Transparency in All Health Care Pricing Act of 2010

See attached addendum for General Lobbying Issue Area: HRC - Health Care Health Care Reform Bill HR 3590 "Patient Protection and Affordable Care Act". parts pertaining to health care reform; Health Care Reconciliation Bill HR 4872 "The Health Care and Education Affordability Reconcilation Act of 2010", parts pertaining to health care reform, reasonable effective dates for compliance with insurance reforms, affordable premiums (insurer tax, insufficient cost containment, weak mandate, restricted age discounts, insurer fees); federal health insurance rate authority, national insurance exchange, grandfathering. Also, subsequent bills/provisions to clarify implementation of HR 3590/HR 4872. Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges. Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations. Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies. Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications. Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels. Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits". Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: "good faith compliance standard", reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR 4757 "Health Insurance Rate Authority Act of 2010"; federal rate review; HR 4700 "Transparency in All Health Care Pricing Act of 2010"; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical home; Health Disparities; Wellness; Chronic Care management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Mandate; MEWAs

Client expense: Not reported · Firm income: Not reported

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

S 2 Middle Class Opportunity Act, Card Check provisions; S 45 MCAP Act, a bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; S 77 Children's Mental Health Parity Act, a bill to amend title XXI of the Social Security Act to provide for equal coverage of mental health services under the State Children's Health Insurance Program; HR 241, a bill to amend title 10, United States Code to require the amounts reimbursed to institutional providers of health care services under the TRICARE program to be the same as amounts reimbursed under Medicare, and to require the Secretary of Defense to contract for health care services with at least one teaching hospital in urban areas; HR 298 Improving Children's Doctor Access Act of 2009, a bill to amend title XXI of the Social Security Act to require SCHIP annual reports to include information on the HEDIS measure relating to access to primary care practitioners by individuals eligible for child health assistance under such plans and on State efforts to avoid certain displacement of private health coverage, and to express the sense of Congress that such States should utilize Consumer Assessment of Healthcare Providers and Systems consumer satisfaction surveys to measure access by such individuals to physicians; HR 468 and S 245 Retooling the Health Care Workforce for an Aging America Act of 2009, a bill to expand, train, and support all sectors of the health care workforce to care for the growing population of older individuals in the United States; HR 676 United States National Health Care Act or the Expanded and Improved Medicare for All Act, a bill to provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes; HR 688 and S 326 Kids First Act, a bill to amend title XXI of the Social Security Act to reauthorize the State Children's Health Insurance Program through fiscal year 2013, and for other purposes; Tricare letter sent to DOD from Sen. Ben Nelson urging DoD to revise the rule, expand the transition to the new payment system, offer other adjustments to cushion the financial blow on certain hospitals, and conduct a detailed analysis of its impact on the field; S 391 Healthy Americans Act, a bill to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away; HR 914 Physician Workforce Enhancement Act of 2009, a bill to amend title VII of the Public Health Service Act to establish a loan program for eligible hospitals to establish residency training programs; HR 936 National Trauma Center Stabilization Act of 2009, a bill to ensure the continued and future availability of lifesaving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, emergency needs, and information technology; S 408 Wakefield Act, a bill to amend the Public Health Service Act to provide a means for continued improvement in emergency medical services for children; HR 1086 Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009; a bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; HR 1101 Midwifery Care Access and Reimbursement Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for reimbursement of certified midwife services and to provide for more equitable reimbursement rates for certified nurse-midwife services; HR 1296 Access for All America Act, a bill to achieve access to comprehensive primary health care services for all Americans and to reform the organization of primary care delivery through an expansion of the Community Health Center and National Health Service Corps programs; HR 1411 United States Primary and Preventive Health Care Corps Act of 2009, a bill to amend the Public Health Service Act to establish a Primary and Public Health Scholarship Program; HR 1460 Nurses Higher Education and Loan Repayment Act, a bill to amend the Public Health Service Act to establish a graduate degree loan repayment program for nurses who become nursing school faculty members; HR 1494 Nursing Home Emergency Assistance Act, a bill to ensure that a private for-profit nursing home affected by a major disaster receives the same reimbursement as a public nursing home affected by a major disaster; HR 1558 and S 623 Preexisting Condition Patient Protection Act of 2009, to prohibit health insurers from denying coverage to people with pre-existing conditions; S 616 Enhancing Safety in Medicine Utilizing Leading Advanced Simulation Technologies to Improve Outcomes Now Act of 2009, a bill to amend the Public Health Service Act to authorize medical simulation enhancement programs, and for other purposes; HR 1581 Patient-Focused Critical Care Enhancement Act, a bill to optimize the delivery of critical care medicine and expand the critical care workforce; S 628 Conrad State 30 Improvement Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities; HR 1614 and S 652 Community Coalitions for Access and Quality Improvement Act of 2009, a bill to authorize the Secretary of Health and Human Services to make grants to community health coalitions to assist in the development of integrated health care delivery; HR 1691 and S 688 Breast Cancer Patient Protection Act of 2009, a bill to require that health plans provide coverage for a minimum hospital stay for mastectomies, lumpectomies, and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations; HR 1699 Patient Access to Critical Lab Tests Act, a bill to require that certain complex diagnostic laboratory tests performed by an independent laboratory after a hospital outpatient encounter or inpatient stay during which the specimen involved was collected shall be treated as services for which payment may be made directly to the laboratory under part B of title XVIII of the Social Security Act; S 703 American Health Security Act of 2009, a bill to provide for health care for every American and to control the cost and enhance the quality of the health care system; HR 1745 Family Health Care Accessibility Act of 2009, a bill to amend the Public Health Service Act to provide liability protections for volunteer practitioners at health centers under section 330 of such Act; S 733 National Trauma Center Stabilization Act of 2009, a bill to ensure the continued and future availability of life saving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, and emergency needs; Letter to HHS about the action plan to prevent Healthcare associated infections; Provided information to members of Congress about the Quality and Patient Safety Transparency initiatives by state; Working with Rep. Nathan Deal to get legislation introduced on provider price transparency; HR 1670 and S 683 Community Choice Act of 2009, to amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports and which would allow disabled Medicaid recipients to receive care in their homes rather than in nursing homes; HR 2003 and S 830 Children's Hospitals Education Equity Act, a bill to modify the definition of children's hospital for purposes of making payments to children's hospitals that operate graduate medical education programs; HR 1998 Health Care Safety Net Enhancement Act of 2009, a bill to improve access to emergency medical services; HR 2043 Nurse Education, Expansion, and Development Act of 2009, a bill to amend the Public Health Service Act to authorize capitation grants to increase the number of nursing faculty and students; HR 2066 Graduate Psychology Education Act of 2009, a bill to amend the Public Health Service Act to promote mental and behavioral health services for underserved populations; S 890 Health Information Technology (IT) Public Utility Act of 2009, a bill to provide for the use of improved health information technology with respect to certain safety net health care providers; HR 2176 Nursing and Allied Health Education Preservation Act of 2009, to amend title XVIII of the Social Security Act to continue the ability of hospitals to supply a needed workforce of nurses and allied health professionals by preserving funding for hospital operated nursing and allied health education programs; HR 2218 Parental Consent Act of 2009, a bill to prohibit the use of Federal funds for any universal or mandatory mental health screening program; S 957 Public Health Emergency Response Act of 2009, a bill to amend the Public Health Service Act to ensure that victims of public health emergencies have meaningful and immediate access to medically necessary health care services; S 958 MediKids Health Insurance Act of 2009, a bill to amend the Social Security Act to guarantee comprehensive health care coverage for all children born after 2009; HR 2231 Public Health Emergency Response Act of 2009, a bill to amend the Public Health Service Act to ensure that victims of public health emergencies have meaningful and immediate access to medically necessary health care services; HR 2233 Health Empowerment Zone Act of 2009, a bill to authorize the Secretary of Health and Human Services to designate health empowerment zones; S 966 and HR 2252 National Health Care Quality Act, a bill to improve the Federal infrastructure for health care quality improvement in the United States; HR 2249 Health Care Price Transparency Promotion Act of 2009, a bill to amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs; HR 2251 and S 973 Resident Physician Shortage Reduction Act of 2009, to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; S 979 and HR 2360 SHOP Act, a bill 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; HR 2273 Nurse Staffing Standards for Patient Safety and Quality Care Act of 2009, a bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals; S 999 Child Health Care Crisis Relief Act of 2009, a bill to increase the number of well-trained mental health service professionals (including those based in schools) providing clinical mental health care to children and adolescents; S 1001 Health Promotion FIRST Act, a bill to provide for increased research, coordination and expansion of health promotion programs through the Department of Health and Human Services; HR 2350 Preserving Patient Access to Primary Care Act of 2009, a bill to amend the Public Health Service Act and the Social Security Act to increase the number of primary care physicians and primary care providers and to improve patient access to primary care services; HR 2369 Improving the Quality of Mental and Substance Use Health Care Act of 2009, a bill to improve mental and substance use health care; S 1020 Patient-Focused Critical Care Enhancement Act, a bill to optimize the delivery of critical care medicine and expand the critical care workforce; S 1022 Nurses' Higher Education and Loan Repayment Act of 2009, a bill to amend the Public Health Service Act to establish a graduate degree loan repayment program for nurses who become nursing school faculty members; HR 2381 Nurse and Health Care Worker Protection Act of 2009, a bill to direct the Secretary of Labor to issue an occupational safety and health standard to reduce injuries to patients, direct-care registered nurses, and all other health care workers by establishing a safe patient handling and injury prevention standard, and for other purposes; HR 2388 Physician Availability Act of 2009, a bill to assure that the services of a nonemergency department physician are available to hospital patients 24 hours a day, seven days a week in all non-Federal hospitals with at least 100 licensed beds; S 1028 Strengthening America's Public Health System Act, a bill to amend the Public Health Service Act to improve the Nation's surveillance and reporting for diseases and conditions; S 1031 National Nursing Shortage Reform and Patient Advocacy Act, a bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals; HR 2427 and S 1050 Informed Consumer Choices in Health Care Act of 2009, a bill to amend title XXVII of the Public Health Service Act to establish Federal standards for health insurance forms, quality, fair marketing, and honesty in out-of-network coverage in the group and individual health insurance markets, to improve transparency and accountability in those markets, and to establish a Federal Office of Health Insurance Oversight to monitor performance in those markets; S 1104 Nurse-Managed Health Clinic Investment Act of 2009, a bill to amend the Public Health Service Act to establish the Nurse- Managed Health Clinic Investment program; HR 2536 Emergency Nursing Supply Relief Act, to provide relief for the shortage of nurses in the United States; HR 2691 a bill to provide assistance to adolescents and young adults with serious mental health disorders as they transition to adulthood ; S 1173 Community-Based Health Care Retraining Act, a bill to establish a demonstration project to train unemployed workers for employment as health care professionals; S 1174 Preserving Patient Access to Primary Care Act of 2009, a bill to amend the Public Health Service Act and the Social Security Act to increase the number of primary care physicians and primary care providers and to improve patient access to primary care services; S 1176 Allied Health Reinvestment Act, a bill to amend the Public Health Service Act to promote and improve the allied health professionals; HR 2744 Equal Rights for Health Care Act Title 42, a bill to prohibit discrimination in Federal assisted health care services and research programs on the basis of sex, race, color, national origin, sexual orientation, gender identity, or disability status; HR 2754 Nurse-Managed Health Clinic Investment Act of 2009, a bill to amend the Public Health Service Act to establish the Nurse-Managed Health Clinic Investment program; S 1220 Patient Access to Critical Lab Tests Act, a bill to require that certain complex diagnostic laboratory tests performed by an independent laboratory after a hospital outpatient encounter or inpatient stay during which the specimen involved was collected shall be treated as services for which payment may be made directly to the laboratory under part B of title XVIII of the Social Security Act; HR 2785 Health Care Paperwork Reduction and Fraud Prevention Act of 2009, a bill to reduce the amount of paperwork and improve payment policies for health care services, to prevent fraud and abuse through health care provider education; HR 2804Ensuring Continuous Coverage under SCHIP Act of 2009, a bill to amend title XXI of the Social Security Act to require 12-month continuous coverage under the State Children's Health Insurance Program; HR 2810 Public Health Workforce Investment Act of 2009, a bill to amend the Public Health Service Act to establish various programs for the recruitment and retention of public health workers and to eliminate critical public health workforce shortages in Federal, State, local, and tribal public health agencies and health centers; HR 2816 States' Right To Innovate in Health Care Act of 2009, a bill to amend the Social Security Act to provide grants and flexibility through demonstration projects for States to provide universal, comprehensive, cost-effective systems of health care coverage, with simplified administration; HR 2824 Doctor-Patient Relationship and Research Protection Act, to enhance the conduct and support of federally funded comparative effectiveness research relating to health care; HR 2891 Access to Frontline Health Care Act of 2009, a bill to amend the Public Health Service Act to direct the Secretary of Health and Human Services to establish a Frontline Providers Loan Repayment Program; HR 2925 Communities Building Access Act, a bill to amend the Public Health Service Act to provide for community projects that will reduce the number of individuals who are uninsured with respect to health care; HR 2930 Primary Care Training Enhancement Act, a bill to enhance the primary care workforce through modifications to the medical residency training programs and use of qualified teaching health centers and through State primary care scholarship and loan repayment programs; S 1278 Consumers Health Care Act of 2009, a bill to establish the Consumers Choice Health Plan, a public health insurance plan that provides an affordable and accountable health insurance option for consumers; HR 2937 and S 1305 MRSA Infection Prevention and Patient Protection Act, a bill to prevent health care facility-acquired infections; HR 2948 Healthcare Improvements for Generating High Performance (HIGH Performance) Act of 2009, a bill to amend title IX of the Public Health Service Act to provide for the implementation of best practices in the delivery of health care in the United States; HR 2957 Rural Health Access Act of 2009, a bill to amend the Public Health Service Act to reauthorize the National Health Service Corps Scholarship and Loan Repayment Programs; S 1299 Worker Infection Protection Act, a bill to protect health care workers and first responders, including police, firefighters, emergency medical personnel, and other workers at risk of workplace exposure to infectious agents and drug resistant infections; Hatch amendment # 21 requiring the IOM to make recommendations to Congress on how to reduce unnecessary hospital readmissions; HR 2975 Medical Practice Protection Act of 2009, a bill to improve the medical care by reducing the excessive burden imposed by the civil liability system on the health care delivery system; HR 3000 Josephine Butler United States Health Service Act, a bill to establish a United States Health Service to provide high quality comprehensive health care for all Americans and to overcome the deficiencies in the present system of health care delivery; HR 3002 and S 1259 PATIENTS Act of 2009, a bill to protect all patients by prohibiting the use of data obtained from comparative effictiveness research accounts to deny coverage of items or services under Federal health care programs and to ensure that comparative effectiveness research accounts for advancements in personalized medicine and differences in patient treatment response; S 1355 Rural Health Clinic Patient Access and Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care for individuals residing in underserved rural areas; S 1403 Strengthen Social Work Training Act of 2009, a bill to amend title VII of the Public Health Service Act to ensure that social work students or social work schools are eligible for support under certain programs that would assist individuals in pursuing health careers or for grants for training projects in geriatrics, and to establish a social work training program; S 1404 Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act of 2009, a bill to implement demonstration projects at federally qualified community health centers to promote universal access to family-centered, evidence-based behavioral health interventions that prevent child maltreatment and promote family well-being by addressing parenting practices and skills for families from diverse socio-economic, cultural, racial, ethnic, and other backgrounds; HR3134 Healthcare Innovation Zone Program Act of 2009, a bill to direct the Secretary of Health and Human Services to establish a Healthcare Innovation Zone pilot program; H.R.3148, a bill to amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings; H.R.3151 and S 1585 Rural Access to Nurse Anesthesia Services Act of 2009, a bill to permit pass-through payment for reasonable costs of certified registered nurse anesthetist services in critical access hospitals notwithstanding the reclassification of such hospitals as urban hospitals, including hospitals located in ``Lugar counties'', and for on-call and standby costs for such services; H.R.3185 and S1569, a bill to amend title XVIII of the Social Security Act to provide payment to hospitals for costs of expanded advanced practice nurse training programs; H.R. 3191 Positive Aging Act of 2009, a bill to amend the Public Health Service Act to provide for integration of mental health services and mental health treatment outreach teams, and for other purposes; H.R. 3199 Emergency Medic Transition (EMT) Act of 2009 , a bill to amend the Public Health Service Act to provide grants to State emergency medical service departments to provide for the expedited training and licensing of veterans with prior medical training; H.R. 3200 America's Affordable Health Choices Act of 2009, a bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending; H.R. 3217 Health Care Choice Act of 2009, a bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; H.R. 3218 Improving Health Care for All Americans Act, a bill to provide a refundable tax credit for medical costs, to expand access to health insurance coverage through individual membership associations (IMAs), and to assist in the establishment of high risk pools; H.R.3234 Community-Based Health Care Retraining Act, a bill to establish a demonstration project to train unemployed workers for employment as health care professionals; H.R. 3242 Women's Health Office Act of 2009, a bill to improve the health of women through the establishment of Offices of Women's Health within the Department of Health and Human Services; S.1459 Health Care Choice Act of 2009, a bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; H.R. 3391 NO TITLE, a bill to allow for the continuation of critical access hospital designation for certain hospitals in geographic areas experiencing population growth; H.R. 3400 Empowering Patients First Act, a bill to provide for incentives to encourage health insurance coverage; HR 3472 a bill to provide for health insurance coverage premium discounts for healthy behavior and improvements toward healthy behavior; HR 3483 Steps Toward Access and Reform (STAR) Act of 2009, a bill to reform the medical liability system, improve access to health care for rural and indigent patients, enhance access to affordable prescription drugs; S 1572, a bill to provide for a point of order against any legislation that eliminates or reduces the ability of Americans to keep their health plan or their choice of doctor or that decreases the number of Americans enrolled in private health insurance, while increasing the number of Americans enrolled in government-managed health care; HR 3652 Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2009, a bill to amend the Public Health Service Act and title XVIII of the Social Security Act to make the provision of technical services for medical imaging examinations and radiation therapy treatments safer, more accurate, and less costly; S 1720 Health Professions and Primary Care Reinvestment Act, a bill to amend title VII of the Public Health Service Act to provide improved training and primary care; HR 3664 Healthcare Innovation Zone Pilot Act of 2009, a bill to direct the Secretary of Health and Human Services to establish a Healthcare Innovation Zone pilot program; S 1730 Fairness in Health Insurance Act, a bill to provide for minimum loss ratios for health insurance coverage; S 1734 Medical Liability Reform Act of 2009, a bill to reduce the cost of health care and ensure patient access to doctors by ending excessive malpractice verdicts through common-sense lawsuit reform; S 1742 Women's Hospitals Education Equity Act, a bill to amend the Public Health Service Act to provide assistance for graduate medical education funding for women's hospitals; Comment letter expressing concerns taht ONC's certification criteria for EHR eliminates flexibility CMS established in rule for achieving meaningful use; HR 4626 Health Insurance Industry Fair Competition Act, to restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers; HR 4851 Continuing Extension Act of 2010, to provide a temporary extension of certain programs; Meetings with CMS and HHS to encourage reimbursement under the National Disaster Medical System for hospitals that provided services to victims of the Haitian earthquake; HR 4700 The Transparency in All Health Care Pricing Act of 2010, to provide for transparency in health care pricing; HR 4803 The Patients Right to Know Act, to ensure health care consumer and provider access to certain health benefits plan information and to amend title XIX of the Social Security Act to provide transparency in hospital price and quality information; HR 6072 and S 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010, to amend titles XVIII and XIX of the Social Security Act to clarify the application of EHR payment incentives in cases of multi-campus hospitals; HR 6376 to amend title XVIII of the Social Security Act with respect to physician supervision of therapeutic hospital outpatient services; HR 6095 to amend title XVIII of the Social Security Act to preserve integrated care for durable medical equipment under the competitive bidding program for qualified hospital-related DME entities; S 3653 Healthcare Bureacrats Elimination Act, A bill to remove unelected, unaccountable bureaucrats from seniors' personal health decisions by repealing the IPAB.

