Prosthetic and Custom Orthotic Parity Act of 2009

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

Parity for insurance reimbursements for prosthetics and custom orthotics, S. 3223, S. 3517, H.R. 2575; Implementation of Affordable Care Act

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

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

Parity for insurance reimbursements for prosthetics and custom orthotics, S. 3517, S. 3223, H.R. 2575; Implementation of Affordable Care Act

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

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

H.R. 724 - America's Partnership for Nursing Education Act; H.R. 1460/S. 1022 - Nurses' Higher Education and Loan Repayment Act; H.R. 1494 - Nursing Home Emergency Assistance Act; S. 179 - Health Information Technology Act; S. 497/H.R. 2043 - Nurse Education, Expansion, and Development Act; H.R. 2350 - Preserving Patient Access to Primary Care Act; Health Reform; H.R. 2381 - Nurse and Health Care Worker Protection Act; H.R. 3962 - Affordable Health Care for America Act; H.R. 3590 - Patient Protection and Affordable Care Act; H.R. 307 - Christopher and Dana Reeve Paralysis Act; H.R. 868 - Direct Support Professional Fairness and Security Act; H.R. 2575/S. 3223 - Prosthetic and Custom Orthotic Parity Act; H.R. 4872 - Reconciliation Act of 2010; H. Res. 510 - Safe Patient Handling and Movement.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), SENATE

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. In health care reform HR 3590. Advocated for health insurance parity for coverage of prosthetic and orthotics devices, components and benefits for other medical and surgical services: under ERISA and HR 2575 for group health plans and group health insurance Supported HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration Supported HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions would have expired without reauthorization. Met with senior Senior SSA officials, as well as Senate and House staff regarding policies and possible legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities, electronic filing of disabilty applications and electronic authorizations for SSA to obtain medical records in connection with disabilities claims. Submitted comments (in response to an SSA request) on complicated medical evidence issues when Social Security disability applicants have a co-occurring alcohol or substance use diagnosis and a serious mental illness. Supported HR 4532 to renew SSAs demonstration authority and to make permanent a successful demonstration that enables both attorneys and non-attorneys (who meet certain qualifications) representing Social Security disability claimants to be paid reasonable fees out of retroactive benefits. This practice enables many claimants (including those with mental illnesses and conditions such as post-traumatic stress disorder) to have good representation rather than to navigate the esoteric and complex application process on their own (often to be denied for procedural rather than substantive reasons). Supported President's Budget proposal for SSA Limitation on Administrative expenses because the increased funding will help cut the backlog and delays in both the initial and hearing level disability determinations, thus providing disability benefits with less delay to people who meet SSA's strict eligibility requirements. Asked HHS to ensure that lifetime caps are prohibited as of September 2010. Health insurance companies are arguing that they can keep lifetime caps on health insurance for up to another year. Met with senior HHS officials to talk about the future of the CLASS Act as well as health reform implementation. Supported the Prosthetic and Custom Orthotic Parity Act of 2010 (HR 2575/S 3220). The legislation would ensure that there that insurance provide equal coverage for prosthetics and orthotics that it does for other medical treatment. Met with senior House and Senate Hill staff to strategize on obtaining sufficient appropriations for the Social Security Administration to reduce the backlog in disability determinations and otherwise better serve people with disabilities. Met with senior SSA officials regarding SSAs new proposal for work incentives under SSDI and other Title II disability Letter in support of S. 3223

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

Patient Protection and Affordable Care Act (P.L. 111-148); Health Care and Education Reconciliation Act (P.L. 111-152) Medicare Orthotics and Prosthetics Improvement Act of 2009 (H.R. 2479); Prosthetic and Custom Orthotic Parity Act of 2009 (H.R. 2575 and S. 3223)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Parity for insurance reimbursements for prosthetics and custom orthotics, S. 3517, S. 3223, H.R. 2575; Implementation of Affordable Care Act

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

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

Parity for insurance reimbursements for prosthetics and custom orthotics, S. 3223, S. 3517, H.R. 2575; Implementation of Affordable Care Act

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

Government targets: 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

H.R. 724 - America's Partnership for Nursing Education Act; H.R. 1460/S. 1022 - Nurses' Higher Education and Loan Repayment Act; H.R. 1494 - Nursing Home Emergency Assistance Act; S. 179 - Health Information Technology Act; S. 497/H.R. 2043 - Nurse Education, Expansion, and Development Act; H.R. 2350 - Preserving Patient Access to Primary Care Act; Health Reform; H.R. 2381 - Nurse and Health Care Worker Protection Act; H.R. 3962 - Affordable Health Care for America Act; H.R. 3590 - Patient Protection and Affordable Care Act; H.R. 307 - Christopher and Dana Reeve Paralysis Act; H.R. 868 - Direct Support Professional Fairness and Security Act; H.R. 2575/S. 3223 - Prosthetic and Custom Orthotic Parity Act; H.R. 4872 - Reconciliation Act of 2010; H. Res. 510 - Safe Patient Handling and Movement.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), 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

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. In health care reform HR 3590. Advocated for health insurance parity for coverage of prosthetic and orthotics devices, components and benefits for other medical and surgical services: under ERISA and HR 2575 for group health plans and group health insurance Supported HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration Supported HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions would have expired without reauthorization. Met with senior Senior SSA officials, as well as Senate and House staff regarding policies and possible legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities, electronic filing of disabilty applications and electronic authorizations for SSA to obtain medical records in connection with disabilities claims. Submitted comments (in response to an SSA request) on complicated medical evidence issues when Social Security disability applicants have a co-occurring alcohol or substance use diagnosis and a serious mental illness. Supported HR 4532 to renew SSAs demonstration authority and to make permanent a successful demonstration that enables both attorneys and non-attorneys (who meet certain qualifications) representing Social Security disability claimants to be paid reasonable fees out of retroactive benefits. This practice enables many claimants (including those with mental illnesses and conditions such as post-traumatic stress disorder) to have good representation rather than to navigate the esoteric and complex application process on their own (often to be denied for procedural rather than substantive reasons). Supported President's Budget proposal for SSA Limitation on Administrative expenses because the increased funding will help cut the backlog and delays in both the initial and hearing level disability determinations, thus providing disability benefits with less delay to people who meet SSA's strict eligibility requirements. Asked HHS to ensure that lifetime caps are prohibited as of September 2010. Health insurance companies are arguing that they can keep lifetime caps on health insurance for up to another year. Met with senior HHS officials to talk about the future of the CLASS Act as well as health reform implementation. Supported the Prosthetic and Custom Orthotic Parity Act of 2010 (HR 2575/S 3220). The legislation would ensure that there that insurance provide equal coverage for prosthetics and orthotics that it does for other medical treatment. Met with senior House and Senate Hill staff to strategize on obtaining sufficient appropriations for the Social Security Administration to reduce the backlog in disability determinations and otherwise better serve people with disabilities. Met with senior SSA officials regarding SSAs new proposal for work incentives under SSDI and other Title II disability

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

Patient Protection and Affordable Care Act (P.L. 111-148); Health Care and Education Reconciliation Act (P.L. 111-152) Medicare Orthotics and Prosthetics Improvement Act of 2009 (H.R. 2479); Prosthetic and Custom Orthotic Parity Act of 2009 (H.R. 2575 and S. 3223)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 724 - America's Partnership for Nursing Education Act; H.R. 1460/S. 1022 - Nurses' Higher Education and Loan Repayment Act; H.R. 1494 - Nursing Home Emergency Assistance Act; S. 179 - Health Information Technology Act; S. 497/H.R. 2043 - Nurse Education, Expansion, and Development Act; H.R. 2350 - Preserving Patient Access to Primary Care Act; Health Reform; H.R. 2381 - Nurse and Health Care Worker Protection Act; H.R. 3962 - Affordable Health Care for America Act; H.R. 3590 - Patient Protection and Affordable Care Act; H.R. 307 - Christopher and Dana Reeve Paralysis Act; H.R. 868 - Direct Support Professional Fairness and Security Act; H.R. 2575/S. 3223 - Prosthetic and Custom Orthotic Parity Act; H.R. 4872 - Reconciliation Act of 2010; H. Res. 510 - Safe Patient Handling and Movement.

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

Parity for insurance reimbursements for prosthetics and custom orthotics, S. 3517, S. 322, H.R. 2575

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Parity for insurance reimbursements for prosthetics and custom orthotics, S. 3223, S. 3517, H.R. 2575

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

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 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

Community Living Assistance and Supports Act (CLASS Act) to create a national insurance program financed by voluntary payroll deductions to provide services to assist people with activities of daily living in order to stay in their homes and communities if they become disabled. People would not be required to qualify for Medicaid or go into a nursing home or other institution in order to receive benefits. In health care reform HR 3590. Advocated for health insurance parity for coverage of prosthetic and orthotics devices, components and benefits for other medical and surgical services: under ERISA and HR 2575 for group health plans and group health insurance Social Security: HR 1093 regarding fee caps to help make sure that attorneysand others representing Social Security disability claimants are paid in a timely manner and to index the allowed fees to the Cost of Living Adjustment. H.R. 2829, the Recidivism Reduction Act to expedite reinstatement of Social Security, SSI, and Medicaid benefits for eligible individuals after incarceration HR 3325 to reauthorize through fiscal 2010 the Work Incentives Planning and Assistance program and the Protection and Advocacy for Beneficiaries of Social Security program, both of which provide employment-related services for people with disabilities. These provisions would have expired without reauthorization. Met with senior Senior SSA officials, as well as Senate and House staff regarding policies and possible legislation to expedite obtaining and review of medical records of disability claimants while protecting privacy rights of people with disabilities, electronic filing of disabilty applications and electronic authorizations for SSA to obtain medical records in connection with disabilities claims. - Met with SSA senior staff regarding draft report of SSA's Occupational Information Development Advisory Panel (OIDAP) that recommends dramatically different procedures to determine eligibility fordisability benefits under both Title II and Title XVI programs. -- Commented on on disabilty determinations for people with drug addiction and/or alcoholism. Supported HR 4532 to renew SSAs demonstration authority and to make permanent a successful demonstration that enables both attorneys and non-attorneys (who meet certain qualifications) representing Social Security disability claimants to be paid reasonable fees out of retroactive benefits. This practice enables many claimants (including those with mental illnesses and conditions such as post-traumatic stress disorder) to have good representation rather than to navigate the esoteric and complex application process on their own (often to be denied for procedural rather than substantive reasons). - Supported President's Budget proposal for SSA Limitation on Administrative expenses because the increased funding will help cut the backlog and delays in both the initial and hearing level disability determinations, thus providing disability benefits with less delay to people who meet SSA's strict eligibility requirements.

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

Private insurance coverage issues pertaining to post-surgical mastectomy products [Patient Protection and Affordable Care Act (H.R. 3590); Affordable Health Care for America Act (H.R. 3962); Prosthetics and Custom Orthotic Parity Act (H.R. 2575) all provisions]; H.R. 4872: Health Care and Education Reconciliation Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.3200 America's Affordable Health Choices Act of 2009; H.R.3590 Patient Protection and Affordable Care Act; H.R.4872 Health Care and Education Reconciliation Act of 2010; H.R. 2575 Prosthetic and Orthotic Parity; H.RES. 1056 Expressing support for designation of April as National Limb Loss Awareness Month

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

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

H.R. 724 - America's Partnership for Nursing Education Act; H.R. 1460/S. 1022 - Nurses' Higher Education and Loan Repayment Act; H.R. 1494 - Nursing Home Emergency Assistance Act; S. 179 - Health Information Technology Act; S. 497/H.R. 2043 - Nurse Education, Expansion, and Development Act; H.R. 2350 - Preserving Patient Access to Primary Care Act; Health Reform; H.R. 2381 - Nurse and Health Care Worker Protection Act; H.R. 3962 - Affordable Health Care for America Act; H.R. 3590 - Patient Protection and Affordable Care Act; H.R. 307 - Christopher and Dana Reeve Paralysis Act; H.R. 868 - Direct Support Professional Fairness and Security Act; H.R. 2575 - Prosthetic and Custom Orthotic Parity Act; H.R. 4872 - Reconciliation Act of 2010.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), SENATE

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. HR 3200 in House, Americas Healthy Future Act (Senate Finance Committee) and Affordable Health Choices Act (Senate HELP Committee) - no Senate bill numbers yet. Support health care reform legislation and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and all Americans (including those who lack health insurance). Issues with asterisks indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for insurance market reforms, such as those included in the Senates Affordable Health Choices Act and the Houses Americas Affordable Health Choices Act that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: oRequiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. oProhibiting annual and lifetime caps on coverage. Currently many insurance companies have a lifetime benefit of $1 million. People with serious injuries or conditions often quickly exceed this cap due to lengthy hospital stays or extensive rehabilitation oRequiring health insurance to cover rehabilitation and habilitative services and durable medical equipment, prosthetics and orthodics. oStop or limit copays for preventive care. Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) Act* and the Community Choice Act.* Provide for comparative effectiveness research and using the resulting information in ways that respects that what works for many people will not work for all; Provide for prevention and wellness including oDeveloping standards for accessible medical equipment; oAuthorizing funds to establish a Prevention and Public Health Investment Fund; oProviding for community Transformation Grants that include focus on the needs of people with disabilities; oIncluding disability status within data collection on health disparities; oProviding training programs for primary care providers and dentistry on how to treat individuals with disabilities; Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including oCovering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs -- that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. CLASS Act* -- S. 697/H.R. 1721 included in the Senates Affordable Health Choices Act. legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living, remain in their homes and off of the Medicaid program. CBO estimates that the CLASS Act will bring billions into the federal treasury and save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670) make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. End Medicares 24-month waiting period* - S 700/HR 1708 -- end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* create non-government independent entities to study the comparative effectiveness of treatments in health care. HR 1346/S 540 * regarding immunity from state laws for companies that have products that are approved medical devices but that cause harm. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Urged legislation to clarify that state Medicaid plans must ensure the provision of mandated care and Services to needy individuals not simply reimburse them, if they manage to obtain such services. (HR 3200 s. 1781(e) (page 826)) Without such a clarifying provision, current trends in the courts could significantly contract the availability of health services to underserved individuals and groups. First month purchase option Maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use so people with long term need will get the wheelchair that they need. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported language in HR 3200 and Senate Finance health bill that would exempt Class III and higher power wheel chairs from the rental period. Community First Choice Option in Americas Healthy Future Act -- allow states to create Medicaid plans that would reverse the institutional bias in Medicaid and provided 6% increase in FMAP matching funds to states. H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. In the House, HR 3962 (Affordable Care for America Act) and in the Senate HR 3590 (Patient Protection and Affordable Care Act) and Americas Healthy Future Act (Senate Finance Committee) and Affordable Health Choices Act (Senate HELP Committee). Support health care reform legislation and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. Provide for insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the medical device excise tax that is proposed in both the House and Senate bills. The excise tax on manufacturers would increase their costs and could potentially increase costs for medical equipment for people with disabilities and chronic conditions who depend on them. Provide for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Provide for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 150% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. continued on next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

Private insurance coverage issues pertaining to post-surgical mastectomy products [Patient Protection and Affordable Care Act (H.R. 3590); Affordable Health Care for America Act (H.R. 3962); Prosthetics and Custom Orthotic Parity Act (H.R. 2575) all provisions]

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.3590 Patient Protection and Affordable Care Act; S.1679 Affordable Health Choices Act; H.R.3962 Affordable Health Care for America Act; H.R. 2575 Prosthetic and Orthotic Parity

