Grassley Questions HHS Secretary on Health Care Access for Iowans, Ongoing Oversight Efforts to Crack Down on Fraud and More

Grassley Questions HHS Secretary on Health Care Access for Iowans, Ongoing Oversight Efforts to Crack Down on Fraud and More

BUTLER COUNTY, IOWA - U.S. Sen. Chuck Grassley (R-Iowa), a senior member and former chairman of the Senate Finance Committee, submitted questions for the record to Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr., about rural health care access and lowering prescription drug costs, as well as Grassley's oversight priorities on behalf of Iowans.

In his questions, Grassley pressed Kennedy about his efforts to lower prescription drug costs, fully utilize the Rural Community Hospital Demonstration program and ease access to Medicare. The senator discussed his Accelerating Kids' Access to Care Act, a new law that simplifies the out-of-state specialized pediatric provider enrollment process, and efforts to reduce prior authorization burden on Iowa health care providers.

Grassley also wrote about his oversight efforts, asking for more information on fraud in federal programs in Minnesota and other states, the Biden administration's treatment of unaccompanied migrant children and allegations of waste at the United Network for Organ Sharing. He also discussed his Fraud Risk Assessment of Obamacare Subsidies Accountability Act, which would require the Centers for Medicare and Medicaid Services (CMS) to improve its fraud risk assessment of Obamacare and issue annual updates to Congress and the Department of Health and Human Services Inspector General.

Senators submit Questions For the Record (QFRs) to hearing witnesses to receive detailed, written responses from witnesses. Grassley expects timely answers from Secretary Kennedy.

Text of Grassley's questions follows:

Grassley's push for the Rural Community Hospital Demonstration program:

For years at these Department of Health and Human Services (HHS) budget hearings, I have asked the HHS Secretary to fully utilize the Rural Community Hospital Demonstration under Medicare. The program had been underutilized for too long. Last May, thanks to your leadership and action, the Centers for Medicare and Medicaid Services filled the 10 open slots in the program. Now, we need to reauthorize this program. I plan to soon introduce a bipartisan bill to do that. Can I get the administration's support for the reauthorization of the Rural Community Hospital Demonstration?

Allegations United Network for Organ Sharing spent $20 million on meetings in a year and deleted records:

I have a question about the Health Resources and Services Administration, or "HRSA." In February, HRSA staff briefed Congressional staff on (OPTN) modernization. During that briefing, HRSA staff alleged the OPTN Board spent $20 million on meetings in one year. HRSA also alleged that United Network for Organ Sharing (UNOS) deleted records during a data transfer to HRSA. What's the status of HRSA's investigation into this alleged deletion of records and has there been any accountability for the excessive spending? Will you commit to providing my office with all requested records?

Lowering prescription drug costs and holding pharmacy benefit managers accountable:

As you know, Congress passed some pharmacy benefit manager (PBM) reform in the February spending package. It was a good first start towards holding powerful prescription drug middlemen accountable and lowering prescription drug costs. I believe more needs to be done on PBM reform, including the Federal Trade Commission (FTC) producing its 6(b) study. As HHS works to implement the PBM reforms from this spending package in the Medicare and commercial health insurance markets, will you commit to ensuring rural pharmacies and patients have a voice in the regulations?

Biden administration's treatment of unaccompanied migrant children:

For years, I have conducted oversight regarding the disgraceful Biden/Harris [administration] treatment of unaccompanied migrant children. Over one month ago, then-Secretary Noem informed the Judiciary Committee that the Trump administration had located over 145,000 children who the Biden administration had lost. Do you have updated figures regarding the number of unaccompanied alien children who've now been located by the Trump administration? If not, do you commit to following up with me about that number?

Massive fraud in Minnesota:

In January, I wrote to you regarding fraud in federal programs in Minnesota and other states. The reports of fraud and waste continue to increase. You've already taken action to combat this fraud, which is what I want to see. Please describe any new actions you plan to take in the coming months to hold the wrongdoers accountable so that this never happens again.