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

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

See attached addendum for General Lobbying Issue Area: HCR Healthcare State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Rescissions and Routine Administrative Functions: Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality: Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity. Health Information Technology Standards: Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform: Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Mandate

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

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

H.R. 1468, Medical Justice Act (Burgess) medical liability reform; H.R. 1493, Quality Health Care Coalition Act (Paul) antitrust exemption for physicians; (cont.) H.R. 1658, Veterans Healthcare Commitment Act (Tiahrt) third party billing by VA for service-connected disabilities; H.R. 2221, Data Accountability and Trust Act (Rush) data security; H.R. 2249, Health Care Price Transparency Promotion Act (Burgess) price transparency; H.R. 2607: Small Business Health Coverage (Johnson) association health plans; H.R. 3081, Continuing Appropriations Act (Lowey) continuing resolution with temporary funding for HHS programs and agencies;H.R. 3082, Continuing Appropriations and Surface Transportation Extensions Act (Edwards) continuing resolution with temporary funding for HHS programs and agencies; H.R. 3590, Patient Protection and Affordable Care Act (Reid) coverage expansions, quality improvements, delivery system reforms, cost containment, health information technology, comparative effectiveness research, administrative simplification, health disparities, prevention and wellness, public health and workforce issues, fraud and abuse; H.R. 4061, Cybersecurity Enhancement Act (Lipinski) privacy protections for health information technology; H.R. 4700, Transparency in All Health Care Pricing Act (Kagen) transparency in health care pricing; H.R. 4803, Patients' Right to Know Act (Barton) health benefits plan information, transparency in hospital price and quality information; H.R. 5324, COBRA Health Benefits Extension Act (Davis) COBRA extension; H.R. 5690, MedMal Act (Gingrey) medical liability reform; H.R. 5777, Best PRACTICES Act (Rush) data security, privacy; DRAFT Boucher-Stearns privacy proposal collection and disclosure of certain personal information; S. 45, Medical Care Access Protection Act (Ensign) medical liability reform; S. 139, Data Breach Notification Act (Feinstein) data security; S. 458, False Claims Act Clarification Act (Grassley) fraud and abuse; S. 510, FDA Food Safety Modernization Act (Durbin) amendments on employer reporting requirements; S. 988, SIMPLE Cafeteria Plan Act (Snowe) cafeteria plans, flexible spending arrangements; S. 1490, Personal Data Privacy and Security Act (Leahy) privacy, identity theft; S. 1734, Medical Liability Reform (Kyl) medical liability reform; S. 2730, COBRA Subsidy Extension and Enhancement Act (Brown) premium assistance for unemployed; S. 3393, COBRA Health Benefits Extension Act (Brown) COBRA extension; S. 3421, Temporary Extension Act (Grassley) premium assistance for unemployed; S. 3548, Extend COBRA Premium Assistance Program Act (Casey) premium assistance for unemployed; S. 3579, Data Security Act (Carper) data security, privacy; S. 3686, Labor-HHS-Education Appropriations Act (Harkin) funding for HHS programs and agencies; and S. 3742, Data Security and Breach Notification Act (Pryor) data security, privacy; and S. 3946, Small Business Paperwork Relief Act (Baucus) employer reporting requirement. HCR (Regulatory Issues): HIPAA administrative simplification issues, including standards for privacy, security, electronic transactions and code sets, identifiers, and enforcement; HIPAA enforcement; FEHBP enrollment data clearinghouse initiative; issues relating to health insurance plan participation in FEHBP, including contract requirements related to interoperability of health information technology, community rating policies, and similarly sized subscriber group (SSSG) requirement; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure, electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues related to genetics and genetic nondiscrimination; issues relating to mental health parity; issues relating to data breach requirements; issues relating to "meaningful use" requirements for health information technology;; issues regarding application of service provider contract rules; medical loss ratios; review of rates for reasonableness; health insurance exchanges; preexisting condition insurance plans; accountable care organizations; internal claims and appeals and external review processes; coverage of preventive services; pre-existing condition exclusions; lifetime and annual dollar limits on benefits rescissions; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; and other issues relating to health care reform implementation.

Client expense: $1,980,000 · Firm income: Not reported

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

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs

Client expense: $1,700,000 · Firm income: Not reported

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

Successful Insurance Industry Implementation of Health Reforms: "good faith compliance standard", reasonable effective dates for compliance with PL 111-148. State Oversight of Premium Increases: S. 3078 and H.R. 4757 "Health Insurance Rate Authority Act of 2010"; federal rate review; H.R. 4700 "Transparency in All Health Care Pricing Act of 2010"; existing state regulatory functions; federal exchanges; state exchanges. Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited. Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individual as well as populations. Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; BCBS commitment to cover individuals up to age 26 on their parent health insurance; H.R. 5200 "FEHBP Dependent Coverage Extension Act." Pre-Existing Condition Exclusions: Pre-existing condition for children; guaranteed issue for children under the age of 19. Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits". Rescissions and Patient Protections: Open enrollment period; adverse selection implications. Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits. Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Healthcare; Evidence Based Care; Healthcare Delivery System Reforms. Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication. Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings/Accounts/Medical Savings Accounts; Individual Mandate; MEWAs. H.R. 2517 "Domestic Partnership Benefits and Obligations Act of 2009".

