Fiscal Responsibility and Retirement Security Act

H.R. 4, Small Business Paperwork Mandate Elimination Act of 2011 H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 436, Protect Medical Innovation Act of 2011 H.R. 452, Medicare Decisions Accountability Act of 2011 H.R. 1173, Fiscal Responsibility and Retirement Security Act of 2011 H.R. 1370, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 2010, Family and Retirement Health Investment Act of 2011 H.R. 2077, MLR Repeal Act H.R. 2112, Consolidated and Further Continuing Appropriations Act, 2012, including an amendment regarding pharmaceutical importation H.R. 3203, Novel Device Regulatory Relief Act of 2011 H.R. 3204, Guidance Accountability and Transparency Act of 2011 H.R. 3205, FDA Renewing Efficiency from Outside Reviewer Management Act of 2011 H.R. 3206, Cultivating Scientific Expertise to Foster Innovation Act of 2011 H.R. 3207, Modernizing Laboratory Test Standards for Patients Act of 2011 H.R. 3208, Patients Come First Act of 2011 H.R. 3209, Premarket Predictability Act of 2011 H.R. 3211, Humanitarian Device Reform Act of 2011 H.R. 3214, Food and Drug Administration Mission Reform Act of 2011 H.R. 3230, Keeping America Competitive through Harmonization Act of 2011 H.R. 4626, Health Insurance Fair Competition Act H.R. 4853, Middle Class Tax Act of 2010 H.R. 5853, Fiscal Responsibility and Retirement Security Act H.R. 2 / S. 192, Repealing the Job-Killing Health Care Law Act H.R. 605 / S. 312, Patients Freedom To Choose Act H.R. 1744 / S. 20, American Job Protection Act H.R. 2529 / S. 1368, Restoring Access to Medication Act S. 17, Medical Device Access and Innovation Protection Act H.R. 5141 / S. 3578, Small Business Paperwork Mandate Elimination Act H.R. 1744 / S.20, American Job Protection Act S. 17, Medical Device Access and Innovation Protection Act S. 223, FAA Air Transportation Modernization and Safety Improvement Act, including the Amendment offered by Senator McConnell to repeal P.L. 111-148, the Patient Protection and Affordable Care Act and an Amendment offered by Senator Stabenow which would repeal Section 9006 of the Patient Protection and Affordable Care Act S. 493, SBIR/STTR Reauthorization Act of 2011, including an Amendment offered by Senator Johanns which would fully repeal Section 9006 of the Patient Protection and Affordable Care Act and Amendment Number 197 offered by Senator Hutchison S. 510, FDA Food Safety Modernization Act, issues related to 1099 reporting amendments S. 668, Health Care Bureaucrats Elimination Act S. 720, Repeal the CLASS Entitlement Act S. 848, Consumer Information Enhancement Act of 2011 S. 1049, Small Business Health Relief Act of 2011 S. 1098, Family and Retirement Health Investment Act of 2011 S. 1880, Jobs and Premium Protection Act S. 1886, Counterfeit Drug Penalty Enhancement Act of 2011 S. 2002, Online Pharmacy Safety Act S. 3501, American Job Protection Act S. 3673, Patients Freedom To Choose Act P.L. 112-009 (Formerly H.R. 4), Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011 Filed comments and met with relevant agencies on regulations implementing health care reform (P.L. 111-148 and 111-152). Regulations commented on include: Medical Loss Ratio (MLR) Request for Information; Adult Child Coverage (Age 26) Interim Final Rule; Grandfathered Plan Status Interim Final Rule; Preexisting Condition Exclusion; Lifetime & Annual Limits; Rescissions; Patient Protections Interim Final Rule; Preventive Services Coverage Interim Final Rule; Internal Claims & Appeals and External Review Processes Interim Final Rule; Preexisting Condition Insurance Plan (PCIP) Interim Final Rule; 1099 Reporting Requirements Request for Comments; Planning and Establishment of State-level Exchanges Request for Comments; National Quality Plan Request For Comments; Non-Discrimination in Favor of Highly Compensated Individuals Request for Comments; Essential Health Benefits (IOM Study); Amended Interim Final Rule for Grandfathered Plan Status; Guidance on OTC Medicine & Definition of Medical Expenses; Development of Health Risk Assessment; Medical Loss Ratio; Rate Increase Disclosure and Review; Value Based Insurance Design; Consumer Operated and Oriented Plan Programs; Nondiscrimination in favor of Highly Compensated Individuals - second notice re: timing; DOL: Retrospective Review Under E.O. 13563; Treasury: Retrospective Review Under E.O. 13563; State Innovation Waivers; ACOs & Medicare Shared Savings Program; Electronic Disclosure by Employee Benefit Plan; Shared Responsibility for Employers Regarding Health Coverage (Section 4980H); Amendment to the Interim Final Rule on Internal Claims and Appeals and External Review Processes; HIPAA Privacy Rule Accounting of Disclosures; Medical Data Sharing. Summary of benefits and Coverage and the Uniform Glossary; Exchange Functions in the Individual market; Health Insurance Premium Tax Credit; Establishment of Exchanges and Qualified Health Plans; Health Coverage Affordability Safe Harbor for Employers. Comprehensive health reform (bills in the Senate and House) - all aspects relating to coverage, financing, and delivery reform, including: 1099 reporting; Grandfathering, HSA and FSA changes; CMS claims database; IPAB; CLASS Act; employer mandate; medical loss ratio; mandated insurance requirements; Exchanges; Medicare reform; regulatory reform; Essential Health Benefits Package; Health Insurance Tax; Medical Device Tax Various issues relating to implementation of P.L. 111-148 (111th Congress), Patient Protection and Affordable Care Act; these issues include anything being implemented during the 112th Congress or rulemaking, medical malpractice reform, exchanges, and flexible spending accounts and health savings accounts; issues related to the regulatory process and legislative corrections to P.L. 111-148, Patient Protection and Affordable Care Act (coverage, financing, and delivery reform, 1099 reporting, Grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS program, employer mandate, medical loss ratio); regulatory process and legislative corrections to P.L. 111-152, Health Care and Education Affordability Reconciliation Act of 2010; ERISA preemption; impact on small business Jennifer Pierotti - Covered Official Positions: Intern, U.S. Senate Committee on Small Business and Entrepreneurship, Minority Staff - Olympia J. Snowe - January 2010 - April 2010

Client expense: $14,250,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Accounting Standards Advisory Board (FASAB), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Office of Management & Budget (OMB), Office of the Comptroller of the Currency (OCC), Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation Security Administration (TSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office

