WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA), a member of the Senate Finance Committee, made the statement below after Finance Committee leaders announced a path forward for an improved version of a bipartisan bill to lower the cost of prescription drugs. Sen. Warner supported the original version of this legislation in July, when it passed the Committee by a bipartisan vote of 19-9.

“I applaud Finance Chairman Grassley and Ranking Member Wyden for reaching a bipartisan agreement on drug pricing legislation we drafted in the Senate Finance Committee earlier this year. This bill will produce billions in savings for seniors by placing a cap on their out-of-pocket spending. It will also prevent drug companies from unfairly jacking up the costs of their products by penalizing companies that increase their prices above the rate of inflation,” said Sen. Warner. “I’m proud to know that this legislation includes language from a bill I authored to reauthorize an independent nonprofit corporation established to save Americans money on their health care costs. This improved bill also extends other important federal funding streams to strengthen our nation’s rural and safety net hospitals, increases access to quality home care for seniors, and improves our nation’s foster care system.”

He continued, “This legislation will bring much-needed relief to Virginians who are struggling to deal with the crushing burden of their health care and prescription drug costs, and will also extend critical programs that support continued health care access and affordability for millions of Americans. I look forward to working with Chairman Grassley and Ranking Member Wyden to pass this overdue legislation through the Senate and get it to the President’s desk for his signature.”

The modified version of the Prescription Drug Pricing Reduction Act of 2019 (PDPRA) – a bipartisan bill passed by the Senate Finance Committee earlier this year – includes language from Sen. Warner’s bipartisan legislation to reauthorize for ten years the Patient Centered Outcomes Research Institute (PCORI), an independent nonprofit corporation established to help patients better understand their diagnostic and treatment options. The modified bill utilizes the savings it creates to pay for this and other important health extenders, including a permanent payment rate increase for low-volume and Medicare dependent hospitals, three-year extensions for the National Quality Forum, the Independence at Home (IAH) program, the Temporary Assistance for Needy Families (TANF) program, and State Health Insurance Assistance Programs. The bill also stops scheduled payment rate cuts to Medicaid Disproportionate Care hospitals that serve a higher percentage of vulnerable individuals.

Like the version of the bill that passed earlier this year, this legislation will lower the cost of prescription drugs by overhauling the Medicare Part D program. It will create a $3,100 yearly out-of-pocket cap to protect seniors with high drug costs and penalize pharmaceutical companies that raise the cost of a prescription drug faster than the rate of inflation. This bill includes an additional provision to further reduce seniors’ out-of-pocket costs by reducing their required cost sharing from 25 percent to 20 percent in the initial coverage phase. It also includes a provision similar to Sen. Warner’s bipartisan legislation that would allow state Medicaid programs grappling with rising drug costs to explore value-based pricing arrangements that peg the price of a drug to its effectiveness.

A recent report on the cost of prescription drugs in Virginia found that the annual cost of prescription drug treatment increased by 57.8 percent between 2012 and 2017, dramatically outpacing the 8.5 percent growth in Virginians’ incomes over the same period.

In Congress, Sen. Warner has long pushed for policy changes to help lower prescription drug costs for Virginia seniors and families. Last month, Sen. Warner introduced a bipartisan bill to reauthorize PCORI and help Americans save on their health costs. In January, Sen. Warner reintroduced legislation to allow Medicare to negotiate prescription drug prices—a move that would cut costs for nearly 43 million seniors enrolled in Medicare Part D.

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WASHINGTON – Today, U.S. Sens. Mark R. Warner (D-VA) and Tim Scott (R-SC) introduced the Ensuring Seniors Access to Quality Care Act to help senior living facilities caring for aging adults to better screen, hire, and retain quality staff. The Ensuring Seniors Access to Quality Care Act would provide nursing home operators with access to the National Practitioner Data Bank (NPDB) – an existing national criminal background check system – a move that would give employers greater ability to screen and vet potential employees to ensure that caregivers do not have a history that would endanger the seniors under their care.

“Anyone with a loved one in a senior living facility should have the peace of mind of knowing that they are receiving care from compassionate, dependable, and well-qualified staff as they live out their golden years,” said Sen. Warner. “This bipartisan legislation will help provide these facilities with the tools they need to hire experienced staff and to continue to meet the demands of high quality care without losing staffing levels.”

Our senior citizens, and their families, know the importance of having well-qualified, compassionate and trustworthy caregivers in senior living facilities,” said Sen. Scott. “The Ensuring Seniors Access to Quality Care Act will help these facilities more efficiently hire the best candidates, and, in turn, provide better care for seniors everywhere.” 

Currently, senior living facilities are not authorized to use the NPDB and instead must rely on state-level criminal background checks that can often omit key details about an employee’s background.

Additionally, the bipartisan legislation amends overly restrictive regulations that bar certain senior living facilities from conducting training programs for in-house Certified Nurse Assistants (CNAs) – individuals who assist patients with their daily activities – for a two-year period after a care facility is found to have deficiencies, such as poor conditions or patient safety violations. Under existing regulations by the Centers for Medicare and Medicaid Services (CMS), senior living facilities that receive a civil monetary penalty (CMP) over $10,000 are automatically prohibited from conducting CNA staff training programs for a period of two years.

According to the Bureau of Labor and Statistics, the need for nursing assistants to care for the growing aging population is projected to rise 9 percent from 2018 to 2028. With this growing need for caregivers, in-house CNA education at senior living facilities often helps meet the need for CNAs. But with the existing two-year lockout period, it can make it more difficult for senior care facilities to properly train new employees and retrain existing employees. Research by CMS also indicates that there is a direct correlation between facilities that are staffed adequately and the high-quality care they provide.

Specifically, the legislation would allow senior living facilities to reinstate its CNA training program if:

• The facility has corrected the deficiency for which the CMP was assessed;
• The deficiency for which the CMP was assessed did not result in an immediate risk to patient safety and is not the result of patient harm resulting from abuse or neglect;
• And the facility has not received a repeat deficiency related to direct patient harm in the preceding two year period.

