To suspend temporarily the duty on 1-Amino-2,6-dimethylbenzene.

HR 3590, S 1790, HR 4872 (as enacted into PL 111-148 and PL 111-152) - issues related to Medicare and Medicaid reform, including issues related to pharmaceutical price calculation and reporting HR 3590, S 1790, HR 4872 (as enacted into PL 111-148 and PL 111-152) - issues related to Medicare and Medicaid reform, including issues related to Medicare Part D Coverage Gap Program

Client expense: $660,000 · Firm income: Not reported

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

S. 1796, to provide affordable, quality health care for all Americans and reduce the growth in health care spending HR 1558 To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and health insurance coverage in the group and individual markets H.R. 2520 to provide comprehensive solutions for the health care system of the United States, and for other purposes HR 3200 America's Affordable Health Choices Act of 2009 H.R.3590: An act entitled The Patient Protection and Affordable Care Act. H.R.3962: To provide affordable, quality health care for all Americans and reduce the growth in health care spending. HR 4757 to provide for the establishment of a health insurance rate authority to establish limits on premium rating HR 4872 The bill makes a number of health-related financing and revenue changes to the Patient Protection and Affordable Care Act enacted by H.R.3590 and modifies higher education assistance provisions S 623 To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and in health insurance coverage in the group and individual markets S 803 A bill to amend the Internal Revenue Code of 1986 to provide a tax credit to employers for the costs of implementing wellness programs, and for other purposes. S. 1099 to provide comprehensive solutions for the health care system of the United States, and for other purposes S. 1679 the Affordable Health Choices Act -- An original bill to make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce. S. 1796, to provide affordable, quality health care for all Americans and reduce the growth in health care spending S. 3078 to provide for the establishment of a health insurance rate authority to establish limits on premium rating

Client expense: $425,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), SENATE, Treasury, Dept of, U.S. Trade Representative (USTR)

Federal policies and legislations regarding utilization of diagnostic products and medical equipment, hospital acquired infections; Patient Protection and Affordable Care Act (H.R. 3590); Health Care and Education Affordability Reconciliation Act (H.R. 4872)

Client expense: Not reported · Firm income: $18,000

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

Matters affecting research, diagnosis, treatment and prevention of breast cancer, including 21st Century Cancer Alert Act Patient Protection and Affordable Care Act (H.R. 3590); Health Care and Education Affordability Reconciliation Act (H.R. 4872)

Client expense: Not reported · Firm income: $24,000

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

Patient Protection and Affordable Care Act (H.R. 3590); Health Care and Education Affordability Reconciliation Act (H.R. 4872)

Client expense: Not reported · Firm income: $45,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Waxman Markey Climate Change Bill; American Clean Energy & Security Act (H.R. 2454); Greenhouse Gas Emissions; Amendments to HR 4872 (health care) relating to Mid-level ethanol blends; Clean Energy Jobs and American Power Act of 2009 (S. 1733); Accelerated, separate and specific EPA regulatory effort with respect to marine vessels and engines; Implementation of Clean Boating Act; EPA CTG for Recreational Boat Paints and Coatings

Client expense: $190,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Council on Environmental Quality (CEQ), Energy, Dept of, Environmental Protection Agency (EPA), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Interior, Dept of (DOI), SENATE, Small Business Administration (SBA), State, Dept of (DOS), Treasury, Dept of, U.S. Coast Guard (USCG), U.S. Trade Representative (USTR)

Insurance reform; Comprehensive Health Care Reform Proposals. H.R. 3962, The Affordable Health Care for America Act, H.R. 3590, The Patient and Affordable Care Act. Also, subsequent bills/provisions to clarify implementation of HR 3590/HR 4872.

Client expense: $320,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HRC - Health Care Health Care Reform Bill HR 3590 "Patient Protection and Affordable Care Act". parts pertaining to health care reform; Health Care Reconciliation Bill HR 4872 "The Health Care and Education Affordability Reconcilation Act of 2010", parts pertaining to health care reform, reasonable effective dates for compliance with insurance reforms, affordable premiums (insurer tax, insufficient cost containment, weak mandate, restricted age discounts, insurer fees); federal health insurance rate authority, national insurance exchange, grandfathering. Also, subsequent bills/provisions to clarify implementation of HR 3590/HR 4872. Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges. Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations. Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies. Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications. Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels. Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits". Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs.

Client expense: $320,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HRC - Health Care Health Care Reform Bill HR 3590 "Patient Protection and Affordable Care Act". parts pertaining to health care reform; Health Care Reconciliation Bill HR 4872 "The Health Care and Education Affordability Reconcilation Act of 2010", parts pertaining to health care reform, reasonable effective dates for compliance with insurance reforms, affordable premiums (insurer tax, insufficient cost containment, weak mandate, restricted age discounts, insurer fees); federal health insurance rate authority, national insurance exchange, grandfathering. Also, subsequent bills/provisions to clarify implementation of HR 3590/HR 4872. Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges. Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations. Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies. Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications. Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels. Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits". Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Insurance reform; Comprehensive Health Care Reform Proposals. H.R. 3962, The Affordable Health Care for America Act, H.R. 3590, The Patient and Affordable Care Act. Also, subsequent bills/provisions to clarify implementation of HR 3590/HR 4872.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Insurance reform; Comprehensive Health Care Reform Proposals. H.R. 3962, The Affordable Health Care for America Act; H.R. 3590, The Patient and Affordable Care Act. Also, subsequent bills/provisions to clarify implementation of HR.3590/HR 4872.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - health care Health Care Reform Bill HR 3590 "Patient Protection and Affordable Care Act", parts pertaining to health care reform; Health Care Reconciliation Bill HR 4872 "The Health Care & Education Affordability Reconciliation Act of 2010", parts pertaining to health care reform, reasonable effective dates for compliance with insurance reforms, affordable premiums (insurer tax, insufficient cost containment, weak mandate, restricted age discounts, insurer fees); federal health insurance rate authority, national insurance exchange, grandfathering. Also, subsequent bills/provisions to clarify implementation of HR.3590/HR 4872.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Rx drug importation into the US, other than by drug manufacturer (no specific bill); requiring safety and cost savings certification by HHS Sec'y in any Rx drug importation legislation (no specific bill); promote public/private partnerships for comparative effectiveness assessments (S. 1213); Physician Payments Sunshine Act of 2009 (S. 301); health care reform; increasing coverage of uninsured; coverage of preventative services; including immunizations; expansion of the 340B pricing program to include additional covered entities and inpatient prescription drug utilization; maintaining market-based, private sector health care delivery system (H.R. 3200; S. 1679; S. 1796; H.R. 3590; H.R. 4872)

Client expense: $3,220,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

Approval and regulation of biosimilars (H.R. 1427; H.R. 1548; S. 726; H.R. 3200; S. 1679; H.R. 4872)

Client expense: $3,220,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

Efforts to amend the Medicare Modernization Act to impose government price controls on prescription drugs (no specific legislation); efforts to ensure appropriate access to vaccines under Medicare (H.R. 3200; S. 1796; H.R. 3590); Expansion of, or increase in, Medicaid rebates (H.R. 3200; S. 1796; H.R. 3590; H.R. 4872)

Client expense: $3,220,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

General issues on comprehensive health reform, including all aspects relating to coverage, financing, and delivery reform (no specific legislation introduced) H.R. 3590, Patient Protection and Affordable Care Act, provisions on Coverage, Delivery Reform and Financing H.R. 4872, Health Care and Education Reconciliation Act, provisions on Coverage, Delivery Reform and Financing H.R. 850, Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (CHOICE) Act of 2009 H.R. 1322, Emergency Retiree Health Benefits Protection Act of 2009 H.R. 1346/S.540, Medical Device Safety Act of 2009 H.R. 3962, Affordable Health Care for America Act H.R. 4626, Health Insurance Industry Fair Competition Act H.R. 3200, America's Affordable Health Choices Act of 2009 Ongoing legislative issues related to health care reform in Senate HELP & Finance Committees, and House Education & Labor, Energy & Commerce, and Ways & Means (legislation not yet introduced) General issues related to medical liability reform and ERISA preemption (specific legislation not yet introduced) H. Res. 1203, a resolution providing for consideration of the Senate amendments to the bill (H.R. 3590) to amend the Internal Revenue Code of 1986 to modify the first-time homebuyers credit in the case of members of the Armed Forces and certain other Federal employees, and for other purposes, and providing for consideration of the bill (H.R. 4872) to provide for reconciliation pursuant to section 202 of the concurrent resolution on the budget for fiscal year 2010, provisions on health care

Client expense: $25,120,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Trade Commission (FTC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Maritime Administration (MARAD), Natl Economic Council (NEC), Natl Security Council (NSC), Office of Management & Budget (OMB), Pipeline & Hazardous Materials Safety Administration, SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), St. Lawrence Seaway Development Corporation, State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR), White House Office

Monitor guidance on application and distribution of ARRA funds. H.R. 3590 Patient Protection and Affordable Care Act, Home visiting provisions. H.R. 4872 Healthcare and Education Rehabiliation Act

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

Government targets: Education, Dept of, HOUSE OF REPRESENTATIVES, SENATE

H.R. 3221 Student Aid and Fiscal Responsibility Act, early learning programs. Labor, Health and Human Services and Education Appropriations: Parent information resource centers, early learning programs H.R. 4872 Healthcare and Education Rehabilitation FY 2011 President Budget proposal, early learning programs

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

Government targets: Education, Dept of, HOUSE OF REPRESENTATIVES, SENATE

H.R. 3221 Budget reconciliation legislation: Pell Grants and student loans. Labor Health and Human Services and Education Appropriations: Title I, Teacher Quality, STEM education HR 4899 FY 2010 Supplemental Disaster Relief and Summer Jobs Act of 2010 FY 2011 President Budget Proposal, Title I, Teacher Quality, STEM Education HR 4872 Healthcare and Education Reconciliation Act

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

Government targets: Education, Dept of, HOUSE OF REPRESENTATIVES, SENATE

Health reform implementation issues regarding coverage and reimbursement for community mental health centers [Affordable Healthcare for America Act (HR 3962); Patient Protection and Affordable Care Act (HR 3590); Health Care and Education Reconciliation Act (HR 4872)]

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

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

Health reform implementation issues regarding coverage and reimbursement for community mental health centers [Affordable Healthcare for America Act (HR 3962); Patient Protection and Affordable Care Act (HR 3590); Health Care and Education Reconciliation Act (HR 4872)]

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

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

Health reform implementation issues regarding coverage and reimbursement for community mental health centers [Affordable Healthcare for America Act (HR 3962); Patient Protection and Affordable Care Act (HR 3590); Health Care and Education Reconciliation Act (HR 4872)]

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

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

Health reform implementation issues regarding coverage and reimbursement for community mental health centers [Affordable Healthcare for America Act (HR 3962); Patient Protection and Affordable Care Act (HR 3590); Health Care and Education Reconciliation Act (HR 4872)]

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

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

HR 525 & S 406 - Association Health Plans. NAIFA opposes exempting AHP's from state benefit, regulatory oversight and solvency laws. S. 1995 allows AHP's to offer only issued plans that are subject to state solvency standards. Some regulatory oversight and an "average" of state mandated coverages. S. 725, HR 1470 - would amend IRC of 1986 to allow self emloyed individuals to deduct health insurance costs in computing self-employment taxes. NAIFA supports. S 207 - Amend the IRC of 1986 to allow deduction for health insurance premiums. NAIFA supports. HR 176 & HR 1177 - would allow unused flexible spending arrangement funds to be carried over to the next year. NAIFA & AHIA favors this option. HR 27 - An "Above the line" deduction for "higher deductible" health plans coupled with HSA's. NAIFA supports. HR 37, S. 978, HR 1872, HR 2063, HR 3873 creates Health Savings Accounts. NAIFA supports. HR 3511, S. 1569. NAIFA supports allowing states to establish LTC partnerships. HR 6331 - Would cut funding for Medicare Advantage - NAIFA opposes. HR 2096 & S. 702 - The Long-Term Care Affordability and Security Act of 2009 expands the authority under IRC Sectioin 125 that allows individuals to pay for certain benefits offered through cafeteria plans and/or flexible spending arrangement s with pre-tax dollars. AHIA & NAIFA support. HR 897 - Allows for Long Term Care insurance to be offered through cafeteria plans and/or FSA's as well as creates an above the line deduction for LTC premiums and provides a tax credit for caregivers. NAIFA & AHIA support. S.82 - A bill to amend title XXI of the Social Security Act to reauthorize the State Children's Health Insurance Program, to limit income eligibility expansions under that program until the lowest income eligible individuals are enrolled, and for other purposes. NAIFA supports. HR 1468 - To provide health care liability reform, and for other purposes. NAIFA supports. HR 1413 - To amend the Internal Revenue Code of 1986 to allow certain public employees a deductioin for distributions from governmental plans for health and long-term care insurance,and for other purposes. NAIFA supports. HR 1279 - To amend the Internal Revenue Code of 1986 to increase the contribution limits to dependent care flexible spending accounts and to provide for a carryover of unused dependent care benefits. NAIFA supports. S. 1177 - Confidence in Long Term Care Insurance Act would instruct the Health and Human Services Department to ask the NAIC to collect data and also create a website called "LTC Insurance Compare" to help consumers research long term care insurance. NAIFA supports. HR 563 - To amend title XXI of the Social Security Act to require States to provide priority under the State Children's Health Insurance Program (SCHIP) to children in families with gross income below 200 percent of the Federal poverty level. NAIFA supports. HR 542 - To amend titles XIX and XXI of the Social Security Act to permit States to rely on findings from an express plan agency to conduct simplified eligibility determinations under Medicaid and the State Children's Health Insurance Program. NAIFA supports. HR 198 - To amend the Internal Revenue Code of 1986 to allow a deduction for amounts paid for health insurance and prescription drug costs of individuals. NAIFA supports. HR 194 - To amend the Social Security Act to guarantee comprehensive health care coverage for all children born after 2009, and for other purposes. NAIFA opposes. HR 2 - To amend title XXI of the Social Security Act to extend and improve the Children's Health Insurance Program, and for other purposes. NAIFA opposes. S 94 - A bill to amend the Internal Revenue Code of 1986 to provide for a nonrefundable tax credit for long-term care insurance premiums. NAIFA supports. HR 1891 - To amend the Internal Revenue Code of 1986 to allow an above-the-line deduction for half of an individual's long-term care insruance premiums. NAIFA supports. HR 897 - To amend the Internal Revenue Code of 1986 to allow individuals a deduction for qualified long-term care insurance premiums, use of such insurance under cafeteria plans and flexible spending arrangements, and a credit for individuals with long-term care needs. NAIFA supports. HR 3590, HR 4872 - Enacts the "Patient Protection and Affordable Care Act." NAIFA opposes certain provisions.

Client expense: $315,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of

HR 275 - To repeal the imposition of 3 percent withholding on certain payments made to vendors by government entities; S 292 - Withholding Tax Relief Act of 2009; HR 4213 - Unemployment Compensation Extension Act of 2010; S 3793 - Job Creation and Tax Cuts Act of 2010; HR 2110 - Mobile Workforce State Income Tax Fairness and Simplification Act; HR 4872 - Health Care and Education Reconciliation Act of 2010; HR 5297 - Health Care and Education Reconciliation Act of 2010;

Client expense: $3,020,000 · Firm income: Not reported

Government targets: Air Force, Dept of, Army, Dept of (Other), Commerce, Dept of (DOC), Defense, Dept of (DOD), Energy, Dept of, Executive Office of the President (EOP), Federal Aviation Administration (FAA), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Justice, Dept of (DOJ), Natl Aeronautics & Space Administration (NASA), Natl Security Council (NSC), Navy, Dept of, Office of Management & Budget (OMB), SENATE, State, Dept of (DOS), Transportation, Dept of (DOT), White House Office

H.R. 3590 and H.R. 4872, the Affordable Care Act, state implementation of health care exchanges

Client expense: Not reported · Firm income: $55,000

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Defense, Dept of (DOD), Energy, Dept of, Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Interior, Dept of (DOI), Labor, Dept of (DOL), SENATE, Transportation, Dept of (DOT), U.S. Fish & Wildlife Service (USFWS)

Medicaid & TANF moderization H.R. 3590 and H.R. 4872, the Affordable Care Act, Medicaid expansion implementation

Client expense: Not reported · Firm income: $55,000

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Defense, Dept of (DOD), Energy, Dept of, Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Interior, Dept of (DOI), Labor, Dept of (DOL), SENATE, Transportation, Dept of (DOT), U.S. Fish & Wildlife Service (USFWS)

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support implementation of comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. Met with senior HHS officials to talk about implementation of health reform. See also Medicare and Medicaid.

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

Government targets: AMTRAK - Natl Railroad Passenger Corporation, Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), SENATE, Social Security Administration (SSA), Veterans Affairs, Dept of (VA)

Healthcare Reform, HR 3590, HR 4872; FSA's, HSA's -S. 3673, Patient' Freedom to Choose Act; Rule on Grandfathered Health Plans - S.J. Res. 39, Enzi Disapproval Resolution

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

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

Labor HHS appropriations stock piling anti-virals for pandemic influenza; Cancer Research Issues - S.3686/HR_, Labor, HHS Appropriations Bill for FY2011; Monitoring the implementation for the Patient Protection and Affordable Care Act, including provisions related to comparative effectiveness research and a regulatory pathway for biosimilars; H.R.1 - Pandemic influenza funding: H.R.1105 Omnibus Appropriations Act of 2010, Food Safety Bill, H.R. 4872 Health Care& Education Reconciliation Act of 2011; issues concerning clincial trials; general health care reform (Patient Protection and Affordable Care Act); Congressional oversight issues; FDA approval and enforcement issues; Pandemic preparedness; Tamiflu; Avastin-breast cancer; following all issues related to health care reform; S.726/HR 1427 - promotiong innovation and access to life-saving Medicine Act; HR 1548 - Pathway for Biosimilars Act; General support for Genentech products; monitor and report on issues relate to implementation to health care reform; H.R. 1548 - Pathway for Biosimilars Act

Client expense: $1,242,641 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 3590, the Patient Protection and Affordable Care Act H.R. 4872, the Health Care and Education Affordability and Reconciliation Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitoring legislation impacting health care reform in HR 4872, the Health Care Education Reconciliation Act; and the CLASS provisions in PL 111-148, the Patient Protection Affordable Care Act.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitoring legislation impacting health care reform in HR 4872, the Health Care Education Reconciliation Act; and the CLASS provisions in PL 111-148, the Patient Protection Affordable Care Act.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Student Financial Aid, Pell Grants, Work-Study Program, Perkins Loan Program, Student Aid and Fiscal Responsibility Act (HR 3221), HR 4872 (Reconciliation Bill)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to comprehensive health care reform: Health Information Technology; ARRA Privacy and Security Rules; Generic Biologics; Comparative Effectiveness; Importation of Prescription Drugs; Competitive Bidding; Chronic Care Management; Healthcare Reform; and Healthcare Implementation H.R. 1 - American Recovery and Reinvestment Act of 2009; Title VIII Department of Labor, Health and Human Services, and Education, and related agencies; Healthcare Research and Quality and Title XIII - Health Information Technology for Economic and Clinical Health Act or the HITECH Act; all sections H.R. 1321 and S. 391 - Healthy Americans Act; all sections H.R. 1427 and S. 726 - Promoting Innovation and Access to Life-Saving Medicine Act; all sections H.R. 1548- Pathway for Biosimilars Act; all sections H.R. 3200 - America's Affordable Health Choices Act; all sections H.R. 3596 - Health Insurance Industry Antitrust Enforcement Act of 2009; all sections H.R. 3962 - Affordable Healthcare for America Act; all sections Public Law 111-148 - Patient Protection and Affordable Care Act; all sections (formerly H.R. 3590) H.R. 4199 - Patient Health and Real Medication Access Cost Savings Act; all sections Public Law 111-152 - Health Care and Education Reconciliation Act of 2010; all sections (formerly H.R. 4872 and S. Con. Res. 13) H.R. 4489 - The FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act of 2010; all sections H.R. 5235 - The Medicare Access to Diabetes Supplies Act; all sections H.R. 3790 - To Amend Title XVIII of the Social Security Act to repeal the Medicare Competitive Acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS); all sections Public Law 104-191 - Health Insurance Portability and Accountability Act (HIPAA); Title II H.R. 5440 - Genomics and Personalized Medicine Act of 2010; all sections

Client expense: $470,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Personnel Management (OPM), Postal Rate Commission, Postal Regulatory Commission, SENATE, U.S. Postal Service (USPS)

H.R. 1586 (Rangel) enhanced Medicaid FMAP; (cont.) H.R. 3590, Patient Protection and Affordable Care Act (Reid) Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform; H.R. 4263, State Medicaid Assistance Extension Act (Baldwin) Medicaid FMAP extension; H.R. 4752, Medicare Prescription Drug Price Negotiation Act (Welch) HHS Secretarys role in negotiating Part D drug prices; H.R. 4872, Health Care and Education Reconciliation Act (Spratt) changes to Medicare Advantage funding, Medicare Part D coverage gap, Medicaid funding; H.R. 4917 (Schauer) Medicare Part D formulary changes; H.R. 4994, Medicare and Medicaid Extenders Act (Lewis) Medicare physician payment, Medicaid and CHIP technical corrections; H.R. 5712, Physician Payment and Therapy Relief Act (Levin) Medicare Physician Payment; H.R. 6303, Medicare Beneficiary Choice Preservation Act (Arcuri) Medicare open enrollment; H.R. 6502, Medicare Beneficiary Preservation of Choice Act (Gonzalez) Medicare open enrollment; S. 1669, Equal Access to Medicare Options Act (Kerry) guaranteed issue Medigap, Medicare Advantage enrollment; S. 3000 (Rockefeller) Medicaid FMAP extension; S. 3421, Temporary Extension Act (Grassley) Medicare physician payment; S. 3793, Job Creation and Tax Cuts Act (Baucus) Medicaid and CHIP technical corrections; S. 4024, Medicare Enhancements for Needed Drugs Act (Wyden) price negotiations, plan information; and S. 4040, Medicare Beneficiary Preservation of Choice Act (Casey) Medicare open enrollment periods. MMM (Regulatory Issues): Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, data, and audit issues, bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits), application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff, measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training, andMedicare/Medicaid integration and contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education program; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues, MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; implementation of MA and Part D changes made in the Accountable Care Act (ACA), including application of the MA STAR system for payment purposes starting 2012 and changes to the Part D coverage gap; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including documentation of citizenship requirements, state benefit flexibility options, and Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including the managed care organization (MCO) prescription drug rebate provisions; and health information technology standards and policies.

Client expense: $1,980,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), 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), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of

H.R. 1253, Health Insurance Restrictions and Limitations Clarification Act (Burgess) disclosure of coverage exclusions; (cont.) H.R. 1583, Insurance Industry Competition Act (DeFazio) McCarran-Ferguson reforms; H.R. 1691, Breast Cancer Patient Protection Act (DeLauro) hospital stays for breast cancer patients; H.R. 3217, Health Care Choice Act (Shadegg) national marketplace; H.R. 3584, Health Care Consumer Protection Act (Forbes) reinstatement of coverage upon payment of overdue premiums; H.R. 3590, Patient Protection and Affordable Care Act (Reid) health insurance cooperatives, multi-state plans, insurance market reforms, health insurance exchanges, benefit packages, medical loss ratios, CLASS Act, regulatory reform, individual coverage requirement, premium assistance, federal rate review process, restrictions on rescissions, health care choice compacts, appeals procedures, disclosure requirements, high risk pool program; H.R. 3596, Health Insurance Industry Antitrust Enforcement Act (Conyers) McCarran-Ferguson reforms; H.R. 4078, Long-Term Care Insurance Disclosure Act (Perriello) model disclosure form for long-term care insurance; H.R. 4563, Cancer Screening Coverage Act (Maloney) coverage requirement for cancer screening; H.R. 4626, Health Insurance Industry Fair Competition Act (Perriello) McCarran-Ferguson reforms; H.R. 4757, Health Insurance Rate Authority Act (Schakowsky) federal rate review process; H.R. 4872, Health Care and Education Reconciliation Act (Spratt) changes to individual coverage requirement, grandfathered plans, immediate insurance reforms, premium assistance, CLASS Act, coverage issues, quality improvements, delivery system reforms; H.R. 5000, Dental Coverage Value and Transparency Act (Andrews) requirements for dental coverage; H.R. 5664, High Risk Pool Fairness Act (Ellsworth ) high risk pools; H.R. 5761 (Melancon) effective date for prohibition on rescissions; H.R. 5808 (Woolsey) government-run plan; H.R. 5844, Fairness in Medigap Options Act (Rothman) guarantee issue and open enrollment for Medigap policies; H.R. 5890, Long-Term Care Insurance Reform Act (Doggett) regulation of LTC insurance; H.R. 6066, Preventing Social Security Fraud Act (Sanchez) requirements for private disability insurers; H.R. 6368, Federal Employee Disability Insurance Act (Holmes-Norton) supplemental disability insurance for federal employees; S. 688, Breast Cancer Patient Protection Act (Snowe) hospital stays for breast cancer patients; S. 1177, Confidence in Long-Term Care Insurance Act (Kohl) LTC consumer protections; S. 1459, Health Care Choice Act (DeMint) national marketplace; S. 1626, Long Term Care Insurance Integrity Act (Klobuchar) third party review of LTCI disputed claims; S. 1636, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) model disclosure forms for LTC insurance; S. 1681, Health Insurance Industry Antitrust Enforcement Act (Leahy) McCarran-Ferguson reforms; S. 3078, Health Insurance Rate Authority Act (Feinstein) federal rate review process; S. 3685 Insurance Competition and Transparency Act (Pryor) FTC authority; S. 3793, Job Creation and Tax Cuts Act (Baucus) health coverage tax credit; and S. 3958, Empowering States to Innovate Act, (Wyden-Brown) state innovation waivers. INS (Regulatory) Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials; implementation of the Mental Health Parity Act requirements; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; internal claims and appeals and external review processes; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits rescissions; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; and other issues relating to health care reform implementation.

Client expense: $1,980,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), 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), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of

H.R. 897, Long-Term Care and Retirement Security Act (Putnam) tax incentives for LTC insurance; (cont.) H.R. 1891, Sunset of Life Protection Act (Alexander) tax incentives for LTC insurance; H.R. 2096, Long-Term Care Affordability and Security Act (Pomeroy) tax incentives for LTC insurance; H.R. 2974: HSAs for Veterans (Campbell) HSA contributions by veterans; H.R. 3478, Patient-Controlled Healthcare Protection Act (Gohmert) HSA improvements, transparency; H.R. 3490, Wellness Programs (Johnson) tax incentives for employer-sponsored wellness programs; H.R. 3508, Healthy Savings Act (Paulsen) HSA improvements; H.R. 3590, Patient Protection and Affordable Care Act (Reid) premium tax, high-value health plan tax, tax credits, LTC insurance in cafeteria plans, FSA limits, tax exclusion for FSAs and HRAs, health savings accounts, tax deduction for itemized medical expenses; H.R. 3610, Health Savings and Affordability Act (Austria) health insurance tax deduction, HSAs; H.R. 3971, Health Savings Account Expansion Act (Flake) HSA improvements; H.R. 4872, Health Care and Education Reconciliation Act (Spratt) changes to premium tax, high-value health plan tax; H.R. 5923 (Paulsen) repeal HSA and FSA restrictions; H.R. 5936, Restoring Assistance for Families' and Seniors' Health Expenses Act (Reichert) treatment of high deductible health plans as qualified health plans, repeal of HSA and FSA restrictions; H.R. 6234, Comprehensive Long-Term Care Support Act (Herseth Sandlin) tax incentives for LTC insurance; H.R. 6517, Omnibus Trade Act (Levin) TAA health coverage tax credits; S. 94, Long-Term Care Family Accessibility Act (Vitter) tax incentives for LTC insurance; S. 702, Long-Term Care Affordability and Security Act (Grassley) tax incentives for LTC insurance; S. 2958 CARE Act (Menendez) tax incentives for LTC insurance, consumer protections for LTC insurance, caregiver tax credits; and S. 3673, Patients Freedom to Choose Act (Hutchison) -- repeal HSA and FSA restrictions. TAX (Regulatory) Issues relating to Health Savings Accounts; issues regarding payment for OTC drugs from a health account; issues regarding deduction for remuneration for insurance services; issues concerning small employer tax credits and retiree coverage reinsurance; issues regarding application of the nondiscrimination rules to insured group health coverage; issues relating to withholding of government contract payments; pre-existing condition insurance plans, internal claims and appeals and external review processes, coverage of preventive services; pre-existing condition exclusions, lifetime and annual dollar limits on benefits, rescissions, and patient protections; grandfathered health plan provisions; dependent coverage; issues relating to IRC Sec 162(m) reporting; and other issues relating to health care reform implementation.

Client expense: $1,980,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), 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), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of

Legislative issues related to access to pharmaceuticals, including Medicare Part D, and Children's Health Insurance Program (CHIP), rebates in Medicaid and for dual-eligibles; comparative effectiveness; 340B Drug Program and related provisions in HR 3590 - Patient Protection and Affordable Care Act; and HR 4872 - Health Care and Education Reconciliation Act.

Client expense: Not reported · Firm income: $90,000

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

Pharmaceutical Manufacturer Tax and related provisions in HR 3590 - Patient Protection and Affordable Care Act; and HR 4872 - Health Care and Education Reconciliation Act.

Client expense: Not reported · Firm income: $90,000

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

S.525/H.R.1298/S.1232, Pharmaceutical Market Access and Drug Safety Act of 2009 - Discussed legislation which would create a system of safe importation of prescription drugs from abroad. S.726/H.R.1427, Promoting Innovation and Access to Life-Saving Medicine Act - Discussed legislation which would create a pathway for the approval of safe, effective biosimilar and generic biologic drugs. H.R.1706, Protecting Consumer Access to Generic Drugs Act of 2009 - Discussed legislation that would prohibit brand name drug companies from compensating generic drug companies to delay the entry of a generic drug into the market, and for other purposes. S. 369, Preserve Access to Affordable Generics Act - Discussed legislation that would prohibit brand name drug companies from compensating generic drug companies to delay the entry of a generic drug into the market,and for other purposes. S.515/H.R.1260/S.610, Patent Reform Act of 2009 - Discussed legislation that would amend federal patent law to rewrite provisions concerning the conditions for patentability. Specifically, AARP weighed in on the inequitable conduct provisions of the legislation. S. 301, Physician Payments Sunshine Act of 2009 - Discussed legislation that would provide for disclosure of gifts given by pharmaceutical and device manufacturers to physicians. S.1315, Federal Food, Drug and Cosmetic Act Amendment/H.R.3777 Drug Price Competition Act - Lobbied to expand the definition of "first applicant" under such Act to allow a generic drug manufacturer that is currently considered an applicant subsequent to a brand-name manufacturer's 180-day exclusivity period to qualify as a first applicant for purposes of filing an abbreviated application for a new drug. Requires such applicant ot submit a substantially complete application that contains and lawfully maintains a certification for such drug. H.R. 3590, Patient Protection and Affordable Care Act - Lobbied in support of and implementation of health care legislation to reform the health care system to provide quality health care and expand access to long-term services and supports. H.R. 4872, Health Care and Education Reconciliation Act - Lobbied in support of and implementation of health care law which makes improvements, such as closing the Part D coverage gap, in the Patient Protection and Affordable Care Act. S. 3606, Agriculture, Rural Development, FDA and related agencies Appropriations Act, FY 2011 - Lobbied for increased funding for the FDA Office of Generic Drugs to reduction of application backlog. H.R. 3081, H.R. 3082, H.J.Res. 105, H.J.Res.101, Continuing Resolution, FY 2011 - Lobbied for funding for FDA Office of Generic Drugs and nutrition assistance. S.3690, the Drug Safety and Accountability Act of 2010 - Requires drug manufacturers to implement quality management plans and document the manufacturing supply chain to ensure the quality and safety of drugs. The bill also would expand FDA authority to recall unsafe drugs, uncluding over the counter drugs, and offers protection to whistle blowers. H.R.5809,would amend the Controlled Substances Act to provide for the take back and safe disposal of controlled substances. The bill provides for an educational effort about proper drug disposal, an EPA report on the same and a GAO report on the effectiveness of disposal programs.

Client expense: $9,120,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), Federal Energy Regulatory Commission (FERC), Federal Reserve System, Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Highway Traffic Safety Administration (NHTSA), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Vice President of the United States, SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, White House Office

S.330/H.R.684, Medicare Prescription Drug Savings and Choice Act of 2009 - Discussed legislation which would create a government-operated Medicare prescription drug plan. Provided information on the need for nursing education capacity and the retention of newer and older nurses in the workplace (no bill). Discussed implementation of healthcare coverage for the 50-64 year old population, age rating, and closing the doughnut hole. S.1133/H.R. 2580, Empowering Medicare Patient Choices Act - Discussed legislation that would promote patient decision aids to help people make informed, evidence-based decisions about health care treatment options. S. 960, Medicare Early Access Act of 2009 - Support for legislation to let Americans aged 55-64 who are otherwise without access to group or public coverage buy into Medicare. H.R. 2700, Prescription Coverage Now Act of 2009 - Discussed legislation that would assist low-invome individuals in obtaining subsidized prescription drug coverage under the Medicare prescription drug program by expediting the application and qualification process and by revising the resource standards used to determine eligibility for such subsidies, and for other purposes. S. 1185, Medicare Financial Stability for Beneficiaries Act of 2009 - Discussed legislation that would ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs. H.R. 2716, Medicare Savings Program Improvement Act of 2009 - Discussed legislation that would provide financial stability for older Americans and people with disabilities through improvements in the Medicare Savings Program. Advocated for modernizing Medicare funding so that nursing education funds are directed to advanced nurse practice programs to help produce more highly-skilled nurses to care for the Medicare population (no bill). Discussed ideas to improve medicare for medicare beneficiaries. (no bill) Discussed Medicare physician payment issues. (no bill) S. 2128, Prevent Healthcare Fraud Act - Discussed Medicare Fraud. Discussed idea of an annual physical for Medicare beneficiaries (no bill). S.975 Seniors and Taxpayers Obligation and Protection Act - Lobbied in support of legislation. S.1256 Home and Community Balanced Incentives Act - Discussed implementation of certain enacted provisions. H.R. 3631, Medicare Premium Fairness Act - Lobbied to pass legislation to allow premiums for Medicare Part B to remain at 2009 levels for all beneficiaries. S. 2926, the Economic Fairness for Seniors Act - Discussed the implications of legislation to provide $250 in economic relief to seniors, veterans and the disabled in response to the lack of a COLA in 2010; allow Medicare Part B premiums to remain at 2009 levels for all beneficiaries and to study the use of a new Consumer Price Index for use in calculating future Social Security COLAs. H.R. 3590, Patient Protection and Affordable Care Act - Lobbied in support of and on new implementation of health care law that would reform the health care system to provide affordable quality health care, reduce drug costs and expand access to long-term services and supports. H.R. 4872, Health Care and Education Reconciliation Act - Lobbied in support of and on implementation of health care law to make improvements in the Patient Protection and Affordable Care Act and implementation of certain provisions. H.R. 4993/S. 2814, Home Health Planning Improvement Act of 2010 - Wrote letters in support of Nurse Practitioners, Clinical Nurse Specialists, and Physician Assistants being able to order Medicare funded home health care. Extension of enhanced FMAP (no bill number) H. R. 3962/P.L. 111-192, Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 - Which among other things, postpones the reduction of Medicare reimbursements for physician services until November 30, 2010. H.R. 6130, Strengthening Medicare Anti-Fraud Measures Act - Discussed medicare fraud. H.R. 5044/S. 3632, Medicare Fraud Enforcement and Prevention Act - Discussed medicare fraud. H.R. 5546, no official title, anti-fraud measure -Discussed medicare fraud. H.R. 5950, Improving Access to Medicare Coverage Act - To count a periof of observation status in a hospital exceeding 24 hours toward satisfying the 3-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare. H.R. 2773/S. 1295, Medicare Transitional Care Act and S. Amdt. 3273, Protection and Affordable Care Act - To cover transitional care services to improve the quality and care under the Medicare Program. S. 3632, The Medicare and Medicaid Fraud Enforcement and Prevention Act of 2010 - Fraud bill would seek to curtail wasted fraud and abuse in the Medicare and Healthcare Programs. House Amendment to Senate Amendment to H.R. 2847 "Jobs for Main Street Act" - Discussed redirection of some TARP funds to extend unemployment insurance and COBRA eligibility and FMAP assistance to state governments. H.R. 4213 American Workers, State, and Business Relief Act/American Jobs and Closing Tax Loopholes Act - Lobbied for extension of UI, COBRA, FMAP, and SGR. S. 3686, Labor, HHS, Education and related agencies Appropriations Act, FY 2011 - Lobbied for FMAP fix and related health care programs. S. 2814/H.R. 4993, Home Health Care Planning Improvements Act of 2010 - Legislation would allow advanced practice nurses and physician assistants to order medicare supported home health care. Discussed Durable Medical Equipment bidding. (no bill) H.R.5712, Physician Payment and Therapy Relief Act of 2010 - Lobbied in support of legislation that would provide a one-month extension of the existing physician payment update. H.R.4994, Medicare and Medicaid Extenders Act of 2010 - Lobbied in support of legislation that would provide a one year extension of the physician payment update. H.R. 3081, Continuing Resolution FY 2011, H.J.Res. 105, making further continuing appropriations for fiscal year 2011, and H.J.Res. 101 making further continuing appropriations for fiscal year 2011 - Lobbied for FMA fix inclusion in appropriations legislation.

Client expense: $9,120,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), Federal Energy Regulatory Commission (FERC), Federal Reserve System, Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Highway Traffic Safety Administration (NHTSA), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Vice President of the United States, SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, White House Office

H.R. 3590, Patient Protection and Affordability Care Act - Lobbied in support of health care legislation and implementation of certain provisions related to affordable quality health care and expand access to long-term services and supports. H.R. 4872, Health Care and Education Reconciliation Act - Lobbied in support of health care law which makes improvements, such as closing the Part D coverage gap, in the Patient Protection and Affordable Care Act and implementation of certain provisions. H.R. 4757/S.3078 Health Insurance Rate Authority Act - Discussed bill that would require the Secretary of Health and Human Services (HHS) to establish a uniform process for the review of potentially unreasonable increases in rates for health insurance coverage, including premiums.

Client expense: $9,120,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), Federal Energy Regulatory Commission (FERC), Federal Reserve System, Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Highway Traffic Safety Administration (NHTSA), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Vice President of the United States, SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, White House Office

H.R.3590, Patient Protection and Affordable Care Act - Lobbied in support of and on implementation of health care legislation that would reform the health care system to provide affordable quality health care and expand access to long-term services and supports. Provided information on the need for nursing education capacity and the retention of newer and older nurses in the workplace (no bill). S.1569/H.R.3185, Medicare Graduate Nursing Education Act - Advocated for modernizing Medicare funding so that nursing education funds are directed to advanced nurse practice programs to help produce more highly-skilled nurses to care for the Medicare population. S. 623/HR 1558, Pre-existing Condition Patient Protection Act of 2009 - Lobbied in support of bill that would prohibit insurers from denying health insurance or delaying coverage for people with pre-existing conditions. H.R. 2778, Health Equity and Accountability through Research Act of 2009 - Lobbied in support of bill that would address racial and ethnic disparities in care. S. 979/HR 2360, Small Business Health Options Programs Act - Lobbied in support of bill that would establish a nationwide health insurance purchasing pool for small businesses and the self-employed that would offer a choice of private health plans and make health coverage more affordable, predictable and accessible. S.1213, Patient-Centered Outcomes Research Act - Lobbied in support of bill that would create a public-private partnership to conduct and disseminate comparative effectiveness research. S. 726/H.R. 1427, Promoting Innovation and Access to Life Saving Medicines - Discussed legislation which would create a pathway for approval of safe, effective biosimilar and generic biologic drugs. H.R. 3090, Health Equity and Accountability Act - Discussed need to end racial and ethnic disparities in care. S. 3686, Labor, HHS, Education and Related Agencies Appropriations Act FY 2011 - Lobbied for funding for healthcare services, research and training involving NIH, AHRQ, CMS, HRSA, HHS and AOA. H.R. 3082, H.R. 3081, H.J. Res.101, H.J. Res. 105, Continuing Appropriations and Surface Transportation Extensions Act, 2011 - Lobbied for funding for various federal programs serving Older Americans, most notably SSA Administrative expenses, LIHEAP, aging services, HECM reverse mortgage subsidy and Section 202, Housing for the Elderly. H.R. 4872, Health Care and Education Reconciliation Act - Lobbied in support of health care law which makes improvements such as closing the Part D coverage gap, in the Patient Protection and Affordable Care Act and implementation of some provisions. H.R. 5364, Special Care Dentistry Act - Discussed bill that would require states to provide oral health coverage for aged, blind,or disabled individuals through a separate state adult dental program, with 100% federal match. H.R. 4213, American Workers, State and Business Relief Act/American Jobs and Closing Tax Loopholes Act - Lobbied for extension of UI, COBRA, FMAP, and SGR. H.R. 3081, Continuing Resolution, FY 2011 - Lobbied for funding for SSA, various health care, employment, aging services and nutrition programs. H.R. 4224, Together We Care Act - Bill creates a three-year pilot program to train public housing residents to provide covered home-based health services. H.R. 5853, Fiscal Responsibility and Retirement Security Act - Bill requires review and approval by law prior to collection of premiums under the CLASS program, to require notice to individuals prior to enrollment, and to require termination of the program in the event of actuarial unsoundness, and for other purposes. S. 2814, Home Health Care Planning Improvement Act of 2010 - Bill recognizes and authorizes nurse practitioners, clinical nurse specialists, certified nurse-midwives and physician assistants as eligible health care professionals who can order home health services under Medicare. H.R. 4993, Home Health Care Planning Improvement Act of 2010 - Bill recognizes and authorizes nurse practitioners, clinical nurse specialists, certified nurse-midwives and physician assistants as eligible health care professionals who can order home health services under Medicare.

Client expense: $9,120,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), Federal Energy Regulatory Commission (FERC), Federal Reserve System, Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Highway Traffic Safety Administration (NHTSA), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Vice President of the United States, SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, White House Office

The Drug and Medical Device Company Gift Disclosure Act Patient Safety Healthcare Associated Conditions (HAC's), Readmissions, and Bundling Comparative Effectiveness Research Health Care Reform Legislation: - H.R. 3200 - America's Affordable Health Choices Act - S. 1679 - Affordable Health Choices Act - America's Healthy Future Act H.R. 3590 - Patient Protection and Affordable Care Act H.R. 3962 - Affordable Healthcare for America Act H.R. 4872 - Healthcare and Education Reconciliation Act

Client expense: $760,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Defense, Dept of (DOD), Energy, Dept of, Environmental Protection Agency (EPA), Federal Highway Administration (FHA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. International Trade Commission (ITC), U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA)