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tv   Surgeon General Jerome Adams Testifies on Substance Abuse  CSPAN  October 28, 2019 10:02pm-11:54pm EDT

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next surgeon general on substance abuse treatment, he testified for the senate finance committee where he outlined various strategies to combat the opioid epidemic including access to treatment, strengthening public health data collection, early intervention and acute pain management. the hearing looked at methamphetamine abuse and addiction treatment center insurance fraud schemes. >> usually do not start these meetings until the ranking member comes but because of the service that we have for congressman cummings plus the fact that we had to change this meeting to adjust to that
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schedule i want to get going and it's going to be in operation because i have another meeting that have to make a form down the hall. i'm going to start out, i know you want to introduce one person, are you under at times contrite push mark if you are all give you the courtesy of going ahead. >> i write. >> i welcome my panelist, today to our hearing on the one-year anniversary of the support act this landmarks acute which many had a hand in developing, responded to the opioid activitc in crisis that is affected every corner of our nation was approximately 130 americans dying from an overdose everything all day.
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we devoted a lot of federal resources to tackling the crisis and look forward to hearing from the surgeon general of this ministration effort to implement the support act on this one-year anniversary, i also commend doctor adams for launching his initiatives to help raise a public awareness about the risk of the opioid issues, challenges remain because 20 million americans still struggle with substance disorder, addiction to other drugs including meth and heroin, equal or greater challenge to some communities and this is true in rural areas of america, another issue is to
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seek or receive treatment in another issue is even those who do seek help lock lacks the expe from the bad in solving this issue which is the second focus of the hearing. it's easier said than done. there's extreme the bad in the extreme good actress but those are between, some for example have not updated their methods to incorporate the latest research about what works best for recovering people, also state requirements for addiction counselors and recovery homes very. example, some states require licensing and recovery home operators while others might only use voluntary certification, that is why we
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have invited to government watchdog agencies and in addiction treatment advocate to our committee to share expertise. we welcome back doctor who testify before the committee last year, we have all seen the media reports about so-called sober homes in florida, pennsylvania, massachusetts and a few other states that exploited addicts with private insurance benefits, we look forward to hearing from her on that subject how geos worked there. i also extend a warm welcome to harry who has the inspector general investigative team, his investigators worked on a recent high-profile case who bombing
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treatment scams in ohio, that investigation a partnership with the fbi in law enforcement led to the indictment of six people shthis year, all six pleaded guilty for medicaid fraud some have called for more measurable addiction treatment standards by which the public would evaluate the effectiveness of substance abuse, treatment programs, the last, gary mindel has gone a step further to not only identifying standards that he believes are key to any successful program but launching quality rating systems, this is unchartered area and treatment sector and we look forward to hearing from him with the progress that has been made with
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the nonprofit organization that has been approved. we are here because too many americans have lost too many loved ones to addiction an overdosed deaths, americans owe pure crisis has left a trail of broken hearts and homes across the country and we are here to help communities get on a path towards health and wellness and millions of americans are seeking a path forward.co working together we can save tax dollars and save lives. >> thank you very much, i want co thank you this is an important issue and we do need to have our committee tackled in a bipartisan way. i also want to thank you for moving this morning start came to 9:00 a.m. because we both know there are members that want to attend the memorial service of chairman cummings. today's hearing will spotlight s the pitfall americans face when they try to find quality
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treatment for substance youth disorder prudent american battling this disease is often jostled and pushed around from one end of the healthcare system to the other. the last thing you need when you're suffering from this disease, yet more obstacle, ripoff artists, pharmacist or out and out abused, the last thing you need is that when all you want to do is get better. too often people expecting to arrive at a legitimate treatment facility only to find that they have fallen prey to his scheme which to drain their bank account and milk their insurance for everything it is worth. in some instances, some
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operators are working to lure patients by paying for plane tickets and promising free rent. once the patients arrive, what they end up getting his lousy care or no care at all. and then the fraudsters go out and build the insurance company for healthcare services that may never have even been performed. one of the biggest problems involves facilities that allegedly treat substance abuse disorders but set up to ripoff taxpayers. the fraudsters illegally recruit patients using bribes and kickbacks and then they milk the taxpayer by billing the patient's health plan for medically unnecessary drug test. schemes like this and were
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grateful to have this terrific group of witnesses today, they will outline these schemes in detail and of course these schemes cost medicare, medicare, private insurance, hundreds of millions of dollars every year. just as month six people operating and network and treatment centers in ohio played guilty to submitting 130,000 medicaid claims, this totaled more than $48 million to medically assisted treatment and other services that were never legitimately provided. part of the reason this fraud is so common because there's no way for a patient and their families to learn about the quality of a treatment facility before they enroll. so today, were going to hear from an organization that says wake up we have to change. public databases and multiple states have successful allow a
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public to identify and compare substance use treatment program. this database and transparency is a type of information that american families deserve to have and they deserve to have it now because it will be a key tool, a fine quality treatment and operators trying to make a quick buck. one other point that occurred to me as we were preparing for this hearing, it is particularly important now to set in place the concrete policies to ripoff and to make sure these programs are not ripped off in the patients are not taken advantage of because when you read the morning newspaper, the factors the state and communities may
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well be on the cusp of receiving tens of billions of dollars from the companies that help see the epidemic. and i can look down the road because of her about this from virtually all of my colleagues. if you are talking about a fund, of tens of billions of dollars, a sum of that size is going to be a magnet for the fraudster in the ripoff artists. this hearing is going to highlight needs to make sure the rules in the road vigorous oversight so those dollars actually go to help patients get the proper care and all the new money does not just find its way into the ripoff artist thank you witnesses.
