Medicare Regulatory and Contracting Reform Act of 2003

HR 1125/S 569 - Amend Title XVIII of Social Security Act to repeal Medicare outpatient rehabilitaiton therapy caps; HR 792/S 493 - Amend Title XVIII of Social Security Act to authorize Physical Therapists to evaluate/treat Medicare beneficiaries without requirement for a physician referral; HR 810 - Medicare Regulatory & Contracting Reform Act; S 1222 - Amend Title XVIII of Social Security Act in determining eligibility for payment under PPS for inpatient rehabilitaiton facilities; HR 2246 - Direct the Secretary of HHS to modify treatment categories for qualification as a rehab hospital for purposes of reimbursement under Medicare PPS for inpatient rehab facilities; HR 2560 - Chiropractic Medicare Freedom & Benefit Protection Act; HR 2905 - Amend Title XVIII of Social Security Act for services of respiratory therapists under plan of care for home health services

Client expense: $920,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE

FFY 2004 Budget Resolution FFY 2004 Labor HHS Appropriations Bill S.889,H.R.1710 The American Hospital Preservation Act of 2003 H.R.1580 the Area Wage and Standardized Rate Act S.138,H.R.816 State Budget Relief Act of 2003 S.511,S.607,H.R.5 Medical Liability Reform S.652,H.R.328 Medicaid DSH Access to Hospitals Act H.R.810 Medicare Regulatory and Contracting Reform Act H.R.1776 The Pension Preservation and Savings Expansion Act of 2003 S.1222, H.R.2246 Medicare Inpatient Rehab. Facility Payment Modifications H.R.934 The Teacher and Nurse Support Act of 2003 H.R.501 Nurse Loan Forgiveness Act S.720,H.R.663,H.R.877 Patient Safety Improvement Act S.869,H.R.817 Assure Access to Mammography Act S.412,H.R.819 Local Medical Emergency Reimbursement Act of 2003 S.486,H.R.953 Paul Wellstone Mental Health Treatment Parity Act S.845,H.R.1689 Legal Immigrant Children's Health Improvement Act of 2003 S.816, H.R.1675 Health Care Access and Rural Equity Act of 2003 H.R.3035 Medication Errors Reduction Act of 2003 H.R.3722 Reporting Undocumented Immigrants Receiving Care S.1, H.R.1 Prescription Drug Benefit P.L.108-173 Medicare Prescription Drug, Improvement and Modernization Act of 2003 P.L.108-27 Jobs & Growth Tax Relief Reconciliation Act H.R.1770 Smallpox Emergency Personnel Protection Act EMTALA Standards Sarbanes-Oxley regulation Internal Revenue Service Form 990 reporting regulations Provider-based designation regulations Indirect Medical Education Relief CMS Conditions of Participation Requirements Automatic implantable cardioverter defibrillators CMS Proposed Outlier Payment Methodology modifications CMS Proposed Patient Experiences of Care Survey Tool CMS Hospital Quality Reporting Pilot Project CMS Proposed Inpatient Rehabilitation PPS Regulations CMS Proposed Inpatient PPS Regulations CMS Proposed Outpatient PPS Regulations CMS Proposed Skilled Nursing Facility PPS Regulations CMS Proposed Inpatient Psychiatric Facility PPS Regulations FDA Bar Code Label Requirements for Human Drug Products and Blood CMS Home Health Quality Initiative CMS Occupational Case Mix Survey

