Resident Physician Shortage Reduction Act of 2007

Extending the Moratoria on the FY2008 Medicaid Intergovernmental Transfer/Cost Limit Regulations and the FY 2008 Medicaid Graduate Education Proposed Rule: Title VII of the "Supplemental Appropriations Act, 2008 (H.R. 2642), "Protecting the Medicaid Safety Net Act of 2008" (H.R. 5613), The Public and Teaching Hospital Preservation Act (H.R. 3533/S. 2400); Increasing Medicare's Resident Limits: Resident Physician Shortage Reduction Act (H.R. 1093/S. 588); Preventing Reductions of Medicare Payments to Anesthesiologists: Medicare Anesthesiology; Teaching Funding Restoration Act of 2007 (HR 2053/S 2056); Improving Cancer Treatment and Care under Medicare: Comprehensive Cancer Care Improvements Act of 2007 (HR 1078); Improving Delivery of Care to Children Under Medicaid: Children's Healthcare and Quality Act of 2007 (HR 2723, S 1226, S 2790); Medicare Value Based Purchasing; Medicare Physician Payments - Preventing a 10% Reduction in CY2008: Medicare Improvements for Patients and Providers Act of 2008 (HR 6331/S 3101); Preserving Access to Medicare Act of 2008 (S 3118); Maintaining Medicare Operating and Capital Indirect Medical Education Payments: Preserving Access to Heathcare (PATH) Act of 2008 (S 3656/HR 7241); Increased Medicare Payments to Nurse-Midwives: Midwifery Care Access and Reimbursement Equity Act of 2007 (HR 864/S 507).

Client expense: $62,000 · Firm income: Not reported

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

H.R.882, Access to Emergency Medical Services Act of 2007, Quality and patient safety. H.R.1093/S.588, Resident Physician Shortage Reduction Act of 2007, Workforce shortage issues. S.543, Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007, Health care issues. H.R.1376/H.R.2606, 340B Program Improvement and Integrity Act, Pharmaceutical related issues. H.R.5544, Patients and Public Health Partnership Act of 2008, Uninsured and medically underserved related issues. S.1693, Wired for Health Care Quality Act , Health information technology related issues. S.1814, Health Information Privacy and Security Act, Health information technology related issues. S.2319, National Trauma Center Stabilization Act of 2007, Emergency readiness and trauma related issues. H.R.5613, Protecting the Medicaid Safety Net Act of 2008, Medicaid regulations related issues. H.R.3533, Public and Teaching Hospital Preservation Act, GME and related issues. S.2460, A bill to extend by one year the moratorium on implementation of a rule relating to the Federal-State financial partnership under Medicaid and the State Children's Health Insurance Program and on finalization of a rule regarding graduate medical education under Medicaid and to include a moratorium on the finalization of the outpatient Medicaid rule making similar changes -- Medicaid related issues. H.R.4105, Medicare Recovery Audit Contractor Program Moratorium Act of 2007, RAC related issues. H.R.1424, Paul Wellstone Mental Health and Addiction Equity Act of 2007, Mental health and addiction parity. S.1083/H.R.1930, Securing Knowledge, Innovation, and Leadership Act of 2007, Healthcare workforce shortage related issues. General monitoring of patient safety and quality issues.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of

Health Information Technology (HIT); providing incentives for the successful adoption of HIT: S.1693, the Wired for Healthcare Quality Act; H.R. 3800, Promoting Health Information Technology Act; H.R. 1952, the National Health Information Incentive Act of 2007; H.R. 6357, the Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008 or the PRO(TECH)T Act of 2008. Expanding health insurance coverage to ensure that more Americans will have access to affordable health insurance: H.R. 506/S.325, Health Partnership through Creative Federalism Act; Health insurance reform, Medicaid, Association Health Plans, Medical Savings Accounts, Tax credits and purchasing pools; S. 1169, the State-Based Health Care Reform Act; H.R. 2351, the Health Care Act of 2007. Reforming the medical liability system in this country to ease existing financial burdens on practicing physicians and to ensure greater patient access to care: S. 243, the Medical Care Access Protection Act of 2007 (MCAP Act); H.R. 2580, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2007. Medical liability demonstration projects. Reforming the Medicare physician reimbursement formula to provide for greater predictability and stability in payments: S. 40, the Geriatric and Chronic Care Management Act, Reform the Sustainable Growth Rate - S. 2785, Save Medicare Act of 2008, H. R. 5445; H.R. 5545 and S. 2729, the Ensuring the Future Physician Workforce Act of 2008, Pay-for-Performance, Patient Centered Medical Home H.R. 3162, the CHAMP Act, care coordination, primary care shortage, CMS proposed changes to work relative value units (RVUs), Medically Unbelievable Edits program, CMS Request for Information (RFI) for Cycle 1 of the Medicare Administrative Contractor (MAC), CMS Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates, Health Care Price Transparency. H.R. 6331/S.3101, the Medicare Improvements for Patients and Providers Act. Ensure adequate funding for federal health programs in the FY08 and FY09 appropriations: Labor/HHS/Education Appropriations bill (including Title VII health professions and student loans) and VA healthcare and research). Address inadequacies in public health programs and funding: Healthcare disparities, anti-smoking (S.625/H.R. 1108, the Family Smoking Prevention and Tobacco Control Act), vaccines (e.g. smallpox, influenza), CMS - Payment for the recently approved Herpes Zoster (Shingles) vaccine and its administration, DEA how e-prescribing systems can meet the Drug Enforcement Administrations (DEAs) prescription requirements under the Controlled Substances Act. Provide loan debt relief for medical students through enhancements to existing programs and the creation of new programs: H.R. 1093, Resident Physician Shortage Reduction Act of 2007; S. 588, Resident Physician Shortage Reduction Act of 2007; S. 1066, Medical Education Affordability Act; Reauthorization of the Higher Education Act, including the restoration of the 20/220 pathway; S. 2303/H.R. 4344, a bill to amend section 435 of the Higher Education Act of 1965 regarding the definition of economic hardship. Preserving the safety net function of federally-funded health care programs, such as SCHIP: H.R. 5268, providing for a temporary increase of the Federal medical assistance percentage under the Medicaid Program; Include expansion of the medical home as well as transformation grants for the medical home in SCHIP re-authorizing legislation Preserving access to primary care services: the impending shortage of primary care physicians, designation of primary care as a shortage profession, scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas, grants for medical school mentorship programs and primary care training in community health centers, increased Title VII funding for primary care health programs, Medicare payment reforms to support the Patient Centered Medical Home, regulatory relief, studies on primary care; S. 1340/H.R. 2244, the Geriatric Assessment and Chronic Care Coordination Act of 2007. Economic Stimulus Package: Increase the federal matching rate under the Medicaid program, re-authorize the SCHIP program with additional funding to assure adequate coverage of all eligible children, targeted increases in Medicare payments for primary care physicians, targeted incentives directed toward primary care physicians in smaller practices to acquire health information technology (HIT) applications to support care coordination through the medical home.

Client expense: $269,132 · Firm income: Not reported

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

Health Information Technology (HIT); providing incentives for the successful adoption of HIT: S.1693, the Wired for Healthcare Quality Act; H.R. 3800, Promoting Health Information Technology Act; H.R. 1952, the National Health Information Incentive Act of 2007; H.R. 6357, the Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008 or the PRO(TECH)T Act of 2008. Expanding health insurance coverage to ensure that more Americans will have access to affordable health insurance: H.R. 506/S.325, Health Partnership through Creative Federalism Act; Health insurance reform, Medicaid, Association Health Plans, Medical Savings Accounts, Tax credits and purchasing pools; S. 1169, the State-Based Health Care Reform Act; H.R. 2351, the Health Care Act of 2007. Reforming the medical liability system in this country to ease existing financial burdens on practicing physicians and to ensure greater patient access to care: S. 243, the Medical Care Access Protection Act of 2007 (MCAP Act); H.R. 2580, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2007. Medical liability demonstration projects. Reforming the Medicare physician reimbursement formula to provide for greater predictability and stability in payments: S. 40, the Geriatric and Chronic Care Management Act, Reform the Sustainable Growth Rate - S. 2785, Save Medicare Act of 2008, H. R. 5445; H.R. 5545 and S. 2729, the Ensuring the Future Physician Workforce Act of 2008, Pay-for-Performance, Patient Centered Medical Home H.R. 3162, the CHAMP Act, care coordination, primary care shortage, CMS proposed changes to work relative value units (RVUs), Medically Unbelievable Edits program, CMS Request for Information (RFI) for Cycle 1 of the Medicare Administrative Contractor (MAC), CMS Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates, Health Care Price Transparency. H.R. 6331/S.3101, the Medicare Improvements for Patients and Providers Act. Ensure adequate funding for federal health programs in the FY08 and FY09 appropriations: Labor/HHS/Education Appropriations bill (including Title VII health professions and student loans) and VA healthcare and research). Address inadequacies in public health programs and funding: Healthcare disparities, anti-smoking (S.625/H.R. 1108, the Family Smoking Prevention and Tobacco Control Act), vaccines (e.g. smallpox, influenza), CMS - Payment for the recently approved Herpes Zoster (Shingles) vaccine and its administration, DEA how e-prescribing systems can meet the Drug Enforcement Administrations (DEAs) prescription requirements under the Controlled Substances Act. Provide loan debt relief for medical students through enhancements to existing programs and the creation of new programs: H.R. 1093, Resident Physician Shortage Reduction Act of 2007; S. 588, Resident Physician Shortage Reduction Act of 2007; S. 1066, Medical Education Affordability Act; Reauthorization of the Higher Education Act, including the restoration of the 20/220 pathway; S. 2303/H.R. 4344, a bill to amend section 435 of the Higher Education Act of 1965 regarding the definition of economic hardship. Preserving the safety net function of federally-funded health care programs, such as SCHIP: H.R. 5268, providing for a temporary increase of the Federal medical assistance percentage under the Medicaid Program; Include expansion of the medical home as well as transformation grants for the medical home in SCHIP re-authorizing legislation. Preserving access to primary care services: the impending shortage of primary care physicians, designation of primary care as a shortage profession, scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas, grants for medical school mentorship programs and primary care training in community health centers, increased Title VII funding for primary care health programs, Medicare payment reforms to support the Patient Centered Medical Home, regulatory relief, studies on primary care; S. 1340/H.R. 2244, the Geriatric Assessment and Chronic Care Coordination Act of 2007. Economic Stimulus Package: Increase the federal matching rate under the Medicaid program, re-authorize the SCHIP program with additional funding to assure adequate coverage of all eligible children, targeted increases in Medicare payments for primary care physicians, targeted incentives directed toward primary care physicians in smaller practices to acquire health information technology (HIT) applications to support care coordination through the medical home.