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and again, thank you for your leadership will work on this in a bipartisan way and i look forward to hearing from the witnesses. >> the senator from maryland to introduce. >> thank you, mr. chairman. i thank you for giving me this courtesy. it's a pleasure to welcome all of our witnesses. but particularly a well of doctor jerome adams. he's a proud son of maryland and a glowing career. he is first winning the procedures scholarship to university of maryland where he received both a bachelor of science and biochemistry and a bachelor of arts from biopsychology. i say that because we had a conversation before the president calls doctor adams the most successful failure, that's because the scotia program is a program that is extremely successful in african-americans obtaining their phd's and going
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on to extraordinarily successful lives. doctor adams does not have a phd, but he does have a masters degree in md degree and of course a successful career, i want to congratulate him for his leadership in our country, the service to our nation, he attended the school of medicine and a company scholar for serving as united states surgeon general he was appointed as the indiana state health commissioner as a u.s. surgeon general, he spends his time focusing on combating the opioid epidemic. he has been on behalf of the intercountry and were very proud of his service and proud to have him heal from the state of
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maryland. >> just go through the testimony i won't feel bad for introducing. >> i talked to all of you about my opening statement because of the tim constraint. would you start, and what we cowill do is go in the order tht you're sitting at the table and then will have questions after you all get done. >> good morning chairman grassley, i wife says to tell barbara hi and we can't wait to bring the kids to the farm. >> everybody knows about my wife does anybody know about me? >> ranking member and distinguished member of the committee if you allow me 20 extra seconds i want to acknowledge the flag flying at half-mast over the capital to lift up the example and accomplishments thatst
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representative cummings, his life is a definition of public service and my condolences go to his family and i've been blessed to know him. my testimony today, i'd like to begin by thanking all of my colleagues for passing the support act which is enabled hhs intercountry to make progress in the fight against the opioid epidemic. i am pleased to be here today on the one-year anniversary. americans overdosed in addiction crisis in one of the most daunting and complex challenges ever. recognizing the scale and scope, hhs launch the strategy in 2017 and under the strategy were to be better addiction, preventing and treatment services to better data and better management, better targeting of overdose reversing drugs and better research. i've been engaged on this problem as an anesthesiologist with chronic pain management and as you heard, as ahead of the state health department dealing with the unprecedented opioid fueled hiv outbreak but by work
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is also very, very personal. my younger brother philip struggles with addiction, his struggle began with untreated depression he needed help medication and opioid issue. with mental health and substance issues he has cycled in and out of incarceration, he is currently serving a ten year prison sentence for crimes committed to support his addiction. this epidemic is blind and color to your average class and it can happen to anyone even the brother of the united states surgeon general. and when stigma keeps people in the shadows, and impedes our collective recovery. to address though. epidemic, my office relieves a spot on opioids, a digital postcard which you can find as surgeon general.gov in an advisory on opiate overdose. i want to leave you with five key messages i detail in the publications.
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number one, early intervention is critical. prevention, screening and programs work but they need to be initiated early in life. we cannot wait until someone is in high schoolt or college befoe we talk about them about the oakwood issue. number two treatment is effective but must be integrated in the mainstream healthcare. medication treatment physical standard but in the course of year only one in four peoplenu with opioid receive specialty treatment. number three, having the loss can save a life through treatment and recovery and hope all of you know about this and carry it, i carry it everywhere we go, it is that easy to save a life. since my book was published almost 3 million have been disturbed into communities but too many still need this. comprehensive community-based support services are essential. i saw this firsthand with second lady pens and i visited the industries in indiana.
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they developed the pilot project pathways to recovery and who failed drug tests are offered drug counseling and participant to stay in the recovery program our short job. recovery support services are vital to bakery in new york, the bakery provides employment and support services without judgment, no resume, no work history, no back contract is required. the bakery's model which i love, we don't hire people to bake brownies, we baked brownies to hire people. more than 60% of bakeries and employees were formerly incarcerated. my fifth point, when it comes to opioid use disorder, society must move from a criminal justice based approach to public health and partnership based stigma and judgment are qbeo people with the disease of addiction, people like my brother from getting the help that they need in the semi- opinion is killing more people than overdose. in conclusion, under this
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ministration and three-year support in a stork investment has been made in combating opioid crisis. by the end of 2019 hhs will have awarded $9 billion in grants to states, tribes and local communities to combat addiction. this includes 1 billion across 375 projects and 41 states part of nih helping to an addiction long-term or heel initiative. it also includes $1.8 billion in the cdc funding states announced last month. these funds expand access to treatment and strengthen dataa and surveillance. since the start of the ministration, we've seen the opioid nationally drop 31% in terms of prescription. we've seen the number of americans receiving treatment girl. now nearly one point to 7 million americans are riers receiving medication and e doubled the number of providers who have the data waiver to prescribe. the prescriptions have risen
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378% and provisional drug overgrowth death have dropped by 5%. the first drop in over 20 years. we are making progress but challenges remain including the resurgence of methamphetamine and need to increase companies and programs and to support emergency department medication treatment programs. we also finally must expand the behavioral workforce senator and i talked about that before the hearing. i promise you, i promise you the hhs and my office will continue our commitment and a focus on the critical health issue, i thank you for the opportunity to testify and i look forward to your question. >> before you begin the background on animal science, how did you end up here. >> there's prior to gap between animal health and public health. >> i needed the explanation.
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>> sure. >> proceeded please. >> chairman grassley, ranking member widened and members of the committee, i'm pleased to be here to discuss the recent report on the oversight of recovery. drugance abuse and illicit use is a problem that has ruined families and takener lives. the dea reports since 2011 drug overdoses alone have been cause of death by injury in the united states outnumbering deaths by guns, car crashes, suicide and homicide. recovery homes can offer safe housing.rtive unfortunately bad actors have used these homes to take advantage of individuals during their time ofnd need. today i would like to highlight two key findings from mydv repo. first we found all five states
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and a review have received complaints of the fraud related to recovery homes. in four of the five florida, massachusetts, ohio in utah had or in the process of conducting investigation. foro, example, officials told jl was extensive afforded a task force found operators were luring individuals to homes with marketing techniques. such as promises of free airfare in rent. recruiters broke with individuals and providers who build the insurance hundreds and thousands of dollars in unnecessary drug testing. home operators were paid 300 or more for every patient they refer. at the time of our report some arrest had been made. in massachusetts the medicaid fraud control unit found some laboratories recovery referred revisiresidents to their own lar drug testing and other labs for kickback and referral when it was not necessary in between s 2017 they settled with