H.R.941/S.823-Medicare Innovaton Responsiveness Act of 2003. H.R.569-Medicare Patient Access to Preventive and Diagnostic Test Act of 2003. H.R.810-Medicare Regulatory and Contracting Reform Act of 2003. H.R.2473/H.R.1 (became PL 1080173)-Medicare Prescription Drug and Modernization Act of 2003. S.1-Prescription Drug and Medicare Improvement Act of 2003. S.1054-Jobs Growth Tax Relief Reconciliation Act of 2003. S.1974-Medicare Prevention and Drug Price Fairness Act. (Bills under Medicare program to provide for expeditious coverage of new medical devices; establish procedures for determining payment amounts for new clinical diagnostic laboratory tests for which payment is made; to strengthen and improve and modernize the Medicare program; and to provide for regulatory relief and contracting flexibility.) H.R.883-Medicare Laboratory Services Access Act of 2003. (A btill to adjust fee for collecting specimen for clinical diagnostic laboratory tests under the Medicare program.) H.R.2342/S.1179-Medicare Chronic Care Improvement Act of 2003. H.R.5219-Essential Medicines for Medicare Act of 2002. (Bills to expand Medicare benefits to prevent, delay, and minimize the progression of chronic conditions and develop national policies on effective chronic condition care.) S.1570-The Fair Case for the Uninsured Act of 2003. (A bill to allow individuals a refundable credit against income tax purchase of private health insurance, and establish state health insurance safety net programs.)

Client expense: $2,440,000 · Firm income: Not reported

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare Prescription Drug, Improvement and Modernization Act of 2003,H.R.1,S.1 Electronic prescribing,coding,regulatory reform,care coordination and disease management,Evaluation and Management(E/M) Services,costof prescription drugs,drug discount cards,rural payments,lab co-pays,Medicaid DSH,Telemedicine,Health Savings Accounts Medicare Regulatory and Contractig Reform Act of 2003,H.R.810,S.1,H.R.1 CMS Rule on the Physicians'Fee Schedule Emergency Medical Treatment and Active Labor Act(EMTALA) HHS Office of Inspector General regulations on hospital privileges and other compliance issues. Payment for vaccines, physician-administered drugs.

Client expense: $1,060,000 · Firm income: Not reported

HR 1/S 1 Medicare Prescription Drug Modernization Act of 2003; HR 1125/S 569 Amend Title XVIII of Social Sec Act to repeal Medicare outpatient rehabilitation therapy caps; HR 1860 Medicare Wellness Act; HR 810 Medicare Regulatory & Contracting Reform Act of 2003; HR 792/S 493, Amend Title XVIII of Soc Sec Act to authorize Physical Therapists to evaluate/treat Medicare beneficiaries without requirement for a physician referral; S 1222 Amend Title XVIII of Social Sec Act in determining eligibility for payment under PPS for inpatient rehab facilities; HR 2246 Direct Sec of HHS to modify treatment categories for qualification as a rehab hospital for purposes of reimbursement under Medicare PPS for inpatient rehab facilities; HR 2560 Chiropractic Medicare Freedom & Benefit Protection Act; HR 2905 Amend Title XVIII of Social Sec Act for services of respiratory therapists under plan of care for home health services

Client expense: $337,925 · Firm income: Not reported

Medicare Inpatient Marketbasket and Indirect Medical Education: The American Hospital Preservation Act of 2003 (H.R.1710/S.899); Medicare Rural, Small Community, and Small City Hospital Package: The Area Wage Index and Standardized Rate Act (H.R.1580); Medicaid: The State Budget Relief Act of 2003 (original bill: H.R.816/S.138); Medical Liability Reform-Help Efficient, Accessible, Low Cost, Timely Health Care (HEALTH) Act of 2003 (H.R.5/S.607); Medicare Rehabilitation Hospital Inpatient Payment Modifications (H.R.2246/s.1222); Rural Hospital Package-Health Care Access and Rural Equity Act of 2003 (H.R.1675/S.816); Regulatory Reform-Medicare Regulatory and Contracting Reform Act. (H.R.810); Pension Fund Protection: The Pension Preservation and Savings Expansion Act of 2003 (H.R.1776); Medication Errors Reduction Act of 2003 (H.R.3035); Teacher and Nurse Support Act of 2003 (H.R.934); Nurse Loan Forgiveness Act (H.R.501); Patient Safety Improvement Act of 2003 (H.R.663/H.R.877/S.720); Assure Access to Mammography Act (H.R.817/869); Local Medical Emergency Reimbursement Act of 2003 (S.412/H.R.819); Paul Wellstone Mental Health Treatment Parity Act (S.486/H.R.953); Elimination of Restrictions on Federal Medicaid and S-CHIP Coverage: The Legal Immigrant Children's Health Improvement Act of 2003 (H.R.1689/S.845);

