Independence at Home Act of 2008

H.R. 1, American Recovery and Reinvestment Act of 2009, provisions relating to SGR, Medicaid, COBRA, comparative effectiveness research, privacy, HIT, 3 percent withhold, fraud and abuse, and Medicare Improvement Fund S. 1, American Recovery and Reinvestment Act of 2009, provisions relating to SGR, Medicaid, COBRA, comparative effectiveness research, privacy, HIT, 3 percent withhold, Medicare Improvement Fund, fraud and abuse, and privacy H.R. 2, Children's Health Insurance Program Reauthorization Act of 2009, all provisions S. 301, Physician Payments Sunshine Act of 2009, all provisions H.R. 5606, Physician Payment Sunshine Act of 2008, all provisions H.R. 1384, to amend part B of title XVIII of the Social Security Act to remove limiting charges under the Medicare Program for non-participating physicians with beneficiary notice and to preempt State laws that prohibit balance billing, all provisions H.R. 6331, Medicare Improvements for Patients and Providers Act of 2008, provisions relating to physician payment, efficiency, and quality improvements H.R. 7114, Independence at Home Act of 2008, all provisions S. 3613, Independence at Home Act of 2008, all provisions H.R. 570, Protecting Patients and Health Care Act of 2009, all provisions S. 391, Healthy Americans Act, provisions relating to health system reform H.R. 1038, Shingles Prevention Act, all provisions S. 295, Medicare Quality and Payment Reform Act of 2009, all provisions Medicare Program - Sustainable Growth Rate - Part D Drugs Program, administrative changes to formula, permanent reform Medicare Program - Medicare Physician Payment - Directed Score Keeping/Rebasing Medicare Program - CMS Enrollment Policies Medicare Program - Balance Billing Medicare Program - Physician Payment Reform Medicare Program - Medicare Physician Payment, Budget Medicare Program - 2009 PQRI Program Medicare program - Healthcare-Associated Infections Medicare Program - Non-coverage Expansion to Three Additional Surgical Procedures Medicare Program - National Provider Identifier Medicare Program - Recovery Audit Contractors (RACs), Value-Based Purchasing (VBP) Medicare Program - Durable Medical Equipment Accreditation Medicare Program - Medicare Administrative Contractors (MACs) Medicare Program - HIPPA: ICD-10 Medicare Program - HIPPA: electronic transactions version 5010 Medicare Program - CMS Incident-to Billing Policy Medicare Program - E-Prescribing Medicare Program - 2010 Draft Call Letter, Medicare Advantage, Quality, and Part D Oversight Medicare Program - 3 percent withhold Medicare Program - Quality Improvement (PCPI/PQRI) Medicare Program - Health Care Transparency Medicare Program - Comparative Effectiveness Research, Clinical Registries Medicare Program - Self-referral Medicare Program - Hospital Error Rates Medicaid Program - Physician-owned Hospitals

Client expense: $4,240,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Environmental Protection Agency (EPA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), State, Dept of (DOS), White House Office