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$40 million. at the time of our report ohio was investigated fraud at the breaking point recovery center. this month senator whiting mentioned, the attorney's office recorded six people from breaking point to healthcare fraufraud conspiracy for billing medicaid more than $48 million in drug and alcohol recovery services that wereng not providd are not medically necessary. to increase oversight, florida, massachusetts and utah establish a licensor or voluntary certification program that included incentives for recovery homes to participate. our other two states ohio and texas did not have similar ,rograms but were providing resources and training to recovery homes. despite such efforts it continues. thees pennsylvania u.s. attorney office has completed ann investigation looking into
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insurance fraud in treatment centers. charges included once again kickbacks for unnecessary drug testing and billing insurance companies at absorbent f rates. they also directed patients who live in company-owned unlicensed recovery home for thea housing was unsafe and employees and patients were engaged in sexuald relationships and managed to relapse. this is the case of the bad guys getting caught in that what lead me too my point. we do not know the total number of recovery homes so therefore we don't know the extent of what is happening. in addition no agency oversees the operation provided nationwide -- >> in closing when run properly recovery homes are no port part of a patient's path to sobriety in combating the op a crisis. our work on recovery homes ass part of gao's broader work. recent reports have explored federal oversight of opioid
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prescribing medicare, we also have ongoing work identifying barriers that they may face with important medication to treat opioid misuse. it's a result of mandates with the support act which was signed into law one year ago today. we highlight this and other work in her latest high risk report which is identified drug misuse as issue requiring very close attention. enqueue chairman grassley, ranking member widened and members of the committee for holdingry this important hearin. this concludes my remarks, i'm happy for any questions you may have. >> good morning chairman grassley and ranking member widened and other distinguished members of the committee. i'm gary, the inspector general for investigation. i am here before you to discuss the efforts to combat the pure crisis. our ongoing work is taking a multifaceted approach. looking at a variety of issues
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on the prescribed treatment mentions of thei crisis. oig is addressing the crisis through the activities, audits, evaluation and data breach. our efforts to combats the opiod abuse while ensuring both substance treatment and continuity of care continue in our top priority for oig. for example we had expanded conductors for the pure crisis significantly over the past several years, resulting in increased over 100% open investigation from 2015 to 2019. just this year the newly launched prescription opioid strikeforce a joint initiative between geo j, iod, dea and fbi in state medicaid fraud control partners took down 73 individuals, 64 medical professionals. their participation in the legal prescribing and distribution of opioids in healthcare fraud
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schemes. opioid fried has a broad range f criminal activity and f prescription drug addiction treatment for billing schemes. a growing concern is fraud involving medication assisted treatment to sober homes and services such as counseling and test reading. this number of treatment operating across the nation continues to increase in connection with increasing demand and availability of federal funds to support the service, we have seen an increase in schemes involving diversion. as our enforcement and oversight efforts to address though. crisis have expanded we have also come to understand the impact that the work can have on the patients that we serve. we recognize that patients were prescribed opioids to shut down toiz do so law enforcement efforts, access to care can and will be disrupted. rather than leaving these patients to potentially turn to another fraudulent provider or
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street drug to meet their needs, we believe it's vital they have access to quality treatment and pain management services with minimal care. this is not something that law enforcement can do alone. ensuring these patients have continuity of care requires at collaboration with our federal, state and local public health service officials. as part of the artful takedown, the law enforcement partners worked in close collaboration with hhs assistant secretary for health and disease control and prevention, use public health service and state public health agencies. we employ strategies and resources to provide assistance that is impacted by law enforcement operation. oig will continue to work hand-in-hand with the public of partners to help ensure access to treatment and continuity of care for patients impact of our efforts. beyond our enforcement efforts we continue to grow the robust
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portfolio of work. that identifies opportunities to strengthen program integrity and protect at-risk patients for prescribing and treatment. pig currently has several opioid treatment audits and evaluations underway. examine issues such as access to medication to treatment and advances the appointment oversight, we look forward to sharing the results of this on the committee when it's complete. the recent data breach on opioid medicare showte significant decline of opioid subscribing. at the same time, it showed the number of patients receiving morphine and medicare is increasing. this is a very positive sign. however, there is still much work to be done to reduced the b legal prescribing of opioids and treatment schemes which only detract from the efforts of those to provide the health these patients really need.
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it will remain vigilant in investigating opioids fraud schemes and working to improve hhs effort difficulty treatment services pre-thank you for allowing me the opportunity to discuss this topic and i look forward to questions you may have. >> before you start, i realize what i said about you and my opening statement, i need to recognize your success in the private sector and now bringing that to the nonprofit organization to help us accomplish his goal. i should have said that. proceed. >> chairman grassley, ranking member and members of the committee, thank you for holding this hearing in treating this substance of america. my name is gary mindel and i'm
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the founder and chief executive officer of shatterproof, a national nonprofit organization dedicated to reverse the addiction crisis of america. for nearly a decade my son brian struggled with substance use disorder, despite our family working tirelessly to find my son the best possible care at a different treatment programs on october 20, 2011 we lost my son brian to this disease of addiction. the months of followed i was destroyed all over again when i learned that research existed proving the types of interventions that would haveat significantly improved outcome for brian and millions of others who were in treatment for addiction. if only we had knownpr what to look for. that is why i found it shatterproof, the first national nonprofit organization dedicated to reversing the addiction crisis in america. to call bushes, we developed a five-point plan to transform the addiction treatment system in the united states.
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number one, a science principles for treating addiction. number two, a quality measurement system. number three, payment reform. number four, treatment capacity. and number five, ending stigma. my remarks today will focus on the second of the five, treatment quality measurement. addiction is a chronicll brain disease and despite the fact there are clear clinical best practices, the use varies widely across the addiction treatment filled in some facilities are still having tactics that are ineffective in methylated ologies. unlike other healthcare services, comprehensive standardized data in the quality of addiction treatment simply does not exist even worse, because consumers, payers and state regulators do not have access to quality measures and
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the forces have not been aligned to support the best practices. >> in 2006 in the landmark report by the institutese of medicine called for the development and dissemination of a common continuously improving measures of the treatment of substance use disorder to drive isality improvement. seizing along the long standing recommendation to develop a public platform known for the three aims. number one, providing patients and family members the information that they need to tiidentify good evidence based treatment for their loved ones. number two, equipping providers with data to advance the use of the bracket system. in number three, entry policy and payment decisions are data driven. the tool builds on the eighth principles of care which were developed with experts in the field to establish addiction should be treated like any other tchronic illness.