Client expense: Not reported · Firm income: Not reported

FFY 2004 Budget Resolution FFY 2004 Labor HHS Appropriations Bill S.889, H.R.1710 The American Hospital Preservation Act of 2003 H.R.1580 The Area Wage and Standardized Rate Act S.138, H.R.816 State Budget Relief Act of 2003 S.511, S.607, H.R.5 Medical Liability Reform S.652, H.R.328 Medicaid DSH: Access to Hospitals Act H.R.810 Medicare Regulatory and Contracting Reform Act H.R.1776 The Pension Preservation and Savings Expansion Act of 2003 S.1222, H.R.2246 Medicare Inaptient Rehab. Facility Payment Modifications H.R.934 The Teacher and Nurse Support Act of 2003 H.R.501 Nurse Loan Forgiveness Act S.720, H.R.663, H.R.877 Patient Safety Improvement Act S.869, H.R.817 Assure Access to Mammography Act S.412, H.R.819 Local Medical Emergency Reimbursement Act of 2003 S.486, H.R.953 Paul Wellstone Mental Health Treatment Parity Act S.845, H.R.1689 Legal Immigrant Children's Health Improvement Act of 2003 S.816, H.R.1675 Health Care Access and Rural Equity Act of 2003 S.1, H.R.1 Prescription Drug Benefit H.R.1770 Smallpox Emergency Personnel Protection Act EMTALA Standards Sarbanes-Oxley regulation Internal Revenue Service Form 990 reporting regulations Provider-based designation regulations CMS Conditions of Participation Requirements Automatic implantable cardioverter defibrillators CMS Proposed Outlier Payment Methodology modifications CMS Proposed Patient Experience of Care Survey Tool CMS Hospital Quality Reporting Pilot Project CMS Proposed Inpatient Rehablitation PPS Regulations CMS Proposed Inpatient PPS Regulations CMS Proposed Outpatient PPS Regulations CMS Proposed Skilled Nursing Facility PPS Regulations FDA Bar Code Label Requirements for Human Drug Products and Blood CMS Home Health Quality Initiative CMS Occupational Case Mix Survey

Client expense: $460,000 · Firm income: Not reported

H.R.1784 - Medicare Renal Dialysis Payment Fairness Act of 2003. H.R.1004 - Kidney Patient Daily Dialysis Quality Act of 2003. S.191/S.178 - Immunosuppresive Drug Coverage Act of 2003 H.R.810 - Medicare Regulatory & Contracting Reform Act of 2003. H.R.128 - Medicare Coverage of Replacement Calcitrol Act of 2003. S.1114 - Kidney Disease Educational Benefits Act of 2003 S.1/H.R.1- Prescription Drug and Medicare Act of 2003.

