Medicare Patient Access to Physical Therapists Act of 2009

H.R. 1829/S.950 - Medicare Patient Access to Physical Therapists Act of 2009: prevent direct access to physical therapists in order to avoid unnecessary and overuse of therapy services. H.R. 3693 - Ensuring the Future Physican Workforce Act of 2009 H.R. 4851 - Continuing Extension Act of 2010 H.J. RES. 45 - Increasing the statutory limit on the public debt H.R. 3962 - Affordable Health Care for America Act H.R. 3962 - The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 H.R. 3961 - Medicare Physician Payment Reform Act of 2009 H.R. 4985 - Medicare Decisions Accountability Act of 2010 H.R. 4872 - Health Care and Education Reconciliation Act of 2010 H.R. 3590 - Patient Protection and Affordable Care Act H.R. 1031 - Health Information Technology Promotion Act of 2009 H.R. 1911 - American Recovery & Reinvestment Act (ARRA) Health Information Technology Meaningful Use Stark II - Physician Ban on Self-Referral and Other Fraud & Abuse: ensure that Stark laws do not prevent timely access to quality medical services. Surgical Workforce Shortage

Client expense: $331,937 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE

Monitored and lobbied upon entire bills of the following: H.R.531, the Access to Frontline Health Care Act of 2011 H.R.1546 / S.829: Medicare Access to Rehabilitation Services Act of 2011; repeal of the Therapy Cap on Outpatient Rehabilitation Services The Medicare Patient Access to Physical Therapists Act (no bill number, formerly H.R.1829 / S.950); to improve access to physical therapists for Medicare beneficiaries

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1829/S.950 - Medicare Patient Access to Physical Therapists Act of 2009: prevent direct access to physical therapists in order to avoid unnecessary and overuse of therapy services. H.R. 3693 - Ensuring the Future Physican Workforce Act of 2009 H.R. 4851 - Continuing Extension Act of 2010 H.J. RES. 45 - Increasing the statutory limit on the public debt H.R. 3962 - Affordable Health Care for America Act H.R. 3962 - The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 H.R. 3961 - Medicare Physician Payment Reform Act of 2009 H.R. 4985 - Medicare Decisions Accountability Act of 2010 H.R. 4872 - Health Care and Education Reconciliation Act of 2010 H.R. 3590 - Patient Protection and Affordable Care Act H.R. 1031 - Health Information Technology Promotion Act of 2009 H.R. 1911 - American Recovery & Reinvestment Act (ARRA) Health Information Technology Meaningful Use Stark II - Physician Ban on Self-Referral and Other Fraud & Abuse: ensure that Stark laws do not prevent timely access to quality medical services. Surgical Workforce Shortage

Client expense: $352,625 · Firm income: Not reported

Monitored and lobbied upon entire bills of the following: H.R.531, the Access to Frontline Health Care Act of 2011 The Medicare Access to Rehabilitation Services Act (no bill number, formerly H.R.43 / S.46); repeal of the Therapy Cap on Outpatient Rehabilitation Services The Medicare Patient Access to Physical Therapists Act (no bill number, formerly H.R.1829 / S.950); to improve access to physical therapists for Medicare beneficiaries

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 43 and S. 46 - Medicare Access to Rehabilitative Services Act of 2009: Support and passage of all provisions, lobbying for the repeal of the provisions of the 1997 Balance Budget Act which imposed a $1840 annual cap on occupational therapy services covered by Medicare. HR 1094/S 3978 - Medicare Home Health Flexibility Act of 2009: All provisions, passage, lobbying for changes to current regulations governing the provision of home health services under Medicare Part B to allow Occupational Therapy to qualify as an initiating service. HR 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009: lobbying against specific provisions in the legislation that would allow athletic trainers to bill Medicare as a therapy service incident to a physicians order. HR 2479 - Medicare Orthotics and Prosthetics Improvement Act of 2009: Oppose. Negatively impacts occupational therapy scope of practice. HR 2068 - Medicare Telehealth Expansion Act of 2009: Advocate for passage and inclusion of occupational therapy. S 1131/HR 2560 - Independence at Home Act of 2009: Support passage and inclusion of occupational therapy. HR 1829/S 950 - Medicare Patient Access to Physical Therapists Act of 2009: advocate for changing the bill to include occupational therapy. HR 3184/S 1186 - Medicare Independent Living Act: Advocate for passage HR 3200 - America's Affordable Health Choices Act of 2009: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and in support of efforts to address shortages in health care workforce, including occupational therapy. HR 2891 - Access to Frontline Health Care Act of 2009: Support passage. HR 3590 (PL 111-148) - Patient Protection and Affordable Care Act: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and in support of efforts to address shortages in health care workforce, including occupational therapy; and oppose Wyden Amendment D-9 offset related to orthotics and prosthetics; advocated to change Lincoln D-10 amendment to reduce the scope of the amendment and to include occupational therapy. Also Educate about recommendations and position of the American Occupational Therapy Association regarding occupational therapy. Advocated for passage of short and long-term solutions to the Medicare Physician Fee Schedule payment cuts spurred by the Sustainable Growth Rate (SGR) formula. No Bill #: Advocate for extension of Medicare Therapy Caps Exceptions process. HR 3790 - To amend title XVIII of the Social Security Act to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner: educated and advocated on impact on occupational therapy services. HR 5040 - Health Information Technology Extension for Behavioral Health Services Act of 2010: advocated for passage and educated about occupational therapy services. HR 1137 - Athletic Trainers Access to Medicare Act - opposed PL 111-152 - Reconciliation Act of 2010 - implentation as it relates to occupational therapy. HR 5712 - Physician Payment and Therapy Relief Act: advocated to reduce impact on occupational therapy for Medicare payment policy changes. HR 1708 - Ending the Medicare Disability Waiting Period Act of 2009: Advocated for passage. HR 4993 - Home Health Care Planning Improvement Act of 2010: Advocated for passage and educated about occupational therapy services. S 3216 - Medicare Rural Health Care Equity Act of 2010: Advocated for passage. HR 4371 - A bill to amend Title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services: Advocated regarding impact to occupational therapy services. No bill: Advocate to Congress and Centers for Medicare/Medicaid Services (CMS) to oppose proposed Multiple Procedure Payment Reductions, cuts to therapy reimbursement in the proposed 2011 Medicare Physician Fee Schedule rule. CMS staff: Marilyn Tavenner, Principal Deputy Administrator and Johnathan Bluhm, Director of Center for Medicare Management HR 1586 - Education and Medicaid Funding for States: Supported passage. HR 4994 - Medicare and Medicaid Extenders Act: advocated for therapy cap exceptions process extension through 2011 and advocated related to RUGS-IV implementation.

H.R. 3854- Small Business Financing and Investment Act H.R. 43/S. 46- Medicare Access to Rehabilitation Services Act of 2009 H.R. 3962- Affordable Health Care Act for America H.R. 3590- Patient Protection and Affordable Care Act Non-discrimination Physician Practice Information Survey Red Flag Rules H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4691-Temporary Extension Act of 2010 H.R. 4851-Continuing Extension Act of 2010 H.R. 4231-Tax Extenders Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 Opt-Out Locum Tenens Consumer Financial Protection Bureau Authority over Health Care Providers/Physical Therapy H.R. 4213- American Jobs, Closing Loopholes and Preventing Outsourcing Act H.R. 3962- Preservation of Access to Care for Medicare Beneficiaries & Pension Relief Act Repeal of 1099 Tax Filing Requirement S. 3987 Red Flag Program Clarification Act

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

H.R. 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 H.R. 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 1430 - The Medicare Oral Health Rehabilitative Enhancement Act Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis of the Inpatient Rehabilitation Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup), development of short-term alternatives Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues-HHPPS Proposed Rule 2011, SNF Updates 2011 Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules H.R. 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives S. 1213- Patient Centered Outcomes Research Act of 2009 H.R. 2068- Medicare Telehealth Enhancement Act of 2009 H.R. 1094- Medicare Home Health Flexibility Act The Addition of a program to the Center for Medicare Services Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries. Medicare SNF PPS FY 2010 Medicare IRF PPS FY 2010 Medicare Home Health PPS CY 2010 H.R. 3590 Patient Protection and Affordable Care Act Physician Practice Information Survey (PPIS) H.R. 4371- To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4851-Continuing Extension Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 H.R. 4662- Lymphedema Diagnosis and Treatment Cost Saving Act of 2010 H.R. 3962- Preservation of Access to Care for Medicare Beneficiaries & Pension Relief Act H.R. 4213- American Jobs, Closing Loopholes and Preventing Outsourcing Act 2011 Medicare Physician Fee Schedule Proposed Rule Health Care Truth and Transparency Legislative Recommendations for Medicaid & CHIP- RFI June 2010 MedPAC Report to Congress-Aligning Incentives in Medicare H.R. 2575/S.3220 -Prosthetic and Custom Orthotic Parity Act of 2009 H.R. 2479- Medicare Orthotics and Prosthetics Improvement Act of 2009 HIT Rules- Meaningful Use Health Exchanges Proposed Rule Multiple Procedure Payment Reduction In Office Ancillary Services/Self Referral Annual Wellness Visit Rule Extension of Federal Medical Assistance Percentages H.R. 4994- the Medicare and Medicaid Extenders Act H.R. 5712- the Physician Payment and Therapy Relief Act of 2010 Comments on Physician Compare Federal External Review Process Comments

HR 43: support repeal caps for Medicare patients needing outpatient physical thereapy. HR 1829: support outpatient therapy for Medicare patients absent doctor referral.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1829/S.950 - Medicare Patient Access to Physical Therapists Act of 2009: prevent direct access to physical therapists in order to avoid unnecessary and overuse of therapy services. H.R. 3693 - Ensuring the Future Physican Workforce Act of 2009 H.R. 4851 - Continuing Extension Act of 2010 H.J. RES. 45 - Increasing the statutory limit on the public debt H.R. 3962 - Affordable Health Care for America Act H.R. 3962 - The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 H.R. 3961 - Medicare Physician Payment Reform Act of 2009 H.R. 4985 - Medicare Decisions Accountability Act of 2010 H.R. 4872 - Health Care and Education Reconciliation Act of 2010 H.R. 3590 - Patient Protection and Affordable Care Act H.R. 1031 - Health Information Technology Promotion Act of 2009 H.R. 1911 - American Recovery & Reinvestment Act (ARRA) Health Information Technology Meaningful Use Stark II - Physician Ban on Self-Referral and Other Fraud & Abuse: ensure that Stark laws do not prevent timely access to quality medical services. Surgical Workforce Shortage

Client expense: $573,687 · Firm income: Not reported

H.R. 43 and S. 46 - Medicare Access to Rehabilitative Services Act of 2009: Support and passage of all provisions, lobbying for the repeal of the provisions of the 1997 Balance Budget Act which imposed a $1840 annual cap on occupational therapy services covered by Medicare. HR 1094 - Medicare Home Health Flexibility Act of 2009: All provisions, passage, lobbying for changes to current regulations governing the provision of home health services under Medicare Part B to allow Occupational Therapy to qualify as an initiating service. HR 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009: lobbying against specific provisions in the legislation that would allow athletic trainers to bill Medicare as a therapy service incident to a physicians order. HR 2479 - Medicare Orthotics and Prosthetics Improvement Act of 2009: Oppose. Negatively impacts occupational therapy scope of practice. HR 2068 - Medicare Telehealth Expansion Act of 2009: Advocate for passage and inclusion of occupational therapy. S 1131/HR 2560 - Independence at Home Act of 2009: Support passage and inclusion of occupational therapy. HR 1829/S 950 - Medicare Patient Access to Physical Therapists Act of 2009: advocate for changing the bill to include occupational therapy. HR 3184/S 1186 - Medicare Independent Living Act: Advocate for passage No bill #: Health Care Reform; Educate about recommendations and position of the American Occupational Therapy Association regarding occupational therapy. HR 3200 - America's Affordable Health Choices Act of 2009: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and in support of efforts to address shortages in health care workforce, including occupational therapy. HR 2891 - Access to Frontline Health Care Act of 2009: Support passage. HR 3590 (PL 111-148) - Patient Protection and Affordable Care Act: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and in support of efforts to address shortages in health care workforce, including occupational therapy; and oppose Wyden Amendment D-9 offset related to orthotics and prosthetics; advocated to change Lincoln D-10 amendment to reduce the scope of the amendment and to include occupational therapy. Advocated for passage of short and long-term solutions to the Medicare Physician Fee Schedule payment cuts spurred by the Sustainable Growth Rate (SGR) formula. No Bill #: Advocate for extension of Medicare Therapy Caps Exceptions process. HR 3790 - To amend title XVIII of the Social Security Act to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner: educated and advocated on impact on occupational therapy services. HR 5040 - Health Information Technology Extension for Behavioral Health Services Act of 2010: advocated for passage and educated about occupational therapy services. HR 1708 - Ending the Medicare Disability Waiting Period Act of 2009: Advocated for passage. HR 4993 - Home Health Care Planning Improvement Act of 2010: Advocated for passage and educated about occupational therapy services. S 3216 - Medicare Rural Health Care Equity Act of 2010: Advocated for passage. HR 4371 - A bill to amend Title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services: Advocated regarding impact to occupational therapy services. No bill: Advocate to Congress and Centers for Medicare/Medicaid Services (CMS) to oppose proposed Medicare Physician Payment Reductions, cuts to therapy reimbursement in the proposed 2011 Medicare Physician Fee Schedule rule. CMS staff: Marilyn Tavenner, Principal Deputy Administrator and Johnathan Bluhm, Director of Center for Medicare Management HR 1586 - Education and Medicaid Funding for States: Supported passage.

H.R. 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 H.R. 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 1430 - The Medicare Oral Health Rehabilitative Enhancement Act Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis of the Inpatient Rehabilitation Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup), development of short-term alternatives Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules Self Referral H.R. 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives S. 1213- Patient Centered Outcomes Research Act of 2009 H.R. 2068- Medicare Telehealth Enhancement Act of 2009 H.R. 1094- Medicare Home Health Flexibility Act The Addition of a program to the Center for Medicare Services Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries. Medicare SNF PPS FY 2010 Medicare IRF PPS FY 2010 Medicare Home Health PPS CY 2010 H.R. 3590 Patient Protection and Affordable Care Act Physician Practice Information Survey (PPIS) H.R. 4371- To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4851-Continuing Extension Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 H.R. 4662- Lymphedema Diagnosis and Treatment Cost Saving Act of 2010 H.R. 3962- Preservation of Access to Care for Medicare Beneficiaries & Pension Relief Act H.R. 4213- American Jobs, Closing Loopholes and Preventing Outsourcing Act 2011 Medicare Physician Fee Schedule Proposed Rule Health Care Truth and Transparency June 2010 Medpac Report to Congress-Aligning Incentives in Medicare H.R. 2575/S.3220 -Prosthetic and Custom Orthotic Parity Act of 2009 H.R. 2479- Medicare Orthotics and Prosthetics Improvement Act of 2009

H.R. 3854- Small Business Financing and Investment Act H.R. 43/S. 46- Medicare Access to Rehabilitation Services Act of 2009 H.R. 3962- Affordable Health Care Act for America H.R. 3590- Patient Protection and Affordable Care Act Non-discrimination Physician Practice Information Survey Red Flag Rules H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4691-Temporary Extension Act of 2010 H.R. 4851-Continuing Extension Act of 2010 H.R. 4231-Tax Extenders Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 Opt-Out Locum Tenens Consumer Financial Protection Bureau Authority over Health Care Providers/Physical Therapy H.R. 4213- American Jobs, Closing Loopholes and Preventing Outsourcing Act H.R. 3962- Preservation of Access to Care for Medicare Beneficiaries & Pension Relief Act

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

H.R. 3854- Small Business Financing and Investment Act H.R. 43/S. 46- Medicare Access to Rehabilitation Services Act of 2009 H.R. 3962- Affordable Health Care Act for America H.R. 3590- Patient Protection and Affordable Care Act Non-discrimination Physician Practice Information Survey Red Flag Rules H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4691-Temporary Extension Act of 2010 H.R. 4851-Continuing Extension Act of 2010 H.R. 4231-Tax Extenders Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 Opt-Out Locum Tenens Consumer Financial Protection Bureau Authority over Health Care Providers/Physical Therapy H.R. 4213- American Jobs, Closing Loopholes and Preventing Outsourcing Act H.R. 3962- Preservation of Access to Care for Medicare Beneficiaries & Pension Relief Act Repeal of 1099 Tax Filing Requirement