H.R. 2, Repealing the Job-Killing Health Care Law Act H.R. 4, Small Business Paperwork Mandate Elimination Act of 2011 H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 436, Protect Medical Innovation Act of 2011 H.R. 452, Medicare Decisions Accountability Act of 2011 H.R. 605, Patients Freedom to Choose Act H.R. 1063, Strengthening Medicare and Repaying Taxpayers Act of 2011 H.R. 1173, Fiscal Responsibility and Retirement Security Act of 2011 H.R. 1370, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 1744, American Job Protection Act H.R. 2010, Family and Retirement Health Investment Act of 2011 H.R. 2077, MLR Repeal Act of 2011 H.R. 4626, Health Insurance Fair Competition Act H.R. 4853, Middle Class Tax Act of 2010 H.R. 5853, Fiscal Responsibility and Retirement Security Act H.R. 5141/S. 3578, Small Business Paperwork Mandate Elimination Act S. 17, Medical Device Access and Innovation Protection Act S. 20, American Job Protection Act S. 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 S. 223, FAA Air Transportation Modernization and Safety Improvement Act, including the Amendment offered by Senator McConnell to repeal P.L. 111-148, the Patient Protection and Affordable Care Act and an Amendment offered by Senator Stabenow which would repeal Section 9006 of the Patient Protection and Affordable Care Act S. 312, Patients Freedom to Choose Act S. 493, SBIR/STTR Reauthorization Act of 2011, including an Amendment offered by Senator Johanns which would fully repeal Section 9006 of the Patient Protection and Affordable Care Act and Amendment Number 197 offered by Senator Hutchison S. 510, FDA Food Safety Modernization Act, issues related to 1099 reporting amendments S. 668, Health Care Bureaucrats Elimination Act S. 720, Repeal the CLASS Entitlement Act S. 848, Consumer Information Enhancement Act of 2011 S. 1049, Small Business Health Relief Act S. 1098, Family and Retirement Health Investment Act of 2011 S. 3501, American Job Protection Act S. 3673, Patients Freedom Choice Act P.L. 111-148 (111th Congress), Patient Protection and Affordable Care Act P.L. 112-009 (Formerly H.R. 4), Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011 Filed comments and met with relevant agencies on regulations implementing health care reform. (P.L. 111-148 and P.L. 111-152) Regulations commented on include: Medical Loss Ratio (MLR) Request for Information; Adult Child Coverage (Age 26) Interim Final Rule; Grandfathered Plan Status Interim Final Rule; Preexisting Condition Exclusion; Lifetime & Annual Limits; Rescissions; Patient Protections Interim Final Rule; Preventive Services Coverage Interim Final Rule; Internal Claims & Appeals and External Review Processes Interim Final Rule; Preexisting Condition Insurance Plan (PCIP) Interim Final Rule; 1099 Reporting Requirements Request for Comments; Planning and Establishment of State-level Exchanges Request for Comments; National Quality Plan Request For Comments; Non-Discrimination in Favor of Highly Compensated Individuals Request for Comments; Essential Health Benefits (IOM Study); Amended Interim Final Rule for Grandfathered Plan Status; Guidance on OTC Medicine & Definition of Medical Expenses; Development of Health Risk Assessment, Medical Loss Ratio, Rate Increase Disclosure and Review; Value Based Insurance Design; Consumer Operated and Oriented Plan Programs; Nondiscrimination in favor of Highly Compensated Individuals - second notice re timing, DOL: Retrospective Review Under E.O. 13563, Treasury: Retrospective Review Under E.O. 13563; State Innovation Waivers; ACOs & Medicare Shared Savings Program; Electronic Disclosure by Employee Benefit Plan; Shared Responsibility for Employers Regarding Health Coverage (Section 4980H); Amendment to the Interim Final Rule on Internal Claims and Appeals and External Review Processes; HIPAA Privacy Rule Accounting of Disclosures; Medical Data Sharing Various issues relating to P.L. 111-148 (111th Congress) also known as the Patient Protection and Affordable Care Act; these issues include anything being implemented during the 112th Congress or rulemaking, medical malpractice reform, exchanges, and flexible spending accounts and health savings accounts; issues related to the regulatory process and legislative corrections to P.L. 111-148, Patient Protection and Affordable Care Act (coverage, financing, and delivery reform, 1099 reporting, Grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS program, employer mandate, medical loss ratio); regulatory process and legislative corrections to P.L. 111-152, Health Care and Education Affordability Reconciliation Act of 2010; ERISA preemption; impact on small business; health care reform; employer mandate repeal Daniel Hillenbrand - Covered Official Positions: Intern - Office of Congressman John Kline

Client expense: $10,010,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Bureau of Economic Analysis, Bureau of Labor Statistics (BLS), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Accounting Standards Advisory Board (FASAB), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Library of Congress (LOC), Natl Economic Council (NEC), Natl Institute of Standards & Technology (NIST), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation Security Administration (TSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office

H.R. 2, Repealing the Job-Killing Health Care Law Act H.R. 4, Small Business Paperwork Mandate Elimination Act of 2011 H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 436, Protect Medical Innovation Act of 2011 H.R. 452, Medicare Decisions Accountability Act of 2011 H.R. 605, Patients Freedom to Choose Act H.R. 1173, Fiscal Responsibility and Retirement Security Act H.R. 1370, a bill to repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act. H.R. 2010, Family and Retirement Health Investment Act of 2011 H.R. 2077, MLR Repeal Act H.R. 4626, Health Insurance Fair Competition Act H.R. 4853, Middle Class Tax Act of 2010 H.R. 5853, Fiscal Responsibility and Retirement Security Act S. 17, Medical Device Access and Innovation Protection Act S. 223, FAA Air Transportation Modernization and Safety Improvement Act, including the Amendment offered by Senator McConnell to repeal P.L. 111-148, the Patient Protection and Affordable Care Act and an Amendment offered by Senator Stabenow which would repeal Section 9006 of the Patient Protection and Affordable Care Act S. 312, Patients Freedom to Choose Act S. 493, SBIR/STTR Reauthorization Act of 2011, including an Amendment offered by Senator Johanns which would fully repeal Section 9006 of the Patient Protection and Affordable Care Act and Amendment Number 197 offered by Senator Hutchison S. 510, FDA Food Safety Modernization Act, issues related to 1099 reporting amendments S. 668, Health Care Bureaucrats Elimination Act S. 720, Repeal the CLASS Entitlement Act S. 848, Consumer Information Enhancement Act of 2011 S. 1049, Small Business Health Relief Act of 2011 S. 1098, Family and Retirement Health Investment Act of 2011 S. 3501, American Job Protection Act S. 3673, Patients Freedom Choice Act H.R. 5141/S. 3578, Small Business Paperwork Mandate Elimination Act H.R. 1744/S.20, American Job Protection Act P.L. 112-009 (Formerly H.R. 4), Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011 Filed comments and met with relevant agencies on regulations implementing health care reform. (P.L. 111-148 and 111-152). Regulations commented on include: Medical Loss Ratio (MLR) Request for Information, Adult Child Coverage (Age 26) Interim Final Rule, Grandfathered Plan Status Interim Final Rule, Preexisting Condition Exclusion, Lifetime & Annual Limits, Rescissions, Patient Protections Interim Final Rule, Preventive Services Coverage Interim Final Rule, Internal Claims & Appeals and External Review Processes Interim Final Rule, Preexisting Condition Insurance Plan (PCIP) Interim Final Rule, 1099 Reporting Requirements Request for Comments, Planning and Establishment of State-level Exchanges Request for Comments, National Quality Plan Request For Comments, Non-Discrimination in Favor of Highly Compensated Individuals Request for Comments, Essential Health Benefits (IOM Study), Amended Interim Final Rule for Grandfathered Plan Status, Guidance on OTC Medicine & Definition of Medical Expenses, Development of Health Risk Assessment, Medical Loss Ratio, Rate Increase Disclosure and Review, Value Based Insurance Design, Consumer Operated and Oriented Plan Programs, Nondiscrimination in favor of Highly Compensated Individuals - second notice re timing, DOL: Retrospective Review Under E.O. 13563, Treasury: Retrospective Review Under E.O. 13563, State Innovation Waivers, ACOs & Medicare Shared Savings Program, Electronic Disclosure by Employee Benefit Plan, Shared Responsibility for Employers Regarding Health Coverage (Section 4980H) Various issues related to P.L. 111-148 (111th Congress) also known as the Patient Protection and Affordable Care Act; these issues include anything being implemented during the 112th Congress or rulemaking, medical malpractice reform, exchanges, and flexible spending accounts and health savings accounts; issues related to the regulatory process and legislative corrections to P.L. 111-148, Patient Protection and Affordable Care Act (coverage, financing, and delivery reform, 1099 reporting, Grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS program, employer mandate, medical loss ratio); regulatory process and legislative corrections to P.L. 111-152, Health Care and Education Affordability Reconciliation Act of 2010; ERISA preemption; impact on small business