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we are currently in phase one of atlas and working with treatment facilities, payers and other stakeholders in six states. delaware, louisiana, north carolina, west virginia, massachusetts in new york. this far, this phase is included major identification and refinement to the national quality expert panel strategy sessions in public, period. these survey items and claims measures in a pilot of patient c experience surveyed across 50 treatments facilities in the state of new york. quality data will be collected and triangulated from three sources. claims data, patient experience survey and treatment facility survey. and reported to the atlas site back to providers to the public to the payers in the states. when i see the public, the
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families. following evaluation of phase one, shatterproof will work with other states to bring the resource to servell more than 21 million americans with a substance usees disorder. atlas is part of shatterproof goal in transforming the addiction treatment system in the united states to reverse the crisis that has had such a severe and tragic toll on far too many. the impact can be averted for so many others. thank you for the opportunity to testify today and i look forward to your questions. thank you. >> will have five-minute rounds of questions. we will start with the surgeon general, first of all thank you for the top priority you have given us surgeon general and probably as an individual to making in addressing opioids and addiction as a top priority and i think the ministration to
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prioritize the carrying out enactment of this legislation. section 7031 of the new law calls for the development best practices and it has the ministration appointed of working through members to develop such best practices or identify the factors that can be used with fraudulent recovery housing operators by support and if not, could you give us a timetable when that might happen. >> thank you foror the questioni went to recognize that iowa has led the way in the countryw of 14.7% decrease in overdose rates over the past year that has been recorded so we need to share more of what's working in iowa a th the rest of the country including connecting people with recovery services. also yout specifically in the spotlight on addiction which are
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highlighted, this came out last year, there was not much fanfare, less going on in dt and folks don't notice when the surgeon general put something out. but i highlighted what to look for in a substance use disorder treatment program. personalized diagnosis assessment and treatment planning long-term disease i management as we learned in indiana, not just substance use disorder in many cases as hiv, hepatitis, reoccurring mental illnesses. access to fda approved medication ineffective behavioral interventions, courtney to care for other diseases and diagnoses and recovery support services. my role is to help give the public the information they need to make informed decisions and we put that out and have the cetreatment binder, 18662 help d beyond that bedding from good from bad i want to turn over to
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gooig. >> i hate to put you on the spot. >> unfortunately we've only encountered the bag. what we see is are institutions that have no intent to provide the services that their billing for. individuals do not receive the counseling that they are supposed to receive. sometimes using prescription as left behind for our staff, nonqualified staff at the facility ready prescription as people walked through the door. there 0 most of the cases that were involved in with the actual interest of the care of the patient. the docketing the services that they need and deserve and often times were paying for. >> i want to ask you a question you refer to in your testimony about not knowing how many homes or where those recovery homesno
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are, do you have any way of telling us what obstacles exist to obtain this information because it seems like we need this information. >> as a mentor and there's no federal oversight it's left up to the state and the state have varying practices. for example, somet are licensed, some require certification, and some involuntary and some flight in the rater. there's many obstacles to identify. >> i would highlight, this ties into question, medicare will release a data book in that is a direct request from the support act which you all past a year ago and this will highlight with people and states were getting recovery and treatment servicess through medicaid and that will be a first important step to
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figuring out who is getting what, where are they get getting it and will assess the good from the back. >> obviously i did not reckon is that you lost your son. and obviously that is a terrible loss for you and i hope you know it's not only your son but everybody else we're trying to help in this regard so we have to appreciate yours. other to ask you this question and this will be my last one. tell us what led you to develop the national standards of care. >> what i saw in the industry
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was about 45 evidence-based practices that treatment programs should be followed eacd of multiple published articles. clinical trial is showing that they work, if you do x, the patient is better if you do abc the patient does better. there were 45 of these approximately. they were not all in one place, they were all different. there's not a business in america has 45 banks, most are successful in narrowing down to less than ten core principles of care and number one that can be readily understood in the surgeon general mention this. less then ten core principles, it can be easily understood but most important to be able to be measured. you cannot measure 45 things but you can measure less than ten. and we purposely selected working with researchers in the
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field and many who drafted the 2006 surgeon general report, 16 which is followed up in thema spotlight. with working with them to draft eight principles of care that can easily measure the most impactful treatment whether inpatient, outpatient opioid, alcohol atlas sent or adult. >> thank you this is been an excellent panel and we thank you for your commitment and compassion to the patient and let me tell you what is foremost on my mind this morning. every morning now we wake up to the news reports that there is this effort with the state and the community to work with the pharmaceutical company income up with the settlement that deals
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with opioid drug addiction in the overdose epidemic that the drug companies contributed in this country. if the court settlements go forward, it is almost certain that a significant portion of that money is going to go to substance abuse treatment. and it ought to. but based on fraud in ripoffs that you are already describing to us today it seems that the lack of oversight could mean with the potential influx of more money, we are creating a perfect storm for more fraud. i think what i would like you to do is tell us, going forward what should the federal government working with the state and the private sector do to make sure that if that
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settlement takes place in the billions of dollars coming in for substance disorder treatment, what should the federal government working in the private sector do to make sure the dollars go to reputable operators and not more fraud. >> it is a big question. however, our work would show that though the certification process, the license process, the charter houses has oversight, it would be good if we can ensure the funds could g- >> what are the gaps in those areas. my understanding, you have identified the gaps today in the oversight of the keynd areas. >> the gaps are numerous. as i mentioned before, there is no federal oversight to help us
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with this program as you mentioned. >> who would you make a point person on the federal side, would this be the center for medicare and medicaid services. >> who would you make the person given the fact there's nobody core needing this. >> we did not look exactly but we do know that tampa is providing grant money and that's one way to tie with the states are doing. >> without be the most cost-effective? based on your work what would be the most cost-effective way federal sidehe that builds gaps, unfortunately we have not looked to say which is better, however, dms are involved -- >> what is the other gap. >> the other gaps is we don't have an understanding in the state are able to do various things, there is not one program, this is a grassroots
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level in the states were interviewed don't want to have the regulations because they're afraid they would have less of the recovery homes. >> what would be the two most serious gaps meaning you have to start somewhere and you have somebody at the federal level core needing and then they will say what the two most serious gaps, if you don't deal with them more money will get ripped off. >> i wish i could answer that but i don't know the answer to that there are many gaps. >> who would? >> who would be able to tell us with all this money coming in what the biggest gaps are. >> that's an excellent question. when you look at the number of individuals that we have to interview to get an understanding of the oversight. >> i think you guys have already started on the way of answering this because you from problems the accrediting organization and
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i gather -- >> i suspect many would agree that it's difficult for the federal government to get down to regulating to the local level. but what the federal government can do is condition all the grants it's giving to states and states during practices. for example, they will give up billions of dollars to states and samsung could condition that money on going to states estate to the following five or six things -- >> my point is, senator has been a leader in working on these behavioral issues right now. were not talking about the federal government taking this over. were talking about the fact that theki federal government, substance abuse, significant amounts of dollars that theus federal government has been involved with in the federal government being a partner with
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the accrediting organizations in the state and the private sector and the like. will hold the record open so the chairman has two go. i'd be very interested in hearing from each of you what do you think the biggest gap are right now and your ideas to help fulfill them and i would also like to throw a bouquet to my seatmate for doing good work on this and being part of the bipartisan coalition that has came up with an actual plan. >> you asked for two things, 22ndit. >> one is hhs polar with better data. i used to run a state health department, the substance use disorder is a big big deal because it will give states better information about what is going on where so they can make better choices about who to lift up because we need to be investigated, the better data is one, number two, as gary
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mentioned, we let the consumers at the local level know what to look for in a treatment center and what shatterproof has put out and what we have put out and to push the information to individuals who are making those decisions in the parents going to treatment center after treatment center in good from bad. we have the checklist available we need to help you push those out. >> will keep the open if you can get it to us in the next ten days. and recommendations to make sure if we see an influx of money -- >> will go to senator i like to recognize this is why weon have this hearing and it's a very constructive conversation. >> the q mr. chairman. drug overdose is now the leading cause of death for those under united of 50 in the states.
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let me let you sink down and for a moment. it's a sobering fact. no matter countries in the middle of a major opioid in math crisis and we must do more to combat the drug epidemic. my home state of montana is math destroying the communities. in fact from 2011 in 2017 there wasm a 450% increase in math cases in montana. with math related deaths rising 375% during those years. unfortunately, in my state of montana the math crisis is disproportionately impacting native american tribes. that's why we had a debate to include the legislation called the mitigating math act to strengthen indian tribes ability
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to combat drug use in the support act which was signed into law by president last year. it was a good first step but we know there's a lot more to do. we need to put an end to the tragic stories we see in the news. no more babies being born addicted to meth, no more stories of meth breaking up families overwhelming the foster care system in montana, no more stories of individuals taking advantage of desperately seeking substance abuse treatments. i speak on behalf of montanans, we have had enough. doctor adams, thank you for being, here. first i would like to invite you and other administration to come to montana to see firsthand how the math crisis, mexican cartel math that is affecting our community. the opioid epidemic has certainly been felt montana, one of the greatest challenges were facing is meth use.