Client expense: $310,000 · Firm income: Not reported

H.R. 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 H.R. 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 1430 - The Medicare Oral Health Rehabilitative Enhancement Act Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis of the Inpatient Rehabilitation Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup), development of short-term alternatives Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues-HHPPS Proposed Rule 2011, SNF Updates 2011 Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules Self Referral H.R. 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives S. 1213- Patient Centered Outcomes Research Act of 2009 H.R. 2068- Medicare Telehealth Enhancement Act of 2009 H.R. 1094- Medicare Home Health Flexibility Act The Addition of a program to the Center for Medicare Services Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries. Medicare SNF PPS FY 2010 Medicare IRF PPS FY 2010 Medicare Home Health PPS CY 2010 H.R. 3590 Patient Protection and Affordable Care Act Physician Practice Information Survey (PPIS) H.R. 4371- To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4851-Continuing Extension Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 H.R. 4662- Lymphedema Diagnosis and Treatment Cost Saving Act of 2010 H.R. 3962- Preservation of Access to Care for Medicare Beneficiaries & Pension Relief Act H.R. 4213- American Jobs, Closing Loopholes and Preventing Outsourcing Act 2011 Medicare Physician Fee Schedule Proposed Rule Health Care Truth and Transparency Legislative Recommendations for Medicaid & CHIP- RFI June 2010 Medpac Report to Congress-Aligning Incentives in Medicare H.R. 2575/S.3220 -Prosthetic and Custom Orthotic Parity Act of 2009 H.R. 2479- Medicare Orthotics and Prosthetics Improvement Act of 2009 HIT Rules- Meaningful Use Health Exchanges Proposed Rule Multiple Procedure Payment Reduction In Office Ancillary Services Annual Wellness Visit Rule Extension of Federal Medical Assistance Percentages

HR 43: support repeal caps for Medicare patients needing outpatient physical thereapy. HR 1829: support outpatient therapy for Medicare patients absent doctor referral.

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

Government targets: Army, Dept of (Other), HOUSE OF REPRESENTATIVES, SENATE

H.R. 1829/S.950 - Medicare Patient Access to Physical Therapists Act of 2009: prevent direct access to physical therapists in order to avoid unnecessary and overuse of therapy services. H.R. 3693 - Ensuring the Future Physican Workforce Act of 2009 H.R. 4851 - Continuing Extension Act of 2010 H.J. RES. 45 - Increasing the statutory limit on the public debt H.R. 3962 - Affordable Health Care for America Act H.R. 3962 - The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 H.R. 3961 - Medicare Physician Payment Reform Act of 2009 H.R. 4985 - Medicare Decisions Accountability Act of 2010 H.R. 4872 - Health Care and Education Reconciliation Act of 2010 H.R. 3590 - Patient Protection and Affordable Care Act H.R. 1031 - Health Information Technology Promotion Act of 2009 H.R. 1911 - American Recovery & Reinvestment Act (ARRA) Health Information Technology Meaningful Use Stark II - Physician Ban on Self-Referral and Other Fraud & Abuse: ensure that Stark laws do not prevent timely access to quality medical services. Surgical Workforce Shortage

Client expense: $439,000 · Firm income: Not reported

H.R. 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 H.R. 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 1430 - The Medicare Oral Health Rehabilitative Enhancement Act Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis of the Inpatient Rehabilitation Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup), development of short-term alternatives Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules Self Referral H.R. 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives S. 1213- Patient Centered Outcomes Research Act of 2009 H.R. 2068- Medicare Telehealth Enhancement Act of 2009 H.R. 1094- Medicare Home Health Flexibility Act The Addition of a program to the Center for Medicare Services Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries. Medicare SNF PPS FY 2010 Medicare IRF PPS FY 2010 Medicare Home Health PPS CY 2010 H.R. 3590 Patient Protection and Affordable Care Act Physician Practice Information Survey (PPIS) H.R. 4371- To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4851-Continuing Extension Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 H.R. 4662- Lymphedema Diagnosis and Treatment Cost Saving Act of 2010 H.R. 3962- Preservation of Access to Care for Medicare Beneficiaries & Pension Relief Act H.R. 4213- American Jobs, Closing Loopholes and Preventing Outsourcing Act 2011 Medicare Physician Fee Schedule Proposed Rule Health Care Truth and Transparency June 2010 Medpac Report to Congress-Aligning Incentives in Medicare H.R. 2575/S.3220 -Prosthetic and Custom Orthotic Parity Act of 2009 H.R. 2479- Medicare Orthotics and Prosthetics Improvement Act of 2009

H.R. 3854- Small Business Financing and Investment Act H.R. 43/S. 46- Medicare Access to Rehabilitation Services Act of 2009 H.R. 3962- Affordable Health Care Act for America H.R. 3590- Patient Protection and Affordable Care Act Non-discrimination Physician Practice Information Survey Red Flag Rules H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4691-Temporary Extension Act of 2010 H.R. 4851-Continuing Extension Act of 2010 H.R. 4231-Tax Extenders Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 Opt-Out Locum Tenens Consumer Financial Protection Bureau Authority over Health Care Providers/Physical Therapy H.R. 4213- American Jobs, Closing Loopholes and Preventing Outsourcing Act H.R. 3962- Preservation of Access to Care for Medicare Beneficiaries & Pension Relief Act

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

H.R. 43 and S. 46 - Medicare Access to Rehabilitative Services Act of 2009: Support and passage of all provisions, lobbying for the repeal of the provisions of the 1997 Balance Budget Act which imposed a $1840 annual cap on occupational therapy services covered by Medicare. HR 1094 - Medicare Home Health Flexibility Act of 2009: All provisions, passage, lobbying for changes to current regulations governing the provision of home health services under Medicare Part B to allow Occupational Therapy to qualify as an initiating service. HR 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009: lobbying against specific provisions in the legislation that would allow athletic trainers to bill Medicare as a therapy service incident to a physicians order. HR 2479 - Medicare Orthotics and Prosthetics Improvement Act of 2009: Oppose. Negatively impacts occupational therapy scope of practice. HR 2068 - Medicare Telehealth Expansion Act of 2009: Advocate for passage and inclusion of occupational therapy. S 1131/HR 2560 - Independence at Home Act of 2009: Support passage and inclusion of occupational therapy. HR 1829/S 950 - Medicare Patient Access to Physical Therapists Act of 2009: advocate for changing the bill to include occupational therapy. HR 3184/S 1186 - Medicare Independent Living Act: Advocate for passage No bill #: Health Care Reform; Educate about recommendations and position of the American Occupational Therapy Association regarding occupational therapy. HR 3200 - America's Affordable Health Choices Act of 2009: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and in support of efforts to address shortages in health care workforce, including occupational therapy. HR 2891 - Access to Frontline Health Care Act of 2009: Support passage. HR 3590 (PL 111-148) - Patient Protection and Affordable Care Act: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and in support of efforts to address shortages in health care workforce, including occupational therapy; and oppose Wyden Amendment D-9 offset related to orthotics and prosthetics; advocated to change Lincoln D-10 amendment to reduce the scope of the amendment and to include occupational therapy. HR4691 (PL 111-144) - Temporary Extensions Act of 2010: Advocate for extension of Medicare Therapy Caps Exceptions process and the Medicare Physicians Payment Update. HR 4851 (PL 111-157) - Continuing Extension Act of 2010: Advocate for extension of Medicare Physicians Payment Update. HR 3692 (PL 111-192) - Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010: Advocated for extension of Medicare Physicians Payment Update. Advocated for passage of short and long-term solutions to the Medicare Physician Fee Schedule payment cuts spurred by the Sustainable Growth Rate (SGR) formula. No Bill #: Advocate for extension of Medicare Therapy Caps Exceptions process. HR 3790 - To amend title XVIII of the Social Security Act to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner: educated and advocated on impact on occupational therapy services. HR 5040 - Health Information Technology Extension for Behavioral Health Services Act of 2010: advocated for passage and educated about occupational therapy services. HR 1708 - Ending the Medicare Disability Waiting Period Act of 2009: Advocated for passage. HR 4993 - Home Health Care Planning Improvement Act of 2010: Advocated for passage and educated about occupational therapy services. S 3216 - Medicare Rural Health Care Equity Act of 2010: Advocated for passage. HR 4371 - A bill to amend Title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services: Advocated regarding impact to occupational therapy services.

HR 43: support repeal caps for Medicare patients needing outpatient physical thereapy. HR 1829: support outpatient therapy for Medicare patients absent doctor referral.

