Preserving Access to Healthcare (PATH) Act of 2008

Medicare inpatient and outpatient hospital payments; Medicaid payments; H.R. 1177 and S. 2381 Sole Community Hospital Preservation Act of 2007, all provisions to amend title XVIII of the Social Security Act to extend and improve protections for sole community hospitals under the Medicare Program; H.R. 2159 and S. 630 Rural Health Services Preservation Act of 2007, all provisions to amend part C of title XVIII of the Social Security Act to provide for a minimum payment rate by Medicare Advantage organizations for services furnished by a critical access hospital and a rural health clinic under the Medicare Program; H.R. 1105 and S. 458 Physician Pathology Services Continuity Act of 2007, all provisions to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; H.R. 2050 Medicaid Emergency Psychiatric Care Act of 2007, all provisions to amend title XIX of the Social Security Act to permit States to obtain reimbursement under the Medicaid Program for care or services required under the Emergency Medical Treatment and Active Labor Act that are provided in a nonpublicly owned or operated institution for mental diseases; H.R. 2860 Health Care Access and Rural Equity (H-CARE) Act of 2007, all provisions related to TITLE I--MEDICARE HOSPITAL SERVICES, including Sec. 101. Fairness in the Medicare disproportionate share hospital (DSH) adjustment for rural hospitals, Sec. 102. Treatment of Medicare hospital reclassifications, Sec. 103. Critical access hospital improvements, Sec. 104. Rebasing for sole community hospitals, Sec. 105. Establishment of rural community hospital (RCH) program and Sec. 106. Hold harmless through 2012 for small rural hospitals and sole community hospitals under the prospective payment system for hospital outpatient department services under the Medicare program; S. 1277 Critical Access to Clinical Lab Services Act of 2007, all provisions to amend title XVIII of the Social Security Act to clarify the treatment of payment under the Medicare program for clinical laboratory tests furnished by critical access hospitals; H.R. 3057 Medicare Long-Term Patient Safety and Improvement Act of 2007, all provisions related to the steps to develop and implement criteria to differentiate long-term care hospitals from other post-acute care settings; H.R. 3453 The Community Clinical Laboratory Fairness in Competition Act of 2007, all provisions related to the Medicare competitive bidding demonstration project for clinical laboratory services; H.R. 5613 Protecting the Medicaid Safety Net Act of 2008, all provisions to extend certain moratoria and impose additional moratoria on certain Medicaid regulations through April 1, 2009; S. 2819 Economic Recovery in Health Care Act,to enact moratoria on the Medicaid and CHIP regulations issued by the Administration over the last year and to provide targeted state fiscal relief; H.R. 4105 Medicare Recovery Audit Contractor Program Moratorium Act of 2007, all provisions relating to impose a moratorium on the use of recovery audit contractors under the Medicare Integrity Program; S. 1605 Craig Thomas Rural Hospital and Provider Equity Act of 2007 all provisions To amend title XVIII of the Social Security Act to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program, and for other purposes; H.R. 615 Puerto Rico Medicare Reimbursement Act 2005, all provisions to increase of the Federal share of Medicare beneficiaries to 100% reimbursement for inpatient services; H.R. 5901Eliminating Disparities in Breast Cancer Treatment Act of 2008, to amend title XVIII of the Social Security Act to eliminate contributing factors to disparities in breast cancer treatment through the development of a uniform set of consensus-based breast cancer treatment performance measures for a 6-year quality reporting system and value-based purchasing system under the Medicare Program; H.R. 5721Strengthening the Safety Net Act of 2008, to amend title XIX of the Social Security Act to provide for a DSH redistribution pool from unexpended Medicaid DSH allotments in order to increase Medicaid DSH allotments for low DSH States and to provide grants for health access networks serving the uninsured; H.R. 2642 Supplemental Appropriations Act of 2008, Title V Medicaid Provisions, all sections related to Medicaid Rules Moratorium, banning physician self-referral and August 17th directive (contained in domestic spending amendment); Section 1011 (MMA, P.L. 108-173) Medicare Modernization Act, two year extension; H.R. 5998 Protecting Children's Health Coverage Act of 2008, to nullify any effectiveness of the August 17, 2007, State health official letter issued by the Centers for Medicare & Medicaid Services; H.R. 5953 and S. 2962 MediFair Act of 2008, to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in rural areas; S. 3116 Outpatient Mental Health Modernization Act of 2008, to amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program, and for other purposes; S. 3118 Preserving Access to Medicare Act of 2008, to amend titles XVIII and XIX of the Social Security Act to preserve beneficiary access to care by preventing a reduction in the Medicare physician fee schedule, to improve the quality of care by advancing value based purchasing, electronic health records, and electronic prescribing, and to maintain and improve access to care in rural areas, and for other purposes; H.R. 6212 and S. 3101 Medicare Efficiency and Development of Improvement of Care and Services Act (MEDICS Act) of 2008 and H.R. 6331 Medicare Improvements for Patients and Providers Act of 2008, to amend titles XVIII and XIX of the Social Security Act to extend expiring provisions under the Medicare Program, to improve beneficiary access to preventive and mental health services, to enhance low-income benefit programs, and to maintain access to care in rural areas, including pharmacy access, and for other purposes; H.R. 6091Save Medicare Act of 2008, to amend title XVIII of the Security Act to preserve access to physicians' services under the Medicare Program; S. 3164 Seniors and Taxpayers Obligation Protection Act of 2008, to amend title XVIII of the Social Security Act to reduce fraud under the Medicare program; H.R. 6912 and S. 3300 Rural Hospital Assistance Act of 2008, to amend title XVIII of the Social Security Act to provide for temporary improvements to the Medicare inpatient hospital payment adjustment for low-volume hospitals and to provide for the use of the non-wage adjusted PPS rate under the Medicare-dependent hospital (MDH) program, and for other purposes; S. 3327 Empowered at Home Act of 2008, to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; H.R. 6394 Border Health Care Relief Act of 2008, to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend Federal reimbursement of emergency health services furnished to undocumented aliens, and for other purposes; S. 3367, to amend title XVIII of the Social Security Act to revise the timeframe for recognition of certain designations in certifying rural health clinics under the Medicare program; S. 3656 and H.R. 7241 Preserving Access to Healthcare (PATH) Act of 2008, a bill to preserve access to healthcare under the Medicare and Medicaid programs. The sections related to the Medicare indirect medical education adjustment factor and the delay in implementation of Medicaid outpatient hospital services regulation; S. 1595 Critical Access Hospital Flexibility Act of 2007, all provisions to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program; S. 2853, to amend title XVIII of the Social Security Act to remove the cap on disproportionate share adjustment percentages for certain rural hospitals; H. R. 7067 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2008, to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; H. R. 6966 and S. 3582 Safeguarding Our Hospitals' Futures Act of 2008, all provisions to require continued application of budget neutrality on a national basis in calculation of the Medicare urban hospital wage floor.

Client expense: $4,910,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Social Security Administration (SSA)

H.R. 1424/S.558 - Paul Wellstone Mental Health Parity & Addiction Act - Sect. 106 of House bill H.R. 4105 - Medicare Recovery Audit Contractor Program Moratorium Act of 2007 - Entire bill H.R. 5613 - Protecting the Medicaid Safety Net Act of 2008 - Entire bill S. 2819 Economical Recovery in Health Care Act of 2008 - Entire bill H.R. 5882 - To recapture employment-based immigrant visas lost to bureaucratic delays and to prevent losses of family-and employment-based immigrant visas in the future - Entire Bill H.R. 5924 - Emergency Nurse Supply Relief Act of 2008 - Entire bill H.R. 5942 - National Trauma Center Stabilization Act of 2008 - Entire bill H.R. 5998 - Protecting Children's Health Coverage Act of 2008 - Medicaid SCHIP Directive, Entire bill H.R. 6163 - Medicare Telehealth Enhancement Act - Entire bill. H.R. 6357 - PRO(TECH)T Act of 2008 - To amend Public Health - Entire bill H.R. 6331 - Medicare Improvements for Patients and Providers Act - Sections 121-125, 145, 205 H.R. 6898 - Health-e Information Technology Act of 2008 - Entire bill H.R. 6966 - Safeguarding Our Hospitals' Futures Act of 2008 - Entire bill H.R. 7067 - Quality FIRST Act of 2008 - Entire bill H.R. 7110 - Job Creation and Unemployement Relief Act of 2008 - Title III, Medicaid FMAP H.R. 7241 - Preserving Access to Healthcare (PATH) Act of 2008 - Entire bill S. 3656 - Preserving Access to Healthcare (PATH) Act of 2008 - Entire bill S. 3101 - Medicare Improvements for Patients and Providers Act - Rural Hospital Provisions

Client expense: $168,500 · Firm income: Not reported

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

See attached Iroquois Healthcare Alliance Federal legislation for October 1 through December 31, 2008 Health Professions and Primary Care Reinvestment Act, S.20.IS / H.R. 7302. IH Protecting Patients and Health Care Act, S.20.IS / HR7301. IH H.R. 7241/S.3656 To preserve access to healthcare under the Medicare and Medicaid programs. H.R. 7302/S.3708 To amend the Public Health Service Act with respect to health professions education, and for other purposes. S.3730 / no companion A bill to expand, train, and support all sectors of the health care workforce to care for the growing population of older individuals in the United States.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.458 Physician Pathology Services Continuity Act, S. 558 The Mental Health Parity Act of 2007, S.630 Rural Health Services Preservation Act, S.860 Early Treatment for HIV Act, S.969 Oppose Reversal of NLRB guidance on when charge nurses are classifed as supervisors, S.1041 Employee Free Choice Act-Oppose Card Check process, S.1604 Nursing Education and Quality of Health Care Act of 2007, S.1693 Health Information Exchange, S.2041 The False Claims Act Correction Act of 2007, S.2460 Extend S.2460 Extend Moratorium on Medicaid Regulations affecting Intergovernmental Transfers, S.2499 Medicare, Medicaid, and SCHIP Extension Act of 2007, S.2620 Temporary increase in federal medical assistance percentages under Medicaid program S.2819 Extend and Establish Moratorium on Medicaid Rules; increase FMAP, S.3101 The Medicare Improvements for Patients and Providers Act S.3656 Preserving Access to Healthcare (PATH) Act of 2008 H.R.800 Employee Free Choice Act Oppose Card Check process H.R.866 Secret Ballot Protection Act H.R.976 Childrens Health Insurance Reauthorization Act of 2007 H.R.1105 Physician Pathology Services Continuity Act H.R.1177 Sole Community Hospital Preservation Act H.R.1424 Paul Wellstone Mental Health & Addiction Equity Act of 2007 H.R.1644 Oppose reversal of NLRB guidance on when charge nurses are classified as supervisors H.R.1663 Medicare Mental Health Modernization Act of 2007 H.R.2159 rural Health Services Preservation Act H.R.2406 Establishes NIST Role in Standard Setting for Health IT H.R.2638 Consolidated Security, Disaster Assistance, and Continuing Appropriations Act, 2009 continuing resolution 2009 H.R.2642, supplemental appropriations Act, 2008 H.R.3162 Children Health and Medicare Protection Act of 2007 H.R.3326 Early Treatment for HIV Act H.R.3533 Public and Teaching Hospital Preservation Act, H.R.4105 One-year Moratorium on the Recovery Audit Contractor (RAC) program H.R.4854 False Claims Act Correction Act of 2007 H.R.5268 Temporary increase in federal medical assistance percentages under Medicaid program H.R.5480 Medicare Funding Warning Response Act of 2008 H.R.5613 Extend and Establish Moratorium on Medicaid Rules H.R.5924 Emergency Nursing Supply Relief Act H.R.6331 Physician Medicare payment relief H.R.6357 Protecting records, optimizing treatment, and easing communication through healthcare technology H.R.6898 Health-e IT Act of 2008 H.R.7067 Quality FIRST Act of 2008 H.R.7110 Job Creation and Unemployment Relief Act of 2008-FMAP Provision H.R.7219 The Protecting Hospital Outpatient and Community Clinic Services Act of 2008 H.R.7241 Preserving Access to Healthcare (PATH) Act of 2008 H.Res.1368 Relating to the House procedures contained in Section 803 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 FFY 2009 Budget and Budget Resolutions/Medicare and Medicaid Cuts FFY 2009 Labor, Health and Human Services, Education and Pension Appropriations bill FFY 2009 Medicare Inpatient Hospital PPS Rules CY 2009 Medicare Inpatient Psychiatric Facility PPS Rules FFY 2009 Medicare Inpatient Rehabilitation Facility PPS and 75% Rule, Rules CY 2009 Medicare Outpatient PPS Rules FFY 2009 Medicare Skilled Nursing Facility PPS Rules CY 2009 Medicare Home Health Agency PPS Rules CY 2009 Medicare Physician Fee Schedule Update CMS Proposed Rule to Limit Intergovernmental Transfers and Certified Public Expenditures CMS Proposed Value-Based Purchasing Program CMS Proposed Rule on Medicaid Graduate Medical Education Payments State Childrens Health Insurance Program funding IRS Form 990 Revision Stark and physician self-referral regulations Hospital pricing transparency Not-for-profit hospital tax-exempt status Medicaid regulations affecting public hospitals, GME, provider tax, outpatient coverage, targeted case management, rehabilitation and school based health Pay for Performance / value based purchasing Health information technology Hospital charity care/financial aid Coverage for undocumented immigrants Associated health plans Coverage for the uninsured Health savings accounts and high-deductible health plans Emergency preparedness Immigration Medicare wage index Community benefit reporting Mental health parity Limited service hospitals Department of Housing and Urban Developments Federal Housing Assistance mortgage program for hospitals Defined benefit pension plans National Institute of Health funding Health care workforce recruiting and training funding Hospital infection reporting Medical error reporting Hospital performance measure reporting Medicare Recovery Audit Contractor Demonstration Project/national expansion Competitive bidding for clinical laboratory services Expansion of the Medicaid 340B drug pricing program CMS August 17th directive to states establishing new requirements for increasing SCHIP coverage False claims act expansion Medicare funding warning/trigger Medicare GME residency slot distribution National Health Service Corp funding Public Health Service Act nursing and allied health professions program funding HRSAs health professions shortage areas and medically underserved areas

