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Construction projects may be subjected to various risks which must be identified, evaluated, and a suitable response to each risk must be determined. The risk response stage is a crucial and significant phase in risk management that requires particular attention. This paper proposes an effective mathematical model for determining the most suitable strategy and action in dealing with both primary and secondary risk events in different risk categories that may arise in a construction project. It also provides a method for estimating or forecasting the anticipated budget for a risk response plan. Another contribution of this study is the development of an innovative approach that combines binary programming with the genetic algorithm. The efficacy of the proposed methodology was examined by its implementation in a real geothermal project. The results demonstrated that the proposed framework serves as a useful tool to tackle the challenges related to the selection and optimization of risk response strategies, as well as setting an appropriate budget for the risk response plan. The suggested model can help decision-makers to assess the variety of viable risk response actions and strategies and arrive at a more well-informed decision

To that end, we ask for your leadership in facilitating a pathway to comprehensive permanent telehealth reform that would provide certainty to beneficiaries and our nation's health care providers while providing sufficient time for Congress and the Administration to analyze the impact of telehealth on patient care.Specifically, we ask that Congress: 1. Authorize the continuation of all current telehealth waivers through December 31, 2024.Currently the HHS Secretary's waiver authority for telehealth expires immediately upon expiration of the PHE. 1 The Administration recognizes the negative impact of this uncertainty, as shown by CMS steps to finalize coverage and payment for codes added to the Medicare Telehealth Services List during the PHE through December 31, 2023. 2 However, CMS is not able to remove certain reimbursement restrictions, such as the pre-pandemic geographic and originating site restrictions, without Congressional authority.It is crucial for Congress to provide HHS with the authority and flexibility to continue to waive these and other statutory requirements, such as in-person requirements for telemental health consultations.It's also crucial that this continuation be broader than CMS and capture important provisions such as the prescribing of controlled substances via telemedicine that affect both federal programs and other health care as policymakers evaluate the evidence needed to support permanent policy.
2. Require HHS complete all feasible evaluations related to telehealth by fall 2023 and combine findings into a single overarching dashboard with recommendations to inform permanent telehealth legislation by Congress.While the lack of telehealth data was once the challenge inhibiting policymaking, that is no longer the case.HHS is conducting and has funded many telehealth studies.For example, the Agency for Healthcare Research and Quality is examining key questions about how telehealth impacts care delivery and health outcomes and the HHS OIG is currently working on at least nine projects directly or tangentially examining telehealth services in Medicare and their impact on health care costs, quality, access, patient and provider experience, potential to address health disparities, and the nature and degree of any additional risk for fraud and abuse.An extension of telehealth flexibility will allow these findings to be aggregated, along with data from industry and findings from academic researchers, to provide a comprehensive analysis for review by policymakers in 2024.
3. Take up permanent, evidence-based telehealth legislation for implementation in 2024.Congress has the opportunity to bring the U.S. health care system into the 21 st century and the responsibility to ensure that innovative delivery models implemented to fight COVID-19 are used to effectively modernize U.S. health care delivery.Telehealth has huge potential to expand access to high-quality virtual care for all Americans.
Following the 2022-2023 evaluation period, all committees of jurisdiction will have at their disposal the necessary data to pursue evidence-based policymaking and take up comprehensive and permanent telehealth reform in a bipartisan manner.A primary benefit of delayed policymaking will be an opportunity for Congress to consider legislation without making assumptions not fully supported by data or evidence.Specifically, we look forward to HHS OIG completing its analyses prior to Congress establishing any new program integrity guardrails.For example, rather than prematurely placing harmful in-person visit requirements that restrict patient access on telehealth, Congress should be able to evaluate exactly what, if any, fraud, waste, and abuse has occurred during the pandemic and consult with the Administration on the best targeted tools to root out any challenges that may exist before and as they occur.
Virtual care is now a fundamental part of the U.S. health care system, and it will improve patient access to highquality care well beyond the COVID-19 pandemic.And while many of the most compelling virtual care clinical use cases are only now emerging, more communities than ever have experienced the powerful impact telehealth has had in bridging gaps in care caused by the crisis-level mental health workforce shortage.Many underserved communities that historically have had limited access to specialty care can now beam in top specialists in neurology, oncology, neonatology, and other critical specialties to help save lives and treat critically ill patients.
Patient satisfaction surveys and claims data from CMS and private health plans demonstrate that many Americans have come to see telehealth as one of the most positive improvements to our nation's health care system in recent memory.Importantly, a majority of U.S. voters believe Congress should protect their ability and choice to see a provider via telehealth post-pandemic. 3 In the 21 st Century, all patients should have the option to receive care virtually when clinically appropriate -Congress should not restrict CMS or other payers from covering appropriate modalities of care.

Many of us previously wrote to share broad priorities for inclusion in any Medicare legislation, including the repeal of the blanket in-person requirements placed on behavioral health. Inperson visit requirements serve as a blunt instrument to restrict access to health care and do not benefit patients or the Medicare program. 4
We believe the recommendations outlined above will provide significant relief to patients and providers concerned about Congress' intent and commitment to telehealth after the end of the COVID-19 PHE.We look forward to working with you to provide certainty to our nation's health care providers and, more importantly, ensure communities across the country can continue to access care when and where they need it.