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

Government targets: Army, Dept of (Other), HOUSE OF REPRESENTATIVES, SENATE

H.R. 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 H.R. 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 1430 - The Medicare Oral Health Rehabilitative Enhancement Act H.R. 2 - Children's Health Insurance Program Reauthorization Act of 2009 Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis of the Inpatient Rehabilitation Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup), development of short-term alternatives Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules Self Referral H.R. 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives S. 1213- Patient Centered Outcomes Research Act of 2009 H.R. 2068- Medicare Telehealth Enhancement Act of 2009 H.R. 1094- Medicare Home Health Flexibility Act The Addition of a program to the Center for Medicare Services Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries. Medicare SNF PPS FY 2010 Medicare IRF PPS FY 2010 Medicare Home Health PPS CY 2010 H.R. 3962 Affordable Health Care Act for America H.R. 3590 Patient Protection and Affordable Care Act Physician Practice Information Survey (PPIS) H.R. 4371- To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4691-Temporary Extension Act of 2010 H.R. 4851-Continuing Extension Act of 2010 H.R. 4231-Tax Extenders Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 H.R. 4662- Lymphedema Diagnosis and Treatment Cost Saving Act of 2010

H.R. 3854- Small Business Financing and Investment Act H.R. 43/S. 46- Medicare Access to Rehabilitation Services Act of 2009 H.R. 3962- Affordable Health Care Act for America H.R. 3590- Patient Protection and Affordable Care Act Non-discrimination Physician Practice Information Survey Red Flag Rules H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4691-Temporary Extension Act of 2010 H.R. 4851-Continuing Extension Act of 2010 H.R. 4231-Tax Extenders Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 Opt-Out Locum Tenens

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

H.R. 3854- Small Business Financing and Investment Act H.R. 43/S. 46- Medicare Access to Rehabilitation Services Act of 2009 H.R. 3962- Affordable Health Care Act for America H.R. 3590- Patient Protection and Affordable Care Act Non-discrimination Physician Practice Information Survey Red Flag Rules H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4691-Temporary Extension Act of 2010 H.R. 4851-Continuing Extension Act of 2010 H.R. 4231-Tax Extenders Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 Opt-Out Locum Tenens

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

H.R. 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 H.R. 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 1430 - The Medicare Oral Health Rehabilitative Enhancement Act H.R. 2 - Children's Health Insurance Program Reauthorization Act of 2009 Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis of the Inpatient Rehabilitation Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup), development of short-term alternatives Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules Self Referral H.R. 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives S. 1213- Patient Centered Outcomes Research Act of 2009 H.R. 2068- Medicare Telehealth Enhancement Act of 2009 H.R. 1094- Medicare Home Health Flexibility Act The Addition of a program to the Center for Medicare Services Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries. Medicare SNF PPS FY 2010 Medicare IRF PPS FY 2010 Medicare Home Health PPS CY 2010 H.R. 3962 Affordable Health Care Act for America H.R. 3590 Patient Protection and Affordable Care Act Physician Practice Information Survey (PPIS) H.R. 4371- To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4691-Temporary Extension Act of 2010 H.R. 4851-Continuing Extension Act of 2010 H.R. 4231-Tax Extenders Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 H.R. 4662- Lymphedema Diagnosis and Treatment Cost Saving Act of 2010

H.R. 1829/S.950 - Medicare Patient Access to Physical Therapists Act of 2009: prevent direct access to physical therapists in order to avoid unnecessary and overuse of therapy services. H.R. 3693 - Ensuring the Future Physican Workforce Act of 2009 H.R. 4851 - Continuing Extension Act of 2010 H.J. RES. 45 - Increasing the statutory limit on the public debt H.R. 3962 - Affordable Health Care for America Act H.R. 3961 - Medicare Physician Payment Reform Act of 2009 H.R. 4985 - Medicare Decisions Accountability Act of 2010 H.R. 4872 - Health Care and Education Reconciliation Act of 2010 H.R. 3590 - Patient Protection and Affordable Care Act H.R. 1031 - Health Information Technology Promotion Act of 2009 H.R. 1911 - American Recovery & Reinvestment Act (ARRA) Stark II - Physician Ban on Self-Referral and Other Fraud & Abuse: ensure that Stark laws do not prevent timely access to quality medical services. Surgical Workforce Shortage

Client expense: $480,000 · Firm income: Not reported

H.R. 43 and S. 46 - Medicare Access to Rehabilitative Services Act of 2009: Support and passage of all provisions, lobbying for the repeal of the provisions of the 1997 Balance Budget Act which imposed a $1840 annual cap on occupational therapy services covered by Medicare. HR 1094 - Medicare Home Health Flexibility Act of 2009: All provisions, passage, lobbying for changes to current regulations governing the provision of home health services under Medicare Part B to allow Occupational Therapy to qualify as an initiating service. HR 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009: lobbying against specific provisions in the legislation that would allow athletic trainers to bill Medicare as a therapy service incident to a physicians order. HR 2479 - Medicare Orthotics and Prosthetics Improvement Act of 2009: Oppose. Negatively impacts occupational therapy scope of practice. HR 2068 - Medicare Telehealth Expansion Act of 2009: Advocate for passage and inclusion of occupational therapy. S 1131/HR 2560 - Independence at Home Act of 2009: Support passage and inclusion of occupational therapy. HR 1829/S 950 - Medicare Patient Access to Physical Therapists Act of 2009: advocate for changing the bill to include occupational therapy. HR 3184/S 1186 - Medicare Independent Living Act: Advocate for passage No bill #: Health Care Reform; Educate about recommendations and position of the American Occupational Therapy Association regarding occupational therapy. HR 3200 - America's Affordable Health Choices Act of 2009: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and in support of efforts to address shortages in health care workforce, including occupational therapy. S. 1679 - Affordable Health Choices Act: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and support of efforts to address shortages in health care workforce, including occupational therapy.. S. 1796 - America's Healthy Future Act: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and in support of efforts to address shortages in health care workforce, including occupational therapy; and oppose Wyden Amendment D-9 offset related to orthotics and prosthetics; advocated to change Lincoln D-10 amendment to reduce the scope of the amendment and to include occupational therapy. HR 2891 - Access to Frontline Health Care Act of 2009: Support passage. HR 3590 (PL 111-148) - Patient Protection and Affordable Care Act: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and in support of efforts to address shortages in health care workforce, including occupational therapy; and oppose Wyden Amendment D-9 offset related to orthotics and prosthetics; advocated to change Lincoln D-10 amendment to reduce the scope of the amendment and to include occupational therapy. HR4691 (PL 111-144) - Temporary Extensions Act of 2010: Advocate for extension of Medicare Therapy Caps Exceptions process and the Medicare Physicians Payment Update. HR 4851 (PL 111-157) - Continuing Extension Act of 2010: Advocate for extension of Medicare Physicians Payment Update.

H.R. 3854- Small Business Financing and Investment Act H.R. 43/S. 46- Medicare Access to Rehabilitation Services Act of 2009 H.R. 3962- Affordable Health Care Act for America H.R. 3590- Patient Protection and Affordable Care Act Non-discrimination Physician Practice Information Survey Red Flag Rules H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4691-Temporary Extension Act of 2010 H.R. 4851-Continuing Extension Act of 2010 H.R. 4231-Tax Extenders Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 Opt-Out Locum Tenens

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

H.R. 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 H.R. 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 1430 - The Medicare Oral Health Rehabilitative Enhancement Act H.R. 2 - Children's Health Insurance Program Reauthorization Act of 2009 Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis of the Inpatient Rehabilitation Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup), development of short-term alternatives Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules Self Referral H.R. 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives S. 1213- Patient Centered Outcomes Research Act of 2009 H.R. 2068- Medicare Telehealth Enhancement Act of 2009 H.R. 1094- Medicare Home Health Flexibility Act The Addition of a program to the Center for Medicare Services Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries. Medicare SNF PPS FY 2010 Medicare IRF PPS FY 2010 Medicare Home Health PPS CY 2010 H.R. 3962 Affordable Health Care Act for America H.R. 3590 Patient Protection and Affordable Care Act Physician Practice Information Survey (PPIS) H.R. 4371- To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4691-Temporary Extension Act of 2010 H.R. 4851-Continuing Extension Act of 2010 H.R. 4231-Tax Extenders Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 H.R. 4662- Lymphedema Diagnosis and Treatment Cost Saving Act of 2010

Medicare/Part B Premium Hold Harmless. H.R. 3631: Provisions extending the current "hold harmless" policy to all Medicare enrollees to ensure 2010 Part B monthly premiums remain at the current rate. Comprehensive Health Care Reform. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 3590: provisions related to reducing Medicare Advantage plan payments, reducing the coverage gap in Part D, requiring wealthier Medicare beneficiaries to pay a greater share of the cost of their premiums under Medicare Parts B and D, permitting the Department of Health and Human Services to negotiate drug prices for the Part D program, simplifying plan benefit designs under Part C, expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS), improving the process for reassigning LIS beneficiaries to new plans, expanding coverage of prevention services establishing a Medicare Commission, providing expanded Medicaid coverage for home and community-based services, expanding Medicaid coverage of attendant and other home services and supports, establishing a new national insurance program for long-term supports and services, authorizing funding to provide language services to limited English proficiency beneficiaries, authorizing the collection of data regarding disparities in the provision of care, providing safeguards and subsidies to assure affordability of health coverage for seniors, preserving state benefit laws and requirements, reducing permitted age rating ratio for insurance premiums, inclusion of patient-centered quality reporting requirements for providers, creating new claims reviews processes and provider certification, requiring reporting by practitioners of gifts received from pharmaceutical and medical device manufacturers. Medicare/Commission. P.L. 111-148, P.L. 111-152, H.R. 4872: creating an independent commission authorized to establish Medicare payment and policy designed to reduce Medicare spending growth. Medicare/Prescription Drug Plan. S. 330, H.R. 684: authorizing the establishment of a Medicare-operated prescription drug plan; S. 266: authorizing the Secretary of Health and Human Services to negotiate lower prescription drug prices. Medicare/Part D Generics. S. 75: requiring the use of generics where available unless the brand name drug is determined to be medically necessary. Medicare/Part D cost-sharing. S. 1630: establishing limits on required beneficiary cost-sharing under Part D drug plans. Medicare/Part D dual eligibles. P.L. 111-148, P.L. 111-152, H.R. 4872, S. 1634: removing enrollment barriers for low-income beneficiaries and establishing a Medicare-operated prescription drug plan. Medicare/Combating Waste, Fraud, Abuse. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 27: relating to provisions to combat waste, fraud, and abuse within Medicare; H.R. 203: increasing civil and criminal penalties for acts involving fraud and abuse and increasing the surety bond amount for suppliers of durable medical equipment. Medicare/Therapy Caps. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 3590, H.R. 43, S. 46: repealing or extending exceptions to outpatient rehabilitation therapy caps. Medicare/Private Contracts. H.R. 164: prohibiting denial of Social Security benefits to persons who elect not to participate in Medicare. Medicare/Hearing Coverage. H.R. 504: authorizing coverage of hearing aids and auditory rehabilitation services under Medicare Part B. Medicare/Dental Coverage. H.R. 870: authorizing coverage under Part B for medically necessary dental procedures. Medicare/Rural Improvements. H.R. 902/S. 382: provision authorizing improvements to services provided to beneficiaries residing in rural areas. Medicare/Shingles Vaccine. H.R. 1038: extending Part B coverage to the shingles vaccine. Medicare/Home Health. H.R. 1094: authorizing home health care agencies to assign the most appropriate skilled service to make the initial assessment visit under a Medicare home health plan of care for rehabilitation services. Medicare/Health Care Vouchers. H.R. 1118: authorizing Medicare-eligible seniors to elect to receive vouchers for a health savings account, premiums for a high deductible health insurance plan, or both, in lieu of regular Medicare benefits and suspending Medicare late enrollment penalties between ages 65 and 70. Medicare/Skilled Nursing Facilities. H.R. 1125, S. 647: provisions related to requiring the reporting of expenditures for nursing services at skilled nursing facilities and requiring disclosure of corporate ownership. Medicare/Prevention. H.R. 1213: provisions authorizing ultrasound screening for abdominal aortic aneurysms to at-risk Medicare beneficiaries between the ages of 65 and 75 without the requirement of a prior initial preventive physical examination; H.R. 1894, S. 769: expanding access to bone mass measurement benefits under Part B. Medicare/Part B Drug Payments. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 3590, H.R. 1392: relating to appropriate Part B payment amounts for drugs and biologicals. Medicare/Low Income Prescription Drug Benefits. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 3590, H.R. 1407, S. 534: authorizing a reduction in cost-sharing under Part D for non-institutionalized, full-benefit dual eligible individuals. Medicare/Disability Benefits. S. 700, H.R. 1708, H.R. 2881: phasing-out the 24-month waiting period for disabled individuals to become eligible for Medicare benefits and eliminating the waiting period for individuals with life-threatening conditions. Medicare/Prescription Drugs for kidney transplants. H.R. 1458, S. 565: provision related to continued coverage for immunosuppressive drugs furnished to beneficiaries that have received kidney transplants and whose entitlement to coverage would otherwise expire. Medicare/Intravenous Drugs. H.R. 1765, S.701: relating to the payment for intravenous immune globulin (IVIG) for the treatment of primary immune deficiency diseases in a patient's home and for certain disposable pumps as durable medical equipment in place of non-disposable pumps. Medicare/Home Infusion Therapy. H.R. 574, S.254: extending Medicare coverage to home infusion therapy. Medicare/Physical Therapy Services. H.R. 1829: authorizing physical therapists to evaluate and treat Medicare beneficiaries without physician referral. Medicare/Part D Premiums. H.R. 1832: limiting Part D premium increases to no more than the Social Security cost-of-living adjustment and requiring the Secretary of Health and Human Services to negotiate lower prescription drug prices. Medicare/Cancer Hospice and Palliative Care. H.R. 1844: provisions authorizing coverage of comprehensive cancer care planning, establishing a Medicare hospice care demonstration, and authorizing grant programs for cancer palliative care and symptom management, provider education, and related research. Medicare/Hospice and Advanced Care Planning. S. 1150, H.R. 2911: provisions related to changing hospice payments and providing advance care planning resources. Medicare/Physician-Manufacturer Transparency. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 3590, S. 301: increasing the transparency of the relationship between physicians and the manufacturers of drugs, devices, biologicals, and medical supplies. Medicare/Care Coordination Services. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 3590, S. 1131, H.R. 2560: provisions establishing pilot care coordination programs. Medicaid/Home and Community-based Long Term Care. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 3590, S. 434, S.1257, H.R. 28552: provisions to remove barriers to providing home and community-based services including providing a state option to provide home and community-based services to individuals for whom such services are likely to prevent, delay, or decrease the likelihood of an individual's need for institutionalized care and authorizing the implementation of assistance grants for states electing to provide home and community-based services under Medicaid; provisions to provide a single point of entry to long term services; provisions to support nursing home diversion programs. Medicaid/Community-based Attendant Services and Supports. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 3590, S. 683, H.R. 1670: authorizing coverage of community-based attendant services and supports under Medicaid, increasing funding and establishing a demonstration program for beneficiaries dually eligible for Medicare and Medicaid. P.L. 110-275, P.L. 108-173: implementation of regulations and guidance relating to beneficiary eligibility, enrollment, and effectiveness of exceptions and appeals processes under Medicare Parts C and D.

HR 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 HR 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 HR 1829 - Medicare Patient Access to Physical Therapists Act of 2009 HR 1430 - The Medicare Oral Health Rehabilitative Enhancement Act HR 2 - Children's Health Insurance Program Reauthorization Act of 2009 Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures (comments) Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Implementation of the classification criteria for inpatient rehab facilities known as the 75 percent rule (comments) Home Health assessment instrument known as OASIS C (comments) National Coverage Determination regarding pulmonary rehab and expansion of a current national coverage determination on Cardiac Rehab (comments) Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis and Alternatives to the Inpatient Rehabilitation 75 percent rule (recommendations) Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup) Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules- Definition of Outpatient Hospital Services Self Referral HR 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives

HR 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 HR 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 HR 1829 - Medicare Patient Access to Physical Therapists Act of 2009 HR 1430 - The Medicare Oral Health Rehabilitative Enhancement Act HR 2 - Children's Health Insurance Program Reauthorization Act of 2009 Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures (comments) Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Implementation of the classification criteria for inpatient rehab facilities known as the 75 percent rule (comments) Home Health assessment instrument known as OASIS C (comments) National Coverage Determination regarding pulmonary rehab and expansion of a current national coverage determination on Cardiac Rehab (comments) Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis and Alternatives to the Inpatient Rehabilitation 75 percent rule (recommendations) Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup) Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Sustainable Growth Rate (SGR) Inpatient Rehab Issues