Client expense: Not reported · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE

S.458 Physician Pathology Services Continuity Act; S.558 The Mental Health Parity Act of 2007; S.630 Rural Health Services Preservation Act; S.860 Early Treatment for HIV Act; S.969 Oppose reversal of NLRB guidance on when charge nurses are classified as supervisors; S.1041 Employee Free Choice Act-Oppose Card Check process; S.1604 Nursing Education and Quality of Health Care Act of 2007; S.1693 Health Information Exchange; S.2041 The False Claims Act Correction Act of 2007; S.2460 Extend Moratorium on medicaid regulations affecting intergovernmental transfers; S.2499 Medicare, medicaid, and SCHIP extension act of 2007; S.2620 Temporary increase in federal medical assistance percentages under Medicaid program; S.2819 Extend and establish moratorium on Medicaid rules; increase FMAP; S.3101 the Medicare improvements for patients and providers act; S.3656 Preserving access to healthcare (PATH) act of 2008; H.R.800 Employee free choice act (oppose card check process); H.R.866 Secret ballot protection act; H.R.976 Children's health insurance reauthoriation act of 2007; H.R.1105 Physician pathology services continuity act; H.R.1177 Sole commuunity hospital preservation act; H.R.1424 Paul Wellstone mental health and addiction equity act of 2007; H.R.1644 Oppose reversal of NLRB quidance on when charge nurses are classified as supervisors; H.R.1663 Medicare mental health modernization act of 2007; H.R.2159 Rural health services preservation act; H.R.2406 establishes NIST role in standard setting for health IT; H.R.2638 Consolidated security, disaster assistance, and continuing appropriations act, 2009; Continuing resolution 2009; H.R.2642 Supplemental appropriations act, 2008; H.R.3162 Children health and Medicare protection act of 2007; H.R.3326 Early treatment for HIV act; H.R.3533 Public and teaching hospital preservation Act; H.R.4105 One-year moratorium on the Recovery Audit Contractor (RAC) program; H.R.4854 False Claims Act Correction Act of 2007; H.R.5268 Temporary increase in federal medical assistance percentages under Medicaid program; H.R.5480 Medicare funding warning response act of 2008; H.R.5613 Extend and establish moratorium on Medicaid rules; H.R.5924 Emergency nursing supply relief act; H.R.6331 Physician Medicare payment releif; H.R.6357 Protecting records, optimizing treatment, and easing communication through healthcare technology; H.R.6898 Health-E IT Act of 2008; H.R.7067 Quality FIRST Act of 2008; H.R.7110 Job Creation and Unemployment Relief Act of 2008-FMAP Provision; H.R.7219 the Protecting Hospital and outpatient and community clinic services act of 2008; H.R.7241 Preserving access to health care (PATH) Act of 2008; H.Res.1368 Relating to the House procedures contained in Section 803 of the Medicare prescription drug improvement and modernization act of 2003; FFY 2009 budget and budget resolutions/Medicare and Medicaid cuts; FFY 2009 Labor, health and human services, education and pension appropriations bill; FFY 2009 Medicare Inpatient hospital PPS rules; CY 2009 Medicare inpatient Psychiatric facility PPS rules; FFY 2009 Medicare inpatient rehabiltiation facility PPS and "75% rule," rules; CY 2009 Medicare otupatient PPS rules; FFY 2009 Medicare skilled nursing facility PPS rules; CY 2009 Medicare home health agency PPS rules; CY 2009 Medicare physician fee schedule update; CMS proposed rule to limit intergovernmental transfers and certified public expenditures; CMS proposed value-based purchasing program; CMS proposed rule on Medicad graduate medical education payments; State childrens health insurance program funding; IRS Form 990 revision; "Stark" and physician self-referral regulations; Hospital pricing transparency; Not-for-profit hospital tax-exempt status; Medicaid regulations affecting public hospitals, GME, provider tax, outpatient coverage, targeted case management, rehabilitation and school based health; pay for performance/value based purchasing; health information technology; hospital charity care/financial aid; Coverage for undocumented immigrants; Associated health plans; Coverage for the uninsured; Health savings accounts and high-deductibel health plans; Emergency preparedness; Immigration; Medicare wage index; Community benefit reporting; mental health parity; Limited service hospitals; Department of Housing and Urban Development's federal housing assistance mortage program for hospitals; Defiend benefit pension plans; National Institute of Health funding; Health care workforce recruting and training funding; Hospital infection reporting; Medical error reporting; Hospital performance measure reporting; Medicare Recovery Audit contractor Demonstration Project/national expansion; Competitive bidding for clinical laboratory services; Expansion of the Medicaid 340b drug pricing program; False claims act expansion; Medicare funding warning/"trigger"; Medicare GME residency slot distribution; National Health Service Corp. funding; CMS directive to states establishing new requirements for increasing SCHIP coverage; Public Health Service Act nursing and allied health professions program funding; HRSA's health professions shortage areas and medically underserved areas.

