Thune Requests Update on IHS Effort to Modernize Purchased and Referred Care Program

thuneheadernew John_Thune,_official_portrait,_111th_CongressThune Requests Update on IHS Effort to Modernize Purchased and Referred Care Program

“By bringing payments under the IHS PRC program in line with other federal health care programs, we will be able to stretch limited dollars and expand access to care in Indian Country.”

WASHINGTON — U.S. Sen. John Thune (R-S.D.) today requested an update from Health and Human Services Secretary Sylvia Mathews Burwell on a pending Indian Health Services (IHS) regulation that would extend access to IHS contract care. The pending regulation would expand Medicare-like rate payment methodologies to all health care services contracted under the Purchased and Referred Care (PRC) program, bringing uniformity to reimbursement rates for contract health care services and establishing reimbursement levels that are in line with services like Medicare, Tricare, and VA benefits. First proposed in late 2014, this regulation has yet to be finalized.

“While the Indian Health Care Improvement Act, which I supported, made needed reforms to health care in Indian Country, considerable work remains to ensure that IHS patients have access to the health care they need,” said Thune. “By bringing payments under the IHS PRC program in line with other federal health care programs, we will be able to stretch limited dollars and expand access to care in Indian Country. The PRC program is not meeting the needs of tribal citizens or being accountable to providers outside the IHS system. I look forward to working with tribes, providers, and the IHS on workable and common-sense solutions to modernize Purchased and Referred Care and ultimately improve the quality of this important program.”

Physicians and other non-hospital providers currently contracting with IHS through the PRC program are often paid at different rates than what is paid for identical services that are provided under Medicare, Tricare, or VA benefits.

In response to ongoing concerns from private health care providers in South Dakota that contract with IHS, Thune’s letter also requests information on IHS efforts to improve its claims administration process. The request is a follow-up to a 2014 staff-led working group that Thune convened, which included private providers, IHS, and tribal stakeholders, during which the claims administration process under the PRC program was discussed.

Full text of the letter can be found below:

The Honorable Sylvia Mathews Burwell
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, D.C. 20201

Dear Secretary Burwell:

I write today regarding an ongoing rulemaking at the Indian Health Service (IHS) with respect to Medicare-like rate (MLR) payment methodologies in the Purchased and Referred Care (PRC) program, formerly Contract Health Service.

As you know, current law requires only Medicare participating hospitals to accept MLR for services contracted by the IHS.  While in some cases IHS or tribes have negotiated lower rates, the current regulatory structure has led IHS to pay for physician and other non-hospital services at billed charges – often much higher than rates paid by insurers and other federal health care programs.  Pursuant to the Indian Health Care Improvement Act, in 2013, the Government Accountability Office (GAO) released its findings on this issue.  The GAO recommended Congress consider capping rates in this  program, which could save the IHS PRC program millions of dollars annually and ultimately expand patient care.

While Congress has not yet acted, in December 2014, the IHS published a notice of proposed rulemaking to expand the MLR to all health care services contracted under the PRC program.  In the course of the rulemaking process, a number of issues were raised by stakeholders and I am hopeful the final rule will reflect a consideration of many of these concerns and ideas.  I was pleased to see that the rule noted that access to care should not be negatively impacted as this regulatory change moves forward.  As almost a year has passed, I am interested in learning where you and the department are in the rulemaking process and when you expect this rule to be finalized and published.

As you make changes to reimbursement, it is imperative that improvements in IHS program administration follow.  Providers continue to express frustration with claims administration in the PRC program.  While a MLR may be appropriate, providers should also expect timely payment and a modernized claims process.  In working with tribes, private providers, and the fiscal intermediary, efficiencies in the existing process must be developed.  Last fall, my office gathered stakeholders from IHS, private providers, and tribal health care officials to initiate a dialogue on this issue.  Since that time, discussions have continued, but unfortunately, problems remain.  I would like an update from you on the continuing involvement of IHS staff in the Great Plains Area and headquarters office to identify efficiencies and continue these discussions in South Dakota and across the country.

I support your policy goal to bring IHS reimbursement in line with other federal programs and expand services.  At the same time, claims administration must be improved.  I urge you to advance this rulemaking and other associated changes that will ensure patients receive needed care while providers are reimbursed in a timely, efficient manner.  I have been exploring these issues over the last several years and I welcome the opportunity to work with you to advance these policy goals.  I look forward to your prompt response.



Thune Expresses Concern Regarding the Future of Agriculture Biotechnology

thuneheadernew John_Thune,_official_portrait,_111th_CongressThune Expresses Concern Regarding the
Future of Agriculture Biotechnology

“I am greatly concerned that just like many other areas of regulatory overreach, future regulation of our biotech crops … could become much more cumbersome and complicated and send the wrong message to our trading partners overseas.”

WASHINGTON — U.S. Sen. John Thune (R-S.D.) today expressed his concern with the Obama administration’s overreach of federal regulation of agriculture biotechnology to a panel of witnesses during a Senate Committee on Agriculture, Nutrition, and Forestry hearing entitled, “Agriculture Biotechnology: A Look at Federal Regulation and Stakeholder Perspectives.”

During his questioning, Thune received confirmation from Environmental Protection Agency, Food and Drug Administration, and U.S. Department of Agriculture witnesses that as a result of their research, foods produced from genetically modified (GM) plants are just as safe as foods produced from non-GM plants.

Opening statement (as prepared for delivery):

“Biotechnology has provided my home state of South Dakota and its number one industry, agriculture, with dramatic yield increases, drought tolerant crops, sustainability, and economic benefits that far exceed the expectations of just 10 or 20 years ago.

“Farmers in South Dakota and across the United States take great pride in not only the amount of the crops they produce and the number of people they feed, but most importantly the safety of the food supply they provide not only for U.S. and global populations, but also for their own families.

“Based on the testimony provided for today’s hearing, I am greatly concerned that just like many other areas of regulatory overreach, future regulation of our biotech crops, especially regarding the approval process, could become much more cumbersome and complicated and send the wrong message to our trading partners overseas – which could be very detrimental to my home state, as it depends heavily on export markets.

“Additionally, the uncertainty created by states individually passing mandatory GMO labeling laws would be devastating to producers as our supply chains are much too complex to meet the needs of 50 states.”


Rounds Chairs Hearing on EPA Regulations

RoundsPressHeader MikeRounds official SenateRounds Chairs Hearing on EPA Regulations

 WASHINGTON—U.S. Senator Mike Rounds (R-S.D.), chairman of the U.S. Senate Environment and Public Works (EPW) Subcommittee on Superfund, Waste Management, and Regulatory Oversight, today conducted a hearing to analyze the process by which the Environmental Protection Agency (EPA) conducts Regulatory Impact Analyses (RIAs) on the new regulations it imposes on the American people. The hearing, entitled Oversight of Regulatory Impact Analyses for U.S. Environmental Protection Agency Regulations, is in response to studies that show EPA has used incomplete, inaccurate and faulty data when analyzing the economic impact its rules will have on citizens and businesses. This has led to more than 3,300 final regulations being published by the EPA since President Obama took office and more than $42 billion in regulatory costs last year alone.

 “Everybody desires clean air and clean water, but we have to ask whether there is a better way to achieve it without imposing burdensome regulations in which the costs outweigh the benefits,” said Rounds during his opening statement. “Due to the EPA’s failure to clearly and accurately quantify the costs and benefits of regulations, agencies are unable to make well-informed decisions. Even more troubling, the public, American businesses and state and local governments are prevented from understanding the real impact of the regulation and meaningfully participating in the rulemaking process.”

Video of Rounds’ Opening Statement


“I’m not lost for I know where I am. But however, where I am may be lost.” (Winnie the Pooh)

This is a the beginning of a Presidential campaign without precedent in my life.  The Democrats are offering a person being investigated by the FBI for national security violations, an avowed Socialist and a person contemplating his third or fourth run for the White House.  On the other hand, the GOP has three candidates who have never held elective office currently being supported by over 50% of Republican primary voters, a son and brother of former Presidents, two Cuban-American Senators, and a covey of guys with great resumes unable to register in most polls (two of whom have won the Iowa caucus).

In one week, we have the last of the likely “cattle call” Republican debates, the CNBC debate in Boulder focusing on foreign policy.   The next sponsors (Fox Business/Wall Street Journal & CNN) haven’t released any details on their debate’s format, length and criteria for participation. I suspect both debate sponsors desire a smaller number of participants (like 5 or 6) but are hoping people drop out so they don’t have to make the tough decision to set a realistic criteria of viability.

The Top-tier candidates are Trump (26.2% Real Clear Politics poll average) & Carson (21.2%). These campaigns are starting to flex some muscles. Like traditional poll leaders who avoid or minimize debates, they issued a joint letter threatening not to participate unless the debate was 2 hours long including commercials (leaving effectively 90 minutes for debate). Frankly, it is too early to go into a prevent defense. These candidates are hot. Hot batters don’t ask for shorter games. Point: It looks like Trump and Carson are starting to think they might actually get the nomination.

Bottom Tier candidates . The first choice and second choice level of support for Kasich, Santorum, Graham, Gilmore, Jindal & Pataki does not add up to the first choice of those in the mid-tier. Additionally, none of them have a combination of 1st & 2nd choice above 5%. Unless something big happens soon for Paul, Christie & Huckabee (collective support is 10%), there is no compelling reason for them either to remain in the race. Point: Taking up space is not an accomplishment.

Mid-tier candidates. Bush (1st & 2nd Choice 18%, $10mm Cash on Hand), Cruz (12%, $13mm), Fiorina (10%, $5.5mm) & Rubio (18%, $11mm) have both the money and a base of support to build upon and attempt to attract support from others. Point: Do not panic. Slippage by Trump & Carson plus the support by those who drop off can change someone’s fortunes.

What has happened since August 7th (right before the Fox debate).

  • Carson: Up 15.4% (Up 9.7% in Iowa & 6.5% in New Hampshire
  • Fiorina: Up 4.6% (up 10% in Iowa & 10% in New Hampshire)
  • Rubio:   Up 3.5% (up 4.3% in Iowa & 4.8% in New Hampshire)
  • Cruz: Up 2.9% (up 2.6% in Iowa & 4% in New Hampshire)
  • Trump: Up 1.9% (up 2% in Iowa & 2% in New Hampshire)
  • Bush: Down 5.5% (down 4.5% in Iowa & 2% in New Hampshire)
  • Bottom Tier candidates: Down 9.5%
  • Walker & Perry: Down 12.5%

Point: 27% of support has been in play (from bottom-tier candidates, Bush, Walker & Perry. 60% of it went to Carson.  If momentum means anything at this stage, only one guy has it.

Current Head-to-Head General Election Matchups (Biden beats all GOP candidates, Sanders loses to all but Trump) :

  • Carson-Clinton: Carson by 4.8%
  • Bush-Clinton: Bush by 1.6%
  • Fiorina-Clinton: Fiorina by 1.0%
  • Rubio-Clinton: Clinton by 1.3%
  • Trump-Clinton: Clinton by 2.5%.
  • Cruz-Clinton: Clinton by 7.7%

Point: This is just a baseline to watch as the campaign progresses and probably increases the odds Biden stays out.

 Random Commentary:

Trump & Carson: Trump is loud and brash but has been more measured and thoughtful lately. Carson is quiet, calm and thoughtful but has been more visceral lately. Neither have records so will we demand greater detail from them or will we just allow them to give us platitudes and bromides? As candidates drop out, will they gain additional support or have they hit their respective peaks?

Bush & Rubio: Is there room for two big fishes from Florida? You are now essentially tied. Who will blink first?

Cruz & Fiorina: Is your only hope Trump & Carson fade? Who has the better strategy- Cruz playing nice with Trump or Fiorina taking the fight to the Manhattan mogul? In either case, neither of you have earned any free media since the last debate. Out of sight, out of mind.

Paul, Christie & Huckabee: Time and money is running short. The upcoming CNBC debate is likely your last realistic opportunity for your campaigns running on fumes. Is there even enough fuel to light a spark or are your campaigns dead and you just don’t know it?

Kasich: Whether you are prepared to admit it or not, you are in the bottom tier with Santorum, Graham, Gilmore, Jindal, & Pataki. Whatever path to the nomination when you saw when you announced is likely covered from a mudslide from your answer on the Iran nuclear deal. Scott Walker went back to Wisconsin. Time for you to go back to Ohio.

Actual Betting odds ( on winners of the GOP nomination:

  1. Rubio: 3.5/1 (29%)
  2. Bush: 4.2/1 (24%)
  3. Trump: 7.2/1 (14%)
  4. Carson: 12/1 (8%)
  5. Cruz: 16/1 (6%)
  6. Fiorina: 18.5/1 (5%)
  7. Christie 25/1 (4%)
  8. Huckabee: 32/1 (3%)
  9. Kasich: 34/1 (3%)
  10. Other/Rest of the Field: 50/1 (2%)
  11. Paul: 80/1 (1%)

Point: It is my observation betters are better at predicting the future than people who write and read blogs. That said, if I was going with the “smart money,” I like Rubio’s odds better than Bush’s.  If I were going to bet on a long-shot, I’d go with Fiorina.  

Two other parting comments:

  1. I think Trump’s ultimate and best play is broker at the convention.  Because Trump has seemed to settle in at 25% support (and appears to have the lowest ceiling based on his Net Favorable/Unfavorable, winning is less likely in a small field.  However, until the field winnows, he is going to win delegates.
  2. I think Carson’s best play is to endorse someone with the expectation to be Vice-President.    Carson has the highest Favorable and Net Favorable/Unfavorable in the field.  There is probably nobody who could change the dynamic more than Carson.  Plus, it would allay any potential concerns whether his prior experience is sufficient to be President of the United States.


Thune Statement on Bill to Stop Sanctuary Cities

thuneheadernewJohn_Thune,_official_portrait,_111th_CongressThune Statement on Bill to Stop Sanctuary Cities  
“Sanctuary policies have allowed thousands of dangerous criminals to return to our nation’s streets, and too many American families have paid a terrible price as a result.”

WASHINGTON — U.S. Sen. John Thune (R-S.D.) today released the following statement after Senate Democrats blocked a bill that would protect families and communities from the dangers posed by sanctuary cities, which harbor criminals who are in this country illegally.

“Sanctuary policies have allowed thousands of dangerous criminals to return to our nation’s streets, and too many American families have paid a terrible price as a result. Yet despite the dangers posed by these policies, Senate Democrats are refusing to even debate this legislation.

“By blocking the bill, Senate Democrats are once again employing their favorite strategy of obstruction. In recent weeks, Democrats have opposed funding for our troops and our veterans, and now they are blocking common-sense legislation that is widely supported by the law enforcement community.”

Currently, there are 340 jurisdictions across the country that have official policies discouraging cooperation with federal immigration enforcement officers, resulting in the release of approximately 1,000 criminal aliens per month.


Daugaard: Open SD Receives Facelift

daugaardheader DaugaardOpen SD Receives Facelift

PIERRE, S.D. – The Bureau of Finance and Management has redesigned state government’s transparency website,, to make financial data more accessible.

Open SD was created in 2008 to provide public access to state financial data and new functionalities have been added over the past seven years. The website is updated daily with information from the state’s central financial systems. Searches for vendor payments, employee salaries and state government contracts are among the most utilized features of the website. The site also provides access to detailed budget information, tax expenditures, financial publications and other open government resources.

The Bureau expects the reorganization will simplify its ability to incorporate other functionalities in the future. In addition to making cosmetic changes to Open SD, the Bureau has reorganized the navigation menu and made the site mobile-friendly. The new site also links to commonly-accessed public information, such as the Boards and Commissions portal and the state statutes and rules websites.

In 2014, the US Public Interest Research Group named Open SD the eighth most improved state government transparency website in the nation and designated South Dakota as the top “Advancing State” for transparency. Since 2011 the South Dakota has improved its US PIRG rating from a D+ to an A-.


So, will Hawks pretend to be Republican-y again to try to gain votes?

I had forgotten about this until one until I started doing a search of campaign finance reports.  If you recall long, long ago during the races of 2012….  Long before we elected Mike Rounds to the US Senate, and no one had any idea who Annette Bosworth was…

As I chronicled in November 2012, a pair of postcards his mailboxes right before the election in the District where Stace Nelson was running, as well as District 9, where Paula Hawks was running, where a Democrat front group – in an attempt to make their party’s candidates – made them try to seem more “Republican-y”:

Who was one of the people behind all of this?  Now Democrat Congressional Candidate Paula Hawks.

As you can see, and as I chronicled back then, Paula Hawks fully contributed half of the funds for the project out of her political campaign account.

It probably doesn’t mean much at this point in the campaign. But as it gets down to the wire, it might be an indicator of the type of deception and dirty tricks we might expect to come out of the Hawks campaign.