“CNAs are essential to the quality care provided in long term care facilities. In addition, the jobs provided by nursing homes and assisted living communities are important to many communities, especially rural areas, where they are often a major employer,” said Mark Parkinson, President and CEO of the American Health Care Association/National Center for Assisted Living. “This bill does two important things. First, it will help ensure that long term care providers have the ability to provide training programs for CNAs. Just as important, it will allow skilled nursing facilities access to the National Practitioner Data Bank, providing a better way to conduct background checks on potential employees. We applaud Senator Warner and Senator Scott for taking this important step to address the worker recruitment and retention challenges facing providers.”

“Workforce development is crucial to our members’ ability to provide top-notch care. The loss of nurse aide training authority is an obstacle to quality improvement for nursing homes, and particularly when increased staffing levels are needed,” said Katie Smith Sloan, President and CEO, LeadingAge. “We have for years advocated for changes to the training lockout mandated under the Nursing Home Reform Act of 1987. This legislation, like similar legislation in the House (H.R. 4468), offers a much-needed solution to help alleviate the severe workforce shortage in long term care. CNAs, who provide direct care to residents, are the backbone of every nursing homes’ team.”

“LeadingAge Virginia applauds Senators Mark Warner and Tim Scott for introducing legislation that will enable training of certified nursing assistants (CNAs). Under federal law, nursing homes are inspected annually and fines are assessed for any deficiencies in compliance with federal regulations. If these fines exceed a certain level, a nursing home automatically loses its authority to train CNAs for two years,” said Melissa Andrews, President and CEO of LeadingAge Virginia. “This ‘CNA Training Lockout’ runs counter to a nursing home’s ability to provide the highest quality of care and we appreciate the Senators for introducing legislation to overcome this barrier.”

“Having started my career in long term care as a nursing assistant, I know how critical they are to providing direct care to thousands of patients and residents every day. Ending the CNA training lockout will have a tremendously positive impact on our ability to train more caregivers to work in our nursing homes,” said David Tucker, Chairman of Virginia Health Care Association – Virginia Center for Assisted Living (VHCA-VCAL) and President and COO of Commonwealth Care of Roanoke.

“Westminster Canterbury Richmond believes that a qualified workforce is crucial for the overall success of a nursing home to provide the highest quality of care. The training lockout is an obstacle to achieving this goal, and we believe this legislation is a positive step forward,” said John Burns, President and CEO of Westminster Canterbury Richmond, and a member of the LeadingAge Virginia Board of Directors.

“At a time where we need more individuals to choose the important and meaningful work of service to older adults throughout this country, limiting the ability to train future generations of care workers is not the answer,” said Rob Liebreich, President and CEO, Goodwin House Incorporated.

“Having access to the National Practitioner Data Bank would be extremely beneficial for us. It would help prevent bad actors from hopping from state to state,” said Melissa Green, Chief Clinical Officer of Trio Health Care, LLC, Hot Springs, VA and a nursing home operator who has facilities close to neighboring states. She cites an incident when it was revealed that an employee had stolen an identity to work as a nurse—without access to the NPDB there was no way to know the actual nurse’s identity was stolen even though the nursing home completed the required background checks.

“Because of the CNA training lockout, we’ve reduced the number of qualified CNAs entering in the workforce, which has had a trickle-down effect on a facility the size of ours,” said Keith Denson, Administrator, Snyder Nursing Home, Inc., Salem, VA. “If we’re not training our people to take care of our unique and wonderful residents, who will do it? Training programs in the community lack the continuity of care and the CNA to resident experience that provider programs offer. I am very appreciative of the trust Sen. Warner has in our ability to train our staff to take care of our residents.”

Sen. Warner has been a longtime advocate of improving long-term care for seniors. In 2000, Sen. Warner’s mother was diagnosed with Alzheimer’s, passing away in 2010 after battling the disease. Her diagnosis and the family’s subsequent struggle to find qualified care and support resources inspired Sen. Warner to launch SeniorNavigator.com, an online information and referral network for older Virginians and their caregivers. In the Senate, Sen. Warner serves as a Co-Chair of the Alzheimer’s Caucus and has helped lead efforts to secure robust funding for Alzheimer’s research, prevention, and treatment. He’s also introduced bipartisan legislation designed to give people with serious illnesses new tools to plan for their care, and empower them to have those choices honored. Sen. Warner has also sponsored legislation that allows seniors with multiple chronic conditions to receive enhanced care in their homes – an effort to decrease hospital readmissions – and expand telehealth services for seniors to increase access to primary care services in rural communities. The Senate unanimously passed this bill in September of 2017, and the bill was signed into law in 2018.

The text of the Ensuring Seniors Access to Quality Care Act is available here.

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WASHINGTON – U.S. Sens. Mark R. Warner (D-VA) and Cory Gardner (R-CO), the bipartisan co-chairs of the Senate Cybersecurity Caucus, issued a statement after convening a classified briefing with Senators and Chris Krebs, Director of the Department of Homeland Security's Cybersecurity and Infrastructure Security Agency (CISA), to discuss the growing threat posed by ransomware attacks:

“The continued prevalence of ransomware should really capture our attention. It’s costly, devastatingly high-impact, growing, and, in most cases, easily preventable with basic responsible cybersecurity practices.

“Ransomware and its destructive cousin wiperware are designed to inflict fear and uncertainty, disrupt vital services, and sow distrust in public institutions. While often viewed as basic digital extortion, ransomware has had materially adverse impacts on markets, social services like education, water, and power, and on healthcare delivery, as we have seen in a number of states and municipalities across the United States.

“We are glad our colleagues in the Senate Cybersecurity Caucus could join Director Krebs for this much-needed conversation about ways Congress and the federal government can better address this important issue.”

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WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA) joined 35 members of the U.S. Senate and 161 members of the U.S. House of Representatives fin filing an amicus brief in the case of June Medical Services LLC v. Gee, which is currently pending before the Supreme Court of the United States and represents a direct challenge to the Supreme Court’s landmark ruling in Roe v. Wade. 

