Medicare Telehealth Enhancement Act of 2009

INS - Quarter 3 2022 Public Law 111-203, H.R. 4173- Dodd-Frank Wall Street Reform and Consumer Protection Act. Issue: Implementation and Regulatory reform. Captive Reinsurance Transactions, Insurance Capital Standards and Global Capital Standards. H.R. 1255/S. 377 - Living Donor Protection Act of 2021. The bill would promote and protect from discrimination living organ donors. Issue: underwriting. S. 862/H.R. 2068 - Clarifying Law Around Insurance of Marijuana Act. To create a safe harbor for insurers engaging in the business of insurance in connection with a cannabis-related business. Issue: underwriting, anti-money laundering. Issue: private equitys growing role in the insurance industry. Issue: S&P proposal on the methodology that is used to rate insurance companies. Issue: Request for information from Congress regarding the diversity and inclusion information in the insurance industry. Issue: Housing Finance Reform. No bill number assigned.

Client expense: $880,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 5084 - Improving Corporate Governance Through Diversity Act. H.R. 5360 - Closing the Racial Wealth Gap Act. H.R. 281 - Ensuring Diverse Leadership Act. H.R. 7946 and S. 4464 - Federal Reserve Racial and Economic Equity Act. HR 1996 and S 910 - The Secure and Fair Enforcement or SAFE Banking Act of 2021. S. 862/H.R. 2068 - The Clarifying Law Around Insurance of Marijuana (CLAIM) Act. H.R. 1832 - Insurance Fairness for First Responders Act of 2019. H.R.3962/S.1625 - Securing and Enabling Commerce Using Remote and Electronic Notarization Act - Issue: remote online notarization. H.R. 2474/S.664 - Protecting Workers Freedom to Organize Act. To amend the National Labor Relations Act, the Labor Management Relations Act, 1947, and the Labor-Management Reporting and Disclosure Act of 1959. Issue: independent contractor status. HR 4865/S. 3198 - Registration for Index-Linked Annuities Act. To direct the SEC to revise any rules necessary to enable issuers of index-linked annuities to use the securities offering forms that are available to other issuers of securities. Issue: index-linked annuities. S. Clarifying that the CFPB does not regulate the business of insurance. Issue: Making Diversity and Inclusion Efforts more Intentional. No bill number assigned. Potential legislation on banning short selling H.R. 1862/S. 1586 - Federal Insurance Office Abolishment Act of 2019. Issue: FIO reform. Discussions related to the following bills from the previous Congress: Public Law 111-203, H.R. 4173- Dodd-Frank Wall Street Reform and Consumer Protection Act. Issue: Implementation and Regulatory reform. Captive Reinsurance Transactions, Insurance Capital Standards and Global Capital Standards. Draft legislation that would require notice of data security breaches. Issue: Cybersecurity and Privacy. H.R. 1523/S. 526 - Modern Worker Empowerment Act. To amend the Fair Labor Standards Act of 1938 to harmonize the definition of employee with the common law. Issue: employee status. S.__ Electronic Signatures in Global and National Commerce Act. To amend the Electronic Signatures in Global and National Commerce Act to accommodate emerging technologies. Issue: electronic signatures Environmental, Social, and Corporate Governance (ESG). No bill number assigned. EO 14032 restrictions on securities related to CMICs H.R. 4350 - National Defense Authorization Act for Fiscal Year 2022. This bill authorizes FY2022 appropriations for military activities and programs of the Department of Defense (e.g., personnel; research, development, test, and evaluation; and procurement of items such as aircraft, missiles, and ammunition). It also prescribes military personnel strengths for FY2022. Issue: remote online notarization and cannabis banking. H.R. 1187 - the ESG Disclosure Simplification Act. This legislation requires the disclosure of key environmental, social, and governance metrics to shareholders of public companies. Issue: ESG. S.Con.Res.14 - Concurrent Resolution on the Budget, FY2022. The budget resolution calls for the $3.5 trillion in long-term investments to be fully offset by a combination of new tax revenues, health care savings, and long-term economic growth. In addition, the agreement would prohibit new taxes on families making less than $400,000 per year, and on small businesses and family farms. Issue: unemployment insurance. S.__ Cannabis Administration and Opportunity Act. This legislation aims to end the decades of harm inflicted on communities of color by removing cannabis from the federal list of controlled substances and empowering states to implement their own cannabis laws. S.2865 - Unemployment Insurance Improvement Act H.R. 3099 - Primary Regulators of Insurance Vote Act of 2021. To amend the Financial Stability Act of 2010 to include the State insurance commissioner as a voting member of the Financial Stability Oversight Council. Issue: FSOC. SEC Proposed Rule to Enhance and Standardize Climate-Related Disclosures for Investors. Issue: ESG Issue: Economic Sanctions on Russia Issue: S&P Global Proposed Methodology And Assumptions For Insurer Risk-Based Capital Adequacy.

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

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

Public Law 111-203, H.R. 4173- Dodd-Frank Wall Street Reform and Consumer Protection Act. Issue: Implementation and Regulatory reform. Captive Reinsurance Transactions, Insurance Capital Standards and Global Capital Standards. Implementation of S. 2270 - Insurance Capital Standards Clarification Act of 2014. The bill would give the Federal Reserve the authority to tailor capital standards for insurance companies subject to Fed supervision. Issue: Capital Standards, Basel III Implementation of H.R. 748 - the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This bill responds to the COVID-19 (i.e., coronavirus disease 2019) outbreak and its impact on the economy, public health, state and local governments, individuals, and businesses. Issue: CECL, TDR, Remote Online Notarization, SBA loans. H.R. 1255/S. 377 - Living Donor Protection Act of 2021. The bill would promote and protect from discrimination living organ donors. Issue: underwriting. S. 862/H.R. 2068 - Clarifying Law Around Insurance of Marijuana Act. To create a safe harbor for insurers engaging in the business of insurance in connection with a cannabis-related business. Issue: underwriting, anti-money laundering. H.R. 3099 - Primary Regulators of Insurance Vote Act of 2021. To amend the Financial Stability Act of 2010 to include the State insurance commissioner as a voting member of the Financial Stability Oversight Council. Issue: FSOC. Issue: private equitys growing role in the insurance industry. Issue: S&P proposal on the methodology that is used to rate insurance companies. Issue: Russian sanctions legislation. Issue: Request for information from Congress regarding the diversity and inclusion information in the insurance industry. Issue: National Association of Registered Agents and Brokers (NARAB) board. No bill number assigned. Issue: Housing Finance Reform. No bill number assigned. Issue: Final margin rules for uncleared swaps transactions with respect to seeded investment funds. No bill number assigned.