Education and support for population-based health programs, such as disease and care management in FFS Medicare and Medicare Advantage, including Special Needs Plans (specifically, the reauthorization of Chronic Care Special Needs Plans, or C-SNPs, the incorporation of reasonable process measures and standards for SNP evaluation, and recommendations for CMS' Chronic Conditions SNP Panel); Medicare pilots and demonstrations such as the Medicare Medical Home Demonstration, Senior Risk Reduction Dem- onstration, Medicare Physician Group Practice Demonstration, Medicare Electronic Health Records Demonstration, the Medicare Coordinated Care Demonstration (MCCD, as authorized under Section 4016 of the Balanced Budget Act of 1997), and Medicare Health Support (as authorized under Section 721 of the Medicare Prescription Drug, Improvement and Modernization Act (MMA), which created the "Voluntary Chronic Care Improvement Program" now called Medicare Health Support) - specifically, the 18-month Report to Congress on Medicare Health Support. Provision of suggestions and recommendations for consideration of the broader inclusion of coordinated chronic care and health service stakeholder expertise in the feasibility study of a Medicare Chronic Care Practice Research Network demonstration program and in outcomes reporting for comparative effectiveness research (authorized in the Medicare Improvements for Patients and Providers Act of 2008). Analysis and discussions regarding the expanded hospital re-admission reporting requirements included in Final IPPS & OPPS Rules. Analysis of Congressional Budget Office reports on health care reform key issues and budget options, and promotion of successful outcomes in population health improvement programs as a component of national reform of care delivery, financing and design, particularly in public sector programs. Promotion of alternative modeling might more fully capture the true costs and savings associated with innovative prevention and treatment techniques in health care. Promotion of consideration of alternative models to assess and adjust risk scores related to the illnesses of beneficiaries in the Medicare program. Support for funding of prevention and wellness programs and initiatives as provided for in the American Recovery and Reinvestment Act of 2009 as passed by the House and Senate. Support for modifying provisions related to HIPAA Privacy rule and security for personal health information as established in the Health-e Information Technology Act (HITECH Act) as part of the American Recovery & Reinvestment Act (ARRA). Encouragement of efforts to preserve HIPAA provisions permitting exchange of protected health information for care coordination and disease management, efforts to advance health information technology deployment, particularly as it would affect individuals with chronic conditions, including e-prescribing, and the creation of interoperability standards and priority use cases and best practices for technology deployment and promotion in care coordination. Support for the exemption of disease management and care coordination efforts from economic stimulus provision that would have required the HHS Secretary to issue new health care operations rules. Analysis and submission of comments regarding the Genetic Information Nondiscrimination Act (GINA) and the creation of regulations by the EEOC defining the employer wellness program exception as provided for in GINA. Education regarding effectiveness of chronic condition care and its benefits to Medicaid and other populations via the sharing of published quality improvement studies that reported cost or utilization outcomes from the intervention and which are target clinical conditions relevant for Medicaid programs. Advocacy for priorities of all stakeholders providing services along the care continuum toward the goal of population health improvement in proposed and realized legislation, including S. 3613 & H.R. 7114, the Independence at Home Act of 2008; S. 631 & H.R. 5765, the Remote Monitoring Access Act of 2007; S. 334, the Healthy Americans Act; S. 1340, the Geriatric Assessment and Chronic Care Coordination Act of 2007; S. 1753, the Healthy Workforce Act of 2007; H.R. 3800, the Wired for Healthcare Quality Act; H.R. 6357, Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology PRO(TECH)T Act of 2008; H.R. 6898, the Health-e Information Technology Act of 2008 (HITECH Act); H.R. 5442, TRUST in Health Information Act of 2008; S. 3101, Medicare Improvements for Patients and Providers Act of 2008; S. 3118, Preserving Access to Medicare Act of 2008; H.R. 853, Wellness and Prevention Act of 2007; H.R.6331, Medicare Improvements for Patients and Providers Act of 2008; the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA); the American Recovery & Reinvestment Act (ARRA); initiatives pertaining to the treatment and prevention of obesity as a chronic disease generally and as a component of population health improvement approaches to addressing the obesity epidemic. Advocacy and support for expansion of Medicare-covered clinical preventive services as recommended by the U.S. Preventive Services Task Force and provided for in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Endorsement of the Healthy Workforce Act of 2009 and promotion of the legislation through the Healthy Workplace Alliance. General advocacy for population health improvement as a tool to improve the quality of health care and health care outcomes, and reduce preventable health care costs, and promotion of health promotion, wellness, and care coordination programs at the White House Regional Health Reform Summits.

H.R. 1, American Recovery and Reinvestment Act of 2009 (as enrolled and agreed to by both House and Senate) -- sections 3000 - 3018, 4301, and 5001; also made contact regarding potential inclusion of home health rural add-on as amendment S. 2181/H.R.3865: The Home Health Care Access Protection Act - All sections H.R. 2860, The Health Care Access and Rural Equity Act of 2007 -- sections 305 and 309 S. 457, Fostering Independence Through Technology Act of 2009 -- All sections S. 1605, Craig Thomas Rural Hospital and Provider Equity Act of 2007 -- sections 11, 14 and 18 S. 1678, Home Health Care Planning Improvement Act of 2007 -- All sections H.R. 6163, Medicare Telehealth Enhancement Act of 2008 -- sections 104, 105, and 106 S. 3613/H.R. 7114, The Independence at Home Act of 2008 -- All sections S. 1340, The Geriatric Assessment and Chronic Care Coordination Act of 2007 -- All sections S. 3484/H.R. 6873 -- The Medicare Hospice Protection Act of 2008 -- All sections S. 421 Hospice Protection Act (2008) -- All sections S. 631 -- The Patient Safety and Abuse Prevention Act of 2009 -- All sections