HR 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 HR 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 HR 1829 - Medicare Patient Access to Physical Therapists Act of 2009 HR 1430 - The Medicare Oral Health Rehabilitative Enhancement Act HR 2 - Children's Health Insurance Program Reauthorization Act of 2009 Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures (comments) Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Implementation of the classification criteria for inpatient rehab facilities known as the 75 percent rule (comments) Home Health assessment instrument known as OASIS C (comments) National Coverage Determination regarding pulmonary rehab and expansion of a current national coverage determination on Cardiac Rehab (comments) Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis and Alternatives to the Inpatient Rehabilitation 75 percent rule (recommendations) Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup) Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules- Definition of Outpatient Hospital Services Self Referral HR 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives

HR 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 HR 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 HR 1829 - Medicare Patient Access to Physical Therapists Act of 2009 HR 1430 - The Medicare Oral Health Rehabilitative Enhancement Act HR 2 - Children's Health Insurance Program Reauthorization Act of 2009 Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures (comments) Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Implementation of the classification criteria for inpatient rehab facilities known as the 75 percent rule (comments) Home Health assessment instrument known as OASIS C (comments) National Coverage Determination regarding pulmonary rehab and expansion of a current national coverage determination on Cardiac Rehab (comments) Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis and Alternatives to the Inpatient Rehabilitation 75 percent rule (recommendations) Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup) Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules- Definition of Outpatient Hospital Services Self Referral HR 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives

HR 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 HR 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 HR 1829 - Medicare Patient Access to Physical Therapists Act of 2009 HR 1430 - The Medicare Oral Health Rehabilitative Enhancement Act HR 2 - Children's Health Insurance Program Reauthorization Act of 2009 Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures (comments) Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Implementation of the classification criteria for inpatient rehab facilities known as the 75 percent rule (comments) Home Health assessment instrument known as OASIS C (comments) National Coverage Determination regarding pulmonary rehab and expansion of a current national coverage determination on Cardiac Rehab (comments) Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis and Alternatives to the Inpatient Rehabilitation 75 percent rule (recommendations) Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup) Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Sustainable Growth Rate (SGR) Inpatient Rehab Issues

H.R. 1829/S.950 - Medicare Patient Access to Physical Therapists Act of 2009: prevent direct access to physical therapists in order to avoid unnecessary and overuse of therapy services. H.R. 1031 - Health Information Technology Promotion Act of 2009: ensure investments in health to produce interoperable and compatible systems/programs. H.R. 1911 - American Recovery & Reinvestment Act (ARRA): funding to help award recipients defray the cost of data collection re quirements initiated pursuant to such Act, and for other purposes. Practice Expense Payment Under Medicare: ensure awareness for the rising cost of practice expenses and the levels paid through Medicare. Payment of Teaching Physicians Under Medicare: ensure that physicians who teach future healers are adequately reimbursed. Payment of Graduate Medical Education Under Medicare: promote ample/adequate federal assistance to individuals enrolled in medical school who can afford the cost. Stark II - Physician Ban on Self-Referral and Other Fraud & Abuse: ensure that Stark laws do not prevent timely access to quality medical services.

Client expense: $620,000 · Firm income: Not reported

S.46/H.R.43: Medicare Access to Rehabilitation Services Act of 2009 S.950/H.R. 1829: Medicare Patient Access to Physical Therapists Act of 2009 Comprehensive Health Reform H.R. 3200: America's Affordable Health Choices Act of 2009 America's healthy Future Act S. 1679: The Affordable Health Choices Act &HR 4314 Continued Government Financing Act H.R. 3590: Patient Protection and Affordable Care Act H.R. 3962 Affordable Health Care for America Act H.R. 4314: Continued Government Financing Act

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

S.46/H.R.43: Medicare Access to Rehabilitation Services Act of 2009 S.950/H.R. 1829: Medicare Patient Access to Physical Therapists Act of 2009 Comprehensive Health Reform H.R. 3200: America's Affordable Health Choices Act of 2009 America's healthy Future Act S. 1679: The Affordable Health Choices Act &HR 4314 Continued Government Financing Act H.R. 3590: Patient Protection and Affordable Care Act H.R. 3962 Affordable Health Care for America Act

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

H.R. 1829/S.950 - Medicare Patient Access to Physical Therapists Act of 2009: prevent direct access to physical therapists in order to avoid unnecessary and overuse of therapy services. H.R. 1031 - Health Information Technology Promotion Act of 2009: ensure investments in health to produce interoperable and compatible systems/programs. H.R. 1911 - American Recovery & Reinvestment Act (ARRA): funding to help award recipients defray the cost of data collection re quirements initiated pursuant to such Act, and for other purposes. Practice Expense Payment Under Medicare: ensure awareness for the rising cost of practice expenses and the levels paid through Medicare. Payment of Teaching Physicians Under Medicare: ensure that physicians who teach future healers are adequately reimbursed. Payment of Graduate Medical Education Under Medicare: promote ample/adequate federal assistance to individuals enrolled in medical school who can afford the cost. Stark II - Physician Ban on Self-Referral and Other Fraud & Abuse: ensure that Stark laws do not prevent timely access to quality medical services.

Client expense: $560,000 · Firm income: Not reported

H.R. 43 and S. 46 - Medicare Access to Rehabilitative Services Act of 2009: Support and passage of all provisions, lobbying for the repeal of the provisions of the 1997 Balance Budget Act which imposed a $1840 annual cap on occupational therapy services covered by Medicare. HR 1094 - Medicare Home Health Flexibility Act of 2009: All provisions, passage, lobbying for changes to current regulations governing the provision of home health services under Medicare Part B to allow Occupational Therapy to qualify as an initiating service. HR 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009: lobbying against specific provisions in the legislation that would allow athletic trainers to bill Medicare as a therapy service incident to a physicians order. HR 2479 - Medicare Orthotics and Prosthetics Improvement Act of 2009: Oppose. Negatively impacts occupational therapy scope of practice. HR 2068 - Medicare Telehealth Expansion Act of 2009: Advocate for passage and inclusion of occupational therapy. S 1131/HR 2560 - Independence at Home Act of 2009: Support passage and inclusion of occupational therapy. HR 1829/S 950 - Medicare Patient Access to Physical Therapists Act of 2009: advocate for changing the bill to include occupational therapy. HR 3184/S 1186 - Medicare Independent Living Act: Advocate for passage No bill #: Health Care Reform; Educate about recommendations and position of the American Occupational Therapy Association regarding occupational therapy. HR 3200 - America's Affordable Health Choices Act of 2009: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and in support of efforts to address shortages in health care workforce, including occupational therapy. S. 1679 - Affordable Health Choices Act: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and support of efforts to address shortages in health care workforce, including occupational therapy.. S. 1796 - America's Healthy Future Act: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and in support of efforts to address shortages in health care workforce, including occupational therapy; and oppose Wyden Amendment D-9 offset related to orthotics and prosthetics; advocated to change Lincoln D-10 amendment to reduce the scope of the amendment and to include occupational therapy. HR 2891 - Access to Frontline Health Care Act of 2009: Support passage. HR 3590 - Patient Protection and Affordable Care Act: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and in support of efforts to address shortages in health care workforce, including occupational therapy; and oppose Wyden Amendment D-9 offset related to orthotics and prosthetics; advocated to change Lincoln D-10 amendment to reduce the scope of the amendment and to include occupational therapy.

H.R. 3854- Small Business Financing and Investment Act H.R. 43/S. 46- Medicare Access to Rehabilitation Services Act of 2009 H.R. 3962- Affordable Health Care Act for America H.R. 3590- Patient Protection and Affordable Care Act Non-discrimination Physician Practice Information Survey Red Flag Rules H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009

Client expense: $210,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

H.R. 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 H.R. 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 1430 - The Medicare Oral Health Rehabilitative Enhancement Act H.R. 2 - Children's Health Insurance Program Reauthorization Act of 2009 Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures (comments) Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Implementation of the classification criteria for inpatient rehab facilities known as the 60 percent rule (comments) Home Health assessment instrument known as OASIS C (comments) Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis and Alternatives to the Inpatient Rehabilitation 60 percent rule (recommendations) Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup), development of short-term alternatives Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules- Definition of Outpatient Hospital Services Self Referral H.R. 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives S. 1213- Patient Centered Outcomes Research Act of 2009 H.R. 2068- Medicare Telehealth Enhancement Act of 2009 H.R. 1094- Medicare Home Health Flexibility Act The Addition of a program to the Center for Medicare Services Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries in rural areas. Medicare SNF PPS FY 2010 Proposed Rule (comments) Medicare IRF PPS FY 2010 Proposed Rule (comments) Medicare Home Health PPS CY 2010 Proposed rule (comments) Health Information Technology H.R. 3962 Affordable Health Care Act for America H.R. 3590 Patient Protection and Affordable Care Act Physician Practice Information Survey (PPIS) H.R. 4371- To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services.