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: "good faith compliance standard", reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 "Health Insurance Rate Authority Act of 2010"; federal rate review; HR 4700 "Transparency in All Health Care Pricing Act of 2010"; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Mandate; MEWAs

Client expense: $222,329 · Firm income: Not reported

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

Implementation of healthcare reform laws - Executive Branch actions re PL 111-148/PL 111-152. Repeal Patient Protection and Affordable Health Care Acts (PL 111-148/PL 111-152) - HR 4901, To repeal the Patient Protection and Affordable Care Act; HR 4903, To repeal the Patient Protection and Affordable Care Act; HR 4910, To repeal the Patient Protection and Affordable Care Act and enact the Empowering Patients First Act in order to provide incentives to encourage health insurance coverage; HR 4919, To repeal the Patient Protection and Affordable Care Act; HR 4972, To repeal the Patient Protection and Affordable Care Act; HR 5005, To repeal the Patient Protection and Affordable Care Act; HR 5073, To repeal the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 and enact the OPTION Act of 2009; HR 5216, To repeal the Patient Protection and Affordable Care Act; HR 5421, To repeal the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, repeal the 7.5 percent threshold on the deduction for medical expenses, provide for increased funding for high-risk pools, allow acquiring health insurance across State lines, and allow for the creation of association health plans; HR 5424, Reform Americans Can Afford Act of 2010 ; HR 5444, Private Option Health Care Act; HR 6355, STAT Act of 2010; S 3147, Patient Choice Restoration Act; S 3152, A bill to repeal the Patient Protection and Affordable Care Act. *Medical liability reform - HR 1468, To provide health care liability reform, and for other purposes; S 45, A bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; HR 5690, Meaningful End to Defensive Medicine & Aimless Lawsuits (MedMal) Act of 2010; S 1734, A bill to reduce the cost of health care and ensure patient access to doctors by ending excessive malpractice verdicts through common-sense lawsuit reform. *Antitrust exemption for physicians - HR 1493, To ensure and foster continued patient safety and quality of care by exempting health care professionals from the Federal antitrust laws in their negotiations with health plans and health insurance issuers. *Third-party billing by VA for service-connected disabilities - HR 1658, To amend title 38, United States Code, to prohibit the recovery by the United States of charges from a third party for hospital care or medical services furnished to a veteran for a service-connected disability. * COBRA subsidies for the unemployed - S 2730, COBRA Subsidy Extension and Enhancement Act of 2009. *COBRA extension - HR 5324, COBRA Health Benefits Extension Act of 2010; S 3393, COBRA Health Benefits Extension Act of 2010. *Transparency in healthcare pricing - HR 4700, Transparency in All Health Care Pricing Act of 2010. *Health benefits plan information, transparency in hospital price and quality information - HR 4803, To ensure health care consumer and provider access to certain health benefits plan information and to amend title XIX of the Social Security Act to provide transparency in hospital price and quality information. *Privacy protections for health information technology - HR 4061, To advance cybersecurity research, development, and technical standards, and for other purposes. *Fraud and abuse - S 458, A bill to amend the False Claims Act. *Cafeteria plans, flexible spending arrangements - S 988, A bill to amend the Internal Revenue Code of 1986 to allow small businesses to set up simple cafeteria plans to provide nontaxable employee benefits to their employees, to make changes in the requirements for cafeteria plans, flexible spending accounts, and benefits provided under such plans or accounts, and for other purposes. * Coverage expansion, quality improvements, delivery system reforms, cost containment, health information technology, comparative effectiveness research, administrative simplification, health disparities, prevention and wellness, public health and workforce issues, fraud and abuse - HR 3590, Patient Protection and Affordable Care Act. *Amendments on employer reporting requirements - S 510, FDA Food Safety Modernization Act. *Employer reporting requirement - S 3946, Small Business Paperwork Relief Act. *Data security - HR 2221, To protect consumers by requiring reasonable security policies and procedures to protect computerized data containing personal information, and to provide for nationwide notice in the event of a security breach; S 139, A bill to require Federal agencies, and persons engaged in interstate commerce, in possession of data containing sensitive personally identifiable information, to disclose any breach of such information. *Price transparency - HR 2249, To amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs. *Association health plans - HR 2607, To amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees. *Privacy, identity theft - S 1490, A bill to prevent and mitigate identity theft, to ensure privacy, to provide notice of security breaches, and to enhance criminal penalties, law enforcement assistance, and other protections against security breaches, fraudulent access, and misuse of personally identifiable information. *Premium assistance for unemployed - S 3421, Protecting Against Indebting our Descendants through Fully Offset Relief (PAID FOR) Temporary Extension Act of 2010; S 3548, Extend COBRA Premium Assistance Program Act of 2010. *Continuing resolution with temporary funding for HHS programs and agencies - HR 3081, Continuing Appropriations Act, 2011; HR 3082, Continuing Appropriations and Surface Transportation Extensions Act, 2011; S 3686, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2011. *Data security, privacy - HR 5777, To foster transparency about the commercial use of personal information, provide consumers with meaningful choice about the collection, use, and disclosure of such information; S 3579, Data Security Act of of 2010; S 3742, Data Security and Breach Notification Act of 2010. *Privacy proposal, collection and disclosure of certain personal information - Proposed legislation re this issue.

Client expense: Not reported · Firm income: $100,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs

Client expense: Not reported · Firm income: Not reported

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

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for general issue area: HCR: Health Issues Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs

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

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

See attached addendum for General Lobbying Issue Area: HRC - Health Care Health Care Reform Bill HR 3590 "Patient Protection and Affordable Care Act". parts pertaining to health care reform; Health Care Reconciliation Bill HR 4872 "The Health Care and Education Affordability Reconcilation Act of 2010", parts pertaining to health care reform, reasonable effective dates for compliance with insurance reforms, affordable premiums (insurer tax, insufficient cost containment, weak mandate, restricted age discounts, insurer fees); federal health insurance rate authority, national insurance exchange, grandfathering. Also, subsequent bills/provisions to clarify implementation of HR 3590/HR 4872. Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges. Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations. Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies. Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications. Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels. Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits". Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Mandate; MEWAs

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Insurance Market Reform: HR 6130 - Strengthening Medicare Anti-Fraud Measure Act of 2010 General Issues: PL 111-148 "good faith compliance standard of HCR Implementation S3078/HR 4757 Rate Authority Act HR 4700 Transparency In All Healthcare Pricing Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs

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

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

Implementation of H.R. 3590, the Patient Protection and Affordable Care Act, to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. Implementation of H.R. 4872, the Health Care and Reconciliation Act of 2010, a bill that makes a number of health-related financing and revenue changes to the Patient Protection and Affordable Care Act, specifically regarding the medical device tax. S.540, Medical Device Safety Act, a bill that would remove federal preemption protection for certain medical devices H.R.1346, Medical Device Safety Act, a bill that would remove federal preemption protection for certain medical devices Reform of the 510 (k) regulatory pathway H.R. 759, Food and Drug Administration Globalization Act, a bill to improve the safety of food, drugs, devices, and cosmetics S. 882, the Drug and Device Accountability Act, a bill to ensure the safety and quality of medical products and enhance the authorities of the FDA H.R. 2502, Comparative Effectiveness Research Act of 2009, a bill to provide for the conduct of comparative effectiveness research for drugs, devices, and other therapies and create a Comparative Effectiveness Research Trust Fund S.1213, Patient-Centered Outcomes Research Act of 2009, a bill to provide for the conduct of comparative effectiveness research for drugs, devices, and other therapies and to establish a Patient-Centered Outcomes Research Trust Fund H.R. 2824, Doctor-Patient Relationship and Research Protection Act, a bill to support federally funded comparative effectiveness research for drugs, devices, and other therapies S.1142, Informed Health Care Decision Making Act, a bill with respect to the inclusion of effectiveness information in drug and device labeling and advertising H.R. 3090, Health Equity & Accountability Act of 2009, provides for the elimination of racial and ethnic health disparities S.660, National Pain Care Policy Act, a bill to promote greater access to chronic pain therapies H.R. 756, National Pain Care Policy Act, a bill to promote greater access to chronic pain therapies H.R. 4700, the Transparency in All Health Care Pricing Act of 2010, to provide for transparency in health care pricing H.R. 2249, the Health Care Price Transparency Promotion Act of 2009, to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs. H.R. 4803, the Patients Right to Know Act, to ensure health care consumer and provider access to certain health benefits plan information and to amend title XIX of the Social Security Act to provide transparency in hospital price and quality information. H.R.1032, Heart Disease Education, Analysis Research, and Treatment for Women Act to amend the Public Health Service Act to improve the prevention, diagnosis, and treatment of heart disease, stroke, and other cardiovascular diseases in women. S.422, Heart Disease Education, Analysis Research, and Treatment for Women Act to amend the Public Health Service Act to improve the prevention, diagnosis, and treatment of heart disease, stroke, and other cardiovascular diseases in women.

Client expense: $450,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, Transportation, Dept of (DOT)

S.660, National Pain Care Policy Act, a bill to promote greater access to chronic pain therapies H.R. 756, National Pain Care Policy Act, a bill to promote greater access to chronic pain therapies S.1380, Medicare Payment Advisory Commission (MedPAC) Reform Act, a bill to make the commission an executive branch agency, and provide the Commission new resources and authority to implement Medicare payment policy S.301, Physician Payments Sunshine Act, a bill that would require disclosure of the relationships between physicians and the manufacturers of drugs and devices H.R. 3138, Physician Payments Sunshine Act, a bill that would require disclosure of the relationships between physicians and the manufacturers of drugs and devices H.R. 2502, Comparative Effectiveness Research Act of 2009, a bill to provide for the conduct of comparative effectiveness research for drugs, devices, and other therapies and create a Comparative Effectiveness Research Trust Fund S.1213, Patient-Centered Outcomes Research Act of 2009, a bill to provide for the conduct of comparative effectiveness research for drugs, devices, and other therapies and to establish a Patient-Centered Outcomes Research Trust Fund H.R. 2824, Doctor-Patient Relationship and Research Protection Act, a bill to support federally funded comparative effectiveness research for drugs, devices, and other therapies S.1142, Informed Health Care Decision Making Act, a bill with respect to the inclusion of effectiveness information in drug and device labeling and advertising H.R. 4700, the Transparency in All Health Care Pricing Act of 2010, to provide for transparency in health care pricing H.R. 2249, the Health Care Price Transparency Promotion Act of 2009, to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs. H.R. 4803, the Patients Right to Know Act, to ensure health care consumer and provider access to certain health benefits plan information and to amend title XIX of the Social Security Act to provide transparency in hospital price and quality information

Client expense: $450,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, Transportation, Dept of (DOT)

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successfuly Insurance Industry Implementation of Health Reforms: "good faith compliance standard", reasonable effective dates for compliance with PL 111-148. State Oversight of Premium Increases: S 3078 and HR 4757 "Health Insurance Rate Authority Act of 2010"; federal rate review; HR 4700 "Transparency in All Health Care Pricing Act of 2010"; existing state regulatory functions; federal exchanges; state exchanges. Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations. Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies. Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open Enrollment Period; Adverse Selection Implications. Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels. Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited. Lifetime and Annual Limits: Lifetime and annual dollar limits on "essential health benefits". Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity. Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation. Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Mandate; MEWAs

Client expense: Not reported · Firm income: Not reported

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

Please see attached addendum for General Lobbying Issue Area: HCR - Health Issues "Good faith compliance standard," reasonable effective dates for compliance with PL 111-148 State oversight of premium increases: S 3708 and HR 4757 "Health Insurance Rate Authority Act of 2010"; federal rate review; HR 4700 "Transparency in All Health Care Pricing Act of 2010"; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; consistent reporting requirements for all insurers; include benefits for individuals as well as populations Dependent health insurance coverage; IRS guidelines on dependent coverage; pre-existing conditions for children; guaranteed issue for children under the age of 19; child-only policies Rescissions and Routine Administrative Functions; internal claims and appeals/ external review; open enrollment period; adverse selection implications Affordable private health care; insurer fees; effective individual mandate; healthcare delivery system reforms; small employer tax credits; adequate insurer reserve levels Grandfathering rules; interim final rule of June 14th; flexibility to modify items that are not specifically prohibited Lifetime and annual limits; lifetime and annual dollar limits on "essential health benefits" Health care quality; patient-centered medical home; health disparities; wellness; chronic care management; comparative effectiveness research; improved delivery system of health care; evidence based care; healthcare delivery system reforms; childhood obesity Health information technology standards; health information privacy; electronic health records; ICD-10 "real time" claims adjudication; data sharing; data aggregation Insurance market reform; individual market reform; small group market reform; small business healthcare; guaranteed issue; community rating; health status rating; individual mandate

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HRC - Health Care Health Care Reform Bill HR 3590 "Patient Protection and Affordable Care Act". parts pertaining to health care reform; Health Care Reconciliation Bill HR 4872 "The Health Care and Education Affordability Reconcilation Act of 2010", parts pertaining to health care reform, reasonable effective dates for compliance with insurance reforms, affordable premiums (insurer tax, insufficient cost containment, weak mandate, restricted age discounts, insurer fees); federal health insurance rate authority, national insurance exchange, grandfathering. Also, subsequent bills/provisions to clarify implementation of HR 3590/HR 4872. Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges. Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations. Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies. Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications. Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels. Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits". Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs OPM Legislative Proposal on FEHBP Subrogation and Reimbursement

Client expense: $1,760,000 · Firm income: Not reported

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

Insurance Market Reform: Healthy Choice Act; MLR; Guaranteed Issue; HSAs / Dependent Health Insurance Coverage Comparative Effectiveness Research HR. 3162 - Federal Regulatory functions - Anti-Trust and McCarran-Ferguson State Oversight of Premiums S. 3078 HR. 4757 HR 4700/ Transparency PL-111-148 Implementation "good faith compliance standards"

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR-Healthcare Successful Insurance Industry Implementation of Health Reforms: "good faith compliance standard", reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 "Health Insurance Rate Authority Act of 2010"; federal rate review; HR 4700 "Transparency in All Health Care Pricing Act of 2010"; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Mandate; MEWAs OPM Legislative Proposal on FEHBP Subrogation and Reimbursement

Client expense: $225,109 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.Res. 1493 (Spratt) budget enforcement resolution; H.R. 1468, Medical Justice Act (Burgess) medical liability reform; H.R. 1493, Quality Health Care Coalition Act (Paul) antitrust exemption for physicians (cont.) H.R. 1658, Veterans Healthcare Commitment Act (Tiahrt) third party billing by VA for service-connected disabilities; H.R. 2221, Data Accountability and Trust Act (Rush) data security; H.R. 2249, Health Care Price Transparency Promotion Act (Burgess) price transparency; H.R. 2607: Small Business Health Coverage (Johnson) association health plans; H.R. 3081, Continuing Appropriations Act (Lowey) continuing resolution with temporary funding for HHS programs and agencies; H.R. 4061, Cybersecurity Enhancement Act (Lipinski) privacy protections for health information technology; H.R. 4213, Tax Extenders Act (Rangel/Baucus) premium assistance for unemployed, Roberts amendment addressing individual coverage requirement; H.R. 4700, Transparency in All Health Care Pricing Act (Kagen) transparency in health care pricing; H.R. 4803, Patients' Right to Know Act (Barton) health benefits plan information, transparency in hospital price and quality information; H.R. 5136, National Defense Authorization Act (Skelton) coverage for dependents under TRICARE; H.R. 5324, COBRA Health Benefits Extension Act (Davis) COBRA extension; H.R. 5690, MedMal Act (Gingrey) medical liability reform; H.R. 5777, Best PRACTICES Act (Rush) data security, privacy; DRAFT Boucher-Stearns privacy proposal collection and disclosure of certain personal information; S. 45, Medical Care Access Protection Act (Ensign) medical liability reform; S. 139, Data Breach Notification Act (Feinstein) data security; S. 458, False Claims Act Clarification Act (Grassley) fraud and abuse; S. 988, SIMPLE Cafeteria Plan Act (Snowe) cafeteria plans, flexible spending arrangements; S. 1490, Personal Data Privacy and Security Act (Leahy) privacy, identity theft; S. 1734, Medical Liability Reform (Kyl) medical liability reform; S. 2730, COBRA Subsidy Extension and Enhancement Act (Brown) premium assistance for unemployed; S. 3393, COBRA Health Benefits Extension Act (Brown) COBRA extension; S. 3421, Temporary Extension Act (Grassley) premium assistance for unemployed; S. 3548, Extend COBRA Premium Assistance Program Act (Casey) premium assistance for unemployed; S. 3579, Data Security Act (Carper) data security, privacy; S. 3686, Labor-HHS-Education Appropriations Act (Harkin) funding for HHS programs and agencies; S. 3742, Data Security and Breach Notification Act (Pryor) data security, privacy HCR (Regulatory Issues): HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets; HIPAA enforcement; FEHBP enrollment data clearinghouse initiative; issues relating to health insurance plan participation in FEHBP, including contract requirements related to interoperability of health information technology, community rating policies, and similarly sized subscriber group (SSSG) requirement; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; issues relating to market consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues related to genetics and genetic nondiscrimination; issues relating to mental health parity; issues relating to data breach requirements; issues relating to "meaningful use" requirements for health information technology; issues relating to Form 5500 reporting requirements; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; internal claims and appeals and external review processes; coverage of preventive services; pre-existing condition exclusions; lifetime and annual dollar limits on benefits rescissions; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; and other issues relating to health care reform implementation.

Client expense: $2,330,000 · Firm income: Not reported

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

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs OPM Legislative Proposal on FEHBP Subrogation and Reimbursement

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

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

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs OPM Legislative Proposal on FEHBP Subrogation and Reimbursement

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

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

Implementation of healthcare reform legislation, coverage expansions, quality improvements, delivery system reforms, cost containment, health information technology, comparative effectiveness research, administrative simplification, health disparities, prevention and wellness, public heath and workforce issues, fraud and abuse - Executive Branch actions re PL 111-148/PL 111-152 *Data security - HR 2221, To protect consumers by requiring reasonable security policies and procedures to protect computerized data containing personal information, and to provide for nationwide notice in the event of a security breach; S 139, A bill to require Federal agencies, and persons engaged in interstate commerce, in possession of data containing sensitive personally identifiable information, to disclose any breach of such information. *Price transparency - HR 2249, To amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs. *Association health plans - HR 2607, To amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees. *Privacy, identity theft - S 1490, A bill to prevent and mitigate identity theft, to ensure privacy, to provide notice of security breaches, and to enhance criminal penalties, law enforcement assistance, and other protections against security breaches, fraudulent access, and misuse of personally identifiable information. *Coverage for dependents under TRICARE - HR 5136, National Defense Authorization Act for Fiscal Year 2011. *Budget enforcement resolution - H.Res 1493, Providing for budget enforcement for fiscal year 2011. *Premium assistance for unemployed - S 3421, Protecting Against Indebting our Descendants through Fully Offset Relief (PAID FOR) Temporary Extension Act of 2010; S 3548, Extend COBRA Premium Assistance Program Act of 2010. *Continuing resolution with temporary funding for HHS programs and agencies - HR 3081, Continuing Appropriations Act, 2011; S 3686, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2011. *Data security, privacy - HR 5777, To foster transparency about the commercial use of personal information, provide consumers with meaningful choice about the collection, use, and disclosure of such information; S 3579, Data Security Act of of 2010; S 3742, Data Security and Breach Notification Act of 2010. *Privacy proposal, collection and disclosure of certain personal information - Proposed legislation re this issue. *Medical liability reform - HR 1468, To provide health care liability reform, and for other purposes; S 45, A bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; HR 5690, Meaningful End to Defensive Medicine & Aimless Lawsuits (MedMal) Act of 2010; S 1734, A bill to reduce the cost of health care and ensure patient access to doctors by ending excessive malpractice verdicts through common-sense lawsuit reform. *Antitrust exemption for physicians - HR 1493, To ensure and foster continued patient safety and quality of care by exempting health care professionals from the Federal antitrust laws in their negotiations with health plans and health insurance issuers. *Third-party billing by VA for service-connected disabilities - HR 1658, To amend title 38, United States Code, to prohibit the recovery by the United States of charges from a third party for hospital care or medical services furnished to a veteran for a service-connected disability. *COBRA assistance - HR 4213, American Workers, State, and Business Relief Act of 2010. * COBRA subsidies for the unemployed - S 2730, COBRA Subsidy Extension and Enhancement Act of 2009. *COBRA extension - HR 5324, COBRA Health Benefits Extension Act of 2010; S 3393, COBRA Health Benefits Extension Act of 2010. *Transparency in healthcare pricing - HR 4700, Transparency in All Health Care Pricing Act of 2010. *Health benefits plan information, transparency in hospital price and quality information - HR 4803, To ensure health care consumer and provider access to certain health benefits plan information and to amend title XIX of the Social Security Act to provide transparency in hospital price and quality information. *Privacy protections for health information technology - HR 4061, To advance cybersecurity research, development, and technical standards, and for other purposes. *Fraud and abuse - S 458, A bill to amend the False Claims Act. *Cafeteria plans, flexible spending arrangements - S 988, A bill to amend the Internal Revenue Code of 1986 to allow small businesses to set up simple cafeteria plans to provide nontaxable employee benefits to their employees, to make changes in the requirements for cafeteria plans, flexible spending accounts, and benefits provided under such plans or accounts, and for other purposes.

Client expense: Not reported · Firm income: $100,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S 2 Middle Class Opportunity Act, Card Check provisions; S 4 Comprehensive Health Reform Act of 2009, a bill to guarantee affordable, quality health coverage for all Americans, and for other purposes; S 45 MCAP Act, a bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; S 77 Children's Mental Health Parity Act, a bill to amend title XXI of the Social Security Act to provide for equal coverage of mental health services under the State Children's Health Insurance Program; HR 241a bill to amend title 10, United States Code, to require the amounts reimbursed to institutional providers of health care services under the TRICARE program to be the same as amounts reimbursed under Medicare, and to require the Secretary of Defense to contract for health care services with at least one teaching hospital in urban areas; HR 298 Improving Children's Doctor Access Act of 2009, a bill to amend title XXI of the Social Security Act to require SCHIP annual reports to include information on the HEDIS measure relating to access to primary care practitioners by individuals eligible for child health assistance under such plans and on State efforts to avoid certain displacement of private health coverage, and to express the sense of Congress that such States should utilize Consumer Assessment of Healthcare Providers and Systems consumer satisfaction surveys to measure access by such individuals to physicians; S 179 Health Information Technology Act of 2009, a bill to improve quality in health care by providing incentives for adoption of modern information technology; HR 468 and S 245 Retooling the Health Care Workforce for an Aging America Act of 2009, a bill to expand, train, and support all sectors of the health care workforce to care for the growing population of older individuals in the United States; HR 676 United States National Health Care Act or the Expanded and Improved Medicare for All Act, a bill to provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes; HR 688 and S 326 Kids First Act, a bill to amend title XXI of the Social Security Act to reauthorize the State Children's Health Insurance Program through fiscal year 2013, and for other purposes; Tricare letter sent to DOD from Sen. Ben Nelson urging DoD to revise the rule, expand the transition to the new payment system, offer other adjustments to cushion the financial blow on certain hospitals, and conduct a detailed analysis of its impact on the field; S 391 Healthy Americans Act, a bill to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away; HR 914 Physician Workforce Enhancement Act of 2009, a bill to amend title VII of the Public Health Service Act to establish a loan program for eligible hospitals to establish residency training programs; HR 936 National Trauma Center Stabilization Act of 2009, a bill to ensure the continued and future availability of lifesaving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, emergency needs, and information technology; HR 956 HealthCARE Act of 2009, a bill to expand the number of individuals and families with health insurance coverage, and for other purposes; S 408 Wakefield Act, a bill to amend the Public Health Service Act to provide a means for continued improvement in emergency medical services for children; HR 1085 Health Insurance Coverage Protection Act, a bill to impose a limitation on lifetime aggregate limits imposed by health plans; HR 1086 Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009; a bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; HR 1101 Midwifery Care Access and Reimbursement Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for reimbursement of certified midwife services and to provide for more equitable reimbursement rates for certified nurse-midwife services; S 441 Quality Reform Expansion and Savings Act of 2009, a bill to encourage the development of coordinated quality reforms to improve health care delivery and reduce the cost of care in the health care system; S 444 National Health Information Technology and Privacy Advancement Act of 2009, a bill to provide for the establishment of a health information technology and privacy system; S 486 Access for All America Act, a bill to achieve access to comprehensive primary health care services for all Americans and to reform the organization of primary care delivery through an expansion of the Community Health Center and National Health Service Corps programs; HR 1253 Health Insurance Restrictions and Limitations Clarification Act of 2009, a bill to require that limitations and restrictions on coverage under group health plans be timely disclosed to group health plan sponsors and timely communicated to participants and beneficiaries under such plans in a form that is easily understandable; HR 1296 Access for All America Act, a bill to achieve access to comprehensive primary health care services for all Americans and to reform the organization of primary care delivery through an expansion of the Community Health Center and National Health Service Corps programs; HR 1411 United States Primary and Preventive Health Care Corps Act of 2009, a bill to amend the Public Health Service Act to establish a Primary and Public Health Scholarship Program; HR 1460 Nurses Higher Education and Loan Repayment Act, a bill to amend the Public Health Service Act to establish a graduate degree loan repayment program for nurses who become nursing school faculty members; HR 1494 Nursing Home Emergency Assistance Act, a bill to ensure that a private for-profit nursing home affected by a major disaster receives the same reimbursement as a public nursing home affected by a major disaster; HR 1558 and S 623 Preexisting Condition Patient Protection Act of 2009, to prohibit health insurers from denying coverage to people with pre-existing conditions; S 616 Enhancing Safety in Medicine Utilizing Leading Advanced Simulation Technologies to Improve Outcomes Now Act of 2009, a bill to amend the Public Health Service Act to authorize medical simulation enhancement programs, and for other purposes; HR 1581 Patient-Focused Critical Care Enhancement Act, a bill to optimize the delivery of critical care medicine and expand the critical care workforce; S 628 Conrad State 30 Improvement Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities; HR 1614 and S 652 Community Coalitions for Access and Quality Improvement Act of 2009, a bill to authorize the Secretary of Health and Human Services to make grants to community health coalitions to assist in the development of integrated health care delivery; HR 1691 and S 688 Breast Cancer Patient Protection Act of 2009, a bill to require that health plans provide coverage for a minimum hospital stay for mastectomies, lumpectomies, and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations; HR 1699 Patient Access to Critical Lab Tests Act, a bill to require that certain complex diagnostic laboratory tests performed by an independent laboratory after a hospital outpatient encounter or inpatient stay during which the specimen involved was collected shall be treated as services for which payment may be made directly to the laboratory under part B of title XVIII of the Social Security Act; S 698 State-Based Health Care Reform Act, a bill to ensure the provision of high-quality health care coverage for uninsured individuals through State health care coverage pilot projects that expand coverage and access and improve quality and efficiency in the health care system; S 703 American Health Security Act of 2009, a bill to provide for health care for every American and to control the cost and enhance the quality of the health care system; HR 1745 Family Health Care Accessibility Act of 2009, a bill to amend the Public Health Service Act to provide liability protections for volunteer practitioners at health centers under section 330 of such Act; S 733 National Trauma Center Stabilization Act of 2009, a bill to ensure the continued and future availability of life saving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, and emergency needs; Letter to HHS about the action plan to prevent Healthcare associated infections; Provided information to members of Congress about the Quality and Patient Safety Transparency initiatives by state; Working with Rep. Nathan Deal to get legislation introduced on provider price transparency; HR 1670 and S 683 Community Choice Act of 2009, to amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports and which would allow disabled Medicaid recipients to receive care in their homes rather than in nursing homes; HR 2003 and S 830 Children's Hospitals Education Equity Act, a bill to modify the definition of children's hospital for purposes of making payments to children's hospitals that operate graduate medical education programs; HR 1998 Health Care Safety Net Enhancement Act of 2009, a bill to improve access to emergency medical services; HR 2043 Nurse Education, Expansion, and Development Act of 2009, a bill to amend the Public Health Service Act to authorize capitation grants to increase the number of nursing faculty and students; HR 2066 Graduate Psychology Education Act of 2009, a bill to amend the Public Health Service Act to promote mental and behavioral health services for underserved populations; S 890 Health Information Technology (IT) Public Utility Act of 2009, a bill to provide for the use of improved health information technology with respect to certain safety net health care providers; HR 2176 Nursing and Allied Health Education Preservation Act of 2009, to amend title XVIII of the Social Security Act to continue the ability of hospitals to supply a needed workforce of nurses and allied health professionals by preserving funding for hospital operated nursing and allied health education programs; HR 2218 Parental Consent Act of 2009, a bill to prohibit the use of Federal funds for any universal or mandatory mental health screening program; S 957 Public Health Emergency Response Act of 2009, a bill to amend the Public Health Service Act to ensure that victims of public health emergencies have meaningful and immediate access to medically necessary health care services; S 958 MediKids Health Insurance Act of 2009, a bill to amend the Social Security Act to guarantee comprehensive health care coverage for all children born after 2009; HR 2231 Public Health Emergency Response Act of 2009, a bill to amend the Public Health Service Act to ensure that victims of public health emergencies have meaningful and immediate access to medically necessary health care services; HR 2233 Health Empowerment Zone Act of 2009, a bill to authorize the Secretary of Health and Human Services to designate health empowerment zones; S 966 and HR 2252 National Health Care Quality Act, a bill to improve the Federal infrastructure for health care quality improvement in the United States; HR 2249 Health Care Price Transparency Promotion Act of 2009, a bill to amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs; HR 2251 and S 973 Resident Physician Shortage Reduction Act of 2009, to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; S 979 and HR 2360 SHOP Act, a bill 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; HR 2273 Nurse Staffing Standards for Patient Safety and Quality Care Act of 2009, a bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals; S 999 Child Health Care Crisis Relief Act of 2009, a bill to increase the number of well-trained mental health service professionals (including those based in schools) providing clinical mental health care to children and adolescents; S 1001 Health Promotion FIRST Act, a bill to provide for increased research, coordination and expansion of health promotion programs through the Department of Health and Human Services; HR 2350 Preserving Patient Access to Primary Care Act of 2009, a bill to amend the Public Health Service Act and the Social Security Act to increase the number of primary care physicians and primary care providers and to improve patient access to primary care services; HR 2369 Improving the Quality of Mental and Substance Use Health Care Act of 2009, a bill to improve mental and substance use health care; S 1020 Patient-Focused Critical Care Enhancement Act, a bill to optimize the delivery of critical care medicine and expand the critical care workforce; S 1022 Nurses' Higher Education and Loan Repayment Act of 2009, a bill to amend the Public Health Service Act to establish a graduate degree loan repayment program for nurses who become nursing school faculty members; HR 2381 Nurse and Health Care Worker Protection Act of 2009, a bill to direct the Secretary of Labor to issue an occupational safety and health standard to reduce injuries to patients, direct-care registered nurses, and all other health care workers by establishing a safe patient handling and injury prevention standard, and for other purposes; HR 2388 Physician Availability Act of 2009, a bill to assure that the services of a nonemergency department physician are available to hospital patients 24 hours a day, seven days a week in all non-Federal hospitals with at least 100 licensed beds; S 1028 Strengthening America's Public Health System Act, a bill to amend the Public Health Service Act to improve the Nation's surveillance and reporting for diseases and conditions; S 1031 National Nursing Shortage Reform and Patient Advocacy Act, a bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals; HR 2427 and S 1050 Informed Consumer Choices in Health Care Act of 2009, a bill to amend title XXVII of the Public Health Service Act to establish Federal standards for health insurance forms, quality, fair marketing, and honesty in out-of-network coverage in the group and individual health insurance markets, to improve transparency and accountability in those markets, and to establish a Federal Office of Health Insurance Oversight to monitor performance in those markets; HR 2520 Patients' Choice Act, a bill to provide comprehensive solutions for the health care system of the United States; HR 2535 Blueprint for Health Act of 2009, a bill to establish a Blueprint for Health in order to create a comprehensive system of care incorporating medical homes to improve the delivery and affordability of health care through disease prevention, health promotion, and education about and better management of chronic conditions; S 1104 Nurse-Managed Health Clinic Investment Act of 2009, a bill to amend the Public Health Service Act to establish the Nurse-Managed Health Clinic Investment program; HR 2536 Emergency Nursing Supply Relief Act, to provide relief for the shortage of nurses in the United States; HR 2691 a bill to provide assistance to adolescents and young adults with serious mental health disorders as they transition to adulthood ; S 1173 Community-Based Health Care Retraining Act, a bill to establish a demonstration project to train unemployed workers for employment as health care professionals; S 1174 Preserving Patient Access to Primary Care Act of 2009, a bill to amend the Public Health Service Act and the Social Security Act to increase the number of primary care physicians and primary care providers and to improve patient access to primary care services; S 1176 Allied Health Reinvestment Act, a bill to amend the Public Health Service Act to promote and improve the allied health professionals; HR 2744 Equal Rights for Health Care Act Title 42, a bill to prohibit discrimination in Federal assisted health care services and research programs on the basis of sex, race, color, national origin, sexual orientation, gender identity, or disability status; HR 2754 Nurse-Managed Health Clinic Investment Act of 2009, a bill to amend the Public Health Service Act to establish the Nurse-Managed Health Clinic Investment program; HR 2778 Health Equity and Accountability through Research Act of 2009, a bill to amend the Public Health Service Act to redesignate the National Center on Minority Health and Health Disparities as the National Institute for Minority Health and Health Disparities; S 1220 Patient Access to Critical Lab Tests Act, a bill to require that certain complex diagnostic laboratory tests performed by an independent laboratory after a hospital outpatient encounter or inpatient stay during which the specimen involved was collected shall be treated as services for which payment may be made directly to the laboratory under part B of title XVIII of the Social Security Act; HR 2785 Health Care Paperwork Reduction and Fraud Prevention Act of 2009, a bill to reduce the amount of paperwork and improve payment policies for health care services, to prevent fraud and abuse through health care provider education; HR 2804Ensuring Continuous Coverage under SCHIP Act of 2009, a bill to amend title XXI of the Social Security Act to require 12-month continuous coverage under the State Children's Health Insurance Program; HR 2810 Public Health Workforce Investment Act of 2009, a bill to amend the Public Health Service Act to establish various programs for the recruitment and retention of public health workers and to eliminate critical public health workforce shortages in Federal, State, local, and tribal public health agencies and health centers; HR 2816 States' Right To Innovate in Health Care Act of 2009, a bill to amend the Social Security Act to provide grants and flexibility through demonstration projects for States to provide universal, comprehensive, cost-effective systems of health care coverage, with simplified administration; HR 2824 Doctor-Patient Relationship and Research Protection Act, to enhance the conduct and support of federally funded comparative effectiveness research relating to health care; HR 2891 Access to Frontline Health Care Act of 2009, a bill to amend the Public Health Service Act to direct the Secretary of Health and Human Services to establish a Frontline Providers Loan Repayment Program; HR 2925 Communities Building Access Act, a bill to amend the Public Health Service Act to provide for community projects that will reduce the number of individuals who are uninsured with respect to health care; HR 2930 Primary Care Training Enhancement Act, a bill to enhance the primary care workforce through modifications to the medical residency training programs and use of qualified teaching health centers and through State primary care scholarship and loan repayment programs; S 1278 Consumers Health Care Act of 2009, a bill to establish the Consumers Choice Health Plan, a public health insurance plan that provides an affordable and accountable health insurance option for consumers; HR 2937 and S 1305 MRSA Infection Prevention and Patient Protection Act, a bill to prevent health care facility-acquired infections; HR 2948 Healthcare Improvements for Generating High Performance (HIGH Performance) Act of 2009, a bill to amend title IX of the Public Health Service Act to provide for the implementation of best practices in the delivery of health care in the United States; HR 2957 Rural Health Access Act of 2009, a bill to amend the Public Health Service Act to reauthorize the National Health Service Corps Scholarship and Loan Repayment Programs; S 1299 Worker Infection Protection Act, a bill to protect health care workers and first responders, including police, firefighters, emergency medical personnel, and other workers at risk of workplace exposure to infectious agents and drug resistant infections; Hatch amendment # 21 requiring the IOM to make recommendations to Congress on how to reduce unnecessary hospital readmissions; HR 2975 Medical Practice Protection Act of 2009, a bill to improve the medical care by reducing the excessive burden imposed by the civil liability system on the health care delivery system; HR 3000 Josephine Butler United States Health Service Act, a bill to establish a United States Health Service to provide high quality comprehensive health care for all Americans and to overcome the deficiencies in the present system of health care delivery; HR 3002 and S 1259 PATIENTS Act of 2009, a bill to protect all patients by prohibiting the use of data obtained from comparative effictiveness research accounts to deny coverage of items or services under Federal health care programs and to ensure that comparative effectiveness research accounts for advancements in personalized medicine and differences in patient treatment response; S 1355 Rural Health Clinic Patient Access and Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care for individuals residing in underserved rural areas; S. 1403 Strengthen Social Work Training Act of 2009, a bill to amend title VII of the Public Health Service Act to ensure that social work students or social work schools are eligible for support under certain programs that would assist individuals in pursuing health careers or for grants for training projects in geriatrics, and to establish a social work training program; S. 1404 Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act of 2009, a bill to implement demonstration projects at federally qualified community health centers to promote universal access to family-centered, evidence-based behavioral health interventions that prevent child maltreatment and promote family well-being by addressing parenting practices and skills for families from diverse socioeconomic, cultural, racial, ethnic, and other backgrounds; HR3134 Healthcare Innovation Zone Program Act of 2009, a bill to direct the Secretary of Health and Human Services to establish a Healthcare Innovation Zone pilot program; H.R.3148, a bill to amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings; H.R.3151 and S 1585 Rural Access to Nurse Anesthesia Services Act of 2009, a bill to permit pass-through payment for reasonable costs of certified registered nurse anesthetist services in critical access hospitals notwithstanding the reclassification of such hospitals as urban hospitals, including hospitals located in ``Lugar counties'', and for on-call and standby costs for such services; H.R.3158 Place Based Health Care Act of 2009, a bill to reform health care delivery by providing incentives for place-based health care, which seeks to bring health services to the patient by locating community health centers, federally qualified health centers, and community integrated health centers in or near settings that already serve a particular target population, such as schools, workplaces, and senior services facilities; H.R.3185 and S1569, a bill to amend title XVIII of the Social Security Act to provide payment to hospitals for costs of expanded advanced practice nurse training programs; H.R. 3191 Positive Aging Act of 2009, a bill to amend the Public Health Service Act to provide for integration of mental health services and mental health treatment outreach teams, and for other purposes; H.R. 3199 Emergency Medic Transition (EMT) Act of 2009 , a bill to amend the Public Health Service Act to provide grants to State emergency medical service departments to provide for the expedited training and licensing of veterans with prior medical training; H.R. 3200 America's Affordable Health Choices Act of 2009, a bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending; H.R. 3217 Health Care Choice Act of 2009, a bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; H.R. 3218 Improving Health Care for All Americans Act, a bill to provide a refundable tax credit for medical costs, to expand access to health insurance coverage through individual membership associations (IMAs), and to assist in the establishment of high risk pools; H.R.3234 Community-Based Health Care Retraining Act, a bill to establish a demonstration project to train unemployed workers for employment as health care professionals; H.R. 3242 Women's Health Office Act of 2009, a bill to improve the health of women through the establishment of Offices of Women's Health within the Department of Health and Human Services; S.1459 Health Care Choice Act of 2009, a bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; S. 1479 NO TITLE, a bill to provide for the treatment of certain hospitals; H.R. 3391 NO TITLE, a bill to allow for the continuation of critical access hospital designation for certain hospitals in geographic areas experiencing population growth; H.R. 3400 Empowering Patients First Act, a bill to provide for incentives to encourage health insurance coverage; H.R.3421 Medical Debt Relief Act of 2009, a bill to exclude from consumer credit reports medical debt that has been in collection and has been fully paid or settled; HR 3472 a bill to provide for health insurance coverage premium discounts for healthy behavior and improvements toward healthy behavior; HR 3483 Steps Toward Access and Reform (STAR) Act of 2009, a bill to reform the medical liability system, improve access to health care for rural and indigent patients, enhance access to affordable prescription drugs, and for other purposes S 1572, a bill to provide for a point of order against any legislation that eliminates or reduces the ability of Americans to keep their health plan or their choice of doctor or that decreases the number of Americans enrolled in private health insurance, while increasing the number of Americans enrolled in government-managed health care; S 1679 Affordable Health Choices Act, an original bill to make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce; HR 3652 Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2009, a bill to amend the Public Health Service Act and title XVIII of the Social Security Act to make the provision of technical services for medical imaging examinations and radiation therapy treatments safer, more accurate, and less costly; S 1720 Health Professions and Primary Care Reinvestment Act, a bill to amend title VII of the Public Health Service Act to provide improved training and primary care; HR 3664 Healthcare Innovation Zone Pilot Act of 2009, a bill to direct the Secretary of Health and Human Services to establish a Healthcare Innovation Zone pilot program; S 1730 Fairness in Health Insurance Act, a bill to provide for minimum loss ratios for health insurance coverage; S 1734 Medical Liability Reform Act of 2009, a bill to reduce the cost of health care and ensure patient access to doctors by ending excessive malpractice verdicts through common-sense lawsuit reform; Senate Finance Committee Americas Healthy Future Act of 2009, Senate Finance Committee health reform bill with provisions on coverage, disease prevention and wellness, delivery system reform, health care quality and efficiency, transparency and program integrity, and financing; Meeting with FTC, senate congressional staff re barriers to clinical integration; HR 3590 Patient Protection and Affordable Care Act, the merged product of the health reform bills from the Senate Finance and Health, Education, Labor and Pensions (HELP) committees; HR 3962 Affordable Health Care for America Act, a bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes; HR 3700 Health Care Bill of Rights Act, a bill to establish requirements for any health reform legislation enacted by the Congress or the President during the 111th Congress; HR 3713 American Health Care Solutions Act of 2009, a bill to provide bipartisan solutions to lower health costs, increase access to affordable coverage, and give patients more choices and control; S 1742 Women's Hospitals Education Equity Act, a bill to amend the Public Health Service Act to provide assistance for graduate medical education funding for women's hospitals; Comments to CMS proposed rule defining meaningful use of electronic Health Records concern that the rules will severely limit hospitals' ability to access federal financing for health information technology and put many hospitals at risk for Medicare payment penalties beginning in 2015; FDA Grants Hospitals 18 Months to Replace Steris System 1 Processor; HR 4626 Health Insurance Industry Fair Competition Act, to restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers; HR 4851 Continuing Extension Act of 2010, to provide a temporary extension of certain programs; Meetings with CMS and HHS to encourage reimbursement under the National Disaster Medical System for hospitals that provided services to victims of the Haitian earthquake; HR 4700 The Transparency in All Health Care Pricing Act of 2010, to provide for transparency in health care pricing; HR 4803 The Patients Right to Know Act, to ensure health care consumer and provider access to certain health benefits plan information and to amend title XIX of the Social Security Act to provide transparency in hospital price and quality information; HR 6072 and S 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010, to amend titles XVIII and XIX of the Social Security Act to clarify the application of EHR payment incentives in cases of multi-campus hospitals; HR 6376 to amend title XVIII of the Social Security Act with respect to physician supervision of therapeutic hospital outpatient services

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

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

Successful Insurance Industry Implementation of Health Reforms: "good faith compliance standard", reasonable effective dates for compliance with PL 111-148. State Oversight of Premium Increases: S. 3078 and H.R. 4757 "Health Insurance Rate Authority Act of 2010"; federal rate review; H.R. 4700 "Transparency in All Health Care Pricing Act of 2010"; existing state regulatory functions; federal exchanges; state exchanges. Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited. Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individual as well as populations. Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; BCBS commitment to cover individuals up to age 26 on their parent health insurance; H.R. 5200 "FEHBP Dependent Coverage Extension Act." Pre-Existing Condition Exclusions: Pre-existing condition for children; guaranteed issue for children under the age of 19. Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits". Rescissions and Patient Protections: Open enrollment period; adverse selection implications. Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits. Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Healthcare; Evidence Based Care; Healthcare Delivery System Reforms. Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication. Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings/Accounts/Medical Savings Accounts; Individual Mandate; MEWAs. H.R. 2517 "Domestic Partnership Benefits and Obligations Act of 2009".

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Rescissions and Routine Administrative Functions: Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality: Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity. Health Information Technology Standards: Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform: Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Mandate

Client expense: $740,000 · Firm income: Not reported

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

See attached addendum for General Lobbying Issue Area: HCR - Healthcare State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Implementation of H.R. 3590, the Patient Protection and Affordable Care Act, to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. Implementation of H.R. 4872, the Health Care and Reconciliation Act of 2010, a bill that makes a number of health-related financing and revenue changes to the Patient Protection and Affordable Care Act, specifically regarding the medical device tax. S.540, Medical Device Safety Act, a bill that would remove federal preemption protection for certain medical devices H.R.1346, Medical Device Safety Act, a bill that would remove federal preemption protection for certain medical devices Reform of the 510 (k) regulatory pathway H.R. 759, Food and Drug Administration Globalization Act, a bill to improve the safety of food, drugs, devices, and cosmetics S. 882, the Drug and Device Accountability Act, a bill to ensure the safety and quality of medical products and enhance the authorities of the FDA H.R. 2502, Comparative Effectiveness Research Act of 2009, a bill to provide for the conduct of comparative effectiveness research for drugs, devices, and other therapies and create a Comparative Effectiveness Research Trust Fund S.1213, Patient-Centered Outcomes Research Act of 2009, a bill to provide for the conduct of comparative effectiveness research for drugs, devices, and other therapies and to establish a Patient-Centered Outcomes Research Trust Fund H.R. 2824, Doctor-Patient Relationship and Research Protection Act, a bill to support federally funded comparative effectiveness research for drugs, devices, and other therapies S.1142, Informed Health Care Decision Making Act, a bill with respect to the inclusion of effectiveness information in drug and device labeling and advertising H.R. 3090, Health Equity & Accountability Act of 2009, provides for the elimination of racial and ethnic health disparities S.660, National Pain Care Policy Act, a bill to promote greater access to chronic pain therapies H.R. 756, National Pain Care Policy Act, a bill to promote greater access to chronic pain therapies H.R. 4700, the Transparency in All Health Care Pricing Act of 2010, to provide for transparency in health care pricing H.R. 2249, the Health Care Price Transparency Promotion Act of 2009, to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs. H.R. 4803, the Patients Right to Know Act, to ensure health care consumer and provider access to certain health benefits plan information and to amend title XIX of the Social Security Act to provide transparency in hospital price and quality information. H.R.1032, Heart Disease Education, Analysis Research, and Treatment for Women Act to amend the Public Health Service Act to improve the prevention, diagnosis, and treatment of heart disease, stroke, and other cardiovascular diseases in women. S.422, Heart Disease Education, Analysis Research, and Treatment for Women Act to amend the Public Health Service Act to improve the prevention, diagnosis, and treatment of heart disease, stroke, and other cardiovascular diseases in women.

Client expense: $490,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, Transportation, Dept of (DOT)

S.660, National Pain Care Policy Act, a bill to promote greater access to chronic pain therapies H.R. 756, National Pain Care Policy Act, a bill to promote greater access to chronic pain therapies S.1380, Medicare Payment Advisory Commission (MedPAC) Reform Act, a bill to make the commission an executive branch agency, and provide the Commission new resources and authority to implement Medicare payment policy S.301, Physician Payments Sunshine Act, a bill that would require disclosure of the relationships between physicians and the manufacturers of drugs and devices H.R. 3138, Physician Payments Sunshine Act, a bill that would require disclosure of the relationships between physicians and the manufacturers of drugs and devices H.R. 2502, Comparative Effectiveness Research Act of 2009, a bill to provide for the conduct of comparative effectiveness research for drugs, devices, and other therapies and create a Comparative Effectiveness Research Trust Fund S.1213, Patient-Centered Outcomes Research Act of 2009, a bill to provide for the conduct of comparative effectiveness research for drugs, devices, and other therapies and to establish a Patient-Centered Outcomes Research Trust Fund H.R. 2824, Doctor-Patient Relationship and Research Protection Act, a bill to support federally funded comparative effectiveness research for drugs, devices, and other therapies S.1142, Informed Health Care Decision Making Act, a bill with respect to the inclusion of effectiveness information in drug and device labeling and advertising H.R. 4700, the Transparency in All Health Care Pricing Act of 2010, to provide for transparency in health care pricing H.R. 2249, the Health Care Price Transparency Promotion Act of 2009, to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs. H.R. 4803, the Patients Right to Know Act, to ensure health care consumer and provider access to certain health benefits plan information and to amend title XIX of the Social Security Act to provide transparency in hospital price and quality information

Client expense: $490,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, Transportation, Dept of (DOT)

See attached addendum for General Lobbying Issue Area: HCR-Healthcare Successful Insurance Industry Implementation of Health Reforms: "good faith compliance standard", reasonable effective dates for compliance with PL 111-148. State Oversight of Premium increases: S 3078 and HR 4757 " Health Insurance Rate Authority Act of 2010"; federal rate review; HR 4700 "Transparency in All Health Care Pricing Act of 2010"; existing state regulatory functions; federal exchange; state exchanges. Medical Loss Ratios: quality improvement definition; Consistent reporting requirements for all insurers. Dependent Health Care Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19. Rescission and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications. Affordable Private Health Care Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels. Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits." Health Care Quality; Patient Centered Primary Care/Medical Homes; Health Disparities; Wellness, Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity. Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD 10. Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Individual Mandates; MEWAs

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs OPM Legislative Proposal on FEHBP Subrogation and Reimbursement

Client expense: Not reported · Firm income: Not reported

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

See Attached HR 2221, Data Accountability and Trust Act HR 2249, Health Care Price Transparency Promotion Act HR 3655, Bereaved Consumers Bill of Rights Act of 2009 HR 4700, Transparency in All Health Care Pricing Act HR 4803, Patients' Right to Know Act' HR 4983, Transparency in Government Act S 139, Data Breach Notification Act S 1490, Personal Data Privacy and Security Act of 2009 S 3078, Health Insurance Rate Authority Act

Client expense: $350,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

H.Res. 1493 (Spratt) budget enforcement resolution; H.R. 1468, Medical Justice Act (Burgess) medical liability reform; (cont.) H.R. 1493, Quality Health Care Coalition Act (Paul) antitrust exemption for physicians; H.R. 1658, Veterans Healthcare Commitment Act (Tiahrt) third party billing by VA for service-connected disabilities; H.R. 2221, Data Accountability and Trust Act (Rush) data security; H.R. 2249, Health Care Price Transparency Promotion Act (Burgess) price transparency; H.R. 2607: Small Business Health Coverage (Johnson) association health plans; H.R. 3590, Patient Protection and Affordable Care Act (Reid) coverage expansions, quality improvements, delivery system reforms, cost containment, health information technology, comparative effectiveness research, administrative simplification, health disparities, prevention and wellness, public health and workforce issues, fraud and abuse; H.R. 4061, Cybersecurity Enhancement Act (Lipinski) privacy protections for health information technology; H.R. 4213, Tax Extenders Act (Rangel/Baucus) premium assistance for unemployed, Roberts amendment addressing individual coverage requirement; H.R. 4691, Temporary Extension Act (Rangel) premium assistance for unemployed; H.R. 4700, Transparency in All Health Care Pricing Act (Kagen) transparency in health care pricing; H.R. 4803, Patients' Right to Know Act (Barton) health benefits plan information, transparency in hospital price and quality information; H.R. 4851, Continuing Extension Act (Levin) premium assistance for unemployed, electronic health records; H.R. 5136, National Defense Authorization Act (Skelton) coverage for dependents under TRICARE; H.R. 5324, COBRA Health Benefits Extension Act (Davis) COBRA extension; H.R. 5486, Small Business Jobs Tax Relief Act (Levin) Camp motion addressing individual coverage requirement; H.R. 5690, MedMal Act (Gingrey) medical liability reform; S.Con.Res. 60, FY 2011 Budget Resolution (Conrad) reserve funds for health priorities; S. 45, Medical Care Access Protection Act (Ensign) medical liability reform; S. 139, Data Breach Notification Act (Feinstein) data security; S. 458, False Claims Act Clarification Act (Grassley) fraud and abuse; S. 988, SIMPLE Cafeteria Plan Act (Snowe) cafeteria plans, flexible spending arrangements; S. 1490, Personal Data Privacy and Security Act (Leahy) privacy, identity theft; S. 1734, Medical Liability Reform (Kyl) medical liability reform; S. 2730, COBRA Subsidy Extension and Enhancement Act (Brown) premium assistance for unemployed; S. 3393, COBRA Health Benefits Extension Act (Brown) COBRA extension; S. 3421, Temporary Extension Act (Grassley) premium assistance for unemployed; S. 3548 (Casey) premium assistance for unemployed HCR (Regulatory Issues): HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets; HIPAA enforcement; FEHBP enrollment data clearinghouse initiative; issues relating to health insurance plan participation in FEHBP, including contract requirements related to interoperability of health information technology, community rating policies, and similarly sized subscriber group (SSSG) requirement; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to implementation of the National Health Information Infrastructure; issues relating to market consolidation; issues relating to quality improvement; issues related to potential priority research topics for the effective health care program; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues related to genetics and genetic nondiscrimination; issues relating to mental health parity; issues relating to data breach requirements; issues relating to "meaningful use" requirements for health information technology; issues relating to Form 5500 reporting requirements; and issues relating to health care reform implementation.

Client expense: $2,290,000 · Firm income: Not reported

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

HR 3590/4872: healthcare reform legislation and reconciliation: provisions related to medical device tax, physician sunshine act, medical device registry, comparative effectiveness research, independent Medicare advisory board, national pain care act. HR 1346/S 540 Medical Device Safety Act: oppose removal of federal preemption. HR 4700/HR 2249/HR 4803 Health Care Pricing Transparency. Potential 510(k) regulatory process reform.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Insurance Market Reform: Healthy Choice Act; MLR; Guaranteed Issue; HSAs / Dependent Health Insurance Coverage Comparative Effectiveness Research HR. 3162 - Federal Regulatory functions - Anti-Trust and McCarran-Ferguson State Oversight of Premiums S.3078 HR. 4757 HR 4700/Transparency PL-111-148 Implementation "good faith compliance standards"

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; BCBS commitment to cover individuals up to age 26 on their parents health insurance; HR5200 "FEHBP Dependent Coverage Extension Act" Pre-Existing Condition Exclusions: Pre-existing condition for children; guaranteed issue for children under the age of 19 Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Recissions and Patient Protections: Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs HR 2517 "Domestic Partnership Benefits and Obligations Act of 2009"

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; BCBS commitment to cover individuals up to age 26 on their parents health insurance; HR5200 "FEHBP Dependent Coverage Extension Act" Pre-Existing Condition Exclusions: Pre-existing condition for children; guaranteed issue for children under the age of 19 Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Recissions and Patient Protections: Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs HR 2517 "Domestic Partnership Benefits and Obligations Act of 2009"

Client expense: $1,520,000 · Firm income: Not reported

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

H.R. 3590, Patient Protection and Affordable Care Act (Reid), H.R. 4700, Transparency in All Health Care Pricing Act (Kagen), H.R. 3962, America's Affordable Health Choices Act (Dingell)

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

Government targets: HOUSE OF REPRESENTATIVES

On HR 4757, the Health Insurance Rate Authority Act; On HR 4700, the Transparency in All Health Care Pricing Act; on Senate Amendment 4361, to curtail pay-for-delay settlements that discourage generic prescription drugs; On S. 3078, the Health Insurance Rate Authority Act

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

Government targets: Agriculture, Dept of (USDA), Consumer Product Safety Commission (CPSC), Environmental Protection Agency (EPA), Federal Deposit Insurance Corporation (FDIC), Federal Reserve System, Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Natl Credit Union Administration (NCUA), Natl Economic Council (NEC), Office of Thrift Supervision (OTS), Office of the Comptroller of the Currency (OCC), SENATE, Securities & Exchange Commission (SEC), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR), White House Office

S 2 Middle Class Opportunity Act, Card Check provisions; S 4 Comprehensive Health Reform Act of 2009, a bill to guarantee affordable, quality health coverage for all Americans, and for other purposes; S 45 MCAP Act, a bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; S 77 Children's Mental Health Parity Act, a bill to amend title XXI of the Social Security Act to provide for equal coverage of mental health services under the State Children's Health Insurance Program; HR 241a bill to amend title 10, United States Code, to require the amounts reimbursed to institutional providers of health care services under the TRICARE program to be the same as amounts reimbursed under Medicare, and to require the Secretary of Defense to contract for health care services with at least one teaching hospital in urban areas; HR 298 Improving Children's Doctor Access Act of 2009, a bill to amend title XXI of the Social Security Act to require SCHIP annual reports to include information on the HEDIS measure relating to access to primary care practitioners by individuals eligible for child health assistance under such plans and on State efforts to avoid certain displacement of private health coverage, and to express the sense of Congress that such States should utilize Consumer Assessment of Healthcare Providers and Systems consumer satisfaction surveys to measure access by such individuals to physicians; S 179 Health Information Technology Act of 2009, a bill to improve quality in health care by providing incentives for adoption of modern information technology; HR 468 and S 245 Retooling the Health Care Workforce for an Aging America Act of 2009, a bill to expand, train, and support all sectors of the health care workforce to care for the growing population of older individuals in the United States; HR 676 United States National Health Care Act or the Expanded and Improved Medicare for All Act, a bill to provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes; HR 688 and S 326 Kids First Act, a bill to amend title XXI of the Social Security Act to reauthorize the State Children's Health Insurance Program through fiscal year 2013, and for other purposes; Tricare letter sent to DOD from Sen. Ben Nelson urging DoD to revise the rule, expand the transition to the new payment system, offer other adjustments to cushion the financial blow on certain hospitals, and conduct a detailed analysis of its impact on the field; S 391 Healthy Americans Act, a bill to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away; HR 914 Physician Workforce Enhancement Act of 2009, a bill to amend title VII of the Public Health Service Act to establish a loan program for eligible hospitals to establish residency training programs; HR 936 National Trauma Center Stabilization Act of 2009, a bill to ensure the continued and future availability of lifesaving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, emergency needs, and information technology; HR 956 HealthCARE Act of 2009, a bill to expand the number of individuals and families with health insurance coverage, and for other purposes; S 408 Wakefield Act, a bill to amend the Public Health Service Act to provide a means for continued improvement in emergency medical services for children; HR 1085 Health Insurance Coverage Protection Act, a bill to impose a limitation on lifetime aggregate limits imposed by health plans; HR 1086 Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009; a bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; HR 1101 Midwifery Care Access and Reimbursement Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for reimbursement of certified midwife services and to provide for more equitable reimbursement rates for certified nurse-midwife services; S 441 Quality Reform Expansion and Savings Act of 2009, a bill to encourage the development of coordinated quality reforms to improve health care delivery and reduce the cost of care in the health care system; S 444 National Health Information Technology and Privacy Advancement Act of 2009, a bill to provide for the establishment of a health information technology and privacy system; S 486 Access for All America Act, a bill to achieve access to comprehensive primary health care services for all Americans and to reform the organization of primary care delivery through an expansion of the Community Health Center and National Health Service Corps programs; HR 1253 Health Insurance Restrictions and Limitations Clarification Act of 2009, a bill to require that limitations and restrictions on coverage under group health plans be timely disclosed to group health plan sponsors and timely communicated to participants and beneficiaries under such plans in a form that is easily understandable; HR 1296 Access for All America Act, a bill to achieve access to comprehensive primary health care services for all Americans and to reform the organization of primary care delivery through an expansion of the Community Health Center and National Health Service Corps programs; HR 1411 United States Primary and Preventive Health Care Corps Act of 2009, a bill to amend the Public Health Service Act to establish a Primary and Public Health Scholarship Program; HR 1460 Nurses Higher Education and Loan Repayment Act, a bill to amend the Public Health Service Act to establish a graduate degree loan repayment program for nurses who become nursing school faculty members; HR 1494 Nursing Home Emergency Assistance Act, a bill to ensure that a private for-profit nursing home affected by a major disaster receives the same reimbursement as a public nursing home affected by a major disaster; HR 1558 and S 623 Preexisting Condition Patient Protection Act of 2009, to prohibit health insurers from denying coverage to people with pre-existing conditions; S 616 Enhancing Safety in Medicine Utilizing Leading Advanced Simulation Technologies to Improve Outcomes Now Act of 2009, a bill to amend the Public Health Service Act to authorize medical simulation enhancement programs, and for other purposes; HR 1581 Patient-Focused Critical Care Enhancement Act, a bill to optimize the delivery of critical care medicine and expand the critical care workforce; S 628 Conrad State 30 Improvement Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities; HR 1614 and S 652 Community Coalitions for Access and Quality Improvement Act of 2009, a bill to authorize the Secretary of Health and Human Services to make grants to community health coalitions to assist in the development of integrated health care delivery; HR 1691 and S 688 Breast Cancer Patient Protection Act of 2009, a bill to require that health plans provide coverage for a minimum hospital stay for mastectomies, lumpectomies, and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations; HR 1699 Patient Access to Critical Lab Tests Act, a bill to require that certain complex diagnostic laboratory tests performed by an independent laboratory after a hospital outpatient encounter or inpatient stay during which the specimen involved was collected shall be treated as services for which payment may be made directly to the laboratory under part B of title XVIII of the Social Security Act; S 698 State-Based Health Care Reform Act, a bill to ensure the provision of high-quality health care coverage for uninsured individuals through State health care coverage pilot projects that expand coverage and access and improve quality and efficiency in the health care system; S 703 American Health Security Act of 2009, a bill to provide for health care for every American and to control the cost and enhance the quality of the health care system; HR 1745 Family Health Care Accessibility Act of 2009, a bill to amend the Public Health Service Act to provide liability protections for volunteer practitioners at health centers under section 330 of such Act; S 733 National Trauma Center Stabilization Act of 2009, a bill to ensure the continued and future availability of life saving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, and emergency needs; Letter to HHS about the action plan to prevent Healthcare associated infections; Provided information to members of Congress about the Quality and Patient Safety Transparency initiatives by state; Working with Rep. Nathan Deal to get legislation introduced on provider price transparency; HR 1670 and S 683 Community Choice Act of 2009, to amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports and which would allow disabled Medicaid recipients to receive care in their homes rather than in nursing homes; HR 2003 and S 830 Children's Hospitals Education Equity Act, a bill to modify the definition of children's hospital for purposes of making payments to children's hospitals that operate graduate medical education programs; HR 1998 Health Care Safety Net Enhancement Act of 2009, a bill to improve access to emergency medical services; HR 2043 Nurse Education, Expansion, and Development Act of 2009, a bill to amend the Public Health Service Act to authorize capitation grants to increase the number of nursing faculty and students; HR 2066 Graduate Psychology Education Act of 2009, a bill to amend the Public Health Service Act to promote mental and behavioral health services for underserved populations; S 890 Health Information Technology (IT) Public Utility Act of 2009, a bill to provide for the use of improved health information technology with respect to certain safety net health care providers; HR 2176 Nursing and Allied Health Education Preservation Act of 2009, to amend title XVIII of the Social Security Act to continue the ability of hospitals to supply a needed workforce of nurses and allied health professionals by preserving funding for hospital operated nursing and allied health education programs; HR 2218 Parental Consent Act of 2009, a bill to prohibit the use of Federal funds for any universal or mandatory mental health screening program; S 957 Public Health Emergency Response Act of 2009, a bill to amend the Public Health Service Act to ensure that victims of public health emergencies have meaningful and immediate access to medically necessary health care services; S 958 MediKids Health Insurance Act of 2009, a bill to amend the Social Security Act to guarantee comprehensive health care coverage for all children born after 2009; HR 2231 Public Health Emergency Response Act of 2009, a bill to amend the Public Health Service Act to ensure that victims of public health emergencies have meaningful and immediate access to medically necessary health care services; HR 2233 Health Empowerment Zone Act of 2009, a bill to authorize the Secretary of Health and Human Services to designate health empowerment zones; S 966 and HR 2252 National Health Care Quality Act, a bill to improve the Federal infrastructure for health care quality improvement in the United States; HR 2249 Health Care Price Transparency Promotion Act of 2009, a bill to amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs; HR 2251 and S 973 Resident Physician Shortage Reduction Act of 2009, to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; S 979 and HR 2360 SHOP Act, a bill 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; HR 2273 Nurse Staffing Standards for Patient Safety and Quality Care Act of 2009, a bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals; S 999 Child Health Care Crisis Relief Act of 2009, a bill to increase the number of well-trained mental health service professionals (including those based in schools) providing clinical mental health care to children and adolescents; S 1001 Health Promotion FIRST Act, a bill to provide for increased research, coordination and expansion of health promotion programs through the Department of Health and Human Services; HR 2350 Preserving Patient Access to Primary Care Act of 2009, a bill to amend the Public Health Service Act and the Social Security Act to increase the number of primary care physicians and primary care providers and to improve patient access to primary care services; HR 2369 Improving the Quality of Mental and Substance Use Health Care Act of 2009, a bill to improve mental and substance use health care; S 1020 Patient-Focused Critical Care Enhancement Act, a bill to optimize the delivery of critical care medicine and expand the critical care workforce; S 1022 Nurses' Higher Education and Loan Repayment Act of 2009, a bill to amend the Public Health Service Act to establish a graduate degree loan repayment program for nurses who become nursing school faculty members; HR 2381 Nurse and Health Care Worker Protection Act of 2009, a bill to direct the Secretary of Labor to issue an occupational safety and health standard to reduce injuries to patients, direct-care registered nurses, and all other health care workers by establishing a safe patient handling and injury prevention standard, and for other purposes; HR 2388 Physician Availability Act of 2009, a bill to assure that the services of a nonemergency department physician are available to hospital patients 24 hours a day, seven days a week in all non-Federal hospitals with at least 100 licensed beds; S 1028 Strengthening America's Public Health System Act, a bill to amend the Public Health Service Act to improve the Nation's surveillance and reporting for diseases and conditions; S 1031 National Nursing Shortage Reform and Patient Advocacy Act, a bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals; HR 2427 and S 1050 Informed Consumer Choices in Health Care Act of 2009, a bill to amend title XXVII of the Public Health Service Act to establish Federal standards for health insurance forms, quality, fair marketing, and honesty in out-of-network coverage in the group and individual health insurance markets, to improve transparency and accountability in those markets, and to establish a Federal Office of Health Insurance Oversight to monitor performance in those markets; HR 2520 Patients' Choice Act, a bill to provide comprehensive solutions for the health care system of the United States; HR 2535 Blueprint for Health Act of 2009, a bill to establish a Blueprint for Health in order to create a comprehensive system of care incorporating medical homes to improve the delivery and affordability of health care through disease prevention, health promotion, and education about and better management of chronic conditions; S 1104 Nurse-Managed Health Clinic Investment Act of 2009, a bill to amend the Public Health Service Act to establish the Nurse-Managed Health Clinic Investment program; HR 2536 Emergency Nursing Supply Relief Act, to provide relief for the shortage of nurses in the United States; HR 2691 a bill to provide assistance to adolescents and young adults with serious mental health disorders as they transition to adulthood ; S 1173 Community-Based Health Care Retraining Act, a bill to establish a demonstration project to train unemployed workers for employment as health care professionals; S 1174 Preserving Patient Access to Primary Care Act of 2009, a bill to amend the Public Health Service Act and the Social Security Act to increase the number of primary care physicians and primary care providers and to improve patient access to primary care services; S 1176 Allied Health Reinvestment Act, a bill to amend the Public Health Service Act to promote and improve the allied health professionals; HR 2744 Equal Rights for Health Care Act Title 42, a bill to prohibit discrimination in Federal assisted health care services and research programs on the basis of sex, race, color, national origin, sexual orientation, gender identity, or disability status; HR 2754 Nurse-Managed Health Clinic Investment Act of 2009, a bill to amend the Public Health Service Act to establish the Nurse-Managed Health Clinic Investment program; HR 2778 Health Equity and Accountability through Research Act of 2009, a bill to amend the Public Health Service Act to redesignate the National Center on Minority Health and Health Disparities as the National Institute for Minority Health and Health Disparities; S 1220 Patient Access to Critical Lab Tests Act, a bill to require that certain complex diagnostic laboratory tests performed by an independent laboratory after a hospital outpatient encounter or inpatient stay during which the specimen involved was collected shall be treated as services for which payment may be made directly to the laboratory under part B of title XVIII of the Social Security Act; HR 2785 Health Care Paperwork Reduction and Fraud Prevention Act of 2009, a bill to reduce the amount of paperwork and improve payment policies for health care services, to prevent fraud and abuse through health care provider education; HR 2804Ensuring Continuous Coverage under SCHIP Act of 2009, a bill to amend title XXI of the Social Security Act to require 12-month continuous coverage under the State Children's Health Insurance Program; HR 2810 Public Health Workforce Investment Act of 2009, a bill to amend the Public Health Service Act to establish various programs for the recruitment and retention of public health workers and to eliminate critical public health workforce shortages in Federal, State, local, and tribal public health agencies and health centers; HR 2816 States' Right To Innovate in Health Care Act of 2009, a bill to amend the Social Security Act to provide grants and flexibility through demonstration projects for States to provide universal, comprehensive, cost-effective systems of health care coverage, with simplified administration; HR 2824 Doctor-Patient Relationship and Research Protection Act, to enhance the conduct and support of federally funded comparative effectiveness research relating to health care; HR 2891 Access to Frontline Health Care Act of 2009, a bill to amend the Public Health Service Act to direct the Secretary of Health and Human Services to establish a Frontline Providers Loan Repayment Program; HR 2925 Communities Building Access Act, a bill to amend the Public Health Service Act to provide for community projects that will reduce the number of individuals who are uninsured with respect to health care; HR 2930 Primary Care Training Enhancement Act, a bill to enhance the primary care workforce through modifications to the medical residency training programs and use of qualified teaching health centers and through State primary care scholarship and loan repayment programs; S 1278 Consumers Health Care Act of 2009, a bill to establish the Consumers Choice Health Plan, a public health insurance plan that provides an affordable and accountable health insurance option for consumers; HR 2937 and S 1305 MRSA Infection Prevention and Patient Protection Act, a bill to prevent health care facility-acquired infections; HR 2948 Healthcare Improvements for Generating High Performance (HIGH Performance) Act of 2009, a bill to amend title IX of the Public Health Service Act to provide for the implementation of best practices in the delivery of health care in the United States; HR 2957 Rural Health Access Act of 2009, a bill to amend the Public Health Service Act to reauthorize the National Health Service Corps Scholarship and Loan Repayment Programs; S 1299 Worker Infection Protection Act, a bill to protect health care workers and first responders, including police, firefighters, emergency medical personnel, and other workers at risk of workplace exposure to infectious agents and drug resistant infections; Hatch amendment # 21 requiring the IOM to make recommendations to Congress on how to reduce unnecessary hospital readmissions; HR 2975 Medical Practice Protection Act of 2009, a bill to improve the medical care by reducing the excessive burden imposed by the civil liability system on the health care delivery system; HR 3000 Josephine Butler United States Health Service Act, a bill to establish a United States Health Service to provide high quality comprehensive health care for all Americans and to overcome the deficiencies in the present system of health care delivery; HR 3002 and S 1259 PATIENTS Act of 2009, a bill to protect all patients by prohibiting the use of data obtained from comparative effictiveness research accounts to deny coverage of items or services under Federal health care programs and to ensure that comparative effectiveness research accounts for advancements in personalized medicine and differences in patient treatment response; S 1355 Rural Health Clinic Patient Access and Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care for individuals residing in underserved rural areas; S. 1403 Strengthen Social Work Training Act of 2009, a bill to amend title VII of the Public Health Service Act to ensure that social work students or social work schools are eligible for support under certain programs that would assist individuals in pursuing health careers or for grants for training projects in geriatrics, and to establish a social work training program; S. 1404 Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act of 2009, a bill to implement demonstration projects at federally qualified community health centers to promote universal access to family-centered, evidence-based behavioral health interventions that prevent child maltreatment and promote family well-being by addressing parenting practices and skills for families from diverse socioeconomic, cultural, racial, ethnic, and other backgrounds; HR3134 Healthcare Innovation Zone Program Act of 2009, a bill to direct the Secretary of Health and Human Services to establish a Healthcare Innovation Zone pilot program; H.R.3148, a bill to amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings; H.R.3151 and S 1585 Rural Access to Nurse Anesthesia Services Act of 2009, a bill to permit pass-through payment for reasonable costs of certified registered nurse anesthetist services in critical access hospitals notwithstanding the reclassification of such hospitals as urban hospitals, including hospitals located in ``Lugar counties'', and for on-call and standby costs for such services; H.R.3158 Place Based Health Care Act of 2009, a bill to reform health care delivery by providing incentives for place-based health care, which seeks to bring health services to the patient by locating community health centers, federally qualified health centers, and community integrated health centers in or near settings that already serve a particular target population, such as schools, workplaces, and senior services facilities; H.R.3185 and S1569, a bill to amend title XVIII of the Social Security Act to provide payment to hospitals for costs of expanded advanced practice nurse training programs; H.R. 3191 Positive Aging Act of 2009, a bill to amend the Public Health Service Act to provide for integration of mental health services and mental health treatment outreach teams, and for other purposes; H.R. 3199 Emergency Medic Transition (EMT) Act of 2009 , a bill to amend the Public Health Service Act to provide grants to State emergency medical service departments to provide for the expedited training and licensing of veterans with prior medical training; H.R. 3200 America's Affordable Health Choices Act of 2009, a bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending; H.R. 3217 Health Care Choice Act of 2009, a bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; H.R. 3218 Improving Health Care for All Americans Act, a bill to provide a refundable tax credit for medical costs, to expand access to health insurance coverage through individual membership associations (IMAs), and to assist in the establishment of high risk pools; H.R.3234 Community-Based Health Care Retraining Act, a bill to establish a demonstration project to train unemployed workers for employment as health care professionals; H.R. 3242 Women's Health Office Act of 2009, a bill to improve the health of women through the establishment of Offices of Women's Health within the Department of Health and Human Services; S.1459 Health Care Choice Act of 2009, a bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; S. 1479 NO TITLE, a bill to provide for the treatment of certain hospitals; H.R. 3391 NO TITLE, a bill to allow for the continuation of critical access hospital designation for certain hospitals in geographic areas experiencing population growth; H.R. 3400 Empowering Patients First Act, a bill to provide for incentives to encourage health insurance coverage; H.R.3421 Medical Debt Relief Act of 2009, a bill to exclude from consumer credit reports medical debt that has been in collection and has been fully paid or settled; HR 3472 a bill to provide for health insurance coverage premium discounts for healthy behavior and improvements toward healthy behavior; HR 3483 Steps Toward Access and Reform (STAR) Act of 2009, a bill to reform the medical liability system, improve access to health care for rural and indigent patients, enhance access to affordable prescription drugs, and for other purposes S 1572, a bill to provide for a point of order against any legislation that eliminates or reduces the ability of Americans to keep their health plan or their choice of doctor or that decreases the number of Americans enrolled in private health insurance, while increasing the number of Americans enrolled in government-managed health care; S 1679 Affordable Health Choices Act, an original bill to make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce; HR 3652 Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2009, a bill to amend the Public Health Service Act and title XVIII of the Social Security Act to make the provision of technical services for medical imaging examinations and radiation therapy treatments safer, more accurate, and less costly; S 1720 Health Professions and Primary Care Reinvestment Act, a bill to amend title VII of the Public Health Service Act to provide improved training and primary care; HR 3664 Healthcare Innovation Zone Pilot Act of 2009, a bill to direct the Secretary of Health and Human Services to establish a Healthcare Innovation Zone pilot program; S 1730 Fairness in Health Insurance Act, a bill to provide for minimum loss ratios for health insurance coverage; S 1734 Medical Liability Reform Act of 2009, a bill to reduce the cost of health care and ensure patient access to doctors by ending excessive malpractice verdicts through common-sense lawsuit reform; Senate Finance Committee Americas Healthy Future Act of 2009, Senate Finance Committee health reform bill with provisions on coverage, disease prevention and wellness, delivery system reform, health care quality and efficiency, transparency and program integrity, and financing; Meeting with FTC, senate congressional staff re barriers to clinical integration; HR 3590 Patient Protection and Affordable Care Act, the merged product of the health reform bills from the Senate Finance and Health, Education, Labor and Pensions (HELP) committees; HR 3962 Affordable Health Care for America Act, a bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes; HR 3700 Health Care Bill of Rights Act, a bill to establish requirements for any health reform legislation enacted by the Congress or the President during the 111th Congress; HR 3713 American Health Care Solutions Act of 2009, a bill to provide bipartisan solutions to lower health costs, increase access to affordable coverage, and give patients more choices and control; S 1742 Women's Hospitals Education Equity Act, a bill to amend the Public Health Service Act to provide assistance for graduate medical education funding for women's hospitals; Comments to CMS proposed rule defining meaningful use of electronic Health Records concern that the rules will severely limit hospitals' ability to access federal financing for health information technology and put many hospitals at risk for Medicare payment penalties beginning in 2015; FDA Grants Hospitals 18 Months to Replace Steris System 1 Processor; HR 4626 Health Insurance Industry Fair Competition Act, to restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers; HR 4851 Continuing Extension Act of 2010, to provide a temporary extension of certain programs; Meetings with CMS and HHS to encourage reimbursement under the National Disaster Medical System for hospitals that provided services to victims of the Haitian earthquake; HR 4700 The Transparency in All Health Care Pricing Act of 2010, to provide for transparency in health care pricing; HR 4803 The Patients Right to Know Act, to ensure health care consumer and provider access to certain health benefits plan information and to amend title XIX of the Social Security Act to provide transparency in hospital price and quality information.

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

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