Client expense: $9,040,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Accounting Standards Advisory Board (FASAB), Federal Aviation Administration (FAA), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Reserve System, Food & Drug Administration (FDA), General Services Administration (GSA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Institute of Standards & Technology (NIST), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Trade Representative (USTR), White House Office

H.R. 1322, Earned Retiree Healthcare Benefits Protection Act of 2011 H.R. 2, Repealing the Job-Killing Health Care Law Act H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 436, Protect Medical Innovation Act of 2011 H.R. 4 / S. 72 / S. 18, Small Business Paperwork Mandate Elimination Act of 2011 S. 312 / H.R. 605, Patients Freedom to Choose Act S. 20, American Job Protection Act S. 17, Medical Device Access and Innovation Protection Act S. 223, FAA Air Transportation Modernization and Safety Improvement Act, including the McConnell and Stabenow amendments to repeal P.L. 111-148, Patient Protection and Affordable Care Act S. 493, SBIR/STTR Reauthorization Act of 2011, including the Johanns and Hutchinson amendments Potential legislation similar to the following: P.L. 111-148, Patient Protection and Affordable Care Act H.R. 4872, Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152), specifically issues related to the regulatory process and legislative corrections S. 510 FDA Food Safety Modernization Act, including issues related to 1099 reporting H.R. 4853 Middle Class Tax Act of 2010 H.R. 5853, Fiscal Responsibility and Retirement Security Act H.R. 4626, Health Insurance Fair Competition Act Education Affordability Reconciliation Act of 2010 Anticipated legislation not yet introduced: Comprehensive health reform and all aspects relating to coverage, financing, delivery reform, 1099 reporting, grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS program, and employer mandate Filed comments and met with relevant agencies on regulations implementing health care reform (P.L. 111-148 and 111-152) Regulations commented on include: Medical Loss Ratio (MLR) Request for Information, see 75 Fed. Reg. 19,297(April 14, 2010) Adult Child Coverage (Age 26) Interim Final Rule, see 75 Fed. Reg. 34,538 (May 13, 2010) Grandfathered Plan Status Interim Final Rule, see 75 Fed. Reg. 34,538-70 (June 17, 2010) Preexisting Condition Exclusion, Lifetime & Annual Limits, Rescissions, Patient Protections Interim Final Rule, see 75 Fed. Reg. 37,18837,241 (June 28, 2010) Preventive Services Coverage Interim Final Rule, see 75 Fed. Reg. 41,72660 (July 19, 2010) Internal Claims & Appeals and External Review Processes Interim Final Rule, see 75 Fed. Reg. 43,330-64 (July 23, 2010) Preexisting Condition Insurance Plan (PCIP) Interim Final Rule, see 75 Fed. Reg. 37,18837,241 (June 28, 2010) 1099 Reporting Requirements Request for Comments, see 75 Fed. Reg. at 49,828 (August 16, 2010) Planning and Establishment of State-level Exchanges Request for Comments, see 75 Fed. Reg. 45,584-90 (August 3, 2010) National Quality Plan Request For Comments, see 75 Fed. Reg. 63478 (October 15, 2010) Non-Discrimination in Favor of Highly Compensated Individuals Request for Comments, see 75 Fed. Reg. 67,975 (November 4, 2010) Essential Health Benefits (IOM Study) Amended Interim Final Rule for Grandfathered Plan Status, see 75 Fed. Reg. 34,53870 (June 17, 2010) Guidance on OTC Medicine & Definition of Medical Expenses, see 75 Fed. Reg. 80,501 (December 22, 2010) Development of Health Risk Assessment, see 75 Fed. Reg. 82400-82402 (December 30, 2010) Medical Loss Ratio, see 75 Fed. Reg. 74,864-74,934 (December 1, 2010) Rate Increase Disclosure and Review, see 75 Fed. Reg. 81,004-81,029 (December 23, 2010) Value Based Insurance Design, see 75 Fed. Reg. 81,544-81,547 (December 28, 2010) Consumer Operated and Oriented Plan Programs, see 76 Fed. Reg. 5,774-5,777 (February 2, 2011) Non-discrimination in favor of Highly Compensated Individuals (second notice), see 75 Fed. Reg. 67,975 (November 4, 2010) Various issues including: ERISA preemption, medical malpractice reform, exchanges, and flexible spending accounts and health savings accounts (specific legislation not yet introduced)

Client expense: $10,890,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Bureau of Citizenship & Immigration Services (BCIS), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Aviation Administration (FAA), Federal Communications Commission (FCC), Federal Reserve System, Federal Trade Commission (FTC), Food & Drug Administration (FDA), General Services Administration (GSA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Institute of Standards & Technology (NIST), Natl Labor Relations Board (NLRB), Natl Mediation Board, Natl Security Council (NSC), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Trade Representative (USTR), White House Office