Grassley's bill requiring improved Obamacare fraud risk assessments:

Despite warnings from the Government Accountability Office (GAO), the Centers for Medicare and Medicaid Services (CMS) last issued a comprehensive fraud risk assessment of Obamacare subsidies in 2018. The fraud assessment should be updated more regularly, considering the fraud, waste and abuse in the program. GAO recommends as a best practice to update the fraud assessment plan more regularly. I have introduced the Fraud Risk Assessment of Obamacare Subsidies Accountability Act, requiring CMS to update its fraud risk assessment of Obamacare subsidies in accordance with industry's best practices. The fraud risk assessment will be required to be updated annually, and CMS will be required to report to Congress and the Department of Health and Human Services Inspector General about its fraud risk assessment and what anti-fraud practices are being utilized. Has the agency updated its fraud risk assessment since December 3, 2025? If so, what date was it updated? Please provide a copy of the assessment.

Reducing administrative burdens for prior authorization:

In January 2024, the Centers for Medicare and Medicaid Services (CMS) finalized regulations that established standardized definitions and prior authorization timeliness requirements for Medicare Advantage, Medicaid managed care and the federal marketplace health plans. In 2024, CMS estimated that the current annual cost of prior authorization paperwork for an individual physician is $52,642 per year and the regulation would reduce paperwork by $21,026, or about 40 percent, in 2026. I have heard from Iowa providers that they have not seen a 40 percent reduction in their prior authorization burden. I want CMS to be aware that this statistic is not proving to be true in the real world from the Iowa physicians and health care providers I talked to. I appreciate that CMS recently released proposed prior authorization regulations that build on the 2024 reforms. Does CMS have an estimate of the financial relief physicians and health care providers will experience from this proposed rule that reduces administrative burden? The proposed 2026 rule does not provide similar cost-benefit analysis data as the 2024 final rule did.

Grassley law improving kids' access to life-saving medical care:

On February 3, President Trump signed into law the fiscal year 2026 funding package that included an important priority of mine, the Accelerating Kids' Access to Care Act. This law will simplify the out-of-state specialized pediatric provider enrollment process so kids with complex medical needs can get the specialized health care they need in a timely manner while still maintaining safeguards to protect program integrity in the Medicaid Program. Critical to implementing this law is the Provider Enrollment, Chain and Ownership System (PECOS), and CMS's ongoing PECOS modernization work.

In CMS's fiscal year 2026 budget justification document, the agency said it planned to resume modernization of PECOS, which has been paused to give CMS time to evaluate and implement the best technical approach moving forward. CMS has communicated that it is committed to improving the provider enrollment experience. In CMS's fiscal year 2027 budget justification document, the agency said it would like to use $56.4 million in discretionary funding and $78.3 million in mandatory funding to continue modernization of PECOS, including improving the provider enrollment experience, transitioning to a cloud-based platform, and improving provider enrollment processing.

Please provide a detailed work plan and milestones of CMS's modernization work of PECOS and how it will help enable implementing the Accelerating Kids' Access to Care Act into law.

Grassley's ACE Kids Act:

I am grateful that advanced medical procedures and disease management strategies have improved life expectancy for children with complex medical needs. These exceptional developments have resulted in a clear need for improvements to assist vulnerable children and their families. Children with complex medical needs see five to six specialists and up to as many as 20 to 30 allied health professionals.

That's why I have worked hard to provide children with complex medical needs with improved care coordination through the Advancing Care for Exceptional (ACE) Kids Act. The 2019 law gave states the opportunity to implement a new optional Medicaid health home benefit for children with medically complex conditions. In 2022, CMS reported to me that several states were interested in implementing this new health home benefit.

Can you provide me with an update on how many states have taken up this new health home benefit and what states are currently pursuing this health home benefit? Additionally, how is CMS actively engaging states, providers, and other members of the public about this optional health home state benefit?

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