeline for vulnerable seniors and others accessing care from the
safety of their own homes.
Currently, authorizations included in the CARES Act to create
additional flexibility for patients and providers using telehealth only
extend through the pandemic.
We don't want to take a step back on telehealth. The Medicare
Payment Advisory Commission (MedPAC) has recommended that we should
``temporarily continue some of the telehealth expansions for a limited
duration of time (e.g., 1 or 2 years after the public health emergency)
to gather more evidence about the impact of telehealth on beneficiary
access to care, quality of care, and program spending to inform any
permanent changes.'' What data or evidence is CMS collecting now to
determine what waivers should be made permanent?
How should telehealth be used moving forward to expand access to
mental and behavior health services for Medicare beneficiaries?
Answer. Telehealth has been invaluable during this pandemic to keep
patients, their providers and their families safe. My brother is a
psychologist, and telehealth has really helped his patients get the
care they need. If I am fortunate enough to be confirmed, I will be
taking a careful look at the telehealth flexibilities under Medicaid
and Medicare before the Public Health Emergency ends to determine what
we can extend administratively and what we will need Congress's help on
to ensure that we use the lessons learned about telehealth during the
pandemic to modernize our health-care system.
organ procurement
Question. Thirty-three Americans die every day waiting for a
lifesaving organ transplant, and Medicare spends roughly $36 billion
annually on care for dialysis patients because there are not enough
kidney transplants available to meet the need. The problem is a network
of unaccountable government monopoly contractors that run the organ
donation system, called organ procurement organizations (OPOs), with a
history of severe performance failure.
Recently, CMS finalized a rule started in the previous
administration that would allow HHS to replace failing OPOs with high
performers, and is projected to save more than 7,000 additional lives
every year, as well as over $1 billion annually to Medicare.
This rule has broad bipartisan support, and is even more important
since COVID-19 damages organs. As CMS Administrator, will you commit to
its swift implementation?
Answer. Thank you for bringing up this important issue. Federal law
tasks CMS with conducting surveys of OPOs and recertifying them. As you
noted, the rule replacing current OPO measures with new transparent,
reliable, and objective outcome measures is now effective. My
understanding is that the new outcome measures will be implemented on
August 1, 2022, the start of the next recertification cycle. If
confirmed, I will work to implement this rule in a timely way and
ensure that all parts of the organ transplant system are as effective
and efficient as possible in order to save as many lives as possible.
medicare advantage
Question. We have seen a growth in the private/public partnership
program in Medicare Advantage (MA). Over 40 percent of Medicare
beneficiaries are choosing Medicare Advantage and they report high
satisfaction with the provider networks, cost savings and coordinated
care.
What role do you see Medicare Advantage having in the future of
Medicare as we work towards modernizing the program?
Medicare Advantage is showing that it can provide lower consumer
costs, offer additional benefits, and achieve better outcomes, like
fewer avoidable hospitalizations including for high need, high risk
patients for the same or lower cost as FFS Medicare.
Research from UnitedHealth Group shows that Hoosiers enrolled in a
Medicare Advantage plan spend nearly $1,800 less on premiums and out-
of-pocket costs than a Hoosier enrolled in traditional Medicare and a
prescription drug plan; and, in addition to the dental, vision, and
hearing benefits typically offered, the average MA beneficiary in
Indiana receives $170 annually in additional benefits such as care
coordination, meals, and non-emergency transportation not offered by
traditional Medicare.
Do you see Medicare Advantage as an important part of modernizing
Medicare while getting better results for our taxpayer dollars?
What will you do to protect this public/private partnership and
keep the program strong?
Answer. Medicare Advantage serves millions of Americans and is an
important option for Medicare beneficiaries. I believe that we have to
take every approach we can to provide people access to quality health
care. If confirmed as CMS Administrator, I look forward to working with
Congress on this important issue.
sepsis testing standard of care
Question. More than 20 million Americans present with symptoms of
sepsis in acute care hospitals annually, and are treated under a
``sepsis protocol'' where blood culture tests are urgently drawn to
diagnose bloodstream infections. However, approximately 40 percent of
these blood culture tests are false positives. This results in patients
being subjected to extended hospital stays and the unnecessary use of
potent antibiotics, which have been proven to contribute to the spread
of antibiotic resistance.
What is CMS doing to ensure that hospitals across the country are
working to reduce their false positive sepsis test rates to ensure
patient safety?
Answer. Thank you for raising this important issue. Timely
diagnosis and treatment of sepsis is a critical issue as are actions
that will enhance antibiotic stewardship. If confirmed, I look forward
to working with you to continuously improve the quality of care that
hospitals are providing to patients, including with respect to
accurately diagnosing sepsis while avoiding unnecessary use of
antibiotics.
end stage renal disease (esrd)
Question. Last November, my staff shared some concerns we heard
from representatives of the kidney care community about the proposed
methodology to incorporate certain drugs into the ESRD bundle. There
have been reports of dialysis patients on these therapies being forced
off treatments that are working for them onto therapies that have not
worked for the patient in the past.
As CMS Administrator, how you will ensure patient quality of care
is not being impacted--specifically for communities of color who are
disproportionately impacted by kidney disease--so that patients can
continue to access these medicines best suited for their treatment?
Answer. I agree that is it important for Medicare beneficiaries,
particularly patients with complex conditions such as ESRD, to have
access to medically necessary treatments. Promoting health equity--
particularly for communities of color and rural areas--needs to be at
the forefront of CMS decision making. If confirmed, I will work to
preserve access to these treatments in Medicare and improve patient
outcomes.
______
Questions Submitted by Hon. Ben Sasse
telehealth
Question. While my colleagues have pointed out many of the ways
COVID-19 has challenged our health-care system and exposed existing
inequities, one bright spot in the pandemic has been increased access
to telehealth services as a way for patients to maintain their health
from the safety of their homes. This has been particularly important
for States like Nebraska with large areas of rural population.
We know that CMS has allowed expanded use of audio-only services
during the pandemic, but how is CMS working to ensure that those
without broadband access can utilize appropriate telehealth services in
a post-pandemic world?
Where do you stand on audio-only telehealth coverage? What about on
payment parity between in-person and virtual services?
How will you approach geographic restrictions, both in patient
location and provider licensure?
If confirmed, how do you plan to evaluate the use of telehealth
over the last year and the places where it should--and potentially
should not--be expanded beyond the end of the national emergency
period?
Answer. Telehealth has been invaluable during this pandemic to keep
patients, their providers, and their families safe. My brother is a
psychologist, and telehealth has really helped his patients get the
care they need. If I am fortunate enough to be confirmed, I will take a
careful look at the telehealth flexibilities under Medicaid and
Medicare before the Public Health Emergency ends. During that review, I
will pay special attention to the issues of equity and access. I will
look at what we can and should extend administratively and where we
will need Congress's help to ensure that we bring the lessons learned
about telehealth during the pandemic forward to modernize our health-
care system.
Question. Individuals with chronic disease place an immense strain
on our health-care system and account for a huge percentage of the
overall costs to taxpayers. I think you would agree that early
identification and treatment is crucial not only among those with
chronic diseases but in our health systems in general. Remote patient
monitoring (RPM) can be beneficial in managing both acute and chronic
conditions and identifying deteriorations in health as early as
possible to allow for the best level of care. Issues with reimbursement
continue to constrain Medicare recipients' access to this level of
monitoring.
Do you see value in increased access to remote patient monitoring
and what are your views on the co-pay requirement for these services?
Answer. Individuals with chronic disease benefit from access to
comprehensive and coordinated care to manage and treat their chronic
conditions and prevent the need for more costly care. Ensuring access
to remote patient monitoring services, including through evaluating the
adequacy of payments, will be important to beneficiaries who may
benefit from these and other virtual services that allow their
physicians to help manage and treat their health conditions outside of
regular office visits.
most favored nation model
Question. I have concerns with the Most Favored Nation model
rulemaking, both with the policy of tying Medicare reimbursements to
the prices foreign countries pay and with the creation of the expansive
rule through the Center for Medicare and Medicaid Innovation (CMMI)
under the guise of being a pilot program.
If confirmed, how will you approach this policy? Do you support
tying the prices of American drugs to foreign prices?
Will you commit to ensuring that CMMI is used as intended rather
than as a congressional workaround?
Answer. Prescription drug costs are too high for American patients
and families. From the meetings I have had with Senators in recent
weeks, I have seen that this is a priority on both sides of the aisle.
I think there is an opportunity for real impact here to lower
prescription drug costs, and--if I am fortunate enough to be
confirmed--I look forward to working with you and other members of
Congress to achieve that goal.
Regarding the Center for Medicare and Medicaid Innovation, the
Innovation Center has been an important tool to test new models to move
our system from one that rewards volume to one that rewards value. It
will continue to be important, as we move forward, to test models that
improve patient care, advance health equity, and lower patient costs.
With 10 years of experience to learn from at the Innovation Center, we
need to look at what has worked and what hasn't, and I look forward to
hearing from you about what you think is working well and what
experiences you've seen on the ground in Nebraska.
medicaid
Question. Enrollment in the Medicaid program has exploded during
the pandemic, partially due to problematic language in last year's
relief bills where States have no choice but to provide services even
to people who are not actually eligible for the program. The Families
First Coronavirus Response Act (FFCRA) offered States an increased
Federal Medical Assistance Percentage (FMAP) for their traditional
Medicaid populations and in turn restricted them from maintaining
control over their Medicaid programs via maintenance-of-effort
requirements. Across the country there are millions of Medicaid
enrollees whose redetermination has been delayed, and in just seven
States where we have data we know that roughly half a million enrollees
are receiving benefits who are ineligible for the program.
Do you commit to working with States and Congress to actually
identify which enrollees are eligible and which are not?
Do you commit to making sure that the Medicaid program is able to
serve those individuals who are truly in need?
Do you believe States should have the right to remove ineligible
enrollees, which is currently restricted by FFCRA?
Answer. Medicaid is a critical lifeline for beneficiaries across
the country. If I am fortunate enough to be confirmed, I will also be
prepared to work with you, other members of Congress, and States to
make sure that payments are made properly and we are good stewards of
the Medicaid program and taxpayer dollars. The requirement related to
enrollment at section 6008(b)(3) of the Families First Coronavirus
Response Act for States receiving the Medicaid FMAP increase will be in
effect until the end of the month in which the COVID-19 public health
emergency ends. As that time grows nearer, it will be important for CMS
to work closely with States to plan for the transition.
durable medical equipment
Question. HHS and CMS have done a lot of work on the Medicare
Durable Medical Equipment benefit, including issuing a proposed rule
late last year that would have made the 50/50 blended rate for rural
areas permanent.
When does CMS plan to issue the final DME rule given the change of
administrations?
Answer. I recognize that rural areas have unique needs and
challenges, including access to durable medical equipment. If I am
fortunate enough to be confirmed, I am happy to look into the status of
this regulation and work with you and your office on this important
issue.
Question. We know that some of our most vulnerable in society rely
on ventilators for their care, yet access to new-generation, multi-
function ventilators can often be restricted by complicated payment
policies that have not adapted for new technologies. This is
particularly important in light of the pandemic, when ventilation in
home care settings allows for more hospital space.
If confirmed, will you work to update CMS payment regulations to
account for advancements in ventilator technology, including adjusting
irregularities in payment that impede patient access?
Answer. We know that some of our most vulnerable patients rely on
ventilators for their care, yet access to new-generation, multi-
function ventilators can often be impeded by statutory payment policies
related to paying for equipment on a cap rental basis and the
reasonable useful lifetime of the equipment. To help ensure access to
ventilators in light of the COVID-19 public health emergency, I
understand that CMS is allowing payment for multi-function ventilators
even if separate devices have not met their reasonable useful lifetime.
I agree that it is incredible what science has been able to do in
recent years with innovative new drugs, treatments and devices. If I am
fortunate enough to be confirmed, I will make sure we are looking at
modernizing the Medicare program to make sure beneficiaries have access
to proven new technology, and I would be happy to work with you on
that.
______
Questions Submitted by Hon. John Barrasso
Question. At the end of 2020, Congress provided relief from
reductions in reimbursement to certain physicians which was included in
last year's physician fee schedule final rule. This was the result of
budget neutrality requirements within the fee schedule. With many
physician practices experiencing substantial challenges as a result of
the COVID-19 pandemic, it is important to ensure providers are able to
continue caring for patients.
Can you please discuss your approach regarding future changes to
the physician fee schedule? In particular your feelings on reducing
reimbursements to providers during the pandemic.
Answer. I believe that ensuring adequate payments for primary care
and specialty physicians is essential to maintain beneficiary access to
high-quality and affordable health care. If confirmed, I will work to
ensure that payments under the Medicare physician fee schedule are
implemented in accordance with the law while preserving beneficiary
access.
Question. Current law requires zero cost sharing for COVID
therapeutics. However, when the Public Health Emergency (PHE) is lifted
many of these policies linked to the PHE declaration will no longer be
in effect under the law and will potentially be subject to CMS'
discretion.
Please discuss your approach to reimbursement for COVID
therapeutics. In particular your feelings on how this issue should be
approach once the PHE is lifted.
Answer. I appreciate Congress's leadership in making sure that
patients suffering from COVID-19 have been able to get the care they
need during the public health emergency. I think we need to look at the
policies in place during the pandemic and determine what we should do
after the pandemic is over, either administratively or with legislation
from Congress. If confirmed, I will be happy to work with you and other
members of Congress as we look beyond the pandemic.
Question. Drugs approved via accelerated approval at the Food and
Drug Administration (FDA) are novel treatments that address urgent and
unmet medical needs involving serious and life-threatening diseases.
As a doctor, I am particularly passionate about the new treatments
approved through this pipeline to treat Duchenne Muscular Dystrophy. As
you know, this is a deadly disease, which until very recently had no
approved treatments. Today we have five treatments approved through
this pathway with many more in development. While certainly not a cure,
these therapies are an important step forward.
Recently, the Medicaid and CHIP Payment and Access Commission
(MACPAC) issued recommendations to increase the required Medicaid
rebates for drugs specifically approved through the accelerated
pathway.
While I appreciate that MACPAC is a congressional advisory body, I
believe their recommendation to single out these therapies is
troubling. In particular, when you consider medications approved in
this manner treat some of our most vulnerable patients and make up a
very small percentage of total Medicaid spending.
Can you discuss your views on Federal reimbursement policies on the
development of new therapies for people with rare diseases?
Answer. Thank you for raising this important issue. It is
incredible what scientific progress has been made with innovative drugs
and treatments, and we need to continue to modernize the Medicare and
Medicaid programs to make sure beneficiaries, including those with rare
diseases, have access to proven new treatments. If confirmed, I would
be happy to examine this particular MACPAC proposal in more detail, and
to work with you and other members of Congress on ways to spur
innovation and facilitate beneficiary access to new advances in
medicine.
Question. Last year I led a bipartisan letter with Senate and House
colleagues to CMS expressing concerns about cuts to hip and knee
replacement in the Calendar Year 2021 (CY21) Physician Fee Schedule and
the implications for value based care.
Specifically, the letter urged CMS to recognize the patient
preoptimization work physicians are doing in alternative payment
models. The CY'21 rule substantially cut lower joint arthroplasty even
though physicians performing those procedure are doing more work and
saving the Medicare Trust Funds money through their record-high
participation in alternative payment models (APMs).
These cuts are concerning. This appears to be a disconnect between
the legacy fee-for-service evaluation of procedures, and innovative
care we are encouraging in APMs. However, the Final Rule indicated
CMS's interest in capturing this patient preoptimization work.
Would you please work with the stakeholders and I on the
preoptimization issue?
More broadly, can you discuss your feeling on alternative payment
models and if there are specific areas where you wish to focus?
Answer. I agree that we should continue efforts to further move our
health-care system towards one that rewards value over volume. Delivery
system reform efforts, including alternative payment models, can
improve quality of care while reducing health-care costs. The
Innovation Center has been an important tool to test new models to move
our system from one that rewards volume to one that rewards value. It
will continue to be important, as we move forward, to test models that
improve patient care, advance health equity, and lower patient costs.
We have now had 10 years of experience to learn from at the Innovation
Center. We need to look at what has worked and what hasn't, and if
confirmed, I will work with you to make sure we recognize the good work
providers are doing to move our system in the right direction, improve
care, and lower Medicare spending.
Question. I support price transparency in the health-care system.
The Trump administration made good progress on this problem with their
hospital price transparency rule, which went into effect on January 1,
2021.
It appears from media reports that many hospitals are not following
the rule. If confirmed, how will you address price transparency in
health care, especially in terms of enforcement of the price
transparency rule?
Answer. I agree that the variation in pricing across hospitals is
not always justified and ultimately can be bad for consumers. For
transparency measures to work properly, patients and their families
must be able to understand them in a meaningful way. If I am fortunate
enough to be confirmed, I look forward to continuing to work on this
issue.
______
Prepared Statement of Hon. Mike Crapo,
a U.S. Senator From Idaho
When we held our hearing for Xavier Becerra to be the Secretary of
Health and Human Services, I noted the size and importance of the
Department he would lead. In normal times, HHS and its agencies provide
health-care coverage to nearly 150 million people, and those agencies
affect the lives of many more on a daily basis. The COVID-19 pandemic
has raised the salience of the Department.
The Department's leadership, including the Deputy Secretary, will
continue to play a key role in bringing us out of the public health
emergency. Similarly, Medicare and Medicaid are providing essential
health care to patients who have suffered disproportionately from the
COVID-19 pandemic.
Looking to the future, the Secretary, the Deputy Secretary, and the
CMS Administrator must carefully evaluate how best to use the resources
available to them to promote the health care of our citizens. They must
do so carefully, constructively, and creatively.
Two months ago, I outlined several issues in the health-care space
where I intend to focus my efforts as ranking member, including
fostering innovation to improve patient care and make our health-care
system more efficient. The COVID-19 pandemic has threatened Americans'
physical and economic health, but it has also reinforced the value of
innovation and provided an opportunity to test changes that foster it.
HHS has used its authority under the public health emergency to
waive numerous requirements to ensure Medicare and Medicaid
beneficiaries and other patients receive care during the pandemic.
Patients and providers have benefited from expanded access to
telehealth and expedited approval of COVID-19 vaccines, diagnostics,
and treatments. Going forward, Medicare and Medicaid patients must have
the same access to innovative items and services as those with
commercial insurance.
We must carefully evaluate our response to the pandemic and
implement appropriate reforms based on the lessons we have learned. HHS
should partner with this committee in that effort. However, media
reports about certain health-care policies that may come before
Congress or be enacted through executive actions are concerning. Some
of these policies, such as including additional benefits under
Medicare, could experience bipartisan support if considered through a
transparent, cooperative process.
Unfortunately, reconciliation does not afford Congress the
opportunity to work together to evaluate these changes and make
necessary reforms to protect the long-term financial viability of the
program. Other policies, such as expanding Obamacare's premium subsidy
to everyone, regardless of income, would be incredibly expensive for
taxpayers without taking appropriate steps to lower the cost of health
insurance. Creative, bipartisan ideas to lower the cost of insurance in
the individual market have been raised by States and my colleagues on
this committee.
I welcome the opportunity to work together on some of these ideas,
such as allowing States to use waivers to their full potential,
diversifying benefit designs, and incentivizing competition.
Finally, I am concerned about paying for some of these policies
through changes to our drug pricing system that could stifle
innovation. We can see the end of the COVID-19 pandemic approaching,
thanks to groundbreaking vaccines developed by pharmaceutical
manufacturers. In this crisis, industry responded to the Nation's call
to arms, code-named Project Warp Speed, developing powerful and
effective vaccines in record time. This success was possible because of
the private sector.
I strongly agree with my colleagues that this innovation is only
valuable if patients can afford it. We should establish an out-of-
pocket spending cap and reform Medicare Part D with the market-based
principles of competition and transparency in mind.
Ms. Palm and Ms. Brooks-LaSure, if you are confirmed, I look
forward to working with you to improve our health-care system. I ask
you to commit to careful assessments of the risks and considerations in
every policy decision you make. Political pressures may make unilateral
action seem attractive, but you should also consider how the market,
individual choice, public policy, and incentives play vital roles in
the development and delivery of health care.
I look forward to hearing your testimony and your responses to
questions. The positions to which you have been nominated have
substantial influence over policy. The members of this committee need
to understand how you will implement the administration's agenda.
We expect your answers, here and in response to QFRs, to be
detailed and candid.
______
Prepared Statement of Andrea Joan Palm, Nominated to be Deputy
Secretary, Department of Health and Human Services
Thank you, Chairman Wyden, Ranking Member Crapo. I am grateful for
the opportunity to testify before you today as President Biden's
nominee for Deputy Secretary of the United States Department of Health
and Human Services. I want to thank Senator Tammy Baldwin for the kind
introduction and for her work on behalf of the people of Wisconsin. And
thank you to the members of this committee for considering my
nomination. I've enjoyed the opportunity to speak with many of you
individually.
I was born and raised in Star Lake, NY--a town of about 1,000
people. When you grow up in a small town, you understand from a young
age that together is the only way to get things done. That sense of
community was formative and is what led me to become a social worker. I
spent my twenties as a caseworker, finding safe homes for children in
crisis and working for people with behavioral health needs.
These experiences shaped the rest of my career. It was the children
and families I worked with during this time that made me want to change
the system and drew me to public policy and public service. The
memories of these kids still motivate me today.
I've spent my entire career focused on health and human services
policy and lifting up our most vulnerable communities, from my time in
the Senate working on the HITECH Act to serving at HHS, where I played
a key role implementing the Affordable Care Act and negotiating
bipartisan policies like the 21st Century Cures Act.
Most recently, I had the privilege of leading Wisconsin's
Department of Health Services. I'm proud of the work I was able to
accomplish in Wisconsin. There, we found ways to make progress on a
bipartisan basis, expanding access to telehealth services and our
innovative Children's Health Insurance Program, and improving delivery
of the Departments' programs to better serve the people of Wisconsin.
And when the pandemic hit, we led with facts, science, and
transparency to protect our communities. As every single State did, we
faced obstacles. But we built a strong State-wide response--leveraging
government assets and the expertise of the private sector--to build
stable testing and contact tracing programs, reach rural communities,
and vaccinate Wisconsinites.
And it's working. Wisconsin is among the top States in vaccinating
its residents.
When I was previously at HHS, then-Secretary Burwell would joke
that if there was an issue that was going to require bipartisan
cooperation, the team should give it to me. She called my portfolio the
``common ground agenda.'' And if I have the honor of being confirmed
and returning to HHS, that's what I'm bringing with me: a common-ground
agenda.
First, we must end the COVID-19 pandemic. I know we can all agree
we have lost far too many Americans to this virus. President Biden put
forward ambitious goals, and Congress has followed through, providing
the resources to get the job done. If confirmed, I look forward to
implementing the American Rescue Plan, getting vaccines in arms,
rebuilding a public health workforce, and securing this Nation's supply
chain.
Second, we must expand access to high-quality, affordable health
care. The American Rescue Plan took major steps to bring down the cost
of health care for working families, but we can't stop there. We must
strengthen our Medicare and Medicaid lifelines; reduce the cost of
prescription drugs; better integrate mental health and substance use
disorder treatment into our health-care system; maintain our global
leadership in research, development and innovation; and ensure that all
Americans have access to quality, affordable health care.
Finally, we must prioritize human services. HHS has an important
role to play. From caring for children, to advancing the health and
well-being of people with disabilities, we must not lose sight of these
core missions.
HHS faces big challenges. And it's our responsibility to be
tireless stewards of an agency that touches nearly every aspect of
American life. To me, that's what public service is all about: making
government work for the people, and leaving the country better than we
found it.
I am ready for the task, and eager to continue serving. Thank you
for considering my nomination.
______
SENATE FINANCE COMMITTEE
STATEMENT OF INFORMATION REQUESTED
OF NOMINEE
A. BIOGRAPHICAL INFORMATION
1. Name (include any former names used): Andrea Joan Palm.
2. Position to which nominated: Deputy Secretary, U.S. Department of
Health and Human Services.
3. Date of nomination: January 18, 2021.
4. Address (list current residence, office, and mailing addresses):
5. Date and place of birth: October 5, 1972, Star Lake, NY.
6. Marital status (include maiden name of wife or husband's name):
7. Names and ages of children:
8. Education (list all secondary and higher education institutions,
dates attended, degree received, and date degree granted):
Washington University.
Dates Attended: August 1994-May 1996.
Degree Received: Master of Social Work.
Date Degree Granted: May 1996.
Cornell University.
Dates Attended: August 1990-May 1994.
Degree Received: Bachelor of Science.
Date Degree Granted: May 1994.
Clifton-Fine Central.
Dates Attended: 7th-12th grade, September 1985-June 1990.
Degree Received: High School Diploma.
Date Degree Granted: June 1990.
9. Employment record (list all jobs held since college, including the
title or description of job, name of employer, location of work, and
dates of employment for each job):
Wisconsin Department of Health Services.
Secretary-designee.
January 2019-January 2021.
Madison, WI.
U.S. Department of Health and Human Services.
Senior Counselor to the Secretary (January 2015-January 2017).
Chief of Staff (April 2013-December 2014).
Counselor to the Secretary for Public Health (October 2011-
April 2013).
Senior Advisor to the White House Domestic Policy Council
(detailed from HHS; August 2010-October 2011).
Acting Assistant Secretary for Legislation (August 2009-July
2010).
Deputy Assistant Secretary for Public Health Legislation
(January 2009-July 2009).
Washington, DC.
Office of Senator Hillary Clinton.
Senior Health Policy Advisor (January 2008-Janaury 2009).
Legislative Assistant (June 2004-January 2008).
Washington, DC.
Office of Congressman Robert T. Matsui.
Legislative Director (December 2003-May 2004).
Senior Legislative Assistant (June 2001-December 2003).
Washington, DC.
Volunteers of America.
Government Relations Manager (June 2000-May 2001).
Public Policy Associate (October 1998-June 2000).
Alexandria, VA.
City of Phoenix.
Policy Analyst, Human Services Department.
June 1997-September 1998.
Phoenix, AZ.
Arizona Justice Institute.
Equal Justice Fellow (Policy Analyst).
October 1996-May 1997.
Phoenix, AZ.
ComCare.
Crisis Counselor.
January 1996-September 1996.
Phoenix, AZ.
Life Crisis Services.
Development Director (part-time).
August 1995-December 1995.
St. Louis, MO.
St. Louis Circuit Attorney's Office.
Victim Services Caseworker (part-time).
January 1995-December 1995.
St. Louis, MO.
Children's Home and Aid Society.
Crisis Counselor.
September 1994-December 1994.
Mobile position; territory included the northern St. Louis, MO
suburbs.
10. Government experience (list any current and former advisory,
consultative, honorary, or other part-time service or positions with
Federal, State, or local governments held since college, including
dates, other than those listed above):
None.
11. Business relationships (list all current and former positions held
as an officer, director, trustee, partner (e.g., limited partner, non-
voting, etc.), proprietor, agent, representative, or consultant of any
corporation, company, firm, partnership, other business enterprise, or
educational or other institution):
None.
12. Memberships (list all current and former memberships, as well as
any current and former offices held in professional, fraternal,
scholarly, civic, business, charitable, and other organizations dating
back to college, including dates for these memberships and offices):
Arizona Arts Chorale.
President (1997-1998).
Member (1996-1998).
Chi Omega Sorority.
Alumna (1994-present).
President (1993-1994).
Rush Chair (1992-1993).
House Manager (1991-1992).
13. Political affiliations and activities:
a. List all public offices for which you have been a candidate
dating back to the age of 18.
None.
b. List all memberships and offices held in and services
rendered to all political parties or election committees,
currently and during the last 10 years prior to the date of
your nomination.
None.
c. Itemize all political contributions to any individual,
campaign organization, political party, political action
committee, or similar entity of $50 or more for the past 10
years prior to the date of your nomination.
See Table.
------------------------------------------------------------------------
Contribution Description Date Amount
------------------------------------------------------------------------
HILLARY FOR AMERICA 2016-07-24 $1,500.00
------------------------------------------------------------------------
HILLARY FOR AMERICA 2016-08-31 $50.00
------------------------------------------------------------------------
HILLARY FOR AMERICA 2016-09-21 $50.00
------------------------------------------------------------------------
HILLARY FOR AMERICA 2016-09-26 $50.00
------------------------------------------------------------------------
HILLARY FOR AMERICA 2016-10-19 $100.00
------------------------------------------------------------------------
HILLARY FOR AMERICA 2016-10-27 $50.00
------------------------------------------------------------------------
HILLARY FOR AMERICA 2016-10-29 $50.00
------------------------------------------------------------------------
HILLARY FOR AMERICA 2016-10-31 $50.00
------------------------------------------------------------------------
HILLARY FOR AMERICA 2016-11-01 $50.00
------------------------------------------------------------------------
HILLARY FOR AMERICA 2016-11-03 $50.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2018-05-07 $250.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2018-09-22 $100.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2018-09-22 $100.00
------------------------------------------------------------------------
HALEY STEVENS FOR CONGRESS 2018-09-22 $250.00
------------------------------------------------------------------------
SINEMA FOR ARIZONA 2018-09-22 $100.00
------------------------------------------------------------------------
BREDESEN FOR SENATE 2018-09-22 $100.00
------------------------------------------------------------------------
BETO FOR TEXAS 2018-09-22 $100.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2018-09-29 $50.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2018-09-29 $50.00
------------------------------------------------------------------------
ROSEN FOR NEVADA 2018-09-30 $100.00
------------------------------------------------------------------------
SINEMA FOR ARIZONA 2018-09-30 $100.00
------------------------------------------------------------------------
HALEY STEVENS FOR CONGRESS 2018-09-30 $100.00
------------------------------------------------------------------------
HALEY STEVENS FOR CONGRESS 2018-09-30 $100.00
------------------------------------------------------------------------
HEIDI FOR SENATE 2018-09-30 $250.00
------------------------------------------------------------------------
BREDESEN FOR SENATE 2018-09-30 $100.00
------------------------------------------------------------------------
DONNELLY FOR INDIANA 2018-09-30 $250.00
------------------------------------------------------------------------
HEIDI FOR SENATE 2018-10-04 $250.00
------------------------------------------------------------------------
ROSEN FOR NEVADA 2018-10-05 $100.00
------------------------------------------------------------------------
ROSEN FOR NEVADA 2018-10-05 $100.00
------------------------------------------------------------------------
ROSEN FOR NEVADA 2018-10-08 $100.00
------------------------------------------------------------------------
ROSEN FOR NEVADA 2018-10-08 $100.00
------------------------------------------------------------------------
HEIDI FOR SENATE 2018-10-08 $100.00
------------------------------------------------------------------------
HEIDI FOR SENATE 2018-10-08 $100.00
------------------------------------------------------------------------
ROSEN FOR NEVADA 2018-10-17 $100.00
------------------------------------------------------------------------
ROSEN FOR NEVADA 2018-10-17 $100.00
------------------------------------------------------------------------
DONNELLY FOR INDIANA 2018-10-18 $150.00
------------------------------------------------------------------------
DONNELLY FOR INDIANA 2018-10-18 $150.00
------------------------------------------------------------------------
BREDESEN FOR SENATE 2018-10-18 $100.00
------------------------------------------------------------------------
BREDESEN VICTORY FUND 2018-10-18 $100.00
------------------------------------------------------------------------
HALEY STEVENS FOR CONGRESS 2018-10-27 $50.00
------------------------------------------------------------------------
HALEY STEVENS FOR CONGRESS 2018-10-27 $50.00
------------------------------------------------------------------------
DONNELLY FOR INDIANA 2018-10-27 $100.00
------------------------------------------------------------------------
DONNELLY FOR INDIANA 2018-10-27 $100.00
------------------------------------------------------------------------
BREDESEN FOR SENATE 2018-10-27 $100.00
------------------------------------------------------------------------
BREDESEN FOR SENATE 2018-10-27 $100.00
------------------------------------------------------------------------
ROSEN FOR NEVADA 2018-10-27 $100.00
------------------------------------------------------------------------
ROSEN FOR NEVADA 2018-10-27 $100.00
------------------------------------------------------------------------
SINEMA FOR ARIZONA 2018-10-27 $100.00
------------------------------------------------------------------------
HEIDI FOR SENATE 2018-10-27 $100.00
------------------------------------------------------------------------
STACEY ABRAMS 2018-10-27 $250.00
------------------------------------------------------------------------
ANDREW GILLUM 2018-10-27 $250.00
------------------------------------------------------------------------
RICHARD CORDRAY 2018-10-27 $250.00
------------------------------------------------------------------------
LAURA KELLY 2018-10-27 $250.00
------------------------------------------------------------------------
TONY EVERS 2018-10-27 $250.00
------------------------------------------------------------------------
STEVE SISOLAK 2018-10-27 $250.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2018-10-27 $100.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2018-10-27 $100.00
------------------------------------------------------------------------
SINEMA FOR ARIZONA 2018-10-28 $100.00
------------------------------------------------------------------------
HEIDI FOR SENATE 2018-10-28 $100.00
------------------------------------------------------------------------
PHIL HERNANDEZ 2019-06-09 $250.00
------------------------------------------------------------------------
JOSH KAUL 2019-06-12 $250.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2019-06-25 $250.00
------------------------------------------------------------------------
HALEY STEVENS FOR CONGRESS 2019-06-25 $250.00
------------------------------------------------------------------------
TONY EVERS 2019-06-29 $250.00
------------------------------------------------------------------------
HALEY STEVENS FOR CONGRESS 2019-09-11 $100.00
------------------------------------------------------------------------
HALEY STEVENS FOR CONGRESS 2019-09-11 $100.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2020-01-14 $100.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2020-01-14 $100.00
------------------------------------------------------------------------
HALEY STEVENS FOR CONGRESS 2020-06-07 $100.00
------------------------------------------------------------------------
HALEY STEVENS FOR CONGRESS 2020-06-07 $100.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2020-06-07 $100.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2020-06-07 $100.00
------------------------------------------------------------------------
MCGRATH FOR U.S. SENATE 2020-06-07 $125.00
------------------------------------------------------------------------
DITCH FUND 2020-06-07 $125.00
------------------------------------------------------------------------
MARK KELLY FOR SENATE 2020-06-07 $100.00
------------------------------------------------------------------------
THERESA GREENFIELD FOR IOWA 2020-06-07 $100.00
------------------------------------------------------------------------
DOUG JONES FOR U.S. SENATE 2020-06-07 $100.00
------------------------------------------------------------------------
HICKENLOOPER FOR COLORADO 2020-06-07 $100.00
------------------------------------------------------------------------
CAL FOR NC 2020-06-07 $100.00
------------------------------------------------------------------------
SARA GIDEON FOR MAINE 2020-06-07 $250.00
------------------------------------------------------------------------
JAIME HARRISON FOR U.S. SENATE 2020-06-07 $250.00
------------------------------------------------------------------------
MONTANANS FOR BULLOCK 2020-06-07 $250.00
------------------------------------------------------------------------
BIDEN FOR PRESIDENT 2020-06-07 $250.00
------------------------------------------------------------------------
BIDEN FOR PRESIDENT 2020-08-27 $250.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2020-08-27 $100.00
------------------------------------------------------------------------
HALEY STEVENS FOR CONGRESS 2020-08-27 $100.00
------------------------------------------------------------------------
MONTANANS FOR BULLOCK 2020-08-27 $250.00
------------------------------------------------------------------------
JAIME HARRISON FOR U.S. SENATE 2020-08-27 $250.00
------------------------------------------------------------------------
SARA GIDEON FOR MAINE 2020-08-27 $250.00
------------------------------------------------------------------------
CAL FOR NC 2020-08-27 $250.00
------------------------------------------------------------------------
DOUG JONES FOR U.S. SENATE 2020-08-27 $100.00
------------------------------------------------------------------------
THERESA GREENFIELD FOR IOWA 2020-08-27 $250.00
------------------------------------------------------------------------
MARK KELLY FOR SENATE 2020-08-27 $100.00
------------------------------------------------------------------------
LAUREN UNDERWOOD FOR CONGRESS 2020-08-27 $100.00
------------------------------------------------------------------------
HALEY STEVENS FOR CONGRESS 2020-08-27 $100.00
------------------------------------------------------------------------
AMY MCGRATH FOR SENATE, INC. 2020-08-27 $250.00
------------------------------------------------------------------------
HICKENLOOPER FOR COLORADO 2020-08-27 $250.00
------------------------------------------------------------------------
JON OSSOFF FOR SENATE 2020-08-27 $250.00
------------------------------------------------------------------------
JON OSSOFF FOR SENATE 2020-12-06 $250.00
------------------------------------------------------------------------
WARNOCK FOR GEORGIA 2020-12-06 $250.00
------------------------------------------------------------------------
14. Honors and awards (list all scholarships, fellowships, honorary
degrees, honorary society memberships, military medals, and any other
special recognitions for outstanding service or achievement received
since the age of 18):
Brown School of Social Work Distinguished Alumni Award,
Washington University: 2016.
15. Published writings (list the titles, publishers, dates, and
hyperlinks (as applicable) of all books, articles, reports, blog posts,
or other published materials you have written):
None.
16. Speeches (list all formal speeches and presentations (e.g.,
PowerPoint) you have delivered during the past 5 years which are on
topics relevant to the position for which you have been nominated,
including dates):
Below is a list that covers my tenure as the Wisconsin
Department of Health Services Secretary-designee. In the 3
years prior to that, I did not deliver any speeches relevant to
the position for which I have been nominated.
------------------------------------------------------------------------
Speech Forum Date
------------------------------------------------------------------------
CCS Spring Conference 2019-04-16
------------------------------------------------------------------------
Wisconsin Assisted Living Association Conference 2019-04-30
------------------------------------------------------------------------
Doctor Day Conference 2019-05-01
------------------------------------------------------------------------
Wisconsin Public Health Association Conference 2019-05-23
------------------------------------------------------------------------
Surgical Collaborative of Wisconsin 2019-05-29
------------------------------------------------------------------------
Bx Health Budget 2019-06-06
------------------------------------------------------------------------
SUD Prevention Conference 2019-06-11
------------------------------------------------------------------------
Drug Endangered Children Conference 2019-07-16
------------------------------------------------------------------------
Wisconsin Personal Services Association Conference 2019-09-18
------------------------------------------------------------------------
Caregivers Taskforce Launch 2019-09-25
------------------------------------------------------------------------
Disability Service Provider Network Conference 2019-10-17
------------------------------------------------------------------------
Covering Wisconsin 211 Webinar 2019-10-21
------------------------------------------------------------------------
DHS DQA FOCUS Conference 2019-11-21
------------------------------------------------------------------------
LeadingAge Conference 2020-02-18
------------------------------------------------------------------------
WAFCA Leadership Summit 2020-03-05
------------------------------------------------------------------------
Rep. Gallagher Teletownhall 2020-03-26
------------------------------------------------------------------------
Rep. Kind Teletownhall 2020-03-26
------------------------------------------------------------------------
Rep. Kind Teletownhall 2020-06-04
------------------------------------------------------------------------
Wisconsin Assisted Living Annual Conference 2020-09-17
------------------------------------------------------------------------
17. Qualifications (state what, in your opinion, qualifies you to
serve in the position to which you have been nominated):
I believe my public health and social services expertise and
extensive health care and management experience qualify me to
serve as the Deputy Secretary of the U.S. Department of Health
and Human Services (HHS).
I have been in public service for the vast majority of my
career, from my earliest days as a caseworker for crime victims
to my time as a crisis counselor for individuals struggling
with serious mental health conditions and contemplating
suicide. I have broad experience in health care, behavioral
health, public health, and children and families issues--
working for private, non-profit organizations, as well as
local, State, and Federal Government in direct service,
policy-making, and administrative roles.
During my tenure at HHS during the Obama-Biden administration,
I worked on the legislative formulation and implementation of
major bipartisan efforts, including the Food Safety
Modernization Act, the Tobacco Control Act, reauthorization of
the Ryan White Act, and the 21st Century Cures Act, among
others. As a member of the HHS Budget Council, I helped craft
and implement each budget enacted during the Obama-Biden
administration.
As the Chief of Staff at HHS, I oversaw the operations of the
Secretary's office, which includes a number of offices that
provide support to the work of the Department and the
Department's external partners, including communications,
legislative and external affairs, as well as the general
counsel, budget, and administrative functions, among others. In
my final role at HHS, I served as the lead for the Department's
agency-wide work to stem the tide of the opioid epidemic and
enact then-Vice President Biden's Cancer Moonshot Initiative.
As the Department of Health Services (DHS) Secretary-designee,
I ran one of the largest State agencies in Wisconsin, with an
annual budget of $12 billion and more than 6,100 employees. I
was responsible for the State Medicaid program, the
Supplemental Nutrition Assistance Program (SNAP), and
behavioral health programs, among others. I was also
responsible for the health and safety of Wisconsinites living
at our seven 24/7 residential facilities. And as the public
health agency for the State of Wisconsin, I led the State's
response to the COVID-19 pandemic.
During my tenure as Secretary-designee, I worked with the
Legislature to enact a bipartisan telehealth bill, which was
fundamental to our ability to expand access to care across the
State, particularly in Wisconsin's many rural communities. It
was also a critical springboard for the State's ability to
maintain and further expand access to care during the pandemic,
particularly for behavioral health care.
I was also proud to secure bipartisan support for State funding
to allow the draw-down of additional Children's Health
Insurance Program dollars to support a Lead Safe Homes
Initiative. Wisconsin is one of just a handful of States to
take this innovative approach to address a critical public
health issue for children and families.
As Secretary-designee, I launched the first-ever employee
engagement effort at DHS, including an annual employee
viewpoint survey to gauge the strengths of the organization and
identify areas for improvement in an effort to attract and
retain the best public servants at DHS.
As we tackle the COVID-19 pandemic and help the American people
recover, the work of the U.S. Department of Health and Human
Services has never been more important than it is right now. I
believe my experiences and background qualify me for the role
of Deputy Secretary, and I am honored by President Biden's
nomination and ready for this responsibility. I would sincerely
look forward to the opportunity to work with the members of
this committee, should I be confirmed.
B. FUTURE EMPLOYMENT RELATIONSHIPS
1. Will you sever all connections (including participation in future
benefit arrangements) with your present employers, business firms,
associations, or organizations if you are confirmed by the Senate? If
not, provide details.
Yes.
2. Do you have any plans, commitments, or agreements to pursue
outside employment, with or without compensation, during your service
with the government? If so, provide details.
No.
3. Has any person or entity made a commitment or agreement to employ
your services in any capacity after you leave government service? If
so, provide details.
No.
4. If you are confirmed by the Senate, do you expect to serve out
your full term or until the next presidential election, whichever is
applicable? If not, explain.
Yes.
C. POTENTIAL CONFLICTS OF INTEREST
1. Indicate any current and former investments, obligations,
liabilities, or other personal relationships, including spousal or
family employment, which could involve potential conflicts of interest
in the position to which you have been nominated.
Any potential conflict of interest will be resolved in
accordance with the terms of my ethics agreement, which was
developed in consultation with ethics officials at the
Department of Health and Human Services and the Office of
Government Ethics. I understand that my ethics agreement has
been provided to the committee. I am not aware of any potential
conflict other than those addressed by my ethics agreement.
2. Describe any business relationship, dealing, or financial
transaction which you have had during the last 10 years (prior to the
date of your nomination), whether for yourself, on behalf of a client,
or acting as an agent, that could in any way constitute or result in a
possible conflict of interest in the position to which you have been
nominated.
Any potential conflict of interest will be resolved in
accordance with the terms of my ethics agreement, which was
developed in consultation with ethics officials at the
Department of Health and Human Services and the Office of
Government Ethics. I understand that my ethics agreement has
been provided to the committee. I am not aware of any potential
conflict other than those addressed by my ethics agreement.
3. Describe any activity during the past 10 years (prior to the date
of your nomination) in which you have engaged for the purpose of
directly or indirectly influencing the passage, defeat, or modification
of any legislation or affecting the administration and execution of law
or public policy. Activities performed as an employee of the Federal
Government need not be listed.
In the last 2 years as Wisconsin Department of Health Services
Secretary-
designee, I have been involved in a number of legislative and
public policy issues at the local and State level on behalf of
my Department and the Evers administration. Also in this role,
I have been involved in advocating at the Federal level on
health policies of concern to the State of Wisconsin. Prior to
that, I had no activity or was an employee of the Federal
government.
4. Explain how you will resolve any potential conflict of interest,
including any that are disclosed by your responses to the above items.
Any potential conflict of interest will be resolved in
accordance with the terms of my ethics agreement, which was
developed in consultation with ethics officials at the
Department of Health and Human Services and the Office of
Government Ethics. I understand that my ethics agreement has
been provided to the committee. I am not aware of any potential
conflict other than those addressed by my ethics agreement.
5. Two copies of written opinions should be provided directly to the
committee by the designated agency ethics officer of the agency to
which you have been nominated and by the Office of Government Ethics
concerning potential conflicts of interest or any legal impediments to
your serving in this position.
I understand that my ethics agreement has been provided to the
committee.
D. LEGAL AND OTHER MATTERS
1. Have you ever been the subject of a complaint or been
investigated, disciplined, or otherwise cited for a breach of ethics
for unprofessional conduct before any court, administrative agency
(e.g., an Inspector General's office), professional association,
disciplinary committee, or other ethics enforcement entity at any time?
Have you ever been interviewed regarding your own conduct as part of
any such inquiry or investigation? If so, provide details, regardless
of the outcome.
No.
2. Have you ever been investigated, arrested, charged, or held by any
Federal, State, or other law enforcement authority for a violation of
any Federal, State, county, or municipal law, regulation, or ordinance,
other than a minor traffic offense? Have you ever been interviewed
regarding your own conduct as part of any such inquiry or
investigation? If so, provide details.
No.
3. Have you ever been involved as a party in interest in any
administrative agency proceeding or civil litigation? If so, provide
details.
I have not been involved in any administrative proceedings or
civil litigation in my personal capacity. Supplemental
information: In my official capacity as former Wisconsin
Department of Health Services Secretary-designee, I was
sometimes named in litigation.
4. Have you ever been convicted (including pleas of guilty or nolo
contendere) of any criminal violation other than a minor traffic
offense? If so, provide details.
No.
5. Please advise the committee of any additional information,
favorable or unfavorable, which you feel should be considered in
connection with your nomination.
N/A.
E. TESTIFYING BEFORE CONGRESS
1. If you are confirmed by the Senate, are you willing to appear and
testify before any duly constituted committee of the Congress on such
occasions as you may be reasonably requested to do so?
Yes.
2. If you are confirmed by the Senate, are you willing to provide
such information as is requested by such committees?
Yes.
______
Questions Submitted for the Record to Andrea Joan Palm
Question Submitted by Hon. Ron Wyden
racial and ethnic disparities within the child welfare system
Question. The child welfare system is rife with racial, ethnic, and
socioeconomic disparities. Black and American Indian children are over-
represented in the child welfare system, and there are clear
disparities that children and families of color experience when
interacting with the child welfare system. As you know, the Family
First Prevention Services Act (FFPSA) is groundbreaking in its support
and financing of evidence-based prevention services for children and
parents to help them stay safely together and thrive.
If confirmed, how will you ensure that FFPSA implementation lives
up to its congressional intent?
In particular, how will you ensure the prevention services
allowable under FFPSA are as inclusive and expansive as possible to
ensure that there are a range of services for States and tribes to
utilize that are culturally sensitive and have demonstrated positive
outcomes for underserved communities, including tribal nations, black,
Latinx, LGBTQ+ communities, and older, aging-out foster youth?
Answer. The Family First Prevention Services Act (FFPSA) is an
important law that seeks to transform child welfare services by
increasing support for evidence-based prevention services to strengthen
families and keep children and youth safely at home and in their
communities with their parents, other family members or kin whenever
possible. If confirmed as Deputy Secretary, I will be committed to
ensuring that the prevention services available are culturally
appropriate and responsive to the needs of all people and communities,
especially communities that have been traditionally underserved. As you
know, the Biden administration and Secretary Becerra are committed to
advancing racial equity and support for underserved communities, as
reflected in the executive order the President signed on his first day
in office, ``Advancing Racial Equity and Support for Underserved
Communities Through the Federal Government.'' As Deputy Secretary, I
will strive to advance this goal in all of our work.
______
Questions Submitted by Hon. Sherrod Brown
provider relief fund
Question. Throughout the past year, Congress has dedicated
significant resources toward supporting hospitals and other health-care
providers who have been negatively impacted by COVID-19. One of the
largest sources of funding for provider relief has been through the
Provider Relief Fund.
If confirmed, will you commit to ensuring future distributions from
the provider relief fund are equitable and transparent, and prioritize
funding for those providers and facilities that continue to
disproportionately struggle because of the pandemic?
Answer. During the pandemic, while some providers have experienced
challenges with overcapacity, many other providers have faced financial
setbacks related to billing disruption, the suspension of non-essential
surgeries and procedures, and health-care staff unable to work. HHS is
committed to supporting providers who are taking care of patients
during this pandemic and to making payments quickly while ensuring
program integrity and effective oversight. If confirmed, I will work to
ensure that the Provider Relief Fund is run transparently and
equitably.
fda consumer protection
Question. The Food and Drug Administration (FDA) is first and
foremost a consumer protection agency; however, in the past there have
been times when the FDA has served as little more than a rubber stamp
for industry. It is time to rebuild consumer confidence in the FDA and
give the FDA the tools, resources, and authorities it needs to help
protect our health and safety.
We have to be more aggressive on youth vaping and nicotine
reduction. We must examine our drug supply chain and assess and correct
vulnerabilities and gaps.
If confirmed, how will you work with Secretary Becerra and the FDA
Commissioner to ensure the consumer, the patient, remains at the center
of all of the work HHS does--including the FDA?
Answer. Patients and families should be at the heart of all of the
work of HHS. It will be necessary for many agencies within HHS to work
together in order to address this important issue. The work of FDA is
critical for assuring consumer protections, including through tobacco
regulation and ensuring the safety and security of our drug supply
chain. If confirmed, I look forward to working on these issues.
biosimilars
Question. Thank you for your commitment to lowering the high cost
of prescription drugs. The robust uptake of biosimilars represents an
opportunity to increase competition in the prescription drug
marketplace and reduce costs for patients and taxpayers. I'd like to
work with you on ways to maximize the uptake of biosimilars as they
enter the market to ensure competition and reduce patient out-of-pocket
cost.
If confirmed, what additional steps should and will you take to
build out a robust biosimilars market and ensure all patients who
require treatment have immediate access to high quality, affordable
biosimilar biologic medicines?
Answer. Like President Biden and Secretary Becerra, I believe we
must do all we can to lower the costs of prescription drugs and make
them more accessible for Americans who depend on them. Competition in
the market has helped control the growth in spending on prescription
drugs. I believe that biosimilars have a role to play in containing the
cost of expensive therapies by creating competition. I am committed to
reducing drug prices and ensuring Americans have access to the drugs
that they need. If confirmed, I look forward to working with you to
find ways to achieve these important goals. I will also work across the
government to address barriers to reducing drug prices.
antibiotic resistance
Question. From the CDC to the World Health Organization, public
health experts consider antibiotic resistance to be one of the top
threats to global health security. The threat posed by superbugs
demands swift action and a robust response.
I urge you to commit to building on the National Action Plan for
Combating
Antibiotic-Resistant Bacteria (CARB) and follow through on coordinated,
strategic actions to address antibiotic resistance.
What actions will you take, amidst and after this pandemic, to
prioritize our Nation's fight against antibiotic resistance in addition
to building out our antibiotic stewardship programs and curbing the
overuse of antibiotics?
Answer. It is clear that antimicrobial resistance (AMR) must be a
top public health priority, not only for the United States but around
the world. Even during this time, AMR remains a top HHS priority, and
if confirmed, we will continue investing in key prevention strategies
like early detection and containment, infection prevention, and
ensuring the appropriate use of antibiotics in the U.S. and around the
world. If confirmed, I will also support efforts to develop new
antibiotics to treat infections that are becoming untreatable.
______
Questions Submitted by Hon. Elizabeth Warren
over-the-counter hearing aids
Question. In 2017, President Trump signed into law the Over-the-
Counter Hearing Aid Act, a bill that I introduced with Senator
Grassley, Senator Hassan, and Senator Isakson. The bill requires the
FDA to categorize certain hearing aids as over the counter (OTC). Under
law, the FDA was required to issue regulations regarding OTC hearing
aid safety and manufacturing by August 18, 2020--but the agency failed
to issue the rules on time. As Deputy Secretary of Health and Human
Services, will you commit to (1) identifying the reason(s) why the OTC
hearing aid proposed rules have been delayed past their statutory
deadline, (2) identifying the individual(s) responsible for developing
and releasing the proposed rules, (3) requiring those individual(s) to
release the proposed rules as soon as possible, and (4) requiring those
individual(s) to communicate frequently with my office on the timeline
for the rules' release?
Answer. Thank you for your leadership on this issue. I commit that,
if confirmed, I will support FDA in its rulemaking regarding over-the-
counter hearing aids and look forward to working closely with you on
this issue. I recognize this is a public health priority as hearing
loss can have a negative effect on communication, relationships, and
other important aspects of life.
third-party medical device servicing
Question. The Food and Drug Administration is responsible for
ensuring the safety of medical devices. While some medical devices are
disposable and are used only once, others are used repeatedly on
multiple patients. Original equipment manufacturers and third-party
entities often refurbish, repair, recondition, rebuild, remarket, or
remanufacture these devices to ensure that they continue to operate
safely and effectively after entering the market.
Entities that perform maintenance activities are subject to
different regulatory requirements depending on the type of maintenance
being performed. Activities that ``significantly change'' the
performance, safety specifications, or intended use of a device are
considered ``remanufacturing'' activities, while activities that do not
change the device are considered ``servicing.'' FDA has committed to
issuing guidance clarifying the difference between ``remanufacturing''
and ``servicing.'' In a 2020 letter to me and Senator Cassidy, FDA
stated that it ``intends to clarify the definitions of these activities
so that entities can determine in which activities they are engaged,
and with which regulatory requirements they should comply.'' The agency
said it would issue the guidance during FY2020, but it has not yet done
so. As Deputy Secretary of Health and Human Services, will you commit
to (1) identifying the reason(s) why this guidance has been delayed,
(2) identifying the individual(s) responsible for developing and
releasing that guidance, and (3) requiring those individual(s) to
communicate frequently with my office on the timeline for the
guidance's release?
Answer. Ensuring the appropriate consumer protections to keep
patients and families safe is a top priority for the Biden-Harris
administration. If confirmed, I commit to supporting FDA in their work
issuing guidance related to third party medical device servicing. I
recognize that this is a complicated issue and regulatory clarity is
very important.
______
Questions Submitted by Hon. Mike Crapo
private insurance markets
Question. How do you view HHS's role in the individual market, and
what reforms would you propose that could affect the types of plans
offered to consumers?
Answer. The Affordable Care Act expanded critical consumer
protections to millions of consumers enrolled in individual market
plans across the country. HHS works together with States to make sure
that consumers receive these important benefits. If confirmed, it will
be a priority of mine to build on the successes of the ACA and to work
with the Centers for Medicare and Medicaid Services to make sure
American patients and their families continue to have access to
quality, affordable health care.
medicaid waivers
Question. What is your view of the appropriate role of incentives
and disincentives in the Federal Government's partnership with State
agencies?
Answer. The partnership between States and the Federal Government
is central to Medicaid. I know each State--including Idaho--is unique,
and innovation is critical to improving the health-care system. If
confirmed, I will support State innovation and the ability of States to
test different models that meet the objectives of the Medicaid program.
I look forward to working with colleagues at the Centers for Medicare
and Medicaid Services on this issue and to hearing morefrom you about
what ideas are working in Idaho.
medicare solvency
Question. Medicare is on a near-term path toward bankruptcy. The HI
trust fund could be insolvent in anywhere from 4 to 5 years. Other than
during the first few years of the Medicare program's existence,
Congress has never allowed the HI trust fund to project less than 4
years of solvency without acting in order to minimize the impact on
health-care providers, taxpayers, and beneficiaries. Given the looming
fiscal crisis, how soon can we expect a comprehensive legislative
proposal from HHS that extends the life of the HI trust fund?
Answer. Medicare solvency is an incredibly important, longstanding
issue. I look forward to working with Congress, and in concert with the
Centers for Medicare and Medicaid Services, on a bipartisan basis to
address this. We will need both short-term and long-term strategies to
make sure Medicare remains a bedrock of our health-care system. It is
essential that we protect and strengthen this program for Americans who
have spent their lives paying into it.
Questions Submitted by Hon. Chuck Grassley
Question. The Family First Prevention Services Act allows States to
receive Federal reimbursement for prevention services in order to keep
children with their families whenever possible. In order to qualify for
IV-E reimbursement, programs are required to be evidence-based.
Currently, there are 29 programs that have been rated as promising,
supported, or well-supported, and many programs are still awaiting
evaluation on the Administration for Children and Families' (ACF)
Clearinghouse. The COVID-19 pandemic has caused prevention service
providers to alter their service models to comply with social
distancing and other precautions. Additionally, some programs have
faced decreased capacity or enrollment, leading to challenges in
maintaining population sizes necessary for an evaluation. If confirmed,
how will you work to ensure that ACF continues to add programs to the
clearinghouse while maintaining the standards for evidence-based
practices required by the Family First Prevention Services Act?
Answer. The Family First Prevention Services Act (FFPSA) is a law
that offers the promise to transform child welfare services by
increasing the availability of
evidence-based prevention services to strengthen families and keep
children and youth safely at home and in their communities with their
parents, or kin whenever possible. If confirmed as Deputy Secretary, I
will work with the leadership of ACF to ensure that the Title IV-E
Prevention Services Clearinghouse has adequate resources to be able to
review and rate programs in a timely manner. I will also support the
continued development of evidence-based practices through support of
quality evaluation.
Question. Many States, including my home State of Iowa, have faced
a shortage of qualified foster parents in recent years. The COVID-19
pandemic has exacerbated these shortages in many areas. In addition to
getting new foster parents involved, there is a challenge in retaining
foster parents for longer than 1 year. If confirmed, how would you work
to improve foster parent recruitment and retention so that children are
not placed in inappropriate settings due to a lack of available foster
homes?
Answer. I understand the important role that foster parents play in
caring for children. As reflected in the policy goals of the Family
First Prevention Services Act, when children must enter foster care,
family foster homes--preferably kinship care--must be the preferred
placement setting and institutional placements used only under limited
circumstances. Whenever possible, child welfare systems must seek
relatives and kin to care for children, to reduce the trauma children
experience when they are separated from their parents. The COVID-19
pandemic has placed great strain on all parents, including foster
parents and kinship caregivers, and has had an impact on the ability to
train and engage prospective foster parents and support existing foster
parents. I think it is essential that child welfare agencies provide
adequate support to foster parents, including relative caregivers and
that they be proactive in recruiting diverse families to meet the needs
of children who must come into foster care. If confirmed, I will work
with leaders of the Administration for Children and Families to provide
support for foster parent recruitment and retention.
Question. The Adoption and Safe Families Act of 1997 required
States to ensure that children in foster care did not languish in the
system without permanency. It established that parental rights should
be terminated if children have been in foster care for 15 out of the
last 22 months. The law allows for exceptions if it is determined that
there is a compelling reason that termination of parental rights is not
in a child's best interest, or other limited reasons. States are not
required to collect data on the enforcement of this law, and often do
not provide a reason for granting an exception. If confirmed, will you
work to improve oversight of this law to ensure that States are acting
in the best interest of children?
Answer. When children must enter into care, it is essential that we
seek to ensure timely permanency. Whenever possible we should seek to
support safe and timely reunification of children with their parents or
extended family, but this is not always possible. As you note, the
Adoption and Safe Families Act of 1997 established time frames for the
filing of petitions to terminate parental rights, but allowed for
certain exceptions. If confirmed, I will work with the Administration
for Children and Families to review oversight of this provision and
explore any additional steps that may be needed to promote the best
interests of children.
Question. In 2017, I sponsored the Over-the-Counter Hearing Aid Act
with Senator Warren, which was included in the FDA Reauthorization Act
of 2017. It required the Food and Drug Administration (FDA) to issue a
regulation by August 2020 establishing the requirements for products in
this category. This legislation was based on recommendations put forth
by the Presidential Council of Advisors on Science and Technology and
the National Academies of Science Engineering and Medicine to increase
consumer access to hearing aid technology and decrease costs associated
with hearing aids. The FDA has not completed rulemaking on this. If
confirmed, will you work to prioritize rulemaking so consumers can
access affordable help for hearing loss that Congress intended?
Answer. Thank you for your leadership on this issue. I commit that,
if confirmed, I will support FDA in its rulemaking and work to ensure
availability of over-the-counter hearing aids. I recognize this is a
public health priority as hearing loss can have a negative effect on
communication, relationships, and other important aspects of life.
Question. I support transparency in the 340B Drug Pricing Program.
The previous administration finalized a 340B Drug Pricing Program
Administrative Dispute Resolution regulation that went into effect in
January 2021. This final rule sets forth the requirements and
procedures for the 340B Program's administrative dispute resolution
(ADR) process. The rule establishes a 340B Administrative Dispute
Resolution Board to review claims. In addition, on December 30, 2020,
the Department of Health and Human Services' Office of the General
Counsel released an advisory opinion. If confirmed, are you committed
to the continued implementation of the 340B Drug Pricing Program
Administrative Dispute Resolution final rule and Office of General
Counsel's advisory opinion? If confirmed, what detailed steps will the
Biden administration take to ensure transparency in the 340B Drug
Pricing Program?
Answer. The 340B Drug Pricing Program is an indispensable program
for our safety-net providers serving some of our neediest populations.
If confirmed, I look forward to working with you and other members of
Congress to uphold the law and ensure this vital program is able to
continue supporting vulnerable communities.
Question. During the last 2 years as chairman of the Senate Finance
Committee, I've focused some of my oversight on what steps the
Department of Health and Human Services has taken to detect and deter
foreign threats to taxpayer-funded research. As part of my oversight,
I've also worked to ensure that the Department's Office of National
Security is given full, complete, and consistent access to all
Intelligence Community information involving threats to the Nation's
health care, such as COVID-19. That office has gained access to some
Intelligence Community elements but more must be done. On March 8,
2021, I wrote a follow-up letter to the Department of Health and Human
Services and the Director of National Intelligence asking what they've
done to incorporate Federal health agencies into the Intelligence
Community. HHS has failed to respond. If confirmed, will you commit to
answering that letter in full? If confirmed, will you commit to
updating me on the functions of the Office of National Security and how
it's interacting within the Intelligence Community?
Answer. HHS is committed to working with Congress on its critical
oversight work. As I noted in my hearing, if confirmed, I look forward
to working with you on this issue.
Question. In 2020, I cosponsored the Temporary Reauthorization and
Study of the Emergency Scheduling of Fentanyl Analogues Act and it was
signed into law. The law extended the Drug Enforcement Administration's
temporary scheduling order to proactively control deadly fentanyl
analogues. Fentanyl-related overdose deaths continue to rise and
sophisticated drug trafficking organizations manipulate dangerous
substances to skirt the law, so this critical law placed fentanyl
substances in Schedule I so that they can be better detected and
criminals can be held accountable for their actions. The law sunsets in
May of 2021. In December 2019, 56 other State and territory Attorneys
General asked Congress to permanently codify a temporary emergency
scheduling order keeping fentanyl-related substances classified as
Schedule I drugs. If confirmed, do you support permanently codifying a
temporary emergency scheduling order keeping fentanyl-related
substances classified as Schedule I drugs?
Answer. If confirmed, I will work with you on legislation to ensure
the appropriate scheduling of fentanyl and fentanyl analogues that pose
a danger.
Question. Science tells us that an unborn child has many of the
neural connections needed to feel pain, perhaps as early as eight weeks
and most certainly by 20 weeks fetal age. Providing health care to
unborn children and their mothers can help reduce infant mortality
rates in low-income communities, research also suggests. Some States
already offer prenatal care and other health services to unborn
children through the Medicaid program. What is your view on whether
unborn children should be entitled to Medicaid coverage, and do you
believe that the Federal Government has a role to play in encouraging
such coverage?
Answer. Medicaid is an important source of pre- and post-natal
care, and if I am confirmed, I will work to ensure access to quality
pregnancy care that improves their own health and the health of their
babies. I was happy to see that Congress included incentives for States
to expand Medicaid postpartum coverage in the American Rescue Plan and
that CMS has approved section 1115 demonstration projects to this
effect. I look forward to working with members of this committee and
Congress to expand access to affordable, quality care, including
through the Medicaid program.
Question. Congress's ability to acquire information from Federal
agencies is critical to its constitutional responsibility of conducting
oversight of the executive branch. If you are confirmed, will you
commit to providing thorough, complete, and timely responses to
requests for information from members of this committee, including
requests from members of the Minority?
Answer. If confirmed, I will provide responses to requests from any
members of this committee.
Question. In 2019, Congress passed bipartisan the Advancing Care
for Exceptional (ACE) Kids Act to improve health outcomes and care
coordination for children with complex medical conditions in Medicaid.
In 2020, I introduced the bipartisan Accelerating Kids' Access to Care
Act to further help families gain access to life-saving care for
children with complex medical conditions. The legislation aims to
facilitate access to care while retaining program safeguards and
reducing regulatory burdens on providers. If confirmed, what steps
would you take to improve the system of care for children with complex
medical conditions?
Answer. Thank you for your leadership on the ACE Kids Act and your
focus on access to care for children with complex medical needs. I
agree that we should do all we can to remove barriers to care for these
children. If I am fortunate enough to be confirmed, I will look forward
to working with you on solutions to ensure children with complex
medical needs get the best care possible.
Question. In Iowa, transitional health plans (including
grandmothered health plans) have enabled many middle-class Iowans to
keep the health plans and doctors they like at a reasonable price since
the Affordable Care Act was implemented. For example, over 56,000
Iowans are covered by grandmothered health plans. To put this in
context, about 60,000 Iowans signed up for the Federal health insurance
exchange in 2021. Iowans have chosen these grandmothered health plans
that meet their individual needs. Currently, grandmothered health
plans' existence is determined by the Department of Health and Human
Services (HHS) through the Centers for Medicare and Medicaid Services
(CMS) annually through non-enforcement extensions. If confirmed, are
you committed to maintaining these affordable, consumer-chosen health
plan options for Iowans by extending the non-enforcement authority?
Answer. Making sure that all Americans have access to quality,
affordable health care is one of the Biden administration's top
priorities. If confirmed, I will examine rules and other policies to
ensure all Americans can access the care that they need.
Question. Since this COVID-19 pandemic began, the Department of
Health and Human Services (HHS) including within the Centers for
Medicare and Medicaid Services (CMS) has provided health-care providers
and patients many flexibilities under the public health emergency
authority including over 80 services now furnished through telehealth
for Medicare patients. A Centers for Disease Control and Prevention
(CDC) Morbidity and Mortality Weekly Report found the use of telehealth
increased 154 percent during the last week of March 2020 during the
emergency of COVID-19 compared to the same period in 2019. We know the
use of telehealth has continued throughout the COVID-19 pandemic. The
data and response from patients and providers prove permitting
telehealth services is a positive action to improve access and care.
This last Congress, we provided permanent coverage for mental health
telehealth visits under Medicare, which is helpful during the pandemic
and will remain critical for many Americans afterwards. If confirmed,
are you committed to working with Congress and in the executive branch
to extend telehealth flexibilities in Medicare beyond the pandemic?
Additionally, some providers, including community health centers, face
regulatory barriers based on provider type or site of service. If
confirmed, do you support removing those telehealth barriers for
certain providers?
Answer. Telehealth is an important tool to improve health equity
and access to health care. Health care should be accessible, no matter
where you live. If confirmed, I would look forward to working with you
and my colleagues at the Centers for Medicare and Medicaid Services on
this issue.
Question. As a direct result of the Affordable Care Act's one-size-
fits-all approach, many Iowans have been priced out of health
insurance. To rectify this, the Trump administration and Iowa Insurance
Division enabled Iowans more choice and competition in the health-care
marketplace by enabling and expanding short-term
limited-duration insurance (STLDI). This gives Iowans access to health
insurance with consumer protections. If confirmed, will you work to
maintain, modify, or rescind the current regulations enabling Americans
to purchase STLDIs?
Answer. Making sure that all Americans have access to quality,
affordable health care is one of the Biden administration's top
priorities. If confirmed, I will examine rules and other policies to
ensure that plans provide Americans access to the care that they need.
Question. It is important to give people affordable options for
health insurance. Small business owners, like Iowa farmers, want to be
able to provide insurance for their employees. Association Health Plans
are a way for these small businesses to band together to expand access
to health insurance and drive down costs. I have introduced legislation
and support efforts to expand the pathway to affordable and accessible
health care remaining open to employees across America. Association
Health Plans allow small businesses to join together to obtain
affordable health insurance as though they were a single large
employer. The coverage offered to association members is subject to the
consumer protection requirements that apply to the nearly 160 million
Americans who receive coverage from large employers. If confirmed, will
you work to maintain, modify, or rescind current regulations enabling
employers and employees access to Association Health Plans?
Answer. Making sure that all Americans have access to quality,
affordable health care is one of the Biden administration's top
priorities. If confirmed, I will examine all rules and policies to
ensure all Americans can access the care that they need.
Question. I support access to affordable health-care coverage for
all Iowans, regardless of their health status or pre-existing
conditions. Americans want to be in control of their own health care.
National, single-payer health systems do not allow that. The Affordable
Care Act took options away from people and adopting a single-payer
system will make that worse. A national, single-payer health system
would eliminate private health insurance for nearly 200 million
Americans and require middle-class Americans to pay much more in taxes.
Single-payer health care would also dramatically increase government
spending substantially, fail to meet patient needs quickly, reduce
provider payments rates and reduce quality of care, and the government
would have more control over health care. It also threatens the
benefits that current seniors on Medicare have paid into the system
their entire working lives. If confirmed, do you intend to take
administrative actions to implement the vision of a one-size-fits-all
government-run health-care scheme like single-payer? If so, please
describe what authority you believe you have to take such actions?
Answer. President Biden has made it very clear that his goals for
improving the American health-care system begin with building on the
successes of the Affordable Care Act, and I am committed to working
toward that goal.
Question. If confirmed, will you take actions that stifle
innovation and competition in health care?
Answer. I believe it is important to foster innovation and
competition in our health-care system. Americans should have access to
health-care services and products at an affordable price.
Question. In 2019, the Trump administration issued two rules
requiring price transparency for hospitals and health plans. The rules
took effect in January 2021. This effort shines a light on the health-
care industry that is all too often shrouded in secrecy. While Congress
can build upon the rules, consumers can finally see sunshine in health-
care pricing. I have cosponsored legislation to codify the two health-
care price transparency rules. This transparency will bring more
accountability and competition to the health-care industry. Consumers
should have the ability to compare health-care prices online so they
can make an informed choice about what's best for them and their
families. If confirmed will you modify, rescind, or maintain the Trump
administration's health-care price transparency regulations?
Answer. If I am fortunate enough to be confirmed, I will ensure
that the Department continues to take steps to improve price
transparency, so consumers can look behind the curtain to understand
how providers and insurers are operating.
Question. Some States have lacked transparency in reporting their
nursing home COVID-19 deaths data. For example, the State of New York
undercounted nursing home deaths by as much as 50 percent and State
officials intentionally withheld data for months. The New York Attorney
General Letitia James released a report in January 2021 suggesting that
many nursing home residents died from COVID-19 in hospitals after being
transferred from their nursing homes. These figures were not reflected
in the New York Department of Health's nursing home death figures for
many months suggesting the State was undercounting by as much as 50
percent. There are also reports finding New York State officials
including members of New York Governor Andrew Cuomo's staff
intentionally withheld data on COVID-19-related deaths in the State's
nursing homes. Following the release of the New York Attorney General
report, the New York Department of Health reported 12,743 nursing home
residents occurred. This included an additional 3,829 confirmed COVID-
19 fatalities of those residents who had been transported to hospitals.
I have warned President Biden that an across-the-board termination of
56 U.S. attorneys could imperil ongoing sensitive investigations. This
concern has been expressed by Senate Democrats. Currently, Toni Bacon
is serving as the U.S. attorney for the Northern District of New York.
Ms. Bacon previously served as Justice Department's national elder
justice coordinator and who currently has jurisdiction over Federal
public corruption crimes in the State. Bacon is the obvious choice to
continue a fair and unbiased investigation into possible violations of
civil liberties of the elderly and the public corruption. Do you
believe Department of Justice must have a fair, unbiased, and
experienced U.S. Attorney in the Northern District of New York, such as
Ms. Bacon?
Answer. I defer to the Department of Justice on the selection of
U.S. attorneys.
Question. I led an effort in the Senate making additional resources
available to support elder justice initiatives that assist older
Americans especially throughout the COVID-19 pandemic. During the 116th
Congress, as Senate Finance Committee chairman, I convened two hearings
on elder justice initiatives and gaps in nursing home oversight. In
December 2020, I urged Senate leadership to make resources available
for regional or statewide strike teams to support nursing homes in
crisis during this pandemic. Through this work, the end-of-year COVID-
19 relief package included $100 million to support elder justice
initiatives, including $50 million for State adult protective service
agencies as they cope with unique challenges of serving vulnerable
populations during the pandemic. This work includes nursing home strike
teams who have provided needed support when an outbreak occurs at a
nursing home or when additional resources are needed to meet the
infection control or diagnostic testing requirements. Have State or
Federal nursing home strike teams been effective at controlling
outbreaks and protecting vulnerable Americans? If so, can you describe
how their work slowed the spread and protected lives?
Answer. It has been heartbreaking to see how hard the COVID-19
pandemic has hit the Nation's nursing homes. Nursing homes and long-
term care facilities are the homes for some of our most vulnerable, and
we must do everything we can to work to protect them and ensure that
they are receiving high quality health care. In Wisconsin, we developed
a variety of strategies, including surging staff and other resources to
assist our skilled nursing facilities protect their residents from
COVID-19. If I have the honor of being confirmed, I look forward to
working on this issue and coordinating with the Centers for Medicare
and Medicaid Services.
Question. The global pandemic has exposed grave concerns our
society must confront to protect the Nation's most vulnerable citizens.
Approximately 1.4 million Americans live in about 15,000 nursing homes
across the country. Many Iowans have a loved one who lives in a long-
term care facility. In 2019, as chairman of the Senate Finance
Committee, I conducted a series of hearings to examine gaps in
enforcement of nursing home abuse. A Government Accountability Office
(GAO) investigation found a 103-percent increase in abuse deficiencies
between 2013 and 2017. The GAO noted abuse in nursing homes is often
underreported. The report documented physical, mental, verbal, and
sexual abuse perpetrated against residents. The number of nursing home
deaths attributed to COVID-19 delivers a wake-up call we can't afford
to ignore. The Federal Government needs to do a better job enforcing
compliance with standards of care. When a loved one requires a long-
term care facility to deliver around-the-clock services, every family
deserves peace of mind that every nursing home resident will receive
high-quality, compassionate care and be treated with dignity and
respect. If confirmed, how will you, as Deputy Secretary, ensure
nursing homes uphold the standard of care that is necessary while not
placing onerous requirements and excessive administrative burdens on
nursing home staff?
Answer. Thank you for your longstanding leadership on this issue.
Nursing homes and long-term care facilities are the homes for some of
our most vulnerable, and we must do everything we can to work to
protect them. If I have the honor of being confirmed, I look forward to
coordinating with colleagues at the Centers for Medicare and Medicaid
Services to improve the safety and quality of care for residents of
nursing homes.
______
Questions Submitted by Hon. John Cornyn
foreign threats to research
Question. Ms. Palm, in 2019, this committee held a hearing on
foreign threats to taxpayer-funded research after multiple reports of
espionage by the People's Republic of China. We have seen attempts by
foreign entities like North Korea to steal intellectual property
related to COVID vaccine development and I continue to hear concerns
from research institutions in Texas.
Do you believe that NIH and other funders of public research should
consider cybersecurity protocols that institutions have in place when
evaluating applications for research grant funds?
What additional initiatives are you considering to ensure taxpayer
funded research is protected from foreign threats?
Answer. Protecting the integrity of taxpayer funded biomedical
research is a matter of great importance. I am committed to working
with Congress, the NIH, and the HHS Office of National Security to
ensure appropriate safeguards are in place to enhance and protect the
security and the integrity of U.S. biomedical research.
supply chain
Question. Regarding further distribution of personal protective
equipment (PPE) and COVID-19 vaccines and ancillary products, how will
government coordination with the private sector be managed? How will
updates and information be communicated to the healthcare supply chain
in a timely manner?
Answer. The global pandemic has highlighted the vulnerabilities of
the health-care supply chain for many products. In order to continue
responding to the COVID-19 pandemic and better prepare the Federal
Government to respond to any future public health emergencies, it is
critical that HHS work to improve and expand health-care supply chain
capabilities. If confirmed, I'm committed to working in coordination
with the private sector on this urgent matter.
Question. How does the new administration plan to coordinate with
and leverage the expertise of the commercial healthcare supply chain to
get product the last mile and get supplies into providers' hands across
the care continuum?
Answer. Coordination across departments, agencies, and industries
is key to ensure the adequacy of the health-care supply chain. If
confirmed, I'm committed to working on this urgent matter.
Question. Once the COVID-19 pandemic is under control, how do you
anticipate partnering with the commercial supply chain to ensure that
the country is ready for the next public health emergency? Have you
considered solutions such as a ``vendor managed inventory'' solution to
help guarantee that non-expired product could be available on demand?
Answer. As the Nation continues to turn the corner on the COVID-19
pandemic, it is important to think ahead to the next public health
emergency. If confirmed, I will work with the Assistant Secretary of
Preparedness and Response (ASPR) to ensure these efforts can increase
the Nation's ability to meet demand in future crises.
Question. How does the Biden administration intend to use the DPA
authority and will the administration do so with thoughtful
consideration of those with expertise in the medical supply chain so
the existing infrastructure and supply are augmented rather than
duplicated?
Answer. If confirmed, I commit to working closely with members of
this committee on efforts related to the COVID-19 response, including
the use of Defense Production Act and its potential impacts.
hospice
Question. Within the Medicare program, State survey agencies (SAs)
are overburdened and often lack the capacity to respond to survey
complaints in a timely and appropriate manner. The ability to respond
to and correct issues arising from complaints is imperative,
particularly for terminally ill beneficiaries in hospice. Accreditation
Organizations (AOs) are also authorized to conduct complaint surveys.
Expanding the use of qualified AOs that are trained in hospice would
alleviate State regulatory burden, while continuing to ensure that all
complaints are addressed in timely coordination with the SAs and CMS.
The expanded use of AOs would lead to increased transparency and
emphasize savings in the hospice community.
How does the administration plan to emphasize the services of
Accreditation Organizations for hospice complaint surveys to relieve
State regulatory burden and improve timely beneficiary safety and
quality?
Answer. Improving the safety and quality of care for American
patients is critical, including in hospice settings. If confirmed I
will work with my colleagues in the Centers for Medicare and Medicaid
Services to make sure complaints are followed up on in a timely manner.
Question. The Hospice Act brought attention to the need for
Medicare surveyors, who are often State surveyors, to specifically be
trained for the hospice population. Similar gaps in knowledge and
judgement occur among the medical reviewers for OIG, MAC and Program
Integrity hospice audits often driven by a similar hospice knowledge
gap and compounded by a chart review that can never replicate the
hospice program physician's real time medical prognostication of the
patients at the end of life. When payment denials are appealed by the
hospice provider, most are overturned on appeal, an expensive and time-
consuming process for both hospices and HHS.
I understand the need for program integrity, but we cannot place so
much of a burden that it creates an issue for providers that could turn
into an access issue for these vulnerable beneficiaries. How will HHS
address the gap in knowledge of Medicare medical reviewers, who
frequently look past the certifying physician's medical judgment as
reflected on the Certification of Terminal Illness (CTI); perhaps
especially when the physician record entries as to the basis for
prognostication are not as detailed as the Medicare reviewer believes
was warranted.
Answer. Thank you for bringing up this issue. If confirmed, I
certainly want to look for any ways to be more efficient and improve
processes, and I will work with my colleagues at the Centers for
Medicare and Medicaid Services to find ways to improve the Medicare
program.
children's health
Question. As HHS Secretary, you will oversee a number of programs
and agencies important to children from health coverage programs vital
to children's health such as Medicaid and the Children's Health
Insurance Program (CHIP) to programs responsible for training the
pediatric health-care workforce like the Children's Hospital Graduate
Medical Education Program (CHGME) to pediatric research initiatives at
the National Institutes of Health.
What are your priorities for child health if confirmed?
Answer. Programs such as Medicaid and the Children's Health
Insurance Program (CHIP) are critical programs that help ensure that
children have adequate access to quality health care. If confirmed, I
would work to ensure children are receiving necessary health care
through both programs. I would also look to better ensure access to
oral health and vision care for children, as both are necessary for
children to thrive in school. And we cannot forget that improving child
health begins with ensuring maternal health. I will work tirelessly to
reduce maternal and infant mortality and morbidity, using the expertise
and resources across HHS.
Further, many other agencies of HHS work improve the lives of
children in matters beyond that of health-care coverage. For example,
the Children's Bureau partners with Federal, State, tribal, and local
agencies to improve the overall health and well-being of our Nation's
children and families. I look forward to working with Congress, and
with State and local partners to make sure that we are doing all we can
to improve child health in this country.
Question. Medicaid and CHIP are critical programs for children,
providing coverage for over 40 million children. Medicaid is also the
backbone of the pediatric health-care system providing care across the
continuum from screenings and preventive to highly specialized
diagnoses and treatments.
What are your plans to strengthen this safety net for children and
the providers who care for them?
Answer. If confirmed, I would work to support and strengthen
Medicaid and CHIP, as well as other programs for children, to ensure
that children have adequate access to quality health care. In
particular, I would look to better ensure access to oral health and
vision care for children, while working to reduce maternal and infant
mortality and morbidity, as well as programs that ensure the safety of
well-being for children and families. If confirmed, I lookforward to
working with you to make sure our children have access to quality care
and are able to thrive.
Question. The pandemic is having a profound impact on children's
health and the providers who care for them.
What are your immediate plans to address the current crisis in the
increasing number of children facing severe mental, emotional and
behavioral health challenges due to social isolation and the serious
impact of the pandemic on the health of their families and caregivers?
Answer. I am deeply concerned about the impact of the COVID-19
pandemic on the mental, emotional, and other behavioral health outcomes
of our children, their families and caregivers. I agree this must be an
urgent national priority. If confirmed, I commit to working on this
issue and I would seek to ensure collaboration across HHS agencies,
including CMS and SAMHSA, to ensure we are fully leveraging CHIP and
Medicaid, and that we do a better job of tackling this important issue.
Question. The pediatric health-care safety net has been affected by
the pandemic in different ways then the adult health-care system, with
less direct Federal financial support because they are not eligible for
Medicare funding streams. What are your plans to sustain a stable
pediatric health-care system now and beyond the pandemic?
Answer. Medicaid and CHIP are lifelines to children and help form
the fabric of the pediatric health-care safety net. Over 77 million
individuals are enrolled in those programs, and about half are
children. It is critical that we work to support our pediatric health-
care safety net and pediatric health-care providers during the COVID-19
pandemic and beyond. If confirmed, I would make it a priority to work
across HHS and with States to provide necessary support to pediatric
providers.
Question. The Children's Hospital Graduate Medical Education
Program (CHGME) provides significant support for the training of
pediatricians and pediatric specialists. But unfortunately, the funding
for this program still lags far behind the Medicare GME program--
funding only half of what Medicare GME provides per resident.
What are your plans to address this gap in training support for our
Nation's pediatric workforce?
Answer. If confirmed, I would work with the resources across the
Department and with States to support the health-care workforce,
including those who work with pediatric populations.
Question. During the pandemic, telehealth has played a major role
in providing access to care for Medicaid beneficiaries, including
children.
How will HHS support the continued use and enhancements needed
under Medicaid to ensure telehealth continues to enable access to care
for children?
Answer. Telehealth is an important tool to improve health equity
and improve access to health care. Health care should be accessible, no
matter where you live. Under current law, States have a great deal of
flexibility with respect to delivering Medicaid services via
telehealth. Medicaid has made great strides in expanding services
available through telehealth, including pediatric services, during the
public health emergency. If confirmed, I will work with CMS to
determine how we can build on this work to improve health equity and
improve access to health care for children.
Question. As you know, pediatric health care is organized
differently than adult health care. Pediatric care is more regionalized
and often results in children, especially those with complex health
needs, having to travel across State lines for care. Under Medicaid,
this can be challenging for them and their providers with different
policies State to State. The ACE Kids Act passed in 2019 and is
effective next year, is one step in addressing these inconsistencies
and getting much needed national data to inform care improvements.
If confirmed, how would you approach these cross-State challenges
that children with complex needs face when traveling for needed care?
Answer. Medicaid and CHIP are crucial to ensuring children have
adequate access to quality health care, especially those with complex
needs. If confirmed, I will work closely with CMS as well as across the
Department to ensure children are receiving necessary health care. I
look forward to working across the administration and with Congress to
make informed decisions that address the specific needs of children
with complex medical conditions.
Question. Oftentimes, changes in the larger health-care landscape
take place, for example in the Medicare program, without a full
examination of how these changes could potentially impact children,
even inadvertently. At times, Medicare policies designed with the
elderly population in mind have been applied to Medicaid or adopted by
State Medicaid programs and private payers.
As you look at health-care changes at the national level as HHS
Secretary, how will you ensure that children's unique health-care needs
are taken into account?
Answer. If confirmed, I will work with Congress and States to spur
and encourage innovation in these important programs. Innovative
delivery system and payment models are vital to ensuring that Medicaid
and CHIP are equipped to address emerging pediatric health issues and
can continue to provide children with access to quality health care.
Question. A major focus in health care among policy makers has been
on pursuing delivery system reforms that improve quality and reduce
costs. The Federal Government has traditionally focused more on adult
populations rather than the needs of children in these reforms. As a
result, Medicaid for children still lags behind Medicare in supporting
improvements in care and innovative payment models.
What steps will you take to promote increased emphasis on these
types of innovations in Medicaid targeting the unique needs of
children?
Answer. If confirmed, I will work with Congress and States to spur
and encourage innovation in these important programs. Innovative
delivery system and payment models are vital to ensuring that Medicaid
and CHIP are equipped to address emerging pediatric health issues and
can continue to provide children with access to quality health care.
______
Questions Submitted by Hon. Richard Burr
countermeasure development
Question. Platform technologies or innovative delivery platforms,
such as a vaccine or therapeutic administered through a patch, that can
deliver medicine to patients in certain circumstances, provide
promising alternatives to traditional medical treatments. These
platform technologies could provide a way to deliver vaccinations to
patients. An innovation that provides a vaccine dose through a patch
platform could replace or provide an alternative to vaccines injected
via needles. A patch delivery platform does not need to be frozen, may
require less ancillary medical supplies, and could be self-administered
at home. If these characteristics were in place for a countermeasure,
public health and health-care organizations could distribute vaccine or
therapeutic doses more widely, improving access to underserved or hard
to reach communities.
How will this administration support the development of alternative
delivery platforms for vaccines and other countermeasures, such as
shelf-stable, self-applied patches during COVID-19?
How will this administration support expanding the use of
alternative vaccine delivery platforms for future pandemic needs?
Answer. I agree that we must do all we can to improve vaccine
technology and make vaccines easier to deliver. If confirmed, I will
work with NIH and FDA, as well as our international partners, to ensure
we take any steps needed to help facilitate the development, review,
and approval of new vaccine technologies.
synthetic biology
Question. President Biden, in his remarks on the American Jobs
Plan, stated ``China . . . is racing ahead of us in the investments
they have in the future.'' Synthetic biology is an emerging field
which, with the appropriate regulatory oversight and investment, has
the potential to provide high-paying U.S. jobs and supply chain
security. How will HHS encourage the development of synthetic biology
and appropriately evaluate the evolving science to ensure a regulatory
approach that does not hamper innovation?
Answer. Synthetic biology is an important, growing field and, if
confirmed, I look forward working across HHS to support U.S. leadership
in this space.
______
Questions Submitted by Hon. Patrick J. Toomey
Question. Over 2 months ago, my staff requested certain documents
from the Department of Health and Human Services commonly referred to
by the previous administration as ``weekly draw down reports.'' These
reports provide some insight into the allocation of Federal funding and
subsequent spending by the States as it relates to COVID-19
supplemental appropriations. It is my understanding that these reports
have been shared with other members of this chamber and are generally
used for press inquiries. However, to date, my office has not received
these reports despite repeated follow-ups with multiple staff members
in the Department.
I think we can both agree that transparency is a good thing--
particularly when it involves trillions of taxpayer dollars. If you are
confirmed, will you commit to making public the funding appropriated,
obligated, and spent on COVID-19 relief in a manner that is easily
accessible and understood by the general public? Further, will you
commit to providing weekly draw down reports with Congress on a weekly
basis?
Answer. If confirmed, I commit to reviewing your request and
providing this committee with information relevant to its oversight
functions.
Question. During your time as Secretary-designee, on multiple
occasions you attempted to bypass the Wisconsin State legislature or
exceeded your authority to extend State-wide stay-at-home orders during
the COVID-19 pandemic. In May 2020, the Wisconsin Supreme Court struck
down Emergency Order #28 because you exceeded your statutory authority
and you did not follow statutory emergency rule-
making procedures established by the State legislature. This order
would have extended a previous executive order which confined all
people to their homes, forbid travel, and closed businesses, but it
also went a step further by establishing a criminal penalty for
violators. Many months later, on October 6, 2020, you signed another
emergency order to limit the number of people in certain public indoor
businesses and private gatherings. The order would have also
implemented a fine for violators. At a press conference on the same
day, you even encouraged local governments to go further and offer more
restrictive orders. The non-partisan Wisconsin Legislative Reference
Bureau (WLRB) reviewed this order and determined it needed to be
promulgated as a rule. A lawsuit was subsequently filed by the
Wisconsin Tavern League on October 12, 2020, arguing that you once
again exceeded your statutory authority and did not follow emergency
rule making procedures established by the State legislature. On April
14, 2020, the Wisconsin Supreme Court ruled the emergency order
violated State law and was not validly enacted.
If confirmed, how can I be assured of your compliance with Federal
laws even if those laws are not popular within your own political
party? Further, do you commit to abiding by the Administrative
Procedure Act when enacting rules and regulations?
Answer. If confirmed, I will follow the law.
Question. Nearly 120,000 children enrolled in Medicaid across the
Appalachian region received at least one opioid prescription in 2018.
In some States, the share of child beneficiaries receiving at least one
prescription opioid outpaced that of adult beneficiaries. This reckless
prescribing puts Medicaid beneficiaries at risk of misuse and overdose.
Despite research demonstrating nonfatal overdoses are among the most
significant predictors of a future overdose, the Medicaid program has
persistently failed to help enrollees in these circumstances. In fact,
a study of 3,606 Medicaid enrolled adolescents (ages 13-22) who
experienced an opioid-related overdose found that only one in 54
received medication-assisted treatment, and less than one in three
received any treatment whatsoever. Equally concerning, Medicaid
beneficiaries often receive a legal opioid prescription even after
suffering a nonfatal, opioid-related overdose.
Senator Joe Manchin (D-WV) and I will be reintroducing the IMPROVE
Addiction Care Act this Congress. This legislation fixes a problem in
the Medicaid program that fails to identify victims of previous
overdoses and ensure prescribers are notified of their patients' fatal
overdoses. Our legislation is supported by a handful of advocacy and
provider groups including Shatterproof, Faces and Voices of Recovery
and the American Society of Addiction Medicine (to name a few).
In your previous role as Secretary-designee, what efficiencies did
you bring to Wisconsin's Medicaid program that directly benefited
individuals suffering from substance use disorder (SUD)? How did you
reduce the silos associated with their care to help connect enrollees
to SUD treatment? Please be specific.
Answer. This was a crisis before the pandemic. And now we know
COVID-19 has taken a toll on Americans in so many different ways. Like
President Biden, I am committed to addressing the substance use
disorder epidemic and to making sure patients have access to
prevention, treatment, and recovery services. In Wisconsin, I was proud
to work with Republicans in the State legislature to enact telehealth
legislation, that among other things, improved access to substance use
disorder treatment in rural and underserved communities. In addition,
we launched a hub and spoke model to better integrate behavioral health
treatment within health care to reduce barriers to care, break down
silos and better coordinate care for Medicaid beneficiaries. If I have
the honor of being confirmed, I look forward to partnering with you to
continue to work on this important issue.
Question. In your testimony, you highlight bipartisan work in your
role at the Department of Health and Human Services under the Obama
administration. However, it does not specify bipartisan work performed
in your most recent role at as Secretary-designee.
What were some of your bipartisan accomplishments with the
Republican-
controlled State legislature in Wisconsin? What major compromises have
you had to make in order to improve Wisconsin's health-care system?
Please be specific.
Answer. I am proud of the work I was able to accomplish in
Wisconsin. There, we secured bipartisan expansion and modernization of
telehealth in the Medicaid program and bipartisan policy changes to
Wisconsin's Children's Health Insurance Program (CHIP). We also worked
in a bipartisan work manner to integrate a hub and spoke model of
behavioral health treatment and stand up a residential treatment
benefit--both of these initiatives improved access to substance use
disorder treatment in Wisconsin. In all of my work, I prioritized
judicious use of taxpayer dollars and working with members of both
parties to improve health care for Wisconsin families.
Question. In your testimony, you highlight reducing ``the cost of
prescription drugs'' as one of your public health priorities.
What policies do you support to reduce the cost of prescription
drugs?
Answer. I believe we must do all we can to lower the costs of
prescription drugs and make them more accessible for Americans who
depend on them. I am committed to finding ways to reduce drug prices
and ensure Americans have access to the drugs that they need. If
confirmed as Deputy Secretary of HHS, I look forward to working with
you and others in Congress to achieve these important goals. I will
also work across the government to address barriers to reducing drug
prices.
______
Questions Submitted by Hon. Tim Scott
on religious liberty, lockdown orders, and reopening schools
Question. During your nomination hearing, you framed your
priorities as part of a ``common-ground agenda.'' I appreciate this
approach, and if you are confirmed, I look forward to working with you
to advance a number of your stated goals, including, most immediately,
a robust scale-up in vaccinations. Bipartisan collaboration has
tremendous value as we seek to end the pandemic, bolster our economy,
and increase access to health care. That said, some of my constituents
have expressed serious concerns with your nomination, primarily focused
on two key issues.
First, with respect to religious liberty, you faced substantial
pushback from conservatives and pro-life advocates during your tenure
at Wisconsin's health department, based in part on your selection of a
longtime Planned Parenthood lobbyist to serve as your deputy, as well
as what some Wisconsin lawmakers have described as vague or
noncommittal responses around the use of public funds for abortion.
Early in the pandemic, a number of State legislators also took issue
with the ability of abortion clinics to continue operating and using
needed medical supplies, even as countless entities across the State
were forced to shutter under your shelter-in-place order. Many South
Carolinians have cited these controversies as significant cause for
concern, particularly given HHS's role in overseeing a broad range of
programs with profound implications for religious liberty and human
life.
Since long before I came to Congress, I have prioritized
protections for religious liberty and freedom of conscience, one of our
core constitutional rights. I have also been a committed defender of
all human life, including the lives of the unborn.
Prior to taking any actions with implications for people of faith,
can you commit to consulting and engaging with religious liberty
advocates, including those who disagree with your previously stated
positions on the issues above?
If confirmed, can you commit, through all of your actions as Deputy
Secretary of HHS, to uphold religious liberty and freedom of conscience
for all Americans, including those with deeply held religious
convictions and beliefs?
Answer. If confirmed, I commit to thoroughly consulting
stakeholders and a diverse set of voices on all relevant issues. If
confirmed, I will follow the law.
Question. I have also heard from constituents across the Palmetto
State with concerns regarding the shelter-in-place order that you
issued in Wisconsin on April 16th of last year, which many have
described as overreaching and arbitrary. In addition to banning non-
essential travel, extending a sweeping shutdown of diverse businesses,
and placing severe restrictions on gatherings, the order in question
adopted steep penalties for violations, with fines of $250 and
imprisonment of up to 30 days on the table. The Wisconsin Supreme Court
majority agreed with the order's critics, with Justice Roggensack
writing, in enjoining the order, ``Rule-making exists precisely to
ensure that kind of controlling, subjective judgment asserted by one
unelected official, Palm, is not imposed on Wisconsin.'' The court's
ruling caught the attention of The Wall Street Journal's editorial
board, which celebrated the decision in an op-ed entitled ``Democracy
Lives in Wisconsin,'' concluding that ``[d]emocracy and the rule of law
don't end because there's a pandemic.''
You were not alone, particularly among blue-State officials, in
issuing and extending far-reaching lockdown orders, and the tumultuous
early days of the pandemic triggered a number of bold decisions across
the Nation, many of which look more rash or counterproductive in
retrospect than they might have appeared at the time. At the same time,
lockdowns have led to dire consequences for scores of Americans,
particularly in the case of vulnerable communities. We have seen
unprecedented learning losses for young people, along with spikes in
suicide, deaths of despair, and economic insecurity.
As you reflect on the past year, what are some of the areas where
you might, in retrospect, have revised your approach to pandemic
response, and what would you cite as some of the lessons learned?
In a letter to the chairman and ranking member, two members of the
House who served in Wisconsin's State government during your time as
Secretary-designate alleged that you ``played a central role in the
shuttering of Wisconsin schools for the final months of the 2019-2020
school year and led many throughout the State to operate in a hybrid or
virtual learning model for 2020-2021.'' How would you respond to these
claims, and what steps do you believe that HHS should take, in concert
with other Federal agencies and with State and local authorities, to
accelerate the reopening of K-12 schools for in-person learning?
Answer. I am proud of the work I was able to accomplish in
Wisconsin. Every single day, I got up and worked tirelessly to protect
the health and well-being of the people of Wisconsin, especially as we
navigated a public health crisis. If confirmed, I commit to working
with the CDC and State and local leaders to ensure everyone has the
resources and support necessary to ensure children nationwide are able
to attend school safely, which is a top priority of the Biden
administration.
on vaccine technology innovation
Question. Vaccine patches represent a promising alternative to
traditional vaccines injected via needles. Vaccine patches do not need
to be frozen, do not use needles, are single-dose, and can be self-
administered at home. By reducing logistical challenge, wastage, and
vaccine hesitancy, they could play a major role in improving our
Nation's response to the COVID-19 pandemic, as well as our preparedness
for future pandemics.
How will this administration support the development of alternative
vaccine platforms, such as shelf-stable, self-applied patches?
How will this administration support the expansion of use of
alternative vaccine platforms for future pandemic needs?
Answer. I agree that we must do all we can to improve vaccine
technology and make vaccines easier to deliver. If confirmed, I will
work with NIH and FDA, as well as our international partners, to ensure
we take any steps needed to help facilitate the development, review,
and approval of new vaccine technologies.
on supply chain resiliency
Question. President Biden, in his remarks on the American Job Plan,
stated ``China is racing ahead of us in the investments they have in
the future.'' Synthetic biology is an emerging field which, with the
proper regulatory regime and investment, will provide high-paying U.S.
jobs and supply chain security.
What legislative steps should Congress take to facilitate HHS
development and support for the U.S. synthetic biology industry?
Answer. I agree that synthetic biology is an area where the U.S.
needs to be the world's leader. I commit to work with you to determine
what legislative or resource needs there may be at HHS to help make
this a reality.
on support for nursing home i-snps
Question. As you know, Institutional Special Needs Plans (I-SNPs)
are a type of Medicare Advantage plan where the only beneficiaries
enrolled are seniors living in nursing homes. When nursing homes offer
these plans, they are 100 percent at risk for all the care their
residents need, either at their facilities or elsewhere. In the push
towards value-based care, nursing homes taking on risk via I-SNPs are
doing exactly what we want to see, but in 2020, being 100 percent at
risk for a population exclusively made up of the individuals most
vulnerable to COVID-19, and most likely to need high-cost
hospitalization, created serious financial challenges for nursing homes
with I-SNPs, including numerous communities in South Carolina. While
nursing homes in general have received funds from the Provider Relief
Fund (PRF), neither HHS nor CMS has provided relief to address the
specific challenges nursing home I-SNPs have faced in order to ensure
this model's continued viability.
Will you commit to using administrative authority to support I-SNPs
and to recognize the significant increased and unexpected costs that
these plans have faced during the COVID-19 emergency?
Answer. It has been heartbreaking to see how hard the COVID-19
pandemic has affected the Nation's nursing home residents. Nursing home
care will absolutely be a focus of mine if confirmed. Medicare
Advantage serves millions of Americans, and I understand that
Institutional Special Needs Plans provide important options for people
in need of the level of care provided in nursing homes and long-term
care facilities. If I have the honor of being confirmed as Deputy
Secretary, I will be happy to work on this issue along with my
colleagues at the Centers for Medicare and Medicaid Services.
______
Questions Submitted by Hon. James Lankford
Question. I am concerned regarding inequities in the distribution
of the Provider Relief Fund. Assisted living providers care for the
population most vulnerable to COVID, yet have received far too little
relief to date. In my State of Oklahoma, assisted living providers care
for over 18,000 seniors in 194 facilities across the State.
Unfortunately, assisted living providers were allocated less than 2
percent of the Provider Relief Fund (about $3 billion dollars) and have
only received about a third of that. The average age of a resident in
assisted living is 85. According to the CDC, this age group is 630
times more likely to die from COVID than a 29-year-old. In assisted
living, these vulnerable individuals need assistance with daily
activities such as eating, using the restroom, taking medications, and
dressing. Social distancing by their caregivers is not possible. Over
40 percent of assisted living residents have Alzheimer's or some form
of dementia. Due to PPE needs, workforce needs and occupancy declines,
assisted living caregivers have incurred over $15 billion in losses. In
Oklahoma, assisted living caregivers have suffered over $235 million in
losses. Now, over half of assisted living facilities Nation-wide are
operating at a loss, and 56 percent say they will not be able to
sustain operations for another year.
I recently signed a letter asking HHS Secretary Becerra to
distribute more of the remaining PRF to assisted living facilities.
Since you may be overseeing this distribution as well, will you
commit to working with all long-term care providers to ensure our
Nation's most vulnerable are properly cared for?
Answer. If confirmed, I commit to working with all of our Nation's
front-line workers to ensure they receive the support and resources
they need to care for those who rely on them.
Question. I know that your home State of Wisconsin has some
similarities to my State of Oklahoma in that we were both hit
exceptionally hard by the opioid epidemic.
Please detail some of the solutions you will work on, if confirmed,
to continue to combat the opioid epidemic.
Answer. HHS has worked aggressively to address our Nation's opioid
epidemic. Progress was being made to increase access to evidence-based
treatment and reduced death by overdose until the pandemic hit. If
confirmed, I will direct HHS agencies, including SAMHSA, HRSA, AHRQ,
CDC, CMS, NIH, FDA and IHS, to work together and with ONDCP and other
White House components, as well as with DOJ and other Federal entities,
including VA and DOD, to increase access to prevention, early
intervention, treatment, and recovery support programs. People with
addiction to these powerful and tenacious drugs deserve access to the
full range of
evidence-based prevention, early intervention, treatment and ongoing
recovery supports. Substance use is a treatable condition. Through
access to evidence-based programs, people can and do recover.
______
Questions Submitted by Hon. Steve Daines
Question. Throughout the pandemic, assisted living providers in my
home State have cared for over 6,000 vulnerable Montanans--many who are
living with Alzheimer's or some form of dementia. Due to PPE needs,
workforce needs, and occupancy declines, I continue to hear that many
of these providers have suffered millions in losses throughout the
pandemic and will struggle to sustain their operations without
financial relief. There is roughly $23 billion remaining in the
Provider Relief Fund to help support our healthcare heroes who are on
the frontlines of the COVID response. I recently urged Secretary
Becerra to distribute more of the remaining PRF to assisted living
facilities and other senior care centers.
Do you support this request?
Answer. If confirmed, I commit to working with all of our Nation's
front-line workers to ensure they receive the support and resources
they need to care for those who rely on them.
Question. For decades, the Federal Government has funded telehealth
research grants. These grants have been administered by more than 10
agencies and operating divisions across the Federal Government.
Unfortunately, navigating the Federal grant process can be a challenge
for the average provider and health system. Also, despite the Federal
Government funding significant amounts of telehealth projects, we have
very little data to point back to and it seems that grant programs can
be duplicative or at odds with prior projects. Additionally, we know
that there is still a learning curve for providers, patients and
caregivers on telehealth. As we continue the shift toward a health-care
system that will include virtual care permanently, I believe there is
value in ensuring there is a function within HHS today to help with
issues of digital literacy and education.
Do you believe that we have a coordinated national telehealth
strategy? Do you agree that a coordinated approach to telehealth
investments and policies across at least HHS is important?
Would it be beneficial for there to be an elevated presence within
HHS leadership to coordinate telehealth investments and policy across
the Federal Government?
How can we improve digital health literacy for beneficiaries,
caregivers and providers alike? Do you agree that this should be a
focus for HHS as telehealth policies are adopted permanently?
Answer. Telehealth has been invaluable during this pandemic to keep
patients, their providers and their families safe, while maintaining
critical access to care. If confirmed, I will take a careful look at
those telehealth flexibilities along with my colleagues at HRSA,
SAMHSA, and CMS. I look forward to hearing more from you about what
existing flexibilities you view as especially important.
Question. About 46 million Americans, nearly 15 percent of the U.S.
population, live in rural areas like my home State of Montana. Those
living in rural areas are more likely to die prematurely and face
higher risks for chronic conditions like heart disease and diabetes.
Americans living in rural communities face 17-percent higher prevalence
of diabetes than those living in urban areas and may have to wait
months before needing to travel great distances to see an
endocrinologist to help manage their condition. This scenario is not
uncommon and instead is the reality of rural Americans that routinely
encounter not just a lack of specialty care but in many cases, primary
care. Digital health tools, including telehealth and remote monitoring,
have the potential to relieve some of the key healthcare challenges
facing rural America.
Can you speak to the promise of telehealth and digital health care
more broadly for rural communities?
Answer. I believe that we have to take every approach we can to
provide Americans access to quality health care, especially in rural
areas, and telehealth is an important tool to improve health equity and
access to health care. Health care should be accessible, no matter
where you live. If confirmed, I will look at how we can use telehealth
to improve health equity and access to health care.
Question. Virtual care can help address existing health disparities
by eliminating the barriers of time, distance, and geography, while
empowering patients to overcome the challenges of accessing in-person
care, something Montanans know too well. One of the lessons learned
from the COVID-19 pandemic is the value of leveraging telehealth to
scale and meet rising demand for key health-care services. Health
workforce shortages were at critical levels before COVID-19.
I was pleased to lead the effort that resulted in section 3701 of
the CARES Act, which created a temporary safe harbor that allows high-
deductible health plans (HDHPs) to cover telehealth and remote care
services prior to a patient reaching their deductible. This important
safe harbor ensures that high-deductible health plans can support
patients that are leveraging virtual care to access a range of critical
health-care services during the pandemic before the annual deductible
is met. The CARES provision extended the safe harbor only through
December 31, 2021.
According to the Bureau of Labor Statistics (BLS), only 15 percent
of workers employed in the private sector participated in an HDHP in
2010. By 2018, that number had risen to 45 percent. Today, the number
is estimated to be 54 percent. Importantly, participation in HDHPs is
even across wage groups and in industries with a significant proportion
of black and Hispanic workers.
As the U.S. health-care system emerges from the pandemic,
permanently extending the HDHP/HSA Telehealth Safe Harbor would allow
half of American workers to continue accessing a range of clinically
appropriate virtual services--for a range of common conditions--without
the burden of first meeting a deductible. I look forward to working
with my colleagues on this committee to support American workers and
ensure this key policy continues beyond 2021.
Do you agree that there is value in expanding access to telehealth
regardless of your health plan design?
Answer. Telehealth has been invaluable during this pandemic to keep
patients, their providers and their families safe, while maintaining
access to critical health care. If I have the honor of being confirmed,
I would be happy to work with you on ways to continue to improve access
to care, including through telehealth.
Question. One of the silver linings of this pandemic has been the
widespread adoption of technology to bring people together, whether it
be families scattered across the Nation or patients and their
providers. Telehealth has truly taken root and we have seen exponential
growth in telehealth adoption across Americans of all ages, locations
and conditions. Much of the growth in usage among Medicare
beneficiaries has been made possible by temporary flexibilities in
place for the duration of the public health emergency. These include
allowing Medicare beneficiaries to have telehealth visits from their
home, regardless of where they live across the country. This has also
allowed new types of providers, such as physical therapists and speech
pathologists to practice via telehealth.
Do you agree that the expanded access to telehealth services has
been an important component in protecting patients and providers during
the Nation's response to COVID-19?
As Congress considers permanent telehealth reform, I hope you will
be willing to work with us to ensure that telehealth is available to
all of those that wish to use it. Do you believe that there are some
telehealth regulatory restrictions that Congress and HHS can work
together to address in the near term?
Answer. Telehealth has been invaluable during this pandemic to keep
patients, their providers and their families safe, while maintaining
access to critical health care. If I have the honor of being confirmed,
I will be taking a careful look at telehealth along with my colleagues
in the Centers for Medicare and Medicaid Services. I look forward to
hearing more from you about what existing flexibilities you view as
especially important.
Question. The coronavirus pandemic has underscored the value of
vaccines for infectious diseases, including those that originate
abroad. We all recognize that COVID-19 will not be the last time we
have to respond to an outbreak for which vaccinations are necessary in
order to stem an emerging public health threat.
Public policy should make vaccines as accessible as possible for
our citizens. That is why current law requires that insurers provide
coverage without cost sharing for all recommended vaccines, without
limitation.
Yet, inexplicably, current HHS regulations implementing the law
limit mandatory coverage to so-called ``routine'' vaccines on the
Immunization Schedules. As a result, many vaccines for infectious
diseases are not covered without cost-sharing, including those for
current vaccines such as rabies, anthrax, Japanese encephalitis, yellow
fever, and cholera, and those vaccines in the pipeline for malaria,
chikungunya, dengue, and Zika.
Last year, my colleagues and I worked on bipartisan legislation
included in the CARES Act that ensures immediate coverage of COVID-19
vaccines with no cost-sharing. As I said then, Montanans and Americans
across the country need access to vaccines, and financial barriers
should not stand in the way during a national emergency or otherwise.
Congress should not have had to be reactive. A forward-looking,
uniform approach is needed to ensure that we are prepared to move
quickly on vaccinations when the next pandemic occurs.
If confirmed, will you commit to quickly bringing agency
regulations in line with the statute requiring no cost-sharing for all
CDC recommended vaccines to maximize access to the best preventative
measures against infectious diseases?
Answer. As we have seen over the past year, vaccines are a critical
part of the public health system working to keep Americans safe. We
need to be prepared for any potential future outbreak, and I agree we
cannot afford to be reactive on this. If confirmed, I would be happy to
work with you to ensure we are ready for the next public health
emergency.
______
Questions Submitted by Hon. Todd Young
mental health
Question. The coronavirus outbreak has created an unprecedented
mental health challenge for our country. While we don't yet know the
full impact of the coronavirus in this area, we do know it has forced
Americans to isolate from their loved ones and other support systems--
causing a troubling spike in mental health and substance abuse
problems. A Kaiser Family Foundation poll found that 45 percent of
adults say the outbreak has affected their mental health, while a
different study estimated that the pandemic could cause as many as
150,000 additional ``deaths of despair'' from suicide and overdose.
In Indiana, preliminary data show that compared with 2019, last
year had nearly a 50-percent increase in overdoses seen in emergency
departments, with an 18-
percent rise across the U.S. in just the first 4 months of the
pandemic. In 2020, there was a 67-percent increase in the use of the
opioid overdose reversal drug naloxone--further indicating a rise in
overdoses.
As HHS Deputy Secretary, how would you try to address this growing
mental health crisis--both in the immediate aftermath of the public
health emergency and in the long term?
Given that mental health services cross many agencies, how will HHS
coordinate efforts on this important issue? What programs or
initiatives around mental health services would be your top priorities
as Deputy Secretary?
Answer. Unfortunately, the COVID-19 pandemic has dramatically
impacted mental health and well-being for too many Americans. If
confirmed, I am committed to working on this issue, including strong
coordination among HHS agencies to support programs and initiatives
across the continuum of prevention, intervention, treatment, and
recovery support services as well as strengthening enforcement of this
country's mental health parity laws.
social determinants of health
Question. Social determinants of health are the economic and social
conditions in which people live, learn, work, and play--such as access
to reliable transportation and stable housing. Addressing these factors
can positively impact the health and well-being of the most vulnerable
Americans.
Do you have specific plans to address the social determinants of
health?
How would you work within HHS to better leverage existing programs
and address the barriers to coordination between health and social
services programs?
Answer. We need to be smarter about tackling our biggest health-
care challenges and understanding the many factors that affect outcomes
is critical. Good data is critical in creating good policy, which can
save money and lives, especially for our most vulnerable. If I have the
honor of being confirmed, coordination across HHS programs would be
instrumental to addressing social determinants of health. I look
forward to working together with you on this important issue.
______
Questions Submitted by Hon. Ben Sasse
telehealth
Question. While my colleagues have pointed out many of the ways
COVID-19 has challenged our health-care system and exposed existing
inequities, one bright spot in the pandemic has been increased access
to telehealth services as a way for patients to maintain their health
from the safety of their homes. This has been particularly important
for States like Nebraska with large areas of rural population.
We know that CMS has allowed expanded use of audio-only services
during the pandemic, but how is CMS working to ensure that those
without broadband access can utilize appropriate telehealth services in
a post-pandemic world?
Where do you stand on audio-only telehealth coverage? What about on
payment parity between in-person and virtual services?
How will you approach geographic restrictions, both in patient
location and provider licensure?
If confirmed, how do you plan to evaluate the use of telehealth
over the last year and the places where it should--and potentially
should not--be expanded beyond the end of the national emergency
period?
Answer. Telehealth is an important tool to improve health equity
and access to health care. Health care should be accessible, no matter
where you live. If confirmed, I would look forward to working with you
and my colleagues at the Centers for Medicare and Medicaid Services on
this issue.
Question. Individuals with chronic disease place an immense strain
on our health-care system and account for a huge percentage of the
overall costs to taxpayers. I think you would agree that early
identification and treatment is crucial not only among those with
chronic diseases but in ourhealth systems in general. Remote patient
monitoring (RPM) can be beneficial in managing both acute and chronic
conditions and identifying deteriorations in health as early as
possible to allow for the best level of care. Issues with reimbursement
continue to constrain Medicare recipients' access to this level of
monitoring.
Do you see value in increased access to remote patient monitoring
and what are your views on the co-pay requirement for these services?
Answer. Individuals with chronic disease benefit from access to
comprehensive and coordinated care to manage and treat their chronic
conditions and prevent the need for more costly care. Ensuring access
to remote patient monitoring services, including through evaluating the
adequacy of payments, will be important to beneficiaries who may
benefit from these and other virtual services that allow their
physicians to help manage and treat their health conditions outside of
regular office visits.
most-favored nation model
Question. I have concerns with the Most-Favored Nation Model
rulemaking, both with the policy of tying Medicare reimbursements to
the prices foreign countries pay and with the creation of the expansive
rule through the Center for Medicare and Medicaid Innovation (CMMI)
under the guise of being a pilot program.
If confirmed, how will you approach this policy? Do you support
tying the prices of American drugs to foreign prices?
Will you commit to ensuring that CMMI is used as intended rather
than as a congressional workaround?
Answer. We can all agree that bringing down the cost of
prescription drugs needs to be a top priority. If confirmed, I will
work to coordinate efforts across the Department to make sure we make
progress toward this goal, and I look forward to working with Congress
on ideas that will result in lower costs for American patients and
families.
coverage options
Question. As you have noted in the past, deductibles and premiums
are often too high in the individual market for people who don't
receive subsidies. This has been particularly true in Nebraska, where
for years we had one provider on the market and where even today the
cheapest plan available on the individual market has a premium of
$1,700 per month for a family of four.
We have too often ignored the fact that States like Nebraska
actually lost health-care options as a result of the ACA. My State
benefited tremendously from the previous administration's rules
expanding Associations Health Plans and Short-Term Limited Duration
Plans, and I'm concerned about the rules establishing these plans
potentially being rescinded due to politics rather than actual data on
their effectiveness or service coverage. These plans are very popular
in my State and often cost less than half as much as ACA plans while
providing more personalized coverage. Having fewer options in this case
actually increases the number of uninsured.
In addition to your support for expanding subsidies in the
individual market, would you also support continued access to more
affordable options, such as Association Health Plans, Short-Term
Limited Duration Plans, and Health Sharing Ministries?
If not, what data can you point to in recent years to say these
plans haven't proven to be popular and affordable options while still
protecting those with pre-existing conditions?
Can you point to any actual evidence that these plans destabilized
the market?
Will you commit to working with Congress and other agencies to
preserve these plan options for the millions of Americans who have
enrolled?
Answer. Making sure that all Americans have access to quality,
affordable health care is one of the Biden administration's top
priorities. If confirmed, I will examine rules and other policies to
ensure all Americans can access the care that they need.
Question. Another popular and successful product in my State are
Medicare Cost Plans, which offer a unique product in supplemental
Medicare. These plans are particularly popular in Western and rural
Nebraska, where beneficiaries typically only have a fee-for-service
product available to them.
Do you believe the rules prohibiting competition between Medicare
Advantage and Medicare Cost Plans make sense in today's market, and
does less competition benefit patients?
Answer. Medicare Advantage and Medicare Cost Plans have an
important role in giving people access to care. If confirmed, I would
be happy to work with you on the unique needs and coverage options
available to Nebraskans.
Question. The previous administration worked on a rule to allow
Direct Primary Care and Health Sharing Ministry expenses to be eligible
expenses for use of health savings accounts under section 213 of the
tax code. I believe strongly that Americans should be allowed to spend
their health savings accounts on these services, and that more
personalized choice in health markets leads to greater outcomes and
higher quality care.
Would you commit to working with me to explore this policy change
and others like it that expand access to these care and coverage
options?
Answer. Making sure that all Americans have access to quality,
affordable health care is one of the Biden administration's top
priorities. As health-care costs have continued to rise, more burden
has been shifted to consumers in the form of greater cost sharing. We
must work to reduce barriers to access, including excessive cost
sharing.
title x, conscience rules
Question. The Department recently announced that it will replace
the previous administration's Protect Life rule, which upheld the long-
time separation between abortion and health services by calling for
title X grant recipients to ensure that abortion services were not co-
located with federally funded services. This policy has been affirmed
previously by the Supreme Court, and I believe it protects the
integrity of the title X program.
If confirmed, how do you plan to amend this rule moving forward?
While it will ultimately be a decision made by Congress, will you
commit to supporting continued inclusion of the Hyde amendment in
future appropriations packages, and if not, what is your justification
for failing to protect the amendment, which has been the law of the
land since 1976 and is supported by a majority of Americans?
Will you commit to not reimpose the contraception mandate on
religious ministries like Little Sisters of the Poor?
Will you commit to ensuring that medical professionals are not
forced to perform procedures, like abortion, that go against their
religious convictions?
Answer. I understand that there are different, deeply held views on
this issue. During my time in the Obama administration, I followed the
law. If confirmed as Deputy Secretary, I will continue to follow the
law.
______
Questions Submitted by Hon. John Barrasso
Question. As a doctor, I strongly support increasing access to
mental health services, especially in rural communities. Senator
Stabenow and I have previously introduced legislation for many years
that would allow mental health counselors and marriage and family
therapists to receive reimbursement from Medicare.
Can you discuss how the Department of Health and Human Services can
improve access for mental health services, especially for those on
Medicare?
In particular, can you comment on the merits of allowing licensed
professional counselors and marriage and family therapists to receive
reimbursements directly from Medicare?
Answer. The COVID pandemic is taking a toll on Americans in so many
ways, including their mental health. However, this Nation's mental
health crisis did not begin and will not end with the pandemic. We have
to address this challenge from every angle, including by bolstering our
mental health workforce. Mental health counselors and marriage and
family therapists have an important role to play in our health-care
system. If confirmed, I will work with you and other members of
Congress to better integrate mental health care into our health-care
system.
Question. Rural communities are facing significant challenges,
especially during the COVID-19 pandemic.
Can you please discuss your priorities for improving health in
rural America?
Answer. I recognize that rural areas have unique needs and
challenges. I've seen how rural areas can vary both among different
States and also within a State. Rural areas in Wyoming can face
different challenges than rural areas in Virginia or Georgia.
The COVID-19 pandemic has further exposed weaknesses in our health-
care system for both providers and patients in rural parts of the
country. Rural hospitals and pharmacies are often the backbones of
their communities, providing both necessary health care and employment.
We should look at ways to bolster the rural health workforce, better
utilize telehealth, and make sure these communities have the support
they need. If confirmed, I look forward to working with you to ensure
that rural communities are not left behind during the pandemic and
beyond.
Question. One of the most common challenges facing rural
communities is recruiting enough health-care providers. These include
doctors, but also nurse practitioners, physician assistants, nurses,
and mental health providers, just to name a few.
What are your general feelings on Federal health-care workforce
policy?
Answer. It is critically important to make sure we have enough
providers to serve beneficiaries throughout the United States,
including those in rural areas. This issue is becoming more acute as
our population ages and doctors and other providers retire. If
confirmed, I look forward to working with you and other members of
Congress to find creative ways to bolster the health-care workforce.
Question. As you know, Medicare is the single largest funder of
graduate medical education. Several years ago George Washington
University released a study which found New York State received 20
percent of all Medicare's graduate medical education (GME) funding
while 29 States, including places struggling with a severe shortage of
physicians, got less than 1 percent.
Do you believe major reforms to Federal GME funding policy are
needed?
Do you believe the current funding formulas exacerbate health-care
disparities in underserved communities?
Answer. I believe it's important to make sure we have enough
providers, particularly as our population ages and doctors and other
providers retire. I want to thank you for your work to add 1,000 new
Medicare graduate medical education slots at the end of last year--the
first increase to the program in nearly 25 years. I understand that
Congress has prioritized these GME slots for teaching hospitals in
underserved communities and other shortage areas, including rural
areas. Prioritizing these communities for GME slots may help with
provider shortages as doctors tend to want to stay where they trained.
If confirmed, I want to work with you to make sure we have a robust
health-care workforce across the country.
Question. It is vital for the United States to learn from the
COVID-19 pandemic and ensure we are better prepared for future public
health emergencies. In particular, I am interested in addressing the
supply chain for personal protective equipment (PPE).
How do you anticipate HHS partnering with the private sector supply
chain to ensure that the country is ready for the next public health
emergency?
Answer. The global pandemic has highlighted the vulnerabilities of
the global supply chain for many products. In order to continue
responding to the COVID-19 pandemic and better prepare the Federal
Government to respond to any future public health emergencies, it is
critical that HHS work to improve and expand domestic supply chain
capabilities. If confirmed, I'm committed to working on this urgent
matter.
______
Prepared Statement of Hon. Ron Wyden,
a U.S. Senator From Oregon
The Finance Committee meets this morning to discuss two key health-
care nominations. Chiquita Brooks-LaSure is nominated to serve as
Administrator for the Centers for Medicare and Medicaid Services, and
Andrea Palm is nominated to serve as Deputy Secretary of the Department
of Health and Human Services.
Ms. Brooks-LaSure has served at OMB, on staff at the Ways and Means
Committee, at HHS, and in the private sector. She helped craft policies
bringing down costs for seniors on Medicare. She helped to develop and
pass key portions of the Affordable Care Act. At HHS she helped
implement the law. She also worked hard to make sure that middle-class
Americans shopping for private health insurance would get a fair shake
thanks to strong consumer protections.
The Trump administration later undermined a lot of those
protections, which has created a lot of new challenges for this
committee and the Biden administration to address.
Ms. Brooks-LaSure is also well-versed in Medicaid policy. She's
worked closely with everybody involved in Medicaid--the Federal
Government, States, and private organizations--to try to expand
coverage, improve care, and help people get ahead.
Continuing on the theme of impeccable qualifications and
experience, Andrea Palm is a proven health-care agency leader who knows
exactly what it takes to run HHS smoothly. She previously served as the
Department's Chief of Staff and senior counselor to the Secretary
during the Obama administration. More recently, she served as
Secretary-designee of the Wisconsin Department of Health Services, a
$12-billion agency with 6,100 employees. She's been the point person
when it comes to the COVID response in the State of Wisconsin. She's
also led efforts to expand insurance coverage, improve mental health
care, and reduce hunger.
Bottom line, these are both highly qualified nominees who will be
ready to go on Day 1 after they're confirmed by the Senate. There's a
lot of work to be done at HHS in the months and years ahead, beginning
with continuing the fight against COVID-19. Vaccinations are way up,
but cases and deaths are still awfully high. There's a long way to go
in this pandemic.
This committee's also going to keep up its work on other health
challenges facing the American people. For example, I've said that
every time we discuss our Federal health programs, we're going to talk
about the transformation of Medicare. Medicare used to be an acute care
program--broken ankles and bouts of the flu. These days it's a chronic
care program--cancer, Alzheimer's, diabetes. This committee led the
passage of the CHRONIC Care Act in 2017. The Trump administration slow-
walked its implementation. I'm going to work with these nominees to
turn that around.
Second, in the American Rescue Plan the Congress made a big down
payment for mental health services based on the CAHOOTS program. It's
all about using health care, rather than law enforcement, to help
people experiencing a mental health crisis. It's been a big success in
Oregon, and I want to expand it even further.
This committee is also putting a special focus on the issue of
inequality in our Federal programs. Especially during the pandemic, the
American people have seen the results of health-care disparities up
close. Blacks, Latinos, and Native Americans have suffered and died
from COVID-19 at much higher rates. However, it's not just about COVID-
19. It's also about maternal health, because women today are more
likely to die in childbirth than their mothers were a generation ago.
I also want to work closely with HHS on the issue of lowering
prescription drug costs. That's because Americans get socked every time
they walk up to the pharmacy window, and it's long past time for
Congress to act.
Finally, this country needs a revolution when it comes to access to
mental health care. The law says that mental health care and physical
health care are equally important, but in practice, mental health is
often given short shrift. This is a major priority for members of this
committee, so we'll continue working closely with these nominees on
this issue--and all these issues I've raised--when they're confirmed.
I want to thank Ms. Brooks-LaSure and Ms. Palm for their
willingness to serve in these extraordinarily challenging and vital
roles. I look forward to the discussion today.
______
National Association of ACOs
601 13th Street, NW, Suite 900 South
Washington, DC 20005
202-640-1985
[email protected]
https://www.naacos.com/
The National Association of ACOs (NAACOS) appreciates the opportunity
to express our views on the nomination of Andrea Joan Palm to be Deputy
Secretary of the Department of Health and Human Services (HHS) and
Chiquita Brooks-LaSure to be Administrator of the Centers for Medicare
and Medicaid Services (CMS). We strongly support the nominations of Ms.
Palm and Ms. Brooks-LaSure and are hopeful that they and the Committee
will consider the following issues in their work ahead.
NAACOS represents more than 12 million beneficiary lives through
hundreds of organizations participating in population health-focused
payment and delivery models in Medicare, Medicaid, and commercial
insurance. Models include the Medicare Shared Savings Program (MSSP),
the Next Generation Model, the Direct Contracting Model, and
alternative payment models supported by a myriad of commercial health
plans and Medicare Advantage. NAACOS is a member-led and member-owned
nonprofit organization that works to improve quality of care, outcomes,
and healthcare cost efficiency.
NAACOS looks forward to working collaboratively with the Committee and
today's nominees on these topics. Mostly notably, we hope these
appointments will bolster the shift to value following recent years of
policies that have hampered that critical transition. The transition to
value should not be taken for granted. While much progress has been
made in the past decade, this transformation is threatened. For
example, according to new data \1\ released by CMS, the number of
participants in the largest and most successful value-based payment
model, the MSSP, reached its lowest level since the Trump
administration took office 4 years ago. As shown below, to start 2021,
477 ACOs are participating in the MSSP, down from a high of 561 in 2018
and the lowest since 480 participated in 2017, the Trump
administration's first year in office.
---------------------------------------------------------------------------
\1\ https://www.cms.gov/files/document/2021-shared-savings-program-
fast-facts.pdf.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
.epsIn contrast to the diminishing number of ACOs, the MSSP continued
to produce greater savings every year and saw its best year yet in
2019,\2\ the most recent year for which data is available. Serving 11.2
million seniors in 2019, the MSSP saved Medicare $2.6 billion and $1.2
billion after accounting for shared savings bonuses and collecting
shared loss payments. Gross savings are shown below.
---------------------------------------------------------------------------
\2\ https://www.naacos.com/press-release--py-2019-results.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
.epsThe Next Generation ACO Model, the premier accountable care model
ran out of the CMS Innovation Center that emphasizes high risk and high
reward, has also demonstrated great results. Serving 1.2 million
patients in 2019, the model saved $559 million compared to the CMS-
generated benchmarks and netted $204 million to the Medicare Trust Fund
after accounting for shared savings, shared losses, and discounts paid
to CMS. NAACOS urges CMS to extend the Next Gen model through 2022,
giving time to install it as a permanent option for ACOs, either as a
stand-alone track or option within MSSP. The model is scheduled to
sunset at the end of 2021. The above results should speak for
---------------------------------------------------------------------------
themselves and substantiate permanentizing.
Given the success of the ACO program and need to strongly support the
transition to value-based care and payment, we request HHS re-examine
the balance of risk and reward for ACOs to bolster ACO growth and
therefore savings to Medicare and to support high quality, coordinated
patient care. Among those changes, we request that HHS and CMS reverse
certain policies from a 2018 MSSP overhaul, which CMS called the ACO
``Pathways to Success.'' That overhaul included some damaging
provisions such as a cut to the share of savings most ACOs are eligible
to keep and a push for ACOs to assume risk too quickly. These policies
have chilled ACO growth and should be changed.
NAACOS also recommends that HHS focus the value transition on
providers, keeping them at the center of payment models instead of
implementing programs and policies to attract new players into
traditional Medicare. As a telling example of CMS's recent approach, in
2018 the agency released a model initially titled ``Direct Provider
Contracting,'' only to later drop the word ``Provider.'' That name
change went along with an emphasis on giving favorable treatment to
entice new participants, such as payers, to the model at the expense of
those who have been on the frontlines of the value transition for the
past decade.
To support the ACO movement and recalibrate the value transition to
center on and support healthcare providers, NAACOS recommends the
following:
Set a national goal to have a majority of traditional Medicare
beneficiaries in an ACO by 2025.
Deprioritize the rush to risk and build a population health
infrastructure.
Address overlap of competing payment models to prioritize total
cost of care models.
Strengthen incentives to attract new ACOs and retain existing
ones.
Provide meaningful funding to build infrastructure necessary to
spur innovation and value through expanded advanced payments and
grants.
To make progress on the broader goals listed above, NAACOS recommends
enacting the following specific policy change this year:
Adapt ACO and alternative payment model methodologies to account
for COVID-19 anomalies.
Halt implementation of the Geographic Option of the Direct
Contracting Model and improve aspects of the Professional and Global
Options to benefit legacy ACOs/providers.
Improve the MSSP by increasing ACO shared savings rates, fixing
key benchmarking and risk adjustment issues, allowing more time before
requiring risk, and revisiting recently finalized quality policies.
Make the Next Generation ACO Model permanent.
Provide more timely and complete data to ACOs.
Ultimately, President Biden's administration inherits fewer ACOs than
the Obama administration left at the start of 2017, which is a trend
NAACOS hopes will be reversed under your leadership at HHS. We
appreciate the work of the Committee on these topics and look forward
to working with the nominees.
______
National Health Law Program
1444 I Street, NW, Suite 1105
Washington, DC 20005
(202) 289-7661
https://healthlaw.org/
April 15, 2021
The Honorable Ron Wyden The Honorable Patty Murray
Chairman Chair
U.S. Senate U.S. Senate
Committee on Finance Committee on Health, Education,
Labor, and Pensions
Washington, DC 20510 Washington DC 20510
The Honorable Mike Crapo The Honorable Richard Burr
Ranking Member Ranking Member
U.S. Senate U.S. Senate
Committee on Finance Committee on Health, Education
Labor, and Pensions
Washington, DC 20510 Washington, DC 20510
Dear Chairman Wyden, Ranking Member Crapo, Chair Murray, and Ranking
Member Burr,
On behalf of the National Health Law Program, we write to urge you to
support Chiquita Brooks-LaSure's confirmation as the next Administrator
of the Department of Health and Human Services' Centers for Medicare
and Medicaid Services (CMS). As a long-time thought leader and expert
on access to health care for low-income people, particularly those most
underserved by our health-care system, Brooks-LaSure has the expertise,
experience, and dedication to advancing access to quality health care
and health equity needed to guide CMS.
CMS provides vital health coverage to more than 100 million people
through Medicaid, CHIP, Medicare, and the health insurance
marketplaces. With over two decades of Medicaid and health-care reform
leadership and expertise under her belt, as well as a demonstrated
commitment to advancing health equity, Brooks-LaSure is an exceptional
candidate to lead CMS.
Before her most recent work as a Managing Director at Manatt, Brooks-
LaSure served in key leadership roles advancing implementation of the
Patient Protection and Affordable Care Act (ACA) within the Obama
Administration. She served as Director of Coverage Policy in the White
Home Office of Health Care Reform, and later as Deputy Director for
Policy at CMS' Center for Consumer Information and Insurance Oversight.
Before that, she served as staff on the House Ways and Means Committee,
where she contributed to the ACA's passage.
Throughout her career, Brooks-LaSure has emphasized Medicaid and the
ACA marketplaces' crucial roles in alleviating racial inequities in
health outcomes. She has called out the role of the Trump
administration's Medicaid work requirements and 2019 public charge rule
in perpetuating health inequities, particularly for people of color.
She has highlighted the importance of more robust data collection to
better serve underserved populations and alleviate health inequities.
Brooks-LaSure has stressed the importance of centering community voices
in health policy development and priority-setting--an approach that is
essential to fostering a healthier and more equitable country for all.
Brooks-LaSure has paid particular attention to our country's
unconscionable Black maternal health crisis. She has underscored the
importance of extending Medicaid and CHIP to 12 months postpartum--a
reform now possible through the American Rescue Plan Act's new state
plan amendment options. She has addressed the importance of efforts to
expand access to doula care. Her testimony at a 2019 House Ways and
Means Hearing on pathways to universal health coverage specifically
highlighted racial injustices in maternal mortality.
The challenges facing this nation are multifold, both acute and long-
simmering. The pandemic has exposed flagrant flaws in our health-care
system and painfully revealed the United States' entrenched health
inequities. There is much to be done and undone to build a more robust
and equitable health-care system. Our country desperately needs a CMS
administrator who will center urgent health equity challenges and
prioritize equitable solutions. We look forward to working with Brooks
LaSure and the team at CMS to advance those solutions. We urge the
Senate to confirm her nomination swiftly and resolutely.
If you have any questions, please contact Madeline Morcelle at
morcelle@healthlaw.
org.
Sincerely,
Elizabeth Taylor Mara Youdelman
Executive Director Managing Attorney, Washington, DC
Office
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