H.R.3590, Patient Protection and Affordable Care Act - Lobbied in support of and on implementation of health care legislation that would reform the health care system to provide affordable quality health care and expand access to long-term services and supports. Provided information on the need for nursing education capacity and the retention of newer and older nurses in the workplace (no bill). S.1569/H.R.3185, Medicare Graduate Nursing Education Act - Advocated for modernizing Medicare funding so that nursing education funds are directed to advanced nurse practice programs to help produce more highly-skilled nurses to care for the Medicare population. S. 623/HR 1558, Pre-existing Condition Patient Protection Act of 2009 - Lobbied in support of bill that would prohibit insurers from denying health insurance or delaying coverage for people with pre-existing conditions. H.R. 2778, Health Equity and Accountability through Research Act of 2009 - Lobbied in support of bill that would address racial and ethnic disparities in care. S. 979/HR 2360, Small Business Health Options Programs Act - Lobbied in support of bill that would 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. S.1213, Patient-Centered Outcomes Research Act - Lobbied in support of bill that would create a public-private partnership to conduct and disseminate comparative effectiveness research. S. 726/H.R. 1427, Promoting Innovation and Access to Life Saving Medicines - Discussed legislation which would create a pathway for approval of safe, effective biosimilar and generic biologic drugs. H.R. 3090, Health Equity and Accountability Act - Discussed need to end racial and ethnic disparities in care. S. 3686, Labor, HHS, Education and Related Agencies Appropriations Act FY 2011 - Lobbied for funding for healthcare services, research and training involving NIH, AHRQ, CMS, HRSA, HHS and AOA. H.R. 3082, H.R. 3081, H.J. Res.101, H.J. Res. 105, Continuing Appropriations and Surface Transportation Extensions Act, 2011 - Lobbied for funding for various federal programs serving Older Americans, most notably SSA Administrative expenses, LIHEAP, aging services, HECM reverse mortgage subsidy and Section 202, Housing for the Elderly. H.R. 4872, Health Care and Education Reconciliation Act - Lobbied in support of health care law which makes improvements such as closing the Part D coverage gap, in the Patient Protection and Affordable Care Act and implementation of some provisions. H.R. 5364, Special Care Dentistry Act - Discussed bill that would require states to provide oral health coverage for aged, blind,or disabled individuals through a separate state adult dental program, with 100% federal match. H.R. 4213, American Workers, State and Business Relief Act/American Jobs and Closing Tax Loopholes Act - Lobbied for extension of UI, COBRA, FMAP, and SGR. H.R. 3081, Continuing Resolution, FY 2011 - Lobbied for funding for SSA, various health care, employment, aging services and nutrition programs. H.R. 4224, Together We Care Act - Bill creates a three-year pilot program to train public housing residents to provide covered home-based health services. H.R. 5853, Fiscal Responsibility and Retirement Security Act - Bill requires review and approval by law prior to collection of premiums under the CLASS program, to require notice to individuals prior to enrollment, and to require termination of the program in the event of actuarial unsoundness, and for other purposes. S. 2814, Home Health Care Planning Improvement Act of 2010 - Bill recognizes and authorizes nurse practitioners, clinical nurse specialists, certified nurse-midwives and physician assistants as eligible health care professionals who can order home health services under Medicare. H.R. 4993, Home Health Care Planning Improvement Act of 2010 - Bill recognizes and authorizes nurse practitioners, clinical nurse specialists, certified nurse-midwives and physician assistants as eligible health care professionals who can order home health services under Medicare.

Client expense: $9,120,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), Federal Energy Regulatory Commission (FERC), Federal Reserve System, Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Highway Traffic Safety Administration (NHTSA), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Vice President of the United States, SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, White House Office

H.R.3590, Patient Protection and Affordable Care Act - Lobbied in support of and on implementation of health care legislation that would reform the health care system to provide affordable quality health care and expand access to long-term services and supports. Provided information on the need for nursing education capacity and the retention of newer and older nurses in the workplace (no bill). S.1569/H.R.3185, Medicare Graduate Nursing Education Act - Advocated for modernizing Medicare funding so that nursing education funds are directed to advanced nurse practice programs to help produce more highly-skilled nurses to care for the Medicare population. S. 623/HR 1558, Pre-existing Condition Patient Protection Act of 2009 - Lobbied in support of bill that would prohibit insurers from denying health insurance or delaying coverage for people with pre-existing conditions. H.R. 2778, Health Equity and Accountability through Research Act of 2009 - Lobbied in support of bill that would address racial and ethnic disparities in care. S. 979/HR 2360, Small Business Health Options Programs Act - Lobbied in support of bill that would 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. S.1213, Patient-Centered Outcomes Research Act - Lobbied in support of bill that would create a public-private partnership to conduct and disseminate comparative effectiveness research. S. 726/H.R. 1427, Promoting Innovation and Access to Life Saving Medicines - Discussed legislation which would create a pathway for approval of safe, effective biosimilar and generic biologic drugs. H.R. 3090, Health Equity and Accountability Act - Discussed need to end racial and ethnic disparities in care. S. 3686, Labor, HHS, Education and Related Agencies Appropriations Act FY 2011 - Lobbied for funding for healthcare services, research and training involving NIH, AHRQ, CMS, HRSA, HHS and AOA. H.R. 3082, H.R. 3081, H.J. Res.101, H.J. Res. 105, Continuing Appropriations and Surface Transportation Extensions Act, 2011 - Lobbied for funding for various federal programs serving Older Americans, most notably SSA Administrative expenses, LIHEAP, aging services, HECM reverse mortgage subsidy and Section 202, Housing for the Elderly. H.R. 4872, Health Care and Education Reconciliation Act - Lobbied in support of health care law which makes improvements such as closing the Part D coverage gap, in the Patient Protection and Affordable Care Act and implementation of some provisions. H.R. 5364, Special Care Dentistry Act - Discussed bill that would require states to provide oral health coverage for aged, blind,or disabled individuals through a separate state adult dental program, with 100% federal match. H.R. 4213, American Workers, State and Business Relief Act/American Jobs and Closing Tax Loopholes Act - Lobbied for extension of UI, COBRA, FMAP, and SGR. H.R. 3081, Continuing Resolution, FY 2011 - Lobbied for funding for SSA, various health care, employment, aging services and nutrition programs. H.R. 4224, Together We Care Act - Bill creates a three-year pilot program to train public housing residents to provide covered home-based health services. H.R. 5853, Fiscal Responsibility and Retirement Security Act - Bill requires review and approval by law prior to collection of premiums under the CLASS program, to require notice to individuals prior to enrollment, and to require termination of the program in the event of actuarial unsoundness, and for other purposes. S. 2814, Home Health Care Planning Improvement Act of 2010 - Bill recognizes and authorizes nurse practitioners, clinical nurse specialists, certified nurse-midwives and physician assistants as eligible health care professionals who can order home health services under Medicare. H.R. 4993, Home Health Care Planning Improvement Act of 2010 - Bill recognizes and authorizes nurse practitioners, clinical nurse specialists, certified nurse-midwives and physician assistants as eligible health care professionals who can order home health services under Medicare.