Client expense: $142,652 · Firm income: Not reported

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

Title VII of the "Supplemental Appropriations Act, 2008 (H.R. 2642), "Protecting the Medicaid Safety Net Act of 2008" (H.R. 5613), The Public and Teaching Hospital Preservation Act (H.R. 3533/S. 2400): Extending the Moratoria on the FY2008 Medicaid Intergovernmental Transfer/Cost Limit Regulations and the FY 2008 Medicaid Graduate Education Proposed Rule; Increasing Medicare's Resident Limits: Resident Physician Shortage Reduction Act (H.R. 1093/S. 588); Preventing Reductions of Medicare Payments to Anesthesiologists: Medicare Anesthesiology; Teaching Funding Restoration Act of 2007 (HR 2053/S 2056); Improving Cancer Treatment and Care under Medicare: Comprehensive Cancer Care Improvements Act of 2007 (HR 1078); Improving Delivery of Care to Children Under Medicaid: Children's Healthcare and Quality Act of 2007 (HR 2723, S 1226, S 2790); Medicare Value Based Purchasing, Medicare Physician Payments: Preventing a 10% Reduction in CY2008: Medicare Improvements for Patients and Providers Act of 2008 (HR 6331/S 3101); Preserving Access to Medicare Act of 2008 (S 3118); Maintaining Medicare Operating and Capital Indirect Medical Education Payments. Increased Medicare Payments to Nurse-Midwives: Midwifery Care Access and Reimbursement Equity Act of 2007 (HR 864/S 507).

Client expense: $57,000 · Firm income: Not reported

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

S. 3230 - Labor HHS appropriations S. 588; H.R. 1093 Residency Caps H.R. 3; S. 5; S. 30 Stem Cell S. 1576 Minority Improvent S. 1066 Medical Affordability Act H.R. 4854, S. 2041 False Claims Correction Act S. 484 Research Misconduct Clinical Trials The role of gene patents in research and genetic testing

Client expense: $110,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), Transportation, Dept of (DOT)

See attached Iroquois Healthcare Alliance Federal legislation for July 1 through September 30, 2008 Preserving Access to Healthcare (PATH) Act, S.3656/ H.R. 7241 blocks for six months implementation of both the Medicare capital IME cut and the Medicaid outpatient regulation Rural Hospital Assistance Act of 2008 S.3300 IS / H.R.6912.IH To amend title XVIII of the Social Security Act to provide for temporary improvements to the Medicare inpatient hospital payment adjustment for low-volume hospitals and to provide for the use of the non-wage adjusted PPS rate under the Medicare-dependent hospital (MDH) program, and for other purposes. Physician Availability Act of 2008 H.R.5739.IH Physician Workforce and Graduate Medical Education Enhancement Act of 2007 HR 2583 IH To amend title VII of the Public Health Service Act to establish a loan program for eligible hospitals to establish residency training programs. Physician Workforce Enhancement Act of 2008 HR 2583 EH Nursing and Allied Health Education Preservation Act of 2008 S.3468 IS /H.R.5174.IH To amend title XVIII of the Social Security Act to continue the ability of hospitals to supply a needed workforce of nurses and allied health professionals by preserving funding for hospital operated nursing and allied health education programs. 340B Program Improvement and Integrity Act of 2007 S.1376 Resident Physician Shortage Reduction Act of 2007 S.588.IS/ H.R.1093.IH Medicare Rural Health Access Improvement Act of 2008 S.2786.IS Physician Availability Act of 2008 HR 5739 IH To assure that the services of a nonemergency department physician are available to hospital patients 24 hours a day, seven days a week in all non-Federal hospitals with at least 100 licensed beds.

Client expense: $80,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.882, Access to Emergency Medical Services Act of 2007, Quality and patient safety. H.R.1093/S.588, Resident Physician Shortage Reduction Act of 2007, Workforce shortage issues. S.543, Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007, Health care issues. H.R.1376/H.R.2606, 340B Program Improvement and Integrity Act, Pharmaceutical related issues. H.R.5544, Patients and Public Health Partnership Act of 2008, Uninsured and medically underserved related issues. S.1693, Wired for Health Care Quality Act , Health information technology related issues. S.1814, Health Information Privacy and Security Act, Health information technology related issues. S.2319, National Trauma Center Stabilization Act of 2007, Emergency readiness and trauma related issues. H.R.5613, Protecting the Medicaid Safety Net Act of 2008, Medicaid regulations related issues. H.R.3533, Public and Teaching Hospital Preservation Act, GME and related issues. S.2460, A bill to extend by one year the moratorium on implementation of a rule relating to the Federal-State financial partnership under Medicaid and the State Children's Health Insurance Program and on finalization of a rule regarding graduate medical education under Medicaid and to include a moratorium on the finalization of the outpatient Medicaid rule making similar changes -- Medicaid related issues. H.R.4105, Medicare Recovery Audit Contractor Program Moratorium Act of 2007, RAC related issues. H.R.1424, Paul Wellstone Mental Health and Addiction Equity Act of 2007, Mental health and addiction parity. S.1083/H.R.1930, Securing Knowledge, Innovation, and Leadership Act of 2007, Healthcare workforce shortage related issues. General monitoring of patient safety and quality issues.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of

H.R.1093/S.588, Resident Physician Shortage Reduction Act of 2007, Workforce shortage issues. H.R.1952, National Health Information Incentive Act of 2007, Health IT issues. General monitoring of Medicare/Medicaid Reimbursement 340 B Program; and patient quality and safety. H.R.3533, Public and Teaching Hospital Preservation Act, GME related issues. H.R.4105, Medicare Recovery Audit Contractor Program Moratorium Act of 2007, RAC related issues. H.R.2606/S.1376, 340B Program Improvement and Integrity Act of 2007, Reimbursement related issues. H.R.4231, Rural Veterans Health Care Access Act of 2007, Veterans healthcare related issues. H.R.1424, Paul Wellstone Mental Health and Addiction Equity Act of 2007, Mental health and addiction parity.