June Medical Services LLC v. Gee addresses the impact of Louisiana’s Act 620, an extreme anti-abortion law that forces abortion providers to obtain admitting privileges at a hospital within 30 miles of their clinic. The law provides no medical benefit and would harm patients by stifling access to abortion care. If the law goes into effect, only one clinic and one abortion provider would remain in Louisiana – a state with over 360,000 women of reproductive age.

“Act 620, disguised as an effort to promote women’s health, provides no medical benefit and instead will only create significant obstacles for women seeking abortions,” the lawmakers wrote in the brief. 

Lawmakers emphasized in the brief that, just three years ago in Whole Woman’s Health v. Hellerstedt, the Court struck down a materially identical Texas law because it imposed significant burdens on abortion access without providing health or safety benefits. Since then, the facts, the law and the Constitution have remained the same. Lawmakers urged the court to uphold its precedent in Roe, Planned Parenthood v. Casey and Whole Woman’s Health and strike down Act 620.

“There is no compelling reason here to upend this settled precedent, and no change of circumstances between Whole Woman’s Health and this action that justifies a different outcome … Laws like Act 620, enacted in defiance of this Court’s constitutional pronouncements, undermine our nation’s confidence in the legislative process and the rule of law,” wrote the lawmakers in the brief.

Read the amicus brief here.  

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WASHINGTON, D.C. – U.S. Senators Mark Warner (D-VA), Tim Kaine (D-VA), and David Perdue (R-GA) introduced bipartisan legislation to allow March of Dimes to continue its lifesaving work on behalf of all moms and babies.

The Protecting Critical Services for Mothers and Babies Act allows March of Dimes to qualify for the same pension funding rules as many other charities and non-profit organizations. Specifically, the bill would designate March of Dimes as a Cooperative and Small Employer Charity (CSEC) pension sponsor to provide it with more predictable and affordable pension funding options.

The change would have no impact on retirees or other participants, and it would come at no cost to taxpayers. 

“This bill will allow March of Dimes to continue fulfilling its lifesaving mission fighting for the health of moms and babies in communities across the country and the globe,” said Senator Warner. 

“March of Dimes does incredible work to support mothers and children,” said Senator Perdue. “Through research, education, and advocacy, March of Dimes helps address the unique challenges that come with growing a family. Our bill simply allows March of Dimes to qualify for the same pension program as other non-profit organizations. Ultimately, this small change ensures March of Dimes can continue lifesaving medical research and programming.” 

“March of Dimes has played a critical role in serving mothers and babies for more than eight decades,” said Senator Kaine. “I’m thrilled they decided to move their headquarters to Crystal City, and I’m pleased to support their important work with bipartisan legislation that will ensure they are subject to the same pension funding rules as many other non-profits and charities.”

Perdue and Kaine’s bill is cosponsored by U.S. Senators Tim Scott (R-SC) and Mark Warner (D-VA). Companion legislation was introduced in the U.S. House of Representatives by U.S. Representatives Lucy McBath (D-GA-06), Rob Woodall (R-GA-07), Don Beyer (D-VA-08), and Phil Roe, M.D. (R-TN-01).

“The March of Dimes organization provides some of our most vulnerable citizens, mothers and infants, with crucial support as they face the challenges of raising a child,” said Senator Scott. “March of Dimes shouldn’t have to choose between providing a reasonable legacy pension program to its employees or continuing their organizational mission. I am proud to support legislation that will allow March of Dimes to continue its mission of lifesaving research, educational resources, and advocacy efforts.”

“For over 80 years, March of Dimes has done the important work of improving health care for our mothers and babies,” said Congresswoman McBath. “As a mother and two-time breast cancer survivor, I am proud to support this legislation that will allow March of Dimes to focus on improving maternal and infant health throughout the country, while ensuring the organization can continue to fulfill its obligations to the workers who carry out this important mission.” 

“Eighty years after the March of Dimes was first established to save lives during the polio epidemic, the organization continues to support mothers and babies around the world through research, education, and support services. Now, at a time when March of Dimes is forced to choose whether to help its employees retire with dignity and financial security or continue its core mission in service to others, Congress must act,” said Congressman Woodall. “I am proud to support this commonsense legislation so that March of Dimes is free to make the financial decisions necessary to ensure the solvency of its pension program and that mothers and babies continue to receive the vital support they need.”

“I am proud of the work March of Dimes has done to support mothers and their children both across the United States and in Virginia’s Eighth Congressional District,” said Congressman Beyer. “It is now our turn to support March of Dimes.  I urge my colleagues in the House to support this bill and I hope it passes as soon as possible.”

“March of Dimes extends its deep appreciation to Rep. Lucy McBath (D-GA), Rep. Rob Woodall (R-GA), Sen. David Perdue (R-GA), and Sen. Tim Kaine (D-VA) for their leadership on bipartisan legislation introduced today that will help us continue to fight for the health of all moms and babies,” said Stacey D. Stewart, President and CEO of March of Dimes. “The legislation allows March of Dimes to have the same predictable and consistent pension funding rules as many other non-profits and charities with legacy pensions. That will ensure we can continue to fund cutting edge research to prevent pre-term birth, implement education and support programs for pregnant women and their families, and work on policy solutions to address our nation’s maternal and infant health crisis. We look forward to working with Congress to enact this commonsense legislation as soon as possible.” 

Click here to view text of the bill. 

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WASHINGTON – Today, U.S. Sen. Mark Warner (D-VA), Sen. Chris Van Hollen (D-MD) and U.S. Representative John Sarbanes (D-Md.) and colleagues sent a letter to House and Senate leadership, urging conference negotiators to include significant increases in funding to the Chesapeake Bay Program within the final Fiscal Year 2020 funding bill. Senator Van Hollen, a member of the Appropriations Committee, and his Bay colleagues fought to pass an increase of $5.28 million – for a total $78.28 million – in the Republican-led Senate’s funding legislation. But to fully invest in the health of the Bay, the Members urge conference negotiators to support the House-passed funding of $85 million.  

The Members write, “As the House and Senate negotiate the final Fiscal Year 2020 funding bill, we urge you to accept the funding level with the increased allocation according to the adopted report language from the House-passed Interior, Environment, and Related Agencies Bill, which provides $85 million in funding for the Environmental Protection Agency’s (EPA) Chesapeake Bay Program.”

They continue, “The Chesapeake Bay is an economic driver for the entire region – including recreation, education, and commercial enterprises.  It is critical that the Chesapeake Bay restoration effort meet its 2025 pollution reduction goals. The Chesapeake Bay Program is a national model for clean water partnerships and an important bellwether for the success of other major body of water restoration efforts around the country.  We are within sight of delivering clean water.  For these reasons, we hope you will support funding the program at $85 million in the conference report.”  

In addition to Senator Van Hollen and Representative Sarbanes, the letter was signed by Senators Ben Cardin (D-Md.), Mark R. Warner (D-Va.), Kirsten Gillibrand (D-N.Y.), Christopher A. Coons (D-Del.), Tim Kaine (D-Va.), Robert P. Casey, Jr. (D-Pa.), Thomas R. Carper (D-Del.), and Joe Manchin (D-W.V.). 

In the U.S. House of Representatives, the letter is signed by Representatives Robert C. “Bobby” Scott (D-Va.), Robert J. Wittman (R-Va.), Steny H. Hoyer (D-Md.), Abigail D. Spanberger (D-Va.), Gerald E. Connolly (D-Va.), Lisa Blunt Rochester (D-Del.), Jamie Raskin (D-Md.), Anthony G. Brown (D-Md.), Eleanor Holmes Norton (D-D.C.), Donald S. Beyer Jr. (D-Va.), Jennifer Wexton (D-Va.), C.A. Dutch Ruppersberger (D-Md.), Elaine G. Luria (D-Va.), A. Donald McEachin (D-Va.), David Trone (D-Md.), Denver Riggleman (R-Va.), Chrissy Houlahan (D-Pa.), Lloyd Smucker (R-Pa.), and Daniel P. Meuser (R-Pa.). 

The full text of the letter is available here and below.

Dear Chairman Shelby, Vice Chairman Leahy, Chairwoman Lowey, Ranking Member Granger:

As the House and Senate negotiate the final Fiscal Year 2020 funding bill, we urge you to accept the funding level with the increased allocation according to the adopted report language from the House-passed Interior, Environment, and Related Agencies Bill, which provides $85 million in funding for the Environmental Protection Agency’s (EPA) Chesapeake Bay Program.

Since the states and EPA agreed to the Chesapeake Bay watershed restoration goals in 2010, much progress has been made towards improving the health of the watershed. Today, we are at a critical juncture in Chesapeake Bay restoration.  Positive signs of recovery have emerged in the Chesapeake Bay itself and in tributaries throughout the entire watershed, proving that the collaborative restoration effort is working.  We are more than half-way to achieving the shared goal of clean water by 2025. 

But as the 2025 deadline approaches, it is clear that more resources are needed to continue the progress made.  New research pertaining to increased nutrient and sediment flows through the Conowingo Dam indicates that we must reduce over 6 million pounds of pollution beyond the original 2010 targets. To address this issue, in December 2017, the Chesapeake Bay Program Principals’ Staff Committee (PSC) agreed to work collaboratively on a separate Conowingo Watershed Implementation Plan (WIP).

More broadly, although we now know what conservation practices provide the greatest return, we lack funding for implementation at the scale required.  Dollars are needed at three levels: 1) the small watershed and innovative practices grant programs; 2) local government technical assistance and implementation; and 3) state-based targeted and cost-effective implementation.

We appreciate the $5.28 million increase for a total of $78.28 million for the EPA Chesapeake Bay Program passed in the recent Senate minibus, but we think the resource needs in the Chesapeake Bay watershed demonstrate a need for an increase to $85 million. By increasing the EPA Chesapeake Bay Program funding level to $85 million, it would be possible to achieve significant measurable results in each of these areas, and each federal dollar leverages many more in State, local and private funding.

The Chesapeake Bay is an economic driver for the entire region – including recreation, education, and commercial enterprises.  It is critical that the Chesapeake Bay restoration effort meet its 2025 pollution reduction goals. The Chesapeake Bay Program is a national model for clean water partnerships and an important bellwether for the success of other major body of water restoration efforts around the country.  We are within sight of delivering clean water.  For these reasons, we hope you will support funding the program at $85 million in the conference report.

Thank you for your consideration of this request.                                                                                                                      

Sincerely,

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Washington, DC -- Today, Senators Mark Warner (D-VA) and Tim Kaine (D-VA) joined Congresswoman Jennifer Wexton (D-VA) in sending a letter requesting that the National Park Service (NPS) conduct a reconnaissance survey to evaluate the suitability of designating the George C. Marshall House, known as Dodona Manor, in Leesburg as an “affiliated area” under NPS.

“Designating the George C. Marshall House as an affiliated area under NPS would bring increased public interest and awareness of Dodona Manor and would produce additional funds to further assist in its preservation,” said the lawmakers in the letter. “Dodona Manor has a clear historic value to our nation. To honor General Marshall’s life and legacy, it would be fitting for Dodona Manor to become an affiliated area under NPS to ensure its preservation for future generations.”

General Marshall led a lifetime of public service, serving as Chief of Staff to the Army during America’s entry into World War II, as Secretary of State where he orchestrated the historic Marshall Plan to rebuild Europe following the war, and as Secretary of Defense after the onset of the Korean War.

Dodona Manor is currently registered as a National Historic Landmark by the Department of the Interior and has been designated by the Commonwealth of Virginia as a Virginia Landmark.

The Marshall House has been an integral part of the Leesburg community for over two centuries. General Marshall and his wife Katherine purchased the property in 1941 as a weekend retreat house, and regularly spent time at the property throughout General Marshall’s tenure as Secretary of State and Secretary of Defense.

Today, the property hosts international exchanges, historical exhibits, community events, and educational programming about the life and legacy of the Marshall family.

The full text of the letter is available here and below.

November 20, 2019

The Honorable David Vela 
Deputy Director, Operations 
Exercising the Authority of the Director 
National Park Service 
1849 C Street NW 
Washington, DC 20240

Dear Deputy Director Vela:

We write to urge the National Park Service (NPS) to conduct a reconnaissance survey to explore the suitability of designating General George Catlett Marshall’s home and gardens, known as Dodona Manor, located at 217 Edwards Ferry Road in Leesburg, Virginia as an affiliated area under NPS. Dodona Manor has great historical and educational significance and NPS’s designation would help preserve the property for future generations. 