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doctor adams, can you speak to how math is the next wave of the open crisis. >> thank you for that and you are right, in montana the overdose rates have gone up 26% in the last year from all substances and while we see a 5% decrease nationwide we seen a 23% increase in overdose death due to meth and t stimulant. you are exactly right and i would loop back to the hhs strategy point number one better prevention treatment and better research on addiction. about a third of my commission core offices had the public service core work at ihs facility, indium research facility. i visited tribes and reservations all over the nation and what i want you toal know, e opiate crisis is not a problem but a failure to recognize untreated behavioral issues and
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build resilience into communities and the failure of a recognition to see there is massive undertreated pain in our country both emotional, mental and physical. we really need to have better prevention treatment and recovery services that includede all those things instead of plain walkable over and over again and will cut out the fire but ms fire will pop up again immersing and particularly in montana on the west coast. >> as we look at the crisis of montana, once upon a time the homegrown math used to be the source of meth had levels of 25%, the today the mexican cartel math haves purity levels north of 95%. it is much25 more potent, the prices have come down because there's more being produced in the distribution has been more
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sophisticated. it literally takes a couple days from the southern border to a reservation. >> i could not have agreed more. we work to bring together public public health, we need to work on the supply side and you talk about that but i will tell you if we don't dealor with demand and if we don't deal with people self-medicating pain and mental health issue there will always be a supply. someone will find a way. >> i completely agree as well. lastly, ial do believe we need e multifaceted approach. you've alluded to that. that's why i have been pressing the nih to develop medication assisted treatment or matt to treat the addiction and while it
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exist for opioid, alcohol and other drugs, there is no matcham for math. doctor adams are you familiar with what nih has done to develop this. >> i had a ten minute conversation with doctor yesterday specifically on this topic and i will tell you what she told me, unfortunately the research out there is not promising in terms of developing mag and they spent millions of dollars and will continue to spend more to develop better solution right now is prevention, trying to get upstream and deal with these problems before they turn into the next wave of a meth epidemic but will continue to devote research to find solutions for people who need to recover. >> would you commit to working with me to advance these efforts to assist on overcoming the meth epidemic. >> absolutely. again the parts ofce our country were native american tribal folks reside are very, very personal to me and it's where i tried to make a point of getting out and visiting and i in hhs commit we will not forget about those individuals and the citizens of our country and they
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should not be forgotten. >> i asked and the numinous consent to enter letters to the law enforcement officers and others into the record these hope to see the devastating effects on substance abuse of the local communities withou ene without objection to order. >> thank you very much. mr. chairman for you in the raking members thank you for holding this hearing into each of you on our panel, thank you very much. it's incredibly important topic that affects all of us in some way. and i'm so sorry to hear about your son brian and i'm sure that he is part of the effort you have put in to moving this forward in making a meaningful fifference for so many other families. i have heard like everyone else so any horrifying stories, individuals and families struggling to get substance abuse and health as well as mental health that is very much
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together, we know many times and mental illness people are self-medicating with alcohol and drugs when underneath there is a mental illness as well, these are very much tied together and people are trying to do the right thing with possible treatment but ultimately as you havele shown people can be taken advantage of. unfortunately i believe this is happening in part because structurally we treat behavior behavioral, addiction and mental health differently for reimbursement, it's quality standards, evidence based but also we predominantly do this and grants rather than reimbursement i could do for healthcare. we have health centers with high standards, you get full reimbursement ifo your physicin and nurse and so on at the health center. we don't yet fully have that on paper but were working very hard on it rightth now. we know right now based on a
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demonstration project, there's a right way to do things and you can spend taxpayer dollars much more wisely with high standards and in fact a couple of years ago i'm so grateful for the senator's leadership on this with me as well. around the table we have oklahoma, oregon, pennsylvania, nevada, new jersey where two years of data of what happened when you set quality standards on addiction treatment and mentalh health. . . . . ntal health and see how it plays out from people going to jail for people getting the treatment that they need and i want to thank the chairman and the members and so many people here for giving us the opportunity to take the next step to more services, more states, to actually be able to put this in place. so
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we have seen in a short amount of time, this has been and samhsa has been a league in making sure that we set up these structures, so general atoms can the excellence treatment act as acll as the behavioral health opportunity center grants that are beginning to move this structure forward. >> thank you for that question. this is very personal to me. my brother as i mentioned sits in jail right now for crimes due to his condition. wert know that many of these disorders are and it's a priority for us to make sure folks that are being treated for these disorders are having these
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issues taken into account and although we are recognizing them before they turn into substance issues and self-medication. you asked for an update and i know you've spoken with the secretary and share your excitement about what is happening. i will tell you first we have behavioral health workforce education grants and we have mental health issues extensions over $550 million distributed to 1200 health centers across the country. then the pilot grants that you mentioned. so far the results look good so i just want to say distinctly that we share your concerns and i want to thank you for your support. you all have seennc a 10% decree in your overdose rate and you've looked at this as a mental and behavioral health issue and a substance issue and not separate out the two. i want to say quickly i often tell folks along time ago
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unfortunately -- anything that happens from here here's a corridor, go see somebody, good luck. we will take care of it as your primary care visit.al as a surgeon general i was talking to providers and professional organizations encouraging them to innovate back into primary care. >> we know that it is a brain disease and that is a very important part of the body. my time is up so i will just indicate in the areas now where we have certified community behavioral health centers we have medication assisted treatment of evidence-based treatment actions working with people and in each of the centers there's also 24 hour access to the services so folks
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are not going to jail or emergency rooms and they are evil to actually talk to someone that is trained to help them. >> i think all of our panelists. i certainly agree with the points that have been made by others that we need more information for the consumers for transparency in order to prevent fraud. i also agree we have to get the matrix for that and that isn't easy. we have to narrow it where consumers can use that the most effectively making decisions. i do think that it does provide some ability to look at a group that has looked into these issues. i want to go on to a point doctor adams made when you talk about the five key messages for addressing the crisis specifically mentioning recovery
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support services. in maryland we found that it's worked well in our community. i included a provision in thesu support act the adult with studying in the medicaid program. support. they are working to increase the capacity and in baltimore county they're looking at nontraditional hours to make sure we have support programs. i would like to get your view how effective you think the programs have been and what we can do to try to encourage more opportunity particularly in the nonconventional hours in the emergency rooms and things like that. >> i have been all overn the
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lcountry and they've done four things, saturated the communities because you can't get someone to treatment and recovery and number two they have had a hand off usually through some sort of a recovery type of program. number three, they provide medication assisted treatment because that is the gold standard and number four, they've had a strong public safety and public health cooperation so that again we shift to medical lies in the problem. you asked what he can do and i will tell you i'm very proud of the fact we've increased the number substantially. 22 have been approved during this administration and that is giving the flexibility to pay for things that they feel are appropriate to improve the success rate when he took
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provided a wraparound services. you are right that it is one of the key tenets making sure you can stop your rate and get people on the pathway to become productive citizens. >> some states have implicated under the support do you have any information as to the effectiveness of the programs under the medicaid program? >> it's good that you mentioned the support act because they are beginning a review that is going to look at the support and the various states. i don't have an answer for you now that we do have work that is beginning that will provide the answer. >> if you could keep us informed ondo that i would very much appreciated. i woulappreciate it. i would like to get to one other issue we are looking at stabilization centers in.
