Community Living Assistance Services and Supports Act

HR 1583 (McCarran-Ferguson). S 819 (Autism). HR 1253 (disclosure rules) HR 1691/S 688 (prohibit plan rescissions and establish minimum hospital stays for cancer patients) HR 1558/S623 ; also HR 1619, S. 643, HR 1092 (prohibit pre-existing condition exclusions). S. 442/ HR 1085 (prohibit aggregate lifetime limit) S. 697 /HR 1721 (Long Term Care) HR 975 (Mammography mandate) HR 1339 (Mandate to cover deformities)

Client expense: $1,641,400 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE

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

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

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

H.R. 2748 - To amend the Internal Revenue Code of 1986 to encourage guaranteed lifetime income payments by excluding from income a portion of such payments. S. 1389 - A bill to clarify the exemption for certain annuity contracts and insurance policies from Federal regulation under the Securities Act of 1933. H.R. 1984 - To amend title I of the Employee Retirement Income Security Act of 1974 to provide special reporting and disclosure rules for individual account plans and to provide a minimum investment option requirement for such plans. H.R. 1988 - To amend title I of the Employee Retirement Income Security Act of 1974 to provide for independent investment advice for participants and beneficiaries under individual account plans. H.R. 2989 - To amend the Employee Retirement Income Security Act of 1974 to provide special reporting and disclosure rules for individual account plans and to provide a minimum investment option requirement for such plans, to amend such Act to provide for independent investment advice for participants and beneficiaries under individual account plans, and to amend such Act and the Internal Revenue Code of 1986 to provide transitional relief under certain pension funding rules added by the Pension Protection Act of 2006. H.R. 2779 - To amend the Internal Revenue Code of 1986 to provide transparency with respect to fees and expenses charged to participant-directed defined contribution plans, and to improve participant communication. S. 697 - A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes. H.R. 1721 - To amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes. H.R. 2733 - To clarify the exemption for certain annuity contracts and insurance policies from Federal regulation under the Securities Act of 1933.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

- HR 109, "To provide for the offering of Health Benefit Plans to individuals, to increase funding for State high risk health insurance pools, and to promote best practice protocols for State high risk pools" a/k/a "America's Affordable Health Care Act", regarding all provisions. - S 391/HR 1321, "A bill to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away" a/k/a "Healthy Americans Act", regarding all provisions. - HR 1, "Making supplemental appropriations for job preservation and creation, infrastructure investment, energy efficiency and science, assistance to the unemployed, and State and local fiscal stabilization, for fiscal year ending September 30, 2009, and for other purposes" a/k/a "American Recovery and Reinvestment Act of 2009", regarding COBRA Benefits Section 3002 and Comparative Effectiveness Council Section 9201. - HR 2096/S 702, "To amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance", a/k/a "The Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - S 1177, "A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes", a/k/a "Long-Term Care Insurance Act of 2009", regarding all provisions. - HR 2520, "To provide comprehensive solutions for the health care system of the United States, and for other purposes", a/k/a "Patients Choice Act", regarding all provisions. - S 1099, "A bill to provide comprehensive solutions for the health care system of the United States, and for other purposes", a/k/a "Patients Choice Act", regarding all provisions. - S 1213, "A bill to amend title XI of the Social Security Act to provide for the conduct of comparative effectiveness research and to amend the Internal Revenue Code of 1986 to establish a Patient-Centered Outcomes Research Trust Fund, and for other purposes", a/k/a "Patient-Centered Outcome Research Act of 2009", regarding all provisions. - HR 1721/S 697, "A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes", a/k/a "Community Living Assistance Services and Supports Act", regarding all provisions. - S 1679, "An original bill to make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce", a/k/a "Affordable Health Choices Act", regarding all provisions. - S 1730, "A bill to provide for minimum loss ratios for health insurance coverage", a/k/a "Fairness in Health Insurance Act of 2009", regarding all provisions. - HR 3200, "To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes", a/k/a "America's Affordable Health Choices Act of 2009" regarding all provisions. - HR 3962, "To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes", a/k/a, "Affordable Health Care for America Act", regarding all provisions. - HR 3590, "Patient Protection & Affordable Care Act", regarding all provisions. - S 1636, "A bill to develop a model disclosure form to assist consumers in purchasing long-term care insurance", a/k/a "Long-Term Care Insurance Consumer Right-to-Know Act", regarding all provisions. - HR 4372, "Health Care and Education Affordability Reconciliation Act", regarding all provisions.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Securities & Exchange Commission (SEC), U.S. Trade Representative (USTR)

- HR 1721/ S 697, "A bill to amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long -term care insurance", a/k/a, "Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - S 434, "A bill 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" a/k/a "Empowered at Home Act", regarding all provisions. - HR 897, "To amend the Internal Revenue Code of 1986 to allow individuals a deduction for qualified long-term care insurance premiums, use of such insurance under cafeteria plans and flexible spending arrangements, and a credit for individuals with long-term care needs" a/k/a "Long-Term Care and Retirement Security Act of 2009", regarding all provisions. - HR 1880, "To establish a system of regulation and supervision for insurers, insurance agencies, and insurance producers chartered or licensed under Federal law that ensures the stability and financial integrity of those insurers, agencies, and producers and that protects policyholders and other consumers served by such insurers, agencies, or producers", a/k/a "The National Insurance Consumer Protection Act", regarding all provisions. - HR 2609, "To establish an Office of Insurance Information in the Department of the Treasury", a/k/a "Insurance Information Act of 2009", regarding all provisions. -HR 2554, "To reform the National Association of Registered Agents and Brokers, and for other purposes", regarding all provisions. - HR 1721/S 697, "A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes", a/k/a "Community Living Assistance Services and Supports Act", regarding all provisions. - S 1177, "A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes", a/k/a "Long-Term Care Insurance Act of 2009", regarding all provisions. - HR 2096, "To amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance", a/k/a "The Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - The Administration's Regulatory Reform Proposal, regarding all provisions. - HR 4173, "To provide for financial regulatory reform, to protect consumers and investors, to enhance Federal understanding of insurance issues, to regulate the over-the-counter derivatives markets, and for other purposes", a/k/a "Wall Street Reform & Consumer Protection Act of 2009", regarding Title VI and Title I Subtitle G. - HR 3126, "To establish the Consumer Financial Protection Agency, and for other purposes", a/k/a, "Consumer Financial Protection Agency Act of 2009", regarding all provisions. - "Restoring American Financial Stability Act", regarding all provisions.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Securities & Exchange Commission (SEC), U.S. Trade Representative (USTR)

Patients' Rights Legislation; PL 110-343: Mental Health Parity; PL 108-173: Medicare Prescription Drug and Mondernization Act of 2003; HR 1721: Comunity Living Assistance Services and Supports Act; HR 1670/S 683: Community Choice Act; HR 3043: Medicare Adult Day Services Act of 2009; PL 111-148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; HR 4872: Health Care and Education Reconciliation Act of 2010; and PL 79-271: Social Security Act of 1935.