As one of only five individuals to serve the United States as a five-star General of the Army, General George C. Marshall was known for his integrity and selfless service that made him an American visionary and hero. General Marshall’s Dodona Manor is rich in history. General Marshall and his wife Katherine purchased Dodona Manor in 1941 and they lived there during the most important period of General Marshall’s career. The Marshall family owned the House during General Marshall’s tenure as U.S. Army Chief of Staff, Special Envoy to China, Secretary of State, President of the American Red Cross, Secretary of Defense after the onset of the Korean War, and Chairman of the American Battle Monuments Commission. Notably, General Marshall was awarded the Nobel Peace Prize in 1953, the only professional soldier so honored, for his leadership and contributions to the economic recovery of Europe following World War II while living in Dodona Manor.

Dodona Manor is now used to preserve and advance General Marshall’s life’s work and legacy. The Marshall home has been impeccably restored to museum standards with original Marshall furnishing, which accurately displays a picture of how this American hero lived to the public. It also presents in an educational format how the Marshall family dedicated themselves to public service and supports educational programming based on General Marshall’s desire to inspire future leaders. By hosting international exchanges, historical exhibits, and community events, Dodona Manor perpetuates his memory and contributes directly to the character and viability of Leesburg.

General Marshall’s House is currently registered with the Department of the Interior as a National Historic Landmark and has been designated by the Commonwealth of Virginia as a Virginia Landmark. Designating the George C. Marshall House as an affiliated area under NPS would bring increased public interest and awareness of Dodona Manor and would produce additional funds to further assist in its preservation.

 Dodona Manor has a clear historic value to our nation. To honor General Marshall’s life and legacy, it would be fitting for Dodona Manor to become an affiliated area under NPS to ensure its preservation for future generations. Therefore, we would appreciate your consideration of our request to conduct a reconnaissance survey. Thank you for your attention to this matter and we look forward to your response.

Sincerely, 

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WASHINGTON – U.S. Sens. Mark R. Warner (D-VA) and Chuck Grassley (R-IA) today formally requested an FBI briefing on its investigation into the fatal shooting of Bijan Ghaisar by U.S. Park Police in 2017. The FBI announced the conclusion to its lengthy investigation last week, but did not fully explain its findings, including why the two officers opened fire on Ghaisar.

The senators have long sought transparency into the circumstances surrounding the deadly use of force and the FBI’s review of the case, but the FBI largely declined to provide details at the time, citing an ongoing investigation. Now that the investigation has concluded, the senators are demanding greater clarity to provide needed transparency and preserve the public trust.

“Despite nearly two years of investigating this incident in which considerable FBI resources were used, the Ghaisar family, Congress, and the general public still do not have all the answers.  The FBI needs to provide a full and thorough account of the events that led to Mr. Ghaisar’s untimely death,” the Senators wrote.

In January of 2018, Warner, along with Sen. Tim Kaine (D-VA) and Rep. Don Beyer (D-VA), pushed the FBI for an update on the status of the FBI’s investigation into the fatal 2017 shooting. In October of that year, Warner sent a letter to the head of the National Park Service (NPS) regarding the circumstances under which U.S. Park Police officers engaged with Mr. Ghaisar.

Grassley, then chairman of the Senate Judiciary Committee, contacted the FBI about the investigation in December of 2018. The FBI responded in March with little information, provoking a follow-up letter from Grassley.

In June, Grassley and Warner decried the opaque and drawn-out nature of the review in letters to both the FBI and NPS. The FBI provided a brief response in August, leaving many questions unanswered. In October, NPS provided a partial response, which prompted a follow-up letter from the Senators seeking more information.

Following the recent conclusion of the FBI’s investigation, the senators pledged to seek greater transparency. Full text of the senators’ official request for a briefing follows. A copy of the letter is available here.

November 20, 2019

The Honorable Christopher Wray

Director

Federal Bureau of Investigations

Washington, D.C. 20535

Dear Director Wray:

We write today to request a briefing and a response to Senator Warner’s letter from January 30, 2018, Senator Grassley’s letters from December 17, 2018, and March 22, 2019, and the Senators’ joint letter from June 18, 2019, on the shooting of Bijan Ghaisar.  While the FBI has announced it has concluded its investigation into the shooting of Mr. Ghaisar, the FBI has continuously refused to answer several questions that were raised in the aforementioned letters because the investigation had yet to conclude.  Now that the investigation has concluded, we expect to receive answers to these questions and a briefing on the FBI’s investigative process and findings. 

Investigations into the use of deadly force must be handled in a way that reinforces public confidence in law enforcement.  Following completion of these types of investigations, it is necessary for investigators to be fully transparent to ensure that the public understands the circumstances of each incident.  This creates transparency and builds public trust in law enforcement.  Despite nearly two years of investigating this incident in which considerable FBI resources were used, the Ghaisar family, Congress, and the general public still do not have all the answers.  The FBI needs to provide a full and thorough account of the events that led to Mr. Ghaisar’s untimely death.

In order to shed light on this delicate situation, we ask that you respond to Senator Grassley’s and Warner’s letters and provide us with a briefing summarizing the findings of this investigation by no later than December 15, 2019.   Additionally, we ask that you please arrange a time to provide our staffs with a briefing no later than December 6, 2019.

Sincerely,

Charles E. Grassley

United States Senator

Mark Warner

United States Senator

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WASHINGTON – Today, U.S. Sens. Mark R. Warner (D-VA), Bill Cassidy (R-LA), Chris Van Hollen (D-MD) and Shelley Moore Capito (R-WV) introduced bipartisan legislation to reauthorize the independent nonprofit corporation established to save Americans money on their health care costs and help patients better understand their diagnostic and treatment options. The Patient-Centered Outcomes Research Institute (PCORI) helps inform health care decisions by providing evidence on the effectiveness, benefits and harms of different treatment options for a condition.

“As medical care and innovation continues to advance, patients have a right to know whether their particular treatment is effective, or whether a different course of action might work better for them,” said Sen. Warner. “Frankly, nobody wants to spend time or money on a procedure they don’t need, but too often, folks don’t have the information they need to make that determination. That’s why I’m proud to introduce this legislation today to help make sure that this crucial institute can continue its work of providing patients and their health care providers with an independent look at their options.” 

“One-size-fits-all medicine does not work. Patients deserve effective and efficient care tailored to them,” said Dr. Cassidy. “Health care costs are lowered when patients have information and can choose what is right for them.”

“This innovative Institute was created to provide patients with the high-quality information they need to make better-informed decisions about their health care. Their work is producing more reliable research to guide health care decisions that increasingly rely on personalized diagnosis and treatments,” said Sen. Van Hollen. “This bill provides the roadmap for the next ten years so they can conduct cutting edge research to improve patient outcomes and save lives.”

“In making health care decisions, it is essential patients have as much useful information as possible,” Sen. Capito said. “PCORI allows patients and their families to compare different treatment options, their effectiveness, and their costs to make more informed decisions. This hopefully helps them not only improve their care, but also spend limited health care dollars more wisely.”

PCORI is an independent nonprofit tasked with examining the relative health outcomes, clinical effectiveness and appropriateness of different medical treatments. Findings from PCORI funded studies are made public so that patients, health care providers and payers can use this information to improve patient care and reduce their health costs. PCORI funded research does not determine coverage or reimbursement decisions at the Centers for Medicare and Medicaid Services (CMS), but CMS can consider PCORI’s research alongside other factors and public input when deciding what procedures it will cover.

Since 2012, PCORI has approved more than $2.3 billion in grants to advance research on patient-centered outcomes. Since PCORI’s authorization, several studies have contributed to significant changes in decision-making and healthcare spending, including helping reduce patient out-of-pocket costs, health spending on unneeded care, unnecessary hospital stays and intensive medical tests. Additionally, research by PCORI has helped to better inform physicians and patients on a broad array of treatments, including opioid prescribing and substance use disorder treatments, obesity weight loss surgery, telehealth use and more. 

The bipartisan Senate legislation would extend PCORI’s funding through FY2029. The bill would also:

Ensure PCORI conducts additional research on rising health care costs by directing researchers to collect data on the potential burdens and economic impacts of the utilization of medical treatments, items and services on different stakeholders and decision-makers. These potential burdens and economic impacts include medical out-of-pocket costs, non-medical costs to the patient and family, effects on future costs of care, workplace productivity and absenteeism and healthcare utilization.

Establish an ‘Expert Advisory Panel for High-Impact Research’ to assist and advise PCORI on ways to better take into account and target diseases, conditions and care interventions that have a high-impact on national health spending.

Improve PCORI’s ability to study the relative cost and effectiveness of prescription drugs, medical devices and other health care interventions by ensuring appropriate patient coverage for PCORI funded clinical trials and studies. The legislation also requires the Government Accountability Office (GAO) to report on remaining barriers to conducting clinical trials and studies.

Direct PCORI to maintain its commitment to robust and meaningful patient engagement, including in the selection of national priority topics and research questions.

Strongly encourage PCORI and AHRQ to maintain their commitment to disseminating and implementing research findings and provide strategies to facilitate the adoption of PCORI-funded research into practice.

“We applaud the introduction of this important piece of legislation to reauthorize the Patient-Centered Outcomes Research institute (PCORI). Continuing their existing funding streams for ten years will ensure that PCORI can continue its vital work producing information patients need to decide the care that is best for them.  We particularly support the emphasis on strengthening the way PCORI engages patients and patient organizations and guidance on using a wide variety of outcomes data to ensure patients’ needs are considered in research,” said Marc Boutin, JD, Chief Executive Officer, National Health Council.

“At the University of Virginia School of Medicine, PCORI is funding projects in rural and underserved areas, including studies intended to reduce cancer disparities in rural Appalachian communities and to compare childhood obesity treatments in the Dan River region. Such work is critical to finding effective health care solutions in these communities. The Patient-Centered Outcomes Research Institute Reauthorization Act will ensure that invaluable health care information and its scientific findings can continue to be generated and disseminated to patients and providers, allowing them to make needed decisions to choose the best treatments,” said Dr. David S. Wilkes, M.D., Dean of the University of Virginia School of Medicine.

“I am grateful for the leadership of Sens. Warner, Cassidy, Van Hollen, and Capito in introducing this legislation,” said Dr. Peter Buckley, M.D., Dean, Virginia Commonwealth University (VCU) School of Medicine, and Executive Vice President for Medical Affairs, VCU Health System. “The Patient-Centered Outcomes Research Institute (PCORI) is a critical, independent funder of research that is truly patient-centered – a key value of the VCU Health System. Reauthorizing PCORI for another ten years and maintaining its unique funding mechanism will ensure continued advances in care and our understanding of what works – and for whom – when it comes to treating disease.”

“PCORI has changed how clinical research is conducted at Johns Hopkins and throughout the United States. Through research networks created by PCORI and standalone studies funded by PCORI, the power of including patients in the design, conduct, and analysis of the studies has been demonstrated multiple times. PCORI-funded studies evaluate the concerns of patients directly important to them and provide the evidence we all need to make better decisions about treatment options. Reauthorization of PCORI will provide the evidence American needs in the next decade to create a health system that delivers effective, patient-centered, and high-value care,” said Dr. Daniel Ford, M.D., M.P.H., Vice Dean for Clinical Investigation, Johns Hopkins School of Medicine.  

The text of this legislation is available here. 

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WASHINGTON – Today, the bipartisan leadership of several key Senate committees urged President Trump’s national security adviser to designate a senior coordinator dedicated to leading the nation’s effort to develop and deploy next-generation communications technologies. In a letter to Robert O’Brien, who was appointed as national security adviser in September, the top Republican and Democratic Senators on the Senate Select Committee on Intelligence, the Senate Homeland Security and Governmental Affairs Committee, the Senate Foreign Relations Committee and the Senate Armed Services Committee stressed the urgent need for the Trump administration to develop a national strategy for 5G, and to prioritize across government agencies the nation’s effort to develop and deploy the technology. 