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i agree medication is important and emergency services are important but the current reimbursement structure works against the stabilization center of the cost is usually covered. what can we do to encourage that type of care that a person that is stress needs to and allow for the funding of programs such asm stabilization centers? >> i would highlight giving states the flexibility to fund these things such as we have done but it you can speak from personal experience about the
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trouble over and over and not having a place for him to go. >> absolutely. and i think it comes back to quality measures as far as measuring and finding true science here to most effective to treat people and having a transparent set of quality measures where the information is published on a regular basis where we talk about them seeing the information, where they can learn to send their family members and that is also to understand which providers are most appropriate in their networks and which are not. and it's also so they can learn from each other. we talked a little bit here about the unscrupulous providers out there. there's a lot of good people in the provider community that are not experts at this. they don't have the information about what programs are the most
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effective and if we have transparent quality information we are not even having to regulate. they will learn from each other. so what is and just ratings but it is quality measurement and quality improvement. >> thank you. >> senator, here's what i found out. your wife sat beside my wife at the international club. we had lunch at the indian museum and she was a hostess at the international club meeting. ift your wife really that activ? is >> she is and many of you noticeknowthis if she just finid treatment for melanoma at the national institute of health and we are cancer free but she
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shared her story and your wife was so incredibly kind. she was nervous telling her story and you can tell i'm pretty nervous about this, too. she did a great job and appreciated the support. >> my wife is a 33 year survivor of breast cancer. >> thank you, chairman grassley and ranking member for holding this hearing. i want to thank all of our distinguished asses for being here today. i particularly want to thank you all for sharing your family's stories because in doing that you do help combat. the stigma that is such a part of this disease and undermines our capacity to treat it sot thank you. as many have mentioned a year ago today the support for the patients and communities the
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passage of the legislation was a critical step in addressing the crisis but it didn't happen overnight and we know that it will take a continuous investment at the federal level to ultimately reverse the tide of what is a horrible epidemic. i look forward to continuing to work on a bipartisan basis to fund the support act an to suppd on the act and expand access to prevention and treatment and recovery services. i wanted to start with a question about services and access for women in particular. they estimated 70% of women entering substance abuse disorder treatment of children and many residential treatment programs don't allow children to be present when the mother is receiving treatment. this is obviously a barrier. we have some good examples of
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what t works and they offer services like that in rochester new hampshire they've proven to be effective and the data shows when they have access to long-term evidence-based treatments outcomes move for the entire family. unfortunately they are few and far between and it's one of only a handful available to women in new hampshire. moreover, reporting from the news outlets throughout new england as well as the gao report we willto discuss today s shown they are not using what we need them to use. one of the best is residency at skan oxford house which is a recovery home model that addresses addiction. only 29% of those in the united states provide recovery housing for women.
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so, what are they doing to expand access to the long-term evidence that allows them to remain with their children in a safe environment and how can the congress to put thos support th, that is what i want youth to answer then how do we ensure we are providing access to the increasing your day learned about the work that they are doing and what are we doing, acl has a national training initiative.
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i've partnered with them to become trainees so we are not playing hot potato and so we can take care of her and two other models i mentioned again emphasizes providing thatug important so i couldn't agree with you more and we try to do all we can they would assimilate the concern and we've looked at reports and we have ongoing work on the term mortality and we
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have a report that is coming off looking at medicaid and opioid use disorder services for pregnant and postpartum women as aal part of the act being relead today. sots there will be some more information there. >> i know i'm running out of time. i will follow-up with you, doctor adams. we have a billt to help to remoe the waiver necessary for the physicians to people toct do treatment. i am concerned if people don't understand it is a gold standard and how important it is i'm concerned about the stigma attached still and i will have a question for the record tobo follow up so we can get the word out how important it is. >> i apologize for passing over you.
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she mentioned that there is a disconnect between what she has been told by experts is the appropriate time for her son to be in a treatment center and what her insurance will cover it and this is not the first time i've heard of this which drives me to the question is there a disconnect between what we know the evidence-based practices for substance use disorder treatment and the coverage of such programs >> yes. i can't say it any plainer than that. they will be magically cured and we know the recovery is a lifetime. they try to emphasize the treatment and recovery and provide the flexibility for the states to be able to provide affordable services moving forward.
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>> what would you recommend to close the gap between what is paid for and what is recommended? >> it's important that folks look at the fact you are not going to solve this problem with a short treatment and we are trained to use the flexibility that we have through the waive waivers. >> it seems to me that this is more sequential david it's working now. >> would an outcome based payment system and sure best practices are followed? >> it's something we are pushing the words and a broad array of areas. the whole fee-for-service world i think needs to be looked at
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very closely. we need to make sure we are paying people to create health and wellness and not paying people to do procedures and again they are committed to providing that flexibility but also to incentivize a new payment model if you look at what we are doing we are trying to help the states so we can scale it up. >> you previously stated you do not support heavy federal regulation but how the highway funds are tied to this for example the federal government tied funds to the addiction space. what wall should they have in te books and what if any should the
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federal government needed to ensure the uniformity? >> before i answer that,me there is one that's very important for all in the field it's part of the license for prescribing could substance is tied to education and if that is done there will be a huge improvement in the system because the doctors right now can prescribe oxycontin, vicodin, percocet without having any training and to have further partner license to be able to do so to be trained in basic prevention and treatment of addiction is a huge lift the country.
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the medical societies conforming to this grouping to be for prescribing guidelines getting tinto thestate funding going fre government and only going to the evidence-based treatment programs following evidence-based practices requiring medical schools in the state to have basic training prevention and treatment of
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addiction would be a significant improvement and if i could add one moreth to eliminate which requires any doctor in the country that wants to prescribe them are trained to become to go through a process licensing training, oversight doctors can prescribe without any additional training why do they have to go through this whole process to prescribe this and the result is less than 5% of the doctors in the country can prescribe this. less than 50% of the counties in the united states. there is legislation now in the congress and i would highly recommend that.
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>> doctor adams and other witnesses, welcome. in the state of indiana we think you are doing the country prou. i was glad to see you highlight the important work. a physician with over three decades of service was senseless because old on july 26, 2017 for refusing to prescribe and opioid if a patient, tragic. and in his memory i worked with them is senator donnelly to pass a tradition in the support act aims to reduce the overprescribing of opioids by examining ways to expandt the ue within the medicare program.