Client expense: $9,120,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), Federal Energy Regulatory Commission (FERC), Federal Reserve System, Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Highway Traffic Safety Administration (NHTSA), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Vice President of the United States, SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, White House Office

H.R. 4626, Health Insurance Industry Fair Competition Act H.R. 5853, Fiscal Responsibility and Retirement Security Act H.R. 4853, Middle Class Tax Act of 2010 H.R. 1322, Emergency Retiree Health Benefits Protection Act of 2009 H.R. 3590, Patient Protection and Affordable Care Act (P.L. 111-148), specifically issues related to the regulatory process and legislative corrections H.R. 4872, Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152), specifically issues related to the regulatory process and legislative corrections H.R. 5141 / S. 3578, Small Business Paperwork Mandate Elimination Act S. 3501, American Job Protection Act S. 3673, Patients' Freedom to Choose Act S. 510, FDA Food Safety Modernization Act, provisions related to 1099 reporting and amendments offered by Senator Mike Johanns and Senator Max Baucus which would repeal Section 9006 of H.R. 3590, Patient Protection and Affordable Care Act S. 3924, Public Accountability in Health Care Implementation Act Filed comments and met with relevant agencies on regulations implementing health care reform (P.L. 111-148 and 111-152) Regulations commented on include: Medical Loss Ratio (MLR) Request for Information Adult Child Coverage (Age 26) Interim Final Rule Grandfathered Plan Status Interim Final Rule Preexisting Condition Exclusion, Lifetime & Annual Limits Rescissions, and Patient Protections Interim Final Rule Preventive Services Coverage Interim Final Rule Internal Claims & Appeals and External Review Processes Interim Final Rule Preexisting Condition Insurance Plan (PCIP) Interim Final Rule 1099 Reporting Requirements Request for Comments Planning and Establishment of State-level Exchanges Request for Comments National Quality Plan Request For Comments Non-Discrimination in Favor of Highly Compensated Individuals Request for Comments Essential Health Benefits (IOM Study) Issues related to ERISA preemption (specific legislation not yet introduced) Various ongoing issues related to Section 9006 of of H.R. 3590, Patient Protection and Affordable Care Act, usually referred to as the 1099 reporting mandate Comprehensive health reform and all aspects relating to coverage, financing, delivery reform, 1099 reporting, grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS program, and employer mandate

Client expense: $36,360,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Aviation Administration (FAA), Federal Election Commission (FEC), Federal Reserve System, Federal Trade Commission (FTC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Justice, Dept of (DOJ), Labor, Dept of (DOL), Maritime Administration (MARAD), Natl Economic Council (NEC), Natl Institute of Standards & Technology (NIST), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), St. Lawrence Seaway Development Corporation, State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Trade Representative (USTR), White House Office

Followed legislation in a variety of areas of interest to American Association of Homes and Services for the Aging, particularly legislation impacting FMAP and the doc fix. We are actively lobbying in support of the CLASS provisions in P.L. 111-148, the Patient Protection Affordable Care Act. Additionally, we are following activity on H.R. 5853, Fiscal Responsibility and Retirement Security Act, S. 3829 Long Term Care Bailout Prevention Act, and P.L. 111-312 The Tax Relief Unemployment Insurance Reauthorization and Job Creation Act of 2010.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 1297 Retirement Security for Life Act. Issue: Tax Incentive for Non Qualified Annuities. H.R. 2748 Retirement Security Needs Lifetime Pay Act of 2009. Issue: Tax Incentive for Annuities. H.R. 519 The Elder Caregiver Support and Information Enhancement Act of 2009. Issue: LTC additional appropriations for LTC Information clearinghouse. H.R. 1961 - Savings for American Families Future Act Issue: savers' credit H.R. 2021 Savings Recovery Act of 2009. Issue: Savers credit. S. 2832 Lifetime Income Disclosure Act. Issue: Annuity illustration on benefit statements. H. R. 4126 Retirement Fairness Act. Issue: Modification of 401(k) Plan Rules. H.R. 4626 - Health Insurance Industry Fair Competition Act. Issue: Amends the McCarran-Ferguson Act to apply to the business of health insurance. H.R. 4742 - SAVE Act. Issue: simplifies SIMPLE IRAs and provides for voluntary Auto IRAs. H.R. 5297 Small Business Lending Fund Act. Issue: Partial Annuitization and Roth Conversions of 401 (k) savings. H.R. 5853: Fiscal Responsibility and Retirement Security Act. Issue: Changes to the CLASS Act. S. 3829- Long-Term Care Bailout Prevention Act. Issue: Repeal of the CLASS Act. S. 3760/ H.R. 6099 - Automatic IRA Act of 2010. Issue: Both provide for mandatory Auto IRAs for workers without pension coverage.

Client expense: $1,631,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attachment. RET Fourth Quarter Report 2010 H.R. 519 The Elder Caregiver Support and Information Enhancement Act of 2009. Issue: LTC additional appropriations for LTC Information clearinghouse. H.R. 1961 - Savings for American Families Future Act Issue: savers' credit H.R. 2021 Savings Recovery Act of 2009. Issue: Savers credit. H.R. 2748 Retirement Security Needs Lifetime Pay Act of 2009. Issue: Tax Incentive for Annuities. H.R. 4126 Retirement Fairness Act. Issue: Modification of 401(k) Plan Rules. H.R. 4626 - Health Insurance Industry Fair Competition Act. Issue: Amends the McCarran-Ferguson Act to apply to the business of health insurance. H.R. 4742 - SAVE Act. Issue: simplifies SIMPLE IRAs and provides for voluntary Auto IRAs. H.R. 5297 Small Business Lending Fund Act. Issue: Partial Annuitization and Roth Conversions of 401 (k) savings. H.R. 5853 - Fiscal Responsibility and Retirement Security Act. Issue: Changes to the CLASS Act. S. 1297 Retirement Security for Life Act. Issue: Tax Incentive for Non Qualified Annuities. S. 2832 Lifetime Income Disclosure Act. Issue: Annuity illustration on benefit statements. S. 3829 - Long-Term Care Bailout Prevention Act. Issue: Repeal of the CLASS Act. S. 3760/ H.R. 6099 - Automatic IRA Act of 2010. Issue: Both provide for mandatory Auto IRAs for workers without pension coverage.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health Insurance reform and Long Term Care issues HR 1, S. 1, S. 725, S. 703, S. 623, S. 207, S. 179, S. 82, S. 45, HR 1558, HR 1495, HR 1470, HR 1468, HR 1413, HR 1279, HR 1092, HR 676, HR 563, HR 542, HR 198, HR 194, HR 109, HR 15, HR 2, S. 702, S. 94, HR 1891, HR 897, HR 3200, HR 3590, HR 3501, HR 3502, HR 3962, HR 4872, H.R. 5853