“While we appreciate the progress being made within and across departments and agencies, we are concerned that their respective approaches are not informed by a coherent national strategy. In our view, the current national level approach to 5G comprises of a dispersed coalition of common concern, rather than a coordinated, interagency activity. Without a national strategy, facilitated by a common understanding of the geopolitical and technical impact of 5G and future telecommunications advancements, we expect each agency will continue to operate within its own mandate, rather than identifying national authority and policy deficiencies that do not neatly fall into a single department or agency. This fractured approach will not be sufficient to rise to the challenge the country faces. We hope that you, as the new National Security Adviser, will make this issue a top priority. We would further urge you to designate a dedicated, senior individual focused solely on coordinating and leading the nation’s effort to develop and deploy future telecommunications technologies. We believe that having a senior leader would position the United States to lead on telecommunications advancements, ensure the United States is appropriately postured against this strategic threat, and demonstrate to our allies the seriousness with which the nation considers the issue,” wrote Sens. Mark R. Warner (D-VA) and Richard Burr (R-NC), the Vice Chairman and Chairman of the Intelligence Committee; Sens. Ron Johnson (R-WI) and Gary Peters (D-MI), the Chairman and Ranking Member of the Homeland Security and Governmental Affairs Committee; Sens. Jim Risch (R-ID) and Bob Menendez (D-NJ), the Chairman and Ranking Member of the Foreign Relations Committee; and Sens. Jim Inhofe (R-OK) and Jack Reed (D-RI), the Chairman and Ranking Member of the Armed Services Committee.

The Senators stressed the dangers of allowing China to continue to lead the development of 5G technology. Maintaining White House focus on 5G is especially important in light of last week’s decision to eliminate the emerging technologies directorate at the National Security Council. 

“While the United States has led in the development and deployment of previous telecommunications evolutions, 5G represents the first evolutionary step for which an authoritarian nation leads the marketplace for telecommunications solutions. China’s leadership, combined with the United States’ increased reliance on high-speed, reliable telecommunications services to facilitate both commerce and defense, poses a strategic risk for the country. We cannot rely exclusively on defensive measures to solve or mitigate the issue, but rather we must shape the future of advanced telecommunications technology by supporting domestic innovation through meaningful investments, leveraging existing areas of U.S. strength, and bringing together like-minded allies and private sector expertise through a sustained effort over the course of decades, not months. A challenge of this magnitude requires a more ambitious response than traditional agency processes can support,” wrote the Senators.

A copy of the letter is available here. 

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WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA), Vice Chairman of the Senate Intelligence Committee and co-founder of the Senate Cybersecurity Caucus, wrote to the Department of Health and Human Services (HHS) regarding a proposed rule by the Centers for Medicare and Medicaid Services (CMS) that would require CMS-funded health plans (including ACA marketplace plans) to allow patients to access their personal health information electronically through third-party consumer applications. In his letter, Sen. Warner urged HHS to include clear standards and defined controls for accessing patient data in order to address the potential for misuse of these interoperability features.

“In just the last three years, technology providers and policymakers have been unable to anticipate – or preemptively address – the misuse of consumer technology which has had profound impacts across our society and economy. As I have stated repeatedly, third-party data stewardship is a critical component of information security, and a failure to ensure robust requirements and controls are in place is often the cause of the most devastating breaches of sensitive personal information,” wrote Sen. Warner. “It is critical that there are proper safeguards are in place to protect patient privacy and sensitive health information. Moreover, there should be more work done by HHS to facilitate greater access to, and transfer of, electronic health information that does not inadvertently enable dominant IT providers to leverage their control over user data outside of the health care context into nascent markets for personalized health products.”

“Across all sectors – including health care – innovative products and services, increasingly dependent upon machine learning, rely on user data as the single most important productive input to innovation and customization. Importantly, however, any approach must balance innovation and ease of access with privacy, security, and a commitment to robust competition. Further, any effort must ensure that such access redounds to the benefit of patients – and that data, once shared with new providers, is not commercialized in ways that benefit those providers without direct benefits or compensation to users,” he continued. “As CMS and HHS move forward with this needed rule – I urge you to include clear standards and defined controls for all stakeholders that ensure third party software applications accessing patient data through APIs are effectively protecting patient information and that patients are appropriately (and routinely) informed, in clear and particularized ways, how their data is used.”

Under the proposed Interoperability and Patient Access rule, CMS would require Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and qualified health plans (QHPs) on the federally-facilitated exchanges (FFEs) to allow patients to access their personal health information electronically through open application programing interfaces (APIs). APIs would allow third-party software applications to connect to, process, and make the data available to patients.

In the letter, Sen. Warner emphasized the importance of allowing patients to easily access their health information. He also noted the similarities between the proposed rule and the ACCESS Act – bipartisan legislation introduced by Sen. Warner that would promote market-based competition among social media platforms by requiring the largest social media companies to make user data portable, and their services interoperable, with other platforms. The ACCESS Act would also allow users to designate a trusted third-party service to manage their privacy and account settings, if they so choose. Additionally, Sen. Warner urged that, at a minimum, the final rule include the following standards:

• Patient Access to Data – A guarantee that patients will have ready access to their personal health data and an ability to regularly monitor and ensure the accuracy of such information. Patients should be informed of all commercial uses of their data, including any third parties their data has been shared with (even if it has alleged to have been anonymized). Patients should also have the right to withhold consent for their data to be shared with third parties, or used in new ways without their consent. Patients should also reserve the right to have third party users dispose of their data upon request.
• Adequate Privacy and Security Safeguards – Ensure participating stakeholders can adequately safeguard patient information by using existing best practices for secure storage and complying with applicable breach notification requirements. Moreover, HHS must work with the FTC and state attorneys general to develop mechanisms to report, supervise, and prosecute privacy and security lapses.
• Documentation of the open API specifications and required security controls – Provide clear attestation of the open API specifications as defined for patient data, the security requirements and controls imposed on healthcare providers, and the third-party platform obligations in managing patient data. 
• Patient Consent and Terms of Use – CMS and HHS should work proactively with the patient, provider and payer community to ensure users have informed proactive consent when user data is shared with a third party. In addition – there should be clear protections in place to ensure third party vendors use patient data solely for purposes in which the patient has expressly given informed proactive consent, including cases where patient information may be sold, and that patients retain the right to direct any party that has acquired their data to delete it upon request. Further, those accessing patient data should be prohibited from conditioning continued access on agreement by the patient to share their data with third parties. 