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how is hhs working on increasing the utilization of these pain management approaches? >> i got to tell you this is a major point of emphasis for usl and it's part of our five-point strategy and it can't happen fast enough. what folks don't realize is that 20 to 25 years ago when they told me this sign it came from a good place and we did and still do have an epidemic of untreated undertreated pain in this country and we went opioids is a problem and now we are pulling them back and we have a significant decrease but what i say to folks is if w that they e also measuring what we are substituting folks will continue to be angry when they don't get their pantry. we will continue to play lockable so this initiative
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afforded 945 million a contractinthecontracting agreemt 41 states to increase the research and practices and we've also gone around the country and left it up to different payment mechanisms p8 they've done a lot to make sure we are paying for the right things and we put a lot on the cms and we've got to remember the other gorilla in the room are the employer-based insurers. we also need to make sure people iare in treatment services that are actually working and this is
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something i placed a great emphasis on during the committee hearings pertaining to the crisis last congress. in your testimony you say that we amassed a massive amount of evidence early intervention treatment and recovery strategies. can you elaborate on the evidence you are referring to especially in terms of treatment because as i travel around the great state of indiana and talk to different service providers, doctors and others i have to say there is heterogeneity and varying perspectives on what works and what doesn't work. >> you mentioned a couple of things. i highlighted this because we need to make sure when someone is done with treatment they can be reintegrated back into the society. the stigma is killing more peopleom than overdose and it causes people to relapse when
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they can find a jo can't find ae reintegrated the society. it's a very important part of thisr and it's taking a the scarlet letter that we attach to people. as far as substance treatment you are right there is too much and i've actually turned over to highlightt some of the key aspects of what we should look for in a treatment center. >> we have talked about the principles of a center should have come in number one a4 and complete assessment not just of addiction issues but also mental health issues and any physical issues complete with all three with an evidence-based instrument proven to be reliable and valid delivered by someone with the credentials and once you have that assessment, to be continually reassessed i have
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chest pains today they will not only based on the first 15 minutes of your treatment will look like the naval test me again and readjusted along the way. many treatment programs don't do that so they will reassess. number three, evidence-based medication. number four, access to behavioral therapy. there's only said or seven but originally in the spotlight tht have randomly controlled trials and tested proven to work. i could go on and on but it's allc on the website and they are easily measured.
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>> it takes 17 years on average for evidence to reachch the fied and that is going to be unacceptable,av so i would welce a future dialogue about things we might be able to do at the federal level to compress that timeframe. >> i will highlight again if lists the steps that we need you all to help share that. >> will you close the meeting, senator cassidy i thank you for this very fruitful meeting. the chair will grant himself as much time as is needed. thank you for being here. first let me highlight something you all had a task force on pain management which is really good
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because the statement earlier said there is still untreated pain if we have people dying of addiction and has no they differentiated between the patient with chronic pain on a stable dose for many years never escalated, working in society. the distinction we have to make as a physician let's not turn our backs if you will on the person can trick a society which includes people in p this room d differentiate that person for those. second, to my folks in the middle, you've been ignored by things thinking about you. i hear the private insurance inmpanies are very capable of looking at pain management, looking at the outcomes of who isrn released it seems to me ths
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would be something done with a supercomputer we have the system
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are they not ready for primetime? >> not quite ready. improving but not quite ready. >> but it's rapidly improving which makes them think 48 are currently participating obviously. so can we take those as a proof of concept that are already submitting adequate data and then creating a system of scales as other states come on board. >> that is something we could explore.
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because the data is there they have to do data into these clearinghouses are better they always do a wonderful job we actually need something real time.it doctor adams is a puzzle to stand up something real-time i
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appreciate your leadership and one of the positions i think you bring up a very important question. >> let me ask one more thing. i've done a lot of work and you mentioned your brother, thank youu for your openness about tht and i think that statistic that i read is 15% entering jail have a mental health issue 30% of females if you have addiction to that you will not be hired. current law is that if you are in jail even before you are adjudicated you lose your va and medicaid benefits. i've been arrested but sometimes
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you spend six months in jail before you go to court and by mentally ill but i've lost my benefits even though subsequently been declared not guilty. this is a fairly common scenario. i'm not making thingssu up. as a physician i know that the formulary doesn't include the psychotropics my care becomes disrupted. the wisdom of allowing medicaid anti-gay benefits at least prior point of being declared guilty or not guilty.
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>> when i saw this firsthand in scott county we actually had to workrd very closely to solve our outbreak because so many folks would cycle on or off and it's a significant problem. >> so they would be admitted into there are developed resistance because they are thee getting off the one that controlled it. whewe need to look at how we can transition the system but i would also say just very plainly and frankly i learned in indiana that if we didn't have a lot of flexibility at the state level some of that is because of the law as it is written correctly so we need to take a look at that and take care of the pers
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person. >> i'm glad senator brown is here because i going to need a bipartisan colleague i think that it is over ten years to allow them to continue. throughout the last hour we talkedj about different components of the epidemic and as we talk about each, we talk about how to remedy each of these individually and i think it would be helpful if we could go back to the surgeon general adams is mentioned three times in theth last hour something ele that i don't think has gotten any time here which is the stigma the surgeon general called the biggest killer out there. he hasn't talked about any of these specific issues. why has he said that?