Client expense: Not reported · Firm income: $20,000

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

Legislation to expand health care coverage and access including provisions contained bills in which would offer Medicare, Medicaid and/or SCHIP to more children, create parity in coverage of mental health benefits, foster reform at the state level, stabilize trauma care, prevent healthcare acquired infections, ensure hospital preparedness, expand the use of health information technology, provide funding for Ryan White programs, increase and stabilize the healthcare workforce HR 2357; MediKids Health Insurance Act of 2007"; to create a new federal healthcare program to provide comprehensive health benefits to children S 1218 /HR 2034, Medicare for All Act; expanding the Medicare program to those under age 65. S 1169; State-Based Health Care Reform Act; to create a five-year pilot program in several states to develop coverage plans for the uninsured HR 1424; Paul Wellstone Mental Health and Addiction Equity Act require group health plans to provide comparable treatment limits and beneficiary cost sharing for medical and mental health benefits. HR 1663, Medicare Mental Health Modernization Act to provide mental health parity in private health insurance and Medicare, and improves coverage for cost-effective and community-based mental health treatment services for seniors and people with disabilities S 895/HR 1535; Children's Health First Act allow states to expand children's health coverage to families up to 400 percent of the Federal poverty level HR 1308S/764, Legal Immigrant Children's Health Improvement Act to permit states the option of coverage of legal immigrants under the Medicaid Program and the State Children's Health Insurance Program S 558, Mental Health Parity Act of 2007 would preserve state laws that are more comprehensive while creating parity in health plans offering mental health coverage by equating financial requirements and treatment limitations for mental health benefits with medical and surgical benefits. S 325/HR 506, Health Partnership Act would provide grants to individual states, groups of states, and portions of states to test various health reform strategies HR1111, Kids Come First Act to ensure that every uninsured child in America has health insurance coverage, HR 3162, "Children's Health and Medicare Protection Act" HR 976 in the Senate, Children's Health Insurance Program Reauthorization Act S 2049, The Better Health for America's Children Act," to block a new policy to limit states' ability to enroll children in the State Children's Health Insurance Program S 2152, Kids First Actalternative SCHIP bill that would restrict coverage to individuals younger than age 19 in low-income families HR 3963; Children's Health Insurance Program Reauthorization Act revised bill to extend and expand the State Childrens Health Insurance Program (SCHIP) HR 2055 Improving Children's Access to Health Care Act, to improve children's access to health care coverage under the Medicaid Program and the State Children's Health Insurance Program (SCHIP). HR 5268: To provide for a temporary increase of the Federal medical assistance percentage under the Medicaid Program HR 3221: Housing and Economic Recovery Act provision that would allow federal home loan banks to issue letters of credit for tax-exempt hospital bonds. HR 7110: Job Creation and Unemployment Relief Act: Title III, temporary increase in Medicaid matching rate Legislation to expand health care coverage and access including provisions which would stabilize medical emergency reimbursement, HR 882, Access to Emergency Services Act that would increase by 10 percent Medicare reimbursements to physicians who provide care in emergency departments (EDs) or post-stabilization care related to emergency medical conditions in other areas of hospitals S 657, A bill to amend the Public Health Service Act to add requirements regarding trauma care HR 6394: Border Health Care Relief Act of 2008 Amends the MPDIMA to extend Sec. 1011 through FY2012 for federal reimbursement of emergency health services furnished to undocumented aliens Legislation to expand health care coverage and access including provisions to ensure patient safety, H.J.RES. 20, Making further continuing appropriations for the fiscal year 2007 provision annual fit-testing of respirators for occupational exposure to tuberculosis. S 2278/HR 4214 Community and Healthcare-Associated Infections Reduction Act to improve the prevention, detection, and treatment of community and healthcare-associated infections Legislation to expand health care coverage and access including provisions to ensure emergency preparedness, HR 727, Trauma Care Systems Planning and Development Act of 2007 would authorize an additional $46 million between fiscal years 2008 and 2012 in spending for rural medical centers that treat patients during times of national crisis HJ Res. 20, Making further continuing appropriations for the fiscal year 2007, extending program to provide funds for hospital preparedness S Con Res 21/H Con Res 99, Budget resolution -- extending program to provide funds for hospital preparedness HR 3043; Labor, HHS Appropriations bill, provide funds for hospital preparedness Legislation to expand health care coverage and access including provisions to promote the use of health information technology: S 1418, Wired for Health Care Quality Act HR3043/S1710, Appropriations Labor, Health and Human Services (HHS), Education, and Related Agencies FY 08, funding for HIT programs HR 1467, 10,000 Trained by 2010 Act, award competitive grants for basic research on innovative approaches to improve health care information systems HR 2406, Healthcare Information Technology Enterprise Integration,guidelines and mechanisms to promote the integration of the healthcare information enterprise. S 1408, Health Information Technology Act, would provide tax incentives and resources to offset the costs of investing in new health information technology. HJ Res. 20, Making further continuing appropriations for the fiscal year 2007, extending program to provide funds for HIT S Con Res 21/H Con Res 99, Budget resolution -- extending program to provide funds for HIT HR 3043, Labor, HHS Appropriations bill, provide funds for HIT HR 2764; omnibus appropriations bill for FY2008 provide funds for HIT HR 6357 : Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008 or the PRO(TECH)T Act, Legislation to expand health care coverage and access including provisions funding HIV/AIDS programs: HJ Res. 20, Making further continuing appropriations for the fiscal year 2007, extending program to provide funds for Ryan White programs S Con Res 21/H Con Res 99, Budget resolution -- extending program to provide funds for Ryan White programs HR3043/S1710, FY 2008 Labor HHS Appropriations Bill, funding for Ryan White programs HR 2764; omnibus appropriations bill for FY2008, funding for Ryan White programs Legislation to expand health care coverage and access including provisions to ensure sufficient workforce within in the healthcare sector S 1604, Nursing Education and Quality of Health Care Act, increases the nurse workforce in rural areas, expands nursing school faculty, and develops initiatives to integrate patient safety practices into nursing education HR 2122, Safe Nursing and Patient Care Act of 2007", limiting the number of mandatory overtime hours a nurse may be required to work S 1639, Comprehensive Immigration Reform, the point-based system for visas, to give nurses special consideration under the point system HR800/S1041, Employee Free Choice Act, require the NLRB to certify a bargaining representative if a majority of the bargaining unit employees have authorized designation of the representative (card-check) HR 2123, Nurse Staffing Standards for Patient Safety and Quality Care Act, to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals HR 378, Nurse and Patient Safety & Protection Act direct the Secretary of Labor to issue an occupational safety and health standard to reduce injuries to patients, direct-care registered nurses, and other health care providers by establishing a safe patient handling standard. HR 1644, Re-Empowerment of Skilled and Professional Employees and Construction Tradesworkers (RESPECT) Act, to amend the National Labor Relations Act to clarify the definition of "supervisor" S446, Nurse Education, Expansion, and Development (NEED) Act, grants based on the number of nursing students enrolled to hire and retain new nursing faculty S 718, The Patient-Focused Critical Care Enhancement Act, provision study the impact of differences in staffing, organization, size, and structure of intensive care units on access, quality, and efficiency of care HJ Res. 20, Making further continuing appropriations for the fiscal year 2007, extending program to provide funds for Nursing Education programs, , national health service corp HR 677, Nursing School Capacity Act authorize IOM study to identify constraints encountered by schools of nursing in admitting and graduating sufficient number of nurses S1577, Patient Safety and Abuse Prevention Act screening of direct patient access employees HR3043/S1710; Labor, HHS Appropriations bill; nursing education, national health service corp. S 588/HR 1093, Resident Physician Shortage Act, to expand the number of physician training positions in 24 states with shortages HR 5924, The Emergency Nurse Supply Relief Act, which would address the retrogression backlog of visas for internationally-educated nurses who have been hired by U.S. hospitals but are not able to come here because of the unavailability of an employment-based (EB) visa.

Client expense: $100,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), SENATE, White House Office

Medicare hospital reimbursement issues and Medicare graduate medical education reimbursement issues (Medicare Improvement for Patients and Providers Act of 2008, H.R.6331, S.3101;CHAMP Act, H.R.3162;Preserving Access to Medicare Act of 2008, S.3118;Inpatient Medicare Prospective Payment System Rule, CMS 1390-P,F;Medicare Recovery Audit Contractor Program Moratorium Act of 2007, H.R.4105;Nursing and Allied Health Education Preservation Act of 2008;H.R.5174;Registered Nurse Safe Staffing Act of 2007, H.R.4138;42 CFR 413.75,H.R.1093,provisions related to Medicare graduate medical education and the counting of resident work hours,HR 615 & 616 relating to Medicare Parity Medicaid reimbursement issues (Iraq War Supplemental Appropriations Bill, H.R.2642-Provision to Place Moratoria on Medicaid Regulations CMS-2258-FC,CMS 2279-P,CMS 2213-P, and CMS-2275-F;Protecting the Medicaid Safety Net Act of 2008, H.R.5613;Public and Teaching Hospital Preservation Act, H.R.3533;Medicaid Advanced Practice Nurses and Physician Assistants Access Act of 2007, H.R.2066;Temporary Increase in FMAP (HR5268, S.2586, H.R.7110, S. 3656)

Client expense: $360,000 · Firm income: Not reported

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

Health Information Technology (HIT); providing incentives for the successful adoption of HIT: S.1693, the Wired for Healthcare Quality Act; H.R. 3800, Promoting Health Information Technology Act; H.R. 1952, the National Health Information Incentive Act of 2007; H.R. 6357, the Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008 or the PRO(TECH)T Act of 2008. Expanding health insurance coverage to ensure that more Americans will have access to affordable health insurance: H.R. 506/S.325, Health Partnership through Creative Federalism Act; Health insurance reform, Medicaid, Association Health Plans, Medical Savings Accounts, Tax credits and purchasing pools; S. 1169, the State-Based Health Care Reform Act; H.R. 2351, the Health Care Act of 2007. Reforming the medical liability system in this country to ease existing financial burdens on practicing physicians and to ensure greater patient access to care: S. 243, the Medical Care Access Protection Act of 2007 (MCAP Act); H.R. 2580, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2007. Medical liability demonstration projects. Reforming the Medicare physician reimbursement formula to provide for greater predictability and stability in payments: S. 40, the Geriatric and Chronic Care Management Act, Reform the Sustainable Growth Rate - S. 2785, Save Medicare Act of 2008, H. R. 5445; H.R. 5545 and S. 2729, the Ensuring the Future Physician Workforce Act of 2008, Pay-for-Performance, Patient Centered Medical Home H.R. 3162, the CHAMP Act, care coordination, primary care shortage, CMS proposed changes to work relative value units (RVUs), Medically Unbelievable Edits program, CMS Request for Information (RFI) for Cycle 1 of the Medicare Administrative Contractor (MAC), CMS Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates, Health Care Price Transparency. H.R. 6331/S.3101, the Medicare Improvements for Patients and Providers Act. Ensure adequate funding for federal health programs in the FY08 and FY09 appropriations: Labor/HHS/Education Appropriations bill (including Title VII health professions and student loans) and VA healthcare and research). Address inadequacies in public health programs and funding: Healthcare disparities, anti-smoking (S.625/H.R. 1108, the Family Smoking Prevention and Tobacco Control Act), vaccines (e.g. smallpox, influenza), CMS - Payment for the recently approved Herpes Zoster (Shingles) vaccine and its administration, DEA how e-prescribing systems can meet the Drug Enforcement Administrations (DEAs) prescription requirements under the Controlled Substances Act. Provide loan debt relief for medical students through enhancements to existing programs and the creation of new programs: H.R. 1093, Resident Physician Shortage Reduction Act of 2007; S. 588, Resident Physician Shortage Reduction Act of 2007; S. 1066, Medical Education Affordability Act; Reauthorization of the Higher Education Act, including the restoration of the 20/220 pathway; S. 2303/H.R. 4344, a bill to amend section 435 of the Higher Education Act of 1965 regarding the definition of economic hardship. Preserving the safety net function of federally-funded health care programs, such as SCHIP: H.R. 5268, providing for a temporary increase of the Federal medical assistance percentage under the Medicaid Program. Preserving access to primary care services: the impending shortage of primary care physicians, designation of primary care as a shortage profession, scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas, grants for medical school mentorship programs and primary care training in community health centers, increased Title VII funding for primary care health programs, Medicare payment reforms to support the Patient Centered Medical Home, regulatory relief, studies on primary care; S. 1340/H.R. 2244, the Geriatric Assessment and Chronic Care Coordination Act of 2007.

Client expense: $276,799 · Firm income: Not reported

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

Health Information Technology (HIT); providing incentives for the successful adoption of HIT: S.1693, the Wired for Healthcare Quality Act; H.R. 3800, Promoting Health Information Technology Act; H.R. 1952, the National Health Information Incentive Act of 2007; H.R. 6357, the Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008 or the PRO(TECH)T Act of 2008. Expanding health insurance coverage to ensure that more Americans will have access to affordable health insurance: H.R. 506/S.325, Health Partnership through Creative Federalism Act; Health insurance reform, Medicaid, Association Health Plans, Medical Savings Accounts, Tax credits and purchasing pools; S. 1169, the State-Based Health Care Reform Act; H.R. 2351, the Health Care Act of 2007. Reforming the medical liability system in this country to ease existing financial burdens on practicing physicians and to ensure greater patient access to care: S. 243, the Medical Care Access Protection Act of 2007 (MCAP Act); H.R. 2580, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2007. Medical liability demonstration projects. Reforming the Medicare physician reimbursement formula to provide for greater predictability and stability in payments: S. 40, the Geriatric and Chronic Care Management Act, Reform the Sustainable Growth Rate - S. 2785, Save Medicare Act of 2008, H. R. 5445; H.R. 5545 and S. 2729, the Ensuring the Future Physician Workforce Act of 2008, Pay-for-Performance, Patient Centered Medical Home H.R. 3162, the CHAMP Act, care coordination, primary care shortage, CMS proposed changes to work relative value units (RVUs), Medically Unbelievable Edits program, CMS Request for Information (RFI) for Cycle 1 of the Medicare Administrative Contractor (MAC), CMS Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates, Health Care Price Transparency. H.R. 6331/S.3101, the Medicare Improvements for Patients and Providers Act. Ensure adequate funding for federal health programs in the FY08 and FY09 appropriations: Labor/HHS/Education Appropriations bill (including Title VII health professions and student loans) and VA healthcare and research). Address inadequacies in public health programs and funding: Healthcare disparities, anti-smoking (S.625/H.R. 1108, the Family Smoking Prevention and Tobacco Control Act), vaccines (e.g. smallpox, influenza), CMS - Payment for the recently approved Herpes Zoster (Shingles) vaccine and its administration, DEA how e-prescribing systems can meet the Drug Enforcement Administrations (DEAs) prescription requirements under the Controlled Substances Act. Provide loan debt relief for medical students through enhancements to existing programs and the creation of new programs: H.R. 1093, Resident Physician Shortage Reduction Act of 2007; S. 588, Resident Physician Shortage Reduction Act of 2007; S. 1066, Medical Education Affordability Act; Reauthorization of the Higher Education Act, including the restoration of the 20/220 pathway; S. 2303/H.R. 4344, a bill to amend section 435 of the Higher Education Act of 1965 regarding the definition of economic hardship. Preserving the safety net function of federally-funded health care programs, such as SCHIP: H.R. 5268, providing for a temporary increase of the Federal medical assistance percentage under the Medicaid Program. Preserving access to primary care services: the impending shortage of primary care physicians, designation of primary care as a shortage profession, scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas, grants for medical school mentorship programs and primary care training in community health centers, increased Title VII funding for primary care health programs, Medicare payment reforms to support the Patient Centered Medical Home, regulatory relief, studies on primary care; S. 1340/H.R. 2244, the Geriatric Assessment and Chronic Care Coordination Act of 2007.

Client expense: $167,205 · Firm income: Not reported

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

Medicare physician payment issues including provisions in H.R. 6331/S. 3101, the Medicare Improvements for Patients and Providers Act; S. 3118, the Preserving Access to Medicare Act. Graduate medical education issues including provisions in S. 588/H.R. 1093, the Resident Physician Shortage Reduction Act of 2007

Client expense: Not reported · Firm income: $50,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 3043; S. 1710 - Labor HHS appropriations S. 588; H.R. 1093 Residency Caps H.R. 3; S. 5; S. 30 Stem Cell S. 1576 Minority Improvent S. 1066 Medical Affordability Act H.R. 4854, S. 2041 False Claims Correction Act S. 484 Research Misconduct Clinical Trials

Client expense: $110,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), Transportation, Dept of (DOT)

Legislation to expand health care coverage and access including provisions contained bills in which would offer Medicare, Medicaid and/or SCHIP to more children, create parity in coverage of mental health benefits, foster reform at the state level, stabilize trauma care, prevent healthcare acquired infections, ensure hospital preparedness, expand the use of health information technology, provide funding for Ryan White programs, increase and stabilize the healthcare workforce HR 2357; MediKids Health Insurance Act of 2007"; to create a new federal healthcare program to provide comprehensive health benefits to children S 1218 /HR 2034, Medicare for All Act; expanding the Medicare program to those under age 65. S 1169; State-Based Health Care Reform Act; to create a five-year pilot program in several states to develop coverage plans for the uninsured HR 1424; Paul Wellstone Mental Health and Addiction Equity Act require group health plans to provide comparable treatment limits and beneficiary cost sharing for medical and mental health benefits. HR 1663, Medicare Mental Health Modernization Act to provide mental health parity in private health insurance and Medicare, and improves coverage for cost-effective and community-based mental health treatment services for seniors and people with disabilities S 895/HR 1535; Children's Health First Act allow states to expand children's health coverage to families up to 400 percent of the Federal poverty level HR 1308S/764, Legal Immigrant Children's Health Improvement Act to permit states the option of coverage of legal immigrants under the Medicaid Program and the State Children's Health Insurance Program S 558, Mental Health Parity Act of 2007 would preserve state laws that are more comprehensive while creating parity in health plans offering mental health coverage by equating financial requirements and treatment limitations for mental health benefits with medical and surgical benefits. S 325/HR 506, Health Partnership Act would provide grants to individual states, groups of states, and portions of states to test various health reform strategies HR1111, Kids Come First Act to ensure that every uninsured child in America has health insurance coverage, HR 3162, "Children's Health and Medicare Protection Act" HR 976 in the Senate, Children's Health Insurance Program Reauthorization Act S 2049, The Better Health for America's Children Act," to block a new policy to limit states' ability to enroll children in the State Children's Health Insurance Program S 2152, Kids First Actalternative SCHIP bill that would restrict coverage to individuals younger than age 19 in low-income families HR 3963; Children's Health Insurance Program Reauthorization Act revised bill to extend and expand the State Childrens Health Insurance Program (SCHIP) HR 2055 Improving Children's Access to Health Care Act, to improve children's access to health care coverage under the Medicaid Program and the State Children's Health Insurance Program (SCHIP). Legislation to expand health care coverage and access including provisions which would stabilize medical emergency reimbursement, HR 882, Access to Emergency Services Act that would increase by 10 percent Medicare reimbursements to physicians who provide care in emergency departments (EDs) or post-stabilization care related to emergency medical conditions in other areas of hospitals S 657, A bill to amend the Public Health Service Act to add requirements regarding trauma care Legislation to expand health care coverage and access including provisions to ensure patient safety, H.J.RES. 20, Making further continuing appropriations for the fiscal year 2007 provision annual fit-testing of respirators for occupational exposure to tuberculosis. S 2278/HR 4214 Community and Healthcare-Associated Infections Reduction Act to improve the prevention, detection, and treatment of community and healthcare-associated infections Legislation to expand health care coverage and access including provisions to ensure emergency preparedness, HR 727, Trauma Care Systems Planning and Development Act of 2007 would authorize an additional $46 million between fiscal years 2008 and 2012 in spending for rural medical centers that treat patients during times of national crisis HJ Res. 20, Making further continuing appropriations for the fiscal year 2007, extending program to provide funds for hospital preparedness S Con Res 21/H Con Res 99, Budget resolution -- extending program to provide funds for hospital preparedness HR 3043; Labor, HHS Appropriations bill, provide funds for hospital preparedness Legislation to expand health care coverage and access including provisions to promote the use of health information technology: S 1418, Wired for Health Care Quality Act HR3043/S1710, Appropriations Labor, Health and Human Services (HHS), Education, and Related Agencies FY 08, funding for HIT programs HR 1467, 10,000 Trained by 2010 Act, award competitive grants for basic research on innovative approaches to improve health care information systems HR 2406, Healthcare Information Technology Enterprise Integration,guidelines and mechanisms to promote the integration of the healthcare information enterprise. S 1408, Health Information Technology Act, would provide tax incentives and resources to offset the costs of investing in new health information technology. HJ Res. 20, Making further continuing appropriations for the fiscal year 2007, extending program to provide funds for HIT S Con Res 21/H Con Res 99, Budget resolution -- extending program to provide funds for HIT HR 3043, Labor, HHS Appropriations bill, provide funds for HIT HR 2764; omnibus appropriations bill for FY2008 provide funds for HIT Legislation to expand health care coverage and access including provisions funding HIV/AIDS programs: HJ Res. 20, Making further continuing appropriations for the fiscal year 2007, extending program to provide funds for Ryan White programs S Con Res 21/H Con Res 99, Budget resolution -- extending program to provide funds for Ryan White programs HR3043/S1710, FY 2008 Labor HHS Appropriations Bill, funding for Ryan White programs HR 2764; omnibus appropriations bill for FY2008, funding for Ryan White programs Legislation to expand health care coverage and access including provisions to ensure sufficient workforce within in the healthcare sector S 1604, Nursing Education and Quality of Health Care Act, increases the nurse workforce in rural areas, expands nursing school faculty, and develops initiatives to integrate patient safety practices into nursing education HR 2122, Safe Nursing and Patient Care Act of 2007", limiting the number of mandatory overtime hours a nurse may be required to work S 1639, Comprehensive Immigration Reform, the point-based system for visas, to give nurses special consideration under the point system HR800/S1041, Employee Free Choice Act, require the NLRB to certify a bargaining representative if a majority of the bargaining unit employees have authorized designation of the representative (card-check) HR 2123, Nurse Staffing Standards for Patient Safety and Quality Care Act, to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals HR 378, Nurse and Patient Safety & Protection Act direct the Secretary of Labor to issue an occupational safety and health standard to reduce injuries to patients, direct-care registered nurses, and other health care providers by establishing a safe patient handling standard. HR 1644, Re-Empowerment of Skilled and Professional Employees and Construction Tradesworkers (RESPECT) Act, to amend the National Labor Relations Act to clarify the definition of "supervisor" S446, Nurse Education, Expansion, and Development (NEED) Act, grants based on the number of nursing students enrolled to hire and retain new nursing faculty S 718, The Patient-Focused Critical Care Enhancement Act, provision study the impact of differences in staffing, organization, size, and structure of intensive care units on access, quality, and efficiency of care HJ Res. 20, Making further continuing appropriations for the fiscal year 2007, extending program to provide funds for Nursing Education programs, , national health service corp HR 677, Nursing School Capacity Act authorize IOM study to identify constraints encountered by schools of nursing in admitting and graduating sufficient number of nurses S1577, Patient Safety and Abuse Prevention Act screening of direct patient access employees HR3043/S1710; Labor, HHS Appropriations bill; nursing education, national health service corp. S 588/HR 1093, Resident Physician Shortage Act, to expand the number of physician training positions in 24 states with shortages HR 5924, The Emergency Nurse Supply Relief Act, which would address the retrogression backlog of visas for internationally-educated nurses who have been hired by U.S. hospitals but are not able to come here because of the unavailability of an employment-based (EB) visa.