Sen. Warner has been a longtime critic of poor cybersecurity practices that compromise Americans’ personal information. Last week, Sen. Warner raised concern with HSS’ failure to act, following a mass exposure of sensitive medical images and information by health organizations. In September, he wrote to TridentUSA Health Services to inquire about the company’s data security practices, following reports that a company affiliate exposed medical data belonging to millions of Americans. Earlier that month, Sen. Warner demanded answers from U.S. Customs and Border Protection (CBP) and South Korean company Suprema HQ, following separate incidents that affected both entities and exposed the personal, permanently identifiable data of many Americans. Sen. Warner has introduced legislation to empower state and local government to counter cyberattacks, and to increase cybersecurity among public companies.

The letter text can be found below and a PDF is available here.

The Honorable Alex M. Azar II

Department of Health and Human Services

Office of the Secretary

200 Independence Avenue, S.W.

Washington, D.C. 20201

Dear Secretary Azar:

I am writing regarding the proposed rule from the Center for Medicare and Medicaid Services (CMS) on Interoperability and Patient Access that would enable third party consumer applications to access sensitive patient and health plan data through application programming interfaces (APIs) [1]. I share the goals of advancing interoperability in patient health information and believe that – implemented appropriately – this proposal could represent a significant step in that direction. However, I urge CMS to take additional steps to address the potential for misuse of these features in developing the rules around APIs. In just the last three years, technology providers and policymakers have been unable to anticipate – or preemptively address – the misuse of consumer technology which has had profound impacts across our society and economy. As I have stated repeatedly, third-party data stewardship is a critical component of information security, and a failure to ensure robust requirements and controls are in place is often the cause of the most devastating breaches of sensitive personal information.

Congress passed the 21st Century Cures Act (P.L. 114-255) with a key objective of improving the protected exchange of electronic health records across the care continuum. Notably, Section 4003 and 4004 included specific provisions to establish a trusted health information exchange framework and reduce information blocking; it stated that there should be regulation over unreasonable practices to interfere with, prevent, or materially discourage access, exchange, or use of a patient’s electronic health records. While your agency has taken substantial steps to implement fundamental aspects of this legislation, it is critical that there are proper safeguards are in place to protect patient privacy and sensitive health information. Moreover, there should be more work done by HHS to facilitate greater access to, and transfer of, electronic health information that does not inadvertently enable dominant IT providers to leverage their control over user data outside of the health care context into nascent markets for personalized health products.

In your proposed rule CMS would specifically require Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and qualified health plans (QHPs) on the federally-facilitated exchanges (FFEs) to allow patients to access their personal health information electronically through an open application programming interface (API). Data should be made available through an API so that third party software applications can connect to, process, and make the data available to patients.

I agree that patients should have an ability to easily acquire their health information. The rule is in many ways consistent with bipartisan legislation I have introduced in Congress – the Augmenting Compatibility and Competition by Enabling Service Switching (ACCESS) Act, which requires our nation’s largest social media companies to make user data portable, and make their services interoperable with other platforms.

Common to both my bill and the proposed rule is a recognition that consumers should have a right to possess their data – and share it with authorized third parties that will protect it. Both proposals also seek to address the control over consumer data that incumbents wield, often to the detriment of new, innovative providers. Across all sectors – including health care – innovative products and services, increasingly dependent upon machine learning, rely on user data as the single most important productive input to innovation and customization. Importantly, however, any approach must balance innovation and ease of access with privacy, security, and a commitment to robust competition. Further, any effort must ensure that such access redounds to the benefit of patients – and that data, once shared with new providers, is not commercialized in ways that benefit those providers without direct benefits or compensation to users.

 As CMS and HHS move forward with this needed rule – I urge you to include clear standards and defined controls for all stakeholders that ensure third party software applications accessing patient data through APIs are effectively protecting patient information and that patients are appropriately (and routinely) informed, in clear and particularized ways, how their data is used. Such standards in a final rule should include at a minimum:

• Patient Access to Data – A guarantee that patients will have ready access to their personal health data and an ability to regularly monitor and ensure the accuracy of such information. Patients should be informed of all commercial uses of their data, including any third parties their data has been shared with (even if it has alleged to have been anonymized). Patients should also have the right to withhold consent for their data to be shared with third parties, or used in new ways without their consent. Patients should also reserve the right to have third party users dispose of their data upon request.
• Adequate Privacy and Security Safeguards – Ensure participating stakeholders can adequately safeguard patient information by using existing best practices for secure storage and complying with applicable breach notification requirements. Moreover, HHS must work with the FTC and state attorneys general to develop mechanisms to report, supervise, and prosecute privacy and security lapses.
• Documentation of the open API specifications and required security controls – Provide clear attestation of the open API specifications as defined for patient data, the security requirements and controls imposed on healthcare providers, and the third-party platform obligations in managing patient data. 
• Patient Consent and Terms of Use – CMS and HHS should work proactively with the patient, provider and payer community to ensure users have informed proactive consent when user data is shared with a third party. In addition – there should be clear protections in place to ensure third party vendors use patient data solely for purposes in which the patient has expressly given informed proactive consent, including cases where patient information may be sold, and that patients retain the right to direct any party that has acquired their data to delete it upon request. Further, those accessing patient data should be prohibited from conditioning continued access on agreement by the patient to share their data with third parties. 

Thank you for your consideration your commitment to advancing interoperability to improve patient care. I believe the outline I have shared would strengthen and ensure the rule achieves its intended purpose.  It is my hope and belief that we can achieve both a higher level of interoperability and patient access to their data, as well as, strong protections for that information. I look forward to continued work with you on this important issue and our shared goals.

Sincerely,

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