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

Health Care Reform - including increased access and coverage, improved quality, reducing disparities, increased support for prevention and wellness, medical homes (no legislation) Medicare and Medicaid - payment and delivery system reform, SGR, comparative effectiveness research, increased transparency, quality reporting, tiering and measurement tools (no legislation) House and Senate Budget Resolution supporting rebasing of Medicare physician payments Medical Liability reform efforts to reduce defensive medicine Antitrust reform to allow physicians to organize new organizations for the delivery of care and to discuss payment methodologies openly (no legislation) PL 111-3 Childrens Health Insurance Program Reauthorization Act of 2009 - law reauthorizing the SCHIP program for children Health Information Technology - funding and implementation of Electronic Medical Records - development of interoperable standards, Privacy and confidentiality provisions (no legislation) Physician workforce: shortages in physicians including primary care, decreasing medical student debt (no legislation) HR 7114, S 3614, Independence at Home Act - legislation to allow persons with chronic illness to stay at home with improved care coordination S. 3398, Medical Device Safety Act legislation which would overturn Supreme Court Decision exempting medical device manufacturers from liability if the device was FDA approved S. 301, Physician Payment Sunshine Act legislation which require pharmaceutical companies and device manufactures to disclosure gifts and other contributions to physicians Federal Trade Commission Final Rule on Identity Theft Red Flags; 16 CFR Part 681; Application of the Red Flags Rule to Physicians - oppose Red Flag Rule requiring physicians to implement identity theft programs in their offices Recovery Audit Contractor (RAC) program - oppose provisions of the new Recovery Audit Program Letter to CMS requesting opportunity to comment on changes to Medicare Quality Improvement Organizations

Health Care Reform - including increased access and coverage, improved quality, reducing disparities, increased support for prevention and wellness, medical homes (no legislation) Medicare and Medicaid - payment and delivery system reform, SGR, comparative effectiveness research, increased transparency, quality reporting, tiering and measurement tools (no legislation) House and Senate Budget Resolution supporting rebasing of Medicare physician payments Medical Liability reform efforts to reduce defensive medicine (no legislation) Antitrust reform to allow physicians to organize new organizations for the delivery of care and to discuss payment methodologies openly (no legislation) PL 111-3 Childrens Health Insurance Program Reauthorization Act of 2009 - law reauthorizing the SCHIP program for children Health Information Technology - funding and implementation of Electronic Medical Records - development of interoperable standards, privacy and confidentiality provisions (no legislation) Physician workforce - shortages in physicians including primary care, decreasing medical student debt (no legislation) HR 7114, S 3614, Independence at Home Act - legislation to allow persons with chronic illness to stay at home with improved care coordination S. 3398, Medical Device Safety Act legislation which would overturn Supreme Court Decision exempting medical device manufacturers from liability if the device was FDA approved S. 301, Physician Payment Sunshine Act legislation which would require pharmaceutical companies and device manufactures to disclose gifts and other contributions to physicians

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

Medicare Improvements for Patients and Providers Act 2008 (H.R. 6331; S. 3101); CMS Proposed Rule for FY 2009 Hospice Payments; Home Health Access Protection Act 2007 (H.R. 3865; S. 2181); Medicare Hospice Protection Act 2008 (H.R. 6873; S. 3484); Independence At Home (S. 3613; H.R. 7114); Medicare Home Health Rural Add-on in CR

Client expense: $34,786 · Firm income: Not reported

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

Vaccine Injury Compensation Program Follow developments within the Administration relating to global health policies concerning U.S. government participation in WHO and UN health initiatives; international public health issues; U.S. sanctions policies; international vaccine issues; vaccine policy at the Pan American Health Organization; HR 3610 HR 5629 Childhood immunizations Dietary supplement issues Implementation issues concerning P.L. 108-173 - The Medicare Prescription Drug, Improvement and Modernization Act of 2003 Drug compounding Alzheimer's care Comparative effectiveness - S.3408 - Comparative Effectiveness Research Act of 2008 S. 1695 Biologics Price Competition and Innovation Act of 2007 H.R. 1812 - Menopausal Hormone Replacement Therapies and Alternative Treatments and Fairness Act Pediatric Studies and Trials Drug Safety/Clinical Trials H.R. 1956 - Patient Protection and Innovative Biologic Medicines Act of 2007 S. 623/HR 1038 - Access to Life Saving Medicine Act, Follow-on Biologics S. 1505 - Affordable Biologics for Consumers Act H.R. 3610 - Food and Drug Import Safety Act of 2007 S.2029 - Vaccine Safety and Payment Health care issues Drug approvals Reimbursement rates S. 334 The Healthy Americans Act H.Con.Res. 342 (BHRT) FDA Pre-emption S.3613, H.R. 7114 - Independence at Home Act S.3409-Drug and Device Accountability Act of 2008 Follow-on biologics Drug importation and counterfeiting Drug advertising Comparative effectiveness Physician payment disclosure Hormone replacement therapies Chronic Illness International public health issues International vaccine issues

Client expense: $1,047,210 · Firm income: Not reported

Vaccines Medicare chronic disease coverage Implementation Issues concerning P.L. 108-173 - the Medicare Prescription Drug, Improvement and Modernization Act of 2003 Medicare coverage of pharmaceuticals, Medicare Part D Issues relating to Medicaid reimbursement for drugs/biologics in Title VI of S.1932-the Deficit Reduction Act of 2005 Pediatric Exclusivity H.R. 4 - Medicare Prescription Drug Price Negotiation Act H.R. 3162 - Children's Health and Medicare Protection Act of 2007 S.1893/H.R. 976 - Children's Health Insurance Progam Reauthorization Act of 2007 S. 2499 - Medicare, Medicaid and SCHIP Extension Act of 2007 Chronic care out of pocket costs S. 2029 - Physician Payments Sunshine Act of 2007 HR 5605 - Physician Payments Sunshine Act of 2007 HR 2185 - Enhanced Healthcare Value for All Act Medicare Prescription Drug Benefit Medicaid drug rebate Medicare Physician Reimbursement package Medicare and Medicaid Drug Reimbursement Medicaid Rebate Medicaid Part D Non-Interference H.R. 6331/S.3101 - Medicare Improvements for Patients and Providers Act of 2008 S.3118 - Preserving Access to Medicare Act of 2008 S.3613, H.R. 7114 - Independence at Home Act

Client expense: $1,047,210 · Firm income: Not reported

Education and support for population-based health programs, such as disease and care management in FFS Medicare and Medicare Advantage, including Special Needs Plans (specifically, the reauthorization of Chronic Care Special Needs Plans, or C-SNPs, the incorporation of reasonable process measures and standards for SNP evaluation, and recommendations for CMS' Chronic Conditions SNP Panel); Medicare pilots and demonstrations such as the Medicare Medical Home Demonstration, Senior Risk Reduction Dem- onstration, Medicare Physician Group Practice Demonstration, Medicare Electronic Health Records Demonstration, the Medicare Coordinated Care Demonstration (MCCD, as authorized under Section 4016 of the Balanced Budget Act of 1997), and Medicare Health Support (as authorized under Section 721 of the Medicare Prescription Drug, Improvement and Modernization Act (MMA), which created the "Voluntary Chronic Care Improvement Program" now called Medicare Health Support). Provision of suggestions and recommendations for consideration of the broader inclusion of coordinated chronic care and health service stakeholder expertise in the feasibility study of a Medicare Chronic Care Practice Research Network demonstration program and in outcomes reporting for comparative effectiveness research (authorized in the Medicare Improvements for Patients and Providers Act of 2008). Analysis and discussions regarding the expanded hospital re-admission reporting requirements included in Final IPPS & OPPS Rules and participation in the listening session for development of transition to a Medicare Value Based Purchasing Program for physician & other professional services. Analysis of Congressional Budget Office reports on health care reform key issues and budget options, and promotion of successful outcomes in population health improvement programs as a component of national reform of care delivery, financing and design, particularly in public sector programs. Encouragement of efforts to preserve HIPAA provisions permitting exchange of protected health information for care coordination and disease management, efforts to advance health information technology deployment, particularly as it would affect individuals with chronic conditions, including e-prescribing, and the creation of interoperability standards and priority use cases and best practices for technology deployment and promotion in care coordination. Education regarding effectiveness of chronic condition care and its benefits to Medicaid and other populations via the sharing of published quality improvement studies that reported cost or utilization outcomes from the intervention and which are target clinical conditions relevant for Medicaid programs. Advocacy for priorities of all stakeholders providing services along the care continuum toward the goal of population health improvement in proposed and realized legislation, including S. 3613 & H.R. 7114, the Independence at Home Act of 2008; S. 631 & H.R. 5765, the Remote Monitoring Access Act of 2007; S. 334, the Healthy Americans Act; S. 1340, the Geriatric Assessment and Chronic Care Coordination Act of 2007; S. 1753, the Healthy Workforce Act of 2007; H.R. 3800, the Wired for Healthcare Quality Act; H.R. 6357, Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology PRO(TECH)T Act of 2008; H.R. 6898, the Health-e Information Technology Act of 2008; H.R. 5442, TRUST in Health Information Act of 2008; S. 3101, Medicare Improvements for Patients and Providers Act of 2008; S. 3118, Preserving Access to Medicare Act of 2008; H.R. 853, Wellness and Prevention Act of 2007; H.R.6331, Medicare Improvements for Patients and Providers Act of 2008; initiatives pertaining to the treatment and prevention of obesity as a chronic disease generally and specifically as related to Medicare Part D coverage of pharmacotherapy as a component of population health improvement approaches to addressing the obesity epidemic. Advocacy and support for expansion of Medicare-covered clinical preventive services as recommended by the U.S. Preventive Services Task Force and provided for in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Endorsement of the Office of the National Nurse initiative, efforts to rename the Chief Nurse Officer of the U.S. Public Health Services as the "National Nurse". General advocacy for population health improvement as a tool to improve the quality of health care and health care outcomes, and reduce preventable health care costs.

S 2337/HR 3363 Long-Term Care Affordability and Security Act - Discussed consumer protections for LTC insurance. S 1070/HR 1783 Elder Justice Act/S 1577 Patient Safety and Abuse Prevention Act of 2007 - Support for both pieces of legislation, strategy for how they might both move forward next year. S 3327/HR 7212 - Empowered at Home Act - Lobbied to adjust budget neutrality requirement in waivers to include costs in both Medicare and Medicaid and other improvements to bill. Also lobbied in support of the bill. HR 7110/S 3604 Job Creation and Unemployment Relief Act - Lobbied for FMAP funding. HR 5613 Protecting the Medicaid Safety Net Act of 2008 - Supported this legislation, particularly provisions related to placing a moratorium on seven harmful Medicaid regulations. Discussed need to strengthen low-income programs by raising asset limits and streamlining rules, and to keep premiums affordable for all beneficiaries, and promote e-prescriptions in medicare (no bill number). S 2408/HR 4296 Medicare Electronic Medication and Safety Protection (E-Meds) Act of 2007- Supported provisions related to requiring e-prescribing in Medicare Part D, at first by providing incentive payments to providers who do and after 2011 lower payments to providers who do not. S 2641 Nursing Home Transparency and Improvement Act and HR 7128 Nursing Home Transparency and Quality of Care Improvement Act - Discussed the bill and provided suggestions for changes to the bill, nursing home quality and proposed five star rating system cms; poor performing nursing homes, family caregiving initiative, nursing home compliance guidelines, Home Health CAHPS, LTC Partnership Program (under Medicaid data reporting requirements), LTC Quality Alliance. To build support and obtain sponsors for Medicaid Family Caregiver Assessment Demonstration proposal (no bill number). Discussion and input on legislation to improve the health/LTC workforce and support family caregivers (no bill number). Advance directives and end-of-life care, education of the public about these issues, portability, and other issues relating to advance directives (no bill number). HR 7114/S3613 Independence at Home Act/Chronic Care Coordination - Lobbied on and support for legislation to provide chronic care coordination services to certain Medicare beneficiaries. S 3101/HR 6331 Medicare Improvements for Patients and Providers Act of 2008 - Discussed implementation to help improve Medicare. Lobbied for appeal notices for Medicare beneficiaries in Medicare Advantage plans (no bill number). S 1102 Part D Equity for Low-Income Services - Lobbied for legislation to increase Medicare Part D LIS. HR 1536 Prescription Coverage Now Act - Lobbied for legislation to increase Medicare Part D LIS asset limits. HR 6033 - Discussed provisions of Home-Based Health Services Job Training and Caregiving Act and ways to improve bill.

H.R. 2860, The Health Care Access and Rural Equity Act of 2007 -- sections 305 and 309 S. 321, Fostering Independence Through Technology Act of 2007 -- All sections S. 1605, Craig Thomas Rural Hospital and Provider Equity Act of 2007 -- sections 14 and 18 S. 1678, Home Health Care Planning Improvement Act of 2007 -- All sections S. 2181/H.R. 3865, The Fair Home Health Care Act -- All sections H.R. 6331, Medicare Improvements for Patients and Providers Act of 2008 -- effort to include home health rural add-on as amendment S. 3101, Medicare Improvements for Patients and Providers Act of 2008 --effort to include home health rural add-on as amendment S. 3118, Preserving Access to Medicare Act of 2008 -- section 112 H.R. 5613/S. 2819, Protecting the Medicaid Safety Net Act of 2008 -- All sections H.R. 2642, Supplemental Appropriations Act, 2008 -- Title VII Medicaid H.R. 6163, Medicare Telehealth Enhancement Act of 2008 -- sections 104, 105, and 106 S. 3613/H.R. 7114, The Independence at Home Act -- All sections S. 1340, The Geriatric Assessment and Chronic Care Coordination Act of 2007 -- All sections S. 3484/H.R. 6873 -- The Medicare Hospice Protection Act -- All sections S. 1628/H.R. 6826 -- The Home Health Care Planning Improvement Act -- All sections S. 1577/H.R. 3078 -- The Patient Safety and Abuse Prevention Act -- All sections