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he said that because it reaches everything we have been talking about for the last hour. if this policy is in jails where people lose their insurance, why is that? because most people in america think that it's bad people doing bad things and can't make good decisions. when the science shows that is not the case. it's why isn't the payment policy equal to other physical disease? because we have grown up in a healthcare industry that believes it's their fault. we shouldn't pay for treatment. the 20% of doctors in this country, excuse me in the state of massachusetts in a recent study that we did, which i suspect is relative to the rest of the country don't want people that are addicted in their waiting rooms. it might affect their practices. 80% of americans in a recent poll 80% in a recent poll said i am uncomfortable associated with
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someone with possession of lightsyards, my friend, my cowor were my neighbor. so, let's say we get through all the hurdles we've been talking about in the last hour, if someone gets the treatment it's one of the reasons they don't go to treatment and they don't want anyone to know. what say they can pass that her all and if the parents force them in to get the treatment and then they find a provider even though there are very few providers treated today for the reasons we have been talking about. then they get to a provider that delivers quality care to all the hurdles we have heard about today and they are successfully treated in the enter a society where 80% of america doesn't want to be workin you working nm are living in their neighborhood, they don't want you to be their friend, to marry their daughter or dating their daughter. i'ma sure my son didn't see thoe statistics were the 20 million
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americans it's not just opioids, 20 million americans who are addicted to drugs or alcohol see that survey that they feel that everyday. >> i think you and doctor adams for being so honest with your experience because that helps to fight stigma. senator brown. >> thank you, sir, thank you all for being here and mr. mandela for coming to my office several months ago. i know there's a lot of pain on the panel and a lot ofk us have hadco deaths in our family but e think should have happened or incarcerations are just difficult times, so thank you for making it a mission of your lives to step up and help others so they don't have to experience the pain many of us in this room have. i want to start with doctor mccauley and a couple of questions for you first. inw the course of the gao work n
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this report, how many instances -- a couple questions together, how many instances of substance abuse disorder treatment related medicare medicaid fraud did you investigate across the five states and of the total, what percentage involved a case where a patient was the perpetrator of the fraud? >> thank you for the question. we are a little different than the ig. we don't do the investigation of the case that would bee a better question for mr. cantrell. howeverf we do take a sample selection over the five states and we found all five states have reported fraud and then we went in and spoke with various actors involved in that including the medicaid fraud unit and to our knowledge, again we don't go into the case, but for example in florida, they were lured there unknowingly and brokered into other places without their knowledge. >> i want too ask and you can
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respondwl to this based on your work is it you your opinion or individuals with a substance disorder diagnosis of seeking treatment are generally the culprits in the cases or more likely the victim's? >> in the cases that we see they are the victims. >> overwhelmingly. >> we certainly have some participating patients who are often maybe theyou are a patient but they are also a patient broker where they try to solicit other individuals to come into the scheme but generally speaking if they are the victims ofie the crimes. >> do you com you both, the twou both believe that states are doing a good job of addressing fraud when you say they maintain the tools they have? at the forefront they had in their hands the tools and authority is necessary to police this fraudulent behavior committed much less often by the victims than the perpetrator?
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>> certainly on the health care fraud space they are very active in this space. our office is very active but where i think that there have been maybe the need for additional oversight not in the law-enforcement space but the oversight of the treatment facilities and quality standards as we have discusseded here tody i'm sure there are plenty treatment centers receiving federalr funding and delivering the product to the treatment that we all expect.a >> the also found in our states florida, massachusetts and utah started certification or licensure programs in texas and ohio while they didn't have the programs that they were providing training and other services to the operators of the homes, they were very concerned and wanting to take over. >> thank you. this question ipe will start eah of you answer if you want and i will preface it by there are i think everyone o every one of us committee both parties think we
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are not arguin not targeting ine prevention education, upscaling treatment and all that and i applaud doctor cassidy for his interest and i know senator markey and others on the pretrial incarcerated to keep them on medicaid. it's just upside down thinking to take away their medicaid when they mostly needed at this point. we are clearly not doing enough to provide the kind of treatment options to everyone that needs them but while the overall, we know the overall number of non- elderly adultsf with a substance abuse disorder receive treatment is low, we know that those with medicaid are significantly more likely to receive treatment than those with private coverage. for instance, thousands or recovering and receiving treatment right now because of medicaid. i recovered at a substance abuse clinic in cincinnati and a man put his hand on his adult
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daughter's arm and said gently my daughter wouldn't be alive if it were not for medicaid. we know those stories and statistics. my question for each of you is if you can answer as closely as you can, yes or no, we are putting additional burdens on the beneficiaries making it harder for themul to access and maintain coverage that could compromise efforts to address the addiction treatmentem and limit access to substance abusem disorders. are those additional burdens helpful or are they not? >> you are talking about medicaid? i would say we want to make medicaid as effective and easy to access as we possibly can and you frameme it as a burden i dot know which particular provisions you are referring to, but i do believe that we should make medicaidn more available and we have tried to give states the flexibility through a record number of waivers to craft the medicaid programs in a way that works for the citizen and
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constituents. >> we currently have work looking at beneficiaries of medicaid and access to medicaid for example. >> we have work that looks at medicaid eligibility, but i do not -- i'm not the expert on that so we would have to get back to you on that. >> i would completely agree with ithe comments earlier. any barriers for those who don't have insurance to get medicaid absolutely create a lot more loss of life in terms of the system peopleld going to the er and present etc., etc.. we need to keep as few barriers as possible so few people can be a medicaid needed and are qualified for medicaid without barriers can absolutely 100%. >> i appreciate the response. i would just close with senator cassidy that the position of the
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work requirements and medicaid programs will have a chilling access to treatment. this hearing underscores the absolute ludicrousness if that is a word and the hardheartedness of far too many people in this body and the trump administration who are trying m to repeal the affordabe ware act and couldn't do it here. they tried very hard and put into that here. they wanted it through the courts and it's hard hearted and stupid and it will mean a lot more people die of this assault on the affordable care act in my state of 900,000 people have insurance that didn't m have it. we know what it means to young people on their parents plan and what it means for the expansion. we had a republican governo havn ohio but showed more courage than most of his party members around the country and expanded medicaid and it saved thousands of lives and it's just
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absolutely cool and stupid policy to think repealing the affordable care act could possibly be good foror the country. thank you. >> senator cassidy, can i make one quick comment? i would adjust very quickly say that i ran stayed department of health and indiana when we expanded coverage to several hundred thousand citizens and as the surgeo surgeon general and t everyone to hear me say that access to quality, affordable healthcare is critically important. this administration believes we should give states the flexibility and opportunity to do that in a way that works best for them that has occurred in indiana and again the record number of other 15 shows the commitment to that flexibility and giving states that flexibility and in my opening statement i talk about the industries and about indiana and new york and i think it's important that when we talk about work, we understand one of
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the biggest predictors of whether someone is going to be successful inen long-term recovy is whether or not they can get back to work and so i will be the first to admit the idea of work requirements is a hot button political topic but i don't want us to lose the strong data that says we need to think about ways that we can help people reintegrate back into society and get a job. that's what i'm focused on as the surgeon general is ho is tag over thhow canwe love for the bf people getting back to work and how can we bring people together so folks can truly recover and thank you so much for the opportunity to testify today. this is a critically important hearing, and i also want to give you a shout out, senator brown, for the work you are doing in ohio. i know you all have been able to drive down your overdose rate in the state by over 10%. and it's because of the partnership. >> it is in large is the extended medicaid and the president of the united states wants to take it away.
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i appreciate who appointed you and i don't know your political philosophy, it doesn't matter but i appreciate your comments on the work requirements to the fact is ifpr the president of te united states wants to wipe off the books in the affordable care act with a placement on medicaid and the fact that we have driven down not very far yet but driven from the death rate in ohio and addiction rate in ohio is because we have a very, very important public health told. >> that will be the final rule the chair will thank you all for your testimony. we leave the record open for two weeks for submissions of questions for the record and the hearing is now adjourned. >> thank you. >> [inaudible conversations]
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we are back with our political roundtable here with us democratic pollster and strategist working for the booker campaign and also worked for the obama presidential campaign in 2008 in six southern states and connor mcgwire the republican pollster and strategist working directly with the republican national committee and work with president trump as well. thanks for being here. let me begin with the pull that showed and we just recently this has come up that 55% of those

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