Client expense: $51,583 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Education, Dept of, Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

S. 697/H.R. 1721: Community Living Assistance Services and Supports (CLASS Act) -- all sections H.R. 3590: Patient Protection and Affordable Care Act -- sections related to home health, hospice, CLASS, and fraud and abuse

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

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

H.R.1192 To amend the Internal Revenue Code of 1986 to provide more help to Alzheimer's disease caregivers. Long Term Care Trust Accounts Act S.702 Long Term Care Affordability and Security Act S.697 CLASS Act S1177 Confidence In LongTerm Care Insurance Act of 2009 H.R.519 To authorize additional appropriations for the family caregiver support program under the Older Americans Act of 1965, and for the National Clearinghouse for Long-Term Care Information, for fiscal years 2010, 2011, and 2012 H.R.2096 Long Term Care Cafeteria and Flexible Spending Account H.R.1721 CLASS Act H.R.897 Deduction for Long Term Care Insurance Premiums under Cafeteria Plans and Flexible Spending Arrangements S.1626 Long Term Care insurance Integrity Act of 2009 S.1796 An original bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes H.R.3200 America's Affordable Health Choices Right-to-Know Act of 2009 S.1679 Affordable Health Choices Act H.R.3962 Affordable Healthcare for America Act S1728 Patient Protection and Affordable Care Act of 2009 HR5890 Long Term Insurance Reform Act of 2010

Client expense: $900,000 · Firm income: Not reported

Government targets: Federal Deposit Insurance Corporation (FDIC), Federal Housing Finance Agency (FHFA), HOUSE OF REPRESENTATIVES, Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of the Comptroller of the Currency (OCC), SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of

S. 683/H.R. 1670, Community Choice Act of 2009, provisions related to Developmental Disabilities H.R.1721/S.697, The Community Living Assistance Services & Supports Act (CLASS Act), provisions related to Developmental Disabilities H.R.2413/S.819, Autism Treatment Acceleration Act, provisions related to Developmental Disabilities H.R.3184/S.1186, Medicare Independent Living Act of 2009, provisions related to Developmental Disabilities Public Law 111-148, Patient Protection and Affordable Care Act, provisions related to Developmental Disabilities Public Law 111-152, Health Care and Education Reconciliation Act of 2010, provisions related to Developmental Disabilities S.4044, Combating Autism Reauthorization Act of 2010, provisions related to Developmental Disabilities

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

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

HR 1583 (Mccarran-Ferguson). S. 819 (mandate autism coverage). HR 1253 (new plan disclosure rules). HR 1691/S. 688 (prohibit plan rescissions and establish minimum length of hospital stays for cancer patients) HR 1558/S. 623 (prohibit pre-existing condition exclusions; also HR 1619, S. 643, HR 1092) S. 442/ HR 1085 (to prohibit aggregate lifetime dollar limit) S> 697/HR 1721 (Long Term Care) H 975 (mammography mandate); HR 1339 (Mandate to cover deformities)

Client expense: $998,150 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE

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

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

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

H.R.1192 To amend the Internal Revenue Code of 1986 to provide more help to Alzheimer's disease caregivers. Long Term Care Trust Accounts Act S.702 Long Term Care Affordability and Security Act S.697 CLASS Act S1177 Confidence In LongTerm Care Insurance Act of 2009 H.R.519 To authorize additional appropriations for the family caregiver support program under the Older Americans Act of 1965, and for the National Clearinghouse for Long-Term Care Information, for fiscal years 2010, 2011, and 2012 H.R.2096 Long Term Care Cafeteria and Flexible Spending Account H.R.1721 CLASS Act H.R.897 Deduction for Long Term Care Insurance Premiums under Cafeteria Plans and Flexible Spending Arrangements S.1626 Long Term Care insurance Integrity Act of 2009 S.1796 An original bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes H.R.3200 America's Affordable Health Choices Right-to-Know Act of 2009 S.1679 Affordable Health Choices Act H.R.3962 Affordable Healthcare for America Act S1728 Patient Protection and Affordable Care Act of 2009 HR5890 Long Term Insurance Reform Act of 2010

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 3200 America's Affordable Health Choices Act S.245/H.R.468 - Retooling for an Aging America, Building the Healthcare workforce. All provisions relating to expanding education and training opportunities in geriatric and long-term care for licensed health professionals, direct care workers, and family caregivers. H.R.3590 Patient Protection and Affordable Care Act - All Sections related to care coordination, transitional care, long term care services and supports access to affordable insurance, provisions related to individuals with Alzheimer's disease and caregivers and provisions related to research including the Cures Acceleration Network. H.R. 4872 Health Care and Education Reconciliation Act of 2010 S.697/H.R.1721, The Community Living Assistance Services and Supports Act, all provisions relating to establishing a national, voluntary disability insurance program S.1004, Realigning Care Act, All Sections S.2809/H.R.4123 Alzheimers Treatment & Caregiver Support Act, All Sections S.3036/H.R.4689 National Alzheimers Project Act, All Sections H.R.908, Missing Alzheimer's Disease Patient Alert Program Reauthorization of 2009

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

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

Patients' Rights Legislation; PL 110-343: Mental Health Parity; PL 108-173: Medicare Prescription Drug and Mondernization Act of 2003; HR 1721: Comunity Living Assistance Services and Supports Act; HR 1670/S 683: Community Choice Act; HR 3043: Medicare Adult Day Services Act of 2009; PL 111-148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; HR 4872: Health Care and Education Reconciliation Act of 2010; and PL 79-271: Social Security Act of 1935.

Client expense: $57,615 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Education, Dept of, Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

- HR 1721/ S 697, "A bill to amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long -term care insurance", a/k/a, "Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - S 434, "A bill 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" a/k/a "Empowered at Home Act", regarding all provisions. - HR 897, "To amend the Internal Revenue Code of 1986 to allow individuals a deduction for qualified long-term care insurance premiums, use of such insurance under cafeteria plans and flexible spending arrangements, and a credit for individuals with long-term care needs" a/k/a "Long-Term Care and Retirement Security Act of 2009", regarding all provisions. - HR 1880, "To establish a system of regulation and supervision for insurers, insurance agencies, and insurance producers chartered or licensed under Federal law that ensures the stability and financial integrity of those insurers, agencies, and producers and that protects policyholders and other consumers served by such insurers, agencies, or producers", a/k/a "The National Insurance Consumer Protection Act", regarding all provisions. - HR 2609, "To establish an Office of Insurance Information in the Department of the Treasury", a/k/a "Insurance Information Act of 2009", regarding all provisions. -HR 2554, "To reform the National Association of Registered Agents and Brokers, and for other purposes", regarding all provisions. - HR 1721/S 697, "A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes", a/k/a "Community Living Assistance Services and Supports Act", regarding all provisions. - S 1177, "A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes", a/k/a "Long-Term Care Insurance Act of 2009", regarding all provisions. - HR 2096, "To amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance", a/k/a "The Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - The Administration's Regulatory Reform Proposal, regarding all provisions. - HR 4173, "To provide for financial regulatory reform, to protect consumers and investors, to enhance Federal understanding of insurance issues, to regulate the over-the-counter derivatives markets, and for other purposes", a/k/a "Wall Street Reform & Consumer Protection Act of 2009", regarding Title VI and Title I Subtitle G. - HR 3126, "To establish the Consumer Financial Protection Agency, and for other purposes", a/k/a, "Consumer Financial Protection Agency Act of 2009", regarding all provisions. - "Restoring American Financial Stability Act", regarding all provisions.