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE

"FY 2009 Inpatient Prospective Payment System (IPPS) rule" urging CMS to withdraw a proposal to eliminate the Medicare indirect medical education (IME) adjustment for teaching hospitals that is provided under the Medicare capital payment system. Preserving Access to Healthcare (PATH) Act of 2008 (S. 3656/H.R. 7241) which would retroactively delay for six months a two-year phase-out of capital IME payments for teaching hospitals that was implemented on October 1, 2008. Hospital wage index reclassification and resolution of regional disparity. Issues related to the reduction of the annual disproportionate share (DSH) payment and problems with the SSI formula calculation. Expanding Medicare payment rules for stroke related telehealth services to include urban areas and the "Medicare Home Infusion Therapy Coverage Act of 2008" (S.3505/HR2567) to provide coverage for infusion-related services, supplies and equipment under Medicare Part B.

Client expense: $303,160 · Firm income: Not reported

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

Medicare hospital reimbursement issues and Medicare graduate medical education reimbursement issues (Medicare Improvement for Patients and Providers Act of 2008, H.R.6331, S.3101;CHAMP Act, H.R.3162;Preserving Access to Medicare Act of 2008,S.3118;Inpatient Medicare Prospective Payment System Rule, CMS 1390-P,F;Medicare Recovery Audit Contractor Program Moratorium Act of 2007, H.R.4105;Nursing and Allied Health Education Preservation Act of 2008;H.R.5174;Registered Nurse Safe Staffing Act of 2007, H.R.4138;42CFR413.75,H.R.1093,provisions related to Medicare graduate medical education and the counting of resident work hours, HR 615 & 616 relating to Medicare Parity; PATH Act of 2008 (S.3656, HR 7241) Medicaid reimbursement issues (Iraq War Supplemental Appropriations Bill, H.R. 2642-Provision to Place Moratoria on Medicaid Regulations CMS-2258-FC,CMS 2279-P,CMS 2213-P, and CMS-2275-F; Protecting the Medicaid safety Net Act of 2008, H.R.5613;Public and Teaching Hospital Preservation Act, H.R.3533;Medicaid Advanced Practice Nurses and Physician Assistants Access Act of 2007, H.R.2066;Temporary Increase in FMAP (HR5268,S.2586, H.R.7110, S. 3656,S.3689 ) Medicaid Outpatient Regulation (ms 2213-F)

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

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

S.3656, H.R. 7241 - Preserving Access to Healthcare (PATH) Act S. 2499 - Medicare, Medicaid, and SCHIP Extension Act of 2007 H.R. 2606 - The 340B Program Improvement and Integrity Act of 2007 S. 1376 - The 340B Program Improvement and Integrity Act of 2007 H.R. 3453 The Community Clinical Laboratory Fairness in Competition Act of 2007 HR 5613 - Protecting the Medicaid Safety Net Act of 2007 S.543 - Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007 S. 2099 - the Preserving Access to Laboratory Services Act of 2007 H.R. 6331/S.3101 - Medicare Improvements for Patients and Providers Act of 2008

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

Government targets: Energy, Dept of, HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE

HR 7110 - Job Creation and Unemployment Relief Act of 2008; Title III, Temporary increase in Medicaid matching rate S 3656 - Preserving Access to Healthcare Act of 2008 HR 7241 - Preserving Access to Healthcare Act of 2008

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6331/S. 3101 The Medicare Improvements for Patients and Providers Act, Sections 121, 122, 123, 124, 131, 132, 135, 145, 149, 150, 151, 161, 205. H.R. 1424 Paul Wellstone Mental Health Parity and Addiction Act, Section 106 in House Bill. S. 558 Mental Health Parity Act 2007, Entire Bill. H.R. 5998 Medicaid SCHIP Directive, Entire Bill. H.R. 6357 To amend the Public Health Service Act. S. 2819 Economical Recovery in Health Care Act of 2008, Entire Bill. H.R. 4105 RAC, Entire Bill. H.R. 5924 Emergency Nursing Supply Relief Act, Entire Bill. H.R. 5882 To recapture employment-based immigrant visas lost to bureaucratic delays and to prevent losses of family-and employment-based immigrant visas in the future, Entire Bill. H.R. 6163 Medicare Telehealth Enhancement Act of 2008, Entire Bill. H.R. 6966 Safeguarding Our Hospitals' Futures Act of 2008, Entire Bill. H.R. 7110 Job Creation and Unemployment Relief Act of 2008, Title III-FMAP. H.R. 7067 Quality FIRST, Entire Bill. H.R. 7241/S. 3656 Preserving Access to Healthcare Act of 2008, Entire Bill. H.R. 5613 Protect Medicaid Safety Net, Entire Bill. H.R. 5942 National Trauma Center Stabilization Act, Entire Bill. S. 3101 The Medicare Improvements for Patients and Providers Act, Rural Hospital provisions. H.R. 4355/S. 2460 To impose moratorium on certain Medicaid payment restrictions, Entire Bill. H.R. 3533 Public and Teaching Hospital Preservation Act, Entire Bill. H.R. 1174 Health Hospitals Act of 2007, Entire Bill. S. 1842/H.R. 2122 Safe Nursing and Patient Care Act of 2007, Entire Bill. S. 3656 Preserving Access to Healthcare (PATH) Act of 2008, Entire Bill. H.R. 7241 Preserving Access to Heatlhcare (PATH) Act of 2008, Entire Bill. H.R. 7067 Quality First Act, Entire Bill.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 7219, Protecting Hospital Outpatient and Community Clinic Services Act of 2008 H.R. 7110, Job Creation and Unemployment Relief Act of 2008 S. 3604, S. 3688, S. 3689, Economic Recovery Act of 2008 H.R. 7067, Quality First Act H.R. 7241 and S. 3656, Preserving Access to Healthcare (PATH) Act of 2008 H.R. 5268 and S. 2620, To Provide a Temporary FMAP Increase H.R. 676, United States Health Insurance Act H.R. 6898, Health e-information Technology Act of 2008 Baucus/Grassley Value-Based Purchasing Draft Bill

Client expense: $200,000 · Firm income: Not reported

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

HR 7110 - Job Creation and Unemployment Relief Act of 2008; Title III, Temporary increase in Medicaid matching rate S. 3656 - Preserving Access to Healthcare Act of 2008 HR 7241 - Preserving Access to Healthcare Act of 2008

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Texas 1115 Waiver HR 3533/S2460 Public and Teaching Hospital Preservation Act all provisions HR 5613 - Protecting the Medicaid Safety Net Act of 2008 all provisions HR 3333/S1576 Minority Health Improvement and Health Disparity Elimination Act all provisions Medicare Improvements for Patients and Providers Act (P.L. 110-275) S 3656/HR 7241 Preserving Access to Healthcare (PATH) Act of 2008

Client expense: $290,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), SENATE, Veterans Affairs, Dept of (VA)

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

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

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

H.R. 7219, Protecting Hospital Outpatient and Community Clinic Services Act of 2008; H.R. 7110, Job Creation and Unemployment Relief Act of 2008; S. 3604, S. 3688, S. 3689, Economic Recovery Act of 2008; H.R. 7067, Quality First Act Administration of the Section 1011 Program; H.R. 7241 and S. 3656, Preserving Access to Healthcare (PATH) Act of 2008; H.R. 5268, Enhanced Health Care Value for All Act of 2007; H.R. 676, United States Health Insurance Act; H.R. 6898, Health-e Information Technology Act of 2008; Baucus/Grassley Value-Based Purchasing Draft Bill

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

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

Economic Recovery in Health Care Act of 2008 (S. 2819) Medicare Recovery Audit Contractor Program Moratorium Act of 2007 (H.R. 4105) Preserving Access To Healthcare Act (PATH Act) (H.R. 7241/S. 3656) Public and Teaching Hospital Preservation Act (H.R. 3533) Section 1011 of the Medicare Modernization Act (MMA) (H.R. 6394) To provide for a temporary increase of the Federal medical assistance percentage under the Medicaid Program, and for other purposes. (H.R. 7110/S. 3604) 340B Program Improvement and Integrity Act of 2007 (H.R. 2606)

Client expense: $12,500 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

(S. 3101, H.R. 6331) A moratorium on CMS rule to phase out budget neutrality factor in the Medicare hospice wage index in medicare legislation . Hospice Protection Act of 2008 (S. 3484, H.R. 6873). Preserving Access to Healthcare Act of 2008 (S. 3656, H.R. 7241).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 5721, Strengthening the Safety Net Act of 2008; H.R. 7219, Protecting Hospital Outpatient and Community Clinic Services Act of 2008; H.R. 1781 and S. 739, Children's Dental Health Improvement Act of 2007; H.R. 7110 and S. 3604, A bill making emergency supplemental appropriations for economic recovery for the fiscal year ending September 30, 2008, and for other purposes; H.R. 7067, the Quality FIRST Act; H.R. 6394, Border Health Care Relief Act of 2008; H.R. 2638, Consolidated Security, Disaster Assistance, and Continuing Appropriations Act, 2009; H.R. 7241 and S. 3656, Preserving Access to Healthcare (PATH) Act of 2008; H.R. 5268; H.R. 6444, Enhanced Health Care Value for All Act of 2007; H.R. 676, United States National Health Insurance Act; H.R. 6898, Health-e Information Technology Act of 2008

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Home and Hospice Care (S. 1678 and H.R. 3865), Rural health (S. 1605 and H.R. 2860); telehealth; medicare and state's health insurance program legislation (H.R. 6331 and S. 3101) (H.R. 5704); Medicare Hospice Protection Act (H.R. 6873 and S. 3484); Health IT legislation; Preserving Access to Health Care Act (S. 3656 and H.R. 7241)

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

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

Home and Hospice Care (S. 1678 and H.R. 3865), Rural health (S. 1605 and H.R. 2860); telehealth; medicare and state's health insurance program legislation (H.R. 6331 and S. 3101) (H.R. 5704); Medicare Hospice Protection Act (H.R. 6873 and S. 3484); Health IT legislation; Preserving Access to Health Care Act (S. 3656 and H.R. 7241)

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

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

Texas 1115 Waiver HR 3533/S2460 Public and Teaching Hospital Preservation Act all provisions HR 5613 - Protecting the Medicaid Safety Net Act of 2008 all provisions HR 3333/S1576 Minority Health Improvement and Health Disparity Elimination Act all provisions Medicare Improvements for Patients and Providers Act (P.L. 110-275) S 3656/HR 7241 Preserving Access to Healthcare (PATH) Act of 2008

Client expense: $290,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), SENATE, Veterans Affairs, Dept of (VA)

S.3656, H.R. 7241 - Preserving Access to Healthcare (PATH) Act S. 2499 - Medicare, Medicaid, and SCHIP Extension Act of 2007 H.R. 2606 - The 340B Program Improvement and Integrity Act of 2007 S. 1376 - The 340B Program Improvement and Integrity Act of 2007 H.R. 3453 The Community Clinical Laboratory Fairness in Competition Act of 2007 HR 5613 - Protecting the Medicaid Safety Net Act of 2007 S.543 - Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007 S. 2099 - the Preserving Access to Laboratory Services Act of 2007 H.R. 6331/S.3101 - Medicare Improvements for Patients and Providers Act of 2008

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

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

S.458 Physician Pathology Services Continuity Act; S.558 The Mental Health Parity Act of 2007; S.630 Rural Health Services Preservation Act; S.860 Early Treatment for HIV Act; S.969 Oppose reversal of NLRB guidance on when charge nurses are classified as supervisors; S.1041 Employee Free Choice Act-Oppose Card Check process; S.1604 Nursing Education and Quality of Health Care Act of 2007; S.1693 Health Information Exchange; S.2041 The False Claims Act Correction Act of 2007; S.2460 Extend Moratorium on medicaid regulations affecting intergovernmental transfers; S.2499 Medicare, medicaid, and SCHIP extension act of 2007; S.2620 Temporary increase in federal medical assistance percentages under Medicaid program; S.2819 Extend and establish moratorium on Medicaid rules; increase FMAP; S.3101 the Medicare improvements for patients and providers act; S.3656 Preserving access to healthcare (PATH) act of 2008; H.R.800 Employee free choice act (oppose card check process); H.R.866 Secret ballot protection act; H.R.976 Children's health insurance reauthoriation act of 2007; H.R.1105 Physician pathology services continuity act; H.R.1177 Sole commuunity hospital preservation act; H.R.1424 Paul Wellstone mental health and addiction equity act of 2007; H.R.1644 Oppose reversal of NLRB quidance on when charge nurses are classified as supervisors; H.R.1663 Medicare mental health modernization act of 2007; H.R.2159 Rural health services preservation act; H.R.2406 establishes NIST role in standard setting for health IT; H.R.2638 Consolidated security, disaster assistance, and continuing appropriations act, 2009; Continuing resolution 2009; H.R.2642 Supplemental appropriations act, 2008; H.R.3162 Children health and Medicare protection act of 2007; H.R.3326 Early treatment for HIV act; H.R.3533 Public and teaching hospital preservation Act; H.R.4105 One-year moratorium on the Recovery Audit Contractor (RAC) program; H.R.4854 False Claims Act Correction Act of 2007; H.R.5268 Temporary increase in federal medical assistance percentages under Medicaid program; H.R.5480 Medicare funding warning response act of 2008; H.R.5613 Extend and establish moratorium on Medicaid rules; H.R.5924 Emergency nursing supply relief act; H.R.6331 Physician Medicare payment releif; H.R.6357 Protecting records, optimizing treatment, and easing communication through healthcare technology; H.R.6898 Health-E IT Act of 2008; H.R.7067 Quality FIRST Act of 2008; H.R.7110 Job Creation and Unemployment Relief Act of 2008-FMAP Provision; H.R.7219 the Protecting Hospital and outpatient and community clinic services act of 2008; H.R.7241 Preserving access to health care (PATH) Act of 2008; H.Res.1368 Relating to the House procedures contained in Section 803 of the Medicare prescription drug improvement and modernization act of 2003; FFY 2009 budget and budget resolutions/Medicare and Medicaid cuts; FFY 2009 Labor, health and human services, education and pension appropriations bill; FFY 2009 Medicare Inpatient hospital PPS rules; CY 2009 Medicare inpatient Psychiatric facility PPS rules; FFY 2009 Medicare inpatient rehabiltiation facility PPS and "75% rule," rules; CY 2009 Medicare otupatient PPS rules; FFY 2009 Medicare skilled nursing facility PPS rules; CY 2009 Medicare home health agency PPS rules; CY 2009 Medicare physician fee schedule update; CMS proposed rule to limit intergovernmental transfers and certified public expenditures; CMS proposed value-based purchasing program; CMS proposed rule on Medicad graduate medical education payments; State childrens health insurance program funding; IRS Form 990 revision; "Stark" and physician self-referral regulations; Hospital pricing transparency; Not-for-profit hospital tax-exempt status; Medicaid regulations affecting public hospitals, GME, provider tax, outpatient coverage, targeted case management, rehabilitation and school based health; pay for performance/value based purchasing; health information technology; hospital charity care/financial aid; Coverage for undocumented immigrants; Associated health plans; Coverage for the uninsured; Health savings accounts and high-deductibel health plans; Emergency preparedness; Immigration; Medicare wage index; Community benefit reporting; mental health parity; Limited service hospitals; Department of Housing and Urban Development's federal housing assistance mortage program for hospitals; Defiend benefit pension plans; National Institute of Health funding; Health care workforce recruting and training funding; Hospital infection reporting; Medical error reporting; Hospital performance measure reporting; Medicare Recovery Audit contractor Demonstration Project/national expansion; Competitive bidding for clinical laboratory services; Expansion of the Medicaid 340b drug pricing program; False claims act expansion; Medicare funding warning/"trigger"; Medicare GME residency slot distribution; National Health Service Corp. funding; CMS directive to states establishing new requirements for increasing SCHIP coverage; Public Health Service Act nursing and allied health professions program funding; HRSA's health professions shortage areas and medically underserved areas.

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE

"Preserving Access to Healthcare (PATH) Act of 2008" (S.3656/H.R.7241), provisions related to a two-year phase-out of capital IME payments for teaching hospitals.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 909/H.R. 1878- Legislation to amend Title XIX of the Social Security Act to permit states, at their option, to require certain individuals to present satisfactory documentary evidence of proof of citizenship or nationality for purposes of eligibility for Medicaid, and for other purposes- entire bill. S.3656/HR 7241- Preserving Access to Healthcare (PATH) Act of 2008- entire bill. H.R. 5268- A bill to provide for a temporary Increase of the Federal Medical Assistance Percentage Under the Medicaid Program- entire bill. H.R. 6331- Medicare Improvements for Patients and Providers Act of 2008, provisions related to Federal Medical Assistance Percentage under Medicaid. H.R. 7219- To impose a moratorium on the implementation of a Medicaid regulation related to the outpatient clinic and hospital facility service definition and upper payment limit, provision related to CMS outpatient rule moratorium- entire bill. S. 1075/H.R. 2523- Unintended Pregnancy Reduction Act- provisions related to Medicaid family planning waiver.

Client expense: $278,579 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 909/H.R. 1878- Legislation to amend Title XIX of the Social Security Act to permit states, at their option, to require certain individuals to present satisfactory documentary evidence of proof of citizenship or nationality for purposes of eligibility for Medicaid, and for other purposes- entire bill. S.3656/HR 7241- Preserving Access to Healthcare (PATH) Act of 2008- entire bill. H.R. 6331- Medicare Improvements for Patients and Providers Act of 2008, provisions related to Federal Medical Assistance Percentage under Medicaid. H.R. 7219- To impose a moratorium on the implementation of a Medicaid regulation related to the outpatient clinic and hospital facility service definition and upper payment limit, provision related to CMS outpatient rule moratorium- entire bill. S. 1075/H.R. 2523- Unintended Pregnancy Reduction Act- provisions related to Medicaid family planning waiver.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6331/S. 3101 The Medicare Improvements for Patients and Providers Act, Sections 121, 122, 123, 124, 131, 132, 135, 145, 149, 150, 151, 161, 205. H.R. 1424 Paul Wellstone Mental Health Parity and Addiction Act, Section 106 in House Bill. S. 558 Mental Health Parity Act 2007, Entire Bill. H.R. 5998 Medicaid SCHIP Directive, Entire Bill. H.R. 6357 To amend the Public Health Service Act. S. 2819 Economical Recovery in Health Care Act of 2008, Entire Bill. H.R. 4105 RAC, Entire Bill. H.R. 5924 Emergency Nursing Supply Relief Act, Entire Bill. H.R. 5882 To recapture employment-based immigrant visas lost to bureaucratic delays and to prevent losses of family-and employment-based immigrant visas in the future, Entire Bill. H.R. 6163 Medicare Telehealth Enhancement Act of 2008, Entire Bill. H.R. 6966 Safeguarding Our Hospitals' Futures Act of 2008, Entire Bill. H.R. 7110 Job Creation and Unemployment Relief Act of 2008, Title III-FMAP. H.R. 7067 Quality FIRST, Enire Bill. H.R. 7241/S. 3656 Preserving Access to Healthcare Act of 2008, Entire Bill. H.R. 5613 Protect Medicaid Safety Net, Entire Bill. H.R. 5942 National Trauma Center Stabilization Act, Entire Bill. S 3101 The Medicare Improvements for Patients and Providers Act, Rural Hospital provisions. H.R. 4355/S. 2460 To impose moratorium on certain Medicaid payment restrictions, Entire Bill. H.R. 3533 Public and Teaching Hospital Preservation Act, Entire Bill. H.R. 1174 Health Hospitals Act of 2007, Entire Bill. S 1842/H.R. 2122 Safe Nursing and Patient Care Act of 2007, Entire Bill.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

"FY 2009 Inpatient Prospective Payment System (IPPS) rule" urging CMS to withdraw a proposal to eliminate the Medicare indirect medical education (IME) adjustment for teaching hospitals that is provided under the Medicare capital payment system. Preserving Access to Healthcare (PATH) Act of 2008 (S. 3656/H.R. 7241) which would retroactively delay for six months a two-year phase-out of capital IME payments for teaching hospitals that was implemented on October 1, 2008. Hospital wage index reclassification and resolution of regional disparity. Issues related to the reduction of the annual disproportionate share (DSH) payment and problems with the SSI formula calculation. Expanding Medicare payment rules for stroke related telehealth services to include urban areas and the "Medicare Home Infusion Therapy Coverage Act of 2008" (S.3505/HR2567) to provide coverage for infusion-related services, supplies and equipment under Medicare Part B.

Client expense: $270,000 · Firm income: Not reported

Government targets: Air Force, Dept of, Army, Dept of (Other), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE

S.458 Physician Pathology Services Continuity Act; S.558 The Mental Health Parity Act of 2007; S.630 Rural Health Services Preservation Act; S.860 Early Treatment for HIV Act; S.969 Oppose reversal of NLRB guidance on when charge nurses are classified as supervisors;S.1041 Employee Free Choice Act-Oppose Card Check Process; S.1604 Nursing Education and Quality of Health Care Act of 2007; S.1693 Health Information Exchange; S.2041 The False Claims Act Correction Act of 2007; S.2460 Extend Moratorium on Medicaid Regulations affecting Intergovernmental Transfers; S.2499 Medicare, Medicaid and SCHIP Extension Act of 2007; S.2620 Temporary increase in federal medical assistance percentages under Medicaid program; S.2819 Extend and Establish Moratorium on Medicaid Rules; increase FMAP; H.R. 800 Employee Free Choice Act-Oppose Card Check Process; H.r. 866 Secret Ballot Protection Act; H.R. 976 Children's Health Insurance Reauthorization Act of 2007; H.R. 1105 Physician Pathology Services Continuity Act; H.R. 1177 Sole Community Hospital Preservation Act; H.R. 1424 Paul Wellstone Mental Health & Addiction Equity Act of 2007; H.R. 1644 Oppose reversal of NLRB guidance on when charge nurses are classified as supervisors; H.R. 1663 Medicare Mental Health Modernization Act of 2007; H.R. 2159 Rural Health Services Preservation Act; H.R. 2406 Establishes NIST Role in Standard Setting for Health IT; H.R. 2642 Supplemental Appropriations Act, 2008; H.R. 3162 Children's Health and Medicare Protection Act of 2007; H.R. 3326 Early Treatment for HIV Act; H.R. 3533 Public and Teaching Hospital Preservation Act; H.R. 4105 One-Year Moratorium on the Recovery Audit Contractor (RAC) Program; H.R. 4854 False Claims Act Correction Act of 2007; H.R. 5268 Temporary increase in federal medical assistance percentages under Medicaid program; H.R. 5613 Extend and Establish Moratorium on Medicaid Rules; HR. 6331 Physician Medicare Payment Relief; H.R. 6357 Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008; FFY 2009 Budget and Budget Resolutions/Medicare and Medicaid Cuts; FFY 2009 Labor, Health and Human Services, Education and Pension Appropriations Bill; FFY 2009 Medicare Inpatient Hospital PPS Rules; CY 2009 Medicare Inpatient Psychiatric Facility PPS Rules; FFY 2009 Medicare Inpatient Rehabilitation Facility PPS and "75% Rule", Rules; CY 2009 Medicare Outpatient PPS Rules; FFY 2009 Medicare Skilled Nursing Facility PPS Rules; CY 2009 Medicare Home Health Agency PPS Rules; CY 2009 Medicare Physician Fee Schedule Update; CMS proposed Rule to Limit Intergovernmental Transfers and Certified Public Expenditures; CMS Proposed Value-Based Purchasing Program; CMS Proposed Rule on Medicaid Graduate Medical Education Payments; State Childrens Health Insurance Program Funding; IRS Form 990 Revision; "Stark" and physician self-referral regulations; Hospital pricing transparency; Not-for-profit hospital tax-exempt status; Medicaid regulations affecting public hospitals, GME, provider tax, outpatient coverage, targeted case management, rehabilitation and school based health; Pay for Performance/Value Based Purchasing; Health Information Technology; Hospital Charity Care/Financial Aid; Coverage for undocumented immigrants; Associated health plans; Coverage for the uninsured; Health savings accounts and high-deductible health plans; Emergency preparedness; Immigration, Medicare wage index; Community benefit reporting; Mental health parity; Limited service hospitals; Department of Housing and Urban Development's Federal Housing Assistance Mortgage program for Hospitals; Defined benefit pension plans; National Institute of Health funding; Health care workforce recruiting and training funding; Hospital infection reporting; Medical error reporting; Hospital performance measure reporting; Medicare Recovery Audit Contractor Demonstration Project/national expansion; Competitive bidding for clinical laboratory services; Expansion of Medicaid 340B drug pricing program; CMS August 17th directive to states establishing new requirements for increasing SCHIP coverage; False claims act expansion; Medicare funding warning/"trigger"; Medicare GME residency slot distribution; National Health Service Corp. funding; Public Health Service Act nursing and allied health professions program funding; HRSA's health professions shortage areas and medically underserved areas; S.3101 The Medicare Improvements for Patients and Providers Act; S.3656 Preserving Access to Healthcare (PATH) Act of 2008; H.R. 2638 Consolidated Security, Disaster Assistance, and Continuing Appropriations Act, 2009 (continuing resolution 2009); H.R. 5480 Medicare Funding Warning Response Act of 2008; H.R. 5924 Emergency Nursing Supply Relief Act; H.R. 6898 Health-e IT Act of 2008; HR. 7067 Quality FIRST Act of 2008; H.R. 7110 Job Creation and Unemployment Relief Act of 2008 (Title III includes FMAP provision); H.R. 7219 The Protecting Hospital Outpatient and Community Clinic Services Act of 2008; H.R. 7241 Preserving Access to Healthcare (PATH) Act of 2008; H.Res.1368 Relating to the House procedures contained in Section 803 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

Client expense: Not reported · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE

H.R. 7241, S.3656, Preserving Access to Healthcare (PATH) Act of 2008. Issues regarding indirect medical education reimbursements for teaching hospitals. H.R. 2606, 340B Program Improvement and Integrity Act of 2007. Issues regarding pharmaceuticals discounted in an outpatient setting. Humane science and toxicity testing. Loan forgiveness for health care providers.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, State, Dept of (DOS)

H.R. 7110 and S. 3604, A bill making emergency supplemental appropriations for economic recovery for the fiscal year ending September 30, 2008, and for other purposes H.R. 7067, the Quality FIRST Act H.R. 6394, Border Health Care Relief Act of 2008 H.R. 2638, Consolidated Security, Disaster Assistance, and Continuing Appropriations Act, 2009 H.R. 5721, Strengthening the Safety Net Act of 2008 H.R. 7219, Protecting Hospital Outpatient and Community Clinic Services Act of 2008 S. 739, HR 1781 Children's Dental Health Improvement Act of 2007 S. 3656, Protecting Access to Healthcare (PATH) Act of 2008 H.R. 7241, Preserving Access to Healthcare (PATH) Act of 2008 H.R. 5268, no bill title- would increase FMAP H.R. 6444, Enhanced Health Care Value for All Act of 2007 H.R. 676, United States National Health Insurance Act H.R. 6898, Health-e Information Technology Act of 2008

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 3656/H.R. 7241, "The Preserving Access to Healthcare Act of 2008." Issue: Preserve Capital IME Payments to teaching hospitals .

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

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