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

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

H.R. 3615, the Home Office Deduction Simplification Act-support H.R. 3765, the REINS Act-support H.R. 5297, the Small Business Jobs Act of 2010- support self employed health insurance tax credit H.R. 5982, the Small Business Tax Relief Act-support H.R.4985, the Medicare Decisions Accountability Act of 2010 H.R.12, the Paycheck Fairness Act-oppose H.R.5853, the Fiscal Responsibility and Retirement Security Act S. 3502, The American Liberty Restoration Act-support S. 3628, the Democracy Is Strengthened by Casting Light on Spending in Elections Act-oppose S. 3578, the Small Business Paperwork Mandate Elimination Act-support Johanns Amendment (SA 4596) to the Small Business Jobs and Credit Act of 2010- support Nelson (FL) amendment #4595 to the Small Business Jobs and Credit Act of 2010- oppose S.J. Res. 39 to overturn the so-called grandfather rule issued by the administration in response to the Patient Protection and Affordable Care Act-support Draft FY 20112015 EPA Strategic Plan Docket ID: EPA-HQ-OPPT-2010-0173] Comments for the Advanced Notice of Proposed Rulemaking on Lead; Renovation, Repair, and Painting Program for Public and Commercial Buildings urging the Department of Treasury not to issue guidance that would allow the plaintiffs trial bar to receive a new tax deduction for certain costs associated with contingency fee lawsuits General Issues Estate Tax Extension of the 2001 and 2003 individual income tax rates IRS Form 1099 Healthcare Reform

Client expense: $685,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Environmental Protection Agency (EPA), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA)

H.R. 1253, Health Insurance Restrictions and Limitations Clarification Act (Burgess) disclosure of coverage exclusions; H.R. 1583, Insurance Industry Competition Act (DeFazio) McCarran-Ferguson reforms (cont.) H.R. 1691, Breast Cancer Patient Protection Act (DeLauro) hospital stays for breast cancer patients; H.R. 1880, National Insurance Consumer Protection Act (Bean) regulatory reform; H.R. 2609, Insurance Information Act (Kanjorski) Federal Office of Insurance Information; H.R. 3217, Health Care Choice Act (Shadegg) national marketplace; H.R. 3584, Health Care Consumer Protection Act (Forbes) reinstatement of coverage upon payment of overdue premiums; H.R. 3596, Health Insurance Industry Antitrust Enforcement Act (Conyers) McCarran-Ferguson reforms; H.R. 4078, Long-Term Care Insurance Disclosure Act (Perriello) model disclosure form for long-term care insurance; H.R. 4563, Cancer Screening Coverage Act (Maloney) coverage requirement for cancer screening; H.R. 4626, Health Insurance Industry Fair Competition Act (Perriello) McCarran-Ferguson reforms; H.R. 4757, Health Insurance Rate Authority Act (Schakowsky) federal rate review process; H.R. 5000, Dental Coverage Value and Transparency Act (Andrews) requirements for dental coverage; H.R. 5297, Small Business Jobs Act (Frank) amendments on employer reporting requirement and individual coverage requirement; H.R. 5664, High Risk Pool Fairness Act (Ellsworth ) high risk pools; H.R. 5761 (Melancon) effective date for prohibition on rescissions; H.R. 5808 (Woolsey) government-run plan; H.R. 5844, Fairness in Medigap Options Act (Rothman) guarantee issue and open enrollment for Medigap policies; H.R. 5853, Fiscal Responsibility and Retirement Security Act (Boustany) delaying implementation of the CLASS program; H.R. 5890, Long-Term Care Insurance Reform Act (Doggett) regulation of LTC insurance; H.R. 5982, Small Business Tax Relief Act (Levin) employer reporting requirements; H.R. 6066, Preventing Social Security Fraud Act (Sanchez) requirements for private disability insurers; H.R. 6368, Federal Employee Disability Insurance Act (Holmes-Norton) supplemental disability insurance for federal employees; S. 688, Breast Cancer Patient Protection Act (Snowe) hospital stays for breast cancer patients; S. 1177, Confidence in Long-Term Care Insurance Act (Kohl) LTC consumer protections; S. 1459, Health Care Choice Act (DeMint) national marketplace; S. 1626, Long Term Care Insurance Integrity Act (Klobuchar) third party review of LTCI disputed claims; S. 1636, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) model disclosure forms for LTC insurance; S. 1681, Health Insurance Industry Antitrust Enforcement Act (Leahy) McCarran-Ferguson reforms; S. 3078, Health Insurance Rate Authority Act (Feinstein) federal rate review process; S. 3685 Insurance Competition and Transparency Act (Pryor) FTC authority; and S. 3793, Job Creation and Tax Cuts Act (Baucus) health coverage tax credit. INS (Regulatory) Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials; implementation of the Mental Health Parity Act requirements; issues related to COBRA subsidy requirements, issues related to genetic nondiscrimination; 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

H.R.3590, Patient Protection and Affordable Care Act - Lobbied in support of and on implementation of health care legislation that would reform the health care system to provide affordable quality health care and expand access to long-term services and supports. Provided information on the need for nursing education capacity and the retention of newer and older nurses in the workplace (no bill). S.1569/H.R.3185, Medicare Graduate Nursing Education Act - Advocated for modernizing Medicare funding so that nursing education funds are directed to advanced nurse practice programs to help produce more highly-skilled nurses to care for the Medicare population. S. 623/HR 1558, Pre-existing Condition Patient Protection Act of 2009 - Lobbied in support of bill that would prohibit insurers from denying health insurance or delaying coverage for people with pre-existing conditions. H.R. 2778, Health Equity and Accountability through Research Act of 2009 - Lobbied in support of bill that would address racial and ethnic disparities in care. S. 979/HR 2360, Small Business Health Options Programs Act - Lobbied in support of bill that would 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. S.1213, Patient-Centered Outcomes Research Act - Lobbied in support of bill that would create a public-private partnership to conduct and disseminate comparative effectiveness research. S. 726/H.R. 1427, Promoting Innovation and Access to Life Saving Medicines - Discussed legislation which would create a pathway for approval of safe, effective biosimilar and generic biologic drugs. H.R. 3090, Health Equity and Accountability Act - Discussed need to end racial and ethnic disparities in care. S. 3686, Labor, HHS, Education and Related Agencies Appropriations Act FY 2011 - Lobbied for funding for healthcare services, research and training involving NIH, AHRQ, CMS, HRSA, HHS and AOA. H.R. 4872, Health Care and Education Reconciliation Act - Lobbied in support of health care law which makes improvements such as closing the Part D coverage gap, in the Patient Protection and Affordable Care Act and implementation of some provisions. H.R. 5364, Special Care Dentistry Act - Discussed bill that would require states to provide oral health coverage for aged, blind, or disabled individuals through a separate state adult dental program, with 100% federal match. H.R. 4213, American Workers, State and Business Relief Act/American Jobs and Closing Tax Loopholes Act - Lobbied for extension of UI, COBRA, FMAP, and SGR. H.R. 3081, Continuing Resolution, FY 2011 - Lobbied for funding for SSA, various health care, employment, aging services and nutrition programs. H.R. 5795, Personalize Your Care Act - Bill gives Americans the opportunity to make advance care plans should he or she become unable to direct their own care. S. 1177, Confidence in Long-Term Care Insurance Act - Bill provides options to help Americans pay for the long-term services and supports they may need, including to help them live in their homes and communities. H.R. 5890, Long-Term Care Insurance Reform Act - Bill provides options to help Americans pay for the long-term services and supports they may need, including to help them live in their homes and communities. S. 776, Promoting Small House Nursing Homes Act - Provides incentives for new, affordable models of long-term services and supports. H.R. 4224, Together We Care Act - Bill creates a three-year pilot program to train public housing residents to provide covered home-based health services. H.R. 5853, Fiscal Responsibility and Retirement Security Act - Bill requires review and approval by law prior to collection of premiums under the CLASS program, to require notice to individuals prior to enrollment, and to require termination of the program in the event of actuarial unsoundness, and for other purposes. S. 2814, Home Health Care Planning Improvement Act of 2010 - Bill recognizes and authorizes nurse practitioners, clinical nurse specialists, certified nurse-midwives and physician assistants as eligible health care professionals who can order home health services under Medicare. H.R. 4993, Home Health Care Planning Improvement Act of 2010 - Bill recognizes and authorizes nurse practitioners, clinical nurse specialists, certified nurse-midwives and physician assistants as eligible health care professionals who can order home health services under Medicare.

Client expense: $4,710,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Energy, Dept of, Federal Communications Commission (FCC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Vice President of the United States, SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, White House Office

Affordable Care Act (ACA) including, definition of "unreasonable" rate increases, medical loss ratio requirements, temporary reinsurance program, and Section 2794; first-dollar coverage of preventive services; HR 5853 (Fiscal Responsibility and Retirement Act), S. 3829 (Long-Term Care Bailout Prevention Act); and health care reform implementation issues.

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

Government targets: Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, Treasury, Dept of

Implementation of healthcare reform legislation, health insurance cooperatives, multi-State plans, insurance market reforms, health insurance exchanges, benefit packages, medical loss ratios, CLASS Act, regulatory reform, individual coverage requirement, premium assistance, Federal rate review process restrictions on recissions, healthcare choice compacts, appeals procedures, disclosure requirements, high risk pool program - Executive Branch actions re PL 111-148 and PL 111-152. *Disclosure of coverage exclusions - HR 1253, 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. *McCarran Ferguson reforms - HR 1583, To further competition in the insurance industry; S 1681, Health Insurance Industry Antitrust Enforcement Act of 2009. *Recissions, hospital stays for breast cancer patients - HR 1691, 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; S 688, 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. *Coverage requirement for cancer screening - HR 4563, Cancer Screening Coverage Act of 2009. *MCCarran-Ferguson antitrust exemption - HR 4626, Health Insurance Industry Fair Competition Act. *Regulatory reform - HR 1880, To establish a system of regulation and supervision for insurers, insurance agencies, and insurance producers chartered or licensed under Federal law that ensures the stability and financial integrity of those insurers, agencies, and producers and that protects policyholders and other consumers served by such insurers, agencies, or producers. *LTC consumer protections - S 1177, A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes. *Federal office of insurance information - HR 2609, To establish an Office of Insurance Information in the Department of the Treasury. *National marketplace - HR 3217, Health Care Choice Act of 2009; S 1459, A bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce. *Reinstatement of coverage upon payment of overdue premiums - HR 3584, To amend the Public Health Service Act to require reinstatement upon payment of all premiums due of group or individual health insurance coverage terminated by reason of nonpayment of premiums. *Changes to McCarran-Ferguson Act - HR 3596, To ensure that health insurance issuers and medical malpractice insurance issuers cannot engage in price fixing, bid rigging, or market allocations to the detriment of competition and consumers; S 1681, A bill to ensure that health insurance issuers and medical malpractice insurance issuers cannot engage in price fixing, bid rigging, or market allocations to the detriment of competition and consumers. *High risk pools - HR 5664, High-Risk Pool Fairness Act. *Effective date for prohibitionon rescissions - HR 5761, To amend the Patient Protection and Affordable Care Act to expedite the application of the provision prohibiting rescissions of health insurance coverage. *Government-run plan - HR 5808, To amend the Patient Protection and Affordable Care Act to establish a public health insurance option. *Guarantee-issue and open enrollment for Medigap policies - HR 5844, Fairness in Medigap Options Act of 2010. *Delaying implementation of the CLASS program - HR 5853, Fiscal Responsibility and Retirement Security Act. *Regulations of LTC insurance - HR 5890, Long-Term Care Insurance Reform Act of 2010. *Third-party review of LTC insurance disputed claims - S 1626, A bill to require issuers of long term care insurance to establish third party review processes for disputed claims. *Model disclosure forms for LTC insurance - S 1636, A bill to develop a model disclosure form to assist consumers in purchasing long-term care insurance. *Model Disclosure form for long-term care insurance - HR 4078, To require the Secretary of Health and Human Services to develop a national model disclosure form to assist consumers in purchasing long-term care insurance. *Federal rate review process - HR 4757, Health Insurance Rate Authority Act of 2010; S 3078, Health Insurance Rate Authority Act of 2010. *Changes to individual coverage requirement, grandfathered plans, immediate insurance reforms, premium assistance, CLASS Act, coverage issues, quality improvements, delivery system reforms - HR 4872, Health Care and Education Reconciliation Act of 2010. *Requirements for dental coverage - HR 5000, Dental Coverage Value and Transparency Act of 2010. *Employer reporting requirements - HR 5982, Small Business Tax Relief Act of 2010. *Requirements for private disability insurers - HR 6066, Preventing Social Security Fraud Act of 2010. *Supplemental disability insurance for Federal employees - HR 6368, Federal Employee Disability Insurance Act of 2010. *FTC authority - S 3685, Insurance Competition and Transparency Act of 2010. *Health coverage tax credit - S 3793, Job Creation and Tax Cuts Act of 2010.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attachment. RET Third Quarter Report 2010 H.R. 519 The Elder Caregiver Support and Information Enhancement Act of 2009. Issue: LTC additional appropriations for LTC Information clearinghouse. H.R. 1961 - Savings for American Families Future Act Issue: savers' credit H.R. 2021 Savings Recovery Act of 2009. Issue: Savers credit. H.R. 2748 Retirement Security Needs Lifetime Pay Act of 2009. Issue: Tax Incentive for Annuities. H. R. 4126 Retirement Fairness Act. Issue: Modification of 401(k) Plan Rules. H.R. 4626 - Health Insurance Industry Fair Competition Act. Issue: Amends the McCarran-Ferguson Act to apply to the business of health insurance. H.R. 4742 - SAVE Act. Issue: simplifies SIMPLE IRAs and provides for voluntary Auto IRAs. H.R. 5297 Small Business Lending Fund Act. Issue: Partial Annuitization and Roth Conversions of 401 (k) savings. H.R. 5853 - Fiscal Responsibility and Retirement Security Act. Issue: Changes to the CLASS Act. S. 1297 Retirement Security for Life Act. Issue: Tax Incentive for Non Qualified Annuities. S. 2832 Lifetime Income Disclosure Act. Issue: Annuity illustration on benefit statements. S. 3760/ H.R. 6099 - Automatic IRA Act of 2010. Issue: Both provide for mandatory Auto IRAs for workers without pension coverage. S. 3829 - Long-Term Care Bailout Prevention Act. Issue: Repeal of the CLASS Act.

Client expense: $830,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1322, Emergency Retiree Health Benefits Protection Act of 2009 H.R. 1346 / S. 540, Medical Device Safety Act of 2009 H.R. 4626, Health Insurance Industry Fair Competition Act H.R. 5141 / S. 3578, Small Business Paperwork Mandate Elimination Act, including provisions related to 1099 reporting H.R. 5297, Small Business Jobs and Credit Act of 2010, including amendments related to the repeal of the 1099 reporting mandate S. 3501, American Job Protection Act, including provisions related to an employer mandate S. 3673, Patients' Freedom to Choose Act, including issues related to FSA and HSA provisions H.R. 5853, Fiscal Responsibility and Retirement Security Act, including provisions related to class act reform H.R. 5982, Small Business Tax Relief Act of 2010 S. 3653, Health Care Bureaucrats Elimination Act, IPAB Reform provisions S.J. Res. 39, A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule relating to status as a grandfathered health plan under the Patient Protection and Affordable Care Act, including provisions related to PPACA grandfathering and IFR The Consumer Information Enhancement Act of 2010, provisions related to Medicare claims database release (bill number not yet assigned) Draft Comprehensive health reform, all provisions relating to coverage, financing, and delivery reform, 1099 reporting, grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS program, and employer mandate (bills in the Senate and House) Various issues related to the regulatory and legislative corrections to the following bills: H.R. 3590, Patient Protection and Affordable Care Act (P.L. 111-148), provisions related to coverage, delivery reform, and financing aspects H.R. 4872, Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), provisions related to coverage, delivery reform, and financing aspects General issues related to ERISA preemption and implementation and the regulatory process following the passage and enactment of health care reform (specific legislation not yet introduced)

Client expense: $29,250,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Export-Import Bank of the United States (EXIM Bank), Federal Communications Commission (FCC), Federal Reserve System, Federal Trade Commission (FTC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Justice, Dept of (DOJ), Labor, Dept of (DOL), Maritime Administration (MARAD), Natl Aeronautics & Space Administration (NASA), Natl Economic Council (NEC), Natl Highway Traffic Safety Administration (NHTSA), Natl Institute of Standards & Technology (NIST), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Office of Management & Budget (OMB), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), St. Lawrence Seaway Development Corporation, State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR), White House Office

S. 1297 Retirement Security for Life Act. Issue: Tax Incentive for Non Qualified Annuities. H.R. 2748 Retirement Security Needs Lifetime Pay Act of 2009. Issue: Tax Incentive for Annuities. H.R. 519 The Elder Caregiver Support and Information Enhancement Act of 2009. Issue: LTC additional appropriations for LTC Information clearinghouse. H.R. 1961 - Savings for American Families Future Act Issue: savers' credit H.R. 2021 Savings Recovery Act of 2009. Issue: Savers credit. S. 2832 Lifetime Income Disclosure Act. Issue: Annuity illustration on benefit statements. H. R. 4126 Retirement Fairness Act. Issue: Modification of 401(k) Plan Rules. H.R. 4626 - Health Insurance Industry Fair Competition Act. Issue: Amends the McCarran-Ferguson Act to apply to the business of health insurance. H.R. 4742 - SAVE Act. Issue: simplifies SIMPLE IRAs and provides for voluntary Auto IRAs. H.R. 5297 Small Business Lending Fund Act. Issue: Partial Annuitization and Roth Conversions of 401 (k) savings. H.R. 5853: Fiscal Responsibility and Retirement Security Act. Issue: Changes to the CLASS Act. S. 3829- Long-Term Care Bailout Prevention Act. Issue: Repeal of the CLASS Act. S. 3760/ H.R. 6099 - Automatic IRA Act of 2010. Issue: Both provide for mandatory Auto IRAs for workers without pension coverage.

Client expense: $1,664,721 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

PPACA - Patient Protection and Affordable Care Act (Medicare Advantage, CLASS Act, cost issues, 1099 reporting issue) S.J.Res. 39 - Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule relating to status as a grandfathered health plan under the Patient Protection and Affordable Care Act; Class Act - oppose H.R. 5982, the Small Business Tax Relief Act of 2010 (1099 reporting provision) H.R.5853 Fiscal Responsibility and Retirement Security Act H.R.4972 To repeal the Patient Protection and Affordable Care Act - support Discharge Petition #11 - support

Client expense: $22,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health Insurance reform and Long Term Care issues HR 1, S. 1, S. 725, S. 703, S. 623, S. 207, S. 179, S. 82, S. 45, HR 1558, HR 1495, HR 1470, HR 1468, HR 1413, HR 1279, HR 1092, HR 676, HR 563, HR 542, HR 198, HR 194, HR 109, HR 15, HR 2, S. 702, S. 94, HR 1891, HR 897, HR 3200, HR 3590, HR 3501, HR 3502, HR 3962, HR 4872, H.R. 5853

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

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

H.R. 5818 Mandate prevention H.R. 5853 CLASS Menthol Regulation

Client expense: $42,156 · Firm income: Not reported

Government targets: Federal Communications Commission (FCC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE, White House Office

Followed legislation in a variety of areas of interest to American Association of Homes and Services for the Aging, particularly legislation impacting FMAP and the doc fix. We are actively lobbying in support of the CLASS provisions in P.L. 111-148, the Patient Protection Affordable Care Act. Additionally, we are following activity on H.R. 5853, Fiscal Responsibility and Retirement Security Act and S. 3829 Long Term Care Bailout Prevention Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE