00:00Grassley I've got six issues. No questions at the end of my issues
00:05You can either agree or disagree or not say anything. Whatever you want to do
00:11I've been working to hold pharmacy benefit managers accountable to lower prescription drug costs
00:17I expect you to work with us to hold these powerful drug middlemen
00:22accountable and support rural pharmacists last year there were at least three bills introduced on
00:29Pharmacy benefit managers with a total of about 65 senators
00:33So this is a big issue in the United States Senate on rural health care
00:38I expect you to protect and support access to rural health care to help achieve this
00:43I believe CMS should take the following actions right away fill the open slots in the rural community hospital
00:50demonstration program
00:52Distribute the new physician residency slots to rural hospitals as the law requires
00:58Ensure that rural emergency hospital program, which is a program
01:02I got passed five years ago is working for rural communities
01:06I've had a big interest in kids with exceptional needs
01:10I expect you to take action to improve care and reduce red tape for kids with complex medical needs
01:16This includes working with states so that they can establish
01:20Health homes for these kids as my bipartisan ACE kids law enabled
01:28Transitional health plans is the fourth one since 2013
01:33CMS under President Obama
01:35Trump and Biden have issued what's called non-enforcement memos to allow
01:41Transitional health plans to be maintained about
01:4535,000 Iowa farmers and small business owners have maintained these health insurance coverage with these plans over
01:53For over a decade. This is a health insurance has purchased after Obamacare became law, but before was a
02:01Implemented and I would expect you to keep access to these health programs
02:07on the subject of waste fraud and abuse
02:11improper payments
02:12In our major health care programs have averaged a hundred twenty two billion dollars annually over the past five years
02:20I'm the author of a major and more recent updates to the federal government's most powerful tool in fighting
02:28Fraud, that's the false claims act since it's an axiom
02:33It's enactment. It's brought seventy eight billion dollars of
02:38taxpayers money lost to fraud back to the federal treasury
02:42CMS with the Justice Department must
02:46Aggressively go after waste fraud and abuse and empower whistleblowers
02:51Which brings this to the attention of most of the people that are following up on the enforcement of the law?
02:58My last one is oversight
03:02In other words the congressional
03:05Responsibility of oversight to see that the president faithfully executes the laws
03:09Allows us to hold bureaucrats accountable to the rule of law and helps keep faith with taxpayers
03:16I expect CMS to provide timely and complete responses to congressional
03:22Oversights and you've answered that question for the chairman of the committee when you were in my office
03:27I said you should have said maybe instead of yes
03:29Because then you don't turn out to be a liar
03:32Like we found over the last 20 or 30 years with the people that have answered that question
03:38So I want you to list of whistleblowers
03:41You don't know what's going on down in the bowels of that big bureaucracy
03:45You have and you need a culture because you can't keep track of every whistleblower
03:50You need a culture that will make sure that middle management
03:54Will pay attention to things that are brought to their attention by whistleblowers and get things corrected
04:00Then they don't have to come to me to get correction made now
04:04You can either answer any way you want to you got 58 seconds
04:09I'll use all 15 seconds. Yes. Yes. Yes. Yes
04:13yes, and maybe only because you said to say maybe when you asked me about responding to your
04:18Your notes because the reality is we may not get to every note
04:21But every single member of the committee has brought up the fact that CMS has not been responsive
04:27So directionally we want to make sure you hear back from us and not just the committee
04:32My hope and I believe this is a firmly held
04:36Reality by many folks on the outside. They don't think they can speak to CMS
04:40They don't know where we're going the private sector can't the American people can't our beneficiaries don't know what's going on
04:46We mail pieces of paper to people it costs us 350 million dollars a year to do that
04:50I don't has anyone ever read their Medicare mail. It's just not riveting reading
04:53I
04:54Believe we can do a much better job by telling the American people what we're going to do
04:59To the point that you actually could imagine us having what most industries do which is a developer conference where you go out and tell
05:06Industry what you need tell the American people what you can offer communicate with them in a frequent and consistent fashion using digital tools
05:13And I believe based on our conversation
05:16that the biggest advice that I might take from you is look down in the depth charts of
05:22CMS for the people who are willing to tell you the truth about what's going on
05:25Don't talk to the head person or the second below them or the third below and go down four or five levels
05:30Where people really are willing to tell you the truth because they're frustrated and that's where
05:34We'll be able to make a massive improvement in the culture of the organization
05:38senator
Comments