Client expense: $1,150,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Securities & Exchange Commission (SEC), U.S. Trade Representative (USTR)

- HR 109, "To provide for the offering of Health Benefit Plans to individuals, to increase funding for State high risk health insurance pools, and to promote best practice protocols for State high risk pools" a/k/a "America's Affordable Health Care Act", regarding all provisions. - S 391/HR 1321, "A bill to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away" a/k/a "Healthy Americans Act", regarding all provisions. - HR 1, "Making supplemental appropriations for job preservation and creation, infrastructure investment, energy efficiency and science, assistance to the unemployed, and State and local fiscal stabilization, for fiscal year ending September 30, 2009, and for other purposes" a/k/a "American Recovery and Reinvestment Act of 2009", regarding COBRA Benefits Section 3002 and Comparative Effectiveness Council Section 9201. - HR 2096/S 702, "To amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance", a/k/a "The Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - S 1177, "A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes", a/k/a "Long-Term Care Insurance Act of 2009", regarding all provisions. - HR 2520, "To provide comprehensive solutions for the health care system of the United States, and for other purposes", a/k/a "Patients Choice Act", regarding all provisions. - S 1099, "A bill to provide comprehensive solutions for the health care system of the United States, and for other purposes", a/k/a "Patients Choice Act", regarding all provisions. - S 1213, "A bill to amend title XI of the Social Security Act to provide for the conduct of comparative effectiveness research and to amend the Internal Revenue Code of 1986 to establish a Patient-Centered Outcomes Research Trust Fund, and for other purposes", a/k/a "Patient-Centered Outcome Research Act of 2009", regarding all provisions. - HR 1721/S 697, "A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes", a/k/a "Community Living Assistance Services and Supports Act", regarding all provisions. - S 1679, "An original bill to make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce", a/k/a "Affordable Health Choices Act", regarding all provisions. - S 1730, "A bill to provide for minimum loss ratios for health insurance coverage", a/k/a "Fairness in Health Insurance Act of 2009", regarding all provisions. - HR 3200, "To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes", a/k/a "America's Affordable Health Choices Act of 2009" regarding all provisions. - HR 3962, "To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes", a/k/a, "Affordable Health Care for America Act", regarding all provisions. - HR 3590, "Patient Protection & Affordable Care Act", regarding all provisions. - S 1636, "A bill to develop a model disclosure form to assist consumers in purchasing long-term care insurance", a/k/a "Long-Term Care Insurance Consumer Right-to-Know Act", regarding all provisions. - HR 4372, "Health Care and Education Affordability Reconciliation Act", regarding all provisions.

Client expense: $1,150,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Securities & Exchange Commission (SEC), U.S. Trade Representative (USTR)

HR 5072, FHA Reform Act of 2010 HR 1728, Mortgage Reform and Anti-Predatory Lending Act HR 3126, Consumer Financial Protection Agency Act of 2009 HR 4173, Wall Street and Consumer Protection Act S 697, HR 1721, CLASS Act S __, Restoring American Financial Stability Act of 2009

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 683/H.R. 1670, Community Choice Act of 2009, provisions related to Developmental Disabilities H.R.1721/S.697, The Community Living Assistance Services & Supports Act (CLASS Act), provisions related to Developmental Disabilities H.R.2413/S.819, Autism Treatment Acceleration Act, provisions related to Developmental Disabilities H.R.3184/S.1186, Medicare Independent Living Act of 2009, provisions related to Developmental Disabilities Public Law 111-148, Patient Protection and Affordable Care Act, provisions related to Developmental Disabilities Public Law 111-152, Health Care and Education Reconciliation Act of 2010, provisions related to Developmental Disabilities

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

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

S. 697/H.R. 1721 - Community Living Assistance Services and Supports (CLASS Act) - All sections H.R. 3590: Patient Protection and Affordable Care Act, H.R. 3590 - sections related to home health, hospice, CLASS, and fraud and abuse H.R. 3962: Affordable Health Care for America Act - sections related to home health, hospice, CLASS and fraud and abuse

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

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

HR 1583 (Mccarran-Ferguson). S. 819 (mandate autism coverage). HR 1253 (new plan disclosure rules). HR 1691/S. 688 (prohibit plan rescissions and establish minimum length of hospital stays for cancer patients) HR 1558/S. 623 (prohibit pre-existing condition exclusions; also HR 1619, S. 643, HR 1092) S. 442/ HR 1085 (to prohibit aggregate lifetime dollar limit) S> 697/HR 1721 (Long Term Care) H 975 (mammography mandate); HR 1339 (Mandate to cover deformities)

Client expense: $638,299 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE

H.R. 2748 - To amend the Internal Revenue Code of 1986 to encourage guaranteed lifetime income payments by excluding from income a portion of such payments. S. 1389 - A bill to clarify the exemption for certain annuity contracts and insurance policies from Federal regulation under the Securities Act of 1933. H.R. 1984 - To amend title I of the Employee Retirement Income Security Act of 1974 to provide special reporting and disclosure rules for individual account plans and to provide a minimum investment option requirement for such plans. H.R. 1988 - To amend title I of the Employee Retirement Income Security Act of 1974 to provide for independent investment advice for participants and beneficiaries under individual account plans. H.R. 2989 - To amend the Employee Retirement Income Security Act of 1974 to provide special reporting and disclosure rules for individual account plans and to provide a minimum investment option requirement for such plans, to amend such Act to provide for independent investment advice for participants and beneficiaries under individual account plans, and to amend such Act and the Internal Revenue Code of 1986 to provide transitional relief under certain pension funding rules added by the Pension Protection Act of 2006. H.R. 2779 - To amend the Internal Revenue Code of 1986 to provide transparency with respect to fees and expenses charged to participant-directed defined contribution plans, and to improve participant communication. S. 697 - A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes. H.R. 1721 - To amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes. H.R. 2733 - To clarify the exemption for certain annuity contracts and insurance policies from Federal regulation under the Securities Act of 1933.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

The Direct Support Professionals Fiarness and Security Act of 2009 (H.R. 868) The Patient Protection and Affordable Care Act (H.R. 3590) The Community Living Services and Supports Act (H.R. 1721 and S. 697) The Community Choice Act of 2009 (H.R. 1670 and S. 683) --American Workers, State and Business Relief Act of 2010 (supported Federal Medicaid Match provisions) (H.R. 4213) --A bill to extend the increase in the FMAP provided in the American Recovery and Reinvestment Act of 2009 for an additional 6 months. (S. 3000)

Client expense: $44,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

H.R. 3200 America's Affordable Health Choices Act S.245/H.R.468 - Retooling for an Aging America, Building the Healthcare workforce. All provisions relating to expanding education and training opportunities in geriatric and long-term care for licensed health professionals, direct care workers, and family caregivers. H.R.3590 Patient Protection and Affordable Care Act S.697/H.R.1721, The Community Living Assistance Services and Supports Act, all provisions relating to establishing a national, voluntary disability insurance program S.1004, Realigning Care Act, All Sections S.2809/H.R.4123 Alzheimers Treatment & Caregiver Support Act, All Sections S.3036/H.R.4689 National Alzheimers Project Act, All Sections H.R.908, Missing Alzheimer's Disease Patient Alert Program Reauthorization of 2009

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

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

Patients' Rights Legislation; PL 110-343: Mental Health Parity; PL 108-173: Medicare Prescription Drug and Mondernization Act of 2003; HR 1721: Comunity Living Assistance Services and Supports Act; HR 1670/S 683: Community Choice Act; HR 3043: Medicare Adult Day Services Act of 2009; HR 3590: The Patient Protection and Affordable Care Act; HR 3962: Affordable Health Care for America Act; HR 4872: Health Care and Education Reconciliation Act of 2010; PL 79-271: Social Security Act of 1935.