Client expense: $170,000 · Firm income: Not reported

Medicare Improvements for Patients and Providers Act 2008 (H.R. 6331; S. 3101); CMS Proposed Rule for FY 2009 Hospice Payments; Home Health Access Protection Act 2007 (H.R. 3865; S. 2181); Medicare Hospice Protection Act 2008 (H.R. 6873; S. 3484); Independence At Home (S. 3613; H.R. 7114); Medicare Home Health Rural Add-on in CR

Client expense: $34,768 · Firm income: Not reported

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

Medicare Improvements for Patients and Providers Act 2008 (H.R. 6331; S. 3101); CMS Proposed Rule for FY 2009 Hospice Payments; Home Health Access Protection Act 2007 (H.R. 3865; S. 2181); Medicare Hospice Protection Act 2008 (H.R. 6873; S. 3484); Independence At Home (S. 3613; H.R. 7114); Medicare Home Health Rural Add-on in CR

Client expense: $34,768 · Firm income: Not reported

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

Independence at Home Act S.3613/ HR.7114

Client expense: $520,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Defense, Dept of (DOD), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, State, Dept of (DOS), U.S. Customs & Border Protection, U.S. International Trade Commission (ITC), U.S. Trade Representative (USTR)

Vaccine Injury Compensation Program Follow developments within the Administration relating to global health policies concerning U.S. government participation in WHO and UN health initiatives; international public health issues; U.S. sanctions policies; international vaccine issues; vaccine policy at the Pan American Health Organization; HR 3610 HR 5629 Childhood immunizations Dietary supplement issues Implementation issues concerning P.L. 108-173 - The Medicare Prescription Drug, Improvement and Modernization Act of 2003 Drug compounding Alzheimer's care Comparative effectiveness - S.3408 - Comparative Effectiveness Research Act of 2008 S. 1695 Biologics Price Competition and Innovation Act of 2007 H.R. 1812 - Menopausal Hormone Replacement Therapies and Alternative Treatments and Fairness Act Pediatric Studies and Trials Drug Safety/Clinical Trials H.R. 1956 - Patient Protection and Innovative Biologic Medicines Act of 2007 S. 623/HR 1038 - Access to Life Saving Medicine Act, Follow-on Biologics S. 1505 - Affordable Biologics for Consumers Act H.R. 3610 - Food and Drug Import Safety Act of 2007 S.2029 - Vaccine Safety and Payment Health care issues Drug approvals Reimbursement rates S. 334 The Healthy Americans Act H.Con.Res. 342 (BHRT) FDA Pre-emption S.3613, H.R. 7114 - Independence at Home Act S.3409-Drug and Device Accountability Act of 2008 Follow-on biologics Drug importation and counterfeiting Drug advertising Comparative effectiveness Physician payment disclosure Hormone replacement therapies

Client expense: $756,650 · Firm income: Not reported

Vaccines Medicare chronic disease coverage Implementation Issues concerning P.L. 108-173 - the Medicare Prescription Drug, Improvement and Modernization Act of 2003 Medicare coverage of pharmaceuticals, Medicare Part D Issues relating to Medicaid reimbursement for drugs/biologics in Title VI of S.1932-the Deficit Reduction Act of 2005 Pediatric Exclusivity H.R. 4 - Medicare Prescription Drug Price Negotiation Act H.R. 3162 - Children's Health and Medicare Protection Act of 2007 S.1893/H.R. 976 - Children's Health Insurance Progam Reauthorization Act of 2007 S. 2499 - Medicare, Medicaid and SCHIP Extension Act of 2007 Chronic care out of pocket costs S. 2029 - Physician Payments Sunshine Act of 2007 HR 5605 - Physician Payments Sunshine Act of 2007 HR 2185 - Enhanced Healthcare Value for All Act Medicare Prescription Drug Benefit Medicaid drug rebate Medicare Physician Reimbursement package Medicare and Medicaid Drug Reimbursement Medicaid Rebate Medicaid Part D Non-Interference H.R. 6331/S.3101 - Medicare Improvements for Patients and Providers Act of 2008 S.3118 - Preserving Access to Medicare Act of 2008 S.3613, H.R. 7114 - Independence at Home Act

Client expense: $756,650 · Firm income: Not reported

Education and support for population-based health programs, such as disease and care management in FFS Medicare and Medicare Advantage, including Special Needs Plans (specifically, the reauthorization of Chronic Care Special Needs Plans, or C-SNPs, the incorporation of reasonable process measures and standards for SNP evaluation, and recommendations for CMS' Chronic Conditions SNP Panel); Medicare pilots and demonstrations such as the Medicare Medical Home Demonstration, Senior Risk Reduction Dem- onstration, Medicare Physician Group Practice Demonstration, Medicare Electronic Health Records Demonstration, the Medicare Coordinated Care Demonstration (MCCD, as authorized under Section 4016 of the Balanced Budget Act of 1997), and Medicare Health Support (as authorized under Section 721 of the Medicare Prescription Drug, Improvement and Modernization Act (MMA), which created the "Voluntary Chronic Care Improvement Program" now called Medicare Health Support). Provision of suggestions and recommendations for consideration of the broader inclusion of coordinated chronic care and health service stakeholder expertise in the feasibility study of a Medicare Chronic Care Practice Research Network demonstration program and in outcomes reporting for comparative effectiveness research (authorized in the Medicare Improvements for Patients and Providers Act of 2008). Provision of comments on the CMS-proposed rule for the Physician Fee Schedule for CY2009, specifically regarding expansion of the Physician Quality Reporting Initiative (PQRI). Encouragement of efforts to preserve HIPAA provisions permitting exchange of protected health information for care coordination and disease management, efforts to advance HIT deployment, particularly as it would effect individuals with chronic conditions, including e-prescribing, and the creation of interoperability standards and priority use cases and best practices for technologies that merge classical medical devices and telecommunications (American Health Information Community Chronic Care Workgroup initiatives). Education regarding effectiveness of chronic condition care and its benefits to Medicaid and other populations via the sharing of published quality improvement studies that reported cost or utilization outcomes from the intervention and which are target clinical conditions relevant for Medicaid programs. Advocacy for priorities of all stakeholders providing services along the care continuum toward the goal of population health improvement in proposed and realized legislation, including S. 3613 & H.R. 7114, the Independence at Home Act of 2008; S. 631 & H.R. 5765, the Remote Monitoring Access Act of 2007; S. 334, the Healthy Americans Act; S. 1340, the Geriatric Assessment and Chronic Care Coordination Act of 2007; S. 1753, the Healthy Workforce Act of 2007; H.R. 3800, the Wired for Healthcare Quality Act; H.R. 6357, Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology PRO(TECH)T Act of 2008; H.R. 6898, the Health-e Information Technology Act of 2008; H.R. 5442, TRUST in Health Information Act of 2008; S. 3101, Medicare Improvements for Patients and Providers Act of 2008; S. 3118, Preserving Access to Medicare Act of 2008; H.R. 853, Wellness and Prevention Act of 2007; H.R.6331, Medicare Improvements for Patients and Providers Act of 2008; initiatives pertaining to the treatment and prevention of obesity as a chronic disease generally and specifically as related to Medicare Part D coverage of pharmacotherapy as a component of population health improvement approaches to addressing the obesity epidemic. Education and coordination of briefings for congressional staff and agency representatives regarding the value for employers and employees of wellness programs and preventive health services as made available in the workplace. General advocacy for population health improvement as a tool to improve the quality of health care and health care outcomes, and reduce preventable health care costs.

S 2337/HR 3363 - Discussion of and support for Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections. S 1070/HR 1783 Elder Justice Act/S 1577 Patient Safety and Abuse Prevention Act of 2007 - Support for both pieces of legislation, strategy for how they might both move forward this year, bill markup, background for score on S.1577. S 2708 Caring for an Aging America Act of 2008 - Provisions related to increasing the number of professionals trained in geriatrics or gerontology, etc., providing input on legislation and encouraging offices to cosponsor the bill. Discussed draft legislation to make changes to Medicaid HCBS, including the Medicaid state plan option, spousal impoverishment, Medicaid Transformation Grants, etc. S 3230 Empowered at Home Act - Lobbied to adjust budget neutrality requirement in waivers to include costs in both Medicare and Medicaid. HR 7110/S 3604 Job Creation and Unemployment Relief Act - Lobbied for FMAP funding. HR 5613 Protecting the Medicaid Safety Net Act of 2008 - Supported this legislation, particularly provisions related to placing a moratorium on seven harmful Medicaid regulations. HR 6331 Medicare Improvements for Patients and Providers Act - Discussed need to strengthen low-income programs by raising asset limits and streamlining rules, and to keep premiums affordable for all beneficiaries, and promote e-prescriptions in medicare. S 2408/HR 4296 Medicare Electronic Medication and Safety Protection (E-Meds) Act of 2007- Supported provisions related to requiring e-prescribing in Medicare Part D, at first by providing incentive payments to providers who do and after 2011 lower payments to providers who do not. S 2641 Nursing Home Transparency and Improvement Act - Lobbied in support of the bill and to increase co-sponsors; criminal background checks for LTC employees; nursing home quality and proposed five star rating system cms; poor performing nursing homes, family caregiving initiative, nursing home compliance guidelines, Home Health CAHPS, LTC Partnership Program (under Medicaid data reporting requirements), status of Nursing Home Value Based Purchasing Demonstration, Prepare to Care for use in innovative employer caregiving programs satellite broadcast, LTC Quality Alliance. HR 2642 - Lobbied for inclusion of Medicaid Regulation Moratoriam in Military Construction and Veterans Affairs Appropriations Act of 2008, and on supplemental appropriations bill. To build support and obtain sponsors for Medicaid Family Caregiver Assessment Demonstration proposal (no Bill). S 2838/HR 6126 - Lobbied to support the Fairness in Nursing Home Arbitration Act and oppose amendments to weaken the bill. Discussion and input on legislation to improve the health/LTC workforce and support family caregivers (no bill). Advance directives and end-of-life care, education of the public about these issues, portability, and other issues relating to advance directives (no bill). S 1577- Support for Patient Safety and Abuse Prevention Act (S 1577) and marking up the bill; provided feedback and in testimony. HR 7114/S3613 Independence at Home Act/Chronic Care Coordination - Feedback on and support for legislation to provide chronic care coordination services to certain Medicare beneficiaries. S 1102 Part D Equity for Low-Income Seniors Act of 2007- Support for Medicare premium protection and modifications to Medicare Savings Programs/Part D Low-Income Subsidy. S. 3118 Preserving Access to Medicare Act - Lobbied in opposition to Grassley-McConnell bill - All provisions related to beneficiary access and Medicare improvements, including e-prescribing. S 3101- Urged support of the Medicare Improvements for Patients and Providers Act of 2008 to help improve Medicare. Green Houses and culture change in LTC facilities, person centered care and medical homes - testimony and input on draft bill - no bill number. Lobbied for appeal notices for Medicare beneficiaries in Medicare Advantage plans (no bill). S 1102 Part D Equity for Low-Income Services - Lobbied for legislation to increase Medicare Part D LIS. HR 1536 Prescription Coverage Now Act - Lobbied for legislation to increase Medicare Part D LIS asset limits. HR 5702 End-of-Life Care Advance Directive Promotion Act - Discussed ideas for end-of-life care legislation and how to help ensure patient wishes are respected; Advance Directive Promotion Act. Provided feedback on draft legislation regarding physician orders for life sustaining treatment. S.334 - Discussed long-term care broadly and including it in health care reform, including the Healthy Americans Act. Discussed voting in LTC facilities, such as nursing homes, current status and law on the issue (no bill). S 3327 - Provided input and support for the Empowered at Home Act to make improvements in Medicaid HCBS; LTC insurance tax incentives and consumer protection improvements and a caregiver tax credit. Invitations and information about a solutions forum on balancing of state LTC systems. HR 3363/S 2337 - Discussed consumer protections for LTC insurance, premium increases and claims denials, support for family caregivers including assessment, consumer complaints and support for the LTC Affordability and Security Act. HR 6033 - Discussed provisions of Home-Based Health Services Job Training and Caregiving Act. H.Con.Res 133 - Provided input on and support for new LTC Awareness Week resolution. LTC - General discussion of LTC, home and community based services, family caregiving, chronic care, workforce, quality and financing options.(no bill) CMS - Lobbied on the Medicare Medical Home Demo implementation.

H.R. 2860, The Health Care Access and Rural Equity Act of 2007 -- sections 305 and 309 S. 321, Fostering Independence Through Technology Act of 2007 -- All sections S. 1605, Craig Thomas Rural Hospital and Provider Equity Act of 2007 -- sections 14 and 18 S. 1678, Home Health Care Planning Improvement Act of 2007 -- All sections S. 2181/H.R. 3865, The Fair Home Health Care Act -- All sections H.R. 6331, Medicare Improvements for Patients and Providers Act of 2008 -- effort to include home health rural add-on as amendment S. 3101, Medicare Improvements for Patients and Providers Act of 2008 --effort to include home health rural add-on as amendment S. 3118, Preserving Access to Medicare Act of 2008 -- section 112 H.R. 5613/S. 2819, Protecting the Medicaid Safety Net Act of 2008 -- All sections H.R. 2642, Supplemental Appropriations Act, 2008 -- Title VII Medicaid H.R. 6163, Medicare Telehealth Enhancement Act of 2008 -- sections 104, 105, and 106 S. 3613/H.R. 7114, The Independence at Home Act -- All sections S. 1340, The Geriatric Assessment and Chronic Care Coordination Act of 2007 -- All sections S. 3484/H.R. 6873 -- The Medicare Hospice Protection Act -- All sections S. 1628/H.R. 6826 -- The Home Health Care Planning Improvement Act -- All sections S. 1577/H.R. 3078 -- The Patient Safety and Abuse Prevention Act -- All sections

Client expense: $92,550 · Firm income: Not reported