Medicare/Part B Premium Hold Harmless. H.R. 3631: Provisions extending the current "hold harmless" policy to all Medicare enrollees to ensure 2010 Part B monthly premiums remain at the current rate. Comprehensive Health Care Reform. H.R. 3590, H.R. 3962, H.R. 3200, S. 1679: provisions related to reducing Medicare Advantage plan payments, reducing the coverage gap in Part D, requiring wealthier Medicare beneficiaries to pay a greater share of the cost of their premiums under Medicare Parts B and D, permitting the Department of Health and Human Services to negotiate drug prices for the Part D program, simplifying plan benefit designs under Part C, expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS), improving the process for reassigning LIS beneficiaries to new plans, expanding coverage of prevention services establishing a Medicare Commission, providing expanded Medicaid coverage for home and community-based services, expanding Medicaid coverage of attendant and other home services and supports, establishing a new national insurance program for long-term supports and services, authorizing funding to provide language services to limited English proficiency beneficiaries, authorizing the collection of data regarding disparities in the provision of care, providing safeguards and subsidies to assure affordability of health coverage for seniors, preserving state benefit laws and requirements, reducing permitted age rating ratio for insurance premiums, inclusion of patient-centered quality reporting requirements for providers, creating new claims reviews processes and provider certification, requiring reporting by practitioners of gifts received from pharmaceutical and medical device manufacturers. Medicare/Commission. S. 1110 and S. 1380: authorizing an enhanced MedPAC as an executive branch commission with authority to implement Medicare payment and policy designed to reduce Medicare spending growth. Medicare/Prescription Drug Plan. S. 330/H.R. 684: authorizing the establishment of a Medicare-operated prescription drug plan; S. 266: authorizing the Secretary of Health and Human Services to negotiate lower prescription drug prices and to use the savings to reduce the coverage gap. Medicare/Part D Generics. S. 75: requiring the use of generics where available unless the brand name drug is determined to be medically necessary. Medicare/Part D cost-sharing. S. 1630: establishing limits on required beneficiary cost-sharing under Part D drug plans. Medicare/Part D dual eligibles. S. 1634: removing enrollment barriers for low-income beneficiaries and establishing a Medicare-operated prescription drug plan. Medicare/Combating Waste, Fraud, Abuse. H.R. 27: relating to additional provisions to combat waste, fraud, and abuse within Medicare; H.R. 203: increasing civil and criminal penalties for acts involving fraud and abuse and increasing the surety bond amount for suppliers of durable medical equipment. Medicare/Therapy Caps. H.R. 43/S. 46: repealing outpatient rehabilitation therapy caps. Medicare/Private Contracts. H.R. 164: prohibiting denial of Social Security benefits to persons who elect not to participate in Medicare. Medicare/Hearing Coverage. H.R. 504: authorizing coverage of hearing aids and auditory rehabilitation services under Medicare Part B. Medicare/Dental Coverage. H.R. 870: authoring coverage under Part B for medically necessary dental procedures. Medicare/Rural Improvements. H.R. 902/S. 382: provision authorizing improvements to services provided to beneficiaries residing in rural areas. Medicare/Shingles Vaccine. H.R. 1038: extending Part B coverage to the shingles vaccine. Medicare/Home Health. H.R. 1094: authorizing home health care agencies to assign the most appropriate skilled service to make the initial assessment visit under a Medicare home health plan of care for rehabilitation services. Medicare/Health Care Vouchers. H.R. 1118: authorizing Medicare-eligible seniors to elect to receive vouchers for a health savings account, premiums for a high deductible health insurance plan, or both, in lieu of regular Medicare benefits and suspending Medicare late enrollment penalties between ages 65 and 70. Medicare/Skilled Nursing Facilities. H.R. 1125, S. 647: provisions related to requiring the reporting of expenditures for nursing services at skilled nursing facilities and requiring disclosure of corporate ownership. Medicare/Prevention. H.R. 1213: provisions authorizing ultrasound screening for abdominal aortic aneurysms to at-risk Medicare beneficiaries between the ages of 65 and 75 without the requirement of a prior initial preventive physical examination; H.R. 1894/S. 769: expanding access to bone mass measurement benefits under Part B. Medicare/Part B Drug Payments. H.R. 1392: relating to appropriate Part B payment amounts for drugs and biologicals. Medicare/Low Income Prescription Drug Benefits. H.R. 1407/S. 534: authorizing a reduction in cost-sharing under Part D for non-institutionalized, full-benefit dual eligible individuals. Medicare/Disability Benefits. S. 700/H.R. 1708, H.R. 2881: phasing-out the 24-month waiting period for disabled individuals to become eligible for Medicare benefits and eliminating the waiting period for individuals with life-threatening conditions. Medicare/Prescription Drugs for kidney transplants. H.R. 1458/S. 565: provision related to continued coverage for immunosuppressive drugs furnished beneficiaries that have received kidney transplants and whose entitlement to coverage would otherwise expire. Medicare/Intravenous Drugs. H.R. 1765/S.701: relating to the payment for intravenous immune globulin (IVIG) for the treatment of primary immune deficiency diseases in a patient's home and for certain disposable pumps as durable medical equipment in place of non-disposable pumps. Medicare/Home Infusion Therapy. H.R. 574/S.254: extending Medicare coverage to home infusion therapy. Medicare/Physical Therapy Services. H.R. 1829: authorizing physical therapists to evaluate and treat Medicare beneficiaries without physician referral. Medicare/Part D Premiums. H.R. 1832: limiting Part D premium increases to no more than the Social Security cost-of-living adjustment and requiring the Secretary of Health and Human Services to negotiate lower prescription drug prices. Medicare/Cancer Hospice and Palliative Care. H.R. 1844: provisions authorizing coverage of comprehensive cancer care planning, establishing a Medicare hospice care demonstration, and authorizing grant programs for cancer palliative care and symptom management, provider education, and related research. Medicare/Hospice and Advanced Care Planning. S. 1150, H.R. 2911: provisions related to changing hospice payments and providing advance care planning resources. Medicare/Physician-Manufacturer Transparency. S. 301: increasing the transparency of the relationship between physicians and the manufacturers of drugs, devices, biologicals, and medical supplies. Medicare/Care Coordination Services. S. 1131, H.R. 2560: provisions establishing pilot care coordination program.

H.R. 43 and S. 46 - Medicare Access to Rehabilitative Services Act of 2009: Support and passage of all provisions, lobbying for the repeal of the provisions of the 1997 Balance Budget Act which imposed a $1840 annual cap on occupational therapy services covered by Medicare. HR 1094 - Medicare Home Health Flexibility Act of 2009: All provisions, passage, lobbying for changes to current regulations governing the provision of home health services under Medicare Part B to allow Occupational Therapy to qualify as an initiating service. HR 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009: lobbying against specific provisions in the legislation that would allow athletic trainers to bill Medicare as a therapy service incident to a physicians order. HR 2479 - Medicare Orthotics and Prosthetics Improvement Act of 2009: Oppose. Negatively impacts occupational therapy scope of practice. HR 2068- Medicare Telehealth .Expansion Act of 2009: advocated for passage HR 2068 - Medicare Telehealth Expansion Act of 2009: Advocate for passage and inclusion of occupational therapy. S 1131/HR 2560 - Independence at Home Act of 2009: Support passage and inclusion of occupational therapy. HR 1829/S 950 - Medicare Patient Access to Physical Therapists Act of 2009: advocate for changing the bill to include occupational therapy.

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

H.R. 1829/S.950 - Medicare Patient Access to Physical Therapists Act of 2009: prevent direct access to physical therapists in order to avoid unnecessary and overuse of therapy services. H.R. 1031 - Health Information Technology Promotion Act of 2009: ensure investments in health to produce interoperable and compatible systems/programs. H.R. 1911 - American Recovery & Reinvestment Act (ARRA): funding to help award recipients defray the cost of data collection re quirements initiated pursuant to such Act, and for other purposes. Practice Expense Payment Under Medicare: ensure awareness for the rising cost of practice expenses and the levels paid through Medicare. Payment of Teaching Physicians Under Medicare: ensure that physicians who teach future healers are adequately reimbursed. Payment of Graduate Medical Education Under Medicare: promote ample/adequate federal assistance to individuals enrolled in medical school who can afford the cost. Stark II - Physician Ban on Self-Referral and Other Fraud & Abuse: ensure that Stark laws do not prevent timely access to quality medical services.

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

Medicare/Part B Premium Hold Harmless. H.R. 3631: Provisions extending the current "hold harmless" policy to all Medicare enrollees to ensure 2010 Part B monthly premiums remain at the current rate. Comprehensive Health Care Reform. H.R. 3200, S. 1679, Senate Finance Committee Mark of Americas Healthy Futures Act: provisions related to reducing Medicare Advantage plan payments, reducing the coverage gap in Part D, requiring wealthier Medicare beneficiaries to pay a greater share of the cost of their premiums under Medicare Part D, reducing the Part A deductible, establishing an out-of-pocket maximum under Medicare, establishing a voluntary comprehensive benefit option under Medicare, authorizing a Medicare-operated Part D drug plan, permitting the Department of Health and Human Services to negotiate drug prices for the Part D program, simplifying plan benefit designs under Parts D and C, expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS), improving the process for reassigning LIS beneficiaries to new plans, expanding coverage of prevention services, integrating mental health services in primary care and community settings, eliminating the 45 percent funding trigger provision, establishing a Medicare Commission, providing Medicaid coverage for home and community-based services, establishing a new national insurance program for long-term supports and services, authorizing funding to provide language services to limited English proficiency beneficiaries, authorizing the collection of data regarding disparities in the provision of care, providing safeguards and subsidies to assure affordability of health coverage for seniors, preserving state benefit laws and requirements, reducing permitted age rating ratio and clarifying the Medicare Secondary Payer statute. Medicare/Commission. S. 1110 and S. 1380: authorizing an enhanced MedPAC as an executive branch commission with authority to implement Medicare payment and policy designed to reduce Medicare spending growth. Medicare/Prescription Drug Plan. S. 330/H.R. 684: authorizing the establishment of a Medicare-operated prescription drug plan; S. 266: authorizing the Secretary of Health and Human Services to negotiate lower prescription drug prices and to use the savings to reduce the coverage gap. Medicare/Part D Generics. S. 75: requiring the use of generics where available unless the brand name drug is determined to be medically necessary. Medicare/Part D cost-sharing. S. 1630: establishing limits on required beneficiary cost-sharing under Part D drug plans. Medicare/Part D dual eligibles. S. 1634: removing enrollment barriers for low-income beneficiaries and establishing a Medicare-operated prescription drug plan. Medicare/Combating Waste, Fraud, Abuse. H.R. 27: relating to additional provisions to combat waste, fraud, and abuse within Medicare; H.R. 203: increasing civil and criminal penalties for acts involving fraud and abuse and increasing the surety bond amount for suppliers of durable medical equipment. Medicare/Therapy Caps. H.R. 43/S. 46: repealing outpatient rehabilitation therapy caps. Medicare/Private Contracts. H.R. 164: prohibiting denial of Social Security benefits to persons who elect not to participate in Medicare. Medicare/Hearing Coverage. H.R. 504: authorizing coverage of hearing aids and auditory rehabilitation services under Medicare Part B. Medicare/Dental Coverage. H.R. 870: authoring coverage under Part B for medically necessary dental procedures. Medicare/Rural Improvements. H.R. 902/S. 382: provision authorizing improvements to services provided to beneficiaries residing in rural areas. Medicare/Shingles Vaccine. H.R. 1038: extending Part B coverage to the shingles vaccine. Medicare/Home Health. H.R. 1094: authorizing home health care agencies to assign the most appropriate skilled service to make the initial assessment visit under a Medicare home health plan of care for rehabilitation services. Medicare/Health Care Vouchers. H.R. 1118: authorizing Medicare-eligible seniors to elect to receive vouchers for a health savings account, premiums for a high deductible health insurance plan, or both, in lieu of regular Medicare benefits and suspending Medicare late enrollment penalties between ages 65 and 70. Medicare/Skilled Nursing Facilities. H.R. 1125, S. 647: provisions related to requiring the reporting of expenditures for nursing services at skilled nursing facilities and requiring disclosure of corporate ownership. Medicare/Prevention. H.R. 1213: provisions authorizing ultrasound screening for abdominal aortic aneurysms to at-risk Medicare beneficiaries between the ages of 65 and 75 without the requirement of a prior initial preventive physical examination; H.R. 1894/S. 769: expanding access to bone mass measurement benefits under Part B. Medicare/Part B Drug Payments. H.R. 1392: relating to appropriate Part B payment amounts for drugs and biologicals. Medicare/Low Income Prescription Drug Benefits. H.R. 1407/S. 534: authorizing a reduction in cost-sharing under Part D for non-institutionalized, full-benefit dual eligible individuals. Medicare/Disability Benefits. S. 700/H.R. 1708, H.R. 2881: phasing-out the 24-month waiting period for disabled individuals to become eligible for Medicare benefits and eliminating the waiting period for individuals with life-threatening conditions. Medicare/Prescription Drugs for kidney transplants. H.R. 1458/S. 565: provision related to continued coverage for immunosuppressive drugs furnished beneficiaries that have received kidney transplants and whose entitlement to coverage would otherwise expire. Medicare/Intravenous Drugs. H.R. 1765/S.701: relating to the payment for intravenous immune globulin (IVIG) for the treatment of primary immune deficiency diseases in a patient's home and for certain disposable pumps as durable medical equipment in place of non-disposable pumps. Medicare/Home Infusion Therapy. H.R. 574/S.254: extending Medicare coverage to home infusion therapy. Medicare/Physical Therapy Services. H.R. 1829: authorizing physical therapists to evaluate and treat Medicare beneficiaries without physician referral. Medicare/Part D Premiums. H.R. 1832: limiting Part D premium increases to no more than the Social Security cost-of-living adjustment and requiring the Secretary of Health and Human Services to negotiate lower prescription drug prices. Medicare/Cancer Hospice and Palliative Care. H.R. 1844: provisions authorizing coverage of comprehensive cancer care planning, establishing a Medicare hospice care demonstration, and authorizing grant programs for cancer palliative care and symptom management, provider education, and related research. Medicare/Hospice and Advanced Care Planning. S. 1150, H.R. 2911: provisions related to changing hospice payments and providing advance care planning resources. Medicare/Physician-Manufacturer Transparency. S. 301: increasing the transparency of the relationship between physicians and the manufacturers of drugs, devices, biologicals, and medical supplies. Medicare/Care Coordination Services. S. 1131, H.R. 2560: provisions establishing pilot care coordination program. Medicaid/Home and Community-based Long Term Care. S. 434, S.1257, H.R. 28552: provisions to remove barriers to providing home and community-based services including providing a state option to provide home and community-based services to individuals for whom such services are likely to prevent, delay, or decrease the likelihood of an individual's need for institutionalized care and authorizing the implementation of assistance grants for states electing to provide home and community-based services under Medicaid; provisions to provide a single point of entry to long term services; provisions to support nursing home diversion programs. Medicaid/Community-based Attendant Services and Supports. S. 683, H.R. 1670: authorizing coverage of community-based attendant services and supports under Medicaid, increasing funding and establishing a demonstration program for beneficiaries dually eligible for Medicare and Medicaid.

H.R. 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 H.R. 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 1430 - The Medicare Oral Health Rehabilitative Enhancement Act H.R. 2 - Children's Health Insurance Program Reauthorization Act of 2009 Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures (comments) Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Implementation of the classification criteria for inpatient rehab facilities known as the 75 percent rule (comments) Home Health assessment instrument known as OASIS C (comments) National Coverage Determination regarding pulmonary rehab and expansion of a current national coverage determination on Cardiac Rehab (comments) Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis and Alternatives to the Inpatient Rehabilitation 75 percent rule (recommendations) Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup) Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules- Definition of Outpatient Hospital Services Self Referral H.R. 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives S. 1213- Patient Centered Outcomes Research Act of 2009 H.R. 2068- Medicare Telehealth Enhancement Act of 2009 H.R. 1094- Medicare Home Health Flexibility Act The Addition of a program to the Center for Medicare Services Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries in rural areas. Medicare SNF PPS FY 2010 Proposed Rule (comments) Medicare IRF PPS FY 2010 Proposed Rule (comments) Medicare Home Health PPS CY 2010 Proposed rule (comments)