Client expense: $70,970 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Education, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

- HR 1721/ S 697, "A bill to amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance" a/k/a "Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - S 434, "A bill 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" a/k/a "Empowered at Home Act", regarding all provisions. - HR 897, "To amend the Internal Revenue Code of 1986 to allow individuals a deduction for qualified long-term care insurance premiums, use of such insurance under cafeteria plans and flexible spending arrangements, and a credit for individuals with long-term care needs" a/k/a "Long-Term Care and Retirement Security Act of 2009", regarding all provisions. - HR 1880, "To establish a system of regulation and supervision for insurers, insurance agencies, and insurance producers chartered or licensed under Federal law that ensures the stability and financial integrity of those insurers, agencies, and producers and that protects policyholders and other consumers served by such insurers, agencies, or producers", a/k/a "The National Insurance Consumer Protection Act", regarding all provisions. - HR 2609, "To establish an Office of Insurance Information in the Department of the Treasury", a/k/a "Insurance Information Act of 2009", regarding all provisions. -HR 2554, "To reform the National Association of Registered Agents and Brokers, and for other purposes", regarding all provisions. - HR 1721/S 697, "A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes", a/k/a "Community Living Assistance Services and Supports Act", regarding all provisions. - S 1177, "A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes", a/k/a "Long-Term Care Insurance Act of 2009", regarding all provisions. - HR 2096, "To amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance", a/k/a "The Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - The Administration's Regulatory Reform Proposal, regarding all provisions. - HR 4173, "Dodd-Frank Act", a/k/a, "To provide for financial regulatory reform, to protect consumers and investors, to enhance Federal understanding of insurance issues, to regulate the over-the-counter derivatives markets, and for other purposes", a/k/a "Wall Street Reform & Consumer Protection Act of 2009", regarding Title II, V, IX. - HR 3126, "To establish the Consumer Financial Protection Agency, and for other purposes", a/k/a, "Consumer Financial Protection Agency Act of 2009", regarding all provisions. - "Restoring American Financial Stability Act", regarding all provisions.

Client expense: $1,270,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Securities & Exchange Commission (SEC), U.S. Trade Representative (USTR)

- HR 109, "To provide for the offering of Health Benefit Plans to individuals, to increase funding for State high risk health insurance pools, and to promote best practice protocols for State high risk pools" a/k/a "America's Affordable Health Care Act", regarding all provisions. - S 391/HR 1321, "A bill to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away" a/k/a "Healthy Americans Act", regarding all provisions. - HR 1, "Making supplemental appropriations for job preservation and creation, infrastructure investment, energy efficiency and science, assistance to the unemployed, and State and local fiscal stabilization, for fiscal year ending September 30, 2009, and for other purposes" a/k/a "American Recovery and Reinvestment Act of 2009", regarding COBRA Benefits Section 3002 and Comparative Effectiveness Council Section 9201. - HR 2096/S 702, "To amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance", a/k/a "The Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - S 1177, "A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes", a/k/a "Long-Term Care Insurance Act of 2009", regarding all provisions. - HR 2520, "To provide comprehensive solutions for the health care system of the United States, and for other purposes", a/k/a "Patients Choice Act", regarding all provisions. - S 1099, "A bill to provide comprehensive solutions for the health care system of the United States, and for other purposes", a/k/a "Patients Choice Act", regarding all provisions. - S 1213, "A bill to amend title XI of the Social Security Act to provide for the conduct of comparative effectiveness research and to amend the Internal Revenue Code of 1986 to establish a Patient-Centered Outcomes Research Trust Fund, and for other purposes", a/k/a "Patient-Centered Outcome Research Act of 2009", regarding all provisions. - HR 1721/S 697, "A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes", a/k/a "Community Living Assistance Services and Supports Act", regarding all provisions. - S 1679, "An original bill to make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce", a/k/a "Affordable Health Choices Act", regarding all provisions. - S 1730, "A bill to provide for minimum loss ratios for health insurance coverage", a/k/a "Fairness in Health Insurance Act of 2009", regarding all provisions. - HR 3200, "To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes", a/k/a "America's Affordable Health Choices Act of 2009" regarding all provisions. - HR 3962, "To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes", a/k/a, "Affordable Health Care for America Act", regarding all provisions. - HR 3590, "Patient Protection & Affordable Care Act", regarding all provisions. - S 1636, "A bill to develop a model disclosure form to assist consumers in purchasing long-term care insurance", a/k/a "Long-Term Care Insurance Consumer Right-to-Know Act", regarding all provisions. - HR 4372, "Health Care and Education Affordability Reconciliation Act", regarding all provisions.

Client expense: $1,270,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Securities & Exchange Commission (SEC), U.S. Trade Representative (USTR)

HR 5072, FHA Reform Act of 2010 HR 1728, Mortgage Reform and Anti-Predatory Lending Act HR 3126, Consumer Financial Protection Agency Act of 2009 HR 4173, Wall Street and Consumer Protection Act S 697, HR 1721, CLASS Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1583 (Mccarran-Ferguson). S. 819 (mandate autism coverage). HR 1253 (new plan disclosure rules). HR 1691/S. 688 (prohibit plan rescissions and establish minimum length of hospital stays for cancer patients) HR 1558/S. 623 (prohibit pre-existing condition exclusions; also HR 1619, S. 643, HR 1092) S. 442/ HR 1085 (to prohibit aggregate lifetime dollar limit) S> 697/HR 1721 (Long Term Care) H 975 (mammography mandate); HR 1339 (Mandate to cover deformities)

Client expense: $1,568,045 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE

H.R.1192 To amend the Internal Revenue Code of 1986 to provide more help to Alzheimer's disease caregivers. Long Term Care Trust Accounts Act S.702 Long Term Care Affordability and Security Act S.697 CLASS Act S.1177 A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes. H.R.519 To authorize additional appropriations for the family caregiver support program under the Older Americans Act of 1965, and for the National Clearinghouse for Long-Term Care Information, for fiscal years 2010, 2011, and 2012. H.R.2096 Long Term Care Cafeteria and Flexible Spending Account H.R.1721 CLASS Act H.R.897 Deduction for Long Term Care Insurance Premiums under Cafeteria Plans and Flexible Spending Arrangements S.1626 Long Term Care insurance Integrity Act of 2009 S.1796 An original bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. H.R.3200 America's Affordable Health Choices Right-to-Know Act of 2009 S.1679 Affordable Health Choices Act H.R.3962 Affordable Healthcare for America Act S1728 Patient Protection and Affordable Care Act of 2009

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of

S. 683/H.R. 1670, Community Choice Act of 2009, provisions related to Developmental Disabilities H.R.1721/S.697, The Community Living Assistance Services & Supports Act (CLASS Act), provisions related to Developmental Disabilities H.R.2413/S.819, Autism Treatment Acceleration Act, provisions related to Developmental Disabilities H.R.3184/S.1186, Medicare Independent Living Act of 2009, provisions related to Developmental Disabilities America's Healthy Futures Act of 2009, provisions related to Developmental Disabilities H.R.3200, America's Affordable Health Choices Act of 2009, provisions related to Developmental Disabilities S.1679, Affordable Health Choices Act, provisions related to Developmental Disabilities H.R.3962, Affordable Health Care for America Act, provisions related to Developmental Disabilities Public Law 111-148, Patient Protection and Affordable Care Act, provisions related to Developmental Disabilities Public Law 111-152, Health Care and Education Reconciliation Act of 2010, provisions related to Developmental Disabilities

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

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

H.R. 2748 - To amend the Internal Revenue Code of 1986 to encourage guaranteed lifetime income payments by excluding from income a portion of such payments. S. 1389 - A bill to clarify the exemption for certain annuity contracts and insurance policies from Federal regulation under the Securities Act of 1933. H.R. 1984 - To amend title I of the Employee Retirement Income Security Act of 1974 to provide special reporting and disclosure rules for individual account plans and to provide a minimum investment option requirement for such plans. H.R. 1988 - To amend title I of the Employee Retirement Income Security Act of 1974 to provide for independent investment advice for participants and beneficiaries under individual account plans. H.R. 2989 - To amend the Employee Retirement Income Security Act of 1974 to provide special reporting and disclosure rules for individual account plans and to provide a minimum investment option requirement for such plans, to amend such Act to provide for independent investment advice for participants and beneficiaries under individual account plans, and to amend such Act and the Internal Revenue Code of 1986 to provide transitional relief under certain pension funding rules added by the Pension Protection Act of 2006. H.R. 2779 - To amend the Internal Revenue Code of 1986 to provide transparency with respect to fees and expenses charged to participant-directed defined contribution plans, and to improve participant communication. S. 697 - A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes. H.R. 1721 - To amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes. H.R. 2733 - To clarify the exemption for certain annuity contracts and insurance policies from Federal regulation under the Securities Act of 1933.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 697/H.R. 1721 - Community Living Assistance Services and Supports (CLASS Act) - All sections H.R. 3590: Patient Protection and Affordable Care Act, H.R. 3590 - sections related to home health, hospice, CLASS, and fraud and abuse H.R. 3962: Affordable Health Care for America Act - sections related to home health, hospice, CLASS and fraud and abuse

Client expense: $130,000 · Firm income: Not reported

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

H.R. 519: ELDER CAREGIVER SUPPORT AND INFORMATION ENHANCEMENT ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE INFORMATION CLEARINGHOUSE HR 1721/S. 697: COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS ACT; PROVISIONS RELATED TO REFORM OF LONG TERM CARE FINANCING H.R. 1961: SAVINGS FOR AMERICAN FAMILIES FUTURE ACT OF 2009; PROVISIONS RELATED TO SAVERS' CREDIT H.R.1984: 401(K) FAIR DISCLOSURE FOR RETIREMENT SECURITY ACT OF 2009; PROVISIONS RELATED TO RETIREMENT PLAN FEE DISCLOSURE H.R. 1988: CONFLICTED INVESTMENT ADVICE PROHIBITION ACT OF 2009; PROVISIONS RELATED TO INVESTMENT ADVICE H.R. 2021: SAVINGS RECOVERY ACT OF 2009; PROVISIONS RELATED TO SAVERS CREDIT HR 2096/S 702: LONG TERM CARE AFFORDABILITY AND SECURITY ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE IN CAFETERIA PLANS AND FLEXIBLE SPENDING ARRANGEMENTS H.R. 2733/S. 1389: FIXED INDEXED ANNUITIES AND INSURANCE PRODUCTS CLASSIFICATION ACT OF 2009; PROVISIONS RELATED TO CLARIFICATION FOR FIXED ANNUITIES REGULATION H.R. 2748: RETIREMENT SECURITY NEEDS LIFETIME PAY ACT OF 2009; PROVISIONS RELATED TO TAX INCENTIVES FOR ANNUITIES H.R. 2779: DEFINED CONTRIBUTION PLAN FEE TRANSPARENCY ACT OF 2009; PROVISIONS RELATED TO 401(K) PLAN FEE DISCLOSURE H.R. 2792: RETIREMENT SAVINGS TRANSPARENCY ACT OF 2009; PROVISIONS RELATED TO PLAN FEE DISCLOSURE H.R. 2989: 401 (K) FAIR DISCLOSURE AND PENSION SECURITY ACT OF 2009; PROVISIONS RELATED TO RETIREMENT PLAN FEE DISCLOSURE H.R. 3551 /S. 1661/S. 906: SENIOR INVESTMENT PROTECTION ACT OF 2009; PROVISIONS RELATED TO PRODUCT SALES TO SENIORS, AND ANNUITIES SALES H.R. 3590: THE PATIENT PROTECTION AND AFFORDABLE CARE ACT; PROVISIONS RELATED TO LONG TERM CARE AND SUPPLEMENTAL PRODUCTS FINANCING, ANDMEDICARE TAX ON NONQUALIFIED ANNUITY INCOME H.R. 4126: RETIREMENT FAIRNESS ACT OF 2009; PROVISIONS RELATED TO MODIFICATION OF 401(K) PLAN RULES H.R. 4173: WALL STREET REFORM AND CONSUMER PROTECTION ACT OF 2009; PROVISIONS RELATED TO THE EXCLUSION OF RETIREMENT BENEFITS FROM CONSUMER FINANCIAL PROTECTION AGENCY, SUITIBILITY OF INSURANCE PRODUCT SALES TO SENIORS, AND SALE OF ANNUITIES H.R. 4626: HEALTH INSURANCE INDUSTRY FAIR COMPETITION ACT; PROVISIONS RELATED TO INSURANCE ANTI-TRUST REGULATIONS (MCCARRON-FERGUSON) H.R. 4742: SMALL BUSINESSES ADD VALUE FOR EMPLOYEES ACT OF 2009; PROVISIONS RELATED TO FOR SIMPLIFICATION OF SIMPLE IRAS, AND VOLUNTARY AUTO IRAS H.R. 4872: HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010; PROVISIONS RELATED TO LONG TERM CARE FINANCING WITHING HEALTH CARE REFORM, AND UNEARNED INCOME TAXATION S. 401: DEFINED CONTRIBUTION FEE DISCLOSURE ACT OF 2009; PROVISIONS RELATED TO 401(K) PLAN FEE DISCLOSURE S. 1177: CONFIDENCE IN LONG TERM CARE INSURANCE ACT OF 2009; PROVISIONS RELATED TO CONSUMER PROTECTION IN LONG TERM CARE S. 1226: LONG TERM CARE INSURANCE INTEGRITY ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE S. 1297: RETIREMENT SECURITY FOR LIFE ACT OF 2009; PROVISIONS RELATED TO NON-QUALIFIED ANNUITIES TAX INCENTIVES S.1636: LONG TERM CARE INSURANCE CONSUMER RIGHT-TO-KNOW ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE CONSUMER PROTECTIONS S. 2832: LIFETIME INCOME DISCLOSURE ACT; PROVISIONS RELATED TO ANNUITY ILLUSTRATION ON BENEFIT STATEMENTS S. 3217: RESTORING AMERICAN FINANCIAL STABILITY ACT OF 2010; PROVISIONS RELATED TO SENIOR INVESTOR PROTECTION ACT, AND EMPLOYER BENEFIT PLANS WITHIN CONSUMER FINANCIAL PROTECTION BUREAU

Client expense: $1,020,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

The Direct Support Professionals Fiarness and Security Act of 2009 (H.R. 868) The Patient Protection and Affordable Care Act (H.R. 3590) The Community Living Services and Supports Act (H.R. 1721 and S. 697) The Community Choice Act of 2009 (H.R. 1670 and S. 683) --American Workers, State and Business Relief Act of 2010 (supported Federal Medicaid Match provisions) (H.R. 4213) --A bill to extend the increase in the FMAP provided in the American Recovery and Reinvestment Act of 2009 for an additional 6 months. (S. 3000)

Client expense: $44,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

Health care issues affecting individuals with neuromuscular disease, including transitional health care issues; rehabilitation research; regulatory pathway for biosimilars -HR 3590 Patient Protection and Affordable Care Act (P.L. 111-148); research and treatment of spinal muscular atrophy -HR 2149/S 1158; the Community Living Assistance Services and Supports Act -HR 1721/S 697; Competitive Bidding Repeal -HR 3790; and H1N1 distribution plans for high priority groups

Client expense: $70,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 519: ELDER CAREGIVER SUPPORT AND INFORMATION ENHANCEMENT ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE INFORMATION CLEARINGHOUSE HR 1721/S. 697: COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS ACT; PROVISIONS RELATED TO REFORM OF LONG TERM CARE FINANCING H.R. 1961: SAVINGS FOR AMERICAN FAMILIES FUTURE ACT OF 2009; PROVISIONS RELATED TO SAVERS' CREDIT H.R.1984: 401(K) FAIR DISCLOSURE FOR RETIREMENT SECURITY ACT OF 2009; PROVISIONS RELATED TO RETIREMENT PLAN FEE DISCLOSURE H.R. 1988: CONFLICTED INVESTMENT ADVICE PROHIBITION ACT OF 2009; PROVISIONS RELATED TO INVESTMENT ADVICE H.R. 2021: SAVINGS RECOVERY ACT OF 2009; PROVISIONS RELATED TO SAVERS CREDIT HR 2096/S 702: LONG TERM CARE AFFORDABILITY AND SECURITY ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE IN CAFETERIA PLANS AND FLEXIBLE SPENDING ARRANGEMENTS H.R. 2733/S. 1389: FIXED INDEXED ANNUITIES AND INSURANCE PRODUCTS CLASSIFICATION ACT OF 2009; PROVISIONS RELATED TO CLARIFICATION FOR FIXED ANNUITIES REGULATION H.R. 2748: RETIREMENT SECURITY NEEDS LIFETIME PAY ACT OF 2009; PROVISIONS RELATED TO TAX INCENTIVES FOR ANNUITIES H.R. 2779: DEFINED CONTRIBUTION PLAN FEE TRANSPARENCY ACT OF 2009; PROVISIONS RELATED TO 401(K) PLAN FEE DISCLOSURE H.R. 2792: RETIREMENT SAVINGS TRANSPARENCY ACT OF 2009; PROVISIONS RELATED TO PLAN FEE DISCLOSURE H.R. 2989: 401 (K) FAIR DISCLOSURE AND PENSION SECURITY ACT OF 2009; PROVISIONS RELATED TO RETIREMENT PLAN FEE DISCLOSURE H.R. 3551 /S. 1661/S. 906: SENIOR INVESTMENT PROTECTION ACT OF 2009; PROVISIONS RELATED TO PRODUCT SALES TO SENIORS, AND ANNUITIES SALES H.R. 3590: THE PATIENT PROTECTION AND AFFORDABLE CARE ACT; PROVISIONS RELATED TO LONG TERM CARE AND SUPPLEMENTAL PRODUCTS FINANCING, ANDMEDICARE TAX ON NONQUALIFIED ANNUITY INCOME H.R. 4126: RETIREMENT FAIRNESS ACT OF 2009; PROVISIONS RELATED TO MODIFICATION OF 401(K) PLAN RULES H.R. 4173: WALL STREET REFORM AND CONSUMER PROTECTION ACT OF 2009; PROVISIONS RELATED TO THE EXCLUSION OF RETIREMENT BENEFITS FROM CONSUMER FINANCIAL PROTECTION AGENCY, SUITIBILITY OF INSURANCE PRODUCT SALES TO SENIORS, AND SALE OF ANNUITIES H.R. 4626: HEALTH INSURANCE INDUSTRY FAIR COMPETITION ACT; PROVISIONS RELATED TO INSURANCE ANTI-TRUST REGULATIONS (MCCARRON-FERGUSON) H.R. 4742: SMALL BUSINESSES ADD VALUE FOR EMPLOYEES ACT OF 2009; PROVISIONS RELATED TO FOR SIMPLIFICATION OF SIMPLE IRAS, AND VOLUNTARY AUTO IRAS H.R. 4872: HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010; PROVISIONS RELATED TO LONG TERM CARE FINANCING WITHING HEALTH CARE REFORM, AND UNEARNED INCOME TAXATION S. 401: DEFINED CONTRIBUTION FEE DISCLOSURE ACT OF 2009; PROVISIONS RELATED TO 401(K) PLAN FEE DISCLOSURE S. 1177: CONFIDENCE IN LONG TERM CARE INSURANCE ACT OF 2009; PROVISIONS RELATED TO CONSUMER PROTECTION IN LONG TERM CARE S. 1226: LONG TERM CARE INSURANCE INTEGRITY ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE S. 1297: RETIREMENT SECURITY FOR LIFE ACT OF 2009; PROVISIONS RELATED TO NON-QUALIFIED ANNUITIES TAX INCENTIVES S.1636: LONG TERM CARE INSURANCE CONSUMER RIGHT-TO-KNOW ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE CONSUMER PROTECTIONS S. 2832: LIFETIME INCOME DISCLOSURE ACT; PROVISIONS RELATED TO ANNUITY ILLUSTRATION ON BENEFIT STATEMENTS S. 3217: RESTORING AMERICAN FINANCIAL STABILITY ACT OF 2010; PROVISIONS RELATED TO SENIOR INVESTOR PROTECTION ACT, AND EMPLOYER BENEFIT PLANS WITHIN CONSUMER FINANCIAL PROTECTION BUREAU

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 716, Access to Cancer Clinical Trials Act (Israel) clinical trials coverage mandate; H.R. 850, Small Business CHOICE Act (Velazquez) small employer health options; H.R. 859, Small Business CHOICE Act (Velazquez) small employer health options; (cont.) INS (Legislative) H.R. 1085, Health Insurance Coverage Protection Act (Eshoo) lifetime benefit limits; H.R. 1092, No Discrimination in Health Insurance Act (Kagen) preexisting condition exclusions, affiliation periods, uniform premiums; H.R. 1253, Health Insurance Restrictions and Limitations Clarification Act (Burgess) disclosure of coverage exclusions; H.R. 1321, Healthy Americans Act (Eshoo) comprehensive health reform; H.R. 1558, Preexisting Condition Patient Protection Act (Courtney) preexisting condition exclusions; H.R. 1583, Insurance Industry Competition Act (DeFazio) McCarran Ferguson reforms; H.R. 1619, Children's Health Protection Act (Schwartz) preexisting condition exclusions for children; H.R. 1691, Breast Cancer Patient Protection Act (DeLauro) rescissions, hospital stays for breast cancer patients; H.R. 1721, CLASS Act (Pallone) national LTC program; H.R. 1880, National Insurance Consumer Protection Act (Bean) regulatory reform; H.R. 2360, SHOP Act (Kind) small employer health options; H.R. 2402, Woman's Health Insurance Fairness Act (Neal) gender rating for health insurance; H.R. 2413, Autism Treatment Acceleration Act (Doyle) coverage for autism spectrum disorders; H.R. 2427, Informed Consumer Choices in Health Care Act (DeLauro) federal standards for health insurance, consumer information; H.R. 2457, Right to a Second Medical Opinion Act (Davis) coverage of second opinions; H.R. 2609, Insurance Information Act (Kanjorski) Federal Office of Insurance Information; H.R. 2635, Gender Equity in Health Premiums Act (Sanchez) gender rating for health insurance; H.R. 2833, Medical Loss Ratios (Ellison) medical loss ratios; H.R. 2940, Women's Obstetrician and Gynecologist Medical Access Now Act (Davis) direct access to ob/gyns; H.R. 3200, Americas Affordable Health Choices Act (Dingell) government-run health plan, health insurance exchange, regulatory reform, health choices commissioner, insurance market reforms, individual coverage requirement, benefit packages, CLASS Act, medical loss ratios, premium assistance; H.R. 3217, Health Care Choice Act (Shadegg) national marketplace; H.R. 3584, Health Care Consumer Protection Act (Forbes) reinstatement of coverage upon payment of overdue premiums; H.R. 3590, Patient Protection and Affordable Care Act (Reid) government-run health plan, health insurance cooperatives, multi-state plans, insurance market reforms, health insurance exchanges, benefit packages, medical loss ratios, CLASS Act, regulatory reform, individual coverage requirement, premium assistance, federal rate review process, health care choice compacts, appeals procedures, disclosure requirements, high risk pool program, McCarran-Ferguson Act; H.R. 3596, Health Insurance Industry Antitrust Enforcement Act (Conyers) changes to McCarran-Ferguson Act; H.R.3681, Fairness in Health Insurance Act (Ellison) medical loss ratios; H.R. 3962, Americas Affordable Health Choices Act (Dingell) government-run health plan, health insurance exchange, regulatory reform, health choices commissioner, insurance market reforms, individual coverage requirement, benefit packages, CLASS Act, medical loss ratios, premium assistance, federal rate review process, health care choice compacts, high risk pool program, McCarran-Ferguson Act; H.R. 4078, Long-Term Care Insurance Disclosure Act (Perriello) model disclosure form for long-term care insurance; H.R. 4563, Cancer Screening Coverage Act (Maloney) coverage requirement for cancer screening; H.R. 4626, Health Insurance Industry Fair Competition Act (Perriello) McCarran-Ferguson antitrust exemption; H.R. 4757, Health Insurance Rate Authority Act (Schakowsky) federal rate review process; H.R. 4872, Health Care and Education Reconciliation Act (Spratt) changes to individual coverage requirement, grandfathered plans, immediate insurance reforms, premium assistance, CLASS Act, coverage issues, quality improvements, delivery system reforms; S. 79, Healthy Businesses, Healthy Workers Reinsurance Act (Kerry) reinsurance; S. 93, Small Business Empowerment Act (Brown) small employer health options; S. 391, Healthy Americans Act (Wyden) comprehensive health reform; S. 442, Health Insurance Coverage Protection Act (Dorgan) lifetime benefit limits; S. 488, Access to Cancer Clinical Trials Act (Brown) clinical trials coverage mandate; S. 623, Pre-existing Condition Patient Protection Act (Rockefeller) preexisting condition exclusions; S. 643, Children's Health Protection Act (Lautenberg) preexisting condition exclusions for children; S. 688, Breast Cancer Patient Protection Act (Snowe) rescissions, hospital stays for breast cancer patients; S. 697, CLASS Act (Kennedy) national LTC program; S. 819, Autism Treatment Acceleration Act (Durbin) coverage for autism spectrum disorders; S. 969, Women's Health Insurance Fairness Act (Kerry) gender rating for health insurance; S. 979, SHOP Act (Durbin) small employer health options; S. 1050, Informed Consumer Choices in Health Care Act (Rockefeller) federal standards for health insurance, consumer information; S. 1149, Annual and Lifetime Health Care Limit Elimination Act (Rockefeller) annual and lifetime coverage limits; S. 1177, Confidence in Long-Term Care Insurance Act (Kohl) LTC consumer protections; (cont.) INS (Legislative) S. 1459, Health Care Choice Act (DeMint) national marketplace; S. 1626, Long Term Care Insurance Integrity Act (Klobuchar) third party review of LTCI disputed claims; S. 1636, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) model disclosure forms for LTC insurance; S. 1679, Affordable Health Choices Act (Harkin) government-run health plan, insurance market reforms, health benefit gateways, benefit packages, medical loss ratios, CLASS Act, regulatory reform, individual coverage requirement, premium assistance; S. 1681, Health Insurance Industry Antitrust Enforcement Act (Leahy) changes to McCarran-Ferguson Act; S. 1730, Fairness in Health Insurance Act (Franken) medical loss ratios; S. 1796, Americas Healthy Future Act (Baucus) government-run health plan, health insurance cooperatives, health insurance exchange, insurance market reforms, individual coverage requirement, benefit packages, premium assistance, medical loss ratios, regulatory reform; S. 3078, Health Insurance Rate Authority Act (Feinstein) federal rate review process INS (Regulatory) Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials; implementation of the Mental Health Parity Act requirements; issues related to COBRA subsidy requirements, and issues related to genetic nondiscrimination.

Client expense: $2,700,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of

H.R. 3200 America's Affordable Health Choices Act S.1004/H.R. 2307 Reaching Elders with Assessment and Chronic Care Coordination Act. All provisions relating to Medicare Part B Coverage of geriatric assessment and chrnoic care management services for eligible beneficiaries and process measures and outcomes for Medicare Beneficiaries with multiple chronic illnesses, including dementia. H.R.3590 Patient Protection and Affordable Care Act S.697/H.R.1721, The Community Living Assistance Services and Supports Act, all provisions relating to establishing a national, voluntary disability insurance program. S.245/H.R.468 - Retooling for an Aging America, Building the Heatlhcare workforce. All provisions relating to expanding education and training opportunities in geriatric and long-term care for licensed health professionls, direct care workers, and family caregivers. S.1004, Realigning Care Act, All Sections S.2809/H.R.4123 Alzheimer's Treatment & Caregiver Support Act, All Sections S.3036/H.R.4689 National Alzheimers Project Act, All Sections

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

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

H.R.3590:Patient Protection and Affordable Care Act of 2010 - Adovacted for comprehensive health reform legislation. H.R. 4872: Health Care and Education Reconciliation Act of 2010 - Advocated for legislative fixes in conjuction with H.R. 3590 Patient Protection and Affordable Care Act of 2010 H.R. 3962: Affordable Health Care for America Act of 2009 - To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. Health Reform - Advocated to provide affordable health care coverage for all, protect and improve the Medicaid safety net, ensure hospital payment reductions coincide with coverage increases, preserve provider conscience protections & maintains current law on abortion, maintain consistency in requirements for charitable hospitals, and narrows the Medicare hospital readmissions policy & supports delivery system reforms to improve quality of care. S.AMDT.2991: Ammends H.R. 3590 Patient Protection and Affordable Care Act of 2009 - Provides states with the option to give legal immigrant families equitable access to health insurance. S. 1150 - Advance Care Planning & Compassionate Care Act of 2009 - A bill to improve end of life care S. 697 & H.R. 1721 - CLASS Act - Establised a national insurance program financed by voluntary payroll deductions to help individuals stay independent and remain in thier communities should the time come when they need assistance with activities of daily living.

Client expense: $280,000 · Firm income: Not reported

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

H.R. 20/S. 324, Melanie Blocker Stokes Mom's Opportunity to Access Health, Education, Research, and Support for Postpartum Depression Act H.R. 193, AmeriCare Health Care Act of 2009 H.R. 468/S. 245, Retooling the Health Care Workforce for an Aging America Act of 2009 H.R. 619, to repeal the exclusion from medical assistance under the Medicaid program of items and services for patients in an institution for mental diseases H.R. 676, United States National Health Care Act or the Expanded and Improved Medicare for All Act H.R.1011, Community Mental Health Services Improvement Act H.R. 1708/S. 700, Ending the Medicare Disability Waiting Period Act of 2009 H.R. 194, MediKids Health Insurance Act of 2009 H.R. 211/S. 211, Calling for 2-1-1 Act of 2009 H.R. 1086, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009 (medical malpractice reform) H.R. 1468, Medical Justice Act of 2009 (medical malpractice reform) S. 45, Medical Care Access Protection Act of 2009 or the MCAP Act (medical malpractice reform) H.R. 1092, No Discrimination in Health Insurance Act of 2009 H.R. 1558, Preexisting Condition Patient Protection Act of 2009 H.R. 914, Physician Workforce Enhancement Act of 2009 H.R. 1457, Geriatrics Loan Forgiveness Act of 2009 H.R. 1932/S. 999 Child Health Care Crisis Relief Act of 2009 H.R. 2537, Mental Health in Schools Act of 2009 H.R. 3090, Health Equality and Accountability Act of 2009 S. 1136/H.R. 3065, Mental Illness Chronic Care Improvement Act S. 391, Healthy Americans Act S. 1110/H.R. 2718, Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 1679, Affordable Health Choices Act H.R. 3191, Positive Aging Act of 2009 H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act H.R. 3961, Physician Payment Reform Act of 2009 H.R. 1721/S. 697, Community Living Assistance Services and Supports (CLASS) Act H.R. 4204/S. 1857, Establishing a Network of Health-Advancing National Centers of Excellence for Depression (ENHANCED) Act of 2009 H.R. 667, the Heroes at Home Act H.R. 2505, the Reaching Rural Veterans Through Telehealth Act S. 1776, Medicare Physician Fairness Act of 2009 H.R. 4872, Health Care and Education Reconciliation Act of 2010 Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule; 75 Federal Register 1844 (January 13, 2010) Interim Final Rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; Docket No. CMS-2009-0040-0048; 75 Federal Register 5410 (February 2, 2010)

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

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

S. 1099, Patients Choice Act and Independent Health Record Trust Act of 2009 S. 391, Healthy Americans Act S. 1679, Affordable Health Choices Act H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act H.R. 1721/S. 697, Community Living Assistance Services and Supports (CLASS) Act H.R. 4872, Health Care and Education Reconciliation Act of 2010

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

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

H.R. 211/S. 211, Calling for 2-1-1 Act of 2009 H.R. 1092, No Discrimination in Health Insurance Act of 2009 H.R. 1558, Preexisting Condition Patient Protection Act of 2009 S. 1180/H.R. 1011, Community Mental Health Services Improvement Act of 2009 S. 391, Healthy Americans Act S. 1110, H.R. 2718, Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 1136, Mental Illness Chronic Care Improvement Act of 2009 S. 1679, Affordable Health Choices Act H.R. 1721/S. 697, Community Living Assistance Services and Supports (CLASS) Act H.R. 4204/S. 1857, Establishing a Network of Health-Advancing National Centers of Excellence for Depression (ENHANCED) Act of 2009 H.R. 3590, Patient Protection and Affordable Care Act H.R. 4872, Health Care and Education Reconciliation Act of 2010 Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule; 75 Federal Register 1844 (January 13, 2010)

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

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

H.R. 193, AmeriCare Health Care Act of 2009 H.R. 676, Expanded and Improved Medicare for All Act S. 93, Small Business Empowerment Act H.R. 850/H.R. 859, Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (CHOICE) Act of 2009 H.R. 15, National Health Insurance Act H.R. 194, MediKids Health Insurance Act of 2009 H.R. 1086, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009 (medical malpractice reform) H.R. 1468, Medical Justice Act of 2009 (medical malpractice reform) S. 45, Medical Care Access Protection Act of 2009 or the MCAP Act (medical malpractice reform) H.R. 1092, No Discrimination in Health Insurance Act of 2009 H.R. 1558, Preexisting Condition Patient Protection Act of 2009 S. 1099, Patients Choice Act and Independent Health Record Trust Act of 2009 S. 391, Healthy Americans Act S. 1679, Affordable Health Choices Act H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act H.R. 3961, Physician Payment Reform Act of 2009 H.R. 1721/S. 697, Community Living Assistance Services and Supports (CLASS) Act H.R. 4872, Health Care and Education Reconciliation Act of 2010 Interim Final Rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; Docket No. CMS-2009-0040-0048; 75 Federal Register 5410 (February 2, 2010)

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

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)