Client expense: $743,405 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

INS -Quarter 2 2022 Public Law 111-203, H.R. 4173- Dodd-Frank Wall Street Reform and Consumer Protection Act. Issue: Implementation and Regulatory reform. Insurance Capital Standards and Global Capital Standards. Implementation of S. 2270 - Insurance Capital Standards Clarification Act of 2014. The bill would give the Federal Reserve the authority to tailor capital standards for insurance companies subject to Fed supervision. Issue: Capital Standards H.R. 1255/S. 377 - Living Donor Protection Act of 2021. The bill would promote and protect from discrimination living organ donors. Issue: underwriting. S. 862/H.R. 2068 - Clarifying Law Around Insurance of Marijuana Act. To create a safe harbor for insurers engaging in the business of insurance in connection with a cannabis-related business. Issue: underwriting, anti-money laundering. Issue: private equitys growing role in the insurance industry. Issue: S&P proposal on the methodology that is used to rate insurance companies. Issue: Request for information from Congress regarding the diversity and inclusion information in the insurance industry. Issue: Housing Finance Reform. No bill number assigned. Issue: Final margin rules for uncleared swaps transactions with respect to seeded investment funds. No bill number assigned.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 5084 - Improving Corporate Governance Through Diversity Act. H.R. 5360 - Closing the Racial Wealth Gap Act. H.R. 281 - Ensuring Diverse Leadership Act. H.R. 7946 and S. 4464 - Federal Reserve Racial and Economic Equity Act. HR 1996 and S 910 - The Secure and Fair Enforcement or SAFE Banking Act of 2021. S. 862/H.R. 2068 - The Clarifying Law Around Insurance of Marijuana (CLAIM) Act. H.R. 1832 - Insurance Fairness for First Responders Act of 2019. H.R.3962/S.1625 - Securing and Enabling Commerce Using Remote and Electronic Notarization Act - Issue: remote online notarization. H.R. 2474/S.664 - Protecting Workers Freedom to Organize Act. To amend the National Labor Relations Act, the Labor Management Relations Act, 1947, and the Labor-Management Reporting and Disclosure Act of 1959. Issue: independent contractor status. HR 4865/S. 3198 - Registration for Index-Linked Annuities Act. To direct the SEC to revise any rules necessary to enable issuers of index-linked annuities to use the securities offering forms that are available to other issuers of securities. Issue: index-linked annuities. S. Clarifying that the CFPB does not regulate the business of insurance. Issue: Making Diversity and Inclusion Efforts more Intentional. No bill number assigned. Potential legislation on banning short selling H.R. 1862/S. 1586 - Federal Insurance Office Abolishment Act of 2019. Issue: FIO reform. Discussions related to the following bills from the previous Congress: Public Law 111-203, H.R. 4173- Dodd-Frank Wall Street Reform and Consumer Protection Act. Issue: Implementation and Regulatory reform. Captive Reinsurance Transactions, Insurance Capital Standards and Global Capital Standards. Draft legislation that would require notice of data security breaches. Issue: Cybersecurity and Privacy. H.R. 1523/S. 526 - Modern Worker Empowerment Act. To amend the Fair Labor Standards Act of 1938 to harmonize the definition of employee with the common law. Issue: employee status. S.__ Electronic Signatures in Global and National Commerce Act. To amend the Electronic Signatures in Global and National Commerce Act to accommodate emerging technologies. Issue: electronic signatures Environmental, Social, and Corporate Governance (ESG). No bill number assigned. EO 14032 restrictions on securities related to CMICs H.R. 4350 - National Defense Authorization Act for Fiscal Year 2022. This bill authorizes FY2022 appropriations for military activities and programs of the Department of Defense (e.g., personnel; research, development, test, and evaluation; and procurement of items such as aircraft, missiles, and ammunition). It also prescribes military personnel strengths for FY2022. Issue: remote online notarization and cannabis banking. H.R. 1187 - the ESG Disclosure Simplification Act. This legislation requires the disclosure of key environmental, social, and governance metrics to shareholders of public companies. Issue: ESG. S.Con.Res.14 - Concurrent Resolution on the Budget, FY2022. The budget resolution calls for the $3.5 trillion in long-term investments to be fully offset by a combination of new tax revenues, health care savings, and long-term economic growth. In addition, the agreement would prohibit new taxes on families making less than $400,000 per year, and on small businesses and family farms. Issue: unemployment insurance. S.__ Cannabis Administration and Opportunity Act. This legislation aims to end the decades of harm inflicted on communities of color by removing cannabis from the federal list of controlled substances and empowering states to implement their own cannabis laws. S.2865 - Unemployment Insurance Improvement Act H.R. 3099 - Primary Regulators of Insurance Vote Act of 2021. To amend the Financial Stability Act of 2010 to include the State insurance commissioner as a voting member of the Financial Stability Oversight Council. Issue: FSOC. SEC Proposed Rule to Enhance and Standardize Climate-Related Disclosures for Investors. Issue: ESG Issue: Economic Sanctions on Russia Issue: S&P Global Proposed Methodology And Assumptions For Insurer Risk-Based Capital Adequacy.

Client expense: $250,000 · Firm income: Not reported

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

Public Law 111-203, H.R. 4173- Dodd-Frank Wall Street Reform and Consumer Protection Act. Issue: Implementation and Regulatory reform. Captive Reinsurance Transactions, Insurance Capital Standards and Global Capital Standards. Implementation of S. 2270 - Insurance Capital Standards Clarification Act of 2014. The bill would give the Federal Reserve the authority to tailor capital standards for insurance companies subject to Fed supervision. Issue: Capital Standards, Basel III Implementation of H.R. 748 - the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This bill responds to the COVID-19 (i.e., coronavirus disease 2019) outbreak and its impact on the economy, public health, state and local governments, individuals, and businesses. Issue: CECL, TDR, Remote Online Notarization, SBA loans. H.R. 1255/S. 377 - Living Donor Protection Act of 2021. The bill would promote and protect from discrimination living organ donors. Issue: underwriting. S. 862/H.R. 2068 - Clarifying Law Around Insurance of Marijuana Act. To create a safe harbor for insurers engaging in the business of insurance in connection with a cannabis-related business. Issue: underwriting, anti-money laundering. H.R. 3099 - Primary Regulators of Insurance Vote Act of 2021. To amend the Financial Stability Act of 2010 to include the State insurance commissioner as a voting member of the Financial Stability Oversight Council. Issue: FSOC. Issue: private equitys growing role in the insurance industry. Issue: S&P proposal on the methodology that is used to rate insurance companies. Issue: Russian sanctions legislation. Issue: Request for information from Congress regarding the diversity and inclusion information in the insurance industry. Issue: National Association of Registered Agents and Brokers (NARAB) board. No bill number assigned. Issue: Housing Finance Reform. No bill number assigned. Issue: Final margin rules for uncleared swaps transactions with respect to seeded investment funds. No bill number assigned.

Client expense: $802,683 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Public Law 111-203, H.R. 4173- Dodd-Frank Wall Street Reform and Consumer Protection Act. Issue: Implementation and Regulatory reform. Captive Reinsurance Transactions, Insurance Capital Standards and Global Capital Standards. Implementation of S. 2270 - Insurance Capital Standards Clarification Act of 2014. The bill would give the Federal Reserve the authority to tailor capital standards for insurance companies subject to Fed supervision. Issue: Capital Standards, Basel III Implementation of H.R. 748 - the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This bill responds to the COVID-19 (i.e., coronavirus disease 2019) outbreak and its impact on the economy, public health, state and local governments, individuals, and businesses. Issue: CECL, TDR, Remote Online Notarization, SBA loans. H.R. ___/S. 1083 - Holocaust Insurance Accountability Act of 2021. This bill allows a beneficiary (or an heir of a beneficiary) of certain insurance policies in effect during the Holocaust to sue in U.S. district court to enforce rights under such policies. * H.R. 1255/S. 377 - Living Donor Protection Act of 2021. The bill would promote and protect from discrimination living organ donors. Issue: underwriting. S. 862/H.R. 2068 - Clarifying Law Around Insurance of Marijuana Act. To create a safe harbor for insurers engaging in the business of insurance in connection with a cannabis-related business. Issue: underwriting, anti-money laundering. H.R. 3099 - Primary Regulators of Insurance Vote Act of 2021. To amend the Financial Stability Act of 2010 to include the State insurance commissioner as a voting member of the Financial Stability Oversight Council. Issue: FSOC. Issue: National Association of Registered Agents and Brokers (NARAB) board. No bill number assigned. Issue: Housing Finance Reform. No bill number assigned. Issue: Final margin rules for uncleared swaps transactions with respect to seeded investment funds. No bill number assigned.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.3765, the Temporary Payroll Tax Cut Continuation Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Issues related to Medicare telehealth, including H.R. 2068 (111th Congress), the Medicare Telehealth Enhancement Act. H.R.1546/S.829, the Medicare Access to Rehabilitation Services Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Various issues related to legislation that allows for Medicare coverage of audiology services. Various issues related to CMS actions surrounding Medicare physician supervision requirements. Various issues related to CMS actions surrounding the therapy cap and the institution of a manual medical review process for therapy services. Various issues related to the Physician Quality Reporting System for audiology and speech-language pathology participation. Various issues related to the Medicare Physician Fee Schedule (MPFS), as related to fees for audiology and speech-language pathology services. Various issues related to preservation of Medicaid funding. Various issues related to implementation of H.R. 3200 (111th Congress), the America's Affordable Health Choices Act. H.R. 8, the American Taxpayer Relief Act of 2012 as related to the Medicare Part B cap on outpatient therapy services and other Medicare fees.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE

H.R.3765, the Temporary Payroll Tax Cut Continuation Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Issues related to Medicare telehealth, including H.R. 2068 (111th Congress), the Medicare Telehealth Enhancement Act. H.R.1546/S.829, the Medicare Access to Rehabilitation Services Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Various issues related to legislation that allows for Medicare coverage of audiology services. Various issues related to CMS actions surrounding Medicare physician supervision requirements. Various issues related to CMS actions surrounding the therapy cap and the institution of a manual medical review process for therapy services. Various issues related to the Physician Quality Reporting System for audiology and speech-language pathology participation. Various issues related to the Medicare Physician Fee Schedule (MPFS), as related to fees for audiology and speech-language pathology services. Various issues related to preservation of Medicaid funding. Various issues related to implementation of H.R. 3200 (111th Congress), the America's Affordable Health Choices Act.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE

H.R.3765, the Temporary Payroll Tax Cut Continuation Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Issues related to Medicare telehealth, including H.R. 2068 (111th Congress), the Medicare Telehealth Enhancement Act. H.R.1546/S.829, the Medicare Access to Rehabilitation Services Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Various issues related to legislation that allows for Medicare coverage of audiology services. Various issues related to CMS actions surrounding Medicare physician supervision requirements. Various issues related to the Medicare Physician Fee Schedule (MPFS), as related to fees for audiology and speech-language pathology services. Various issues related to preservation of Medicaid funding. Various issues related to implementation of H.R. 3200 (111th Congress), the America's Affordable Health Choices Act.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE

H.R.3765, the Temporary Payroll Tax Cut Continuation Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Issues related to Medicare telehealth, including H.R. 2068 (111th Congress), the Medicare Telehealth Enhancement Act. Various issues related to legislation that allows for Medicare coverage of audiology services. H.R.1546/S.829, the Medicare Access to Rehabilitation Services Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Various issues related to CMS actions surrounding Medicare physician supervision requirements. Various issues related to the Medicare Physician Fee Schedule (MPFS), as related to fees for audiology and speech-language pathology services. Various issues related to preservation of Medicaid funding. Various issues related to implementation of H.R. 3200 (111th Congress), the America's Affordable Health Choices Act.

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

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

H.R.3765, the Temporary Payroll Tax Cut Continuation Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Issues related to Medicare telehealth, including H.R. 2068 (111th Congress), the Medicare Telehealth Enhancement Act. Various issues related to legislation that allows for Medicare coverage of audiology services. H.R.1546/S.829, the Medicare Access to Rehabilitation Services Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Various issues related to CMS actions surrounding Medicare physician supervision requirements. Various issues related to the Medicare Physician Fee Schedule (MPFS), as related to fees for audiology and speech-language pathology services. Various issues related to preservation of Medicaid funding. Various issues related to implementation of H.R. 3200 (111th Congress), the America's Affordable Health Choices Act.

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

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

H.R.1546/S.829, the Medicare Access to Rehabilitation Services Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Various issues related to implementation of H.R. 3200 (111th Congress), the America's Affordable Health Choices Act. Various issues related to legislation that allows for Medicare coverage of audiology services. Various issues related to CMS actions surrounding Medicare physician supervision requirements. Various issues related to the Medicare Physician Fee Schedule (MPFS), as related to fees for audiology and speech-language pathology services. Various issues related to preservation of Medicaid funding. Issues related to Medicare telehealth, including H.R. 2068 (111th Congress), the Medicare Telehealth Enhancement Act and other demonstration projects.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Occupational Safety & Health Administration (OSHA), SENATE

H.R. 1479/S.905, Hearing Aid Assistance Tax Credit Act 2011, as related to approval of a tax credit for the purchase of hearing aids. Issues related to Medicare telehealth, including H.R. 2068 (111th Congress), the Medicare Telehealth Enhancement Act. H.R. 531, Access to Frontline Health Care Act of 2011, as related to student loan forgiveness.

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

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

Issues related to implementation of H.R. 3200 (111th Congress) related to speech-language pathology and audiology services. Issues related to Medicare telehealth, including H.R. 2068 (111th Congress), Medicare Telehealth Enhancement Act. H.R. 1479, Hearing Aid Assistance Tax Credit Act, as related to approval of a hearing aid tax credit. Issues related to OSHA's hearing conservation programs. H.R. 531, Access to Frontline Health Care Act of 2011, as related to student loan forgiveness.

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

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

HR 27 Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the SCHIP for any fiscal year for certain Medicaid expenditures; HR 465 a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009, a bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals; HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262 Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the MedPAC on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 MedPAC Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the MedPAC, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; H.R. 3138 Physician Payments Sunshine Act of 2009, a bill to amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; HR 3141 Strengthening the Health Care Safety Net Act of 2009, a bill to amend title XIX of the Social Security Act to provide for a DSH redistribution pool from unexpended Medicaid DSH allotments in order to increase Medicaid DSH allotments for low DSH States and to provide grants for health access networks serving the uninsured; H.R. 3152 Helping Seniors Choose their Medicare Drug Plan Act, a bill to amend titles XVIII of the Social Security Act to ensure that low-income beneficiaries have improved access to prescription drugs under the Medicare and Medicaid programs; S. 1423 Medicaid Birth Center Reimbursement Act, a bill to amend title XIX of the Social Security Act to require coverage under the Medicaid Program for freestanding birth center services;. 1427 Department of Veterans Affairs Hospital Quality Report Card Act of 2009, a bill to amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health care quality in Department of Veterans Affairs Medical Centers, and for other purposes; H.R. 3172 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; H.R. 3184 Medicare Independent Living Act of 2009, a bill to amend title XVIII of the Social Security Act to eliminate the in the home restriction for Medicare coverage of mobility devices for individuals with expected long-term needs; H.R. 3356 Medicare Beneficiary Freedom to Choose Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify the use of private contracts by Medicare beneficiaries for professional services and to allow individuals to choose to opt out of the Medicare part A benefits; H.R. 3361 Medicare Patient Safeguards Act of 2009, a bill to provide a process for public comment and Medicare Evidence Development & Coverage Advisory Committee review of certain Medicare national coverage determinations; HR 3369 and S.1521 Improve Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to require provider payments under Medicare and Medicaid to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions; S.1522 Outpatient Mental Health Modernization Act of 2009, a bill to amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program; H.R. 3374 Medicare and Medicaid Access Project through Information Technology (MAP IT) Act, a bill to provide for a demonstration project relating to the impact of health information technology on chronic disease management under the Medicare and Medicaid programs; H.R. 3430 DSH Collaborative Care Network Pilot Program Act of 2009, a bill to establish a Medicare DSH pilot program under which participants shall establish collaborative care networks to reduce the use of emergency departments, inpatient and other expensive resources of hospitals and other providers and provide more comprehensive and coordinated care to low-income individuals, including those without health insurance coverage, and to establish a Collaborative Care Network Center; Neal Letter to Pelosi, Opposition to the Independent Medicare Advisory Council (IMAC) and MedPAC Reform Act (HR 2718, S1110, S 1380); HR 3556 NO TITLE, a bill to require the Secretary of Health and Human Services to establish a self-referral disclosure protocol under the Medicare Program to enable health care providers of services and suppliers to disclose violations of section 1877 of the Social Security Act; S 1669 Equal Access to Medicare Options Act of 2009, a bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy; HR 3631 Medicare Premium Fairness Act, a bill to amend title XVIII to provide for the application of a consistent Medicare part B premium for all Medicare beneficiaries in a budget neutral manner for 2010; HR 3653 Medicare Card Security Act of 2009, a bill to amend title II of the Social Security Act to prohibit the display of Social Security account numbers on Medicare cards; HR 3663 NO TITLE, a bill to amend title XVIII of the Social Security Act to delay the date on which the accreditation requirement under the Medicare Program applies to suppliers of durable medical equipment that are pharmacies; HR 3665 Ryan White Grantee Medicaid Payment Equity Act of 2009, a bill to amend title XIX of the Social Security Act to provide for payment for Medicaid services furnished by Ryan White part C grantees under a cost-based prospective payment system; HR 3675 National Quality Cancer Care Demonstration Project Act of 2009, a bill to improve the quality and cost effectiveness of cancer care to Medicare beneficiaries by establishing a national demonstration project; HR 2962 Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, a bill to amend title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the prohibition on physician self-referral; HR 3693 Ensuring the Future Physician Workforce Act of 2009, a bill to amend title XVIII of the Social Security Act to modify Medicare physician reimbursement policies to ensure a future physician workforce; HR 3961, HR 4154, S 1600 and Reid amendment 3305 Medicare Physician Payment Reform Act of 2009 and Statutory Pay-As-You-Go Act of 2009, a bill to amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration; HR 4250 Medicaid DSH Integrity Act, a bill to direct the Secretary of Health and Human Services to revise regulations implementing the statutory reporting and auditing requirements for the Medicaid disproportionate share hospital ("DSH") payment program to be consistent with the scope of the statutory provisions and avoid substantive changes to preexisting DSH policy; S 1776 Medicare Physician Fairness Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes; S 3000 a bill to extend the increase in the FMAP provided in the American Recovery and Reinvestment Act of 2009 for an additional 6 months; HR 4213 American Workers, State, and Business Relief Act of 2010 a bill that includes an extension of the Recovery Acts increased Federal match for state Medicaid programs. The passed bill extends the increased FMAP through June 30, 2011, which is estimated to provide states with an additional $25.5 billion in FMAP; Letter to Pelosi and Reid expressing opposition to establishment of an Independent Payment Advisory Board (IPAB); Medicaid FMAP ARRA Extension Letter to Senator Reid to include an extension of federal Medicaid assistance to states in legislative proposals to increase employment and rebuild the nations economy; Space, Burgess, Stearns and Engel House Health IT letter and Klobuchar and Hatch Senate Health IT letter to CMS urging a modification of CMS proposed definition of and requirements for hospitals to become qualified as meaningful users of certified electronic health record (EHR) technology; S 3028 Medicare Mental Health Inpatient Equity Act, to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 4872 The Health Care and Education Affordability Reconciliation Act of 2010, to provide for reconciliation pursuant to section 202 of the concurrent resolution on the budget for fiscal year 2010; Meetings with CMS to urge a different interpretation of the Medicare conditions of participation interpretive guidelines on governance which were intepreted to require that each organization with a CCN have a separate governing body, medical staff, etc. in order to be accredited ; HR 5712 Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 to provide for certain clarifications and extensions under Medicare, Medicaid, and the Children's Health Insurance Program; HR 6005 Ensuring Equality for Early EHR Adoption Act of 2010, to amend titles XVIII and XIX of the Social Security Act to provide for the temporary treatment of certain electronic health records as certified EHR technology for purposes of health information technology payment incentives under the Medicare and Medicaid Programs. Sen. Stabenow and Sen. Murkoswki, Rep. Crowley and Rep. Sessions letter to CMS asking to reevaluate the proposed IPPS regulations that will hit hospital payments in FY 2011; Rep. Pomeroy and Rep. Moran letter to CMS, regarding concerns of the proposed Medicare OPPS regulation for FY 2011 does not show continued access to full range of outpatient therapeutic services for small, rural & CAH hospitals; Discussion with CMS about implementation of the self-referral disclosure protocol; HR 5712 Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 or Physician Payment and Therapy Relief Act of 2010, to provide for certain clarifications and extensions under Medicare, Medicaid, and the Children's Health Insurance Program; HR 6005 Ensuring Equality for Early EHR Adoption Act of 2010, to amend titles XVIII and XIX of the Social Security Act to provide for the temporary treatment of certain electronic health records as certified EHR technology for purposes of health information technology payment incentives under the Medicare and Medicaid Programs.

Client expense: $5,390,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office

HR 3200 -- America's Affordable Health Choices Act of 2009 America's Healthy Future Act of 2009; Home health reimbursement HR 2068-- The Medicare Telehealth Enhancement Act of 2009

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 3200 -- America's Affordable Health Choices Act of 2009 America's Healthy Future Act of 2009 HR 2068-- The Medicare Telehealth Enhancement Act of 2009; Home health reimbursement

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

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.

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

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

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), 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), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

Medicare Access to Community Health Centers Act (H.R.1643/S.648); Childrens Health Insurance Program Reauthorization Act of 2009 (H.R.2/S.275); Medicaid Prescription Drug Rebate Equalization Act of 2009(S.547/H.R.904); Medicare Telehealth Enhancement Act of 2009 (H.R.2068); Medicare Transitional Care Act (S.1295); AIDS/HIV/STI Screening Act (no bill#); Kids First (no bill#); Reaching Elders with Assessment and Chronic Care Management and Coordination Act (S.1004); EHR for Health Centers Clarification (H.R.6348); Medicare/Medicaid inclusion of onsite translation, social worker, and non-medically needed transport (no bill#); Coordinated Care Networks (H.R.3043, H.R.1614); Medicare ER Diversion Program (no bill#); DSH Collaborative Care Network Pilot Program Act of 2009 (H.R.3430); Helping Fill the Medicine Rx Gap Act (H.R.2777); Tax Extenders (H.R.4213; Medicare Payment Charge House and Senate FMAP extension.

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

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

American Health Security Act (H.R. 1200); Access for All America Act (H.R. 1296/S.486); Primary Care Volunteer Incentive Act (H.R. 1185); Health Access and Health Professions Supply Act (S.790); Title VII Reauthorization (S.1720); Conrad State 30 Improvement Act (S.628); Recognizing the value of community health centers (HCon.Res.144/S.Con.Res.25). Tri-Caucus Health Equity and Accountant Act; Health Information Technology Public Utility Act of 2009 (S.890); Womens Medical House Demonstration Act (S.1303); Family Healthcare Accessibility Act (H.R.1745); Community Coalitions for Access and Quality Improvement Act (H.R.1614/S.652); Health Access and Health Professions Supply Act (S.790); GAO Study request on VA/CHCs Act (no bill#); Affordable Health Choices Act (H.R.3200); Resident Physician Shortage Act (S.973/H.R.2251); Seniors Mental Health Access Improvement Act (H.R.1693/S.671); Public Health Workforce Development Act (H.R.2620/S.1143); Helping Fill the Medicine Rx Gap Act (H.R.2777/S.1201); Primary Care Training Enhancement Act (H.R.2930); Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act (S.1404); Community & Rural Medical Residency Preservation Act (S.1300) Americas Healthy Future Act of 2009, Chairmans Mark Senate Finance Committee; MedPAC Reform Act of 2009 (S.1110); Consumers Health Care Act of 2009 (S.1278); Preserving Patient Access to Primary Care Act of 2009 (H.R.2350); Senate HELP Affordable Health Choices Act (S.1679); Medicare Telehealth Enhancement Act of 2009 (H.R.2068); Medicare Transition Care Act of 2009 (S.1295); School Based Health Clinic Establishment Act of 2009 (H.R.3003); DSH Collaborative Care Network Pilot Program Act of 2009 (H.R.3430); Affordable Health Care for America Act (H.R.3962); The Patient Protection and Affordable Care Act (H.R.3590); Community-Based Residency Training Act (H.R.4409); Reconciliation Act of 2010 (H.R.4872); EHR Classification for health centers (H.R.6348); Senate EHR/HIT Clarification; Vision Preservation Act (draft); Family Health Care Accessibility Act of 2010(H.R.1745).