Client expense: Not reported · Firm income: Not reported

Government targets: Army, Dept of (Other), SENATE

H.R. 724 - America's Partnership for Nursing Education Act; H.R. 1460/S. 1022 - Nurses' Higher Education and Loan Repayment Act; H.R. 1494 - Nursing Home Emergency Assistance Act; S. 179 - Health Information Technology Act; S. 497/H.R. 2043 - Nurse Education, Expansion, and Development Act; H.R. 2350 - Preserving Patient Access to Primary Care Act; Health Reform; H.R. 2381 - Nurse and Health Care Worker Protection Act; H.R. 3962 - Affordable Health Care for America Act; H.R. 3590 - Patient Protection and Affordable Care Act; H.R. 307 - Christopher and Dana Reeve Paralysis Act; H.R. 868 - Direct Support Professional Fairness and Security Act; H.R. 2575 - Prosthetic and Custom Orthotic Parity Act.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), SENATE

H.R. 2575 (Prosthetic & Orthotic Parity Act), senate version waiting to be introduced.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2575 (Prosthetic & Orthotic Parity Act), senate version, waiting to be introduced

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. HR 3200 in House, Americas Healthy Future Act (Senate Finance Committee) and Affordable Health Choices Act (Senate HELP Committee) - no Senate bill numbers yet. Support health care reform legislation and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and all Americans (including those who lack health insurance). Issues with asterisks indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for insurance market reforms, such as those included in the Senates Affordable Health Choices Act and the Houses Americas Affordable Health Choices Act that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: oRequiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. oProhibiting annual and lifetime caps on coverage. Currently many insurance companies have a lifetime benefit of $1 million. People with serious injuries or conditions often quickly exceed this cap due to lengthy hospital stays or extensive rehabilitation oRequiring health insurance to cover rehabilitation and habilitative services and durable medical equipment, prosthetics and orthodics. oStop or limit copays for preventive care. Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) Act* and the Community Choice Act.* Provide for comparative effectiveness research and using the resulting information in ways that respects that what works for many people will not work for all; Provide for prevention and wellness including oDeveloping standards for accessible medical equipment; oAuthorizing funds to establish a Prevention and Public Health Investment Fund; oProviding for community Transformation Grants that include focus on the needs of people with disabilities; oIncluding disability status within data collection on health disparities; oProviding training programs for primary care providers and dentistry on how to treat individuals with disabilities; Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including oCovering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs -- that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. CLASS Act* -- S. 697/H.R. 1721 included in the Senates Affordable Health Choices Act. legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living, remain in their homes and off of the Medicaid program. CBO estimates that the CLASS Act will bring billions into the federal treasury and save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670) make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. End Medicares 24-month waiting period* - S 700/HR 1708 -- end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* create non-government independent entities to study the comparative effectiveness of treatments in health care. HR 1346/S 540 * regarding immunity from state laws for companies that have products that are approved medical devices but that cause harm. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Urged legislation to clarify that state Medicaid plans must ensure the provision of mandated care and Services to needy individuals not simply reimburse them, if they manage to obtain such services. (HR 3200 s. 1781(e) (page 826)) Without such a clarifying provision, current trends in the courts could significantly contract the availability of health services to underserved individuals and groups. First month purchase option Maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use so people with long term need will get the wheelchair that they need. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported language in HR 3200 and Senate Finance health bill that would exempt Class III and higher power wheel chairs from the rental period. Community First Choice Option in Americas Healthy Future Act -- allow states to create Medicaid plans that would reverse the institutional bias in Medicaid and provided 6% increase in FMAP matching funds to states. H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services.

S. 634/HR 1585, HR 1324, HR 1995/S. 844, HR 2426/S.1048, HR 2575, HR 3200, S. 1679, Americas Healthy Future Act (no number assigned to date), HR 2590, S. 1040, HR 2730, S. 254/HR 574, HR 2360/S. 979, HR 3668, S. 1473/HR 1402. (See next page) S. 634/HR 1585, The Fitness Integrated with Teaching Kids Act Support entire bill; Amends the Elementary and Secondary Education Act of 1965 to improve standards for physical education. (Lobbyists used: Meghan Riley) HR 1324, The Child Nutrition Promotion and School Lunch Protection Act of 2009 Support entire bill; To amend the Child Nutrition Act of 1966 to improve the nutrition and health of school children by updating the definition of `food of minimal nutritional value' to conform to current nutrition science and to protect the Federal investment in the national school lunch and breakfast programs. (Lobbyists used: Meghan Riley) HR 1995/S. 844, The Eliminating Disparities in Prevention, Access and Care Act Support entire bill: Would expand resources at NIH and CDC to promote research, treatment, and education regarding diabetes in minority populations. (Lobbyists used: Meghan Riley, Kathryn Murray) HR 2426/S.1048, The Menu Education and Labeling (MEAL) Act - ADA supports legislation to provide nutritional information on menus in chain restaurants. ADA also supports menu labeling language included in the S. 1679, Affordable Health Choices Act (Lobbyist used: Meghan Riley) HR 2575, The Prosthetic and Custom Orthotic Parity Act of 2009 ADA supports the entire bill; to ensure equal treatment for patients who have suffered limb loss. (Lobbyists used: Meghan Riley) HR 3200, America's Affordable Health Choices Act of 2009 ADA is interested in any reform of the health care system and has spoken with offices about this legislation. Specifically, ADA is working to discuss coverage, access, quality, prevention issues. We are supportive of health care reform but have not given expressed support of this bill. (Lobbyists used: Tekisha Dwan Everette, Kathryn Murray, Meghan Riley) S. 1679, Affordable Health Choices Act - ADA is interested in any reform of the health care system and has spoken with offices about legislation. Specifically, ADA is working on coverage, access, quality, and prevention issues. We are supportive of health care reform but have not endorsed any specific piece of legislation in the Senate. (Lobbyists used: Tekisha Dwan Everette, Kathryn Murray, Meghan Riley) Americas Healthy Future Act (no number assigned to date) - ADA is interested in any reform of the health care system and has spoken with offices about legislation. Specifically, ADA is working on coverage, access, quality, and prevention issues. We are supportive of health care reform but have not endorsed any specific piece of legislation in the Senate. (Lobbyists used: Tekisha Dwan Everette, Kathryn Murray, Meghan Riley) HR 2590, The Preventing Diabetes in Medicare Act - ADA supports the entire bill to provide for medical nutrition therapy under Medicare. (Lobbyists used: Meghan Riley) S. 1040, Seniors Medication Co-Payment Reduction Act - ADA supports the entire bill to provide value-based insurance design. (Lobbyist used: Meghan Riley) HR 2730, The Student-to-School Nurse Ratio Improvement Act - ADA supports the entire bill to increase the number of school nurses relative to students. (Lobbyist used: Meghan Riley) S. 254/HR 574, Medicare Home Infusion Therapy Coverage Act ADA supports the entire bill to provide coverage of home infusion therapy under the Medicare program. (Lobbyist Used: Kathryn Murray) HR 2360/S. 979, The Small Business Health Options Program Act of (SHOP Act). Neutral, but held conversations about possible changes; To amend the Public Health Service Act to establish a nationwide health insurance purchasing pool for small businesses and the self employed that would offer a choice of private health plans and make health coverage more affordable, predictable, and accessible. (Lobbyists used: Kathryn Murray) HR 3668 - ADA supports the entire bill; A bill to reauthorize the Special Diabetes Programs for Type 1 diabetes and Indians. (Lobbyist Used: Tekisha Dwan Everette) S. 1473/HR 1402, Catalyst to Better Diabetes Care Act of 2009 ADA supports the entire bill to change the care and treatment of diabetes in the US. (Lobbyist Used: Kathryn Murray) Issues worked on the Hill not yet reflected in legislation: The Gestational Diabetes Act (GeDi Act) - Support entire bill; Legislation expands screening, diagnosis, data collection and treatment of gestation diabetes and the children born from women with gestational diabetes. (Lobbyists used: Kathryn Murray, Meghan Riley) The Diabetes Treatment and Prevention Act Support entire bill; Amends the Public Health Service Act to require the Director of the Centers for Disease Control and Prevention (CDC) to establish the Division of Diabetes Translation to eliminate diabetes, allocates funding for the Division of Diabetes Translation, and provides for pilot programs for diabetes. (Lobbyists used: Meghan Riley, Kathryn Murray) Diabetes coordinator; ADA is interested in supporting legislation that will create a diabetes coordinator within the Department of Health and Human Services. (Lobbyist used: Meghan Riley, Kathryn Murray) Diabetes Prevention Program; ADA is pursuing legislation to expand the DPPI, a community-based diabetes prevention program that stemmed from the successful NIH Clinical Trial. (Lobbyist used: Meghan Riley)

Private insurance coverage issues pertaining to post-surgical mastectomy products [America's Affordable Health Choices Act (H.R. 3200); Affordable Health Choices Act (S. 1679); Americas Healthy Future Act draft; Prosthetics and Custom Orthotic Parity Act (H.R. 2575) all provisions]

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See next page Support comprehensive health care reform and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and all Americans (including those who lack health insurance). We hope that comprehensive health care reform will: Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) Act* and the Community Choice Act.* Provide for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Provide for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry on how to treat individuals with disabilities; Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs -- that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. Provide for insurance market reforms, such as those included in the Senates Affordable Health Choices Act and the Houses Americas Affordable Health Choices Act that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting lifetime caps on coverage. Currently many insurance companies have a lifetime benefit of $1 million. People with serious injuries or conditions often quickly exceed this cap due to lengthy hospital stays or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. *Pursued both independently and as part of health care reform: CLASS Act* -- S. 697/H.R. 1721 included in the Senates Affordable Health Choices Act. Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS Act will bring billions into the federal treasury and save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. HR 1346/S 540 * Support legislation to prohibit immunity from state laws for companies that have products that are approved medical devices but that cause harm. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services.

Prosthetic and Orthotic Parity Act (HR 2575) Healthcare reform (HR 3200, Affordable Health Choices Act, Medicare Two Year Waiting Period, health disparities, first month purchase option)

Client expense: Not reported · Firm income: Not reported

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

See next page Support comprehensive health care reform and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and all Americans (including those who lack health insurance). We hope that comprehensive health care reform will: Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) Act* and the Community Choice Act.* Provide for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Provide for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry on how to treat individuals with disabilities; Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs -- that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. Provide for insurance market reforms, such as those included in the Senates Affordable Health Choices Act and the Houses Americas Affordable Health Choices Act that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting lifetime caps on coverage. Currently many insurance companies have a lifetime benefit of $1 million. People with serious injuries or conditions often quickly exceed this cap due to lengthy hospital stays or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. *Pursued both independently and as part of health care reform: CLASS Act* -- S. 697/H.R. 1721 included in the Senates Affordable Health Choices Act. Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS Act will bring billions into the federal treasury and save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. HR 1346/S 540 * Support legislation to prohibit immunity from state laws for companies that have products that are approved medical devices but that cause harm. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services.

Private insurance coverage issues pertaining to post-surgical mastectomy products; House and Senate comprehensive health reform legislation; Affordable Health Choices Act draft; HR 2575- Prosthetics and Custom Orthotic Parity Act (all provisions)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See next paget for S. 634/HR1585 ,HR 1324, H.R. 1402, H.R. 2360/S. 979, H.R. 2426/S. 1048, H.R. 2575, H.R. 1995/S. 844, H.R. 3200. S. 634/HR1585, The Fitness Integrated with Teaching Kids Act of 2007 Support entire bill; Amends the Elementary and Secondary Education Act of 1965 to improve standards for physical education. (Lobbyists used: Abby Bownas, Meghan Riley) HCR HR 1324, the Child Nutrition Promotion and School Lunch Protection Act of 2009. Support entire bill; To amend the Child Nutrition Act of 1966 to improve the nutrition and health of schoolchildren by updating the definition of `food of minimal nutritional value' to conform to current nutrition science and to protect the Federal investment in the national school lunch and breakfast programs. (Lobbyists used: Abby Bownas, Meghan Riley) HCR H.R. 1402, the Catalyst to Better Diabetes Care Act of 2009 Support the entire bill; to catalyze change in the care and treatment of diabetes in the United States. (Lobbyists used: Abby Bownas, Kathryn Murray) HCR H.R. 1995/S. 844, The Eliminating Disparities in Prevention, Access and Care Act Support entire bill: Would expand resources at NIH and CDC to promote research, treatment, and education regarding diabetes in minority populations. (Lobbyists used: Abby Bownas, Meghan Riley, Kathryn Murray) HCR H.R. 2360/S. 979, The Small Business Health Options Program Act of (SHOP Act). Neutral, but held conversations about possible changes; To amend the Public Health Service Act to establish a nationwide health insurance purchasing pool for small businesses and the self employed that would offer a choice of private health plans and make health coverage more affordable, predictable, and accessible. (Lobbyists used: Kathryn Murray, Abby Bownas, Ken Van Pool) HCR H.R. 2426/S. 1048, the Menu Labeling and Education (MEAL) Act, ADA supports legislation to provide nutritional information on menus in chain restaurants. ADA also supports menu labeling language included in the Affordable Health Choices Act, draft health reform legislation. (Lobbyist used: Meghan Riley, Abby Bownas) HCR H.R. 2575, The Prosthetic and Custom Orthotic Parity Act ADA support the entire bill; to ensure equal treatment for patients who have suffered limb loss. (Lobbyists used: Abby Bownas, Meghan Riley) HCR H.R. 3200, Health Care Reform; ADA is interested in any comprehensive reform of the health care system. Specifically, ADA is working to discuss coverage, access, quality, prevention issues. Draft legislation, the Affordable Health Care Choices Act, has been introduced in both the House and the Senate but has not been assigned bill numbers. (Lobbyists used: Abby Bownas, Kathryn Murray, Meghan Riley, Peter Kay, Ken Van Pool) HCR Issues worked on the Hill not yet reflected in legislation: Transportation Reauthorization; ADA is interested in the drafting of the successor to SAFETEA-LU transportation reauthorization legislation. Support developing performance based outcomes related to public health for the next transportation bill, including physical activity and Safe Routes to School. (Lobbyists used: Abby Bownas, Meghan Riley.) The Child Nutrition Reauthorization: ADA is interested in certain provisions that may be included in the Child Nutrition Reauthorization that will be drafted this year. Provisions affecting school meals, foods sold outside of school meals and local wellness policies will all be included in this omnibus legislation and are of interest to ADA. (Lobbyist used: Meghan Riley.) The Gestational Diabetes Act (GeDi Act) - Support entire bill; Legislation expands screening, diagnosis, data collection and treatment of gestation diabetes and the children born from women with gestational diabetes. (Lobbyists used: Abby Bownas, Kathryn Murray, Meghan Riley) HCR The Diabetes Treatment and Prevention Act Support entire bill; Amends the Public Health Service Act to require the Director of the Centers for Disease Control and Prevention (CDC) to establish the Division of Diabetes Translation to eliminate diabetes, allocates funding for the Division of Diabetes Translation, and provides for pilot programs for diabetes. (Lobbyists used: Abby Bownas, Peter Kay, Meghan Riley, Kathryn Murray) HCR The Diabetes Screening and Medicaid Savings Act Support the entire bill; Amends title XIX (Medicaid) of the Social Security Act to require states to provide diabetes screening tests under the Medicaid program for adult enrollees with diabetes risk factors and provides a comprehensive package for individuals with diabetes. (Lobbyist used: Abby Bownas, Kathryn Murray) HCR Diabetes coordinator; ADA is interested in supporting legislation that will create a diabetes coordinator within the Department of Health and Human Services. (Lobbyist used: Abby Bownas, Kendall Van Pool, Meghan Riley, Kathryn Murray) HCR