Client expense: $120,000 · Firm income: Not reported

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

H.R. 1093/S. 588, "Resident Physician Shortage Reduction Act" Issue: Medicare Resident Limits-Removing the cap on the number of residents Medicare will count when determining teaching hospitals' Medicare Indirect Medical Education and Direct Graduate Medical Education payments.

Client expense: $140,000 · Firm income: Not reported

Government targets: Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA)

H.R.882, Access to Emergency Medical Services Act of 2007, Quality and patient safety. H.R.1093/S.588, Resident Physician Shortage Reduction Act of 2007, Workforce shortage issues. S.543, Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007, Health care issues. H.R.1376/H.R.2606, 340B Program Improvement and Integrity Act, Pharmaceutical related issues. H.R.5544, Patients and Public Health Partnership Act of 2008, Uninsured and medically underserved related issues. S.1693, Wired for Health Care Quality Act , Health information technology related issues. S.1814, Health Information Privacy and Security Act, Health information technology related issues. S.2319, National Trauma Center Stabilization Act of 2007, Emergency readiness and trauma related issues. H.R.5613, Protecting the Medicaid Safety Net Act of 2008, Medicaid regulations related issues. H.R.3533, Public and Teaching Hospital Preservation Act, GME and related issues. S.2460, A bill to extend by one year the moratorium on implementation of a rule relating to the Federal-State financial partnership under Medicaid and the State Children's Health Insurance Program and on finalization of a rule regarding graduate medical education under Medicaid and to include a moratorium on the finalization of the outpatient Medicaid rule making similar changes -- Medicaid related issues. H.R.4105, Medicare Recovery Audit Contractor Program Moratorium Act of 2007, RAC related issues. H.R.1424, Paul Wellstone Mental Health and Addiction Equity Act of 2007, Mental health and addiction parity. S.1083/H.R.1930, Securing Knowledge, Innovation, and Leadership Act of 2007, Healthcare workforce shortage related issues. General monitoring of patient safety and quality issues.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of

H.R.1093/S.588, Resident Physician Shortage Reduction Act of 2007, Workforce shortage issues. H.R.1952, National Health Information Incentive Act of 2007, Health IT issues. General monitoring of Medicare/Medicaid Reimbursement 340 B Program; and patient quality and safety. H.R.3533, Public and Teaching Hospital Preservation Act, GME related issues. H.R.4105, Medicare Recovery Audit Contractor Program Moratorium Act of 2007, RAC related issues. H.R.2606/S.1376, 340B Program Improvement and Integrity Act of 2007, Reimbursement related issues. H.R.4231, Rural Veterans Health Care Access Act of 2007, Veterans healthcare related issues. H.R.1424, Paul Wellstone Mental Health and Addiction Equity Act of 2007, Mental health and addiction parity.

Client expense: Not reported · Firm income: $20,000

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

Health Information Technology (HIT); providing incentives for the successful adoption of HIT: S.1693, the Wired for Healthcare Quality Act; H.R. 3800, Promoting Health Information Technology Act; H.R. 1952, the National Health Information Incentive Act of 2007. Expanding health insurance coverage to ensure that more Americans will have access to affordable health insurance: H.R. 506 /S.325, Health Partnership through Creative Federalism Act; Health insurance reform, Medicaid, Association Health Plans, Medical Savings Accounts, Tax credits and purchasing pools; S. 1169, the State-Based Health Care Reform Act; H.R. 2351, the Health Care Act of 2007. Reforming the medical liability system in this country to ease existing financial burdens on practicing physicians and to ensure greater patient access to care: S. 243, the Medical Care Access Protection Act of 2007 (MCAP Act); H.R. 2580, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2007. Medical liability demonstration projects. Reforming the Medicare physician reimbursement formula to provide for greater predictability and stability in payments: S. 40, the Geriatric and Chronic Care Management Act, Reform the Sustainable Growth Rate - S. 2785, Save Medicare Act of 2008, H. R. 5445; H.R. 5545 and S. 2729, the Ensuring the Future Physician Workforce Act of 2008, Pay-for-Performance, Patient Centered Medical Home H.R. 3162, the CHAMP Act, care coordination, primary care shortage, CMS proposed changes to work relative value units (RVUs), Medically Unbelievable Edits program, CMS Request for Information (RFI) for Cycle 1 of the Medicare Administrative Contractor (MAC), CMS Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates, Health Care Price Transparency. H.R. 6331/S.3101, the Medicare Improvements for Patients and Providers Act. Ensure adequate funding for federal health programs in the FY08 and FY09 appropriations: Labor/HHS/Education Appropriations bill (including Title VII health professions and student loans) and VA healthcare and research). Address inadequacies in public health programs and funding: Healthcare disparities, anti-smoking, vaccines (e.g. smallpox, influenza), CMS - Payment for the recently approved Herpes Zoster (Shingles) vaccine and its administration, DEA how e-prescribing systems can meet the Drug Enforcement Administrations (DEAs) prescription requirements under the Controlled Substances Act. Provide loan debt relief for medical students through enhancements to existing programs and the creation of new programs: H.R. 1093, Resident Physician Shortage Reduction Act of 2007; S. 588, Resident Physician Shortage Reduction Act of 2007; S. 1066, Medical Education Affordability Act; Reauthorization of the Higher Education Act, including the restoration of the 20/220 pathway; S. 2303/H.R. 4344, a bill to amend section 435 of the Higher Education Act of 1965 regarding the definition of economic hardship. Preserving the safety net function of federally-funded health care programs, such as SCHIP: H.R. 5268, providing for a temporary increase of the Federal medical assistance percentage under the Medicaid Program. Preserving access to primary care services: the impending shortage of primary care physicians, designation of primary care as a shortage profession, scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas, grants for medical school mentorship programs and primary care training in community health centers, increased Title VII funding for primary care health programs, Medicare payment reforms to support the Patient Centered Medical Home, regulatory relief, studies on primary care; S. 1340/H.R. 2244, the Geriatric Assessment and Chronic Care Coordination Act of 2007.

Client expense: $334,690 · Firm income: Not reported

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

Health Information Technology (HIT); providing incentives for the successful adoption of HIT: S.1693, the Wired for Healthcare Quality Act; H.R. 3800, Promoting Health Information Technology Act; H.R. 1952, the National Health Information Incentive Act of 2007. Expanding health insurance coverage to ensure that more Americans will have access to affordable health insurance: H.R. 506 Health Partnership through Creative Federalism Act; Health insurance reform, Medicaid, Association Health Plans, Medical Savings Accounts, Tax credits and purchasing pools; H.R. 2351, the Healthcare Act of 2007; S. 1169, the State-Based Health Care Reform Act. Reforming the medical liability system in this country to ease existing financial burdens on practicing physicians and to ensure greater patient access to care: S. 243, the Medical Care Access Protection Act of 2007 (MCAP Act); H.R. 2580, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2007. Medical liability demonstration projects. Reforming the Medicare physician reimbursement formula to provide for greater predictability and stability in payments: S. 40, the Geriatric and Chronic Care Management Act, Reform the Sustainable Growth Rate - S. 2785, Save Medicare Act of 2008, H. R. 5445; H.R. 5545 and S. 2729, the Ensuring the Future Physician Workforce Act of 2008, Pay-for-Performance, Patient Centered Medical Home H.R. 3162, the CHAMP Act, care coordination, primary care shortage, CMS proposed changes to work relative value units (RVUs), Medically Unbelievable Edits program, CMS Request for Information (RFI) for Cycle 1 of the Medicare Administrative Contractor (MAC), CMS Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates, Health Care Price Transparency. H.R. 6331/S.3101, the Medicare Improvements for Patients and Providers Act. Ensure adequate funding for federal health programs in the FY08 and FY09 appropriations: Labor/HHS/Education Appropriations bill (including Title VII health professions and student loans) and VA healthcare and research). Address inadequacies in public health programs and funding: Healthcare disparities, anti-smoking, vaccines (e.g. smallpox, influenza), CMS - Payment for the recently approved Herpes Zoster (Shingles) vaccine and its administration, DEA how e-prescribing systems can meet the Drug Enforcement Administrations (DEAs) prescription requirements under the Controlled Substances Act. Provide loan debt relief for medical students through enhancements to existing programs and the creation of new programs: H.R. 1093, Resident Physician Shortage Reduction Act of 2007; S. 588, Resident Physician Shortage Reduction Act of 2007; S. 1066, Medical Education Affordability Act; Reauthorization of the Higher Education Act, including the restoration of the 20/220 pathway; S. 2303/H.R.. 4344, a bill to amend section 435 of the Higher Education Act of 1965 regarding the definition of economic hardship. Preserving the safety net function of federally-funded health care programs, such as SCHIP: H.R. 5268, providing for a temporary increase of the Federal medical assistance percentage under the Medicaid Program. Preserving access to primary care services: the impending shortage of primary care physicians, designation of primary care as a shortage profession, scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas, grants for medical school mentorship programs and primary care training in community health centers, increased Title VII funding for primary care health programs, Medicare payment reforms to support the Patient Centered Medical Home, regulatory relief, studies on primary care; S. 1340/H.R. 2244, the Geriatric Assessment and Chronic Care Coordination Act of 2007.

Client expense: $334,690 · Firm income: Not reported

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

Health Information Technology (HIT); providing incentives for the successful adoption of HIT: S.1693, the Wired for Healthcare Quality Act; H.R. 3800, Promoting Health Information Technology Act; H.R. 1952, the National Health Information Incentive Act of 2007. Expanding health insurance coverage to ensure that more Americans will have access to affordable health insurance: H.R. 506 Health Partnership through Creative Federalism Act; Health insurance reform, Medicaid, Association Health Plans, Medical Savings Accounts, Tax credits and purchasing pools; H.R. 2351, the Healthcare Act of 2007; S. 1169, the State-Based Health Care Reform Act. Reforming the medical liability system in this country to ease existing financial burdens on practicing physicians and to ensure greater patient access to care: S. 243, the Medical Care Access Protection Act of 2007 (MCAP Act); H.R. 2580, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2007. Medical liability demonstration projects. Reforming the Medicare physician reimbursement formula to provide for greater predictability and stability in payments: S. 40, the Geriatric and Chronic Care Management Act, Reform the Sustainable Growth Rate - S. 2785, Save Medicare Act of 2008, H. R. 5445; H.R. 5545 and S. 2729, the Ensuring the Future Physician Workforce Act of 2008, Pay-for-Performance, Patient Centered Medical Home H.R. 3162, the CHAMP Act, care coordination, primary care shortage, CMS proposed changes to work relative value units (RVUs), Medically Unbelievable Edits program, CMS Request for Information (RFI) for Cycle 1 of the Medicare Administrative Contractor (MAC), CMS Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates, Health Care Price Transparency. H.R. 6331/S.3101, the Medicare Improvements for Patients and Providers Act. Ensure adequate funding for federal health programs in the FY08 and FY09 appropriations: Labor/HHS/Education Appropriations bill (including Title VII health professions and student loans) and VA healthcare and research). Address inadequacies in public health programs and funding: Healthcare disparities, anti-smoking, vaccines (e.g. smallpox, influenza), CMS - Payment for the recently approved Herpes Zoster (Shingles) vaccine and its administration, DEA how e-prescribing systems can meet the Drug Enforcement Administrations (DEAs) prescription requirements under the Controlled Substances Act. Provide loan debt relief for medical students through enhancements to existing programs and the creation of new programs: H.R. 1093, Resident Physician Shortage Reduction Act of 2007; S. 588, Resident Physician Shortage Reduction Act of 2007; S. 1066, Medical Education Affordability Act; Reauthorization of the Higher Education Act, including the restoration of the 20/220 pathway; S. 2303/H.R. 4344, a bill to amend section 435 of the Higher Education Act of 1965 regarding the definition of economic hardship. Preserving the safety net function of federally-funded health care programs, such as SCHIP: H.R. 5268, providing for a temporary increase of the Federal medical assistance percentage under the Medicaid Program. Preserving access to primary care services: the impending shortage of primary care physicians, designation of primary care as a shortage profession, scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas, grants for medical school mentorship programs and primary care training in community health centers, increased Title VII funding for primary care health programs, Medicare payment reforms to support the Patient Centered Medical Home, regulatory relief, studies on primary care; S. 1340/H.R. 2244, the Geriatric Assessment and Chronic Care Coordination Act of 2007.

Client expense: $173,509 · Firm income: Not reported

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

Preventing Reductions to Medicaid Hospital Payments: Public and Teaching Hospital Preservation Act (HR 3533/S 2460), FY2008 Medicaid Intergovernmental Transfer/Cost Limit Regulations, FY2008 Medicaid Graduate Medical Education Proposed Rule, Protecting the Medicaid Safety Net Act of 2008 (HR 5613); Supplemental Appropriations Acts, 2008 (HR 2642); Increasing Medicare's Resident Limits: Resident Physician Shortage Reduction Act (HR 1093/S 588); Preventing Reductions of Medicare Payments to Anesthesiologists: Medicare Anesthesiology; Teaching Funding Restoration Act of 2007 (HR 2053/S 2056); Improving Cancer Treatment and Care under Medicare: Comprehensive Cancer Care Improvements Act of 2007 (HR 1078); Improving Delivery of Care to Children Under Medicaid: Children's Healthcare and Quality Act of 2007 (HR 2723, S 1226, S 2790); Medicare Value Based Purchasing, Medicare Physician Payments: Preventing a 10% Reduction in CY2008: Medicare Improvements for Patients and Providers Act of 2008 (HR 6331/S 3101); Preserving Access to Medicare Act of 2008 (S 3118); Maintaining Medicare Indirect Medical Education Payments. Increased Medicare Payments to Nurse-Midwives: Midwifery Care Access and Reimbursement Equity Act of 2007 (HR 864/S 507).

Client expense: $41,000 · Firm income: Not reported

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

Legislation to expand health care coverage and access including provisions contained bills in which would offer Medicare, Medicaid and/or SCHIP to more children, create parity in coverage of mental health benefits, foster reform at the state level, stabilize trauma care, prevent healthcare acquired infections, ensure hospital preparedness, expand the use of health information technology, provide funding for Ryan White programs, increase and stabilize the healthcare workforce. HR 2357; MediKids Health Insurance Act of 2007"; to create a new federal healthcare program to provide comprehensive health benefits to children S 1218 /HR 2034, Medicare for All Act; expanding the Medicare program to those under age 65. S 1169; State-Based Health Care Reform Act; to create a five-year pilot program in several states to develop coverage plans for the uninsured HR 1424; Paul Wellstone Mental Health and Addiction Equity Act require group health plans to provide comparable treatment limits and beneficiary cost sharing for medical and mental health benefits. HR 1663, Medicare Mental Health Modernization Act to provide mental health parity in private health insurance and Medicare, and improves coverage for cost-effective and community-based mental health treatment services for seniors and people with disabilities S 895/HR 1535; Children's Health First Act allow states to expand children's health coverage to families up to 400 percent of the Federal poverty level HR 1308S/764, Legal Immigrant Children's Health Improvement Act to permit states the option of coverage of legal immigrants under the Medicaid Program and the State Children's Health Insurance Program S 558, Mental Health Parity Act of 2007 would preserve state laws that are more comprehensive while creating parity in health plans offering mental health coverage by equating financial requirements and treatment limitations for mental health benefits with medical and surgical benefits. S 325/HR 506, Health Partnership Act would provide grants to individual states, groups of states, and portions of states to test various health reform strategies HR1111, Kids Come First Act to ensure that every uninsured child in America has health insurance coverage, HR 3162, "Children's Health and Medicare Protection Act" HR 976 in the Senate, Children's Health Insurance Program Reauthorization Act S 2049, The Better Health for America's Children Act," to block a new policy to limit states' ability to enroll children in the State Children's Health Insurance Program S 2152, Kids First Actalternative SCHIP bill that would restrict coverage to individuals younger than age 19 in low-income families HR 3963; Children's Health Insurance Program Reauthorization Act revised bill to extend and expand the State Childrens Health Insurance Program (SCHIP) HR 2055 Improving Children's Access to Health Care Act, to improve children's access to health care coverage under the Medicaid Program and the State Children's Health Insurance Program (SCHIP). Legislation to expand health care coverage and access including provisions which would stabilize medical emergency reimbursement, HR 882, Access to Emergency Services Act that would increase by 10 percent Medicare reimbursements to physicians who provide care in emergency departments (EDs) or post-stabilization care related to emergency medical conditions in other areas of hospitals S 657, A bill to amend the Public Health Service Act to add requirements regarding trauma care Legislation to expand health care coverage and access including provisions to ensure patient safety, H.J.RES. 20, Making further continuing appropriations for the fiscal year 2007 provision annual fit-testing of respirators for occupational exposure to tuberculosis. S 2278/HR 4214 Community and Healthcare-Associated Infections Reduction Act to improve the prevention, detection, and treatment of community and healthcare-associated infections Legislation to expand health care coverage and access including provisions to ensure emergency preparedness, HR 727, Trauma Care Systems Planning and Development Act of 2007 would authorize an additional $46 million between fiscal years 2008 and 2012 in spending for rural medical centers that treat patients during times of national crisis HJ Res. 20, Making further continuing appropriations for the fiscal year 2007, extending program to provide funds for hospital preparedness S Con Res 21/H Con Res 99, Budget resolution -- extending program to provide funds for hospital preparedness HR 3043; Labor, HHS Appropriations bill, provide funds for hospital preparedness Legislation to expand health care coverage and access including provisions to promote the use of health information technology: S 1418, Wired for Health Care Quality Act HR3043/S1710, Appropriations Labor, Health and Human Services (HHS), Education, and Related Agencies FY 08, funding for HIT programs HR 1467, 10,000 Trained by 2010 Act, award competitive grants for basic research on innovative approaches to improve health care information systems HR 2406, Healthcare Information Technology Enterprise Integration,guidelines and mechanisms to promote the integration of the healthcare information enterprise. S 1408, Health Information Technology Act, would provide tax incentives and resources to offset the costs of investing in new health information technology. HJ Res. 20, Making further continuing appropriations for the fiscal year 2007, extending program to provide funds for HIT S Con Res 21/H Con Res 99, Budget resolution -- extending program to provide funds for HIT HR 3043, Labor, HHS Appropriations bill, provide funds for HIT HR 2764; omnibus appropriations bill for FY2008 provide funds for HIT Legislation to expand health care coverage and access including provisions funding HIV/AIDS programs: HJ Res. 20, Making further continuing appropriations for the fiscal year 2007, extending program to provide funds for Ryan White programs S Con Res 21/H Con Res 99, Budget resolution -- extending program to provide funds for Ryan White programs HR3043/S1710, FY 2008 Labor HHS Appropriations Bill, funding for Ryan White programs HR 2764; omnibus appropriations bill for FY2008, funding for Ryan White programs Legislation to expand health care coverage and access including provisions to ensure sufficient workforce within in the healthcare sector S 1604, Nursing Education and Quality of Health Care Act, increases the nurse workforce in rural areas, expands nursing school faculty, and develops initiatives to integrate patient safety practices into nursing education HR 2122, Safe Nursing and Patient Care Act of 2007", limiting the number of mandatory overtime hours a nurse may be required to work S 1639, Comprehensive Immigration Reform, the point-based system for visas, to give nurses special consideration under the point system HR800/S1041, Employee Free Choice Act, require the NLRB to certify a bargaining representative if a majority of the bargaining unit employees have authorized designation of the representative (card-check) HR 2123, Nurse Staffing Standards for Patient Safety and Quality Care Act, to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals HR 378, Nurse and Patient Safety & Protection Act direct the Secretary of Labor to issue an occupational safety and health standard to reduce injuries to patients, direct-care registered nurses, and other health care providers by establishing a safe patient handling standard. HR 1644, Re-Empowerment of Skilled and Professional Employees and Construction Tradesworkers (RESPECT) Act, to amend the National Labor Relations Act to clarify the definition of "supervisor" S446, Nurse Education, Expansion, and Development (NEED) Act, grants based on the number of nursing students enrolled to hire and retain new nursing faculty S 718, The Patient-Focused Critical Care Enhancement Act, provision study the impact of differences in staffing, organization, size, and structure of intensive care units on access, quality, and efficiency of care HJ Res. 20, Making further continuing appropriations for the fiscal year 2007, extending program to provide funds for Nursing Education programs, , national health service corp HR 677, Nursing School Capacity Act authorize IOM study to identify constraints encountered by schools of nursing in admitting and graduating sufficient number of nurses S1577, Patient Safety and Abuse Prevention Act screening of direct patient access employees HR3043/S1710; Labor, HHS Appropriations bill; nursing education, national health service corp. S 588/HR 1093, Resident Physician Shortage Act, to expand the number of physician training positions in 24 states with shortages