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

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

Issues related to home and hospice care, rural telehealth, Medicare and state's health insurance program legislation. Home Health Care Access Protection Act of 2010 (S. 3315) Commission on Improving Long-Term Care and Community Services Act of 2010 (H.R. 5187) Home Health Care Planning Improvement Act of 2010 (H.R. 4993) The Patient Protection and Affordable Care Act" (H.R.3590) Medicare Adult Day Care Services Act of 2009 (H.R. 3043) Medicare Rural Home Health Preservation Act of 2009 (S. 1123) Seniors and Taxpayers Obligation Protection Act of 2009 (S. 975) Medicare Telehealth Enhancement Act of 2009 (H.R. 2068) Medicaid Accountability through Transparency Act (S. 974) Home Healthcare Nurse Promotion Act of 2009 (H.R. 1928) Fostering Independence Through Technology Act of 2009 (S. 457) The Employee Free Choice Act (S. 560/H.R. 1409) The Elder Care Tax Credit (H.R. 517)

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

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

H.R. 3200, America's Affordable Health Choices Act, as related to speech-language pathology and hearing services H.R. 2068, Medicare Telehealth Enhancement Act, as related to inclusion of audiologists and speech-language pathologists H.R. 1646, Hearing Aid Assistance Tax Credit Act, as related to approval of hearing aid tax credits Issues related to OSHA and hearing conservation program feasibility H.R. 1246/S.3199, the Early Hearing Detection and Intervention Act, as related to provisions concerning hearing loss in children. S.3987/H.R.6420 -- Red Flag Program Clarification Act of 2010, as related to the exemption of speech-language pathology and audiology practices.

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

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

S. 3015 (111th Congress)/H.R. 3865 (110th Congress): The Home Health Care Access Protection Act -- all sections S. 457/H.R. 3030: Fostering Independence Through Technology Act of 2009 -- all sections S. 1157: Craig Thomas Rural Hospital and Provider Equity Act -- sections 11, 14, and 18 S. 2814/H.R. 4993: Home Health Care Planning Improvement Act -- all sections H.R. 2068, Medicare Telehealth Enhancement Act -- sections 104, 105, and 106 S. 1131/H.R. 2560: The Independence at Home Act -- All sections H.R.3790: (Bill to repeal competitive acquisition program for DME) All sections H.R. 1: American Recovery and Reinvestment Act of 2009 Sections relating to technology

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

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

Medicare Access to Community Health Centers Act (H.R.1643/S.648); Childrens Health Insurance Program Reauthorization Act of 2009 (H.R.2/S.275); Medicaid Prescription Drug Rebate Equalization Act of 2009(S.547/H.R.904); Medicare Telehealth Enhancement Act of 2009 (H.R.2068); Medicare Transitional Care Act (S.1295); AIDS/HIV/STI Screening Act (no bill#); Kids First (no bill#); Reaching Elders with Assessment and Chronic Care Management and Coordination Act (S.1004); EHR for Health Centers Clarification (H.R.6348); Medicare/Medicaid inclusion of onsite translation, social worker, and non-medically needed transport (no bill#); Coordinated Care Networks (H.R.3043, H.R.1614); Medicare ER Diversion Program (no bill#); DSH Collaborative Care Network Pilot Program Act of 2009 (H.R.3430); Helping Fill the Medicine Rx Gap Act (H.R.2777); Tax Extenders (H.R.4213); Medicare Payment Change House and Senate; FMAP extension.

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

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

American Health Security Act (H.R. 1200); Access for All America Act (H.R. 1296/S.486); Primary Care Volunteer Incentive Act (H.R. 1185); Health Access and Health Professions Supply Act (S.790); Title VII Reauthorization (S.1720); Conrad State 30 Improvement Act (S.628); Recognizing the value of community health centers (HCon.Res.144/S.Con.Res.25). Tri-Caucus Health Equity and Accountant Act; Health Information Technology Public Utility Act of 2009 (S.890); Womens Medical House Demonstration Act (S.1303); Family Healthcare Accessibility Act (H.R.1745); Community Coalitions for Access and Quality Improvement Act (H.R.1614/S.652); Health Access and Health Professions Supply Act (S.790); GAO Study request on VA/CHCs Act (no bill#); Affordable Health Choices Act (H.R.3200); Resident Physician Shortage Act (S.973/H.R.2251); Seniors Mental Health Access Improvement Act (H.R.1693/S.671); Public Health Workforce Development Act (H.R.2620/S.1143); Helping Fill the Medicine Rx Gap Act (H.R.2777/S.1201); Primary Care Training Enhancement Act (H.R.2930); Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act (S.1404); Community & Rural Medical Residency Preservation Act (S.1300) Americas Healthy Future Act of 2009, Chairmans Mark Senate Finance Committee; MedPAC Reform Act of 2009 (S.1110); Consumers Health Care Act of 2009 (S.1278); Preserving Patient Access to Primary Care Act of 2009 (H.R.2350); Senate HELP Affordable Health Choices Act (S.1679); Medicare Telehealth Enhancement Act of 2009 (H.R.2068); Medicare Transition Care Act of 2009 (S.1295); School Based Health Clinic Establishment Act of 2009 (H.R.3003); DSH Collaborative Care Network Pilot Program Act of 2009 (H.R.3430); Affordable Health Care for America Act (H.R.3962); The Patient Protection and Affordable Care Act (H.R.3590); Community-Based Residency Training Act (H.R.4409); Reconciliation Act of 2010 (H.R.4872); EHR Clarification for health centers (H.R.6348); Senate EHR/HIT Clarification; Vision Preservation Act (draft).

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

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

Medically Fragile Children's Act (H.R. 1117) Medicare Access to Rehabilitation Services Act (S. 46/H.R. 43) Medicare Telehealth Enhancement Act (H.R. 2068) Rural Telemedicine Enhancing Community Health Act (S. 2741) Senior's Medication Co-payment Reduction Act (S. 1040) Temporary Extension Act of 2010 (Medicare Therapy Caps) (H.R. 4691) Conditions of Participation for Hospitals and Critical Access Hospitals: Credentialing and Privileging of Telemedicine Physicians and Practitioners (CMS-3227-P)

Client expense: $141,999 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Equal Employment Opportunity Commission (EEOC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), 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 - 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.

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

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

HR 27 Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the SCHIP for any fiscal year for certain Medicaid expenditures; HR 362 and S 318 Medicare Rural Health Access Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas; HR 465 a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; HR 619 a bill to amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; HR 1188 and S 468 Access to Emergency Medical Services Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to emergency medical services and the quality and efficiency of care furnished in emergency departments of hospitals and critical access hospitals by establishing a bipartisan commission to examine factors that affect the effective delivery of such services, by providing for additional payments for certain physician services furnished in such emergency departments, and by establishing a CMS Working Group, and for other purposes; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; Letter to CMS asking to eliminate the state-specific budget neutrality policy for the rural and imputed rural floor indices in the upcoming FY2010 Inpatient Prospective Payment System Rule (IPPS); Working on legislation to amend the Medicare Recovery Audit Contractor Program; S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2124 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and(d) of section 114 of the Medicare, Medicaid, & SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; S 935 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2525 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1108 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; Letters and further discussions to CMS, Physician Supervision for Outpatient Service, resend policy changes requiring direct physician supervision for all PSO therapeutic Outpatient Service provided in and on hospital campus under Medicare, and withdraw change to minimize legal risk for years 2001-2009; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009, a bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2753 a bill to delay the implementation of new Medicare hospital geographic wage reclassification criteria until the Secretary of Health and Human Services issues a proposal to revise the hospital wage index classification system that addresses certain considerations; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals; HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2844 Medicare Payment Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262 Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2919 Medicare Efficiency Incentive Act of 2009, a bill to amend part B of title XVIII of the Social Security Act to provide Medicare physician incentive payments for efficient areas; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the MedPAC on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; HR 2959 Accountable Care Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to establish an accountable care organization pilot program to reduce the growth of expenditures and improve health outcomes under the Medicare Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 MedPAC Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the MedPAC, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; H.R. 3138 Physician Payments Sunshine Act of 2009, a bill to amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; HR 3141 Strengthening the Health Care Safety Net Act of 2009, a bill to amend title XIX of the Social Security Act to provide for a DSH redistribution pool from unexpended Medicaid DSH allotments in order to increase Medicaid DSH allotments for low DSH States and to provide grants for health access networks serving the uninsured; H.R. 3152 Helping Seniors Choose their Medicare Drug Plan Act, a bill to amend titles XVIII of the Social Security Act to ensure that low-income beneficiaries have improved access to prescription drugs under the Medicare and Medicaid programs; S. 1423 Medicaid Birth Center Reimbursement Act, a bill to amend title XIX of the Social Security Act to require coverage under the Medicaid Program for freestanding birth center services; S. 1427 Department of Veterans Affairs Hospital Quality Report Card Act of 2009, a bill to amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health care quality in Department of Veterans Affairs Medical Centers, and for other purposes; H.R. 3172 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; H.R. 3184 Medicare Independent Living Act of 2009, a bill to amend title XVIII of the Social Security Act to eliminate the in the home restriction for Medicare coverage of mobility devices for individuals with expected long-term needs; H.R. 3256 Rural Community Hospital Demonstration Extension Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; H.R. 3356 Medicare Beneficiary Freedom to Choose Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify the use of private contracts by Medicare beneficiaries for professional services and to allow individuals to choose to opt out of the Medicare part A benefits; H.R. 3361 Medicare Patient Safeguards Act of 2009, a bill to provide a process for public comment and Medicare Evidence Development & Coverage Advisory Committee review of certain Medicare national coverage determinations, and for other purposes; HR 3369 and S.1521 Improve Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to require provider payments under Medicare and Medicaid to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions; S.1522 Outpatient Mental Health Modernization Act of 2009, a bill to amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program; H.R. 3374 Medicare and Medicaid Access Project through Information Technology (MAP IT) Act, a bill to provide for a demonstration project relating to the impact of health information technology on chronic disease management under the Medicare and Medicaid programs; H.R. 3422 Medicare Support for Rural Hospitals Act, a bill to amend title XVIII of the Social Security Act to make temporary improvements to the Medicare inpatient payment adjustment for low-volume hospitals; H.R. 3430 DSH Collaborative Care Network Pilot Program Act of 2009, a bill to establish a Medicare DSH pilot program under which participants shall establish collaborative care networks to reduce the use of emergency departments, inpatient and other expensive resources of hospitals and other providers and provide more comprehensive and coordinated care to low-income individuals, including those without health insurance coverage, and to establish a Collaborative Care Network Center; Neal Letter to Pelosi, Opposition to the Independent Medicare Advisory Council (IMAC) and MedPAC Reform Act (HR 2718, S1110, S 1380); HR 3556 NO TITLE, a bill to require the Secretary of Health and Human Services to establish a self-referral disclosure protocol under the Medicare Program to enable health care providers of services and suppliers to disclose violations of section 1877 of the Social Security Act; S 1669 Equal Access to Medicare Options Act of 2009, a bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy; HR 3631 Medicare Premium Fairness Act, a bill to amend title XVIII to provide for the application of a consistent Medicare part B premium for all Medicare beneficiaries in a budget neutral manner for 2010; HR 3653 Medicare Card Security Act of 2009, a bill to amend title II of the Social Security Act to prohibit the display of Social Security account numbers on Medicare cards; HR 3663 NO TITLE, a bill to amend title XVIII of the Social Security Act to delay the date on which the accreditation requirement under the Medicare Program applies to suppliers of durable medical equipment that are pharmacies; HR 3665 Ryan White Grantee Medicaid Payment Equity Act of 2009, a bill to amend title XIX of the Social Security Act to provide for payment for Medicaid services furnished by Ryan White part C grantees under a cost-based prospective payment system; HR 3675 National Quality Cancer Care Demonstration Project Act of 2009, a bill to improve the quality and cost effectiveness of cancer care to Medicare beneficiaries by establishing a national demonstration project; HR 2962 Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, a bill to amend title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the prohibition on physician self-referral; Meeting with CMS re implementation of new requirements for insurance providers to report payment responsibility for Medicare Secondary Payer program; HR 3693 Ensuring the Future Physician Workforce Act of 2009, a bill to amend title XVIII of the Social Security Act to modify Medicare physician reimbursement policies to ensure a future physician workforce; HR 3961, HR 4154, S 1600 and Reid amendment 3305 Medicare Physician Payment Reform Act of 2009 and Statutory Pay-As-You-Go Act of 2009, a bill to amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration; HR 4250 Medicaid DSH Integrity Act, a bill to direct the Secretary of Health and Human Services to revise regulations implementing the statutory reporting and auditing requirements for the Medicaid disproportionate share hospital ("DSH") payment program to be consistent with the scope of the statutory provisions and avoid substantive changes to preexisting DSH policy; S 1776 Medicare Physician Fairness Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes; discussion with the HHS Office of the National Coordinator for Health Information Technology of hospital concerns around development of requirements for meaningful use of Electronic Health Records (EHR) to qualify for Medicare and Medicaid incentive payments for EHR development; S 3000 a bill to extend the increase in the FMAP provided in the American Recovery and Reinvestment Act of 2009 for an additional 6 months; HR 4213 American Workers, State, and Business Relief Act of 2010 a bill that includes an extension of the Recovery Acts increased Federal match for state Medicaid programs. The passed bill extends the increased FMAP through June 30, 2011, which is estimated to provide states with an additional $25.5 billion in FMAP; Letter to Pelosi and Reid expressing opposition to establishment of an Independent Payment Advisory Board (IPAB); Medicaid FMAP ARRA Extension Letter to Senator Reid to include an extension of federal Medicaid assistance to states in legislative proposals to increase employment and rebuild the nations economy; Space, Burgess, Stearns and Engel House Health IT letter and Klobuchar and Hatch Senate Health IT letter to CMS urging a modification of CMS proposed definition of and requirements for hospitals to become qualified as meaningful users of certified electronic health record (EHR) technology; S 3028 Medicare Mental Health Inpatient Equity Act, to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 4872 The Health Care and Education Affordability Reconciliation Act of 2010, to provide for reconciliation pursuant to section 202 of the concurrent resolution on the budget for fiscal year 2010; Meetings with CMS to urge a different interpretation of the Medicare conditions of participation interpretive guidelines, as currently interpreted guidelines would require accreditation of each hospital as a standalone entity and require them to each have a separate governing body, medical staff, etc. in order to be accredited by the joint commission; Crowley- Sessions Letter to CMS urging reevaluation of the IPPS regulation that would apply a 2.9 percent cut to hospital payments in FY 2011; Letter to CMS re development of the Self-referral disclosure protocol that is authorized by the PPACA; HR 5712 Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 to provide for certain clarifications and extensions under Medicare, Medicaid, and the Children's Health Insurance Program; HR 6005 Ensuring Equality for Early EHR Adoption Act of 2010, to amend titles XVIII and XIX of the Social Security Act to provide for the temporary treatment of certain electronic health records as certified EHR technology for purposes of health information technology payment incentives under the Medicare and Medicaid Programs. Sen. Stabenow and Sen. Murkoswki, Rep. Crowley and Rep. Sessions letter to CMS asking to reevaluate the proposed IPPS regulations that will hit hospital payments in FY 2011; Pomeroy, Moran letter to CMS, regarding concersn of the proposed Medicare OPPS regulation for FY 2011 does not show continued access to full range of outpatient therapeutic services for small, rural & CAH hospitals.

Client expense: $4,270,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office

Issues related to home and hospice care, rural telehealth, Medicare and state's health insurance program legislation. Home Health Care Access Protection Act of 2010 (S. 3315) Commission on Improving Long-Term Care and Community Services Act of 2010 (H.R. 5187) Home Health Care Planning Improvement Act of 2010 (H.R. 4993) The Patient Protection and Affordable Care Act" (H.R.3590) Medicare Adult Day Care Services Act of 2009 (H.R. 3043) Medicare Rural Home Health Preservation Act of 2009 (S. 1123) Seniors and Taxpayers Obligation Protection Act of 2009 (S. 975) Medicare Telehealth Enhancement Act of 2009 (H.R. 2068) Medicaid Accountability through Transparency Act (S. 974) Home Healthcare Nurse Promotion Act of 2009 (H.R. 1928) Fostering Independence Through Technology Act of 2009 (S. 457) The Employee Free Choice Act (S. 560/H.R. 1409) The Elder Care Tax Credit (H.R. 517)

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

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

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

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.3200, America's Affordable Health Choices Act of 2009, as related to speech-language pathology and hearing services H.R.2068, Medicare Telehealth Enhancement Act of 2009, related to the inclusion of audiologists and speech-language pathologists H.R. 1646, Hearing Aid Assistance Tax Credit Act, as related to the approval of hearing aid tax credits H.RES.913, as related to the recognition of the American Speech-Language-Hearing Association H.R.1246, Early Hearing Detection and Intervention Act of 2009, as related to provisions concerning hearing loss.

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

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

HR 3200 -- America's Affordable Health Choices Act of 2009 America's Healthy Future Act of 2009 HR 2068-- The Medicare Telehealth Enhancement Act of 2009; Home health reimbursement

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 3200 -- America's Affordable Health Choices Act of 2009 America's Healthy Future Act of 2009; Home health reimbursement HR 2068-- The Medicare Telehealth Enhancement Act of 2009

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

Government targets: 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 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

Client expense: $310,000 · 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), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

S. 3015 (111th Congress)/H.R.3865 (110th Congress): The Home Health Care Access Protection Act - All sections S. 457/H.R. 3030: Fostering Independence Through Technology Act of 2009 -- All sections S. 1157: Craig Thomas Rural Hospital and Provider Equity Act -- sections 11, 14 and 18 S. 2814/H.R.4993: Home Health Care Planning Improvement Act -- All sections H.R. 2068, Medicare Telehealth Enhancement Act -- sections 104, 105, and 106 S. 1131/H.R. 2560: The Independence at Home Act -- All sections S. 1104/H.R. 2307: RE-Aligning Care Act -- All sections S. 421: Medicare Hospice Protection Act -- All sections S. 631: The Patient Safety and Abuse Prevention Act of 2009 -- All sections S. 1123: The Medicare Rural Home Health Preservation Act All sections H.R.3790: (Bill to repeal competitive acquisition program for DME) All sections S.3000: (Bill to extend Medicaid FMAP for six months) All sections H.R.4263: State Medicaid Assistance Extension Act of 2009 All sections H.R. 1: American Recovery and Reinvestment Act of 2009 Sections relating to technology

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

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

Medically Fragile Children's Act (H.R. 1117) Medicare Access to Rehabilitation Services Act (S. 46/H.R. 43) Medicare National Coverage Analysis: Counseling to Prevent Tobacco Use and Tobacco-Caused Disease (CMS-00420N) Medicare National Coverage Analysis: Ventricular Assist Devices (CAG-00119R2) Medicare Telehealth Enhancement Act (H.R. 2068) Rural Telemedicine Enhancing Community Health Act (S. 2741) Senior's Medication Co-payment Reduction Act (S. 1040) Temporary Extension Act of 2010 (Medicare Therapy Caps) (H.R. 4691)

Client expense: $105,016 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Equal Employment Opportunity Commission (EEOC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE

American Health Security Act (H.R. 1200); Access for All America Act (H.R. 1296/S.486); Primary Care Volunteer Incentive Act (H.R. 1185); Health Access and Health Professions Supply Act (S.790); Title VII Reauthorization (S.1720); Conrad State 30 Improvement Act (S.628); Recognizing the value of community health centers (HCon.Res.144/S.Con.Res.25). Tri-Caucus Health Equity and Accountant Act; Health Information Technology Public Utility Act of 2009 (S.890); Womens Medical House Demonstration Act (S.1303); Family Healthcare Accessibility Act (H.R.1745); Community Coalitions for Access and Quality Improvement Act (H.R.1614/S.652); Health Access and Health Professions Supply Act (S.790); GAO Study request on VA/CHCs Act (no bill#); Affordable Health Choices Act (H.R.3200); Resident Physician Shortage Act (S.973/H.R.2251); Seniors Mental Health Access Improvement Act (H.R.1693/S.671); Public Health Workforce Development Act (H.R.2620/S.1143); Helping Fill the Medicine Rx Gap Act (H.R.2777/S.1201); Primary Care Training Enhancement Act (H.R.2930); Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act (S.1404); Community & Rural Medical Residency Preservation Act (S.1300) Americas Healthy Future Act of 2009, Chairmans Mark Senate Finance Committee; MedPAC Reform Act of 2009 (S.1110); Consumers Health Care Act of 2009 (S.1278); Preserving Patient Access to Primary Care Act of 2009 (H.R.2350); Senate HELP Affordable Health Choices Act (S.1679); Medicare Telehealth Enhancement Act of 2009 (H.R.2068); Medicare Transition Care Act of 2009 (S.1295); School Based Health Clinic Establishment Act of 2009 (H.R.3003); DSH Collaborative Care Network Pilot Program Act of 2009 (H.R.3430); Affordable Health Care for America Act (H.R.3962); The Patient Protection and Affordable Care Act (H.R.3590); Community-Based Residency Training Act (H.R.4409); Reconciliation Act of 2010 (H.R.4872).

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

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

Medicare Access to Community Health Centers Act (H.R.1643/S.648); Childrens Health Insurance Program Reauthorization Act of 2009 (H.R.2/S.275); Medicaid Prescription Drug Rebate Equalization Act of 2009(S.547/H.R.904); Medicare Telehealth Enhancement Act of 2009 (H.R.2068); Medicare Transitional Care Act(S.1295); AIDS/HIV/STI Screening Act (no bill#); Kids First (no bill#); Reaching Elders with Assessment and Chronic Care Management and Coordination Act (S.1004); Medicare/Medicaid inclusion of onsite translation, social worker, and non-medically needed transport (no bill#); Coordinated Care Networks (H.R.3043, H.R.1614); Medicare ER Diversion Program (no bill#); DSH Collaborative Care Network Pilot Program Act of 2009(H.R.3430); Helping Fill the Medicine Rx Gap Act (H.R.2777); Tax Extenders (H.R.4213)

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

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

HR 27 Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the SCHIP for any fiscal year for certain Medicaid expenditures; HR 362 and S 318 Medicare Rural Health Access Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas; HR 465 a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; HR 619 a bill to amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; HR 1188 and S 468 Access to Emergency Medical Services Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to emergency medical services and the quality and efficiency of care furnished in emergency departments of hospitals and critical access hospitals by establishing a bipartisan commission to examine factors that affect the effective delivery of such services, by providing for additional payments for certain physician services furnished in such emergency departments, and by establishing a CMS Working Group, and for other purposes; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; Letter to CMS asking to eliminate the state-specific budget neutrality policy for the rural and imputed rural floor indices in the upcoming FY2010 Inpatient Prospective Payment System Rule (IPPS); Working on legislation to amend the Medicare Recovery Audit Contractor Program; S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2124 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and(d) of section 114 of the Medicare, Medicaid, & SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; S 935 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2525 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1108 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; Letters and further discussions to CMS, Physician Supervision for Outpatient Service, resend policy changes requiring direct physician supervision for all PSO therapeutic Outpatient Service provided in and on hospital campus under Medicare, and withdraw change to minimize legal risk for years 2001-2009; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009, a bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2753 a bill to delay the implementation of new Medicare hospital geographic wage reclassification criteria until the Secretary of Health and Human Services issues a proposal to revise the hospital wage index classification system that addresses certain considerations; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals; HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2844 Medicare Payment Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262 Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2919 Medicare Efficiency Incentive Act of 2009, a bill to amend part B of title XVIII of the Social Security Act to provide Medicare physician incentive payments for efficient areas; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the MedPAC on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; HR 2959 Accountable Care Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to establish an accountable care organization pilot program to reduce the growth of expenditures and improve health outcomes under the Medicare Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 MedPAC Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the MedPAC, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; H.R. 3138 Physician Payments Sunshine Act of 2009, a bill to amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; HR 3141 Strengthening the Health Care Safety Net Act of 2009, a bill to amend title XIX of the Social Security Act to provide for a DSH redistribution pool from unexpended Medicaid DSH allotments in order to increase Medicaid DSH allotments for low DSH States and to provide grants for health access networks serving the uninsured; H.R. 3152 Helping Seniors Choose their Medicare Drug Plan Act, a bill to amend titles XVIII of the Social Security Act to ensure that low-income beneficiaries have improved access to prescription drugs under the Medicare and Medicaid programs; S. 1423 Medicaid Birth Center Reimbursement Act, a bill to amend title XIX of the Social Security Act to require coverage under the Medicaid Program for freestanding birth center services; S. 1427 Department of Veterans Affairs Hospital Quality Report Card Act of 2009, a bill to amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health care quality in Department of Veterans Affairs Medical Centers, and for other purposes; H.R. 3172 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; H.R. 3184 Medicare Independent Living Act of 2009, a bill to amend title XVIII of the Social Security Act to eliminate the in the home restriction for Medicare coverage of mobility devices for individuals with expected long-term needs; H.R. 3256 Rural Community Hospital Demonstration Extension Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; H.R. 3356 Medicare Beneficiary Freedom to Choose Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify the use of private contracts by Medicare beneficiaries for professional services and to allow individuals to choose to opt out of the Medicare part A benefits; H.R. 3361 Medicare Patient Safeguards Act of 2009, a bill to provide a process for public comment and Medicare Evidence Development & Coverage Advisory Committee review of certain Medicare national coverage determinations, and for other purposes; HR 3369 and S.1521 Improve Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to require provider payments under Medicare and Medicaid to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions; S.1522 Outpatient Mental Health Modernization Act of 2009, a bill to amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program; H.R. 3374 Medicare and Medicaid Access Project through Information Technology (MAP IT) Act, a bill to provide for a demonstration project relating to the impact of health information technology on chronic disease management under the Medicare and Medicaid programs; H.R. 3422 Medicare Support for Rural Hospitals Act, a bill to amend title XVIII of the Social Security Act to make temporary improvements to the Medicare inpatient payment adjustment for low-volume hospitals; H.R. 3430 DSH Collaborative Care Network Pilot Program Act of 2009, a bill to establish a Medicare DSH pilot program under which participants shall establish collaborative care networks to reduce the use of emergency departments, inpatient and other expensive resources of hospitals and other providers and provide more comprehensive and coordinated care to low-income individuals, including those without health insurance coverage, and to establish a Collaborative Care Network Center; Neal Letter to Pelosi, Opposition to the Independent Medicare Advisory Council (IMAC) and MedPAC Reform Act (HR 2718, S1110, S 1380); HR 3556 NO TITLE, a bill to require the Secretary of Health and Human Services to establish a self-referral disclosure protocol under the Medicare Program to enable health care providers of services and suppliers to disclose violations of section 1877 of the Social Security Act; S 1669 Equal Access to Medicare Options Act of 2009, a bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy; HR 3631 Medicare Premium Fairness Act, a bill to amend title XVIII to provide for the application of a consistent Medicare part B premium for all Medicare beneficiaries in a budget neutral manner for 2010; HR 3653 Medicare Card Security Act of 2009, a bill to amend title II of the Social Security Act to prohibit the display of Social Security account numbers on Medicare cards; HR 3663 NO TITLE, a bill to amend title XVIII of the Social Security Act to delay the date on which the accreditation requirement under the Medicare Program applies to suppliers of durable medical equipment that are pharmacies; HR 3665 Ryan White Grantee Medicaid Payment Equity Act of 2009, a bill to amend title XIX of the Social Security Act to provide for payment for Medicaid services furnished by Ryan White part C grantees under a cost-based prospective payment system; HR 3675 National Quality Cancer Care Demonstration Project Act of 2009, a bill to improve the quality and cost effectiveness of cancer care to Medicare beneficiaries by establishing a national demonstration project; HR 2962 Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, a bill to amend title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the prohibition on physician self-referral; Meeting with CMS re implementation of new requirements for insurance providers to report payment responsibility for Medicare Secondary Payer program; HR 3693 Ensuring the Future Physician Workforce Act of 2009, a bill to amend title XVIII of the Social Security Act to modify Medicare physician reimbursement policies to ensure a future physician workforce; HR 3961, HR 4154, S 1600 and Reid amendment 3305 Medicare Physician Payment Reform Act of 2009 and Statutory Pay-As-You-Go Act of 2009, a bill to amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration; HR 4250 Medicaid DSH Integrity Act, a bill to direct the Secretary of Health and Human Services to revise regulations implementing the statutory reporting and auditing requirements for the Medicaid disproportionate share hospital ("DSH") payment program to be consistent with the scope of the statutory provisions and avoid substantive changes to preexisting DSH policy; S 1776 Medicare Physician Fairness Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes; discussion with the HHS Office of the National Coordinator for Health Information Technology of hospital concerns around development of requirements for meaningful use of Electronic Health Records (EHR) to qualify for Medicare and Medicaid incentive payments for EHR development; S 3000 a bill to extend the increase in the FMAP provided in the American Recovery and Reinvestment Act of 2009 for an additional 6 months; HR 4213 American Workers, State, and Business Relief Act of 2010 a bill that includes an extension of the Recovery Acts increased Federal match for state Medicaid programs. The passed bill extends the increased FMAP through June 30, 2011, which is estimated to provide states with an additional $25.5 billion in FMAP; Letter to Pelosi and Reid expressing opposition to establishment of an Independent Payment Advisory Board (IPAB); Medicaid FMAP ARRA Extension Letter to Senator Reid to include an extension of federal Medicaid assistance to states in legislative proposals to increase employment and rebuild the nations economy; Space, Burgess, Stearns and Engel House Health IT letter and Klobuchar and Hatch Senate Health IT letter to CMS urging a modification of CMS proposed definition of and requirements for hospitals to become qualified as meaningful users of certified electronic health record (EHR) technology; S 3028 Medicare Mental Health Inpatient Equity Act, to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 4872 The Health Care and Education Affordability Reconciliation Act of 2010, to provide for reconciliation pursuant to section 202 of the concurrent resolution on the budget for fiscal year 2010; Meetings with CMS to urge a different interpretation of the Medicare conditions of participation interpretive guidelines, as currently interpreted guidelines would require accreditation of each hospital as a standalone entity and require them to each have a separate governing body, medical staff, etc. in order to be accredited by the joint commission; Crowley- Sessions Letter to CMS urging reevaluation of the IPPS regulation that would apply a 2.9 percent cut to hospital payments in FY 2011.

Client expense: $4,230,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office

H.R. 2068 - The Medicare Telehealth Enhancement Act of 2009 Credentialing and Privileging of Telehealth Providers

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

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

Medically Fragile Children's Act (H.R. 1117) Medicare Access to Rehabilitation Services Act (S. 46/H.R. 43) Medicare National Coverage Analysis: Ventricular Assist Devices (CAG-00119R2) Medicare Telehealth Enhancement Act (H.R. 2068) Rural Telemedicine Enhancing Community Health Act (S. 2741) Senior's Medication Co-payment Reduction Act (S. 1040) Temporary Extension Act of 2010 (Medicare Therapy Caps) (H.R. 4691)

Client expense: $135,901 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Equal Employment Opportunity Commission (EEOC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Transportation, Dept of (DOT)

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

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.3200, America's Affordable Health Choices Act of 2009, as related to speech-language and hearing services H.R.2068, Medicare Telehealth Enhancement Act of 2009, related to the inclusion of audiologists and speech-language pathologists H.R. 1646, Hearing Aid Assistance Tax Credit Act, as related to the approval of hearing aid tax credits H.RES.913, as related to the recognition of the American Speech-Language-Hearing Association

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

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