Client expense: Not reported · Firm income: $60,000

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

S. 1, H.R. 1 H.RES. 299, H.R. 359, H.R. 2473, H.R. 2596: “Medicare Prescription Drug and Modernization Act of 2003” Legislation to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program, to amend the Internal Revenue Code of 1986 to allow a deduction to individuals for amounts contributed to health savings security accounts and health savings accounts, to provide for the disposition of unused health benefits in cafeteria plans and flexible spending arrangements, and for other purposes. S. 7 “Prescription Drug Benefit and Cost Containment Act of 2003” Legislation to amend title XVIII of the Social Security Act to provide coverage of outpatient prescription drugs under the Medicare program and to amend the Federal Food, Drug, and Cosmetic Act to provide greater access to affordable pharmaceuticals, and for other purposes. S. 382: “Medicare Cholesterol Screening Coverage Act of 2003” Legislation to amend title XVIII of the Social Security Act to provide for coverage of cardiovascular screening tests under the Medicare program. S. 823, H.R. 941: “Medicare Innovation Responsiveness Act of 2003” Legislation to amend title XVIII of the Social Security Act to provide for the expeditious coverage of new medical technology under the Medicare program, and for other purposes. H.R. 810: “Medicare Regulatory and Contracting Reform Act of 2003” Legislation to amend title XVIII of the Social Security Act to provide regulatory relief and contracting flexibility under the Medicare Program. H.R. 1568: “Medicare Rx Now Act of 2003” Legislation to amend part B of title XVIII of the Social Security Act to provide for a prescription drug benefit with a high deductible at no additional premium and access to discount prices on drugs and to provide for the operation of such benefit without a deductible for certain low-income Medicare beneficiaries. H.J.RES.3 Legislation to disapprove under the Congressional Review Act the rule submitted by the Centers for Medicare & Medicaid Services, relating to revisions to payment policies under the Medicare physician fee schedule for calendar year 2003 and other items, published in the Federal Register on December 31, 2002. Department of Health and Human Services, Centers for Medicare and Medicaid Services, 42 CFR Parts 412 and 413, Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2004 Rates; Proposed Rule, May 19, 2003 Communications with Centers for Medicare and Medicaid Services, U.S. Congress and Administration requesting National Coverage Decision for MADIT II indication for ICDs and provided supporting information.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

S. 1 Medicare Reform Legislation H.R. 1 Medicare Reform Legislation H.R. 569 Medicare Access to Preventative and Diagnostic Tests Act H.R. 810 Medicare Needlestick Prevention Act H.R. 941 Medicare Innovation and Responsiveness Act

Client expense: $369,392 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

--HR 2473, Amend Title XVIII of Social Sec Act to provide for prescription drug coverage under Medicare Program --HR 1/S 1, Medicare Prescription Drug and Modernization Act of 2003 --S 569, HR 1125, Amend Title XVIII of Social Sec Act to repeal Medicare outpatient rehabilitation therapy caps --HR 792, S 493, Amend Title XVIII of Social Sec Act to authorize Physical Therapists to evaluate/treat Medicare beneficiaries without requirement for a physician referral --HR 810, Medicare REgulatory and Contracting Act of 2003 --S 1222,Amend Title XVIII of Social Sec Act in determing eligibility for payment under PPS for inpatient rehab facilities --HR 2246, Direct Secretary of HHS to modify treatment categories for qualification as a rehab hospital for purposes of reimbursment under Medicare PPS for inpatient rehab facilities HR 1860, Medicare Wellness Act

Client expense: $337,925 · Firm income: Not reported

Medicare Inpatient Marketbasket and Indirect Medical Education: The American Hospital Preservation Act of 2003 (S899/H.R.1710); Medicare Rural, Small Community, and Small City Hospital Package: The Area Wage and Standardized Rate Act (S.pending/H.R.1580); Medicaid: State Budget Relief Act of 2003 (S.138/H.R.816); Medical Liability Reform: Help Efficient, Accessible, Low Cost, Timely Health Care (HEALTH) Act of 2003 (S.607/H.R.5); Medicaid DSH: Access to Hospitals Act (S.652/H.R.328); Regulatory Reform: Medicare Regulatory and Contracting Reform Act (S.pending/H.R.810); The Pension Preservation and Savings Expansion Act of 2003 (S.pending/H.R.1776); Medicare Inpatient Rehabilitation Facility Payment Modifications (S.pending/H.R.2246); The Teacher and Nurse Support Act of 2003 (S.pending/H.R.934); Nurse Loan Forgiveness Act (S.pending/H.R.501); Patient Safety Improvement Act of 2003 (S.720/H.R.663 & 877); FFY 2004 Hospital-Related Bioterrorism Preparedness Funding (President's FFY 2004 Budget Proposal); Assure Access to Mammography Act (S.869/H.R.817); Local Medical Emergency Reimbursement Act of 2003 (S.412/H.R.819); Paul Wellstone Mental Health Treatment Parity Act (S.486/H.R.953); The Legal Immigrant Children's Health Improvement Act of 2003 (S.845/H.R.1689)

Client expense: Not reported · Firm income: Not reported