Client expense: $120,000 · Firm income: Not reported

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

Preventing Reductions to Medicaid Hospital Payments: Public and Teaching Hospital Preservation Act (HR 3533/S 2460), FY2008 Medicaid Intergovernmental Transfer/Cost Limit Regulations, FY2008 Medicaid Graduate Medical Education Proposed Rule, Protecting the Medicaid Safety Net Act of 2008 (HR 5613); Increasing Medicare's Resident Limits: Resident Physician Shortage Reduction Act (HR 1093/S 588); Preventing Reductions of Medicare Payments to Anesthesiologists: Medicare Anesthesiology Teaching Funding Restoration Act of 2007 (HR 2053/S 2056); Improving Cancer Treatment and Care under Medicare: Comprehensive Cancer Care Improvements Act of 2007 (HR 1078); Improving Delivery of Care to Children Under Medicaid: Children's Healthcare and Quality Act of 2007 (HR 2723, S 1226); Medicare Value Based Purchasing, Medicare Physician Payments: Preventing a 10% Reduction in CY2008, Maintaining Medicare Indirect Medical Education Payments.

Client expense: $30,850 · Firm income: Not reported

H.R. 3043; S. 1710 - Labor HHS appropriations S. 588; H.R. 1093 Residency Caps H.R. 3; S. 5; S. 30 Stem Cell S. 1576 Minority Improvent S. 1066 Medical Affordability Act S. 484 Research Misconduct Clinical Trials

Client expense: $110,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Defense, Dept of (DOD), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), Transportation, Dept of (DOT)

H.R.882, Access to Emergency Medical Services Act of 2007, Quality and patient safety. H.R.1093/S.588, Resident Physician Shortage Reduction Act of 2007, Workforce shortage issues. S.543, Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007, Health care issues. H.R.1376/H.R.2606, 340B Program Improvement and Integrity Act, Pharmaceutical related issues. H.R.5544, Patients and Public Health Partnership Act of 2008, Uninsured and medically underserved related issues. S.1693, Wired for Health Care Quality Act , Health information technology related issues. S.1814, Health Information Privacy and Security Act, Health information technology related issues. S.2319, National Trauma Center Stabilization Act of 2007, Emergency readiness and trauma related issues. H.R.5613, Protecting the Medicaid Safety Net Act of 2008, Medicaid regulations related issues. H.R.3533, Public and Teaching Hospital Preservation Act, GME and related issues. S.2460, A bill to extend by one year the moratorium on implementation of a rule relating to the Federal-State financial partnership under Medicaid and the State Children's Health Insurance Program and on finalization of a rule regarding graduate medical education under Medicaid and to include a moratorium on the finalization of the outpatient Medicaid rule making similar changes -- Medicaid related issues. H.R.4105, Medicare Recovery Audit Contractor Program Moratorium Act of 2007, RAC related issues. H.R.1424, Paul Wellstone Mental Health and Addiction Equity Act of 2007, Mental health and addiction parity. S.1083/H.R.1930, Securing Knowledge, Innovation, and Leadership Act of 2007, Healthcare workforce shortage related issues. General monitoring of patient safety and quality issues.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of

H.R.1093/S.588, Resident Physician Shortage Reduction Act of 2007, Workforce shortage issues. H.R.1952, National Health Information Incentive Act of 2007, Health IT issues. General monitoring of Medicare/Medicaid Reimbursement 340 B Program; and patient quality and safety. H.R.3533, Public and Teaching Hospital Preservation Act, GME related issues. H.R.4105, Medicare Recovery Audit Contractor Program Moratorium Act of 2007, RAC related issues. H.R.2606/S.1376, 340B Program Improvement and Integrity Act of 2007, Reimbursement related issues. H.R.4231, Rural Veterans Health Care Access Act of 2007, Veterans healthcare related issues. H.R.1424, Paul Wellstone Mental Health and Addiction Equity Act of 2007, Mental health and addiction parity.

Client expense: Not reported · Firm income: $10,000

Medicare Physician Reimbursement; Medicare Geographic Practice Cost Indices (GPCI); Florida Medical Residency Slots; Medicare Quality Improvement Organizations (QIO); S. 588/H.R. 1093, The Resident Physician Shortage Reduction Act of 2007; S. 1947, The Continuing the Advancement of Quality Improvement Act of 2007; S. 2785, The Save Medicare Act of 2008; H.R. 4736

Client expense: Not reported · Firm income: $40,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health Information Technology (HIT); providing incentives for the successful adoption of HIT: S.1693, the Wired for Healthcare Quality Act; H.R. 3800, Promoting Health Information Technology Act; H.R. 1952, the National Health Information Incentive Act of 2007; Expanding health insurance coverage to ensure that more Americans will have access to affordable health insurance: H.R. 506, Health Partnership through Creative Federalism Act; Health insurance reform, Medicaid, Association Health Plans, Medical Savings Accounts, Tax credits and purchasing pools. Reforming the medical liability system in this country to ease existing financial burdens on practicing physicians and to ensure greater patient access to care: S. 243, the Medical Care Access Protection Act of 2007 (MCAP Act); H.R. 2580, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2007. Medical liability demonstration projects. Reforming the Medicare physician reimbursement formula to provide for greater predictability and stability in payments: S. 40, the Geriatric and Chronic Care Management Act, Reform the Sustainable Growth Rate - S. 2785, Save Medicare Act of 2008, H. R. 5445; H.R. 5545 and S. 2729, the Ensuring the Future Physician Workforce Act of 2008, Pay-for-Performance, Patient Centered Medical Home H.R. 3162, the CHAMP Act, care coordination, primary care shortage, CMS proposed changes to work relative value units (RVUs), Medically Unbelievable Edits program, CMS Request for Information (RFI) for Cycle 1 of the Medicare Administrative Contractor (MAC), CMS Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates, Health Care Price Transparency. Ensure adequate funding for federal health programs in the FY08 and FY09 appropriations: Labor/HHS/Education Appropriations bill (including Title VII health professions and student loans) and VA healthcare and research). Address inadequacies in public health programs and funding: Healthcare disparities, anti-smoking, vaccines (e.g. smallpox, influenza), CMS - Payment for the recently approved Herpes Zoster (Shingles) vaccine and its administration, DEA how e-prescribing systems can meet the Drug Enforcement Administrations (DEAs) prescription requirements under the Controlled Substances Act. Provide loan debt relief for medical students through enhancements to existing programs and the creation of new programs: H.R. 1093, Resident Physician Shortage Reduction Act of 2007; S. 588, Resident Physician Shortage Reduction Act of 2007; S. 1066, Medical Education Affordability Act; Reauthorization of the Higher Education Act, including the restoration of the 20/220 pathway. Preserving the safety net function of federally-funded health care programs, such as SCHIP: H.R. 5268, providing for a temporary increase of the Federal medical assistance percentage under the Medicaid Program. Preserving access to primary care services: the impending shortage of primary care physicians, designation of primary care as a shortage profession, scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas, grants for medical school mentorship programs and primary care training in community health centers, increased Title VII funding for primary care health programs, Medicare payment reforms to support the Patient Centered Medical Home, regulatory relief, studies on primary care.

Client expense: $225,704 · Firm income: Not reported

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

Health Information Technology (HIT); providing incentives for the successful adoption of HIT: S.1693, the Wired for Healthcare Quality Act; H.R. 3800, Promoting Health Information Technology Act; H.R. 1952, the National Health Information Incentive Act of 2007. Expanding health insurance coverage to ensure that more Americans will have access to affordable health insurance: H.R. 506, Health Partnership through Creative Federalism Act; Health insurance reform, Medicaid, Association Health Plans, Medical Savings Accounts, Tax credits and purchasing pools. Reforming the medical liability system in this country to ease existing financial burdens on practicing physicians and to ensure greater patient access to care: S. 243, the Medical Care Access Protection Act of 2007 (MCAP Act); H.R. 2580, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2007. Medical liability demonstration projects. Reforming the Medicare physician reimbursement formula to provide for greater predictability and stability in payments: S. 40, the Geriatric and Chronic Care Management Act, Reform the Sustainable Growth Rate - S. 2785, Save Medicare Act of 2008, H. R. 5445; H.R. 5545 and S. 2729, the Ensuring the Future Physician Workforce Act of 2008, Pay-for-Performance, Patient Centered Medical Home H.R. 3162, the CHAMP Act, care coordination, primary care shortage, CMS proposed changes to work relative value units (RVUs), Medically Unbelievable Edits program, CMS Request for Information (RFI) for Cycle 1 of the Medicare Administrative Contractor (MAC), CMS Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates, Health Care Price Transparency. Ensure adequate funding for federal health programs in the FY08 and FY09 appropriations: Labor/HHS/Education Appropriations bill (including Title VII health professions and student loans) and VA healthcare and research). Address inadequacies in public health programs and funding: Healthcare disparities, anti-smoking, vaccines (e.g. smallpox, influenza), CMS - Payment for the recently approved Herpes Zoster (Shingles) vaccine and its administration, DEA how e-prescribing systems can meet the Drug Enforcement Administrations (DEAs) prescription requirements under the Controlled Substances Act. Provide loan debt relief for medical students through enhancements to existing programs and the creation of new programs: H.R. 1093, Resident Physician Shortage Reduction Act of 2007; S. 588, Resident Physician Shortage Reduction Act of 2007; S. 1066, Medical Education Affordability Act; Reauthorization of the Higher Education Act, including the restoration of the 20/220 pathway. Preserving the safety net function of federally-funded health care programs, such as SCHIP: H.R. 5268, providing for a temporary increase of the Federal medical assistance percentage under the Medicaid Program. Preserving access to primary care services: the impending shortage of primary care physicians, designation of primary care as a shortage profession, scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas, grants for medical school mentorship programs and primary care training in community health centers, increased Title VII funding for primary care health programs, Medicare payment reforms to support the Patient Centered Medical Home, regulatory relief, studies on primary care.

Client expense: $175,401 · Firm income: Not reported

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

H.R. 1093/S. 588, "Resident Physician Shortage Reduction Act" Issue: Medicare Resident Limits-Removing the cap on the number of residents Medicare will count when determining teaching hospitals' Medicare Indirect Medical Education and Direct Graduate Medical Education payments.

Client expense: $120,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA)

HR 1, HR477, HR882, HR976,HR1093,HR1655,HR2050,HR2164,HR2580,HR2583,HR2584,HR2626,HR2669,HR2749,HR2764,HR2900 HR3043,HR3074,HR3162,HR3173,HR3344,HR3495,HR3533,HR3963,PL 110-53,PL110-84 & PL110-161, S4, S60,S243,S244,S588,S999,S1003,S1082,S1310,S1408,S1519,S1588,S1642,S1644,S1710,S1789,S1873,S1893,S1970,S2319 S2499

Client expense: $1,129,163 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 945, the Tanning Accountability Accountability and Notification Act of 2007; H.R. 1093, the Resident Physician Shortage Reduction Act of 2007; H.R. 1188, the Psoriasis and Psoriatic Arthritis Research, Care and Cure Act of 2007; H.R. 2406, a bill to authorize the NIST to increase efforts in support of the integration of healthcare enterprise in the U.S.; H.R. 2749, the Voluntary Medicare Quality Reporting Act of 2007; H.R. 2900, PDUFA of 2007; H.R. 3162 the SCHIP Act of 2007; HHS Appropriations Act

Client expense: $260,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE, White House Office

H.R. 3043; S. 1710 - Labor HHS appropriations S. 588; H.R. 1093 Residency Caps H.R. 3; S. 5; S. 30 Stem Cell S. 1576 Minority Improvent S. 1066 Medical Affordability Act S. 484 Research Misconduct Clinical Trials

Client expense: $160,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Defense, Dept of (DOD), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), Transportation, Dept of (DOT)

10,000 Trained by 2010 Act (HR 1467); Labor/HHS/Education Appropriations Bill (HR3043/S1710); Public and Teaching Hospital Preservation Act (HR3533); Resident Physician Shortage Reducation Act (S588/HR1093); Medicare Anesthesiology Teaching Funding Restoration Act of 2007 (HR2053/S2056); Resident Limit Request; College Cost Reduction and Access Act (HR 4153/ S2258); Physician Workforce and Graduate Medical Education Enhancement Act of 2007(HR2583); Section 340B Public HealthAct

Client expense: $30,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Natl Science Foundation (NSF), SENATE

* Issue: To preserve Medicare Direct Graduate Medical Education payments to teaching hospitals. Issue: To preserve Medicare Indirect Graduate Medical Education payments to teaching hospitals. H.R. 3162, "The Children's Health and Medicare Protection Act, Title III. Issue: To restore Medicare payments to physicians. H.R. 3533, "Public and Teaching Hospital Preservation Act." S. 2460 "To extend by one year the moratorium on Implementation of a rule." Issue: Retain Medicaid Graduate Medical Education payments to providers. Medicare Hospital Payments and Proposals Related to Medical-Severity Diagnosis Related Groups. Issue: Retain Medicare Indirect Graduate Medical Education Payments and Direct Graduate Medical Education Payments to teaching hospitals for residents in non-hospitals sites. H.R. 1093/S. 588, "Resident Physician Shortage Reduction Act" Issue: Medicare Resident Limits-Removing the cap on the number of residents Medicare will count when determining teaching hospitals' Medicare Indirect Medical Education and Direct Graduate Medical Education payments. Issue: To preserve Medicare Indirect Graduate Medical Education payments to teaching hospitals. H.R. 3162, "The Children's Health and Medicare Protection Act, Title III. Issue: To restore Medicare payments to physicians. H.R. 3533, "Public and Teaching Hospital Preservation Act." S. 2460 "To extend by one year the moratorium on Implementation of a rule." Issue: Retain Medicaid Graduate Medical Education payments to providers. Medicare Hospital Payments and Proposals Related to Medical-Severity Diagnosis Related Groups. Issue: Retain Medicare Indirect Graduate Medical Education Payments and Direct Graduate Medical Education Payments to teaching hospitals for residents in non-hospitals sites. H.R. 1093/S. 588, "Resident Physician Shortage Reduction Act" Issue: Medicare Resident Limits-Removing the cap on the number of residents Medicare will count when determining teaching hospitals' Medicare Indirect Medical Education and Direct Graduate Medical Education payments.

Client expense: $260,000 · Firm income: Not reported

Government targets: Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA)

* Issue: To preserve Medicare Direct Graduate Medical Education payments to teaching hospitals. Issue: To preserve Medicare Indirect Graduate Medical Education payments to teaching hospitals. H.R. 3162, "The Children's Health and Medicare Protection Act, Title III. Issue: To restore Medicare payments to physicians. H.R. 3533, "Public and Teaching Hospital Preservation Act." S. 2460 "To extend by one year the moratorium on Implementation of a rule." Issue: Retain Medicaid Graduate Medical Education payments to providers. Medicare Hospital Payments and Proposals Related to Medical-Severity Diagnosis Related Groups. Issue: Retain Medicare Indirect Graduate Medical Education Payments and Direct Graduate Medical Education Payments to teaching hospitals for residents in non-hospitals sites. H.R. 1093/S. 588, "Resident Physician Shortage Reduction Act" Issue: Medicare Resident Limits-Removing the cap on the number of residents Medicare will count when determining teaching hospitals' Medicare Indirect Medical Education and Direct Graduate Medical Education payments. 18 19 20 21 22 23

Client expense: $260,000 · Firm income: Not reported

Government targets: Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA)

S 5, Stem Cell Research Enhancement Act of 2007; Childrens Health Insurance Program Reauthorization Act of 2007, S.1893; Childrens Health and Medicare Protection (CHAMP) Act of 2007 (HR 3162); Resident Physician Shortage Act of 2007, S.588, HR 1093; Physician Shortage Elimination Act of 2007, S. 896, HR 410; Veterinary Public Health Workforce Expansion Act, S. 746, HR 1232

Client expense: $180,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Education, Dept of, Energy, Dept of, Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Natl Institutes of Health (NIH), Natl Science Foundation (NSF), SENATE, U.S. Agency for International Development (USAID), UNDETERMINED, White House Office

General monitoring of patient safety and quality issues. H.R.882, Access to Emergency Medical Services Act of 2007, Health care issues. H.R.1093/S.588, Resident Physician Shortage Reduction Act of 2007, Workforce shortage issues. S.543, Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007, Health care issues.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of

H.R.1093/S.588, Resident Physician Shortage Reduction Act of 2007, Workforce shortage issues. H.R.1952, National Health Information Incentive Act of 2007, Health IT issues. General monitoring of Medicare/Medicaid Reimbursement 340 B Program; and patient quality and safety.

Client expense: Not reported · Firm income: $40,000

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

(cont'd) (6) H.R. 2900, the Prescription Drug User Fee Amendments of 2007, (7) H.R. 3162, the Children's Health and Medicare Protection Act of 2007, and (8) the Departments of Labor, Health and Human Servivces, and Education and Related Agencies Appropriations Act of 2007. (1) H.R. 945, the Tanning Accountability and Notification Act of 2007, (2) H.R. 1093, the Resident Physician Shortage Reduction Act of 2007, (3) H.R. 1188, the Psoriasis and Psoriatic Arthritis Reseach, Care and Cure Act of 2007, (4) H.R. 2406, a bill to authorize the National Insitutes of Standards and Technology to increase its efforts in support of the integration of healthcare enterprise in the United States, (5) H.R. 2749, the Voluntary Medicare Quality Reporting Act of 2007, [continued on next page]

Client expense: $492,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE

H.R. 3043; S. 1710 - Labor HHS appropriations S. 588; H.R. 1093 Residency Caps H.R. 3; S. 5; S. 30 Stem Cell S. 1576 Minority Improvent S. 1066 Medical Affordability Act S. 484 Research Misconduct Clinical Trials

Client expense: $80,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Defense, Dept of (DOD), Education, Dept of, Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), Transportation, Dept of (DOT)

Physicians in Armed Forces Managed Care Reform S. 588 - Resident Physician Shortage Reduction Act of 2007 S. 1066 - Medical Education Affordability Act H.R. 1093 - Resident Physician Shortage Reduction Act of 2007 Health Information Technology

Client expense: $10,332,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE